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Hematological Pathologist

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Like a good mystery?

Dr. Brent Wood says hematological pathology -- or hematopathology, as he calls it -- is like a mystery. "It is! It's detective work."

Wood is associate director of the hematology and hematopathology laboratories at the University of Washington Medical Center. "What we mainly do is work on lymphoma, and leukemia [cancers of white blood cells] and other diseases that arise from blood platelets," he explains. "In many cases we spend a lot of time looking at things under a microscope -- at glass slides."

So what mysteries has Wood solved lately? His last research paper dealt with lymphoma in lung transplant patients. "We looked at whether it came from the recipient or the donor," he says.

It turns out the immune-suppressive drugs the transplant patients are given to keep them from rejecting the transplant also keep the body from fighting viruses it normally keeps in check. The virus starts to multiply and spread, and the patient develops lymphoma.

So how does it feel to be a medical mystery solver? "It's kind of the best of all possible worlds," says Dr. Lois Shepherd, a hematological pathologist. Shepherd runs a hospital's routine blood lab and is medical director of the blood bank. Making blood cells give up their secrets is her favorite part of the job.

If a patient is diagnosed with leukemia, Shepherd helps determine what form of leukemia it is. "We look for differences on the surface of the cells," she explains. From Shepherd's perspective, acute myeloid leukemia and acute lymphoid leukemia look quite different. "Proteins on the surface of the cells say, 'Yes, I'm a myeloid,' or 'Yes, I'm a lymphoid.'"

Blood tests sometimes reveal a patient's symptoms aren't linked to cancer at all. A patient may complain of fatigue, bone aches and bruising. It could be leukemia, so the physician orders blood tests. But Shepherd may discover a simple vitamin deficiency. "You give them vitamin B12. They feel good!" she explains.

Shepherd chose to study hematological pathology after living in England for a while. "In England, you do both. You do lab work and get involved with patients," she remembers.

"It wasn't so much, 'Yes, I want to be a lab hematologist,' as just falling into that area. I'm really glad. It's turned out really well!"

Wood also discovered hematological pathology well into his academic career. "I did an MD and a PhD at the same time," he remembers. During his sixth or seventh year in medical school, Wood became interested in hematological pathology -- it seemed like an ideal way to combine his interest in science and medicine. His position at the university has proved that. "I like the mixture: microscope work, interpretation of clinical lab results, interactions with clinicians.

"A lot of people get into medicine for direct contact with patients," says Wood. He says you have to know what you like in order to get what you need from the field. Pathology generally offers less patient contact than clinical medicine.

Both Shepherd and Wood have to keep up with the fast pace of change. Wood's lab tests new diagnostic techniques, looking for those which work efficiently and inexpensively. "There are always new antibodies and developments in molecular biological techniques. It's never static. I have to teach, research, publish, plus do clinical work."

The pace of change is exciting and exasperating. Sometimes there just aren't enough hours in the day to do everything he wants to do!

As much as he enjoys his work, Wood says anyone considering a career in hematopathology should realize this is a very specialized career. It means spending a lot of years in school, and that can be expensive. For instance, his student loans total about $75,000. "At the school I went to, some had debts over $100,000." he says. "It's something you need to think about."

Wood says he sometimes wonders what it would have been like to do something else. "But I'm happy with the way things turned out," he says. And why not? There are always more mysteries to solve!