it is HealthLine on PBS Fort Wayne I'm your host Mark Evans.

Thank you for watching and we do hope you'll participate our conversation tonight we'll have the phone number on the screen in just a few well actually just pop up there just like magic.

>> There you go.

It's 866- (969) 27 two zero for the long distance calls or put a two six zero for that (969) if it's local and we are going to be talking about hematology nonmalignant blood disorders with Dr. Robert Mangus who is a hematologist oncologist and it was about a year ago almost exactly that you were on the program.

That's right is my hematology month or something and I missed something.

>> No, although our national meetings are coming up next month.

OK, well maybe it's all top of mind, right.

Well great to have you on the show.

I know that we had several phone calls last time and I do want to just start the program by you know, mentioning I was in high school and took Latin for three years and I know that Kema is the Greek word for blood.

Blood?

Yes.

Your blood.

So we put that together.

But what exactly is a hematologist and if you could explain the difference between a hematologist and oncologist.

>> Sure.

So it's basically all things blood so it's white cells, red cells.

>> It's blood platelets that help you form a plug if you get a cut or a scrape.

So and it's looking at blood and it's sorting out the mysteries of why people have high count's low counts, why they're hired and why they bruise other problems.

Hematology has been around for more than a hundred years the science of oncology and most people that that we see were that do what I do they're boarded in both hematology, in oncology oncology beings in the study of cancer.

>> So how the two combine it seems like an odd combination on the surface but it really grew out of hematology because the first treatable cancers tended to be some of the blood cancers like leukemia and lymphoma.

>> And so most people are aborted in both.

And so, you know, if you if you see the sign on the door that says cancer, it doesn't always mean that it's cancer.

There's sent there also for further examination of blood disorders that aren't cancerous and that's what we want to focus on tonight because the last time when you were here we focused on the other cancers.

But if we have phone calls regarding blood cancers, I'm sure that you're not going to shoot them away.

>> I won't.

OK, very good.

Well, we've got that deal going on.

All right.

Very well.

>> What is the education required to be a hematology?

Oh goodness.

Well, after high school and college is four years of med school and then there's three years of internal medicine.

>> So what I do is I see adults.

>> So the pediatric hematology is a separate specialty.

So we do three years of internal medicine residency and then we do typically at least three years of what's called a fellowship in hematology oncology often both.

>> OK, very good.

So when we're talking about the nonmalignant blood disorders until I did some research today I really didn't realize there were several huge but you've listed it looks like about five or six that you really want to focus on but why don't you mention and talk about those and and what kind of conditions those are?

>> Sure, sure.

I mean there's that you could the list is almost endless but there's several things that are common.

>> I think probably the most common thing that we see is anemia or low blood count, low red blood cells, low hemoglobin concentration.

It's very common in women isn't very common.

>> It's it's it's the most common thing we see in the quote unquote benign category.

Benign diseases are nonmalignant but they can they can still kill you or they can ruin your life for years and not know about it.

>> For instance, iron deficiency we usually divide into iron deficiency and other sources of anemia.

Iron deficiency is extremely common in women and frankly in men too.

>> OK, and so we our first goal is to try to find out the reason and then we fix it.

We always want to iron deficiency is not really a diagnosis in of itself.

>> You've got to have a reason also and you need to fix it.

For example maybe a liver problem causing usually not iron although some people if they have cirrhosis it's very common to to bleed easily.

Sometimes they'll have what's called a coagulopathy and they will get iron deficient.

The most common reasons for iron deficiency generally not nutritional but for women with menstrual blood losses it's for people with bariatric surgery that can absorb iron.

>> A lot of people are on aspirin or Plavix for heart disease and they don't know it and they bleed extremely slowly or they don't absorb it well and they think they're just tired or they think they're getting old and they're a little tired and the next thing you know that their hemoglobin is about half of what it should be.

>> OK, so what is the first thing you would do as a physician to figure out what's wrong with a blood count?

>> OK, I mean that's and usually by the time they've seen me they've already had a blood count by either the E.R.

or their primary physician a blood count it's common.

>> But if somebody goes to the doctor and feels well for many doctors it's not necessarily an automatic part of that blood evaluation.

>> They may get checked for cholesterol or sugar but a CBC or complete blood count which includes white cells, red cells and platelets is not automatic.

>> Having said that, fatigue is common.

So if you're fatigued and that's part of the reason you're going to the doctor or getting that annual checkup, typically they will check a blood count because it's such a common reason people can be fatigued and have a perfectly normal blood count.

>> There are other reasons other fatigue they need to check those out.

>> Exactly.

We have a call coming in.

Of course everyone who would like to give us a call and ask a question either for yourself or a loved one you can give us a call 866- (969) 27 two zero and it looks like Cheryl is calling in and I think the word anemia might have triggered this question which is very good.

>> What is sickle cell anemia?

Sure.

So that is certainly a not just an anemia but a whole disease that we do see that is what's called a hemoglobinopathies the hemoglobin, the red blood cell.

There is pathology of that red blood cell and the proteins are not of functioning in the right way and they tend to sickle or stack up and they sludgy in the bloodstream and so it does cause anemia but it also causes other problems related to circulation and so it's a considerable disease.

The good news with that condition is it's easy to diagnose now I will say that people almost always know about that in childhood.

So when we see somebody it's usually when they're graduating from the pediatric hematologist turning twenty or twenty one or whatever, it's still a very difficult disease although I will say that after years and years of having nothing new just in the last five years we've had two or three new medications that have help.

>> They don't they don't cure it.

It's a chronic condition.

The only cure is a bone for that it's a bone marrow transplant which you say well that's not cancer but they still do transplants on some teenagers usually by the time you're adult they're not doing that OK, but it's a chronic condition.

It's treatable.

>> I think it's better than it used to be but it still can be difficult.

Is your life shortened?

Unfortunately it's still shortened, although it's not shortened as much.

These people tend to be at higher risk for things like strokes, heart attack but based on circulation issues by these abnormal red cells.

>> OK, well we want to thank Cheryl for that question's very interesting low platelet counts.

>> I see that popping up a lot when we're talking about hematology.

>> Sure that so platelets are a blood element that help you form a plug if you get a cut or a scrape.

So if you're so if your platelet count is low then you can have easy Brous ability or even bleeding problems.

>> A lot of people will have a slightly accounting.

>> They're fine but there's a few people that will have a severely low platelet count for a variety of reasons.

>> Sometimes that's related to chemotherapy.

It can be related to liver disease .

>> Sometimes it's it's what we call an autoimmune disease meaning that it happens frankly for no good reason that we can see other than the body reacting against itself.

Sometimes that condition is called ATP or immune thrombocytopenia Porpora and some of those people do need treatment.

They can have severe bleeding problems.

Fortunately our therapies are pretty good for that and most of the time we can treat that with medication.

A few people still need spleen removal which is the old standard treatment from 60 years ago.

>> Yeah, and I'm so glad you brought that up.

What does a spleen do?

>> So the spleen has more than one function as if you're very, very young.

It helps in immune function and still has some of that effect as an adult.

>> So as an adult it's number one function is to call out or get rid of older red blood cells in any of us there's a finite lifespan for a red blood cell.

>> If you think about it, it's got to deliver oxygen to all the tiny tissues in your fingertips and as time goes by it gets a little more brittle and less functional, less efficient in the delivery of the oxygen.

>> So a normal red blood cell lasts about one hundred days and so we continuously have to make have to make new ones in the spleen helps get rid of those and some of the older platelets but it also has some immune function even as an adult such that if we cut the spleen out or if a surgeon I'm not a surgeon but if a surgeon cuts that out, we need to give some vaccines against certain what are called encapsulated bacterial organisms so you can actually live a full life for that, correct?

>> Yeah, and many people do now I will say that we do that lest spleen removals are done versus say 40 years ago partly because we have better treatments for this condition.

>> ITP which again is a condition of low platelet counts oral medication, some injection medication usually pretty easy traditionally the treatment for that had been steroids which are cheap but they can give you a lot of side effects if you're on a long time.

>> Absolutely.

All right.

Well, let's go to line five.

>> It looks like Dan he would rather be off the air and that's quite all right.

He's asking can you get a full body blood transfusion to get rid of blood?

>> A blood disorder typically not.

So again, we're also the docs that help decide when a transfusion is needed.

Right.

There are rare circumstances almost goes back to the second question.

>> There are rare situations where you give several units of blood in that setting in a sense to replace the abnormal cells.

>> But that's just a very temporary effect in general the a transfusion does not fix a blood disorder but we use that certainly frequently in our patients.

>> Go back to the oncology portion.

>> If we have somebody on chemotherapy and the accounts are too low we'll transfuse certainly transfusions are given for somebody that has severe emergent bleeding in the emergency department that that's another use for that.

We also treat conditions such as mild dysplasia where they have poorly formed bone marrow and just can't make their red blood cells.

And like I mentioned, a red letter only lasts about one hundred days to 120 days and so you've got to keep making new ones right.

So it is not unusual for us to be the writers of transfusions probably within the hospital, the hematologists or largest writer of transfusion.

>> Well, getting back to the spleen, I don't want to harp on that too much but if that is actually removed, do you have to have transfusions to get those blood cells back in your system generally?

>> Not generally not.

All right.

Its biggest use is in this condition even that is less than it used to be.

>> OK, I had one hero high or low white cell count you kind touched on that.

>> Sure.

So people get nervous.

Do they have leukemia and we are the docs that see leukemia again that's over into the oncology end of things.

>> But we start with that evaluation most of the time when somebody has and let me start with the low white blood count that never makes the newspapers because no nobody dies of it and there's not a race run for it.

Some people get nervous because they say gee, if I don't have any white cells as my immune function impaired and unless you're on chemotherapy, the answer is usually no with rare exceptions what is normal?

>> It's what?

Ninety five percent of the population so two point five percent of the population could be on either end.

We see a lot of people once for maybe a low ish white count where their red cells are fine and their platelets are fine and it's an isolated white count.

>> It's an abnormal blood test but it's been that way their whole life and they're fine and some of those people just need a reassurance.

>> The other end is a mildly elevated and again I don't want to discuss leukemia today necessarily unless somebody asks but that's the first thing we look at.

Yeah.

We make sure they don't have something like that in some of those people end up needing marrow examinations to sort that out but a lot of people will have a mildly high white count that's a result of either chronic inflammation or cigaret smoking.

Obviously we'd like them to stop and so we see that a lot and most of those people are just finding that the counts themselves aren't harmful, that they just need clarification as to why.

>> OK, very good.

And if our viewers or some of our viewers are just now watching and tuning in, we thank you very much for watching HealthLine of course here on PBS Fort Wayne and the number is on your screen to call.

>> We're talking to Dr. Robert Mangus who is a hematologist oncologist.

>> So let's move on here and talk about some of these other more common condition that you might see in your office.

>> But you were talking a little bit about bleeding disorders before.

Does that include hemophilia?

>> It does now no hemophilia is a little different in Fort Wayne .

We really most of those people we would refer down to Indianapolis we don't have a hemophilia center here.

>> We have everything right almost not quite hemophilia is basically a disorder, an inherited disorder of a clotting proteins and so there are other common bleeding disorders that people have that we do treat here.

I mentioned it P but there are other conditions such as bond with LeBron disease which is the most common inheritable bleeding disorder more common than people think.

>> But you have to think about it to to test for it right?

>> Yeah.

So how would you know you might have that how would you know to go to well again it's tough because a little bleeding or bruising is common if you've got bruising on the thin skin of your forearms.

Most of that isn't truly a blood disorder.

It's it's what we call vascular propre which is related to the thinness of the skins and the blood vessels over time or sometimes medication again harkening back to the aspirin.

Aspirin is a great drug if you need it but not everybody needs to be on aspirin.

>> If you're on aspirin you'll you'll bruise a little bit, OK and explain something to me.

Yeah, All right.

So again, it's hard to say when but certainly if you have multiple bruises if it's bigger than a half dollar, sure you could mention that to your doctor and most of those people are still fine.

>> A few might have a disorder.

I'll just look at my arm one day and think where did that come from?

So it's true I'm less suspicious of the forums and I would be if it were on the chart.

>> OK, well that's that's good to know.

That's good to know and of course yeah I'm no spring chicken so things are going to happen anyway.

>> And then we talked a little bit about blood clots as well our blood clots good.

>> Or any blood clot at all.

Well you want to have a balance OK that's that's what what the beauty of the body is part of the beauty of the body is that it has this balance between blood clotting and bleeding because you want to call out a little bit if you got a bad cut or scrapes surgery you want it to stop but you don't want it to be pathologic.

You don't want to go overboard and you want to you want to be able to have reasonable circulation.

So in that blood clot really we're talking about divi t or P deep venous thrombosis commonly in the leg, sometimes in the arm and P which is pulmonary embolism in the lungs which can be serious life threatening can take your life .

>> Absolutely.

But if you get a blood clot like that anywhere like in your legs or can't that travel like eventually get you.

>> Yeah there is concern and so we treat it yeah.

If it's a it's treatable absolutely.

If it's a deep thrombosis yeah we put people on anticoagulation oh that's good.

>> And so we see people commonly in that setting to help sort out though often it's it's often not in the emergency department it's often after the fact where we're sorting out well why did this happen and how long should they be on treatment and what treatment they should be on.

Right.

We try to do the why and often we can but but sometimes it's a mystery.

>> But there are certain factors that go into that sedentary lifestyle.

If you've just had a big surgery, if you've done a lot of traveling or people travel, you can't not travel to Seattle.

>> Right.

Right, exactly.

against smoking if you're on hormones, certain hormones, female or male if you're on testosterone, that's a risk factor again, if you're a little overweight the other thing that I think is important and that is hereditary risk and that's where we often come in in terms of testing some but not all if they have a family history of blood clots we do special testing to see if they have certain genetic disorders that might influence how we treat and how long we treat.

>> OK, well we have another call coming in now.

It's from Donald prefers to be off the air but he says the doctor mentioned that the lack of red blood cells can cause tiredness when other blood disorders may have this side effect and how can it be resolved?

>> That's a tough question because it's because fatigue is common.

I there are many reasons for tiredness and fatigue.

You just want to make for some people it can be more serious other disorders it can be medications that people take even if they're helpful in other ways they may be very appropriate but they give you a fatigue.

>> There could be a side effect but you hate to miss anemia because usually that's easy to fix.

>> I mean I mentioned iron but there's other you know, those other causes and we evaluate for those and and treat those to now pardon me you mentioned the iron deficiency is one of the more common ones.

What would you would probably prescribe if somebody had low iron in their blood, maybe a prescription?

>> Sure.

And I think that's an important point.

Ion's been around forever.

It's usually very cheap and there's different brands and I'm not sure I have a favorite brand.

I mean usually just go with what's the cheapest over the counter.

It doesn't require a prescription these days.

Right.

The other thing that I think is important these days is we used to say oh, take lots of iron ore. >> They found that taking one every other day or one day is is just as good or better than taking two or three a day if you take that many a day you're just going to get side effects and bloated and upset stomach and that's I mean we still get involved then but we start with Aurelien.

One thing that we do commonly in the office is give intravenous iron which I think has been has helped many, many people because there's people that either can't tolerate or will iron or they can't absorb it.

>> That's the situation.

People that have had bariatric surgery, for instance, they just can't absorb it.

It happens slowly.

They're not bleeding but they can absorb iron and they just think it happens so slowly that they don't notice it.

But the next they're severely anemic.

>> So you give them an I.V.

or absolutely.

Oh yeah.

These days in the old there were shots but in these days it's usually an infusion and there are different brands probably silly to go into the varieties of the brands but to say that they're effective and are generally extremely well tolerated and they really make a difference.

>> One more point iron deficiency I forget fatigue.

>> Everybody has fatigue so that's nonspecific.

A lot of people with this will also have leg cramps.

But one specific symptom if you got ice craving or if you crave, you know, something unusual dirt or chalk, I know it sounds crazy.

>> Wow.

But that's a huge sign for iron iron iron.

Oh, I thought of that ice craving and people can even hurt their teeth.

>> You know they come in with a cup of ice.

Well and I've heard of people actually eating Chalke and they don't know why but they crave it.

>> You've got to check for iron.

Wow.

That answers that question.

All right.

So we've talked about some of the treatment options you it sounds to me like it's probably going to be a transfusion maybe an I.V.

maybe a prescription.

>> What other options for treatment are there?

Well, it depends on the cause.

I mean, again, there's many reasons for anemia for some people if they have kidney failure or even if it's not so bad that they're on dialysis, that's a common reason for anemia in all of us.

There's a hormone called erythropoietin that's produced mainly in the kidneys which we can give as a shot and can help keep the blood count up and and prevent people from needing transfusion and maybe feel a little more energetic.

That's been around for thirty years and that's been helpful again for some of these people.

There are other reasons for anemia for some of them if we can't sort it out we'll then do what's called a bone marrow examination which isn't the highlight of the day for most people it's not as bad as they heard from their neighbor or their cousin.

It's a little bit uncomfortable for men.

>> It's looking needle here most of the time we don't I we can do it certainly most of the time we do it towards the back and what's called the posterior crest just a few inches over from the back a little uncomfortable when we pull that out but that can often help us solve the mystery so some of these people will have conditions where they just can't make red blood cells and for some of them we have medications that we can put them on and help out.

>> OK, very good.

>> Yeah.

All right.

Some of the signs and symptoms and that might indicate someone would have to might have a blood disorder of some sort.

>> Sure.

What what would be the red flags for them say well you're allowed to have a bad day but if you have persistence is losing weight you don't know why if you have enough sweats that you're changing your bed sheets every night.

>> Oh, you know, if you're running fevers without clear infection or fever that doesn't go away after an antibiotic certainly if you know I mean I'm getting away from the original anemia topic but it all overlaps if you notice persistent lymph node enlargement again if you have considerable bruising or especially blood blisters on the inside of your mouth, that's kind of a concerning sign that your platelets might be really low or you might have a coagulation disorder.

>> That's interesting.

Yeah.

OK, let's see.

We have one more call coming and we're running out of time but I'm not sure if that didn't look like it is actually coming in.

So I'll go and ask my question here.

>> Is there anything we could do to prevent blood disorders?

>> That's another tough question.

Some some of them yes.

Some of them no.

I mean don't smoke.

I mean I know that's probably true of everybody you have on your show.

Right.

That's sort of a simple wouldn't be called HealthLine if we advocated smoking.

>> Right.

Right.

I mean pay attention to your health and get get checked.

Like I said, don't go years with feeling fatigued.

>> You know, talk to somebody get the get the blood get the blood drawn.

>> And I think the other thing is at least in the past I think it's changing a little bit.

But in years past often people would say well I'm over 60 or whatever and just go on an aspirin.

I don't think that's true.

I think you need an aspirin.

Yes.

If you've had past stroke or past MRI or coronary stent but not everybody in the country needs aspirin because it can cause some harm too.

>> It's a great medicine but it can cause some harm.

It's not for everybody.

All right.

And then one other question here and I think it's important to ask the covid-19 thing and it seems like it's affecting everything in the world of hematology and oncology.

Sure.

Have you seen any types of changes or anything that would affect your world in your research?

>> Sure, sure.

Well, besides still wearing mask when we're at the hospital we do that still of course.

Yeah.

So the trouble with the again for the malignant patients lymphoma, multiple myeloma even if they're doing well with their disease they are still immune suppressed and unfortunately, you know, all of us have experience.

Some people that even even died of it or had considerable illness from it and so those people are extra risk and unfortunately even if they do all they should and get all the vaccines, they tend not to respond as well to the vaccines.

And so fortunately there are being developed other things such as ever a which I'm not an expert on but and other things that can help but it has affected that in that manner.

>> Yes, probably less so the the nonmalignant patients.

All right.

We only have a few seconds left.

We have one question Becky wants to know the symptoms of hemophilia in children.

Oh, children again I'm not a pediatrician but a lot of them they can have bruising but also joint issues.

>> It tends to affect the joints.

>> Hemothorax is in the joints.

All right.

You see that physician and get referral.

Yes, correct.

OK, Dr. Robert Mangus, thank you so much.

>> Always a great conversation and hope to have you back before another year.

Oh sure.

All right.

>> Thank you.

And we thank you for watching and for all the fine phone calls with great questions and until next Tuesday night we hope that you'll have the best health possible.

>> So good night and good