Hematology – An ever-evolving specialty of lab medicine

Blood-related diseases and disorders are a global health challenge and are associated with high morbidity and mortality. The growing demand for blood and blood components is identified as one of the key factors to trigger the hematology analyzers and reagents market growth in the forthcoming years.

Blood component therapy allows patients to benefit from one pint of whole blood. As a result, the rising demand for blood and blood components for treating medical conditions is further boosting the demand for hematology analyzers for measuring blood constituents. The rising number of organ-transplant procedures is another factor responsible for the need. It is predicted that the hematology analyzers and reagents market will register a CAGR of nearly 6 percent by 2023. However, challenges in the growth remains – the lack of adoption of automated hematology analyzer solutions by smaller laboratories and standardization of processes to validate the automated cell counters. The high cost of the initial set up and instrumentation and the subsequent cost of maintenance are likely to affect the demand for hematology analyzers.

Hematology analyzers, on the other hand, are becoming increasingly complex with more and more quantitative parameters being reported in the complete blood count. It is imperative, therefore, that before an instrument is used for testing patient samples, it must undergo an evaluation by an organization or laboratory, independent of the manufacturer. The evaluation should demonstrate the performance, advantages, and limitations of instruments and methods.

Recent trends and the future. Apart from the many advanced clinical parameters like immature granulocytes (IG), immature platelet fraction (IPF), reticulocyte hemoglobin equivalents (Ret-He), hematopoietic progenitor cells (HPC) and many more, digital microscopy and even counting has kept the manufacturers interested till date.

Digital image-based hematology systems. Digital imaging systems have a long history, starting in the late 1960s and the early 1970s. These systems performed a five-part WBC differential and morphologic examination on wedge smears. The cost of the systems, continued maintenance, system performance limitations (based on wedge smears, cell distribution on the slide, and staining consistency) followed by the availability of 3PD and the 5PD automated on routine hematology cell counting analyzers contributed to the demise of these original systems. With the improvement of computer systems, sophisticated processing and graphics software, and the advent of artificial neural networks, image-based systems have returned to routine hematology laboratories.

The type of systems are available:

Cell locator systems with pre-classification of cells for verification of cells by a skilled operator; and

Image-based hematology systems that perform a CBC, five-part normal differential and, in some instruments, a reticulocyte count. (If any abnormal cells are detected, the sample is flagged by the instrument for further review by a skilled operator).

Hematology practice has evolved as a distinctive science under laboratory medicine over the years. So much so that super-specialized clinical courses and fellowship programs in hematology are now chosen and practiced by medical graduates in India.

As laboratory medicine progresses further, despite advancements in technology and artificial intelligence (AI) becoming more dominant, India will still need more specialists and consultant hematologists to cater to the growing need. This is particularly true for maintaining the national need for hematologists where training resource requirements and competitive transitional milestones are substantial. Hence, when national data suggests that future medical research need in a scientific area is currently being met in less than optimal manner, strategies to expand research and training capacity must follow.