Myeloproliferative Disorders refer to a set of conditions of bone marrow and blood whereby the bone marrow produces excessive amounts of one particular type of blood cell or more. When blood tests show a recurrent case of unexplained leukocytosis or elevated white blood cell levels persistently, a hematological examination is essential.
Persistent leukocytosis does not mean that the person has Myeloproliferative Disorders. It is known that various factors, including infection, inflammation, medicine, stress, smoking, etc., can also lead to an increase in white blood cell levels. However, if the anomaly persists without any specific explanation, then the hematologist may consider a bone-marrow disorder or some other hematological condition to cause the anomaly.
In this group of editorials, there are three hematology specialists, who are located in India and are introduced to the readers.
- Dr. Ganesh Jaishetwar
- Dr. Rohan Halder
- Dr. Praveen Kumar Jha
What Are Myeloproliferative Disorders?
Myeloproliferative Disorders are diseases that lead to excessive blood cell generation by the bone marrow. More recent classification recognizes myeloproliferative neoplasms which can target RBC (red blood cells), WBC (white blood cells), or platelets.
Examples include:
- Polycythemia vera
- Essential thrombocythemia
- Primary myelofibrosis
- Chronic myeloid leukemia
- Other myeloid neoplasms.
The diagnosis is established based on blood tests, blood smear tests, history, and molecular testing.
Why Persistent Leukocytosis Needs Proper Evaluation
The term leukocytosis is used to indicate higher than normal levels of white blood cells. Temporary increases are possible in infections and other types of inflammations. Thus, a single abnormal blood test cannot be used to diagnose Myeloproliferative Disorders.
When uncomplicated leukocytosis persists over time, doctors may look into the following:
- Blood counts and differentials
- Past blood test results
- A peripheral blood smear
- Medications taken
- Possible infections and diseases
- Physical examination
- Medical and family history
- Molecular or genetic tests when necessary
- Bone marrow examination when clinically indicated
The evaluation is individualized since persistent leukocytosis can be caused by many reasons.
Top 3 Doctors for Myeloproliferative Disorders in India
1. Dr. Ganesh Jaishetwar
Dr. Ganesh Jaishetwar has a position of a Senior Consultant in the fields of hematology, Hemato-Oncology and Bone Marrow Transplantation at Yashoda Hospitals in Hitec City in Hyderabad. His qualifications include MD, DM in Clinical Hematology, PDF-BMT from TMC, Fellowship in leukemia and BMT from a Canadian hospital as well as multiple other qualifications such as MACP. There are 25+ years of experience noted at Yashoda Hospitals.
The area of expertise as seen in public domain includes blood cancers, myelodysplastic syndromes, Myeloproliferative Disorders, bleeding and clotting disorders and bone marrow transplantation.
In case there are patients suffering with unexplained increased leukocyte levels then, considering his hematologic experience the evaluation of myeloproliferative disorders is suitable.
2. Dr. Rohan Halder
Dr. Rohan Halder is a specialist in the Department of Haemato-Oncology & Bone Marrow Transplantation at Rajiv Gandhi Cancer Institute & Research Centre. His academic background includes MBBS, MD, DM (Clin. Haematology), and PDCC (Haemato-Oncology). According to the hospital, he has at least 10 years of experience in the management of haematological malignancies.
His fields of specialization are in Myeloproliferative Neoplasms, Myelodysplastic syndromes, Chronic Myeloid leukaemia, Acute leukaemias and Bone marrow failure syndromes.
This establishes that Dr. Rohan Halder can be considered as a specialist for the patients presenting signs of unexplained abnormal blood counts which might be attributed to Myeloproliferative Disorders.
3. Dr. Praveen Kumar Jha
Dr. Praveen Kumar Jha works as a hematologist in Medanta located in Patna. According to his profile, he is skilled in several areas including congenital blood disorders, hematological cancers, and bone marrow transplantation. His areas of specialization include leukemia, lymphoma, multiple myeloma, myelodysplastic syndromes, Myeloproliferative Neoplasms, disorders of red blood cells and platelets, and bleeding and clotting disorders.
He is also experienced in conducting bone marrow examination, stem cell transplantation, and cellular therapies.
Patients suffering from persistent leukocytosis who need to undergo hematological testing can take advantage of Dr. Praveen Kumar Jha’s knowledge in Myeloproliferative Disorder as well as other blood disorders.
Myeloproliferative Disorders and Unexplained Leukocytosis
The connection between Myeloproliferative Disorders and leukocytosis is significant but not to be exaggerated.
The presence of a raised white blood cell count on its own can be due to various reasons, therefore, it is necessary to analyze the results of a full blood count and not only focus on the elevated white blood cell number.
Depending on the context, further testing could include:
- Level of white blood cells
- Percentage of hemoglobin and platelets
- Peripheral Smear
- Evaluation of infection
- Molecular tests
- Study of bone marrow when justified
Certain Myeloproliferative Disorders lead to typical changes in the blood cell counts and require specialized hematological and molecular investigations.
When Should You See a Hematologist?
A consultation in hematology might be necessary if blood counts are abnormal, unexplained, or repeatedly observed.
If you have the following results, talk to a doctor:
- Repeatedly high white blood cell count
- Unexplained abnormal values of different blood cell line items
- Continuous changes of platelet or red blood cell counts
- Problems with peripheral smear
- Uncovered spleen enlargement without any explanation
- Other constitutional manifestations in addition to abnormal blood counts
- Blood abnormality that remains unexplained even after a primary examination.
These findings may not necessarily mean that Myeloproliferative Disorders are present but may require additional medical evaluation.
How Are Myeloproliferative Disorders Investigated?
Myeloproliferative Disorders cannot be diagnosed solely by the presence of leukocytosis. In forming a diagnosis, the hematologist must use clinical findings together with laboratory tests and, if necessary, molecular or bone-marrow investigations.
The investigation may comprise:
Comprehensive clinical history and examination
Full blood count with differential
Peripheral blood smear
Further laboratory tests
Molecular tests when warranted
Bone-marrow examination when applicable
The particular tests are determined by the blood-count profile and the suspected diagnosis.
Can Persistent Leukocytosis Always Be Prevented?
Leukocytosis is not a disease but a laboratory finding. Among the causes of leukocytosis we find transient infectious and inflammatory processes, drug actions, and some blood diseases.
For this reason, it is incorrect to prevent Myeloproliferative Disorders by assuming that any increase in white blood cells signifies something wrong in the bone marrow. The causes of persistent abnormalities should always be analyzed by a trained specialist.
Read More: Approach to a Case of Chronic Refractory Symptomatic Leukocytosis of Unknown Origin (CRESLUO)
FAQs About Myeloproliferative Disorders
What is meant by Myeloproliferative Disorders?
Myeloproliferative Disorders refer to any of the disorders which result in an abnormal increase in the production of blood cells by the bone marrow.
Is leukocytosis synonymous to Myeloproliferative Disorders?
No, leukocytosis can arise due to several different factors, including infections, inflammation, drugs, etc.
Under what conditions does persistent leukocytosis become alarming?
If the increased levels of leukocytes persist without any known cause then it becomes important to see a doctor, and in such cases it is better to consult a hemologist.
Are Myeloproliferative Disorders responsible for increased number of leukocytes?
Yes, increased leukocyte level is sometimes found in patients having Myeloproliferative Disorders.
Which doctor specializes in Myeloproliferative Disorders?
A hemologist can be consulted for unexplained blood count abnormalities and Myeloproliferative Disorders.
Conclusion
Although persistent and unexplained leukocytosis merits serious evaluation, leukocytosis does not always indicate that the patient is suffering from Myeloproliferative Disorders. Rather, systematic testing can enable differentiation between transient/reactive causes of this condition and relevant hematological diseases that need special treatment.
This editorial comparison features
- Dr. Ganesh Jaishetwar
- Dr. Rohan Halder
- Dr. Praveen Kumar Jha
They are all specialists in the field of hematology with published articles related to the topic of study and a publicly available record of their academic achievements in the field of study.
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