Rochester General Hospital has a long standing tradition of excellence in hematology, notably through the direction of the Department of Medicine by Dr. Lawrence Young in the 1950s who was a renowned expert in red cell disorders. In subsequent decades, Dr. John Olson helped establish the affiliated Hemophilia Treatment Center as a leading comprehensive care center for patients in the 13 county wide area with hemophilia and related bleeding disorders such as von Willebrand’s. This tradition of thorough hematological care and expertise continues now into this decade through the leadership of Dr. Prad Phatak, the chief of the Hematology/Oncology Unit, Dr. Ronald Sham, director of the Anticoagulation Unit and medical director of the Mary M. Gooley Hemophilia Center, and Dr. Peter Kouides, research director of the Mary M. Gooley Hemophilia Center.
Rochester General Hospital, particularly with its very active cardiovascular program, requires in-house expertise in hematological disorders in support of the patient with a thrombotic or hemorrhagic event or the patient with an abnormal hemogram. There are complementary clinical research programs in close collaboration with the clinical pathology department, particularly through the expertise of Dr. William Fricke, a pathologist with training and expertise in disorders of hemostasis and thrombosis. The high volume of cardiovascular cases at this hospital has provided us with many opportunities in optimizing the diagnosis and management of hematological complications. In the laboratory, Dr. Fricke has been studying methods to increase the sensitivity of the diagnosis of heparin induced thrombocytopenia. This includes several methodologies that we are applying in predicting the risk of hemorrhage and in diagnosing an underlying disorder of hemostasis in patients who have suffered a hemorrhagic event such as a major post partum hemorrhage, retroperitoneal hematoma after abdominal surgery or chronic menorrhagia.
The incidence of thrombosis compared to many other medical conditions is quite common, occurring in 1:1000 patients. The last five years has seen emergence of the discovery of new hypercoagulable states. We have been instrumental in bringing the methodology for testing for these to the Rochester area.
Various ongoing projects continue to enhance the outpatient care of patients with hematological disorders at RGH. For example, there are over 350 patients with hereditary hemochromatosis being followed through the Mary Gooley Hemophilia Center. Present studies are examining the differences between patients in maintaining the “de-ironed state” after induction phlebotomy.
Another common clinical situation is menorrhagia, 5% of women of reproductive age report heavy menstrual bleeding. We have established a program to thoroughly study these patients for an underlying disorder of hemostasis through a recently completed prevalence study in Rochester that demonstrated that approximately 18% of women presenting with menorrhagia had subnormal von Willebrand factor levels. Efforts have been focused now to try to determine the optimal treatment for these women with a bleeding disorder and menorrhagia through a study funded through the Centers for Disease Control. It is our hope in the next five years to develop effective treatments in general for women with heavy menstrual bleeding.
Besides our clinical research interests and treatment programs in the fields of hemochromatosis, thrombosis and von Willebrand’s disease; we continue to have an active program of care for patients with malignant hematological disorders such as leukemia, lymphoma and myeloma. The care of patients with these disorders will benefit greatly from our collaboration with the Roswell Park Cancer Institute. This affiliation will provide access to investigational therapeutic agents that are not available anywhere in the Rochester area.
The clinical research programs and efforts outlined above reflect an enthusiasm that we all share at the Lipson Center. We look forward to continuing to provide state of the art clinical care and research to blood disorder patients.