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Hematopathology is defined by the Accreditation Council for Graduate Medical Education as the practice of pathology concerned with the study and diagnosis of human diseases involving hematolymphoid cells and tissues and blood coagulation.
Hematopathology is a unique field that encompasses both anatomic and clinical pathology while also using molecular technology and flow cytometric analysis. Along with flow cytometry, hematopathologists utilize various other tools and technologies—such as histology, immunohistochemistry, cytogenetics, DNA sequencing, and other molecular analysis—to make diagnoses and predict responses to therapy.
Hematopathologists specialize in looking at lymph nodes, bone marrow, and peripheral blood smears; they often sign out morphology as well as flow cytometry and are responsible for integrating the results of genetic studies. Diagnosis of hematolymphoid neoplasms requires extensive integration of morphologic, clinical, and ancillary testing data, all of which has an element of urgency that can keep things exciting.
Frequently Asked Questions
The challenges can include high demand and caseload, as well as staffing issues and potential limitations on available tests in private practices. Employers may require board certification in hematopathology or a certain amount of experience, such as two years after fellowship. They may also expect that you sign out other surgical pathology subspecialties or be more involved on the clinical pathology side, depending on the practice setting. The field is evolving and there is an increasing need for working knowledge in molecular pathology. Lastly, finding an ideal job may require relocation.
The standard hematopathology fellowship is one year following an AP/CP residency. However, some institutions have a two-year fellowship with a greater focus on research for one year.
On-call time is not universal for hematopathologists, but it certainly exists and can vary by the specific practice or program. Some indicate that it’s rare or not typical, while others state there is frequent on-call time, especially in certain programs or private practice, where on-call time might be divided up among 10 full-time pathologists. The reasons for on-call time depend on circumstances as well, with some mentioning it’s to cover acute situations like leukemias, while others don’t necessarily specify a reason.
Hematopathologists’ case volumes vary depending on the practice setting, but generally there is a high demand for services. Some practices may see up to 30,000 cases a year, and the daily case volume could cover 5–15 bone marrows, 10 peripheral blood smears, and a couple of lymph nodes. Others are more in the daily range of 3–5 bone marrow biopsies, 4–8 peripheral blood smears, 12 outside consult cases, and 1–2 lymph nodes/tissues.
In addition to the high case volume, hematopathologists utilize ancillary studies, such as immunohistochemical stains, cytogenetics, FISH, molecular analysis, and flow cytometry—sometimes up to 40+ tests per week. In many cases, these ancillary tests are routinely run to be integrated into the final diagnosis.
The exact volume and types of cases can also be affected by the referring hematologists and oncologists as well as patient demographics.
Hematopathologists interact with a wide range of specialties, including hematologists/oncologists, surgeons, interventional radiologists, pathologists, infectious disease specialists, and rheumatologists, as well as advanced practice providers, fellows, and residents. Despite usually working most closely with hematology/oncology clinicians, radiologists, and surgeons, the many varied interactions between hematopathology and these and other medical professionals in the field can be a highlight of the subspecialty.
Yes. There are several organizations, including the Association for Molecular Pathology (AMP), the Society for Hematopathology (SH), the International Clinical Cytometry Society (ICCS), and the American Society of Hematology (ASH). Additionally, some hematopathologists belong to the European Association for Haematopathology (EA4HP) and the International Society for Advancement of Cytometry (ISAC). These organizations provide a platform for hematopathologists to share knowledge, collaborate on research, and advance the field.
Hematopathology frequently utilizes molecular studies—such as clonality and next generation sequencing studies—making it a natural fit with molecular pathology.
However, hematopathology also pairs well with several other pathology subspecialties, including cytogenetics, cytopathology, blood bank, general surgical pathology, pediatric pathology, or a surgical pathology subspecialty like gastrointestinal or thoracic. Overall, hematopathology benefits from collaborations with other pathology subspecialties to provide comprehensive care for patients.
Patient interaction is rare for hematopathologists. Typically, most hematopathologists have minimal interaction with patients, with some exceptions in certain institutions where they may perform bone marrow biopsies and/or fine needle aspirations. In some cases, hematopathologists who oversee coagulation testing may also interview patients prior to testing.
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