Haematology departmentsinindia

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Haematology departmentsinindia

  1. 1. Editor Dr M B Agarwal HaematologyDEPARTMENTS IN INDIA
  2. 2. A frequently asked question by a student who completes his postgraduate examination in medicine / paediatrics or pathology relates to choosing a centre where he can pursue his career in haematology. Often he is lost as he can't find many institutions offering formal training / qualifications or even an informal opportunity to learn the subject. Forty years ago, as a student, I faced this problem. At that time, many outlets did not exist and one had to look to the western world to achieve this goal. However, today, after 40 years, the situation has remarkably changed. Today, one can be very proud of over 25 institutions in India where top quality diagnostic and therapeutic haematology is being practiced, taught and researched. This booklet is a modest attempt to assemble information about such centres of excellence and make it available to those who need it most i.e. a student desirous of pursuing his career in the field of haematology. I am grateful to the faculty of these institutions for their authoritative write ups. The contributors have done a marvelous job at a very short notice. I am sure that this book will be a Bible for those who need and who will benefit from this information. Dr. M.B. Agarwal November 2013 From The Editor's desk
  3. 3. Contents The list is arranged alphabetically as per city Institute Contributed by Page No. 1. Gujarat Cancer Research Institute (GCRI), Ahmedabad Pankaj Shah 3 Sandip Shah 2. Narayana Health City, Bengaluru Sharat Damodar 5 3. Postgraduate Institute of Medical Education & Research Neelam Varma 6 (PGIMER), Chandigarh 4. S.C.B. Medical College, Cuttack Sudha Sethy 8 R.K. Jena 5. All India Institute of Medical Sciences (AIIMS), Delhi Renu Saxena 11 6. Army Hospital (Research & Referral i.e. R & R), Delhi Ajay Sharma 13 Sanjivan Sharma Jasjeet Singh 7. Guru Teg Bahadur Hospital (GTB Hospital), Delhi Usha Rusia 15 8. Indraprastha Hospital Apollo Hospitals, Delhi Amita Mahajan 17 9. Maulana Azad Medical College (MAMC) & Tejinder Singh 20 Lok Nayak Hospital, Delhi Parul Sobti 10. Rajiv Gandhi Cancer Institute, Delhi Dinesh Bhurani 21 Gauri Kapoor 11. Sir Ganga Ram Hospital, Delhi Manorama Bhargava 23 12. Medical College, Kolkata Utpal Chaudhuri 29 13. NRS Medical College, Kolkata Maitreyee Bhattacharyya 33
  4. 4. Institute Contributed by Page No. 14. Tata Medical Centre (TMC), Kolkata Mayur Parihar 37 Deepak Mishra Reena Nair Mammen Chandy 15. Sanjay Gandhi Postgraduate Institute (SGPGI), Lucknow Soniya Nityanand 45 16. Christian Medical College (CMC), Ludhiana M. Joseph John 49 Naveen Kakkar 17. B.J. Wadia Hospital for Children, Mumbai Bharat Agarwal 54 18. KEM Hospital, Mumbai Farah Jijina 58 Chandrakala S. 19. LTMG Hospital, Sion, Mumbai Mamta Manglani 61 20. National Institute of Immuno-Haematology (NIIH), Mumbai K.Ghosh 64 21. P.D. Hinduja National Hospital, Mumbai Farah Jijina 68 Shanaz Khodaiji 22. Tata Memorial Hospital (TMH), Mumbai S.D. Banavali 70 23. Tata Memorial Centre, Mumbai Navin Khattry 73 S.D. Banavali 24. Armed Forces Medical College (AFMC), Pune AFMC Group 77 25. Sahyadri Hospital, Pune Shashi Apte 82 26. Shere-E-Kashmir Institute of Medical Sciences, Srinagar M. I. Quadri 87 27. Christian Medical College (CMC), Vellore Alok Srivastava 89
  5. 5. Contributed by Bharat Agarwal, MD Head of Department Department of Pediatric Hematology & Oncology B J Wadia Hospital for Children Parel, Mumbai 400012 Narendra Agrawal, DM (Clin Haematology) Consultant Haemato-Oncologist & BMT Rajiv Gandhi Cancer Inst & Research Center, Rohini Sector - 5 New Delhi 110085 Shashi Apte, MD Head Department of Haematology & BMT Unit Sahyadri Speciality Hospital Pune 411004 S.D. Banavali, MD Professor & Head Department of Medical Oncology Tata Memorial Centre Mumbai 400012 Manorama Bhargava, MD, FAMS Senior Consultant & Chairperson Department of Haematology Sir Ganga Ram Hospital Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi 110060 Maitreyee Bhattacharyya, MD (Gen Med), DM (Clinical Haematology) Professor & Head Department of Haematology N.R.S Medical College Kolkata 700014
  6. 6. Mammen Chandy, MD, FRACP, FRCPA, FRCP Director Tata Medical Center New Town, Rajarhat Kolkata 700156 Tathagat Chatterjee, MD, DM, FUICC, FISHTM Professor & Head Department of Immuno-Haematology & Transfusion Medicine Armed Forces, Medical College Pune 411040 Utpal Chaudhuri, MD Director Institute of Haematology & Transfusion Med MCH Building, Medical College 3rd Floor, 88 College Street Kolkata 700073 Sharat Damodar, MD, DNB, DM Consultant Haematologist & BMT Physician Narayana Hrudayalaya & Muzumdar Shaw Canver Centre 258 / A, Bommasandra Industrial Area, Anekal Taluk Bengaluru 560099 K. Ghosh, MD Director Institute of Immuno-Haematology 13th Floor, Multi-storey Building KEM Hospital, Parel Mumbai - 400 012 Rabindra Kumar Jena, MD. PhD,FISHBT Professor and Head Dept. of Clinical Hematology S.C.B. Medical College & Hospital Cuttack 753007 Odisha
  7. 7. Farah Jijina, MD Consultant Hematologist/Hemato-oncologist PD Hinduja Hospital (Mahim) and Hinduja Heathcare (Khar) Veer Savarkar Marg, Mahim Mumbai 400 016 & Professor Haematology KEM Hospital Parel Mumbai 400012 M. Joseph John, MD, DM Associate Professor & Head Clinical Haematology, Haemato-Oncology & Bone marrow (Stem cell) Transplant Unit Christian Medical College Ludhiana 141088 Naveen Kakkar, MD Professor of Pathology In-charge of Special Tests Laboratory Clinical Haematology, Haemato-Oncology & Bone marrow (Stem cell) Transplant Unit Christian Medical College Ludhiana 141088 Navin Khattry, MD, DM Professor Department of Medical Oncology Tata Memorial Centre Mumbai 400012 Shanaz Khodaiji, MD Consultant Hematology and Transfusion Medicine Department of Laboratory Medicine P.D. Hinduja National Hospital & MRC Veer Savarkar Marg, Mahim Mumbai 400016 Amita Mahajan, MD Senior Consultant, Paediatric Haematology & Oncology, Indraprastha Apollo Hospitals, Delhi
  8. 8. Mamta V Manglani, Professor & Head, Department of Pediatrics Chief, Div. of Hematology-Oncology Programme Director, Paediatric Centre of Excellence for HIV Care LTM Medical College & General Hospital, Sion Mumbai 400022 Deepak K Mishra, MD, MAMS, FICPath, FISHTM, FUICC, PDF (Haematology - AIIMS) Senior Consultant & Head (Haemato-Pathology) Head, Department of Laboratory Sciences Tata Medical Center New Town, Rajarhat Kolkata 700156 Reena Nair, MD Senior Consultant Clinical Haematology Department Tata Medical Centre New Town, Rajarhat Kolkata 700156 Velu Nair, AVSM, VSM** Dean & Deputy Commandant Senior Consultant Medicine & Haematology Armed Forces Medical College Pune 411040 Soniya Nityanand, MD PhD Professor & Head Dept of Hematology Sanjay Gandhi PG Inst. of Medical Sciences, Rae Bareily Road LUCKNOW 226014 Mayur Parihar, Associate Consultant Department of Haemato-Pathology & Cytogenetics Tata Medical Centre New Town, Rajarhat Kolkata 700156 M.I. Quadri, MD Director Dr. Quadri's Hematology Center & Clinical Laboratory Srinagar
  9. 9. Usha Rusia, MD Professor & HOD Department of Pathology University College of Medical Sciences and Guru Teg Bahadur Hospital Shahdara Delhi 110095 Chandrakala S, MD, DM Fellowship in Leukemia and BMT Associate Professor. Dept of Hematology KEM hospital, Parel Mumbai 400012 Renu Saxena, MD, FNAMS, FIMSA Professor & Head Department of Hematology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029. Sudha Sethy, MD Assistant Professor Department of Clinical Hematology S.C.B. Medical College & Hospital Cuttack 753007 Odisha Pankaj M. Shah, MD Vice President Gujrat Cancer Society Advisor to Chairman Gujarat Cancer & Research Institute Ahmedabad 380016 Prof Emeritus Medical Oncology Trustee : Sadvichar Parivar Sandip A. Shah, MD Consultant Haemato-Oncologist Department of Medical Oncology Gujarat Cancer And Research Institute Ahmedabad 380016
  10. 10. Ajay Sharma, MD Prof & Sr Advisor Dept of Hematology & Stem Cell Transplantation Army Hospital( Research & Referral) New Delhi Sanjeevan Sharma, MD Dept of Hematology & Stem Cell Transplantation Army Hospital( Research & Referral) New Delhi Jasjeet Singh, MD Dept of Hematology & Stem Cell Transplantation Army Hospital( Research & Referral) New Delhi Tejinder Singh, MD, FICP, FISHTM Director - Professor Department of Pathology Maulana Azad Medical College Bahadur Shah Zafar Marg New Delhi 110002 Parul Sobti, MD Department of Pathology Maulana Azad Medical College Bahadur Shah Zafar Marg New Delhi 110002 Alok Srivastava, MD, FRACP, FRCPA, FRCP Professor & Head Department of Haematology Christian Medical College Vellore - 632004 Neelam Varma, MD, FISHTM, Professor & Head - Hematology, V Floor, SS Anand Block (Research Block A), Post-Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012
  11. 11. Gujarat Cancer & Research Institute, Ahmedabad Hemato-oncology department Pankaj Shah, Sandip Shah Department of Medical & Pediatric Oncology, GCRI was established in 1972under the leadership of Dr. Pankaj Shah (Founder Head of Medical Oncology Department). Other developments were establishment of Pediatric Oncology Department in 1992 – first of it's kind in India and Haematopoietic Stem Cell Transplant Unit in 2002. GCRI also has an active and dynamic Research division with state of the art facilities even for molecular research since 1986.The Super Speciality DM Medical Oncology Course started in 1991 with four students per year which has now increased to 10 students per year since 2011. The Department of Medical and Paediatric Oncology renders services to Adult & Paediatric patients, both solid tumours and Haematological malignancies.The indoor facility consists of 127 beds for adults and 25 beds for Paediatric patients. Other facilities includes, Leukemia and neutropenia ward with 22 beds, HSCT unit with 4 rooms and Medical ICU etc. Team members Dr. Pankaj M. Shah - Professor Emeritus and Former Hon. Director, GCRI. Dr. Kirti M. Patel - Dean GCS medical college, Former HOD- Medical Oncology Dept. and Deputy Director, GCRI. Dr. Shilin N. Shukla - Former Hon. Director, GCRI and HOD – Medical Oncology Dept. Dr. Asha S. Anand – Professor and Chief of medical oncology Dr. Shailesh S. Talati – Professor and chief of medical unit III Dr. Sandip A. Shah - Associate Professor(part time practicing) Dr. Harsha P. Panchal - Associate Professor Dr. Apurva A. Patel - Associate Professor Dr. Sonia K. Parikh - Associate Professor Dr. Bhavesh B. Parekh - Assistant Professor (practicing) Adult hemato-oncology The department of the Medical Oncology provides services to adult patients with cancer of which apporx. 20% have haematological malignancy. Pediatric hemato-oncology The Paediatric Oncology centre has dedicat. The department of the Medical Oncology provides services to paediatric patients. There are about 47 (25 Paediatric, 22 Leukemic) bedded indoor facilities at Paediatric Oncology Centre. 1 3
  12. 12. Bone marrow transplantation The department of the Medical & Paediatric Oncology has an active HSCT unit under the able leadership of Dr. Sandip Shah. They have performed 207 transplantations till date.They include autologous, allogenic, umbilical cord transplantation, as well as 3 MUD HSCT. They were done for variety of indications like haematological malignancies, solid tumors, thalassemias and others. Financial Aid for Patients GCRI has always strived to offer financial aid to economically backward patients with curable malignancies. Various financial aids are MA Yojna for BPL patients, School health program for children upto 18 yrs of age, LIG scheme for econimically backward patients, Adoption scheme through which donors from society adopt a patient and give part of the expense (rest is borne by GCS), partial reimbursement of bills by GCS etc. Contact details Phone (GCRI) : +91-79- 2268 8000 (Hunting) Phone (GCS) : +91-79- 2268 1433 , 2268 8017 Fax : +91-79-2268 5490 E-mail: gcriad1@bsnl.in Website: http://www.cancerindia.org 4 Service Output of last year from April 2012 to March 2013 No. Details of Work Done Nuber 1 New and referred cases 1079 2 Follow-up cases 15078 3 Day care chemotherapy administration 5700 4 Minor procedures - Bone marrow aspiration/biopsyIntrathecal, Pleural & Ascitic Fluid aspiration 4100 5 No. Of Hemato-oncology cases 460 6 Benign Haematological Diseases – Aplastic anemia, ITP etc. >100 Service Output of last year from April 2012 to March 2013 No. Details of Work Done Adult 1 New plus first time referred cases 10936 2 Follow-up cases 68055 3 Day care chemotherapy administration 40969 4 Minor Procedures - Bone marrow aspiration/biopsy Intrathecal, Pleural & Ascitic Fluid aspiration 8638 5 Haematological Malignancies 1283 6 Benign Haematological Diseases – Aplastic anemia, ITP etc. >200
  13. 13. Narayana Health City, Bengaluru Department Of Haematology Sharat Damodar The Department of Haematology was started in April 2004 as a one man unit in the Narayana Hrudayalaya hospital. A three bedded bone marrow transplant unit was established in October 2004 and the first transplant for a child with thalassemia was conducted in November 2004. Since then the department has steadily grown over a period of time to its current position and is currently situated in the Mazumdar Shaw Cancer center in Narayana Health city. Over the last year the OPD patients have crossed 7000/yr and in-patient admissions have crossed 1400/yr. The total number of bone marrow transplants has crossed 280 till date which is the largest number in Karnataka, of which 60 were done in the last year 2012. The new bone marrow transplant unit is a 14 bedded state of the art unit which is seen in the picture attached (jpg 35). The transplants conducted till date includes autologous, allogeneic – matched sibling, cord blood, Matched unrelated and haplo- identical transplants. The department has a fellowship program in Haemato-oncology under the auspices of Rajiv Gandhi University, running from 2010 and 9 students have joined till date. In addition we have been granted 4 seats in DNB Haematology starting Jan 2014 - students eligible are MD/DNB General medicine, Paediatrics and Pathology. Faculty 1. Dr Sharat Damodar MD,DNB,DM - Senior consultant and HOD 2. Dr Sunil Bhat MD, FPHO, Fellow Paed onc/BMT Univ Sydney - Paediatric consultant 3. Dr Nataraj KS MD, DM - Consultant 4. Dr Shoba Badiger MD, DNB, FHO - Paediatric consultant 5. Dr Akshatha MD - Fellow 6. Dr Shruthi Kodad DNB - Fellow 2 5
  14. 14. Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh Hematology Services Neelam Varma Hematology Service in PGIMER, Chandigarh comprises of 3 components: diagnostic service by Hematology department, adult clinical hematology unit (of department of Internal Medicine) and pediatric hematology-oncology unit (of department of Pediatrics). Hematology section of the erstwhile Pathology department was upgraded to a full department in 1976. Foundation of Hematology specialty was essentially laid by Dr. K. C. Das in 1964, who was appointed as Lecturer. He rose to become the first Professor in Hematology in 1977. He has made great research contributions in the field of B12-folate metabolism. Other faculty members also joined and contributed immensely, namely, Dr. (Mrs.) A. Perkash, Dr. Swaroop, Dr. Dipika Mohanty, Dr. Sumitra Dash, Dr. G. Garewal and Dr. Neelam Marwaha. Several investigative sections were established focusing on coagulation disorders, nutritional anemia, cytogenetics, radioisotopic studies and hemoglobinopathies. Ph.D. programme was introduced in 1970. Department was accorded the status of 'Advanced Centre for Hematology', by Indian Council of Medical Research, in 1982. Departmental research activities concerning nutritional anemias, hematological malignancies, hemoglobinopathies and coagulation/hemostasis have made a major impact nationally and internationally. The department was the first in India to start leukemia cytochemistry to classify leukemias. Subsequently immunophenotyping of leukemias by immunofluorescence and APAAP was established. Investigations for bleeding disorders and platelet function tests were also started. Hematology department in association with the department of Pediatrics started investigations for Genetic Disorders and the laboratory infrastructure was upgraded by the Department of Biotechnology grant. Prof. G. Garewal started the Molecular Hematology Laboratory to establish molecular analysis of Thalassemias. The data generated has been used for introducing prenatal diagnosis of thalassemias. Mutational analysis of G6PD deficiency was started under a research project. Dr. Neelam Varma has expanded leukemia cytogenetics, chromosomal breakage studies and molecular genetic analysis of malignant and pre-malignant hematological disorders. These investigations are being offered for diagnosis as well as therapy monitoring. Molecular tests for mutations associated with venous thrombosis have been established through a grant by Department of Biotechnology and this facility has been incorporated in patient care. Etiology of bone marrow failure syndromes and the role of constitutional factors (Fanconi anemia and others) was studied by Dr Neelam Varma under a DBT project. Flow cytometry for acute and chronic leukemias and paroxysmal nocturnal haemoglobinuria (PNH) has been established since 1996 by Dr. Neelam Varma. Dr Reena Das has extended the molecular analysis and gene sequencing for alpha thalassemia and hemophilias. Dr Jasmina Ahluwalia has contributed to start new advanced investigations in the Coagulation Laboratory which is now fully automated. Majority of the investigations performed by the department are under quality surveillance and utmost care is taken by the faculty to maintain high standards of the investigations as well as the teaching program. Dr. Man Updesh Singh Sachdeva, Dr. Shano Naseem, Dr. Prashant Sharma and Dr. Narender Kumar are making excellent contributions in 3 6
  15. 15. the diagnostic and research activities of Hematology department. Department is presently pursuing research projects concerning chronic myeloproliferative disorders, chronic lymphocytic leukemia, red cell membrane diseases, stem cell transplantation, acute leukemia, coagulation/ platelet function studies etc. MSc Medical Technology (Hematology) course was started in 2010 and DM Hematopathology course was started in July 2011. Department of Hematology also makes major contribution to the teaching programmes of BSc MLT, MSc MLT and MD Pathology courses. MD Pathology residents are posted for 11 months in Hematology department. Adult clinical hematology service was started in 1978 by Dr. Juginder Kaur within department of Internal Medicine. Dr. Subhash Varma joined in 1979 and has led the service since then. Stem cell transplant (SCT) programme was started in 2005 and more than 100 autologous and allogeneic SCTs have been performed so far. DM course in Clinical Hematology was started in July 2011. Adult clinical hematology service is managed by 3 clinical hematology faculty members (Dr. Pankaj Malhotra, Dr. Alka Khadwal, Dr. Gaurav Prakash), other faculty members of Internal Medicine unit I (Dr. Savita Kumari, Dr. Sanjay Jain, Dr. Vikas Suri), DM Clinical Hematology fellows, senior and junior residents of Internal Medicine. Pediatric hematology-oncology unit (of department of Pediatrics) was started by Prof. RK Marwaha in 1982. Later Dr. Amita Trehan and Dr. Deepak Bansal have joined. DM in Pediatric hematology- oncology was started in July 2009. Hematology department, adult clinical hematology unit and pediatric hematology-oncology unit conduct combined as well as individual sessions for the teaching programmes of DM Hematopathology, DM Clinical Hematology and DM pediatric hematology-oncology courses. Presently our institute has the capacity to provide state-of-the-art diagnostic services for patients with hematological disorders, including investigations for cyto-morphological appraisal, flowcytometry, cytogenetic/ molecular genetic analysis for malignant, pre-malignant and benign hematological diseases, coagulations disorders, hemolytic anemias and nutritional anemias etc. Adult and pediatric clinical services are geared to provide efficient management for patients with hematological disorders. Professor Sumitra Dash was the President of the Indian Society of Hematology and Blood Transfusion for the year 2004. Prof. Subhash Varma is the current president of the society. 7
  16. 16. S.C.B. Medical College & Hospital, Cuttack Department of Haematology Sudha Sethy, R.K. Jena General History The department of Clinical Hematology has been created in this institute since 1972 as a Higher specialty with sincere effort of Prof (Dr.) Janmejaya Nayak , M.D , Ph.D which is under broad specialty of medicine. Initially it was provided with a post of register. One Graduate Lab. Technician and two attendants with facilities of both out-door service twice a week and indoor beds. In 1984, one post of Associate Professor was created and posted and since then it is functioning as an independent department. The effort which has been started by Prof. Nayak was carried out by Prof. Upendra Nayak. After the retirement of Prof. Upendra Nayak the department is being proudly headed by Prof. R.K.Jena since 2003. In the year 2009 the State Govt. has been pleased to increase the number of beds from existing 13 to 20 and also this year in 2013 the Govt. has sanctioned a separate Day Care Unit for the department of Clinical Hematology with 10 sanctioned beds. Hence as on today 30 beds are functioning in this department of Clinical Hematology at S.C.B.Medical College Cuttack. There is one sanctioned post of Professor, one post of Associate Professor and one post of Assistant Professor in the department of Clinical Hematology. In this department extra SR posts and two additional Assistant professor posts and one Associate professor post are to be sanctioned during this financial year as the BMT unit is to be functional in 2013-14. Already the proposal to open DM Course in the Department of Clinical Hematology in this academic session 2013-14 with 2 seats of DM is for consideration by the MCI and MCI will visit the department of Clinical Hematology, SCB Medical College, Cuttack this year. Services Available a) OPD : Monday & Friday's - 9am-5pm, (Closed on Govt. Holidays) b) Indoor : Everyday including Holidays c) Lab : Independent State of Art Equipments installed in the hematology laboratory : i) Sebia Minicap Electrphoresis Machine For both Hb Electrophoresis (Capillary Zone) and Serum Electrophoresis with Immuno- fixation (IgG, A,M Kappa, Lambda for myeloma protein) ii) Fully Automated Coagulometer For Coagulation profile of Blood (PT, APTT, Sr. Fibrinogen, FDP etc. and factor Estimation VIII/IX iii) 5 Part Differential Fully Automated Cell Counter (Hematology Analyser) For Blood parameters like CBC+diff+retics count. iv) Flowcytometer For Immunophenotyping of Acute Leukemia panel, BCR-ABL (Qualitative) and chronic Leukemia panel study by CD Markers. 4 8
  17. 17. 9 v) BM Study : BM Aspiration & Biopsy d) Emergency : Day care centre functions from 9 AM to 5 PM on every working days. Regularly doctors are on call to other specialties as and when required. One doctor is always in call in the department of Clinical Hematology for indoor patients on daily basis and also attends emergency calls of other patients admitted to other wards as and when required. Chronicles of HOD's 1. Prof. Janmejaya Nayak, M.D, Ph.D 1972- 1995 2. Prof. Upendra Nayak, M.D , Ph.D,FISHBT 1995- 2003 3. Prof. (Dr.)Rabindra Kumar Jena, M.D., Ph.D, FISHBT 28th October 2003 to Cont… Faculties Prof. (Dr.) Rabindra Kumar Jena, M.D., Ph.D, FISHBT 28th October 2003 to Cont… Professor & Head : Clinical Hematology S.C.B. Medical College & Hospital, Cuttack Prof. Upendra Nayak, M.D., Ph.D, FISHBT May - 2013 to Cont… Professor : Clinical Hematology S.C.B. Medical College & Hospital, Cuttack Dr. Sudha Sethy, MD 17th February 2010 to Cont… Assistant Professor: Clinical Hematology S.C.B. Medical College & Hospital, Cuttack Dr. Rajeeb Kumar Nayak, M.D. 2nd August 2007 to Cont… Assistant Professor: Clinical Hematology S.C.B. Medical College & Hospital, Cuttack D.M. Course Two seats of DM is to be opened in this academic year. BMT unit Is to be functional by the end of March -2014. Prof. Janmejaya Nayak
  18. 18. Research activities and project I. International Trial of Glivec in Chronic Myeloid Leukemia. (Glivec) Imatinib is given free to newly diagnosed cases of CML. Dept. of Clinical Hematology has been recognized as a nodal center for this treatment Dr.R.K.Jena has been recognized as one of the Principal investigator . 2. Genetic Study- Study of interaction between Sickle Cell Gene and Beta-Thalassemia Gene with resultant phenotypic expressions by Dr.R.K.Nayak. 3. Genetic Study- Study of Beta- thalassemia (Beta- globulin) gene mutation and different phenotypes in Beta-Thalassemia and Sickle Beta-Thalssemia by Dr.Mishra. 4. Minimum Residual Disease (MRD)- Assessment in Acute Lymphoblastic Leukemia by Flowcytometer- Dr.Sudha Sethy. Ongoing with Collaboration with other Institutes 1. Identification of molecular markers in the Pathogenesis of Acute myeloid Leukemia from Indian Population. Collaboration with Molecular pathology & clinical research service by super Religare (SRL) Laboratories limited, Mumbai. 2. Identification of molecular markers in Pathogenesis of Acute Lymphoblastic Leukemia from Indian Population Collaboration with Molecular pathology & clinical research service by super Religare (SRL)Laboratories limited, Mumbai. 3. Computer based Acute lymphoblastic leukemia (ALL) diagnosis and prognosis collaboration with Department of Electrical engineering National Institute of Technology Rourkela (NIT). 4. Improvement of L-Aspiration for treatment of Childhood (ALL) collaboration with KIIT university, Bhubaneswar. Research Activities and Conferences Conference 1. 53rd Annual Conference of Indian Society of Hematology and Blood Transfusion (ISHBT), 9-11th Nov.2012, Hotel Chariot, Puri, Odisha 2. VIII Annual Conference of Odisha Hematology to be held at IGH ,Rourkela on 11th – 12th May-2013 CME 1. International CME, Collaboration with European Hematology Association (EHA-ISHBT Joint CME): 8TH November, 2012, S.C.B Medical College & Hospital, Cuttack 2. CME on Flowcytometry in S.C.B. Medical College & Hospital on 11.08.2012 3. CME on Role of Engineering Science in the Development of Health Care system on 17.03.2013, NIT Rourkela Workshop Pre Conference Workshop : 7th November 2012, S.C.B Medical College & Hospital, Cuttack 1. Diagnosis of Acute Leukemia by Flowcytometry 2. Capillary Zone Electrophoresis (both Hb, Serum) 3. Coagulation profile by Automated Coagulometer National Hematology (ISHBT) Quiz 1. Rourkela IGH on 11th May-2013 2. MKCG Medical College & Hospital Berhampur on 24.07.2013 3. VSS Medical College Burla on 31.07.2013 4. SCB Medical College & Hospital, Cuttack on 24.07.2013 5. Final Selection (Odisha State) on 03.08.2013 at S.C.B. MCH, Cuttack 10
  19. 19. All India Institute of Medical Sciences (AIIMS), Delhi Department of Haematology Renu Saxena The Hematology department, AIIMS, was created in 1989 with Prof A.K. Saraya as the first head of department. It is a unique department, comprising both clinical and laboratory divisions for diagnosis and management of patients with benign and malignant hematological disorders. After Dr Saraya's retirement in 1994, Dr M Bhargav took over as Head till 2001 when Dr VP Choudhry became head till 2007. Dr. R Saxena took over Departmental headship from 2007 till date. The other faculty members include Professor HP Pati, Professor Mahapatra, Dr. Seema Tyagi, (Addl. Professor), Dr. Tulika Seth, (Addl. Professor) and Dr. Pravas Mishra, (Addl. Professor). The department has the following facilities: Hematopathology a) Routine Services : The department offers state of the art services for hemogram, work up for hemolytic anemia, detailed coagulation and thrombophilia work up. b) Specialized tests ŸMolecular genetics of hematological disorders: The department performs PCR based tests for prenatal diagnosis of hemophilia,thalassemias, acute and chronic leukemias. ŸFlow cytometry: This is currently is being used for Immunophenotyping of acute and chronic leukemia, PNH, platelet function defects and hereditary spherocytosis. ŸImmunohistochemistry: Immunohistochemistry for diagnosis of lymphomas and CLPDs. ŸPlatelet function studies: These include platelet aggregometry and VWD workup. ŸQuality Control: The department, along with ISHTM, runs a national external quality assessment programme in hemogram. Currently it has approximately 1300 participant laboratories from all over India. Clinical hematology division ŸWards: There 50-60 inpatients at any given time. These patients are spread out over general and private and emergency wards. ŸTransplant: Blood and Marrow transplant: Our transplant program started in 2004. We have performed 143 transplants till date. These include allogenic transplants for aplastic anemia, leukemias and thalassemias. ŸHematology Day care: The day care functions 24 hours a day, except Sundays. It experiences a daily turnover of nearly 30–40 patients/day including chemotherapy, blood and blood component transfusion and all routine OPD procedures like bone marrow aspirate and biopsy. ŸOPD Service: The hematology outpatient clinic (OPD) is situated on the third floor of the Raj Kumari OPD block. It runs six days per week (from Monday to Saturday). The main OPDs are on Monday, Wednesday 5 11
  20. 20. 12 and Friday with each OPD serving 140 patients on an average with an additional load on Mondays which also runs the chronic myeloid leukemia clinic in the mornings. The other days serve as specialty clinics. New patients are registered on the main OPD days. The breakup of the OPD is as follows: 1. Monday: Chronic myeloid leukemia and Hemato-Oncology clinic: This clinic looks after patients of chronic myeloid leukemia and various other hematological malignancies including acute leukemias, Myelomas, Lymphomas. The CML clinic runs in the mornings and the remaining patients are seen in the afternoons. 2. Tuesday: Transplant Clinic: This clinic works up patients who have been planned for a transplant and follows up transplanted patients. 3. Wednesday: This OPD looks after hemolytic anemias including thalassemics. It also looks after Immune mediated hematological patients such as Immune thrombocytopenic purpura and Autoimmune hemolytic anemia. 4. Thursday: Hemostasis clinic:This clinic looks after coagulation and bleeding problems. It includes patients with deep vein thrombosis and also patients with various bleeding problems. 5. Friday: This OPD is devoted to patients with various marrow failure problems including aplastic anemia which forms the bulk of patients attending this clinic. 6. Saturday: This clinic looks after Hemato-Oncology patients who have completed therapy. Resident training Department of Hematology, AIIMS provides two DM courses: DM Hematopathology and DM clinical hematology and has a vibrant pHD program.The training in the department provides a comprehensive laboratory and clinical training: 1. DM Hematopathology DM Hematopathology started in 2001. This training includes training in highly sophisticated technologies like molecular genetics, flow cytometry, detailed hemostatic and hemolytic anemia work up alongwith clinical exposure. Our alumni are working in various parts of India and abroad. Till date, 16 students have been awarded given DM hematopathology. 2. DM Clinical hematology DM Clinical Hematology started in 2001. The training provides a comprehensive training in both adult and pediatric hematology. Residents are trained to manage the complete gamut of benign and malignant disorders. They receive a broad based training including stem cell transplant. Our alumni are working in various parts of India and abroad. Till date, 22 students have been awarded DM clinical hematology. 3. Ph.D. The department has a vibrant Ph.D. programme pertaining to research on various aspects of hematology. The Ph.D. entrance test is conducted by AIIMS six monthly. Till date, 13 Ph.D. degrees have been awarded. 4. Miscellaneous Training of MD Pathology students and basic scientists/technicians is also carried out. Our alumni list is available at AIIMS website. Research Research remains one of the strong points of the department with publications in several high impact journals. The department is engaged in research pertaining to molecular genetics, flowcytometry, detailed hemostasis and prenatal diagnosis of genetic hematological disorders alongwith clinical trials.
  21. 21. Army Hospital, Delhi Research & Referral Ajay Sharma, Sanjivan Sharma & Jasjeet Singh Army Hospital (Research & Referral) is a premier institution of armed forces medical services, providing tertiary level medical care to serving and retired armed forces personnel and their families. This institution has more than 30 super-speciality departments, with well equipped transplantation facilitie in as many as seven departments (renal, cardiac, liver, orthopaedic, eye and hematology). The department of hematology was established in 1994 and the facility of stem cell transplantation started functioning since 1998.The department has all the essential components of various hematology branches including clinical hematology, stem cell transplantation & research, hematopathology, immunohematology, molecular hematology and transfusion department. The hematology labs are well equipped and provide state of art investigative facilities for all kinds of haematological problems. The department offers benign as well as onco hematology services, has special outpatient clinics for BMT and thalassemia and hemophilia patients. The centre has appx 100 male, female and pediatric patient beds, providing comprehensive health care services for all kinds of hematological diseases. It has an ultra-modern blood and marrow transplantation (BMT) unit. The first HSCT was undertaken in 1998, for a patient of CML, and till Sept 2013, appx 400 transplants have been carried out. The institute offers both autologous and allogeneic HSCT to its clientele which include serving and retired armed forces personnel, and their families. Allogeneic transplants have been undertaken for almost all types of benign and malignant haematological disorders, whereas, autologous transplants have mainly been carried out mainly for multiple myeloma and acute myeloid leukemia. It is also worth mentioning that AHRR has taken up a few autologous transplants for auto-immune disorders with fairly satisfactory long term outcomes. This is the only centre in the country to do so. The 275 odd allogeneic transplants have all been related donor transplants. This year we have started haploidentical transplants as well. The matched unrelated transplants are also being taken up in our institute soon. All patients post transplants are being followed up using DNA STR sequence based chimerism studies done monthly for first six months and then on case to case basis. Amongst the allogeneic transplants, 50 children with thalassemia major have undergone BMT with more than 80% cure rates. The other disorders for which allogeneic transplants have been undertaken include AML(55), CML(42), Aplastic anemia (31), ALL(27), MDS(9), and others including inherited bone marrow failure syndromes, inherited metabolic disorders, PNH, and JMML. The overall survival in most malignant conditions has been close to 50% at a median follow up of 18 months. The department has an ultra modern well equipped stem cell lab, where a number of stem cell projects are being carried out. The department has been involved in a large number of research projects under aegis of armed forces medical research council, dept of biotechnology, govt of India besides many departmental research projects. Over 1000 papers have been published by various branches of the department. 6 13
  22. 22. 14 The department imparts training to postgraduates and post doc research fellows. The department is conducting PhD program, besides training post- graduates in clinical & lab hematology and stem cell transplantation. The centre has obtained approval for DNB training in Hematology and will be taking up students from next year.
  23. 23. Guru Teg Bahadur Hospital (GTB), Delhi Department of Hematology Usha Rusia The hematology section in the department of Pathology UCMS and GTB hospital was established in 1982 by Professor SK Sood, a known figure and a stalwart of hematology. Since then the department has made considerable strides to position itself in the fore front as a premier department imparting quality diagnostic workup of hematological disorders and educating post graduates under the stewardship of Prof Nishi Madan who was heading the department for over a decade and has superannuated a few years back. The Department currently has a very dedicated and enthusiastic faculty in Prof Usha Rusia who heads the department, Prof Meera Sikka, Prof Satendra Sharma, Dr Mrinalini Kotru, Assoc Prof, and Drs Preeti Diwaker and Nadeem Tanwar, both Astt Professors who have joined the faculty last year. The motto of the Department is Our Utmost for the Highest which each one is striving to achieve within the prevailing circumstances and constraints . Senior Faculty members have also held various offices in the Indian Society of Hematology and transfusion medicine and Delhi society of Hematology and have been awarded the Fellowship of ISHTM in recognition of their work and promotion of hematology as a discipline Currently and in the past senior faculty members have been nominated to expert Task force panels constituted by ICMR ,DST, UGC, UNICEF and WHO in recognition of their experience in the field of hematology. The faculty has won several awards and prizes in various National and International conferences and has published extensively. The department has developed expertise in some key fields such as Nutritional anemia, hemolytic anemia and hematological malignancies especially CML in which pioneering work is being carried out as evidenced by scientific papers published in these fields . Iron deficiency has been the focus in nutritional anemia, not only because of its high prevalence in India but also in the region where our institute is located. The department has been part of several UNICEF and ICMR projects dealing with prevalence, diagnosis and prophylaxis in nutritional anemia . High impact articles have been published in National and International journals in this field . The Department is a nodal centre for Thalassaemia diagnosis and participates actively in antenatal diagnosis and thalassaemia care projects of the Delhi Government. The Dept is also equipped for molecular studies and was part of the multi centric projects conducted by ICMR. A project funded by ICMR has mapped the Prevalence of beta thalassaemia mutations in northern India and HFE gene mutations in beta thalassaemia. Besides this work on prevalence of genetic polymorphism in several genes of interest in haematological and non-hematological related disorders such as e NOS polymorphism in young patients with ischemic heart disease and type II DM and mitochondrial mutations in CKD is being carried out . In hematological malignancies , besides routine workup including immunophenotyping of leukemias and lymphomas, a number of research projects some of them funded by UGC and DST have studied the pathogenesis of myelofibrosis in CML and the effect of Imatinib on myelofibrosis. The ongoing 7 15
  24. 24. 16 studies focus on the role of VEGF in neoangiogenesis in haematological malignancies including Multiple myeloma and Acute and Chronic leukemia. The Department is a nodal centre for Hemophilia diagnosis and care of Delhi Government. Besides routine diagnostic tests the laboratory has facilities for a number of advanced tests such as Factor assays, fibrinolysis and markers for Thrombophilia. The Department is well equipped for advanced techniques such as Flow Cytometry, PCR, RT- PCR and HLA typing and is in process of setting up cytogenetic and molecular diagnosis of leukemia. Training is provided for the Degree of MD (Pathology) to 14 postgraduates annually under the University of Delhi. It is a matter of pride that success rate is hundred percent year after year. Besides PG training the Department is also involved in the training and teaching of 150 under graduate students and laboratory technologists both from the institution and from other affiliated institutions of the Government of Delhi.
  25. 25. Indraprastha Apollo Hospitals, Delhi Haematology Services Amita Mahajan The Hospital Indraprastha Apollo Hospitals, New Delhi is the First Hospital in India to be Internationally Accredited by Joint Commission International (JCI). It is a tertiary care hospital with over 700 beds. Clinical Hematology Services T h e h o s p i t a l i s p r o v i d i n g multidisciplinary care for Malignant and non-malignant haematological diseases since its inception. There are dedicated Adult Hematology and Oncology, Pediatric Hematology and Oncology, and Blood & Marrow Transplant teams. The Pediatric Hematology and Oncology division is an integral part of Apollo Centre of Advanced Paediatrics. Treatment is delivered for both hematological cancers and solid tumors as per protocols currently giving the best outcomes anywhere in the world. A team of pathologists, surgeons, and radiation oncologists backs this service, as optimal treatment requires multi disciplinary involvement. State of the art treatment is given in a patient friendly setting. There is a dedicated thalassemia unit for patients with thalassemia major and a day care ward. Multidisciplinary managed is offered for thalassemia at a subsidized cost. Bone Marrow Transplant Unit A six bedded HEPA-filtered laminar air flow unit and state of the art stem cell processing unit backed up by excellent laboratory services compares with the best standard of care internationally. The Blood & Marrow Transplant Department is offering allogeneic and autologous transplant to both adults and children with malignant and non-malignant conditions. The Apollo group had performed more then 500 bone marrow transplant. Our outcomes are at par with international standard. The diseases treated are leukemias, lymphomas, Multiple Myeloma, neuroblastoma, and some other solid malignancy, thalassemia, Sickle cell anemia, aplastic anemia and other immune deficiency and storage disorders. We are offering not only matched related allogenic transplant but matched unrelated, cord blood and haplo-identical transplant as well. Hemato-Pathology Services The laboratory is equipped with completely automated instruments which include new generation cell counters, coagulometers, flowcytometer, Real Time PCR. The Department carries out complete work up Acute and Chronic Leukemias including Flowcytometry for Immunophenotyping and Molecular Tests such as Multiplex PCR and Real Time PCR to detect the genetic abnormalities. Chimerism 8 17
  26. 26. 18 studies are carried out to study monitor allogeneic bone marrow transplants. The Department also carries out complete work up of Anaemia including Hemoglobinopathies. Comprehensive workup for bleeding disorders and thrombotic disorders is available. The laboratory is equipped with third generation Platelet Aggregometer which enables diagnosis of rare platelet aggregation defects. A high degree of internal and external quality control is maintained. Transfusion Medicine, Transplant immunology and molecular biology Services The hospital offers state of art transfusion services which provide NAT tested, pre storage leuco- depleted, irradiated blood components and apheresis services; including stem cell collection, processing and storage. In addition the department performs regular screening for any irregular red cell antibodies and the extended blood group phenotyping of Thalassemia patients, helping us in providing the safest possible blood for them. The aphresis lab is functional 24 hours, all days. It is equipped with fully automated cell separators, which are flexible to produce various components. The various procedures undertaken include: ŸPlateletpheresis ŸPlasmapheresis ŸGranulocytapheresis Besides these the department also performs special procedures such as: ŸTherapeutic Plasma Exchange ŸPeripheral Blood Stem Cell (PBSC) collection: Autologous and Allogenic ŸRed Cell Exchange Our laboratory is equipped with the fully automated platform Galileo from Immucor for Immunohaematology work up of donors & patients. Besides the fully automated system, the laboratory also utilizes the gel technology by DIAMED. The ELISA based tests are performed on a fully automated walk away system EVOLIS. Latest third/fourth generation kits are used for testing. Individual Donor (ID)-NAT testing based on Transcription Mediated Amplification by ProcleixUltrio Assay in the NAT Laboratory. Voluntary blood donation program The Department has initiated an in-house voluntary blood donation program wherein a list of hospital employees willing to donate voluntarily is maintained. This also includes donors with rare blood groups who can be called at the Eleventh hour for blood donation. These Voluntary Blood Donors play a pivotal role in maintaining safe and adequate blood supply that forms the backbone of any Blood Transfusion Service. The Department also maintains the registration of Voluntary Blood Donors who are willing to donate blood at the hospital. These Voluntary Blood Donors are encouraged to become regular repeat Voluntary blood donors instead of just one-time voluntary blood donors. Voluntary donors at our hospital are also provided with certain special incentives. As per the departmental policy that all donors who have donated 4 times in a year or at least in 2 years are entitled for an Executive Apollo Health Check up.
  27. 27. Services provided by immunology & molecular biology Prenatal & Postnatal Diagnosis ŸChromosomal Analysis (GTG Banding) - Abortus Material ŸAmniotic Fluid - Karyotyping-GTG banding, FISH Ploidy for Chromosome 21,18,13,X and Y (5 probes analysis) ŸChromosomal GTG Banding+ Ploidy analysis forCVS-Complete Analysis (Karyotyping Chromosome 21,18,13,X and Y by FISH Cytogenetics ŸStress Cytogenetics for Aplastic Anaemia ŸChromosomal Analysis (GTG Banding) -Peripheral Blood ŸChromosomal Analysis (GTG Banding) -Bone Marrow ŸCouple Karyotype from peripheral blood samples Fluorescence in situ Hybridization (FiSH) for Hematological malignancies ŸFISH FOR ALL PANEL, AML panel, CLL panel, CML, MDS PANEL MULTIPLE MYLOMA t(11;14), t(14;18), 13q(del), p53(17p13) ŸFISH FOR 1q25,LSI19q13/LSI19p13, XY, CEP-12, N-myc, LSI D7S486(7q31)CEP-7q LSI 1p36/LSI ŸHer 2 Neu Gene Amplification by FISH with on Paraffin Embedded tissue Sections HLA typing for Kidney, Liver and Bone Marrow Transplant ŸHLA CLASS –I/II PCR-SSP/SSOP ŸHla Lymphocyte Cross-match & Hla Typing (Donor & Patient) ŸHLA B-27, HLA B-51, HLA B-17, HLA-B 15 (SSP-PCR) ŸPanel reactive antibody test ŸDonor specific antibody test Infectious Marker Screening ŸHBV/HCV- Quantification/ Qualitative (PCR) ŸHCV genotype ŸHIV-Viral Load ŸMRD ASSESSMENT (Q-RT-PCR FOR BCR-ABL GENE) ŸHIV Proviral DNA ŸHIV Genotypic Drug Resistance Molecular Genetics ŸThalassemia - Alpha, Beta & Gamma Gene Mutation Analysis ŸThrombophilia Profile(FAC V+MTHFR+Prothrombim gene). 19
  28. 28. Maulana Azad Medical College & Lok Nayak Hospital, New Delhi Department of Hematology Parul Sobti, Tejinder Singh 9 20 The Maulana Azad Medical College is situated in the capital city of Delhi. It straddles the historic old city of Delhi on one side and the more modern Lutyen's Delhi on the other. The sprawling campus includes the college and three of its major associated hospitals namely Lok Nayak Hospital, GB Pant Hospital and the Guru Nanak Eye Centre. This institution is named after the great patriot and educationist, Maulana Abdul Kalam Azad and has been in existence since 1959. The college made its humble beginning in hospital block of Irwin (Lok Nayak) hospital 1958. The Department of Hematology was established as a part of the Department of Pathology in 1978. The Department is headed by Dr.Tejindar Singh and has four faculty members, two senior residents and six junior residents (MD students) and seven technologists to man the laboratories. It processes 10,000 samples in a year including bone marrow aspirates and bone marrow trephine biopsies. The laboratory has facilities for cytochemistry, immunohistochemistry, flowcytometry, HPLC and Coagulation studies. A hematology clinic is run in coordination with the Department of Medicine every Wednesday since 1978. Patients with various non Neoplastic and Neoplastic Hematological diseases give blood samples in the morning and reports are dispatched by two pm, after which the patients attend the Hematology clinic. Dr.Naresh Gupta, Professor of Medicine, is running a Hemophilia centre in this campus. This centre which has over 1,600 patients with Hemophilia and treats around 35 patients everyday. It was declared the best facility in the field due to its excellent services by the World Federation of Hemophilia. Established in 2008, HDCC has grown exponentially to become possibly the largest comprehensive hemophilia care centre in India. The attached laboratory has facilities for coagulation studies, Factor assay, and Factor VIII inhibitor assay. The centre provides factor VIII replacement therapy to patients. The Department of Paediatrics under Dr.AP Dubey is running a Thallasemia day care centre which was established in 1978, which has facilities for diagnosis and treatment of children suffering from thallasemia and other haemoglobinopathies. The Department of Hematology conducts teaching of undergraduate and post graduate students. It has organised 16 CME and workshops on bone marrow biopsy interpretation, acute leukemia diagnosis and flow cytometry etc attended by hundreds of delegates from all over India. It is involved in various research activities including thallasemia, leukemia flow cytometry, multiple myeloma, chronic lymphoproliferative disorders, haematological alterations in HIV infection etc. The department is running Fellowship in Hematopathology of one year duration under the I n d i a n C o l l e g e o f Pathologists.
  29. 29. Rajiv Gandhi Cancer Institute and Research Centre, Delhi Haematology services Narendra Agrawal Introduction Rajiv Gandhi Cancer Institute and Research Centre (RGCI) was established in year 1996 by the Indraprastha Cancer Society with a vision to provide best and comprehensive cancer care under one roof at affordable cost to masses. As cancer patients often require multispeciality treatment like medical, surgical as well as radiation, the hospital envisioned to provide medical oncology, surgical oncology and radiation oncology services since its inception. Pediatric hemato-oncology department was established in 1997 after Dr Gauri Kapoor joined the institute. A bone marrow transplant unit (BMTU) was started in year 2001 and first autologous BMT was done in 2001. The services in the hospital took a leap in 2007 when first haematologist, Dr Dinesh Bhurani, joined the institute. The facility of allogeneic stem cell transplantation started soon after his arrival in the institute. Facility Currently the hospital is a renowned name in the field of cancer care and BMT. We have a separate unit for adult and pediatric Hematology and Hemato-oncology services which is dedicated for patients with all malignant as well as non-malignant haematological conditions and bone marrow/ stem cell transplantation (both allogeneic and autologous). The BMT unit has 8 HEPA filtered rooms. The Hematology services need a strong back up of blood bank and laboratory department. Without a good laboratory and blood bank services, haematologist is just a crippled species. We at RGCI, are fortunate to have a very strong laboratory and blood bank back up. The department of laboratory services is headed by Dr Anurag Mehta. Hemato-pathology section of the lab is being looked after by Dr Sonal Jain, DM Hematology from AIIMS Delhi. Our blood bank is providing NAT safe blood and round the clock irradiated blood products. Our peripheral blood stem cell pheresis is also being done regularly at blood bank of RGCI and the current volume of stem cell pheresis is approximately 150 per year. Apart from pheresis, we also have cryopreservation facility at our blood bank. Overall the lab and blood bank backup is very strong and efficient at RGCI and provides most of the services in house The haematology team Dr Dinesh Bhurani: First haematologist who joined RGCI was Dr Dinesh Bhurani. He is a graduate from GR medical college Gwalior and MD from Pt JLN medical college Raipur. He joined department of Hematology at CMC vellore and became first DM Hematology student of India. After completing DM, he joined FRCPA (Australia) for next 4 year. He came to RGCI in 2007 and started developing and improving Hematology services at the institute. Soon after his arrival at RGCI, his activities came into full swing when he performed first allogeneic BMT of the institute and gave a new hope to the patients who needed this treatment. He strived hard to expand Hematology services and ran the department single handed for next 3 years 10 21
  30. 30. till a second person, Dr Shishir Seth DM Hematology, Fellow Leukemia/BMT VGH Vancouver Canada, joined the department in Jan 2011. The team of both haematologists took the Hematology services at the institute to a substantially high level. Dr Narendra Agrawal: Soon the Hematology unit needed third person to handle the rapidly expanding work and patient load. Dr Narendra Agrawal came to institute in January 2012. He studied MBBS and MD from RNT medical college Udaipur and JLN medical college Ajmer, Rajasthan and DM Hematology from AIIMS, Delhi. Dr Shishir Seth left the institute in June 2013 and went to Apollo Hospital Delhi. Dr Rayaz Ahmed: Dr Rayaz Ahmed joined the institute in July 2013. He is a medical graduate from Pt JLN medical college Raipur and MD from Dr V M Medical College Solapur. After MD, he went to CMC Vellore to join the department of Hematology as senior resident and DM student. He gave his services at CMC vellore for full 8 years as senior resident/ DM student, then assistant professor and thereafter associate professor. The Pediatric hemato-oncology team Dr Gauri Kapoor, Director of pediatric hemato-oncology: She joined the institute in 1997. She is a graduate and postgraduate in pediatrics from Lady Hardinge Medical College Delhi and PhD in molecular oncology from University of Delhi with a post graduate clinical experience of 24 years. Her experiences include fellowships at Tata Memorial Hospital Mumbai for 3 years and in USA (including St Jude Children's Research Hospital, Memphis). She was awarded Heinz fellowship by Royal College of Pediatrics and Child Health, London in 2001. Dr Sandeep Jain: He is a graduate from medical college Surat, Gujrat and DNB pediatrics from Mata Chanan Devi Hospital Delhi. He was awarded Indian Academy of Pediatrics Fellowship in pediatric hemato-oncology in 2009. He is serving at the institute since 2006, initially as fellow and thereafter as consultant. Dr Anshul Gupta: He is a graduate and MD pediatrics from JLN medical college Aligarh. He has been a Fellow of National Board of Examinations (FNB Pediatric hemato-oncology) and is presently working as clinical associate in department of pediatric hemato-oncology. Dr Silky Jain: She is a graduate and MD pediatrics from Maulana Azad medical college Delhi and is currently pursuing fellowship of national board of examinations. Achievements: Academic ŸNational board of examinations recognized the pediatric hemato-oncology and started post doctoral fellowship in pediatric hemato-oncology since 2008. Four fellows have completed their training so far in pediatric hemato-oncology. ŸDNB oncology program in medical oncology/ hemato-oncology with 3 candidates coming in every year. Achievements: bone marrow/stem cell transplantation ŸPerformed nearly 300 stem cell transplants so far till Oct 2013 including 80 transplants in last one year. Ÿ12 haplo-identical stem cell transplants so far (for acute leukemia, CML in blast phase, aplastic anemia and a rare tumor blastic plasmacytoid dendritic cell neoplasm) with 75% survival. ŸGot registered with NMDP this year and became first NMDP transplant centre of India To conclude, RGCI is a leading Hematology and stem cell transplant centre of north India, providing all forms of advanced Hematology services as well as involved in research and academics. 22
  31. 31. Sir Gangaram Hospital, Delhi Department of Haematology Manorama Bhargava From a relatively small Haematology laboratory about 10 years ago, to a composite Department of Haematology, with clinical and laboratory faculty working together under one roof for better service, resident training and research activities, we indeed have come a long way. Our mission is to provide state of the art investigative facilities for the comprehensive diagnosis of haematologic diseases and the highest quality of clinical care for our patients with the latest therapeutic tools. In addition, to impart training and mentor the next generation of academic hematologists, through our Diplomate of National Board (DNB) programme, is a high priority. For Ph.D, Guru Gobind Singh Indraprastha University has accorded the status of Approved Research Centre to Sir Ganga Ram Hospital and the head of the department is an approved PhD guide. Department has its own SOPs and protocols and has accreditation for the laboratory services from the National Accreditation Board for Testing Laboratories (NABL). I. Staff, faculty and Residents Faculty 1. Prof. Dr. Manorama Bhargava, Senior Consultant & Head, Former Professor and Head of Haematology, All India Institute of Medical Sciences. 2. Dr. Amrita Saraf, Consultant. 3. Dr. Jasmita, Consultant. 4. Dr. Sabina Langer, Consultant. 5. Dr. Vandana Arya, Scientist. Ex-Head 1. Prof. Dr. S.K. Sood. Residents Non-DNB Senior residents - 2 DNB Senior Residents - 6 Technologists 24-Highly trained and competent senior technicians man the various stations for bench work. II. Education Department of Hematology, SGRH started the DNB course in Hematology of the National Board of Examinations in 2008, the first such course in the country in the superspeciality of Hematology. It is equivalent to DM in Hematology. 23 Teaching on Multihead Microscope 11
  32. 32. 24 Eligibility for the examination and admission procedure is as per the National Board of Examinations (http://www.natboard.edu.in/). No. of seats: 02 per year The department participates in and holds many CME programmes and conferences. III. Hematology Services A. Clinical Hematology services Outpatient services are being run six days a week including general OPD once a week. Indoor admissions are done in SGRH and City Hospital affiliated to SGRH. The department has a unique opportunity to provide services to patients of Hematological malignancies as well as benign hematological disorders. The spectrum includes acute and chronic leukemias, lymphomas, MDS, myeloproloferative neoplasms, multiple myeloma, deep vein thrombosis, ITP, various hemolytic anemias including hemoglobinopathies. Bleeding disorders covering coagulation factor deficiencies as well as qualitative platelet disorders are covered in detail. The department works in close association with Departments of Medical Oncology, Paediatric Hematology-Oncology and Internal Medicine both for clinical service and education. SGRH is a center of excellence for both autologous and allogeneic stem cell transplants including the umbilical cord blood transplants. B. Hematopathology services The laboratory is widely known as a centre of excellence for providing diagnostic facilities for a wide spectrum of hematologic disorders using cutting edge technology. It is recognized as a referral centre for second opinion on difficult and rare cases by hospitals and institutions nationwide. Equipments: Beckman LH 780, two DxH 800 analysers, Excyte ESR equipment, Chronolog platelet aggregometer, Biorad variant II, coagulometers-ACL TOP 500, Elite Pro, ACL 7000, Electrophoresis equipment Chorus, ELISA system, Flowcytometers BD Canto II and Beckman Coulter FC 500. Routine and special investigations Complete blood counts
  33. 33. Haemorrhagic disorders PT, APTT, TT, assays of factor VIII, IX, vWF. Platelet count, Fibrinogen estimation, Quantitative D-dimer, Clot retraction test, clot solubility test, APTT mixing, PT mixing, factor Xa assays. Platelet Aggregometry Platelet function tests for qualitative platelet defects, von Willebrands disease, Drug resistance to aspirin and clopidogrel. Thrombophilia Tests for antiphospholipid syndrome and lupus anticoagulants: APTT with lupus sensitive reagent, APTT– dependent inhibitor screen, dRVVT, KCT, Anti-cardiolipin antibodies (ACA), b2 GPIG, b2 GPIM, Anti-ds- DNA antibodies; Protein C, Protein S & Antithrombin, Factor V leiden (APC- R) estimation. Molecular assays Mutations of Factor V (Leiden), Prothrombin gene mutation, MTHFR genes, JAK2V617F. HPLC and Hemolytic disorders Screening/testing for beta- thalassemia & hemoglobinopathies b y H L P C a n d h e m o g l o b i n electrophoresis at alkaline & acid pH are routinely done. More than 30,000 antenatal screens have been analysed to date. Other tests are G-6- PD screening, Osmotic fragility test, Heat instability test for unstable haemoglobin, Heinz bodies, Haemoglobin F Cytochemistry (Kleihauer test), Haemosiderin in urine, Methaemoglobin estimation, sickling test for Hb S. Leukemias & lymphomas Detailed work-up by CBC, bone marrow examination, Cytochemistry and flow cytometry on acute and chronic leukemias, myelodysplastic syndromes, Multiple myeloma and lymphoproliferative disorders. 25 The Chronolog Dual-Channel Platelet Aggregometer.
  34. 34. 26 Flowcytometry BD FacsCanto II and FC 500 ŸLeukemia and lymphoma immunophenotyping (Acute leukemia panel, ŸCLL panel, Lymphoma panel). ŸMRD assay ŸMultiple myeloma ŸMyelodysplastic syndrome ŸFour color single tube CD4 & CD8 counts (HIV panel). ŸEnumeration of B-, T-& NK cells. ŸPNH panel extended panel ŸFlowcytometric HLA Cross-Match (Donor specific). ŸStem cell enumeration based on ISHAGE protocol. Molecular Haematology Qualitative and quantitative assays for BCR-ABL. TEL-AML1, PML-RARa, JAK2, FLT-3 (D835 & ITD) mutations, NPM-1 mutation, RUNX1-RUNX1T1, CBFB- MYH11, MTHFR, Factor V Leiden and Prothrombin gene mutations. Autoimmune Markers ANA-3 (Western blot), ds-DNA, p-ANCA, c-ANCA by ELISA Electrophoresis Serum protein electrophoresis, Immunofixation electrophoresis, Urinary protein electrophoresis. Free light chain assay by minineph. IV. Research projects 1. Completed 1. b-Thalassemia mutations in subjects with borderline Hb-A2 values: a pilot study in North India. 2. A comparative study of bone marrow flowcytometric immunophenotyping, bone marrow aspirate and biopsy in evaluation of involvement by non Hodgkins lymphoma. 3. Cytogenetic and molecular profile of Acute Myeloid Leukemia in India. 4. Safety and efficacy of Bortezomib+dexamethasone in newly diagnosed patients of multiple myeloma. 5. Clinicomorphologic spectrum of myelodysplastic syndrome.
  35. 35. 2. Ongoing projects 1. Clopidogrel and Aspirin Resistance in Indian Patients with Coronary Artery Disease and their associations with CYP2C19, CYP3A5 and GPIIa/GPIIIa gene polymorphisms (ICMR grant approved). 2. To assess the role of prothrombotic genetic markers in Ischemic Cerebrovascular stroke. 3. Evaluation of association between Thrombophilia and Unexplained Pregnancy Loss. 4. Multiparametric flowcytometric determination of minimal residual disease in multiple myeloma. 5. Flowcytometric and molecular studies of apoptotic and proliferative markers in Myelodysplastic syndromes. V. Some Recent Publications 1. Sharma P, Bhargava M, Sukhachev D, Datta S, Wattal C. LH750 hematology analyzers to identify malaria and dengue and distinguish them from other febrile illnesses. Int J Lab Hematol. 2013 Jun 15. doi: 10.1111/ijlh.12116. [Epub ahead of print] 2. Khan AA, Saraf A, Bhargava M, Kumar V. Role of flow cytometry in the diagnosis of acute promyelocytic leukemia. Am J Clin Pathol. 2013 Jun; 139(6):829. 3. Kumar J, Bhargava M, Aggarwal S. Bevacizumab-induced reversible thrombocytopenia in a patient with adenocarcinoma of colon: rare adverse effect of bevacizumab. Case Rep Oncol Med. 2012; 2012:695430. 4. Sharma P, Bhargava M. Degenerative Changes in t(9;22)-positive Precursor B-lineage ALL: A Potential Diagnostic Pitfall. J Pediatr Hematol Oncol. 2012 Dec 13. [Epub ahead of print] 5. Khan AA, Siraj F, Bhargava M, Aggarwal S. Successful treatment of multicentric Castleman's disease accompanying myeloma with bortezomib. BMJ Case Rep. 2012 Dec 20;2012. 6. Sharma P, Gogia S, Sadaqat M, et al. Glanzmann Thrombasthenia in pregnancy: The value of a probing bleeding history. Clin Appl Thromb Hemost. Clin Appl Thromb Hemost. 2012 Jan- Feb;18(1):110-2. 7. Rangan A, Dadu T, Sharma P, et al. b-Thalassemia Mutations in Subjects with Borderline HbA2 Values: A Pilot Study in North India. Clin Chem Lab Med.2011; 49:1-4. 8. Bhargava M, Sindhuri U, Saluja S, et al. Volume, conductivity and scatter properties of Leucocytes (VCS technology) as a highly sensitive and specific predictor of blood culture proven neonatal sepsis. Int. J. of Lab. Hematology vol 33 (suppl 1), May 2011. 9. Bhargav M, Sharma P, Sukhachev. Discriminant value of volume, conductivity and scatter properties of leucocytes (VCS Technology) for rapid and reliable diagnosis of malaria and dengue fever.(Abstract). Blood on line at http://bloodjournal.hematologylibrary.org/site/misc/ASH Meeting Abstracts Info.xhtml. 10. Bhargava M, Sindhuri U, Saluja S et al. Volume, Conductivity and Scatter properties of leucocytes (VCS Technology) is a highly sensitive and specific predictor of blood culture proven neonatal sepsis. Published online in Blood, December 2010 (http://bloodjournal.Hematologylibrary,org/misc/ASH_meeting_Abstracts_info.dtl). 11. Rangan A, Sinha S, Handoo A, Bhargava M. Ascitic fluid cytology and flow cytometry in the primary diagnosis of lymphoma – a case Report. Indian J Hematol Blood Transfus.2010; 26:15-18. 12. Dadu T, Rangan A, Bhargava M. CD4+/NKa+/CD8dim+ T-Cell large granular lymphocytic leukaemia: a rare entity. J Postgrad Med. 2010;56(3):223-224. 27
  36. 36. 13. Gogia A, Kakar K, Byotra SP, Bhargava M. Aggressive natural killer cell leukemia. JAPI. 2010; 58:704-706. 14. Rangan A, Arora B, Rangan P, Dadu T. Florid plasmacytosis in a case of acute myeloid leukemia: A diagnostic dilemma. Indian J Med Paediatr Oncol.2010;31:36-38. 15. Rangan A, Handoo A, Sinha S, Saxena R, Verma I.C., Kumar S., Sood S.K. and Bhargava M. Utility of Family Studies in Diagnosing Abnormal Hemoglobins.Thalassemia states. Indian J. Pediatrics.2009;76:615–21. 16. Dadu T, Rangan A, Handoo A, Bhargava M. Primary non-secretory plasma cell leukemia with atypical morphology – a case report. Indian J Hemat Blood.Tranfus.2009;25:81-83. 17. Rangan A, Choudhry D.R., Sinha S., Handoo A., Bhargava M. Secondary Myelofibrosis in a case of Aplastic Anemia. J Clin Diagn Res.2009;3:1587-96. Accreditation The laboratory is NABL accredited. Quality assurance Quality assurance is a major concern of the department. It covers all aspects of laboratory functioning i.e. pre-analytical, analytical and post-analytical; turn around time; maintenance of equipment; selection of tests & reagents; standardization & validation of tests before they are introduced; and training of personnel. 28
  37. 37. Medical College, Kolkata Institute of Haematology & Transfusion Medicine Utpal Chaudhuri 12 29 Prior to 1968, Haematology in West Bengal existed only at Calcutta School of Tropical Medicine, the birthplace of Haematology in India. The need for additional centre for management of haematological disorders was long been felt. But it was not until 1968, when Government of West Bengal took the decision to start a haematology unit under the department of Medicine at Medical College, Kolkata. A small unit with one consultant, a small lab and about 10 beds started its journey in a small room at the famous MCH building of Medical College. Dr. Sandhya Ghose took the charge. Later on Prof. R.N.Roy, another eminent haematologist was associated with this unit. Suffering humanity in west Bengal at least got another place to get specialised opinion on haematology. The academic activity was mostly limited to undergraduate teaching. Dr. Sandya Ghose nurtured the unit just like her child and struggled untiringly to make improvement which was palpable. With an army of two technician and three resident house physician, she delivered the best treatment available at that time to the patients who flocked to the haematology OPD in increasing numbers. With little support from the authority, she started the basic haematological investigations. Her struggle continued till 1988 when she decided to call it quit. In these years, many students blossomed under her some of them became well known haematologists in the country and abroad. It continued till 1990s when Dr. Utpal Chaudhuri joined as a consultant in the unit and inherited the struggle from his mentor. In late 90's the health department decided to upgrade the small unit to a separate department of Haematology freeing it from the clutches of Medicine. A slow but steady improvement was going on with introduction of automated cell counter, electrophoresis apparatus with densitometry facilities. However, the load of haematology patients, especially thalassaemias are increasing by leaps and bounds and it was also felt that people should be trained in haematology to provide better diagnostic and treatment facilities. With objective in mind, the government of West Bengal upgraded the existing haematology department of Medical College to a centre of excellence leading to the formation of Institute of Haematology & Transfusion Medicine (IHTM) in October 2002 covering an area of about 15000 sq.ft on the third floor of MCH Building. Prof. Utpal Chaudhuri was appointed as the first director of
  38. 38. 30 the institute. Besides the tratment facility, an elaborate laboratory complex was set up with facilities to diagnose various haematological disorders. T h e i n d o o r f a c i l i t y consisted of 40 beds including a 10 bedded day care. The day care facility is available six days a week and transfusion dependent thalassaemia p a t i e n t s g e t b l o o d transfusion free of cost. The indoor beds are mostly occupied by patients suffering from haematological malignancies and were offered treatment following latest international protocols. The institute has small stem cell transplantation unit where it has carried out a number of autologous stem cell transplantation for multiple myeloma patients. Very soon it will have state of the art stem cell transplantation unit. OPD Service IHTM runs regular haematology OPD twice a week where all patients suffering from haematological disorders are attended. Besides this, the institute runs special clinics as follows: ŸThalassaemia Clinic once in a week every Monday. IHTM has more than 1500 registered thalassaemia patients. ŸSpecial Thalassaemia clinic every Monday attending limited number of thalassaemia patients who are examined thoroughly for other problems like endocrine, growth, psychological etc. ŸAcute Leukaemia Clinic every Monday to follow up acute leukaemia patients who are in remission. ŸHaemophilia Clinic every Friday to cater over all management of haemophilia patients. IHTM has about five hundred registered haemophilia patients. ŸChronic Leukaemia Clinic every Saturday to attend patients suffering from CML and CLL. The diagnostic services provided by IHTM include ŸGeneral Haematology Service like CBC etc. ŸHaemolytic Anaemia Lab provides facility for HPLC, Mutation Detection and other related facilities. ŸFlow Cytometry Lab instituted with the help of FIST program of DST, Govt. of India regularly carry out immunophenotyping of Acute and Chronic Leukaemias at surprisingly low cost in the interest of poor patients. ŸHaemostasis Lab deals with coagulation studies including factor assays and platelet function tests. ŸMolecular Biology Lab does the mutation detection of beta thalassaemia patients of the institute. It also successfully runs pre natal diagnostic services for beta thalassaemia.
  39. 39. Academic activity While IHTM is trying to provide state of the art diagnostic and treatment facilities it is not lagging behind in the academic front. The institute started DM (Clinical Haematology) course in 2006 and was one of the three recognized centres to run this course (the other two being AIIMS, New Delhi and CMC, Vellore). The course is run successfully and students qualified from this institute are occupying important positions in various parts of the country. The DM course originally started with one seat was later increased to three seats every year. Many of the DM students earned compliments by presenting research papers in various academic forum in the country and abroad. Regular academic programs includes seminars, journal clubs, CME The students undergoing DM(Clinical haematology) course are thoroughly trained in both laboratory and clinical haematology. IHTM also organizes Dr. Sandhya Ghose Memorial Oration which over the years are addressed by haematologists of international repute. The present faculty includes persons who well aclaimed both in and outside the country. ŸProf. Utpal Chaudhuri, Director, almost single handed transformed the scenario of haematology in the Government Hospital in West Bengal. ŸProf. Prantar Chakrabarti, a very bright and very active person who are trying to put the institute in the international field. ŸDr. S.S. Ray, Assoiciate Professor, very sincere and academic person. ŸDr. Uttam Nath, Assistant Professor, very energetic and devoted haematologiist. ŸDr. Arnab Chattopadhyay, Assistant Professor plays the pivotal role in the flow cytometry lab. ŸDr. Sambit samanta, Assistant Professor, an upcoming haematologist with good administrative capabilitiy. Research activity IHTM also plays a significant role in the research in Haematology. With funding from various central agency like DST, DBT, it conducted basic researches on platelets and other fields. The institute can boast of a number of international and national publication to its credit. Completed projects 1. “Evaluation of the mechanism of the synergism between Purinergic and Adrenergic receptors and search for Platelet based markers of A C S ( A c u t e C o r o n a r y Syndrome” Funding Agency - Department of Science & Technology, Govt. of India 2. "Jai Vigyan Mission" Project on Community Control of Thalassaemia Syndromes Funding Agency - Indian Council of Medical Research 31
  40. 40. 3. Rapid and Economic Sampling of red cell disorder using photodetector aided multipurpose set up – CP-STIO project Funding Agency - Department of Science & Technology, Govt. of India 4. Targeted therapy and drug resistance in Multiple Myeloma : a nanotechnology based approach Funding Agency - Department of Bio-Technology, Govt. of India Ongoing Project 1 “A study of genotypic characterization of Beta Thalassaemia and the causes of the phenotypic diversity of haemoglobin E - Beta Thalassaemia in West Bengal”. Funding Agency - West Bengal State Health & Family Welfare Samiti under State Thalassaemia Control Program 2. Jeevan Asha Project on quality of care of thalassemics in a center with limited resources Funding Agency - ONGC Officers' Wives Mahila Samiti 3. Molecular study of Oral Squamous Cell Carcinoma samples with respect to micro RNA, prevalence of HPV infection and P53 gene expression status and its relevance in determining the resection margin Funding Agency - Department of Science & Technology, Govt. of India In the year 2000, ICMR started its Jai Vigyan Mission Project on Thalassaemia, a multicentric project and IHTM was one of the centres. Later on with the starting of State Thalassaemia Control Program, IHTM has become one of the nodal centres for screening of thalassaemia carriers throughout the state of West Bengal and till date screened about 30000 people. It also monitors activities of another 11 centres entrusted with the job of thalassaemia carrier screening. The thalassaemia Unit consists of Medical Officers, Counsellors, Medical Technologists and Data Entry Operators. All the data about the screening program is stored using a software named "Thalamon" though which activities of all the centres are monitored. The thalassaemia Unit also organises cultural and academic program on 8th May every year on the occasion of World Thalassaemia day. 32
  41. 41. N.R.S. Medical College, Kolkata Department of Haematology Maitreyee Bhattacharyya Today the haematology department of N.R.S Medical College has made his position in the haematology map of India. The journey started long back in 1974. The humble beginning Wayback in 1974, hematology wing, at N.R.S. Medical College started as a unit under department of medicine to cater the needs of hematology patients exclusively. It was then housed in a single room with a very tiny space for laboratory. The unit comprised of a faculty (teacher) trained in hematology, who was posted under the department of medicine, along with one technician & a group D staff. The unit in this initial phases was headed by Dr Sandhya Ghose, Dr Manju Duttachaudhuri & Dr M.M. Rakshit sequentially. A total of ten beds were provided from the department of medicine. Two house physicians (from the department of medicine) were allotted to the unit. Activities included-outpatient clinic-twice in a week, indoor admission & attending referred cases. Basic instruments were scanty - 1-2 monocular microscopes, a water bath, few wintrobe & westergren tubes, couple of centrifuge machines, few bone-marrow aspiration needles. The faculty in-charge of the unit, had to work overtime single handedly to provide adequate hematology services as well as teaching students. After about a decade, the unit was provided additional space, better ward facilities and some additional essential items. In spite of repeated efforts nothing substantial was achieved. Begining of a new era Dr. M. K. Ghosh joined the department in mid nineties, he was fortunate enough to visit few established hematology setups in the country. He got inspired & could realize that to sustain in this speciality, it needs to transform the existing set-up into a comprehensive hematology department, outside the prevailing domain of medicine. Dr Ghosh was a post-graduate in medicine with exclusive hematology training under Prof. Sandhya Ghosh besides training in general medicine. He was also fortunate enough to be posted as a clinical tutor in the prestigious hematology department of Calcutta School of Tropical Medicine (first time in the history of hematology in West-Bengal). Bolstering of the department by younger generation Dr. Maitreyee Bhattacharya, present head of the department, joined as a clinical tutor in late nineties when only a post of clinical tutor was sanctioned by the health department. With her intense involvement, both Dr. Ghosh and Dr. Bhattacharyya embarked upon an intense drive for upgradation of the hematology service and academic activities. In the beginning of 2000, it was officially declared an independent department of its own-one dream fulfilled. In 2002 Dr. Maitreyee was selected for D.M (CLINICAL HEMATOLOGY) in hematology department of AIIMS (New Delhi). Infact she is the first DM (Clinical Haematology) from the East & North East India. During this time the hematology department gradually started its journey for induction into the national field. With the initiative of Prof. Ghosh N.R.S. Medical College became the principal centre for ICMR sponsored multicentric - JAY VIGYAN MISSION PROJECT for assessing the most recent status of thalassaemia burden in the country. After 13 33
  42. 42. Dr. Maitreyee, another highly talented boy Dr. Tuphan Kanti Dolai, joined as clinical tutor in the department. He also got selected at AIIMS- D.M. (clinical hematology). During this period, the relentless persuasion for the upgradation continued ceaselessly. New posts were created for professor, associate professor, assistant professor & clinical tutors along with non- academic Senior Residents. D.M. course in Clinical Hematology was permitted to start from 2009 and got recognised in 2012 at the time of the final examination of the first batch. Presently the department has three seats for DM (Clinical Hematology). Dr M.K. Ghosh retired from the service on 28th February, this year. Prof. Maitreyee Bhattacharyya took the reins from Dr Ghosh. Glorious present The faculty of great pride ŸProf. Maitreyee Battacharya, D.M. Clinical Haematology (AIIMS), H.O.D. ŸDr. Tufan Kanti Dolai, D.M. Clinical Haematology (AIIMS), Associate Professor ŸDr. Shaymali Dutta, D.M. Haemato-pathology (AIIMS), Associate Professor ŸDr Rajib De, D. M. Clinical Haematology. (WBUHS, Kolkata), Assistant Professor ŸDr. Sanjay Misra, M.Sc, PhD, Biochemist ŸDr. Aditi Sen, M. Sc, PhD Molecular Biologist Instruments of vital importance ŸAutomated cell counters of various parameters ŸHPLC machines for thalassaemia diagnosis ŸPlatelet aggregometer ŸAdvanced coagulometer for full coagulation ŸSerum protein electrophoresis system Ÿ-80 centrigrade refrigerator, Blood bank refrigerator ŸChemiluminiscence ŸSemiautoanalysers for departmental biochemistry ŸApheresis machine ŸPCR , gel doc, nanodrop spectra 34
  43. 43. Facilities available Clinics Twice a week general OPD, 3 special clinic - Thalassaemia, Haemostasis & Leukemia 52 indoor beds with day care facilities Laboratoray All basic haematological investigations Haemostasis : Coagulation profile, Factor assay, Fibrinogen, Protein C, Protein S, ProC globe, Lupus anti-coagulant, Platelet aggregation Leukemia : Cytochemistries, Immunophenotyping Haemoglobinopathy work up Serum protein electrophoresis Iron & Vit B12 Molecular study for thalasseamia mutation Prenatal diagnostic services for thalassaemia Achievements i) D.M. – Clinical Haematology course – students from different parts of India come for training ii) This department has the unique credit of the first successful BMT venture by a state govt 35
  44. 44. institution. As of now, more than 25 successful BMT (both auto and allogenic) have been carried out by the department iii) Nodal centre for the control of thalassaemia in the state iv) Fully equipped with molecular diagnosis of thalassaemia which is under the charge of a molecular biologist. v) International updates : Thalassaemia update in 2011 - attended by Sir David J Weatheral, Nancy olivieri, Anuj Premawardhena, Suthat Futcheron among others. 2013 international confernce attended by- Neil Youmg, Antonio palumbo, Anuj Premawardhena besides national stalwarts Academic schedules Seminars - weekly Grand round - weekly Case presentation (both-clinical & lab) - weekly Journal club - fortnightly Comprehensive examinations - at three months interval Thesis review - at six monthly interval The department periodically arranges guest lecture by eminent hemologists, both from the country as well as from abroad. Various projects are undertaken by the faculties sponsored by ICMR, DBT & other academic funding bodies We aspire to be a super speciality department of repute with all our endeavours, God willing. 36
  45. 45. Tata Medical Centre (TMC), Kolkata Department of Haematology Mayur Parihar, Deepak Mishra, Reena Nair, Mammen Chandy Tata Medical Center (TMC), Kolkata is a philanthropic initiative from the House of Tata. Its mission is to promote Prevention, Early Diagnosis, Treatment, Rehabilitation, Palliation and Research for cancer patients. The Tata Medical Center is a comprehensive cancer care centre with well-trained professional staff and equipped with modern facilities and the most contemporary medical equipment. The centre provides a wide spectrum of services from Diagnosis and Therapy, to Rehabilitation and Palliative support in cancer. Efforts are on to add Preventive services in the near future. This state-of-the-art Hospital has been set up with strategic alliance and assistance from the Tata Memorial Centre, Mumbai, which is one of the premier national institutions for cancer prevention, treatment, education and research with nearly 70 years of experience. TMC is a not-for-profit initiative that is aimed specifically at helping cancer patients from the East and North East of India and also from the neighbouring countries like Bangladesh, Bhutan and Nepal. The Hospital, with a capacity of 167 beds, serves all sections of the Society, with 50% of the infrastructure earmarked for free or subsidized treatment for the underprivileged sections. The Institution's objective is to excel in service, education and research. In its 2nd phase it will add another 242 beds to cater to the growing number of patients visiting the hospital for treatment. Haemato Oncology Services The department of Clinical Hematology in TMC is involved in the treatment of malignant blood disorders (Acute & Chronic Leukemias and Lymphomas), Myeloma and some benign blood disorders. TMC possesses a state-of-the-art bone marrow transplant unit with 9 beds, another first for this part of the country. This unit has been designed based on international standards, with definitive measures for asepsis including HEPA filtered air. The unit is capable of autologous and allogeneic transplants, matched 14 STRATEGIC PARTNERSHIPS: ŸTata Memorial Centre, Mumbai ŸCMC, Vellore ŸDuke Cancer Center, US ŸAmerican Cancer Society ŸBritish Council ŸNGO Partners 37
  46. 46. unrelated donor transplants, haplo as well as cord blood transplants. The unit has a separate area for management of donors and collecting peripheral blood stem cells. The unit also boasts of a stem cell cryopreservation laboratory (-180°C, in vapour phase of liquid nitrogen). The Stem Cell Cryopreservation laboratory is equipped with a Planar Control Rate Freezer with liquid nitrogen system to aid in stem cell transplantations. The CHART 800 Series LN2 cryopreservation System with attached two liquid nitrogen tanks aid in long term storage of stem cells. The lab is complete with Thermo Class-II bio-safety cabinet, sterile connecting device, water baths, electronic balance, heavy duty and table-top centrifuges for stem cell processing and cryo-preservation. The BD FACS Canto II flow cytometer performs the CD34 enumeration and viability studies for stem cell harvests. Bone Marrow Transplant Unit Nine transplant beds in the first unit of its kind in eastern India. Care has been taken to ensure the most suitable environment for the patient during his/her immunologically vulnerable period. The hospital started transplantation in December 2011 and has performed more than 65 transplants in the last 18 months, primarily allogeneic. A couple of MUD transplants from the DKMS Registry, Germany have also been done. The transplant numbers are steadily going up and the results are comparable to the best centres in the west. Laboratory Services The Hospital has state-of-the-art laboratory services compliment the highly superior clinical services, offering patients the widest range of investigations which include all subspecialties, i.e., Haematology, Clinical Chemistry including drug assays, Clinical Pathology, Microbiology, Virology, Serology, Tumour Histopathology & Cytopathology, Molecular Pathology, Cytogenetics and Histo-compatibility. ŸThe Haematology laboratory is completely automated with state-of-the-art equipments. Beckman Coulter LH780, the fully automated 5–part differential cell counter with auto slide-maker and stainer HAEMATOLOGY FACULTY:: ŸProf Mammen Chandy ŸProf Vaskar Saha ŸDr. Reena Nair ŸDr. Anupam Chakrapani ŸDr. Arpita Bhattacharya ŸDr. Saurav Bhave ŸDr. (Col ) Deepak K Mishra ŸDr. Mayur Parihar ŸDr. Neeraj Arora ŸDr. Sabita Biswas 38
  47. 47. is the work-horse in this lab. Coagulation is fully automated with IL Elite PRO analyser. Cytochemical staining is automated using a Thermac auto-staining system. There i s a n a d v a n c e d p l a t e l e t aggregometer, both for whole blood and PRP (Chronolog Model 700) for platelet function defects as well as a R O T E M f o r r o t a t i o n a l thromboelastometry study during prolonged & complicated cancer surgery. The 3-Laser BD FACS Canto II performs 8 colour flowcytometric analyses in leukaemia / lymphoma d i a g n o s i s , M R D d e t e c t i o n , h a e m a t o p o i e t i c s t e m c e l l enumeration and cell cycle studies. The Sebia HYDRASIS II automated electrophoresis platform performs the h a e m o g l o b i n & p r o t e i n electrophoresis including immuno- fixation electrophoresis in diagnosis of plasma cell disorders and h a e m o g l o b i n o p a t h i e s . T h e nephelometer from Binding Site supplements further by doing the FLC assays and Ig quantifications. Though a cancer hospital, the lab houses a BIORAD HPLC system for Hb variant analysis in thalassaemias / haemoglobinopathies. In addition the lab has spectrophotometer for kinetic red cell enzyme assays (G6PD), automated ESR equipment and performs all kinds of special stains (NAP, Esterases, AP, TRAP etc.) employed in haematology. Besides the sophisticated blood and bone marrow testing, the bone marrow biopsies have access to all possible IHC markers. The in-house facilities for molecular haematology and cytogenetic tests for hematological malignancies encompass the entire diagnostic algorithm. ŸThe Molecular Genetics laboratory is comprehensive equipped with Applied Biosystems 7500 Real Time PCR System, Rotorgene RQ-PCR system, ABI 3500 8-capillary DNA sequencer and Luminex automated SSOP HLA testing platform. Besides there are 3 thermal cyclers, 8 electrophoresis systems, automated BIORAD gel documentation facility and a Nano-Drop. The laboratory has a QIACUBE, which fully automates DNA/RNA extraction. Besides this, the FELLOWS: ŸDr. Sumit Goyal, (BMT) ŸDr. Vishvadeep Khushoo, (Clinical Haematology) ŸDr. Damodar Das, (Clinical Haematology) ŸDr. Sriram Ravichandran, (Clinical Haematology) ŸDr. Monali Gupta (Haemat-Path) ŸDr. Aroonima Mishra (Haemat-Path) ŸDr. Subhosmito Chakravarty (Bio-Chemistry) ŸDr. Neelesh Jain (Transfusion Medicine) ŸDr. Supriya Dhar (Transfusion Medicine) ŸDr. Sonal Dalvi Mitra (Pediatric Hematology ŸDr. Ranjan Tiwari (Pediatric Hematology ŸDr. Debjani Ghosh 39
  48. 48. laboratory houses all other standard systems to support molecular diagnostic work. The lab offers molecular diagnostic and monitoring facilities in haematological malignancies (AML, ALL, CML, HCL, etc.) including post-BMT chimerism analysis. The HLA lab performs HLA-A, B & DR typing by low to intermediate resolution SSOP technique in an automated Luminex platform. It also does the SSP technique to cross- validate results & resolve ambiguities. The molecular lab also supports the entire spectrum of molecular virology assays that is so important for a comprehensive cancer centre including a busy BMT facility. ŸThe Cytogenetics laboratory is involved in chromosomal analysis of tumour cells by both conventional cytogenetics (karyotyping) and molecular cytogenetics (Fluroscent in situ hybridization, FISH). An a u t o m a t e d k a r y o t y p i n g s y s t e m (MetaSystems GmbH, Germany) along with Carl Zeiss capturing station is used for analyzing and reporting the cytogenetic abnormalities. The laboratory also does stress cytogenetic analysis for chromosomal breakage syndromes (Fanconi Anemia) that are premalignant conditions and may evolve into leukemias. Besides it has many other probes applied on tissue sections to diagnose Lymphomas. The department shall soon be acquiring an automated cytogenetic scanning system of Carl Zeiss with a digital slide (V-SLIDE) software that should help in automated metaphase scanning, spot counting, mutlicolour FISH and digital archiving of slides for entire pathology laboratory. ŸThe Biochemistry laboratory offers biochemical diagnostic support through Vitros 5600® integrated system (J&J); providing routine chemistry, immunoglobulin quantification and special chemistry tests. Vitros 250 (J&J) serves as the back-up analyzer. Therapeutic Drug Monitoring (TDM) also uses the Vitros 5600 platform with assays for Methotrexate and Cyclosporine. Advanced HPLC system from BIORAD allows us to detect various haemoglobin abnormalities and glycated haemoglobin. Acquisition of a Mass Spectrometer is in the pipeline for TDM and pharmacokinetic studies. ŸThe Microbiology laboratory aims to provide a timely, clinically relevant, and quality assured diagnostic test results in Bacteriology, Virology, Mycology, and Parasitology for in-patients, out-patients at an affordable price. The diagnostic facilities in the Microbiology laboratory are state-of- the-art. The department also provides Environmental Microbiology service, which is so important in a cancer hospital with BMT facility. This involves using the Airborne Particle Counter (Ergo Touch Pro 40
  49. 49. and RCS High Flow Microbial Air Sampler from Biotest), and doing water microbiology using the membrane filtration technology from Millipore. ŸThe Histopathology laboratory provides comprehensive anatomical pathology services on Leica fully automated histopathology workstations, which include fully automated tissue processing (Leica Peloris II & ASP), embedding, microtomy, slide staining and cover-slipping. Immuno- histochemistry is performed on fully automated Leica Bondmax / Roche Ventana immunohistochemistry systems and more than 120 IHC markers are available to make comprehensive histopathological diagnosis. The Cytopathology Laboratory provides a wide range of diagnostic cytology services that include FNACs, exfoliative and liquid based cytology. Immuno-cytochemistry is employed routinely to smears, so as IHC on cell-blocks. A Thermac cytospin prepares smears. A fully automated thin- prep system (Hologic) has been acquired for thin-prep cytology. ŸThe hospital, being an academic medical institution, has all the facilities to perform clinical autopsies. The reporting room houses a top-end Leica Binocular triple-head microscope along with a high fidelity camera / 46'' LED Monitor system for teaching, slide seminars and consensus reporting. The Multi Disciplinary Team board room also has facility of microscope with high fidelity camera / 46'' LED Monitor system for Multi Disciplinary Team meetings. A digital pathology system is also in the offing for slide archiving and digital consultations. Transfusion Medicine The Department of Transfusion Medicine at TMC offers a comprehensive range of services unique to the requirements of oncology and hematology. The mission of the department is to save lives of people who need blood and blood components. Blood is collected from voluntary and family replacement donors. 800 units of blood, on an average, are collected every month and its rising. All blood units are tested using a highly sensitive testing protocol for infection markers to make transfusion safe for all patients. All units are separated into components, with leucocytes removed for cancer patients. Almost 1500 component units are issued to patients every month. TMC has the first 'blood irradiator' in the whole of Eastern India, essential for transfusion in immunocompromised patients. The department is an integral part of the bone marrow transplant program where stem cells are collected for autologous and allogenic transplant program by automated apheresis machines (Cobe Spectra, Hemonetics). Robotic machines and bar codes are used for routine operations to avoid clerical mistakes and precision performance. The Department has a unique distinction of being the first Blood Bank to be accredited by the NABH (National Accreditation Board for Hospitals and Healthcare Providers) within the first year of its operations. 41
  50. 50. Infection Control at Tata Medical Center The Infection Control system at Tata Medical Center, Kolkata, comprises of a coordinated set of policies, procedures, strategic goals and operational initiatives that are planned, administered, delivered and evaluated through a multi-disciplinary team effort for prevention, surveillance, diagnosis, and treatment of infections. Information Technology The Tata Consultancy Services (TCS) has a legacy of managing healthcare IT needs of users and addressing their challenges (e.g., rising costs, improvement in the quality of treatments, patient safety and availability and collaboration of information). The systems and workflows in Tata Medical Center are aided by a comprehensive Hospital Management System, developed by Tata Consultancy Services (TCS), running on a state-of-the- art IT infrastructure designed and implemented by TCS. TMC is currently using the software for all patient records; outpatient, inpatient and operation theatre. A team of s o f t w a r e a n d n e t w o r k professionals from TCS are posted at TMC for operational support as well as new innovative additions to the HMS. Currently a software package for Pathology reporting is being developed for India with inputs from TMC and Duke University in the United States. EDUCATION AT TATA MEDICAL CENTER Currently, there are 2 year Fellowship Programs in Surgical Oncology ( GI, GU, Breast, Gynaecologic, Head & Neck, Plastic & Reconstructive ), Clinical Haematology, Bone Marrow Transplantation, Medical Oncology, Radiation Oncology, Paediatric Haematology / Oncology, Anaesthesiology, Diagnostic Imaging, Nuclear Medicine, Onco-Pathology, Haemato-Pathology, Molecular Pathology, Cytogenetics, Clinical Chemistry, Clinical Microbiology & V i r o l o g y , C l i n i c a l Pharmacology and Transfusion Medicine. It will be upgraded to Education Block 42

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