Haematology

Tackling haematology is never easy. Revision can be a struggle, as it may not always be obvious which topic areas will be directly relevant to clin­ical practice. We still, however, benefit from an understanding of these areas and an appreciation of how to do and interpret the basics and when more expertise is required. Sometimes the answers require a trip right back to the stem cell. A junior doctor’s most frequent contact with haematology is in interpreting a full blood count. In this task, the core skills of the chapter come to the fore— in response to an anaemia, we should be able to explore the possibilities of iron deficiency, vitamin deficiency, and haem­olysis. On seeing a thrombocytopenia or an abnormal clotting profile, we should be able to make a clinical assessment and perform further appropriate tests, with a view to suggesting differential diagnoses. The questions in this chapter aim to build confidence in these tasks. There is a lot more to haematology, however, than a blood count. As a junior doctor, there will be regular practical challenges such as pre­scribing and altering anticoagulation therapy, overseeing the safe delivery of a blood transfusion, and managing acute situations such as sickle- cell crises. The way forward is to be able to master these basics and start to see the bigger picture. This means developing a feel for the more subtle symptoms and signs of haematological disease and becoming proactive in the face of abnormal blood results. As with all of the chapters in this book, it is a way of thinking that is crucial— one that allows confident management of common situations and recognition of potentially catastrophic conditions, but also one that encourages creativity and initiative. When faced with a clinical conun­drum, we should have the knowledge and confidence to ask appropri­ately: ‘Is the answer in the blood?’