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  • 1. Editor Dr M B Agarwal HaematologyDEPARTMENTS IN INDIA
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  • 51. University recognized courses once the Hospital finishes 3 years of operations, as required by MCI. The Hospital has been recognised for MSc in Oncology Nursing by the West Bengal University of Health Sciences, the State Government and the Indian Nursing Council (INC). The hospital will soon induct 5 nursing students for the M.Sc. program. An Education Block is being planned as part of the Phase II Expansion Plan. This will offer the infrastructure to conduct multiple education programs. Collaborations In keeping with its thrust for excellence, TMC is partnering with many international organizations to maintain the highest standards of service, education and research. RESEARCH AT TATA MEDICAL CENTER The Tata Medical Center is committed to research and development in all aspects of cancer and its management. Our aim is to develop a solid platform for clinical, laboratory and translational research in oncology. The ambit of research at Tata Medical Center will cover phase I/II/II clinical trials as well as laboratory and technical studies on a wide range of subjects. Collaborative research and developmental activities with some of the best academic hospitals are planned. A memorandum of understanding (MoU) has already been signed with Duke University in the United States for collaboration in a wide range of activities, including clinical research as well as health information technology. TMC is uniquely equipped for research of the highest standards. The hospital has state of the art infrastructure in all clinical and laboratory departments. Clinical information storage and flow is entirely electronic, with excellent search and retrieval facilities. The faculty has an excellent academic background and research experience. A large fellowship program has been initiated in all departments to foster new research and developmental activities under faculty supervision. In our endeavour to win the battle over cancer we have invested heavily in research and development. Whilst clinical research is currently active in our centre, we would like to establish the translational research facilities at the earliest. The hospital close to its current location is setting up the Tata Translational Cancer Research Centre (TTCRC). The Mission Statement for the TTCRC will be that the TATA Translational Cancer Research Centre in Kolkata will create a vibrant interactive environment for clinicians, scientists and industry to work together to deliver a better future for cancer patients in India. Our aim is to integrate scientific enquiry into routine clinical practice; bridging the translational gap between inquiry, investigation and application for patients with cancer. All this cannot be done within the working structure of a busy hospital. Thus the TATA Translational Cancer Research Centre (TTCRC) has been created to act as the research and implementation arm of the TATA Medical Centre. It is important to appreciate that this centre will serve not only TMC/TTCRC but Kolkata in the first instance, spreading out to the North East in due course. 43
  • 52. University Subject Duke University, USA King's College London, UK Manchester University, UK Medical Research Council, UK Christie Hospital Manchester, UK INDOX Cancer Research Network, UK International Nosocomial Infection Control Consortium (INICC) Tata International Social Entrepreneurship Scheme (Tata ISES) Radiation Oncology, Molecular Genetics, Palliative Care, Nursing, Information Technology Nursing Education Medical Technologist Training Epidemiology Radiation Oncology, Laboratories, Translational Research Anti Cancer Therapeutics Infection Monitoring Economic and Social Studies 44
  • 53. Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), Lucknow Department of Haematology Soniya Nityanand After the initiation of clinical services in SGPGI in 1988, hematology patients were initially managed in the Department of Immunology and under the Headship of Prof SS Agarwal, the Dept. developed two major streams- autoimmunity and immune malignancies (hematological malignancies). Further, Prof SS Agarwal after visiting the BMT Unit of the Fred Hutchinson Cancer Centre at Seattle, USA, for 3 months, got approvals from the Institute and the State Govt. for establishing a BMT unit at SGPGIMS. When Dr Soniya Nityanand, joined as an Assistant Prof in Immunology in 1993, she was deputed for the Hematology patient care services and for teaching/training in hematology. She was also deputed to develop the BMT Program at the Institute. Later when Dr Sunil Dabadghao, joined as an Asst Prof in the Dept of Immunology in 1998, he was Took care of hematology patients, till he left in 2002. Over the years there was a consistent increase in the number of hematological patients being treated in the Dept of Immunology and in the year 1999 a Bone Marrow/Hematopoietic Stem Cell Transplantation (BMT/HSCT) program was successfully established by Dr Soniya Nityanand. Noting this significant increase in the hematology and BMT/HSCT patients, the Institute decided to have a separate Dept. of Hematology which was established in 2003 with Dr Soniya Nityanand as its head and is a composite Dept. with both clinical and laboratory components. It was the first Dept. of Hematology to have been established in the State of U.P. and is the only centre in UP performing BMTs. Faculty of the Dept Dr. Soniya Nityanand, Prof. & Head (Clinical Hematology/BMT): from 2003 till date Dr. Rajesh Kashyap, Addl. Prof. (Clinical Hematology): from 2003 till date Dr. Ritu Gupta, Asst. Prof. (Lab Hematology): from 2003-2005 Dr. Shawji Sukumuran, Asst Prof (Clinical Hematology/BMT): from 2003-2004 Dr. Ruchi Gupta, Asstt Prof (Lab Hematology): from 2011 till date Dr. Khaliqur Rahman, Asst Prof (Lab Hematology): from 2013 till date Stem Cell Research Scientists Dr. Naresh Tripathy: from 2005 till date Dr. Sachin Jadhav: from 2005 till date Dr. Leena Rastogi: from 2012 till date Dr. Yamunna Mohanram: from 2012 till date Dr. Ramalingaswami Fellow: Dr. Chandra Chaturvedi: from Oct 3, 2013 15 45
  • 54. Department Facilities A. Clinical Facilities ŸWard: 24 general beds, 05 Private Rooms ŸPre-BMT/Hematology ICU: 07 beds, for management of patients with severe neutropenic complications, induction phase of acute myeloid leukemia, as a step-up and step-down unit for BMT/HSCT patients ŸBMT: 02 beds ŸOPD: Consultation Rooms, Procedure Room, and an OPD chemotherapy room ŸStem Cell Harvesting Facility: 02 apheresis machines (Spectra Optia Apheresis System, Caridian BCT, USA) B. Laboratories ŸAdvanced Flow Cytometry and Sorting Lab ŸBone Marrow/Hematopoietic Stem Cell Transplantation (HSCT) Lab ŸDrug Assay & Coagulation Lab ŸPlatelet Aggregation Studies Lab ŸMolecular Hematology Lab ŸMorphology Lab ŸMyeloma Lab C. Stem Cell Research Facility (SCRF) The SCRF has Culture Labs for normoxic and hypoxic culture of stem cells, Stem Cell Biology Lab, Molecular Biology Lab. In addition the SCRF has the following unique facilities. Current Good Manufacturing Practice (cGMP) Facility: This facility has been established under a Program Support Project, entitled “Mesenchymal stem cell therapy in myocardial infarction, stroke, renal failure and diabetes”, funded by DBT, Govt. of India, New Department staff 46
  • 55. Delhi (PI: Dr Soniya Nityanand). This facility is meant for generation/processing of stem cells for clinical trials and therapy. Small Animal Imaging Facility (SAIF): The Small Animal Imaging Facility (SAIF) presently has a small animal SPECT/CT (Bioscan, USA), procured from an Indo-Denmark bilateral collaborative research project funded by DBT, Govt of India, New Delhi (PI: Dr. Soniya Nityanand). This is the second small animal SPECT- CT equipment in the country and is open for use to all scientists of the country. Teaching Program The Dept runs i) MCI recognized DM Hematology course ii) MCI registered PDCC course in Hemato-Oncology iii) PhD Program Research Since its inception, the Dept. is deeply engaged in basic and translational research work. The areas of research interest of the faculty are as follows: Dr Soniya Nityanand ŸStem Cell Research and Therapy: (i) Basic biology and therapeutic applications of human mesenchymal stem cells (MSC), with special interest in fetal MSC from different sources; (ii) Cardiovascular and renal regenerative potential of different populations of MSC in pre-clinical animal models using animal CT-SPECT and 2-D ECHO; (iii) Clinical trials with mesenchymal stem cells and bone marrow stem cells; (iv) Biology and characterization of human bone marrow derived multipotent adult progenitor cells (MAPC). ŸAplastic anemia: Immunopathogenesis and newer therapeutic strategies. ŸBiology and epigenetics of Acute Lymphoblastic Leukemia in India. ŸImmune mechanisms in Takayasu's arteritis Dr Rajesh Kashyap ŸClinical presentation and management of Extra-nodal lymphomas Dr Ruchi Gupta ŸMultiparametric Flow Cytometry in MDS, immunophenotyping of acute leukemias and chronic lymphophroliferative disorders in peripheral blood, bone marrow, body fluids and fine needle aspiration samples. ŸPlatelet aggregation studies. Dr Kaliqur Rahman ŸMolecular analysis of CML 47
  • 56. Awards and Honors Dr Soniya Nityanand Ÿ2009 - Prof. SR Naik Award, for Outstanding Research Investigator, SGPGIMS, Lucknow Ÿ2009 - Fellowship of the Indian Academy of Sciences, Bangalore. India Ÿ2006 - Fellowship of the National Academy of Sciences, Allahabad, India Ÿ2005 - Rajib Goel Young Scientist Award, Kurukshetra University, Kurukshetra Ÿ2004 - Pratima & Sucharu Stree Shakti Award for the Best Woman Scientist of the Year Ÿ2003 - DBT National Biosciences Career Award, New Delhi Dr Rajesh Kashyap Ÿ2013 - Member of National Academy of Medical Sciences, India Sister Madhuri Smith, Specialist Nurse, Bone Marrow Transplantation Ÿ2011 - National Florence Nightingale Nurses Award Dr Sunil Chauhan, PhD student Ÿ2006 - Prof SS Agarwal award for excellence in research, SGPGIMS, Lucknow Future Plans The Dept. plans to expand its faculty strength, which is a burning need of the Dept. The new building of the Dept. is near completion. It has 02 Blocks- the Academic Block and the Clinical Block. The Academic Block which consists of Offices, Labs and Teaching Facilities, is currently being handed over. The Clinical Block consisting of OPD day, day care ward, in patients-ward and a 10-bed BMT Unit will be handed over in the next few months. Once the new BMT ward is functional, the Dept. will start a 01 year post-doctoral Fellowship in Bone Marrow Transplantation. A new building of Stem Cell research Center with a (i) cGMP facility having 04 productions suites, (ii) In vitro stem cell research labs, (iii) Cryo-facility, is near completion. In this Centre, clinician-scientists and basic research scientists will closely work together in stem cell research and therapy. The Centre also plans to run MD/PhD and MSc/PhD programs in stem cell research and therapy. 48
  • 57. Christian Medical College, Ludhiana Clinical Haematology, Haemato-Oncology & Bone Marrow (Stem cell) Transplant services M Joseph John and Naveen Kakkar 'The Past, Present and Future’ A brief look into our history: (The past) Christian Medical College, Ludhiana was established in the year 1894 by Dame Edith Mary Brown and this year we are celebrating 119 years of service to the nation. It is a non-profit organization which envisions providing quality medical care from primary to tertiary level in India, with an emphasis on serving the needy and downtrodden. Health outreach in the country is done by training of medical personnel specifically to reach out to needy areas of the country after graduation and post-graduation. The college was upgraded to MBBS course in 1953 and more than 2500 MBBS students have graduated from the portals of this institution and many of these graduates and post graduates are working in some of the most backward areas of India. At the same time others have moved on to research and have pioneered innovation and quality health care across the world. The institution has grown over the years into 700 bed multispecialty, tertiary health care center. It has pioneered as well as developed many initiatives in the field of medicine and has had a major contribution to health care particularly in North India, as a major referral center. Haematology-Oncology services The pioneering and legendary work on Clinical Hematology was started by Dr. Betty Cowan a Scottish Physician, in the 1960's. She established assays for vitamin B12 and folate in the Medical Research laboratory in the days when this was done by a very labor intensive method using the growth of lactobacillus bacteria and her work is internationally recognized which earned her MBE (Member of British Empire). The pioneering Medical Oncology and Hemato-Oncology work was started by Dr Alex Zachariah since the 70s (As recorded with International Union against Cancer Directory). Dr. William Robinson MD spent a year with in CMC in 1970s to help develop the Medical Oncology Unit. Dr. Sewa Legha MD has been helping CMC in medical oncology and Haem-Onc since 1974 while he was with National Cancer Institute in USA and ever since he has been giving his time and talent to help CMCL in Medical Oncology. Dr. Edward B Crowell MD did excellent Clinical Hematology work during 1976-1990 and treated patients with leukaemia, lymphoma and myeloma. His wife Dr Susan Crowell, took over the medical research laboratory and established chromatographic assay for haemoglobin, G6PD assay and tests to support multiple myeloma evaluation and treatment. Dr. Anna Mani continued his excellent work in Clinical Haematology and did initial work on Haemophilia in Punjab. Dr. Reginald Britt came from UK several times in the 70s right up till 2006 and helped in the Clinical Hematology work and laboratory up gradation. For his work in India, he was awarded the MBE. Current work: (The present) Christian Medical College, Ludhiana (CMCL) established a dedicated Clinical Haematology, 16 49
  • 58. Haemato-Oncology and Bone Marrow Transplant Unit in Punjab in 2007. Bone Marrow (Stem Cell) Transplant programme was started in October 2008 and subsequently CMCL has done 57 transplants till now. (45 allogeneic and 12 autologous transplants) over the last 5 years for various haematological conditions like, aplastic anemia, multiple myeloma, acute lymphoblastic leukemia, chronic myeloid leukemia and genetic diseases like thalassaemia and Wiskott Aldrich syndrome (WAS). However, the major area of focus remains thalassaemia transplants. Vision statement of our unit To meet the haematological, oncological and stem cell transplant needs of patients through ethical high quality patient care by constant innovation towards premium personalized patient care and specialized training of the health professionals. Mission statement of our unit To create an outstanding Department of Clinical Haematology, Haemato-oncology & Bone Marrow (Stem cell) Transplant Unit, which is worthy of the healing ministry of Christ. This we will do through service, education and training, with the aim of producing professionally excellent, ethically sound individuals who will go out as servant leaders of health teams and healing communities. Motto of our unit “Quality, Competency and Research” Major focus of services at present 1. Diagnosis and treatment of benign and malignant haematological diseases. 2. Bone Marrow (Stem cell) Transplantation services of haematological diseases (benign and malignant). Staff pattern and table of organization Clinical Wing Laboratory wing Associate Professor & Head Lab technicians Assistant Professors Medical officers Physician assistants Ward 6 Oncology nurses BMT unit nurses Ancillary staff, helpers, sanitation workers Assistant Professor* Medical officers* Physician assistant* Day Care nurses Special Tests Lab in- Professor in pathology chargeMedical Oncology UnitClinical Haematology and Bone Marrow Transplant Unit Assistant Professor & Head Office secretary and clerks Clinical Trial co-ordinator BMT co-ordinator 50
  • 59. 3. Stem cell transplantation for thalassaemia. 4. Haemophilia care. Facilities available related to haematology, oncology and stem cell transplant services 1. Full-fledged blood bank 2. Dedicated irradiator for blood and platelets. 3. Comprehensive laboratory support from biochemistry, haemato-pathology and microbiology 4. Special tests laboratory for coagulation work and stem cell analysis 5. Stem cell cryopreservation facility 6. Haematology - Oncology ward 7. Day care center 8. Bone marrow transplant unit (with HEPA filter) - 5 bedded Training programmes: 1. Haematology-Oncology and stem cell transplant Physician assistant/technician course. (Recently accredited by Baba Farid University of Health Sciences) Collaborative work: 1. Haemophilia twinning programme with Henry Ford Hospital through the World Federation of Haemophilia. 2. Center of Excellence in Comprehensive hemophilia care Developments over the last few years 1. New 5 bedded Bone Marrow Transplantation Unit: Recently opened, this would be meet need to conduct multiple bone marrow transplants at a given time and reduce the waiting periods for transplant. 2. Day care unit: Inaugurated in 2102, this has provided more space and improved significantly the care given to patients who come to haematology and oncology units. 3. Matched Unrelated Donor (MUD) Stem cell transplant: (MUD) transplant is now being extended to patients with thalassaemia apart from leukemia patients. Our new BMT unit – 5 bedded 51
  • 60. 4. Centre of Excellence (COE) in Haemophilia care: Clinical Haematology Unit started the first comprehensive haemophilia care centre in this part of the country with a multi-disciplinary approach. We have also signed a memorandum of understanding with Baxter India Private, Limited for the COE. As part of this collaboration, we have organized training workshops for doctors and technicians to disseminate information regarding hemophilia diagnosis and training. 5. World Federation of Haemophilia (WFH) Twinning Programme with Henry Ford Hospital, Detroit: CMC, Ludhiana has tied up with Henry Ford hospital, Detroit, USA as part of the twinning programme through the World Federation of Haemophilia. We have been able to streamline many aspects of haemophilia care and improve our existing facilities. We have also been able to conduct workshops for doctors as well as patients. We have become a referral centre for hemophilia care in Northern India for a population of 40 million. 6. Haemophilia Clinic: Started a comprehensive haemophilia clinic from May 2012 as part comprehensive haemophilia programme to provide appropriate care for patients with haemophilia who are suffering from joint problems. Specialists from 8 different units come together to discuss and make the treatment plans for patients with joint problems. Every 2nd Wednesday, Haemophilia meetings are attended by four to five patients. 7. SIR RATAN TATA TRUST support of transplant patients: Under the Individual grants programme, for patients undergoing bone marrow transplant at Christian Medical College, Ludhiana, Sir Ratan Tata Trust has been supporting us for the last 3 years. The existing grant has been extended for the next 3 years till 2016. Further plans (The future) 1. Molecular laboratory to support the haematology/oncology and stem cell transplant services. 2. To work towards establishing DM/Fellowship programmes by the year 2014 – 15. 3. Further training for laboratory technicians (BSc MLT/MSc/PhD) 4. To develop a dedicated research wing to support and initiate active research in the unit. 5. Capacity development: empowerment of Physician assistants and nurses by training and workshops to take on specific areas of independent responsibilities. 6. To establish a state of the art primary immunodeficiency evaluation laboratory. 7. Establish outreach programmes for thalassaemia, haemophilia and haematological malignancies. Awareness activities towards thalassaemia transplants. Our new Day Care center 52
  • 61. Our team: “Coming together is the beginning, staying together is progress, working together is success” - Henry Ford 8. To work towards definite data base management systems in place for audit, analysis and future research. Summary We have been blessed to have many people who paved the way over the years to help us reach till now. The goal of our team is “Quality, Competency and Research”. We firmly believe that with the God almighty at the helm of affairs and a spirited team, CMC Ludhiana will be able to fulfill the vision of providing excellent care for the people of India. 53
  • 62. B. J. Wadia Hospital for Children, Mumbai Department of Pediatric Hematology & Oncology Bharat Agarwal The Department of Pediatric Hematology & Oncology (DPHO) has been rendering its services for outpatients, ambulatory and indoor care of children with blood disorders and cancer since 1984. Dr. Zinet Currimbhoy started this service with a vision and zeal that inspires us even today. She was the driving force for the growth and expansion of the unit from 1984 until 1996 when Dr. Rashmi Dalvi took over as the head of this program until 2001. Dr. Bharat Agarwal has been leading the unit since 2001 until date. The department has witnessed an exponential growth over the years, and today our staff & service have a good standing not only with the patients but also the fraternity. The beginnings In 1984, Dr. Currimbhoy started using the pathology laboratory as the base for all hematology / oncology activities. She believed in the adage “Hematology / Oncology consultation is incomplete without a thorough clinical examination of the patient and the review of his / her peripheral blood smear”. Hence she had to establish herself next to the microscope that was available only in the pathology laboratory. During this period, hematology consultations were not many; and all oncology patients were referred to Tata Hospital. Today we have more than 1500 new referrals each year; of these more than 100 new cases are for pediatric oncology. Dr. Sunil Abhyankar joined the DPHO as the “first part time fellow” in 1984. He is now a very Senior Bone Marrow Transplant (BMT) Consultant in the U.S. In 1986 a section of the pathology laboratory : the far end corridor was cordoned to create the physical space for DPHO. We had a small procedure room attached for out patient interventions. The number of patients / referrals kept rising and we had to move to a much bigger space on the first floor. Half of the ward 13 with its side room was allocated to DPHO in 1992-93. We created a 'state of the art' department with 3 consulting rooms, a specialized hematology laboratory, a well equipped procedure room and a twelve bed “Day Care Service” unit. This was one of its kind in the whole country in that era. We were very proud of the new setup ! We have never looked back since then…. The aim of department is to provide holistic care to children who have debilitating illness in the prime of their life. ŸThe department receives around 1,500 new patients in OPD and 5000 patients come for follow-up/treatment thus making around 7,000 OPD references in a year B J Wadia Hospital for Children 17 54
  • 63. ŸDay care attendance of about 3,000 on yearly basis for procedures like transfusion, chemotherapy, bone marrow aspiration and blood sampling ŸIn-door admissions are about 1,000 per year ŸThe department receives patients from various off-site locations across the country for expert opinion and treatment ŸThe centre is affiliation by National Board and IAP for training and teaching post graduate students and fellows in this specialised field. Over the years, the department has produced highly competent and experienced professionals ŸThe department includes seasoned physicians working as honorary consultants and staff Department Structure Honarary Faculty 1. Dr. Bharat Agarwal, Head of the Department 2. Dr. Mukesh Desai, Hon. Consultant and Immunology In-charge 3. Dr. Nitin Shah, Hon. Consultant and Hematology In-charge 4. Dr. Archana Swami, Hon. Consultant and Oncology In-charge 5. Dr Sangeeta Mudaliar, Hon. Project officer The Honarary Doctors are supported by a dedicated Support Team. All members of the Wadia Hospital PCU work together in order to provide treatment, care and support for children with cancer and their families. Out Patient Services New Patients : Everyday at 9.00 a.m. Hematology / Oncology Follow up OPD : Tuesday & Friday 9.00 a.m. onwards Thalassemia Transfusion OPD : Mon, Wed, Thurs, Sat 9.00 am onwards Thalassemia Followup OPD : Monday, Wednesday, Thursday, Saturday 9.00 a.m. onwards Long term follow up of cancer : Friday at 11.00 a.m. Out patient service is open from 8 a.m. to 5 p.m. every day (Monday to Saturday). Particularly we have 2 large follow up OPDs, on Tuesday and Friday morning, while emergencies are received at any time. Department of Pediatric Hematology & Oncology, Division of Immunology 55
  • 64. On a busy outpatient day !!!! Post Doctoral Fellowship training : PHO 56
  • 65. Day Care Ward Ambulatory care is provided between 8 a.m. to 5 p.m. Monday to Saturday in a 12 bedded facility. In this Day Care Service ward the thalassemia and oncology patients receive blood transfusion, the oncology patients receive intrathecal and infusion chemotherapy, the hemophiliacs receive factor replacement etc. A number of investigations and therapeutic procedures are also carried out in the procedure room. In-Patient Service Indoor patients from medical and surgical units and intensive care areas are opined on and managed by the department in various wards on a daily basis. On an average 15-25 such indoor patients are directly under the care of this unit at any given time. These patients require specialized hematological investigations, procedures and therapy (chemotherapy) which is carried out in the ambulatory care facility. Since 2007 a separate 10 beds indoor unit was created exclusively for pediatric oncology inpatients. Hematology Laboratory The department runs a specialized hematology laboratory where the following investigations are done: CBC, Hemolytic anemia profile, coagulation profile, bone marrow aspiration and biopsy, cytochemical stains etc. Oncology nursing Administration of chemotherapy is a very specialised service. The daily activities of the department are managed by our Oncology nurse. She is the backbone of our Day Care Service. Our nurses are also encouraged to present papers in international conferences to highlight the work done by them. Academic Activities The Department of Pediatric Hematology & Oncology has initiated a “Post doctoral fellowship” training program of 2 years in Pediatric Hematology and Oncology at B.J. Wadia Children's Hospital in February 2007, under the auspices of National Board of Examination, Delhi ( ). This is one of the first centre in the country to start this course. The first two students for this course were selected by merit on the basis of a National level entrance examination conducted by National Board of Examination, Delhi. The first batch of successful specialists in Pediatric Hematology and Oncology has passed in April 2009 (Dr. Priti Mehta & Dr. Nirav Buch). Two new students were enrolled in 2009 (Dr. Priyanka Sharma & Dr. Purvi Kadakia) & 2010 (Dr. Pinky Shah & Dr. Asruti Kaccha). Regular academic sessions are conducted for this fellowship course with additional sessions for preparing the candidates for their exit exams. Collaboration with Jiv Daya Foundation & Cankids In January 2010 the Trustees of JDF visited the department & proposed to financially support our unit with the salaries of 6 staff members. Two oncology fellows, two oncology nurses & two social workers have joined the department under the collaboration with JDF /Cankids. This has been a major boost to the level of services provided by our department. The social workers dedicated to the unit have been a great asset in providing the much required psycosocial support to our patients and their families. Improvement in Treatment Statistics www.natboard.nic.in Percentage of Children abandoning treatment: Overall Survival Rate: Ÿ2009: 37% (25/68) Ÿ2009: 43% Ÿ2010: 25% (23/91) Ÿ2010: 47% Ÿ2011: 14% (12/84) Ÿ2011: 62% 57
  • 66. KEM hospital, Mumbai Dr. J.C. Patel Hematology Department Farah Jijina, Chandrakala S The Dr. J.C. Patel Hematology Department is one of the biggest hematology departments in Mumbai. It provides hemato-oncology services to patients referred to the KEM Hospital. Diagnostic and therapeutic procedures are performed on patients suffering from various hematological disorders such as anemia, leukemia, lymphomas, myelomas, bleeding disorders etc. The center is affiliated to the Hemophilia Society of Mumbai, and caters to the therapeutic needs of about 650 hemophilia patients in and around Mumbai. The Department has many collaborative research projects in the field of hemophilia, hemoglobinopathies, thrombophilia, myelodysplasia etc with the National Institute of Immunohaematology (ICMR). There is also a regular exchange of ideas and experiences with the Tata Memorial Hospital. In 1961, Dr. J. C. Patel, Hon. Physician, Seth GS Medical College and KEM Hospital, obtained a grant of Rs. 30,000.00 from Glaxo Laboratories Ltd. to start work in Hematology. A full time medical officer and technician were appointed to work under the guidance of Dr. J.C. Patel and Prof. N.M. Purandare. Over a period of six months, they established many of the laboratory tests necessary for diagnosis of various hematological disorders that were encountered in practice. Data of the hematological cases seen over a period of ten years was compiled, analyzed and presented to the administration with a suggestion that the Municipal Corporation should start a hematology department. The MCGB was thus persuaded to start a hematology department and appointed a Hon Asst Hematologist. Gradually, with the help of a generous donation of Rs.600, 000.00 from Dr. J C Patel, grants and assistance from BARC and ICMR, the diagnostic and therapeutic range for various hematological diseases was expanded. These resulted in reference of cases from various hospitals in the city as well as from all over the country. Since its inception, 5-15 scientific papers were published in Indian and international journals over the next 25 years. Several monograms were published. The Department organized several national and international conferences and staff members of the department held important offices in various national and international societies as well as in WHO advisory committee. Several postgraduate students (in general medicine and pediatrics) carried out work on various hematological topics in the department to write their dissertations. Staff members of the department received various prestigious awards and orations from various national societies and institutions. Staff members of the department acted as editor, sectional editor, referee and judge for medical journals and textbooks, and also contributed chapters to books of the stature of Oxford Textbook of Medicine. The department was named after Dr. J C Patel, in view of his immense contribution to the field of Hematology in 1977. The department was headed by one of our prominent hematologists of Mumbai Dr B C Mehta till his retirement in 1991. In 2001, The Medical Council of India (MCI) gave permission to start DM Clinical Hematology. The teachers appointed for the super specialty course were Dr Dipika Mohanty, Dr K Ghosh and Dr Farah Jijina. This was and still is the only center in Maharashtra to have a DM Clinical Hematology. The first batches of students were admitted from 2002. 18 58
  • 67. Subsequently, the MCI recognized our DM Clinical Hematology course in 2012, with full retrospective effect. To date, fourteen students have completed their DM degree from our department and practicing Hematology in India and other countries. In a year, we see about 4000 - 4500 patients on an outpatient basis and about 1000 - 1500 in hospital patients. We also run a specialized laboratory where about 7000 samples are processed annually. Our Department works in close collaboration with the National Institute of Immuno Hematology where majority of the specialized investigations including molecular research is done, at very economical rates. This ensures that patients are well worked up, without incurring crippling expenses. The Comprehensive Hemophilia Care Centre has been started in the department from 1993 where hemophilia patients from all over the country are managed. The center is also recognized by WHF as an international hemophilia training center. The ward is attended by qualified personnel from the occupational therapy and orthopedic departments, to ensure complete care of all major problems of Hemophilia under one roof. A number of complicated cases of hemophilia are taken care of in the ward, including referrals from other hospitals and states from all over the country. This Department has been a Centre of Excellence for hemophilia care. The first autologous bone marrow transplant was successfully done in a multiple myeloma patient in 2013. Departmental Services The Dr. J C Patel Hematology Department provides the following services at the KEM Hospital for all hematology related disorders: 1. Indoor and outdoor patients' services 2. Referral call services for all the departments. 3. Bone Marrow Aspiration and biopsy. 4. Comprehensive Hemophilia Care. 5. Hemato-oncological malignancies: Diagnostic and therapeutic. 6. Hematological emergencies: Diagnostic and therapeutic. 7. Hematological laboratory services: Diagnostic. 8. Hemostatic laboratory services: Diagnostic Our Patient Department Service The outpatient department service is provided twice a week to old and new patients. All interesting cases and patients with a hematological diagnosis are systematically examined and investigated; separate proforma files are prepared which give complete details of examination and investigations and are maintained in the department for future follow-up and reference. Day - care services All patients with thalassemia and transfusion dependent anemias are given transfusions on a day care basis. Bleeding disorders like hemophilia and vWD are treated regularly with factor and component therapy. Patients requiring chemotherapy for malignancies are likewise treated in the day care. Indoor Patients Service Indoor patient service is provided around the clock to patients suffering from hematological disorders, both benign and malignant, such as megaloblastic anemia, myelodysplastic syndrome, leukemias, multiple myeloma etc that require inpatient management. 59
  • 68. Intensive / Emergency Hematology Services Serious patients with bleeding manifestations such as hemophilia, bleeding disorders, acute leukemia's etc are admitted round the clock for their diagnosis and management. The hematological laboratory provides the backing for handling these emergency cases. Faculty members: Dr. Farah Jijina M.D Honorary Professor Dr. Chandrakala.S. M.D., D.M Fellowship in Leukemia and BMT Assoc. Professor Just another day in our ward !!! 60
  • 69. Lokmanya Tilak Municipal Medical College & General Hospital Division of Pediatric Hematology Department of Pediartics Mamta Manglani The Division of Pediatric Hematology-Oncology was established in the year 1976 by Dr. M. R. Lokeshwar, then Honorary Asst Professor of pediatrics due to his passion for the subject. Dr. Mamta Manglani joined him in the year 1987. This was the first of its kind in the city of Mumbai in a municipal medical college affiliated hospital. Presently, we are a unit with Professor and Head, and an Assistant Professor, fellows and resident doctors. We also have staff appointed through collaboration with the Jiv Daya Foundation, Dallas, Texas, USA. This includes 4 staff nurses, one field worker, one data manger and a social worker besides a staff nurse through Municipal Corporation, for looking after indoor patients and, one staff nurse to look after Thalassemia Day Care Centre. The Division caters to patient care (outdoor and indoor), teaching and research. The unit consists of a 15 bedded ward with 5 isolation cubicles (centrally air conditioned) for high risk oncology patients. Besides, we have a pediatric intensive care unit, where any of the children requiring intensive management are transferred and managed. We are in the process of establishing a new state-of-the- art ward for children with hematologic and oncologic disorders with help from a donor. This will be a 15 bedded ward with the latest equipment and 2 beds for stem cell transplantation likely to be installed in June 2014. The Pediatric Hematology-Oncology OPDs run on every Tuesday and Friday with almost 3000 to 4000 patients per year. There are about 80 to 100 new Oncology patients registered per year and about 750 to 800 new Hematology patients registered every year. The palliative care OPD is held on Tuesdays 19 61 The Hematology-Oncology Ward Pediatric Oncology Cubicles with Isolation
  • 70. 62 and Thursdays in the Pediatric OPD complex. This is managed by volunteers along with one of the Assistant Professors in the department and resident doctors. There is a centrally air-conditioned laboratory under the department which performs various tests including complete blood counts with five part differential (on a particle cell counter), reticulocyte counts, sickling, ESR, bleeding profile including PT, PTT, TT, plasma fibrinogen, Factor XIII assay, HPLC on Variant II for hemoglobinopathies, serum iron studies, DCT, ICT, qualitative G6PD estimation etc. Peripheral blood smears and bone marrow aspirate smears are reported by the resident doctors and fellows and are confirmed by faculty. We are in the process of procuring flowcytometer for oncology patients and for stem cell transplant. The Thalassemia Day Care Centre has now been upgraded to a state-of-the-art centre with 15 recliner chairs and 8 beds and can cater to 23 to 25 patients daily and 280-300 patients monthly. We also extend our expertise to all Thalassemia Day Care Centres in the vicinity in and around Mumbai. We conduct mentoring workshops for staff of these day care centres as well as for patients and parents from time to time. We conduct annual check-up for every thalassemic registered at our centre. This includes evaluation for bone disease, cardiac iron overload by an MRI, endocrine evaluation done by a visiting endocrinologist in the OPD. Thalassemia Day Care Centre with 15 Recliners We now run one year post doctoral Fellowship courses in Pediatric Hematology–Oncology (post MD/DNB/DCH) under Maharashtra University of Health Sciences. Till date, 6 students have availed of these courses and have been awarded the Fellowship. The Department has organized various local, regional, national and international conferences, workshops and seminars. The faculty and postgraduate students participate in various national and international conferences and CMEs. Some of the research activities undertaken in the division include the following: 1. NESTROFT (Naked Eye Single Tube Red Cell Osmotic Fragility Test) as a screening test for beta-thalassemia trait in population. 2. Effect of L-Carnitine in m u l t i p l y t r a n s f u s e d thalassemic children. 3. Psychological impact in children with thalassemia major. The New Thalassemia Day Care Centre with 8 beds
  • 71. 4. Prevalence of lead poisoning in children. 5. CD4, CD8 and Immunoglobulin levels in multi-transfused thalassemic patients. 6. Prevalence of Vitamin C deficiency in multi-transfused thalssemic patients. 7. Antenatal screening of mothers and their spouses for thalassemia minor and prevention of births of thalassemia major children. 8. SIPPET International multicentric trial on “(Inhibitor Development in Previously Untreated Patients (PUPs) or Minimally Blood Component-Treated Patients (MBCTPs) when Exposed to plasma- derived von Willebrand Factor-Containing Factor VIII (VWF/FVIII) Concentrates and to Recombinant Factor VIII (rFVIII) Concentrates: An Independent, International, Multicentre,Prospective, Controlled, Randomised, Open Label, Clinical Trial. 63
  • 72. National Institute of Immunohaematology, Mumbai A Mecca for Haematologists and Transfusion Experts in India K Ghosh N a t i o n a l I n s t i t u t e o f Immunohaematology is an unique Institute in India dedicated to r e s e a r c h a n d s e r v i c e i n Haematology and Transfusion Medicine. This Institute originally started as the Blood Group Reference Centre (BGRC) of ICMR in 1957 with the mandate of developing transfusion medicine research and human resource development in Transfusion Medicine. However, during the last 56 years under the able guidance of Dr.H.M.Bhatia, Dr.S.V.Apte, D r. D i p i k a M o h a n t y a n d Dr.K.Ghosh, the Institute has developed into a leading centre for Haematology and Transfusion Medicine service in the country. In one of the scientometric publications, the Institute has been rated as one of the top Institutes with highest research output for Research in Genetic Haematology Disorders. (Gupta BM, Journal of Blood Disorders and Transfusion, 2012;4:3) In addition to transfusion medicine, haemoglobinopathies, red cell enzymopathies and membranopathies, cytogenetics and molecular genetics of hematological disorders, cellular and experimental immunology, pediatric immunology and immunodeficiencies, thrombosis and hemostasis, haemato - virology, HLA and transfusion transmitted viral infections, are some of the areas of service, research and human resource development. The centre has been a support not only to all the government and municipal medical colleges in and across Mumbai metropolis, but hospitals like Tata Memorial Hospital and many other corporate and government hospitals in Mumbai and the rest of India also regularly take advantage of the services provided by the Institution. This centre is a WHO recognized Blood Group Testing Laboratory, International Hemophilia Training Centre, Thrombosis and to Haemostasis training centre of International Society of Thrombosis and Haemostasis (ISTH) and National Reference Laboratory for HIV infection. As a result the Institute not only trains national trainees but also international trainees from various countries. The Institute is recognized by Mumbai University as well as Maharashtra University of Health Sciences and West Bengal University of Health Sciences, for the Ph.D programme and by Mumbai University for the M.Sc programme by research. The Institute imparts training for MD (Transfusion Medicine) and 20 64
  • 73. DM (Clinical Haematology) students of KEM Hospital and Seth GS Medical College, Mumbai. There are many seminal contributions made by the Institute in the field of haematology and immunohaematology. 1. Discovery of Bombay (Oh) and Indian (In) blood groups. 2. Discovery of first case of G6PD deficiency in the country. 3. Discovery of several unique haemoglobins and coagulation proteins like Hb D Agri, Hb M Ratnagiri, Fibrinogen - Mumbai, Prothrombin Mumbai to name a few. 4. Discovery of a family with Co(a - b-) blood group. 5. Seminal work on various lectins found in India which are useful as reagents for blood group systems. 6. Discovery of association of HLA B-27 with haemophilia associated chronic synovitis. 7. Demonstration of several molecular variants of Fanconi's anemia in this country. 8. dglobin mutations as a cause of normal HbA b- thalassemia carriers in the country.2 9. Thombophilia as a cause of recurrent pregnancy loss and salvaging the pregnancy with LMW - heparin. 10. Thromophilia as an important modulator of bleeding in severe inherited bleeding disorders. 11. Molecular pathology of many haemoglobinopathies, red cell enzymopathies, congeniatal bleeding disorders, leukemias, immuno deficiency disorders as well as many new HLA antigen polymorphisms. 12. Hydroxyurea as an important iron chelating agent in addition to its effect on fetal hemoglobin induction in sickle cell anemia and b- thalassemia. 13. Factor V Leiden as an important cause of Budd Chiari Syndrome in this country. 14. Developing various strategies to reduce factor concentrate usage in severe haemophilia. 15. Developing prenatal diagnostic technologies in various inherited severe haemoglobinopathies, red cell eyzymopathies, coagulation disorders. 16. Developing techniques and methodologies to treat severe iso immunization and neonatal isoimmune thrombocytopenia. 17. Diagnosing fetal pathology from circulating fetal DNA in mother's blood. 18. Direct effect of EACA in reducing the effect of inhibitors in haemophilia. The above mentioned list is indicative but not all inclusive. The Institute has several patents to its credit and some of these techniques are already in routine use. One of the unique features of the Institute is its ability to train and transfer advanced technologies to various medical colleges in this country. Medical college - Kolkata, Govt.Medical College - Nagpur, NRS Medical College - Kolkata, St John's Medical College - Bangalore, Christian Medical College, Ludhiana are few of the medical colleges benefitted from this technology transfer. Strengthening of centres in the north-eastern region in immunohaematology and other areas as well as other regions under the tribal health research forum of ICMR is an on-going activity. The Institute is now looking forward to working in the backward areas of the country. The Institute plans to start a National Centre for Hemoglobinopathy Research and Training (NCHRT)” in Chandrapur town of Vidarbha region and 4 acres of land has already been acquired for this purpose. The Institute 65
  • 74. is also looking forward towards substantial expansion of its activities and areas of research once the Center for Molecular Haemtology and Transfusion Medicine (CMHT) is ready in the recently acquired land at Nahur in Mumbai. Blood Group Reference Centre (BGRC) was the early dawn of this illustrious Institute with more than 2000 research papers to its credit. Its progress towards the service of humanity through patient service, translational research, twinning programmes and training for manpower development and basic research has created a unstoppable momentum. This momentum is created by the dedicated scientists, staff and students of the Institute as also the goodwill and help of innumerable doctors and scientists in the country who in some way have contributed to its present development. Tribal Health Research Activities Trainings/Workshops Conducted 66
  • 75. State of the art laboratories 67
  • 76. P.D. Hinduja National Hospital and Medical Research Centre, Mumbai Hematology Division Shanaz Khodaiji, Farah Jijina The Hematology Division of P.D. Hinduja National Hospital and Medical Research Centre consists of laboratory hematology and clinical hematology manned by specialists in both fields. Hematology - Laboratory Medicine The Hematology section of the department of Laboratory Medicine caters not only to in-patients but to a large number of out-patients as well. Since Hinduja Hospital is a multi-specialty tertiary care hospital, the hematology lab serves as a reference centre for patients from Mumbai and other parts of Maharashtra and India. The Hematology lab offers an exhaustive menu of investigations Complete blood counts (CBC) are done on top of the line hematology analyzers which give multiple parameters for each blood cell in every sample within a minute along with flags and signals which serve as a warning for abnormalities of red cells, white cells and platelets. All such 'flagged' samples are reviewed by the hematologist and a descriptive report with advice is issued to the patient. A large variety of tests for characterizing complex bleeding and thrombotic disorders are available. These include coagulation factor assays, tests for thrombophilia and platelet function tests. Reliable monitoring of oral anticoagulation is made possible with the help of high quality reagents. Recently introduced tests are anti-Factor Xa assay for monitoring of low molecular weight heparins and gel particle immunoassay for diagnosing heparin-induced-thrombocytopenia (HIT) Other specialized investigations include study of abnormal hemoglobins by high performance liquid chromatography (HPLC) and tests to diagnose cause of hemolytic anemias. Acute leukemias, chronic lymphoproliferative disorders and other benign conditions are diagnosed from examination of the peripheral blood, bone marrow aspirates/biopsies and flow cytometry. The flow cytometry lab is equipped with a FacCanto II flow cytometer (BD) which is capable of performing 8 - colour analysis simultaneously. This is a powerful tool for diagnosis, monitoring, staging and prognosis of a large number of hematological malignancies and in the work-up of immunological disorders (HIV). We have introduced a number of other tests after due validation. These are PNH by FLAER and MRD in acute B-cell leukemias, primary immunodeficiency screening, CD34 stem cell counts, platelet antigen assay and rituximab monitoring by flow. Other applications in the pipe line include flow for MDS and platelet function disorders Molecular tests for diagnosing thrombotic disorders such as Factor V Leiden mutation and myeloproliferative diseases (JAK-2 mutations) are also available to facilitate diagnosis of these conditions. The department undertakes 3 to 4 research projects a year for MSc, PhD and DNB students under the aegis of the National Health and Education Society which is the in-house research body. Many of 21 68
  • 77. these studies have been published in national and international journals. The department added a feather in the cap by collaborating with BD to become the first clinical Centre of Excellence (PDHNH-BD COE) in the country. Under this tie-up, many training programs are conducted which benefit the aspiring as well as experienced flow cytometrists. The department has applied for and is certain of being recognized as a centre for PDCC fellowship in Hematopathology. The lab follows a strict policy of quality control. We are accredited by the College of American Pathologists (CAP) and are in the process of acquiring NABL accreditation. Consultants: Dr Shanaz Khodaiji, Dr Kunal Sehgal Clinical Associate: Dr Dia Mansukhani Clinical Hematology The clinical hematology division has two hematology consultants Dr. Farah Jijina is full time Consultant Clinical Haematologist & Hemato Oncologist at P. D. Hinduja Hospital, Mahim, Mumbai. Her prior experience includes, Professor & Head of Dept. of Hematology, KEM Hospital, Mumbai, till 2012 (total 20 years at KEM hospital, Hematology). She is also a Postgraduate teacher for super specialty, DM Clinical Hematology, MUHS. Dr. Balkrishna Padate is a full time Consultant in Haematology, Haemato-Oncology and Bone Marrow Transplantation (BMT) in Mumbai, at P. D. Hinduja National Hospital and Research Center, Mahim. He trained in Hematology in the UK. He was associated with The Royal Free Hospital, London for Haemato-oncology and BMT/SCT. He has also worked as a consultant Haematologist NHS, UK. Both consultants have daily OPDs, and all haematological disorders, both benign and malignant are seen by them. Day care, short stay and indoor facilities are all available for patient care! Both consultants also work in close collaboration with the laboratory, facilitating patient care. Both consultants are actively involved in academic activities such as teaching students and junior doctors, presenting papers at conferences and publications. A state of the art Bone Marrow Transplant Unit has been constructed and is ready. Autologous transplants in the hematology division have already started and the hospital will start offering allogenic transplant facilities very soon, under Dr Padate. A close synergy exists between the lab and clinical hematologists resulting in excellent patient care. 69
  • 78. Tata Memorial Hospital (TMH), Mumbai Haematology Services Shripad D. Banavali History Tata Memorial Hospital (TMH), inaugurated on February 28, 1941, was founded by the house of Tata, one of the leading industrialist families of India. It was later given to the Government of India, and since 1962 has been operated by the Department of Atomic Energy. TMH was merged with the Cancer Research Institute (CRI, Est. 1952) in 1966, under the banner of Tata Memorial Centre (TMC). TMC's third arm was a Clinical Research Center (CRC) established in 2005 at Kharghar, New-Mumbai. TMC is the national comprehensive cancer centre for prevention, treatment, education and research in cancer and is recognized as one of the leading cancer centre in this part of the world. In order to fulfill its objective of providing the highest standards of patient care, the center has been continuously upgrading its administrative structure and constantly upgrading its use of technology in order to deliver optimal cancer care as well as conduct research and education at a globally competitive level. As the premier cancer center in the country, TMC provides leadership for the national strategy for cancer control. Last year more than 50,000 new patients were registered at TMC. Clinical Care Surgery remains the basic approach to treatment, especially for patients with solid tumors. Nearly 6300 major surgical procedures are performed annually in 20 state-of-the-art operating theatres at TMC. Wherever possible, conservative organ-sparing surgery is performed. Nearly 6000 patients are treated with radiotherapy each year with equipment that includes state-of-the-art technology. At TMC there are 5 cobalt units, 6 linear accelerators, 2 high dose brachytherapy units, several treatment planning systems with computerized tomographic (CT) stimulators, and two Image Guided Radiotherapy units with Helical Tomotherapy (IGRT). The radiology department is equipped with ultrasonography, mammography, CT-Scanners, MRI equipment and has excellent interventional radiology facilities. The nuclear medicine department has access to the latest isotopes for nuclear imaging and possesses three Positron Emission Tomography-CT units. Since this year, TMC has gone paper-less. All the clinical data and reports are directly entered into the Hospital Information System and so are immediately available. The radiology films can be accessed on computers in the clinics through the standard system for transmitting high quality images, known as PACS system. This on- line data can also be accessed from home by the staff. TMH is equipped with an excellent microbiology laboratory, a pathology laboratory with immuno-histochemistry facilities, a hematology lab (with automated cell counters and flow cytometers), a cytogenetics laboratory and molecular biology laboratory. All the laboratories are accredited by an autonomous body established by the Indian Government called the National Accreditation Board for Testing and Calibrating laboratories. TMH was the first to introduce the concept of joint (multidisciplinary)-clinics in India in the 1980s, and in 2009, TMH was the first oncology facility in the country to introduce the concept of Disease Management Groups (DMGs). The groups presently include adult Hemato-Lymphoid neoplasms, Bone & Soft Tissue tumors, Breast cancer, Gastro-Intestinal tumors, Gynecological cancer, Head & Neck cancers, Neuro-oncological tumors, Thoracic cancers, Urological cancers, Pediatric Hematological and lymphoid tumors and Pediatric Solid Tumors. The aim of this “division of labor” was 22 70
  • 79. to ensure a team approach and provision of care in accordance with evidence-based standards and access to the full range of potential therapies for all patients, together with involvement of patients in decisions about their care, aiming for better outcomes and increased patient satisfaction. At the same time, this will also help in the advancement of science. The strategy for early diagnosis, treatment, rehabilitation, pain relief and palliative care has been established in a comprehensive and multidisciplinary approach for a total cancer care programme. There is an active medical social worker department which looks after the social, financial, travel and accommodation needs of the patients. Additionally, several voluntary non-governmental organizations (NGOs) have been working with TMH to help patients deal with the implications of the successive stages of their disease management. Adult Hemato-Lymphoid DMG In the year 2012, 3037 new patients were registered in the Adult Hemato Lymphoid Division. Of these 390 patients were registered in Acute Leukemia Clinic; 909 in Lymphoma Clinic; 240 in the BMT clinic; and, 129 in the Myeloma clinic. The total work load can be gauged by 54,769 OPD visits and 1957 admissions. The emphasis of the division was to improve the early results for leukemia and lymphoma patients by decreasing the early treatment related mortality and morbidity. Through a process of triage and constant OPD and ward supervisions, the division was successful in substantially bringing down the 100 day mortality from 222 in 2010 to 157 in 2011. The division started the first 'Registry for Epidemiology and End Result Analysis – Lymphoma (REAL_L)” initially at Mumbai level and later expanded the same at National level. 1361 patients have been registered by end of 2011. This would be very valuable in generating India related data in the future. The division has partially shifted from TMH to ACTREC in 2011 and presently has 17 in-patient beds and CML follow-up OPD there. The aim is to shift the entire Adult Hemato-Lymphoid unit to ACTREC in a new wing in the near future. The Bone Marrow Transplant (BMT) unit is already functioning at ACTREC since November 2007. About 70 transplants are done every year. Results here are amongst the best in the world with a 100 day mortality of <5% and 365 day mortality of about 25% (80% of deaths due to relapse). Presently there are 14 new DM (Medical Oncology) seats and 1 BMT Fellow-ship at TMH. All these residents rotate through this DMG. Classes for all students (residents and nurses) are conducted thrice a week. Registrars are also encouraged to participate in research projects with consultants, which include clinical studies and laboratory based projects, retrospective analysis and are also encouraged to publish during their training period. The DMG undertook a total of 54 research studies in recent years. Out of 54, 11 were student research (6 completed), 25 studies were initiated by investigators (10 completed) and 18 studies were sponsored clinical trials. In 2012 the DMG published 20 articles related to its research activity and members also contributed 8 chapters to various books Pediatric Hemato-Lymphoid DMG The important function of Pediatric Hemato-lymphoid DMG is to provide service of international standards to patients, conduct research in to novel locally-relevant therapeutic strategies and educate trainees to expand the treatment net for Pediatric hemato-lymphoid cancers in India. A total of 694 new patients were registered in 2012. There were 400 new cases of acute leukemias and 123 new cases of lymphomas which are among the highest seen by any Pediatric cancer unit in the world. However this number does not give justice, as majority of these require intense, curative and prolonged therapies with multiple outpatient and inpatient visits. This is reflected by the nearly 34,718 OPD visits in 2012 (average OPD of 150 patients every day). The division treated more than 400 acute leukemia patients and 123 new cases of lymphoma in 2012, which is the largest number by any one center throughout the world. 71
  • 80. PHLG has set up an organized psychosocial-economic support group to provide holistic care of children and their families during treatment consisting of social workers, data managers, counselors, psychologists, and multiple NGOs to ensure accommodation, travel support, emotional & nutritional help, transfusion support and education etc. The establishment of social support group has dramatically decreased the abandonment rates (TR&A) from >20% in 2009 to 9.5% in 2010. This has further reduced to 5% in 2012. This highly successful model of support won the international society of Pediatric Oncology (SIOP) award at London meeting in 2012. The overall induction mortality rates in leukemias have reduced from 8% in 2010 to 4.5% in 2012 by a process of triage, constant supervision & aggressive management of treatment related complications. Number of patients being treated as per standard TMH protocols has improved from 79% in 2010 to 89% in 2012 with reduction in the rates of TR&A and second opinions. The Pediatric cancer registry maintains details of epidemiology and outcomes of all Pediatric hemato-lymphoid cancers. The disease free survival amongst BMT patients is 70% and transplant related mortality is 6%. The division has developed locally relevant, risk stratified, cost effective protocols and all pediatric cancer patients are uniformly treated on protocols. The overall survival has improved up-to 70% to 90% for most childhood hematological cancers at TMH. Presently there are 2 new DM (Pediatric Oncology) seats and 1 Pediatric Oncology Fellow-ship at TMH. All these residents rotate through this DMG. Classes for all students are conducted thrice a week. Registrars are also encouraged to participate in research projects with consultants. The DMG undertook a total of 43 research studies in recent years. Out of 43, 10 were student research (7 completed), 30 studies were initiated by investigators (9 completed) and 3 studies were sponsored clinical trials. In 2012 the DMG published 15 articles related to its research activity and members also contributed 6 chapters to various books. 72
  • 81. Tata Memorial Centre, Mumbai Overview of BMT Programme in ACTREC Navin Khattry, S D Banavali The Bone Marrow transplant (BMT) unit of Tata Memorial Centre started in 1983 at Tata Memorial Hospital (TMH), being the first hospital in the country to perform bone marrow transplant. Since then approximately 660 transplants have been performed both in adult and pediatric patients of which 55% have been allogeneic transplants. Though most transplants have been performed in patients suffering from hematological malignancies such as acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and lymphomas, approximately 10% of transplants have been performed for benign diseases such as aplastic anemia and thalassemia. The transplant unit shifted from TMH to our new research center at ACTREC, Kharghar, Navi Mumbai and was commissioned on 14th November 2007. This is a six bedded BMT unit, with each room having terminal HEPA filter. Approximately 320 allogeneic (45%) and autologous (55%) transplants have been performed in our new centre. Since last 4 years, more than 50 transplants are done each year as shown in Fig.1. Encouraged by the initial success and in order to cater to the needs of those who do not have an HLA- matched sibling, an ambitious program of Matched Unrelated Donor Transplant was successfully initiated in November 2009, using HLA matched stem cells from international Unrelated Donor Registries. Similarly unrelated cord transplant programme was started in April 2010. And recently we have begun doing haplo-identical transplants for patients who do not have a fully matched related or unrelated donor. Similarly a new review and funding mechanism was initiated in 2009 for offering free or greatly subsidized BMT as a life saving measure for deserving poor patients. More than 60 such autologous and allogeneic transplants have been done since 2009 under this scheme. The BMT unit is also involved in training of DM students as part of their 3 year Medical Oncology curriculum. Each student spends approximately 4-6 months in this unit and gets acquainted with 23 Figure 1: Number of autologous and allogeneic transplants per year since March 1983. 73
  • 82. various conditioning protocols used and post transplant care of patients. They are also encouraged to do research projects during their rotation. BMT Fellowship of 1 year for post DM students of Medical Oncology and Hematology has also been recently initiated. Various research protocols have been initiated over the last few years in ACTREC. Transplant medicine has moved to the next level with various methods of graft engineering being attempted to reduce toxicity and improve disease free survival. The unit plans to initiate several translational research studies that will lead to clinical benefits to our patients in future. Outcome data in various diseases since November 2007- May 2013 Since November 2007 – May 2013 approximately 294 transplants have been done in ACTREC as shown in Fig 2. AML and ALL comprise majority of allogeneic transplants while Hodgkin's disease and multiple myeloma comprise the majority of autologous transplants. At a median follow up of 24 months, the overall survival (OS) and relapse free survival (RFS) of all patients is shown in Fig 3. Figure 3: OS and RFS of all patients and according to type of transplant. Figure 2. No. of transplants in various diseases from November 2007- May 2013 74
  • 83. The OS and RFS of patients with AML and ALL are shown in Fig 4. Similarly the OS and RFS of patients with Hodgkins and Non- Hodgkins lymphoma, multiple myeloma and aplastic anemia undergoing autologous and allogeneic transplants are shown in Fig. 5 and Fig. 6 respectively. Figure 4: OS and RFS of patients undergoing allogeneic transplant for AML and ALL Figure 5: OS and RFS of patients undergoing autologous transplants for lymphomas. Figure 6: OS and RFS of patients undergoing autologous transplants for multiple myeloma and OS and graft failure free survival of patients undergoing allogeneic transplant for aplastic anemia. 75
  • 84. Mortality and Relapse Since 1983, there has been a steady decrease in the 100 day and 365 day mortality of patients in each decade in our center. The mortality has decreased from approximately 50% in the first decade to less than 10% from November 2007 onwards. This is shown in Figure 7. The overall transplant related mortality (TRM), autologous and allogeneic TRM respectively, relapse rate and cause of death in all patients undergoing transplant in ACTREC is shown in Fig 8. The Way Forward After reestablishing itself in ACTREC, The BMT Programme of Tata Memorial Center is poised to venture into more sophisticated cellular therapies and do meaningful clinical research to further improve outcomes of transplant and also improvise ways to decrease cost of transplants. Figure 8: Incidence of Transplant Related Mortality, Relapse and cause of Death Figure 7: Decade wise 100 and 365 day mortality since March 1983- May 2013. 76
  • 85. Armed Forces Medical College (AFMC), Pune Hematology Services Armed Forces Hematology Group The Armed Forces Medical Services (AFMS) is the largest Haematology network in the country providing comprehensive medical care to almost one crore people comprising of, all serving and ex- servicemen along with their families belonging to the triservices from the Army, Navy and Air force. At present Hematology centres are fully functional at Army hospital Research and Referral (AHRR), New Delhi, Command Hospital Southern command (CHSC),Pune, Armed forces medical college (AFMC),Pune, Indian Naval Hospital Ship (INHS Asvini), Bombay, Command Hospital Eastern command (CHEC),Kolkata and Command Hospital(Air Force), Bangalore. The centres at Delhi and Pune are the larger Haematology centres comprising of 4-5Clinical Haematologist and two Haematopathologist besides a back-up of Molecular lab and state-of-the art Transfusion centres providing component and stem cell apheresis. The centre at Bombay is a medium sized one having 2- 3 Clinical Haematologist besides a Haematopathologist where-as the centres at Kolkata and Bangalore are smaller with the facility of a Clinical Haematologist and back-up of Haematopathology and molecular set-up. BMT centres are available in both large and medium sized centres. A humble beginning was made In Nov 1993 when Lt Col Velu Nair first started the Department of Clinical Haematology at the Army Hospital Delhi Cantt. It was started with 10 beds situated in acute medical ward. However over a period of three years the number of beds was increased to thirty and the Clinical Haematology Department became fully functional with both in-patient and out-patient departments, under his stewardship; The center had a Single Consultant till 1997.Presently he is a Maj Gen and the Dean of the prestigious AFMC.Initially patients of Acute Leukaemias, Bone marrow failure syndrome (including patients of MDS and Aplastic anaemia), those suffering from deep vein thrombosis and other thrombotic disorders, bleeding diathesis including Haemophilia, ITP as well as various haemolytic disorders were managed in this centre. Intensive chemotherapy for Acute Leukemia was also initiated as also immunomodulatory treatment for hypoplastic anaemias.The Dept was functional in the new location in May 1997 at Army Hospital(R&R). A second Consultant, Lt Col Rajat Kumar, was posted in late 1997. He too made a significant contribution to the Dept and took 24 Maj Gen Velu Nair 77
  • 86. premature retirement in 2003 and joined AIIMS, New Delhi as Professor of Haematology. Lt Col Ajay Sharma joined the Dept in 2003. He is presently H e a d o f t h e D e p t o f Haematology at Army Hospital(R&R) in the rank of a Brigadier and has strived hard to upgrade various facilities in the department. Presently Col Jasjit Singh and Lt Col Sanjeevan Sharma are posted as Clinical Haematologist. Surg/Capt Satya Ranjan Das, Lt Col Rajan Kapoor, Col Tarun Varma and Lt Col Vinod Raghavan have all worked in this dept. Majority of these clinical Haematologists have been trained at CMC Vellore while three have trained at AIIMS New Delhi. Transfusion support was catered by Armed Forces Transfusion Centre (AFTC), where, in the beginning, a V50 hemonitics instrument was used for platelet apheresis. State-of-the-art component therapy was the backbone of the Haematology center and AFTC provided a round-the-clock 24hrs service. Some of the prominent Haematopathologist in this center during that period included Rear Admiral Monisha Jaiprakash who was then a Lt Col, Brig PS Dhot, Brig Khetrapal, Col Saha and Brig Salopal and Col Aloke Sen. During Dengue epidemic in 1996 Department of Clinical Haematology AHRR firmly established itself as a leader in Haematological practices in Delhi with successful management of more than five hundred cases of Dengue including a large number of Dengue hemorrhagic fever. An advanced MCP 3P Hemonetics and several horizontal platelet agitators were procured and installed at AFTC, Blood bank at AH(R&R) as also in the transplant unit. In 1997 AHRR became fully functional in the new hospital location. Forty five beds were allotted for Haematology patients which included thirty male, ten female and five paediatric beds. At the same time a neutropenic unit was also created. In the same year planning for high efficiency particulate air (HEPA) filtered three bedded Bone Marrow Transplantation (BMT) with six bedded step-down unit was initiated which fruitified in 2002. Additional equipments in form of apheresis machine (, Kobe, Baxter Haemonitics) and cryopreservation facilities (liquid nitrogen and -86 C deep freezers) were installed. Till date approximately 400 transplants (65% allogeneic) have been performed with 69 - 70% overall survival. This included allogeneic, autologous as well as cord transplants. BMT initially was started with autologous transplantation in Multiple Myelomas and Lymphomas and subsequently, allogeneic BMT was started in diseases like AML, CML, Thalassemia Major and Aplastic Anemia. Allogeneic BMT has also been performed for some rare genetic disorders including Fanconi anaemia, Diamond Blackfan anaemia and Adrenoleucodystrophy. Haematopathology Lab at the erstwhile Army Hospital Delhi Cantt, located near Kirby Place was popularly known as the A-4 lab. This was set up in the early 1990s by Lt Col Ramji Rai who later retired as the Director General Medical Services in the rank of a Lt Gen. This lab functioned as a Leukemia diagnostic lab employing morphological and cytochemical approach to the diagnosis of Acute Leukaemias. This lab had all the facilities for haemolytic and coagulation work-up by manual method. The lab was amalgamated with Command Pathology Laboratory of Western Command in 1999. The last Pathologist to be posted at A-4 lab was Maj T Chatterjee who is currently Professor and Head Dept of Immunohaematology, AFMC, Pune in the rank of Col. The Haematopathology Lab at Army Hospital (Research& Referral) was set up in 1996. Lt Gen Ramji Rai, Col VK Kumar, Col DK Mishra, Col Jyoti Kotwal, Col T Chatterjee, Col B Asthana and Col Prosenjit Army Hospital (Research& Referral) Delhi Cantt 78
  • 87. Ganguli are some of the Haematopathologist who have contributed to the excellent growth of this fine dept. Lt Col Velu Nair and Lt Col Mishra initiated flowcytometry in early 2000 which was further expanded by Col J Kotwal and Col T Chatterjee. Flow cytometry contributed significantly to augment diagnostic accuracy and estimations for MRD in hematological malignancies. The state-of-the-art Molecular lab was set up in 2003 under the guidance of then Professor and Head of AH(R&R), Col GS Chopra who is a renowned Transplant Pathologist and presently holding the appointment of Lt Gen in the Army Medical Corps. Col Jasmeet Kaur who joined the Dept in 2006 helped to establish chimerism study for BMT. Latest techniques in Molecular Haematology like BCR-ABL, JAK2 Mutation, PML-RARA RQ-PCR analysis as well as MRD were set up subsequently by Col DK Mishra, Col Jyoti Kotwal and Col T Chatterjee. Col Prosenjit Ganguli was instrumental in setting the stem cell lab in the Dept.Today this lab is considered one of the finest Haematopathology Labs in the country. The AH(R&R) imparts training to all Post-graduate students in Medicine. Regular courses are carried out for paramedics to make them multifaceted and proficient in apheresis, care of PICC, Hickman, administration of chemotherapy and blood products as well as skilled assistants in bone marrow aspiration, biopsy and intrathecal therapy. The team of paramedics is also trained in Bone Marrow harvest for transplantations. To start with there were only 3 paramedics, which has steadily increased to a panel of of 30 Haematology trained paramedics who are invaluable to the organization. DM students in hematology were rotated in AHRR BMT centre and students from other centers also visited this unit. Research has been a key thrust area of work and multiple projects funded by various agencies including Armed Forces Medical Research Council (AFMRC), DBT and ICMR have been successfully undertaken for projects on Aplastic Anaemia, Acute Leukemia, conditioning protocol in BMT, thrombosis including thrombosis in high altitude areas and published in peer-reviewed journals. Haematologist from armed forces who were “Presidents of the Indian Society of Haematology and Blood Transfusion” include Brig (Retd) PS Dhot, Maj Gen Velu Nair and Col (Retd) DK Mishra. They also have contributed significantly to Delhi Society of Haematology in all its academic and organizational activities. Brig PS Dhot and Maj Gen Velu Nair were its past Presidents and the present designate is Brig Ajay Sharma. Col T Chatterjee is currently an Executive Body Member of the ISHTM. He has also been the Secretary of DSH as well as its Treasurer. Maj Gen Velu Nair, AVSM, VSM** is a Co-Chairperson of the stem cell task force of DBT and has been instrumental in raising the standards of research in armed forces by being part of various multi centric trials. He is also a member of the ICMR stem cell task force and a part of the ICMR group which formulated the guidelines for stem cell research in the country. He and the armed forces team has undertaken numerous collaborative projects with ICMR, DBT, DRDO including numerous multi center projects and trials in the field of stem cells, leukaemia and Bone marrow failure syndrome. The Dept of Haematology at Armed Forces Medical College (AFMC) & Command Hospital Southern Command (CHSC) Pune has been functional since 1996 and includes a BMT unit. AFMC is a premier medical college and has been consistently ranked as one of the best medical colleges in India (India Today survey on top medical colleges). The department is expected to expand with the construction of new ultra-modern Hematology centre, construction of which has already been started. Department of Hematology is involved in training of undergraduates (UG) and postgraduates (PG) in Medicine, many of them who have gone on to do their thesis on hematology topics. Our UG and PG have consistently made a mark in various local and national hematology quiz programmes. Col VD Charan, Col H Motwani and Brig Ajay Sharma are some of the prominent Haematologists who have served in Pune complex. Currently Lt Col Rajan Kapoor is posted at this centre with Lt Col Vishal Sondhi as Paediatric Haematologist. Brig Ajay Sharma performed the first allogeneic transplant in a Thalassaemic child in this center in 2002. The Dept of Immunohematology & Blood Transfusion, AFMC, Pune is a unique Institution by itself. It is the oldest Dept of AFMC and has started a MD course in Immunohaematology& Transfusion Medicine since 2008. 79
  • 88. In April 1942, two British Base Transfusion Units with their associated field transfusion services were made available to India. These transfusion units were responsible for the production of Crystalloid solutions and providing blood transfusion. Soon after the World War II was over, the Blood Transfusion Units were disbanded and a centralized Army Transfusion Centre was established in Poona to cater t o t h e t r a n s f u s i o n requirements of the Army. T h e D e p a r t m e n t o f Transfusion Medicine was formed on 01 May 1948 by incorporation of the Army Transfusion Centre with Armed Forces Medical College (AFMC). The first HOD was Padmashri Lt Col GWG Bird, who discovered Lectins. Lectins are seed extracts which are very useful in blood banking. The department manufactured and supplied all resuscitation fluids. It ran a blood bank for Military Hospitals located in Poona and even extended its services to civilians in times of need. It manufactured dry plasma and blood grouping sera for the Armed Forces, which was discontinued in 1972. It was also responsible for the preparation and assembly of all transfusion sets for supply to hospitals and field units. Since 1997 the manufacture of Crystalloids at has been completely stopped. Today it has a state-of-the art licensed Blood Bank with component & apheresis facilities. In addition, it regularly undertakes plasma exchange therapy, prepares single donor platelet concentrates, and harvests haematopoietic stem cells for stem cell transplantation in various haematological and non- haematological conditions. This dept. also runs a state of the art coagulation & thrombophilia laboratory. Eighty registered Thalassemic patients routinely take blood transfusions from the blood bank. To facilitate detection of haemoglobinopathies, HPLC facility for hemoglobin assay is available. The department has the unique distinction of conducting a three year MD course in the subject Immunohematology and Blood Transfusion since April 2008. In addition this department has been nominated as the center for conducting DNB practical examination consecutively for the last three years. It is the only center in the country which conducts DNB examination for the subject in Immunohematology & blood transfusion. Presently Col Tathagata Chatterjee is the Professor& Head of this Dept with Col Joseph Philip and Surg/Cdr RS Mallhi as faculties. Approx. 40 blood donation camps are organized every year. These include both voluntary blood donation camps organized in civil institutes /firms/organizations, & in army establishments. The department is focused on advancing the science and practice of transfusion medicine and cellular therapies by implementing complete automation and computerization, setting up pathogen inactivation facilities, nucleic acid testing for screening for infectious diseases, stem cell research capabilities, and long term storage of frozen RBCs. Some of the prominent Haematopathologist to have headed the Dept includes Brig Rathin Dutta, Maj Gen Octania, Col AK Dutta, Brig Hassan, Col GLN Swamy, Rear Admiral Monisha Jaiprakash, Col Harsh Kumar, Brig RS Sarkar, Col Lahiri and Col Machwe. Department of Hematopathology AFMC is well equipped with diagnostic facilities which include multi- 80
  • 89. color flow cytometry, cytogenetics and molecular diagnostics for various benign and malignant hematology disorders. Col DK Mishra, Col Jyoti Kotwal, Col T Chatterjee and Surg Capt Manu have all worked in this Dept and helped train UGs, PGs and paramedical staff. The Dept of Haematology at INHS Asvini has Surg/Capt Satya Ranjan Das who is credited with starting the first Autologous BMT in that centre. Surg/Capt Gaurav Narula, a Paediatric Haematologist was posted in this unit and has currently retired and is a Professor of Haematology at TMH Bombay. Lt Col Suman Kumar Parmanik is the Clinical Haematologist at Command Hospital, Kolkata and is consolidating the pioneering works of Maj Gen Velu Nair, Col H Mothwani and Col T Chatterjee who had all served in that Hospital earlier.Lt Col Tarun Verma is the Haematologist at Command Hospital, Lucknow and he has also performed Autologous Stem cell transplants both at Lucknow as well as at Northern Command Hospital at Udhampur. Over the years many hematologists have contributed towards growth of hematology in Armed Forces. Maj Gen Velu Nair, AVSM, VSM** who is presently Dean of AFMC has been the father figure to all hematologists of AFMS. The frequent change in appointments as a result of the transferrable job in the armed forces has been perceived as the limiting factor by the environment. On the contrary we in the armed forces feel strongly that this “change is the pillar of our strength”. Change invariably invites new ideas, policies and research areas, hitherto, untread. The unique quality of networking, communication and registry within the armed forces has ensured mainstream continuity of all policies. Lt Col GWG Bird 81
  • 90. Sahyadri Speciality Hospital, Pune Department of Haematology Shashi Apte From a relatively small Haematology laboratory and OPD in 1999, to a composite Department of Haematology, at SSH 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. Sahyadri group has now 8 hospitals in Pune with 950 beds. 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. To impart training and mentor the next generation of academic hematologists, Diplomate of National Board (DNB) program started in 2012. Even before DNB program started we trained 9 candidates at the dept. Dept works in close liaison with premier institutes like NCCS, IISER and Pune University in field of basic research. SSH got NABH accreditation and Laboratory got NABL accreditation. Staff, faculty and Residents Clinical Hematologists 1) Dr. S. Apte , MD ( Int Medicine ), FRCPA ( Australia ) 2) Dr. S .Melinkeri, MD ( Int Medicine ), DM ( CMC, Vellore ) 3) Dr. S. Kannan , DNB ( Int Medicine ), DM ( CMC, Vellore ) 4) Dr. Akash Kalro, MD ( Int Medicine ), FRCPA ( Australia ) DNB ( Hematology ) Residents, Started in 2012 1) Dr. Abhishek Dudhatra - 2nd Year 2) Dr. Girish Kamath - 1st Year 3) Dr. Nidhi Chaturvedi - 1st Year Non DNB Hematology Residents, working for more than 4 years 1) Dr. Sneha Kurhade 2) Dr. Aditi Joshi Hemato - Pathologist 1) Dr. Vijaya Gadage, MD ( Path ) 2) Dr. Sushil Agarwal, MD ( Path ) 25 82
  • 91. 3) Dr. Shital Joshi , MD ( Path ) Past Faculty : Dr. Anjali Kelkar ( 1999 - 2012 ) Dr. V. Melinkeri ( 2008 - 2012 ) Histopathologist 1) Dr. Sudhir Kambale, MD ( Path ) 2) Dr. P. Kanitkar, MD ( Path ) 3) Dr. V. Ingale, MD ( Path ) Molecular Biologist 1) Dr. Sonali Sanghavi, MD PhD Clinical Geneticist 1) Dr. Chaitanya Datar, MD ( Pead ) Cytogentecist 1) Mrs. S. Vaidya, MS 2) Dr. A. Babarekar, PhD Transfusion Medicine 1) Dr. Smita Joshi, MD 2) Dr. Purnima Rao, PhD MIcrobiology / Mycology 1) Dr. M. Kavathekar, MD Physiotherapy 1) Dr. Rohini Dange Clinical Trial Co-ordinators 1) Dr. Anagha Parakhi 2) Dr. Sucheta Wakekar Data Manager 1) Mrs. Dipti Khedekar Dept Secretaries 1) Amruta Sane 2) Ajit Wanjale Total Technicians : 112 24-Highly trained and competent senior technicians man the various stations in the laboratory and transfusion services for bench work. II. Education Department of Hematology, SSH started the DNB course in Hematology of the National Board of Examinations in 2012, the second such course in the country in the superspeciality of Hematology. It is equivalent to DM in Hematology. 83
  • 92. 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 IIIA. Clinical Hematology services Outpatient services are being run six days a week involving 3 consultants, around 16000 patients attended Hemat OPD in 2012. Indoor facility is in SSH, 4000 patients were treated on IPD basis. 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. We are a referral center for bleeding disorders. 902 various congenital bleeding. Disorder patients are SSH is a center of excellence for both autologous and allogeneic stem cell transplants including the umbilical cord blood transplants. We are a non network unit status sanctioned by NMDP, USA IIIB. 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 10000, Elite Pro, ACL 7000, Electrophoresis equipment Chorus, ELISA system, Flowcytometers FC 500. Routine and special investigations Complete blood counts Haemorrhagic disorders PT, APTT, TT, All Factor assays, vWF studies, Platelet function studies including platelet receptor studies, 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. The Chronolog Dual-Channel Platelet Aggregometer Thrombophilia Tests for antiphospholipid syndrome and lupus anticoagulants: APTT with lupus sensitive reagent, APTT– dependent inhibitor scree, 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. 84
  • 93. Molecular assays Mutations of Factor 5(Leiden), Prothrombin gene mutation, MTHFR genes, JAK2V617F, F12 mutation HPLC and Hemolytic disorders Screening/testing for beta-thalassemia & hemoglobinopathies by HLPC and hemoglobin electrophoresis at alkaline & acid pH are routinely done. Very busy Beta Thal screening program involving schools, colleges and pre employment program with companies 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. Running B thal screening program for schools/colleges and industry 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. Flowcytometry FC 500 ŸLeukemia and lymphoma immunophenotyping (Acute leukemia panel, ŸCLL panel, Lymphoma panel). ŸMRD monitoring ŸMultiple myeloma ŸMyelodysplastic syndrome ŸFour color single tube CD4 & CD8 counts ŸEnumeration of B-, T-& NK cells. ŸPNH panel extended panel ŸCD34 enumeration based on ISHAGE protocol. ŸCD4/CD8/CD25-FOXP3 analysis ŸFoetal RBC in maternal circulation - Project Molecular Haematology Qualitative and quantitative assays for BCR-ABL. TEL-AML1, PML-RARa, JAK2, FLT-3 (D835 & ITD) mutations, NPM-1 mutation, FLT 3ITD RUNX1-RUNX1T1, CBFB-MYH11, MTHFR, Factor V Leiden and Prothrombin gene mutations. Started Telomere length assays. Autoimmune Markers: ANA-3 (Western blot), ds-DNA, p-ANCA, c-ANCA by ELISA. Electrophoresis: Serum protein electrophoresis, Immunofixation electrophoresis, Urinary protein electrophoresis. 85
  • 94. IV. Research projects 1. Completed 1. MRD for acute Leukemia by TCR gene rearrangement and Heavy chain 2. A comparative study of bone marrow flowcytometric immunophenotyping and molecular technique for APML MRD 3. Fludarabine in SAA 4. Arsenic Trioxide in APML 5. Joint replacement surgery in Hemophilia 6. Low dose factor replacement for surgery in PWH 7. Endurance v/s Muscle strength in PWH 8. Coronary artery diseases in congenital bleeding disorders 9. Flu Cy conditioning in SAA SCT 2. Ongoing projects 1. RQ PCR BCR ABL major at 0,3,6,12,24 months and comparison with EUTOS and Sokalscore 2. Drop in CD4/CD8 conts and rise in Neutrophils and outcome of Acute ITP in adults 3. Day 8 steroid response and co relation of D14 and D35 MRD by Flow in ALL 4. Flu Cy conditioning and Post Transplat Cy in SAA SCT 5. Auto PBSCT in Auto Immune diseases 6. Impact of Telomere length in CML and response to TKI therapy 3. Clinical global trials Hematology dept is involved in 18 global trials for Hematological disorders Clinical Trial unit of the dept successfully passed the audit by US FDA in 2012 Accreditation: The laboratory is NABL accredited The Dept and Sahyadri Speciality Hospital is NABH accredited Quality assurance: Dept and laboratories participate in EQAS programs JACIE accreditation is on way 86
  • 95. Sher-i-Kashmir Institute of Medical Sciences, Sri Nagar Department of Clinical Hematology M. I. Quadri Ex-HOD/Prof Clinical Hematology & Transfusion Medicine This institute was conceived with the objective of providing facilities of specialized medical care and to develop super specialties that would provide tertiary health-care. Also to provide need oriented education in medical sciences and clinical research. The construction of the Institute commenced in the year 1976. The Institute was partially commissioned on 5th December 1982. By an Act of Legislature on 19th August 1983, Sher-i-Kashmir Institute of Medical Sciences was granted a Deemed University status. The department of Clinical Hematology was one among the earliest departments which were commissioned & operational in 1982. I had a distinction of being first faculty member of the Institute. Initially for few months we started hematology laboratory work by manual techniques. Within 6-8 months automation started. This department was first to have Hematology Analyzers (Coulter Hemo W, Thrombocounter, S7 & so on) in India. Within 2 years of commissioning of Institute, the department of Clinical Hematology had complete automation in all its sub-specialties. The department was running 2 OPDs in a week. As per policy, faculty positions were open to any body having MD Pathology, MD Medicine & MD Pediatric with 2 years experience in Hematology/Clinical Hematology. The department was so attractive that 4 Senior Residents with MD Medicine, MD Pediatrics & MD Pathology joined the department. We had 12 beds for admission & these were always full & there was need for expansion. We started treating all Leukemias/lymphomas who were otherwise travelling to Delhi & Mumbai (Bombay then). 3 of our ALL patients are living with children (>25 years survival). Among various reasons for quick recognition & advancement of Department was the trust of Administration especially Prof. A.M Jan (Vice-chairman Governing Body) on our abilities & talent. We had first CME on Nutritional Anemia in 1984. We published more than 30 research papers in first 10 years. We were able to secure a very interesting project from ICMR also. One among best senior residents & later on faculty member was DR. Ramesh Pandita. He contributed immensely to the department. The department suffered maximum during militancy & my senior residents & faculty migrated. I had to look after many departments in addition to my own department during those days. Finally I also had to leave in 1994. In spite of this loss, the department got new faculty & they are working with zeal. They have regained the trust & confidence. Presently the treatment of hematological diseases at this department is at par with other reputed centers in India. The faculty is working towards establishing the facility of Bone Marrow transplantation. Stem Cell Transplant is available in sister department of Medical Oncology. Dr. Samoon Jeelani (retired recently), Dr. Javeed Rasool, Dr. Aleem Jan & Dr. Geelani have enriched the department as faculty members. Faculty with hemato-pathology background will be soon joining the department. 26 87
  • 96. Clinical Hematologists/Hematologists were almost non-available 10 years back but now there are more than half a dozen of Hematologists in the state. I am sure that Department of Hematology will be one of the excellent centers for Blood Diseases in coming years. 88
  • 97. Christian Medical College, Vellore The Department of Haematology Alok Srivastava The beginning The department of Haematology was created in its current form in this institution in the late 1980s. However, hematology services and research have existed in the institution from the 1950s. Starting in the late 1950s and early 1960s, there was significant interest in two aspects of hematology - nutritional anemias and hemostasis along with transfusion services. These were the areas that were relatively easily recognized clinically and for which there were major needs for services at that time. Starting with Dr. Selwyn J. Baker, who joined the institution in 1955 and set up the beginnings of the transfusion service as well as laboratory hematology, it was Dr. Robert Carman who joined in 1963 and truly expanded this service. The detailed and systematic evaluation of disorders of hemostasis that was done at that time was indeed remarkable. CMC was one of the few places in the country where factor assays could be done in those days. Later on, further clinical services were developed under the guidance of Dr. B.M Pulimood from the 1970s, including the treatment of hematological malignancies, while Dr. Baker went on to research nutritional anemias along with Dr. Sheila Pereira of the pediatrics department. In the laboratory, it was the combination of Dr. Ramani Pulimood, Dr. Annie Sudarsanam and Dr. Uma Khanduri who created one of the most advanced and high quality laboratory hematology and transfusion medicine service available in the country at that time. They not only provided diagnostic services but also advised general physicians and pediatricians on the evaluation of patients with difficult to diagnose anemias and bleeding disorders. Questioning what was in the literature and research was also an integral part of this service. The department and its development On this background and heritage of a fairly wide spectrum of laboratory and clinical hematological services being provided by a variety of extremely good and committed team in different departments, it was Dr. Mammen Chandy, who then tried to bring all the clinical services together from1983, after completing his training in hematology. This also included a lot of the pediatric hematology services, some of which were managed in conjunction with colleagues from the child health services for very small children (less than 2 years). After functioning for a few years from the general medical department, in the late 1980s, a separate department of Haematology was created, as it stands today. He was joined by Dr. David Dennison in 1986 while I joined the team in 1987. In the first 10 years or so, we concentrated on developing the highest quality of clinical services. The aim was to consolidate the work that had already been done and add to it in a way that would build and provide for a complete hematology service. We initiated contemporary protocols for acute leukemias, started a systematic clinical service for bleeding disorders, particularly with respect for surgery for those patients, which at that time was hardly done anywhere else in the country. The first bone marrow transplantation was done in 1986. Even though there were very few people, the emphasis on research continued. We have always believed that our main strength will be the people we have. By the early 1990s, we had three full time trained faculty in the department but the numbers of patients were increasing all the time. We were very fortunate to have some excellent people who worked in the department at that time for 27 89
  • 98. their training and in the process helped our services as well. These include, Major Velu Nair and Dr. Shashi Apte, both of whom have subsequently gone on to play major roles in hematology in India. Current faculty Recognizing our own need for qualified clinical faculty and that in the country, we initiated the first DM training program in Clinical Haematology in the country in 1999 after overcoming several challenges. Three people who had joined the department in the mid to late 1990s, Dr. Vikram Mathews (1996), Dr. Biju George (1997) and Dr. Auro Viswabandya (1999), then went on to complete their DMs in 2001, 2002 and 2004, respectively, in the first three batches. They now form the pillars of the clinical service. The team has grown further with Dr. Aby Abraham joining the faculty after completing his training in 2009. Other junior colleagues work in the department for shorter periods. Dr. Mammen Chandy retired from the institution in 2011. It was our aim to not only develop clinical services but also molecular genetics for these services and research, so as to cover all aspects of hematology to contemporary standards. With our first major research grant in 1993, we established a genetics and flow-cytometry laboratory in 1994. Around that time, we also initiated a PhD program in the department. Dr. B. Poonkuzhali and Dr. R.V. Shaji who had joined the department from the basic science stream were the first two PhD candidates. They completed their PhD in 1999 and 2001, respectively and became faculty in the department after that. The scientific faculty grew further when Dr. Eunice Sindhuvi and Dr. Jayandharan G.R. joined after completing their PhD in 2006 and 2008, respectively. Together, these faculty have helped consolidate and expand the molecular genetics platform into what today is the largest such service in the country in a medical institution. Supported by laboratory hematology colleagues from the Department of Immunohematology and Transfusion Medicine, Dr. Dolly Daniel, Dr. Sukesh Nair, Dr. Joy Mammen and Dr. Usha Sitaram as well as other colleagues in that department, we form a fairly large group of people who now provide the largest comprehensive hematology service in the country. Given these numbers of faculty and the infrastructure that we have, indeed, anything less would be unacceptable! The close collaboration that was established more than 50 years ago between faculty in the various clinical departments and laboratory, continues today. Apart from our services and teaching programs, another example of this collaboration is the joint external quality assessment program that we provide to the country for tests of hemostasis, transfusion medicine and molecular genetics. (www.cmc-eqas.net) Clinical services The clinical services provided by the department of Hematology are indeed very wide, covering all aspects of adult and pediatric hematological diseases. We cater to about 30000 patients in the out- patient clinics and about 3000 in-patients every year. We run the largest hematopoietic stem cell transplant (SCT) program in the country performing about 150 allogeneic and 50 autologous SCTs every year. Unfortunately, this is still inadequate for the demands that exist as our waiting list for elective transplants is nearly 2 years. There are comprehensive clinical services for hematological malignancies with a special focus on the treatment of acute promyelocytic leukemia with arsenic trioxide, an extremely cost-effective treatment with excellent results.The department has spearheaded this work in the country with colleagues from other institutions in what is perhaps the only multicenter clinical trial in acute leukemia in the country so far. This led to local manufacture of this drug making it rapidly available in the country at very affordable costs. We have also developed a multidisciplinary comprehensive care team for the management of hereditary bleeding disorders which are particularly common in southern India due to consanguineous marriages, including carrier detection and prenatal diagnosis. This work also has major international recognition. For hemoglobin disorders, we provide the full range of care from prenatal diagnosis to stem cell transplantation. The details of all the clinical and laboratory services are available on our website. (www.cmchaematology.org) 90
  • 99. Laboratory services The clinical service is backed by a very wide range of molecular genetics, cytogenetic and flowcytometric laboratory services that have been developed within the department of Hematology. These include genetic diagnosis for a wide range of hemoglobin disorders, hereditary bleeding disorders as well hematological malignancies such as acute and chronic leukemias, lymphomas and plasma cell dyscrasias as well allogeneic transplant related services. Without this support from molecular hematology laboratories, we would not be able to provide the quality of clinical care that we wish to provide. These services have been developed over the last two decades by the clinical and laboratory faculty of the department as mentioned above. Given the importance of cytogenetics in the management of hematological malignancies, we have also established a cytogenetcis laboratory in the department for karyotyping and fluorescent in-situ hybridization (FISH). Dr. Vivi Srivastava from the Cytogenetics unit helps the department for this service. Training Given the paucity of trained personnel in the country in hematological sciences, we have considered it our responsibility to develop appropriate training programs for different needs. As mentioned above, we initiated a PhD program in basic medical sciences with a focus on hematological diseases in the mid 1990s. After a prolonged pursuit through the approval systems in the country, we finally initiated the first DM (Clinical Hematology) training program in India in 1999. We now take four students every year. In addition, we have a post-doctoral fellowship program for those wanting to acquire expertise in diagnostic molecular genetics after an MD in Pathology or related subjects. We also have a technical training program for graduates in life sciences to acquire skills for techniques in molecular genetics. Apart from these certified training courses, we have also trained a large number of physicians in different aspects of clinical and laboratory hematology. They now provide these services across the country. To help familiarize MD (Medicine, Pediatric s and Pathology) students in the country with the scope of hematology, we conduct an annual CME program for these students. To help secondary hospitals develop basic hematology services or enhance them, we have an annual program where we encourage small teams of clinical and laboratory physicians / technologists (including blood bank) to come together for training for a week. A more focused training program on comprehensive care for people with hemophilia and other hereditary bleeding disorders is also conducted one a year. The department is also recognized as an International Hemophilia Training Center of the World Federation of Hemophilia (http://www.wfh.org/en/page.aspx?pid=831) since 1998. Research We believe that we will only be able to improve and maintain the quality of our service that we provide if we are continuously engaged in research - both clinical and laboratory. Towards clinical research, we have two approaches. The first is to conduct or participate in prospective clinical trials. The second is to audit and analyze our own data. For this, we have established an elaborate system of maintaining data bases of individual patient outcomes for many of the common conditions that we treat. This allows us to review our own data from time to time and not only report them in the literature but also assess our own quality. Bench research involves many areas such as genetics of leukemias and mechanisms or drug resistance, with particular reference to acute myeloid leukemia, acute promyelocytic leukemia and chronic myeloid leukemia. There is significant work also going on with genetics of hemoglobin disorders and iron metabolism, hemostasis disorders and certain constitutional bone marrow failure syndromes. In recent years, we have also invested in developing a gene therapy for hematological diseases. This includes work related to the adeno associated virus (AAV) as vectors for gene therapy. Novel forms of AAV have been created in different serotypes with modifications of capsid proteins that are meant to increase their efficiency of transduction. These vectors could be used for clinical trials in hemophilia B, hematological malignancies and even non- hematological diseases. We have also just initiated some work with lentiviral vectors for transferring the globin genes into hematopoietic stem cells as a prelude to our planned attempts at developing 91
  • 100. gene therapy for thalassemia. The details of the work being done in all these areas and the faculty responsible are mentioned on our website: www.cmchaematology.org and www.cscr.in. The faculty have obtained research grants worth more than 25 crores in the last 20 years and published more than 200 original papers. Multidisciplinary team We need to recognize that our clinical and laboratory services are now supported by a large number of multidisciplinary staff. We have between 15-20 senior registrars at any time who are an integral part of the clinical services. There are also a large number of nurses, led by Ms. Selva Titus Chacko, who make up the team. They are indeed critical to both our out-patient and in-patient services. Starting in the mid-1990s, we have developed a team of nurses to take care of all central IV lines, blood sampling from them, chemotherapy and transfusions. The laboratory work is supported by nearly twenty five technical staff, led by Ms. Shankari Devi. We have a data management team led by our biostatistician, Ms. M.L. Kavitha. There is a clinical research management team that helps with all clinical trials led by Mr. Christopher Benjamin. There are several secretarial and other support staff who help in so many ways to make the department what it is. Without their dedication and work, we would not be what we are. It is a privilege to have been a part of this story and building up this team and department over the last 25 years. While drawing some satisfaction from the contributions that we make to hematology in India through the services and education that we provide and the research that we do, we are also very conscious of the many challenges ahead. 92
  • 101. We accept that this, by no means, is a complete list. Due to various reasons, certain hospital department names from the field of haematology in India may have been missed and we regret for the same.