"Blood is a special juice." - Johann Wolfgang von Goethe
Haematology is the study of diseases of the blood, bone marrow and lymphatic system. It covers a broad spectrum - from benign changes such as anemia to complex haematological diseases such as leukaemia, lymphoma and multiple myeloma.
Hematology is a highly interdisciplinary specialty that requires close cooperation with other medical fields such as oncology, immunology, infectiology, rheumatology, transfusion medicine, radiology and internal medicine.
In the Hematology Center of the MEDIZINICUM our patients benefit from a holistic approach: you are in the best possible medical and logistical hands with us, because:
We offer a complete range of hematological diagnostics and therapy - from blood and bone marrow diagnostics and molecular genetic testing to modern therapeutic procedures and stem cell transplants.
Our hematology specialists work closely with other disciplines in the hospital, e.g. oncology, rheumatology, cardiology, radiology and psychosomatics - for the best possible and seamless patient care.
Thanks to our interdisciplinary structure, we are able to treat even complex clinical pictures quickly, in a targeted and patient-centered manner - on an outpatient basis or in cooperation with specialized partner clinics.
The anemiacolloquially known as anemia, occurs when there is a lack of red blood pigment, hemoglobin, and/or a lack of red blood cells (erythrocytes). Anemia leads to a lack of oxygen in the organs and tissues, as oxygen transport is impaired.
Anemia is only a symptom and expression of other diseases.
Causes of anemia can be
Typical symptoms of anemia
Leukopenia refers to an insufficient number of white blood cells. This can be caused by a formation disorder in the bone marrow, by side effects of medication, in the context of other diseases, e.g. rheumatic diseases or infections, e.g. caused by viral pathogens. In particular, a distinction must be made as to which type of white blood cells (e.g. granulocytes, lymphocytes, monocytes) are reduced. If there is a lack of white blood cells, especially a reduced granulocyte count, there is an increased risk of infection, especially bacterial infections. In some cases, inflammation of the oral mucosa may occur.
Leukocytosis occurs when too many white blood cells are produced. This can occur as a natural reaction of the body, e.g. in the case of infections. However, certain medications, e.g. corticosteroids, can also lead to an increase in the leukocyte count.
Malignant diseases, e.g. leukaemia, which can be characterized by an uncontrolled formation of pathological leukocytes in the bone marrow, must be distinguished.
There are a large number of benign and malignant diseases of the hematologic type.
Thrombocytopenia refers to a lack of blood platelets. Together with coagulation factors, these are necessary for hemostasis. The platelets clump together in the event of an injury, causing the blood vessel to block and thus stop the bleeding.
Thrombocytopenia can be caused by
Symptoms of a reduced platelet count
Acute leukaemia is a malignant disease of the bone marrow, which is characterized by the uncontrolled proliferation of immature precursor cells, so-called blasts, in the bone marrow.
If left untreated, acute leukaemia is fatal.
Depending on which precursor cell is affected, a distinction is made between acute myeloid leukaemia and acute lymphoblastic leukaemia.
Acute leukemia is diagnosed in approximately 4 out of 100,000 adults per year. The risk of developing acute leukemia fall ill increases with age. The average age of onset is over 60 years. Acute myeloid leukemia is diagnosed in about 80% of cases in adulthood, acute lymphoblastic leukemia in only about 20% of patients. Acute lymphoblastic leukemia is the most common form of childhood leukemia.
In most cases, the cause of leukemia cannot be determined. Previous radiotherapy or chemotherapy the risk of acute leukemia may be increased. Damage to the bone marrow caused by radioactive radiation or chemical substances such as benzene also increase the risk of developing acute leukemia. In very rare cases, leukemia is associated with a hereditary disease, e.g. Down syndrome
The symptoms can vary and result from the displacement of the normal bone marrow cells by the leukemia cells.
Typical blood count changes occur with anemia, a reduction in platelets and an increase or reduction in white blood cells. This result in general weakness, paleness, shortness of breath. Infections often occur. Involvement of other organs can lead to swelling of the lymph nodes, enlargement of the liver and spleen, as well as changes to the gums. Patients often describe pain in bones and limbs.
If acute leukemia is suspected, further diagnostic measures are necessary after a detailed medical history and physical examination.
In addition to the blood test, a precise microscopic differentiation of the blood cells is necessary. As the disease originates in the bone marrow, a bone marrow examination is necessary. The bone marrow is histologically as well as genetically and molecularly. An ECG, an ultrasound examination of the abdominal organs and heart and a lung function test are carried out to check organ function. In some cases, further examinations such as computer tomography or an MRI are necessary.
The therapy depends on the type of leukemia, additional prognostic features of the disease, the patient's age, concomitant diseases and general condition. A distinction is made between a curative and a palliative therapeutic approach.
Curative therapy
The aim of curative therapy is to cure the patient. Part of curative leukemia therapy is chemotherapy with several chemotherapeutic agents. As this therapy is usually very intensive, it is carried out in hospital. The prerequisite for intensive therapy is a good general condition and the absence of serious concomitant diseases. To intensify the therapy, a stem cell transplant using stem cells from a related or unrelated donor is often necessary.
Palliative therapy
If the patient is in a reduced general condition, advanced age or severe comorbidities, the aim of palliative therapy should be to control the disease while maintaining the patient's quality of life. This is achieved with less intensive chemotherapeutic agents, which are usually administered on an outpatient basis. can and can lead to improved survival.
Chronic forms of leukemia are divided into chronic myeloid leukemia and chronic lymphocytic leukemia. The onset of the disease is usually slow and is often asymptomatic in the initial phase.
The chronic lymphocytic leukemia is a malignant disease of the blood system, specifically of the lymphoid blood cell line. As CLL leads to a significant increase in mature lymphocytes and their exudation into the blood, the disease is referred to as leukemia.
It is one of the most common forms of leukemia in the western world and occurs mainly at an older age age. CLL occurs in approximately 6 per 100,000 inhabitants per year. The average age of patients is 70 years.
The cause of CLL is not yet fully understood. Gradual genetic changes over a longer period of time are assumed to be one of the causes. Signaling pathways that regulate the proliferation and degradation of cells are disrupted in CLL. This leads to an uncontrolled proliferation of lymphocytes as the disease progresses.
In many cases, chronic lymphocytic leukemia is diagnosed by chance. Patients often stand out due to enlarged lymph nodes in various parts of the body. As the lymphocytes displace the healthy bone marrow, there is a drop in normal blood cells and thus anemia with weakness, tiredness and paleness. A lack of platelets leads to an increased tendency to bleed. Other symptoms may include weight loss, fever and night sweats.
After a comprehensive medical history and physical examination, a special microscopic differentiation of the blood is carried out. Only in rare cases is a bone marrow examination necessary for the diagnosis. An ultrasound examination of the lymph nodes and abdominal organs is helpful for staging. In a few cases, further radiological diagnostics, such as computer tomography, are required.
The course of CLL can be very variable. The disease is often associated with a long-lasting stable phase in which few symptoms occur. In this phase, most patients do not require treatment. As the disease progresses and the symptom burden increases, therapy is indicated. The treatment of CLL is palliative in nature. This means that the disease can be pushed back, but cannot be completely cured. Various chemotherapeutic drugs (cytostatics) and antibody therapies are available for treatment. New, so-called targeted drug therapies (Brutontyrosine kinase inhibitors and BCL2 inhibitors) have significantly improved the response of the disease and have largely replaced chemotherapy
Chronic myeloid leukemia is a malignant disease with a slow progression. In over 90% of cases, a typical genetic change, the so-called Philadelphia chromosome, is present. This causes degeneration of the blood stem cells in the bone marrow, which leads to uncontrolled proliferation of certain subgroups of white blood cells (leukocytes). If left untreated, the disease progresses through a long chronic phase into a more rapidly progressing aggressive phase and then progresses to a full-blown acute leukemia.
Approximately 1-2 adults per 100,000 inhabitants are diagnosed with CML each year. Chronic myeloid leukemia can occur in any age group and the risk increases with age.
In many cases, chronic myeloid leukemia is diagnosed by chance due to a change in blood count, in particular an increase in white blood cells (leukocytes) at an early stage. Fatigue and weakness with a lack of resilience and sometimes night sweats may occur. Particularly in advanced stages, patients notice pressure in the left upper abdomen caused by an enlargement of the spleen.
After a detailed medical history and a physical examination, the blood count is examined in more detail and differentiated microscopically. The typical genetic change in CML can be determined by a blood test. A bone marrow examination is necessary to classify the stage and exclude other genetic changes. The abdominal organs, in particular the spleen and liver size are checked by an ultrasound examination.
Through the use of so-called targeted molecular therapies (tyrosine kinase inhibitors), the treatment of CML patients has improved enormously. Many patients respond very well and quickly to the therapy. The response to therapy is monitored by regular blood tests. Until a few years ago, it was assumed that that medication must be taken permanently. More recent clinical studies have shown that some patients with a very good response to therapy do not need to take the medication permanently.
Myelodysplastic syndrome (MDS) is a disease of the bone marrow. Changes in the stem cells in the bone marrow lead to dysplasia, malformations of the cells. This leads to an uncontrolled proliferation of precursor cells (blasts). There is a deficiency of healthy blood cells in the blood (anemia, leukocytopenia and thrombocytopenia). In the further course, the disease progresses until it turns into acute leukemia.
Myelodysplastic syndrome often occurs with increasing age (mean age of onset 75 years). The diagnosis is made in around 4 out of 100,000 adults per year.
MDS is caused by a genetic change in the blood stem cells in the bone marrow. These genetic changes often occur with increasing age damage to the DNA structure of the cell. Previous tumor therapies, such as radiotherapy or chemotherapy, promote the development of MDS.
The symptoms are due to an insufficient number of functioning blood cells. This can lead to anemia, leukocytopenia and leukocytopenia (reduced number of white blood cells) and the associated increased susceptibility to infection and/or an increased tendency to bleed due to thrombocytopenia. thrombocytopenia (lack of blood platelets) may occur.
In many cases, the blood count change is discovered by chance during a laboratory examination. After a precise differentiation of the cells in the blood, a bone marrow examination is necessary. For this purpose, an aspiration of liquid bone marrowas well as the removal of a bone cylinder (biopsy). The histological processing of the bone marrow confirms the diagnosis and examines the cells for genetic and molecular genetic changes.
The blood test can rule out other causes such as iron or vitamin deficiency.
Treatment is based on the classification and prognostic risk classification. This is determined, among other things, by the detection of certain genetic or molecular genetic changes.
The supportive therapy depends on the affected cell series. In the case of anemia, from a certain haemoglobin value erythrocyte transfusions are given. In some cases, erythropoietin is used as drug support.
If the platelet count is low and there are signs of bleeding platelet transfusions are administered.
Patients with a low leukocyte count are at risk of infection. Antibiotics are used if there are signs of infection or fever.
Targeted drugs can be used for certain genetic changes.
If high-risk MDS is present and the patient is in good general health, there is always an indication for treatment. A curative approach, i.e. the possibility of a cure, exists through an allogeneic stem cell transplant.
Myeloproliferative syndromes are disorders of bone marrow function caused by a genetic defect in the stem cells in the bone marrow. This change leads to an increased formation of blood cells, whereby all three cell lines can be affected.
Depending on the cell line affected, we differentiate between:
Chronic myeloid leukemia (CML)
The polycythemia vera is mainly characterized by an uncontrolled proliferation of red blood cells (erythrocytes). The high number of erythrocytes can lead to circulatory disorders and vascular occlusions.
The polycythemia vera occurs in 1-2 people per 100,000 inhabitants per year. The average age at diagnosis is 65 years.
The main aim of the therapy is to reduce the risk of thromboembolic events by reducing the erythrocyte count. This can be achieved with medication and phlebotomy therapies. A cure for polycythemia vera is currently not possible with these measures. As the disease progresses, a transition to secondary myelofibrosis is possible. myelofibrosis is possible.
The disease is caused by a clonal change in the blood stem cell, which leads to increased hematopoiesis and, in the further course of the disease, to connective tissue proliferation/fiberization. fibrosis of the bone marrow. As the disease progresses, the condition of the bone marrow causes reduced hematopoiesis. Disease-associated gene mutations make it possible to distinguish between molecular subgroups. These are also important markers to individually assess the prognostic risk for each patient.
The myelofibrosis occurs in 0.5 to 1.5 per 100,000 inhabitants per year and is therefore a rare disease. The disease predominantly occurs in older people with an average age of 65 years.
In the early form of the disease, there is usually an increased number of leukocytes and possibly also platelets. As the disease progresses, anemia increasingly comes to the fore, followed by a reduction in platelets. In many cases, the spleen becomes clinically enlarged (due to compensatory hematopoiesis in the organ). Patients often complain of constitutional symptoms such as weight loss, night sweatsfever. Serious complications can be of a thromboembolic nature due to the initial increase in blood cells. In some cases the myelofibrosis can develop into secondary acute leukemia.
As the course of the disease is highly variable, special risk scores have been developed. This allows the individual risk for each patient to be better assessed and the treatment selected accordingly.
The therapy of myelofibrosis depends on the risk group, the symptoms, the age of the patient and the presence of concomitant diseases.
Low-risk patients are usually monitored and, if necessary, treated with medication to reduce the number of blood cells and prevent thromboembolic complications.
The only curative therapy for myelofibrosis is allogeneic stem cell transplantation. Due to its intensity, this is primarily offered to patients with a higher risk and a good general condition.
Effective and well-tolerated oral medications are available that can reduce the size of the spleen reduce the size of the spleen and alleviate the symptoms of the disease (weight loss, night sweats and weakness) reduce the symptoms of the disease (weight loss, night sweats and weakness).
Chronic myeloid leukemia is a malignant disease with a slow progression. In over 90% of cases, a typical genetic change, the so-called Philadelphia chromosome, is present. This causes degeneration of the blood stem cells in the bone marrow, which leads to uncontrolled proliferation of certain subgroups of white blood cells (leukocytes). If left untreated, the disease progresses through a long chronic phase into a more rapidly progressing aggressive phase and then progresses to a full-blown acute leukemia.
Approximately 1-2 adults per 100,000 inhabitants are diagnosed with CML each year. Chronic myeloid leukemia can occur in any age group and the risk increases with age.
In many cases, chronic myeloid leukemia is diagnosed by chance due to a change in blood count, in particular an increase in white blood cells (leukocytes) at an early stage. Fatigue and weakness with a lack of resilience and sometimes night sweats may occur. Particularly in advanced stages, patients notice pressure in the left upper abdomen caused by an enlargement of the spleen.
After a detailed medical history and a physical examination, the blood count is examined in more detail and differentiated microscopically. The typical genetic change in CML can be determined by a blood test. A bone marrow examination is necessary to classify the stage and exclude other genetic changes. The abdominal organs, in particular the spleen and liver size are checked by an ultrasound examination.
Through the use of so-called targeted molecular therapies (tyrosine kinase inhibitors), the treatment of CML patients has improved enormously. Many patients respond very well and quickly to the therapy. The response to therapy is monitored by regular blood tests. Until a few years ago, it was assumed that that medication must be taken permanently. More recent clinical studies have shown that some patients with a very good response to therapy do not need to take the medication permanently.
The term malignant lymphoma refers to a group of malignant diseases in which the lymphatic system is affected. An uncontrolled proliferation of cells of the lymphatic system occurs. These cells are found in the bone marrow, the lymph nodes, the spleen and many other organs.
Typically, the first noticeable symptom is swelling of one or more lymph nodes. As the disease can also occur in other organs, the symptoms are usually very variable.
There are a number of subgroups of malignant lymphomas. These differ in terms of treatment and prognosis.
Malignant lymphomas are rare compared to other tumor diseases. However, an increase in frequency has been observed in recent years.
The age of onset varies greatly depending on the subgroup of lymphoma.
So-called indolent (slowly progressing) lymphomas tend to be a disease of older people. Aggressive (rapidly progressing) lymphomas are often found in younger patients (20 to 40 years).
The cause of most lymphoma diseases unclear. Radioactive irradiation or environmental toxins may be a cause.
A small group of lymphomas can be triggered by viruses or bacteria.
In most cases, there is swelling of the lymph nodes. In the case of lymphoma infestation of an organ, other symptoms may be in the foreground, e.g. headaches or epileptic seizures in the case of lymphoma of the central nervous system or skin changes in the case of cutaneous (skin) lymphoma.
In advanced stages, patients describe general weakness and weight loss, night sweats or fever.
To make a diagnosis, a tissue sample (biopsy) is taken from a lymph node. from a lymph node or from an affected organ. If the diagnosis is confirmed by pathological processing of the tissue, further examinations are necessary for staging. Depending on the subgroup of the lymphoma, radiological examinations are necessary, usually a computer tomography but also MRI examinations. It is also necessary to examine the bone marrow to rule out the presence of lymphoma.
In order to recommend treatment, it is necessary to check certain organ functions, such as an ultrasound of the heart and a lung function test.
Due to the many subgroups of malignant lymphomas, the therapy also differs.
Chemotherapy is the most important measure in the treatment of lymphoma. Radiotherapy is important in isolated cases or in combination with chemotherapy.
In a number of subgroups, immunotherapy, such as monoclonal and bispecific antibodies through to CAR T-cell therapy.
The prognosis also differs from the lymphoma subgroup. Aggressive lymphomas in particular have a good chance of recovery with intensive therapy. In the case of low-malignant (indolent, slow-moving) lymphomas, there is no prospect of a cure in the majority of patients. In these cases, the treatment goal is a long-lasting remission and therefore a long treatment-free interval.
Due to the many subgroups of malignant lymphomas, the therapy also differs.
Chemotherapy is the most important measure in the treatment of lymphoma. Radiotherapy is important in isolated cases or in combination with chemotherapy.
In a number of subgroups, immunotherapy, such as monoclonal and bispecific antibodies through to CAR T-cell therapy.
The prognosis also differs from the lymphoma subgroup. Aggressive lymphomas in particular have a good chance of recovery with intensive therapy. In the case of low-malignant (indolent, slow-moving) lymphomas, there is no prospect of a cure in the majority of patients. In these cases, the treatment goal is a long-lasting remission and therefore a long treatment-free interval.
Certain subgroups of malignant lymphomas:
Multiple myeloma is a subgroup of malignant lymphomas. However, the disease is characterized by a different set of symptoms. The course of multiple myeloma can vary greatly. The clinical picture of patients ranges from an asymptomatic preliminary stage of multiple myeloma, so-called monoclonal gammopathy of unclear significance (MGUS), which is only characterized by laboratory abnormalities, to a symptomatic and aggressive course of the disease.
The origin of the disease is a degeneration of the plasma cell in the bone marrow and thus its uncontrolled proliferation. The abnormal plasma cell produces an increased amount of ineffective immunoglobulins. These immunoglobulins can be detected as paraproteins in the blood or as components of these, so-called light chains, in the patient's blood and/or urine.
The disease is characterized by destructive bone changes, so-called osteolysis, which can lead to bone fractures in advanced stages.
The risk of developing the disease increases with age; the average age of onset is 73 years. Approximately 4 per 100,000 inhabitants are diagnosed with multiple myeloma each year.
In most cases, there is no trigger for multiple myeloma. Radioactive radiation, congenital immunodeficiencies or auto-immune diseases can possibly increase the risk of developing multiple myeloma.
Symptoms often occur in the later stages of the disease. In a large proportion of patients, multiple myeloma manifests itself through bone pain or fractures.
In addition to these, other symptoms such as signs of anemia (weakness, tiredness, paleness, shortness of breath on exertion), increased susceptibility to infection or signs of kidney damage (water retention, foamy urine) may occur.
After a medical history and a physical examination, blood and urine tests are carried out. If these tests lead to the suspicion of multiple myeloma, further examinations are necessary. Among other things, a bone marrow examination is used to determine the infiltration of the bone marrow by the myeloma. Genetic and molecular genetic tests are also carried out on the bone marrow cells are carried out in order to certain genetic changes that may be prognostic.
A radiological diagnosis, either by computer tomography (CT) or magnetic resonance imaging (MRI), is made to determine the extent of the bone changes.
The standard therapy for multiple myeloma comprises combined systemic therapy, stem cell transplantation (autologous stem cells) in younger patients and, in a few cases, radiotherapy.
In recent years, the treatment options for multiple myeloma have developed significantly. New substances, immunotherapies such as monoclonal and bispecific antibodies or CAR T-cell therapies have significantly improved response rates.
Malignant diseases of the blood
Malignant diseases of the lymphatic system
At MEDIZINICUM, we focus on comprehensive diagnostics, including:
The therapy is based on the latest standards - individually adapted to the type of disease, genetic characteristics, age, general condition and concomitant diseases.
Our offer includes:
Our hematology team under the direction of Prof. Dr. Dr. h.c. Nicolaus-Martin Kröger and Dr. med. Christine Wolschke are among the leading national and international specialists in their field. Both are authors of authoritative guidelines and have decades of clinical experience.
Prof. Dr. Nicolaus Martin Kröger
Specialist in haematology and
oncology
Dr. med. Christine Wolschke
Specialist in internal medicine, specializing in haematology and internal oncology
20354 Hamburg
20354 Hamburg
20354 Hamburg
22607 Hamburg-Othmarschen
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