President's Message

Dear Members,
Indian Society of Haematology and Blood Transfusion (ISHBT) was established in 1973 with a mission to promote excellence in patient care, research and education in clinical haematology, laboratory haematology and transfusion medicine. ISHBT now works in the field of laboratory haematology and clinical haematology only, after transfusion medicine colleagues formed a separate body. ISHBT promotes and guides research in clinical, molecular and genetics study related to blood and its disorders. We are also working for the development of basic haematology labs and molecular laboratory services. ISHBT encourages academics events like annual conference and peripheral CMEs that bring together haematologists around the globe. To encourage haematologists, it conducts awards for best papers on haematology, best published articles in national/international journals and prestigious orations during annual conference. ISHBT has international collaboration with European Haematology Association (EHA) and American Society of Haematology (ASH) which provide haematologists an international platform to discuss and allows broad diffusion of their knowledge. It has a popular journal (Indian Journal of Haematology and Blood Transfusion), indexed in PubMed and other renowned sites. The ISHBT helps government to formulate the guidelines of prevention and treatment of haematological disorders. Indian College of Haematology is the academic wing of ISHBT which focuses on academic activities, and it gives fellowships (FICH) to the esteemed members contributing to the field of Haematology in India. ICH is planning to bring out with guidelines on management of common haematological disorders, already it has brought out guidelines on sickle cell disease and the guidelines on nutritional anaemia will be published soon.

Clinical and Laboratory Hematology are fascinating for a specialty practice, but we need to make sure that our fascination is benefitting the society too. Our fascination will benefit the society only when we are capable of solving diagnostic issues and management issues in a cost-effective manner. Unlike the present generation hematologists, the old generation hematologists like me, were good at internal medicine and that helped us in solving diagnostic problems. My association with Hematology started incidentally, just because I started working under Prof KA Salim, who was a consultant hematologist in UK, who joined the Calicut Medical College in the department of internal medicine in 1984. I joined that unit as a junior faculty in 1987 and we were looking after Internal Medicine and Hematology all throughout. I still consider that as a great model, to preserve and nurture our clinical skills- Clinical skill is our tool for practicing Medicine. Later I was in charge of the hematology unit for two decades till I retired from the medical college in 2015. I am happy that I was responsible for several of my students getting attracted into hematology, but countless numbers of my PG students became general physicians with adequate competence in clinical hematology as well. This was possible only because of the unique arrangement that we had at our medical college, looking after internal Medicine and Hematology together.

Whether you are multitasking or working solely in Hematology, there are a few important points the young aspirants and trainees need to take care of.

• Doctors should strive to acquire maximum clinical skill before focusing on narrow specialties, especially, in India where patients have the freedom to consult specialist doctors without being referred by experienced family doctors, since there are not enough family doctors to guide the people in India.
• As responsible citizens, I feel we all need to work for promoting family doctors who should form the base or foundation of our profession. Without a strong foundation any structure would be weak, and it would become weaker as time passes and would even collapse at some point. In most countries the hematologist or other specialists comes into picture only after a diagnosis- and for that reason- the specialists could even afford to be poorer in clinical diagnosis and clinical skill. But in reality, those who are good at clinical skill only will make good hematologists too-therefore it is mandatory to acquire clinical skill before focusing on specialties like Hematology.
• We should realize that diagnosis needs thorough clinical evaluation before ordering laboratory tests and should not believe that diagnosis would be delivered to us through the numerous laboratory tests alone. There were patients who were confidently diagnosed as MDS, with positive genetic mutation and was advised BMT, later diagnosed as pure B12 deficiency using clinical skill, even when the B12 levels were normal. The tell-tale evidence on the skin and the history that patient did not consume meat are more important than B12 levels. Sometimes NHL diagnosed confidently by morphology and Immuno-histochemistry can become SLE, after a good clinical evaluation and autoimmune work up. Pleural fluid cytology diagnosed as malignant pleural effusion could become tuberculosis when we apply sufficient clinical skill, the wrong report was due to a sampling error in one patient, another patient diagnosed as adenocarcinoma was APLAS with pulmonary embolism, since it is well known that desquamated mesothelial cells may be wrongly reported as adenocarcinoma even by experienced cytopathologists. Secondary polycythemias routinely end up having a wrong diagnosis of PRV due to the overdependence on laboratory and not using clinical skill. Therefore, we should not depend too much on laboratory for everything. Some of the named syndromes like Castleman disease, Rosai Dorfman disease, Kikuchi’s disease etc. are not diagnosis in themselves- they are just histopathological curiosities described by observant pathologists- the causes of these we need to identify. Even an obvious bone marrow suppression occurring due to chemotherapy may be happening in the background of several nutritional deficiencies, like B12, FA Vit D and even protein – unless we correct these deficiencies as well, patient would never make a proper recovery. Several refractory anemias are due to multiple nutritional problems coming together- there is no point getting one definite diagnosis by some abnormal test reports, it could be only tip of the iceberg. Overlap between autoimmune disorders and malignancy, overlap between nutritional disorders and hematological disorders, overlap between Infections and hematological problems are very common in clinical practice. It is better to avoid algorithm based diagnostic work up and avoid the strict protocol-based treatment and we should learn to modify them in the given patient and given clinical setting. These algorithms and protocols are only a rough plan or guideline for the beginners- we need to know how to individualize or make them tailor made to the situation and the patient in question. It also means that, we need to study the patient before applying that protocol or algorithm- or we need to individualize and modify it – all these needs tremendous clinical skill. In short, the mindset of an astute clinician is essential to make a good hematologist. Those desirous of becoming clinical hematologists should undergo intensive training in general medicine/pediatrics before they take up clinical hematology as a specialty.

Being doctors we must be responsible citizens too and should be aware of an unpleasant truth that, India now has a very high burden of communicable and non-communicable diseases, probably the highest in the world, despite being very rich, in financial and human resources. Despite being the richest nation, USA too has a high disease burden, but it is mostly the noncommunicable diseases. In both countries the poorer people have to depend on charity and philanthropy for treatment of diseases. By following the footsteps of USA, we have now created a more serious situation than USA due to inadequate focus on social security and human development. Philanthropy has a great market in India and USA, anyone can capture enough opportunities for winning awards and medals too in this situation. We have forgotten not only to provide the social determinants of health but had also forgotten to build a base for modern medicine, with the family doctors. One reality every budding doctor should know is that the most fascinating and satisfying job in the medical profession for socially minded multitaskers is to work as GP or family doctor- the governments and the doctors in India do not realize that. If we had adequate numbers of family doctors, they would be preventing diseases and promoting health and making early diagnosis besides connecting well with people. The patients undergoing chemotherapy or other procedures, those needing palliative care all will have an excellent follow up care under them. New generation of students are getting disenchanted with medicine due to lack of opportunities for social service, but family practice provides immense opportunities for that. Besides that, due to absence of this ground force, who would connect well with people, there is no one to do the lesion work between people and hospitals, that hospitals and doctors are attacked. Students should also know that they can be hematologist too while practicing as GP or as family doctors.

Already we have too many unscientific practices in medical profession which are being popularized with the blessings of the governments due to our false beliefs and sentiments rooted in the so-called rich tradition, of which we are falsely taking pride of. Please know that using such wrong sentiments and the unscientific practices are being promoted in the huge vacuum created by missing of trained family doctors in India.

Dr. P. K. Sasidharan

President ISHBT