Laboratory hematology in the current era

Hematology as a field of medicine has always been ever-evolving. As the incidence of cancers, including blood cancers, is on the rise and people are living longer, the prevalence of blood cancers is increasing steadily. Despite this increasing magnitude of the health problem, deaths due to blood cancers are on a decreasing trend due to major developments in the field. There are tools like immunotherapy and genomics that enable treat these diseases better. As the ageing population increases, many chronic non-malignant hematological disorders are also increasing in number. Hematologists treating nonmalignant blood disorders also have more sophisticated, targeted treatment tools like gene therapy and genomic editing technologies.

Laboratory hematologist (hematopathologist) plays an extremely important role in critical treatment decisions taken by clinical hematologist, e.g., if a patient with anemia reaches a clinician, further management depends on the cause of anemia, which the hematopathologist must determine. Similarly, various types of blood cancers must be correctly diagnosed and categorized for the clinician to execute specific treatment plans. Besides playing an important role in diagnosis, tests like minimal residual disease analysis and finding specific drug targets in these cancers are necessary part of blood cancer management. Non-malignant disorders like coagulation disorders require highly specialized testing services by expert hematopathologist. With the advent of newer, more sophisticated treatment modalities at the hands of clinical hematologists, the role of the laboratory doctor has become increasingly more challenging and responsible.

Routine follow-up hemograms of blood disorders require high accuracy and fast turnaround. Thus, highly accurate, high-throughput automated machines become paramount to meeting patient needs. At the same time, these always require specialist supervision. Specialist hematopathologists are limited in number and are centered in reference laboratories in the metropolitan cities. Most chain laboratories have many satellite laboratories, which ensure that patients in the remotest parts of the country have access to the laboratory facilities. However, taking the specialist supervision to the remotest patient remains a challenge, thus widening the gap in the quality of healthcare available to different regions.

There is a need to bridge this gap between specialists and patients in the world’s remotest parts. Thus, there is a need to build a digital network with the help of digital pathology, slide scanners, and cloud-based sharing of the relevant images. There should be an attempt to integrate the satellite laboratories with the reference laboratory (where the specialist hematopathologist is located) to avoid any gaps in the diagnosis and management of complex hematological disorders. This technology is available with many market players like Cellavision, Morphle, Sigtuple, Scopio Labs, and many more. There is a need to bring down the cost of these systems so that they can be used to deliver the best healthcare to the masses.

Hematology, like many other fields of medicine, is moving toward digital transformation. A huge amount of data, which provides diagnostic insights, makes it possible to integrate clinical, laboratory, and complex genomic data and provide personalized diagnosis, treatment options, and prognostication and pave the way for precision medicine. This is an exciting evolution, which brings with it incredible opportunities for improved outcomes. However, there are challenges that need to be overcome to make this opportunity available to all. To make this opportunity feasible and available for all, laboratories have to play a proactive role. This role requires laboratory physicians to improvise the diagnostic panels, make them cost effective, and at the same time more relevant to our population. Improvising genome panels, integrating conventional morphology and other laboratory parameters with relevant molecular investigations is paramount for triaging the limited resources, thus enabling best healthcare for all.

Laboratory hematologist must play proactive role in this digital health revolution, so that technology empowers us to provide equitable health for all.