Why was I referred to a blood specialist?

If your doctor has sent you to a “hematology and oncology specialist”, the first thought that came to mind was probably, “Does that mean I have cancer?” That is a natural question. The honest answer is: a referral to this specialty does not mean cancer, and nothing can be guaranteed without a proper check. Nobody can tell from a referral alone whether all is well or not.

A blood specialist is not only about cancer

A hematologist is a doctor who specializes in diseases of the blood. These diseases are not only blood cancers. People are referred to this specialist if they have anemia, unusual bleeding or bruising, or have formed a clot. “Oncology” is the cancer side, and some of the people referred really do need it, but many do not.

The most common reasons for referral

An unusual blood test result. The complete blood count (CBC) measures the numbers of red cells, white cells and platelets. When one of them is high or low, your doctor may send you. A few points:

• Low white cells have many causes, including some medicines, autoimmune diseases, bone marrow disease and sometimes cancer. High white cells are also usually an infection or a reaction to a medicine.
• Low platelets can follow a viral infection, or come with an autoimmune disease or vitamin B12 deficiency. A mild type is also seen in pregnancy. High platelets also have causes such as infection, inflammation, anemia or bleeding.
• Low hemoglobin means anemia, and its most common cause is iron deficiency.
• An abnormal test result is not always a sign of disease or cancer. One test alone does not diagnose.

Anemia or tiredness with no explanation. The doctor wants to find the cause.

A blood clot or unusual bleeding. Pain and swelling in one leg, a clot in the lung, easy bruising and bleeding, very heavy periods. These too are a hematologist’s work.

A swollen gland. A swollen lymph node is usually due to infections such as a cold and sore throat. Blood or lymph cancer is an uncommon reason. When the gland has not shrunk after a week, is hard, or comes with night sweats and fever, doctors usually look into it further.

Concern about cancer. Sometimes a doctor makes an urgent referral because of signs that need specialist checking. An urgent referral does not confirm cancer either.

What happens at the visit?

The steps are usually like this:

1. A conversation. The doctor asks about symptoms, history of illness, medicines, supplements and family history. Bring your documents (test results and earlier reports).
2. An examination. Including feeling the glands of the neck, armpit and groin.
3. A decision about further checks. The same test may be repeated, further tests requested, or imaging or a biopsy may be needed. It may turn out that a simple reason such as iron deficiency or an infection was behind the abnormal test.
4. A plan. Some people need treatment and some need only follow-up and periodic tests.

What helps?

• Write down your list of questions. For example: Why was I sent? What further tests are needed? When will the result be ready? Which symptoms mean I should call quickly?
• Bring a companion to take notes.
• Do not guess the outcome before the visit. A single test number without symptoms and your other tests has no firm meaning; share what you have read with the doctor.
• If you develop dangerous symptoms (a high fever during treatment, severe bleeding, sudden shortness of breath, pain and swelling in one leg, signs of stroke) do not wait for your appointment; go to the emergency department or call 115 (Iran’s emergency number).

In summary

A referral to a hematologist means your doctor wants a specialist to see your test. The result may be simple, follow-up may be needed, and in some cases a more serious disease is raised. None of this can be said before the check. What can be said is that a careful check is the right next step.

Every patient’s treatment plan is different; ask your doctor about your own situation.