For many years the mammalian blood cell system has provided cell biologists and haematologists with one of the best experimental models in which to unravel how one stem cell -- the hematopoietic stem cell -- gives rise to many different types of progeny. Numerous models of lineage relationships have emerged, but the most influential of these, in which differentiating cells undergo a series of binary choices, has been increasingly challenged in recent years -- to the extent that the accumulation of new findings recently culminated in a Nature commentary suggesting that "the latest research will necessitate revision of textbook accounts". This book brings together contributions from many leading experts in the field of blood cell development who each discuss both the overall process of hematopoiesis and the origins and development of each of the cells of the blood and immune systems. It describes how new molecular, cellular and -- particularly -- transgenic tools are helping us understand the processes that control the lineage fates of hematopoietic stem and progenitor cells and how lineage-committed progeny develop along particular maturation pathways.

Granulocytes are a category of white blood cells characterised by the presence of granules in their cytoplasm. This book examines the characteristics of eosinophil granulocytes, its biological functions, its role in inflammation and its clinical significance in children. This book also reviews the role of granulocytes on the onset of tissue-destructive diseases when exposed to stress. In addition to the cases of disease, some physiological phenomena are also responsible for the stress-induced granulocytosis. Thus this book will also expands upon the role of granulocytes associated with various diseases and some physiological responses. Other topics discussed in this book include the role of basophil, the minute group of granulocyte, in tropical infections and in immune regulations; polymorphonuclear neutrophilic granulocytes (neutrophils), which are the most dangerous cells in the organism and their role in transient states of autoimmunity, and the effects of nucleoli change during differentiation and maturation of granulocytes.

Hematopoietic stem cell transplantation (HSCT) is the transplantation of blood stem cells derived from the bone marrow (that is, bone marrow transplantation) or blood. Stem cell transplantation is a medical procedure in the fields of haematology and oncology, most often performed for people with diseases of the blood, bone marrow, or certain types of cancer. Stem cell transplantation was pioneered using bone-marrow-derived stem cells by a team at the Fred Hutchinson Cancer Research Center from the 1950s through the 1970s led by E. Donnall Thomas, whose work was later recognised with a Nobel Prize in Physiology and Medicine. Thomas' work showed that bone marrow cells infused intravenously could repopulate the bone marrow and produce new blood cells. His work also reduced the likelihood of developing a life-threatening complication called Graft-versus-host disease. With the availability of the stem cell growth factors GM-CSF and G-CSF, most hematopoeitic stem cell transplantation procedures are now performed using stem cells collected from the peripheral blood, rather than from the bone marrow. Collecting stem cells provides a bigger graft, and does not require that the donor be subjected to general anaesthesia to collect the graft. Hematopoeitic stem cell transplantation remains a risky procedure with many possible complications; it has always been reserved for patients with life-threatening diseases. This book presents recent leading research in the field.

There are two dominant aspects which conclude the coagulation cascade: the importance of the tissue factor pathway in initiating clotting and the interaction between pathways. Two main pathways are recognised the extrinsic and the intrinsic. At the side of vascular injury endothelial cells are converted in a pro-thrombotic state or become detached to exposed circulating blood to thrombogenic constituents of the sub-endothelial matrix. Activation of platelets and formation of fibrin occur simultaneously and interdependently to effect haemostasis. The activated platelets express the receptor GPIb-IX-V complex that further strengthens the adhesion by linking to von Willebrand factor expressed on the sub-endothelial matrix. A platelet monolayer which covers the injured area recruits and aggregates activated platelets to form a platelet plug by linking to fibrinogen molecules. Activation of a series of inactive precursors leads to the formation of thrombin that cleaves fibrinogen to fibrin. The sequence of reactions interacting between factor X represents the common pathway of coagulation. Factor X can be activated in turn by either the tissue factor pathway or the contact activation pathway of coagulation, which is initiated by the complex of tissue factor and factor VIIa. The latter involves a series of zymogen protease reactions that are initiated by contact activation of factor XII to XIIa. As the haemostatic process starts, a series of inhibitory mechanisms is activated involving antithrombin III, protein C, protein S, the tissue factor pathway inhibitors 1 and 2 and platelet inhibitors (prostaglandin I2, nitric oxide). Fibrinolytic mechanisms assure the clot's remodelling and elimination in the prospect of restoring the vessels patency. During the fibrinolytic process plasmin cleaves polymerised fibrin to fibrin degradation products. The liver plays a predominant role in the regulation of haemostasis. By producing most clotting factors (except tissue factor TF) and inhibitors (antithrombin III, protein C, protein S, C1 inhibitor), as well as a number of the proteins involved in fibrinolysis (plasminogen, a2-antiplasmin), and by clearing from the bloodstream activated enzymes involved in clotting or fibrinolysis, the liver protects against both bleeding and overwhelming activation of coagulation. There is a common bleeding profile emerging in the overwhelming majority of liver diseases. The severity of documented coagulation disorders varies analogically to the degree of the hepatocellular injury. The importance of the coagulopathy is underlined by the incorporation of the coagulation parameters into prognostic scores assessing fulminant hepatic failure and cirrhosis. The purpose of this book is to review the coagulation profile in acute liver failure, liver cirrhosis, autoimmune cholestatic, viral and various hepatic diseases. Diagnostic and therapeutic modalities in coagulation defects in liver diseases are also reviewed.

The proposed book focuses on 'blood infections', a common group of haematology and infectious disorders in aspects relating to the tropical medicine. The book covers specifically the clinical aspects, scientific laboratory aspects, public health aspects, as well as the social sciences relating to these important diseases. The common blood infections, including other disorders, which relate to blood disorders are summarised, presented, and discussed. The book presents summative data from the molecular to the population scales, as well as additional metanalysis for important topics.

Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. It is used for the prophylaxis of thrombosis and embolism in many disorders. Its activity has to be monitored by frequent blood testing for the international normalised ratio (INR). It is named for the Wisconsin Alumni Research Foundation. Warfarin is a synthetic derivative of coumarin, a chemical found naturally in many plants, notably woodruff (Galium odoratum, Rubiaceae), and at lower levels in liquorice, lavender and various other species. Warfarin was originally developed as a rat poison; however, more modern poisons are much more potent and toxic (e.g., brodifacoum). Warfarin and contemporary rodenticides belong to the same class of drugs (coumarins) and both decrease blood coagulation by interfering with vitamin K metabolism. For this reason, drugs in this class are also referred to as vitamin K antagonists.

Sickle cell anaemia is an inherited blood disorder, characterised primarily by chronic anaemia and periodic episodes of pain and occurring in approximately 1 in every 400 African-American infants born in the United States each year. Individuals of Mediterranean, Arabian, Caribbean, South and Central American, and East Indian ancestry can also be affected. The underlying problem involves haemoglobin, a component of the red cells in the blood. The haemoglobin molecules in each red blood cell carry oxygen from the lungs to the body organs and tissues and bring back carbon dioxide to the lungs. In sickle cell anaemia, the haemoglobin is defective. After the haemoglobin molecules give up their oxygen, some of them may cluster together and form long, rod-like structures. These structures cause the red blood cells to become stiff and to assume a sickle shape. Unlike normal red cells, which are usually smooth and donut-shaped, the sickled red cells cannot squeeze through small blood vessels. Instead, they stack up and cause blockages that deprive the organs and tissue of oxygen-carrying blood. This process produces the periodic episodes of pain and ultimately can damage the tissues and vital organs and lead to other serious medical problems. Unlike normal red blood cells, which last about 120 days in the bloodstream, sickled red cells die after only about 10 to 20 days. Because they cannot be replaced fast enough, the blood is chronically short of red blood cells, a condition called anaemia. Sickle cell anaemia is caused by an error in the gene that tells the body how to make haemoglobin. The defective gene tells the body to make the abnormal haemoglobin that results in deformed red blood cells. This book gathers the latest research in this important field.

Angiogenesis -- the growth of new blood vessels -- is an important natural process occurring in the body, both for health and as related to disease. Angiogenesis occurs in the healthy body to help heal wounds and to help restore blood flow to tissues after injury or insult. In females, Angiogenesis also occurs during the monthly reproductive cycle (to rebuild the uterus lining, to mature the egg during ovulation) and during pregnancy (to build the placenta, the circulation between mother and foetus). The healthy body controls Angiogenesis through a series of 'on' and 'off' switches. The main 'on' switches are known as Angiogenesis-stimulating growth factors. The main 'off' switches are known as Angiogenesis inhibitors. When angiogenic growth factors are produced in excess of angiogenesis inhibitors the balance is tipped in favour of blood vessel growth. When inhibitors are present in excess of stimulators, angiogenesis is stopped. The normal, healthy body maintains a perfect balance of angiogenesis modulators. In general, angiogenesis is 'turned off' by the production of more inhibitors than stimulators. Tumour angiogenesis is the proliferation of a network of blood vessels that penetrates into cancerous growths, supplying nutrients and oxygen and removing waste products. Tumour angiogenesis actually starts with cancerous tumour cells releasing molecules that send signals to surrounding normal host tissue. This signalling activates certain genes in the host tissue that, in turn, cause proteins to encourage growth of new blood vessels. This new book examines its angiogenesis within the context of theory and its applications to cancer treatment.

This new book brings together leading research from around the globe. Leukaemia is a cancer that begins in blood cells. In people with leukaemia, the bone marrow produces abnormal white blood cells. The abnormal cells are leukaemia cells. At first, leukaemia cells function almost normally. In time, they may crowd out normal white blood cells, red blood cells, and platelets. The scope of the book includes the four common types of leukaemia: Chronic lymphocytic leukaemia (chronic lymphoblastic leukaemia, CLL) most often affecting people over age 55. Chronic myeloid leukaemia (chronic myelogenous leukaemia, CML) affects mainly adults. Acute lymphocytic leukaemia (acute lymphoblastic leukaemia, ALL) the most common type of leukaemia in young children. Acute myeloid leukaemia (acute myelogenous leukaemia, AML) which occurs in both adults and children. New advances in diagnosis, pathogenesis and therapy are presented.

This open access book has been written by ten Belgian health care professionals, nurses, university professors and doctors specializing in palliative care and ethicists who, together, raise questions concerning the practice of euthanasia. They share their experiences and reflections born out of their confrontation with requests for euthanasia and end-of-life support in a country where euthanasia has been decriminalized since 2002 and is now becoming a trivial topic.Far from evoking any militancy, these stories of life and death present the other side of a reality needs to be evaluated more rigorously.Featuring multidisciplinary perspectives, this though-provoking and original book is intended not only for caregivers but also for anyone who questions the meaning of death and suffering, as well as the impact of a law passed in 2002. Presenting real-world cases and experiences, it highlights the complexity of situations and the consequences of the euthanasia law.This book appeals to palliative care providers, hematologists, oncologists, psychiatrists, nurses and health professionals as well as researchers, academics, policy-makers, and social scientists working in health care. It is also a unique resource for those in countries where the decriminalization of euthanasia is being considered. Sometimes shocking, it focuses on facts and lived experiences to challenge readers and offer insights into euthanasia in Belgium.

With authoritative coverage of rare and common hemostatic disorders, Consultative Hemostasis and Thrombosis, 4th Edition, keeps you both up to date with all that's new in this fast-moving field as well as reviewing background and development and citing pertinent classical literature. Broad differential diagnoses are provided, underscoring the editors' position that correct treatment begins with correct diagnosis. This trusted resource by Drs. Craig S. Kitchens, Craig M. Kessler, Barbara A. Konkle, Michael B. Streiff, and David A. Garcia is designed for rapid reference and critical decision making at the point of care. Emphasizes real-world problems and solutions, with quick access to concise descriptions of each condition, associated symptoms, laboratory findings, differential diagnosis, and treatment. Features a user-friendly design, full-color format, abundant laboratory protocols, and at-a-glance tables and charts throughout. Provides thorough updates on core information on hemostasis and thrombosis, including deep venous thrombosis (DVT), pulmonary embolisms, hypercoagulability, thrombocytopenia, von Willenbrand disease, and more. Covers new treatment information on hemophilia A and B. Contains new chapters on hereditary hemorrhagic telangiectasia, hemolytic uremic syndrome, and paroxymal nocturnal hemoglobinuria. Two new editors, Dr. Michael B. Streiff and Dr. David A. Garcia, offer fresh perspectives and valuable experience. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

This clinical casebook covers transfusion medicine theory and its practical implications for the obstetrical hemorrhage patient through the presentation of cases on actively bleeding patients. Each case features a unique clinical scenario involving a bleeding patient and outlines different aspects of safe and effective transfusion support. The cases contain current evidence on the latest topics in the field, such as the use of antifibrinolytic agents and coagulation factor concentrates in the setting of massive obstetrical hemorrhage. In addition to the actively bleeding patient, the casebook includes other important management topics, including the role of plasma exchange in thrombotic microangiopathies during pregnancy; treatment of hyperhemolysis in a patient with hemoglobinopathy; and recommended management of patients with red cell antibodies found on prenatal testing. Other immunohematology topics such as post-natal management of an RhD negative woman for the prevention of hemolytic disease of the newborn due to anti-Rh(D) are included. Written by transfusion medicine, coagulation, obstetrical, and anesthesiology experts, Transfusion Management of the Obstetrical Patient: A Clinical Casebook is a concise yet comprehensive resource for anesthesiologists, obstetricians, pathologists, hematologists, and other practitioners who treat obstetrical hemorrhage patients.

More than 2 billion people worldwide have some form of anemia. Even so, the condition is greatly misunderstood and often improperly treated. "The Iron Disorders Institute Guide to Anemia" contains everything a patient needs to know about the different forms of anemia, symptoms, treatment, and diet. It provides patients and family members with everything they need to be proactive with their physicians, including information about what doctors must do to differentiate between different causes and how each cause is treated.

Based on the proceedings of the International Convocation on Immunology held recently at the State University of New York at Buffalo, this up-to-date resource provides a state-of-the-art examination of blood transfusion practice and its future possibilities.
Explains the immunological effects of blood transfusion as well as its immunological and microbiological hazards and offers potential remedies!

Understanding the causes of anemia is critical to inform appropriate strategies to prevent and treat anemia, particularly to reduce the risk of anemia and the burden of disease. The strength of this book lies in its cross-disciplinary nature. This publication summarizes the current state of evidence on the multifactorial causes of anemia, with a specific focus on nutritional anemia. The chapter authors are leading experts in nutrition and global health. The introductory chapters provide an overview of the global burden of anemia prevalence, the economic implications and functional consequences of anemia, and the significance of these factors to guide policy and programs. Subsequent chapters provide current evidence on iron and other micronutrient metabolism and homeostasis in regards to anemia, the multifactorial contributors to anemia (e.g. infection and genetics), and the interactions between nutrients that may contribute to anemia. The summarizing chapters detail program and policy approaches to treat, prevent and reduce anemia in the global context. Nutritional Anemia is a comprehensive resource for those involved in global health and nutrition policy, strategy, programming, or research, and serves as a guide for how government, NGO, and international agencies can effectively treat, prevent and reduce anemia globally.

This revised and updated second edition of Handbook of Hematologic Malignancies continues to be an essential and "go-to" resource for the busy hematologist, hematologic oncologist, hematopathologist, oncology advanced practice provider, oncology nurse, and trainee. Concisely organized, each chapter provides the most current, need-to-know points of diagnosis, prognosis, therapeutic management, and clinical trial opportunities for each hematological malignancy. Chapters are complete with richly illustrated figures to highlight the hematopathologic characteristics of diseases in addition to helpful tables on differential diagnosis, prognostic scoring systems, molecular profiles, and therapeutic options. A new case-based chapter concludes the handbook with clinical cases designed to test a clinician's knowledge of pathologic diagnosis and clinical presentation of diseases covered in the book. With over twenty new FDA-approved indications since publication of the first edition, including breakthroughs with CAR-T therapy, and other evidence-based treatment options for patients with hematologic disease, this book serves as quick reference to practice changing information on challenging diagnostic dilemmas, frontline and refractory treatment scenarios, and more.The subspecialty field of hematologic oncology is ever-changing and expanding with available treatment options and this second edition keeps the busy clinician abreast of recent findings and their impact on evidence-based treatment and management. Written by experienced clinicians at the world-renowned Moffitt Cancer Center in Tampa, Florida, as well as contributions from leading academicians, hematologists, and oncologists throughout the country, this unique handbook is packed with authoritative knowledge and clinical insight into all known hematologic cancers. Key Features: Includes seven new chapters covering CAR-T and novel therapeutic options including CD19 CAR-T therapy, novel cellular therapies, cytokine release syndrome, cancer associated thrombosis, and more Comprises compact and updated disease-site chapters describing new standards of care and management considerations in bullet point format with key references Highlights important diagnostic tools that assist with conducting key differential diagnoses and unveiling answers to diagnostic dilemmas Provides updates of potential practice-changing clinical trials and paradigm shifting treatment considerations in each disease-based chapter Purchase includes digital access for use on most mobile devices or computers

Ineffective haematopoiesis in bone marrow and peripheral cytopenias are features of bone marrow failure and related syndromes. These diseases can progress to myelodysplastic syndrome, acute myeloid leukaemia, and other malignancies. Acute myeloid leukaemia is a heterogeneous complex malignancy characterized by proliferating myeloblasts in the bone marrow and a diverse range of recurrent molecular aberrations that occur in many different combinations. More specifically, the authors explore the McDonough strain of feline sarcoma virus-related tyrosine kinase 3 receptor mutations present in about 30-35% of acute myeloid leukaemia patients. The way in which the Wnt signalling pathway plays an important role in normal haematopoiesis and its deregulation associated with acute myeloid leukaemia is also discussed. This compilation also explores the importance of residual leukemic cells in disease relapse prognosis, as the new definition of the European LeukemiaNet for complete remission includes minimal or measurable residual disease negativity. Mutations detected in patients with clonal haematopoiesis are addressed, including those which most commonly affect DNMT3A, ASXL1, TET2, JAK2, SF3B1, SRSF2, and TP53 genes that had previously been identified as drivers in various myeloid neoplasms. The authors provide an overview of the roles of extracellular vesicles in multiple myeloma, their capacity as emerging biomarkers, and implications for liquid biopsy for detection and monitoring. The penultimate study focuses on toll-like receptors, which play an essential role in the recognition of invading pathogens via specific microbial molecular motifs, forming a bridge between the innate and adaptive immune responses. In conclusion, this compilation explores PROTACs, proteolysis targeting chimeras, which mediate the degradation of proteins of interest by hijacking the activity of E3-ubiquitin ligases for POI polyubiquitination and subsequent degradation by proteasome.

In this compilation, the authors review the biological aspects of myelodysplastic syndrome disease, diagnosis, and treatment, as well as innovations involving genetics and new treatment perspectives. Myelodysplastic syndromes are a heterogeneous group of clonal haematopoietic stem cells disorders characterized by dysplasia, as well as peripheral blood cytopenias with a hypercellular marrow and ineffective hematopoiesis. Myelodysplastic syndromes are frequently associated with acute and chronic inflammation, and autoimmune disorders such as: rheumatoid arthritis, bowel disease, diverse types of vasculitis, autoimmune anemias, several rheumatic and skin disorders, and certain thyroid disorders. Spliceosome mutations are the most frequent mutations found in blood and bone marrow cells of myelodysplastic syndromes patients. As such, the authors explore the four predominant splicing factor genes: SF3B1, SFRS2, U2AF1, ZRSR2. Subsequently, this collection discusses the CSNK1A1 gene in the context of myelodysplastic syndromes. It is located at 5q32 within the deleted region, which encodes for casein kinase 1I+/- (CK1I+/-). CK1I+/- is a component of a multiprotein I(2)-catenin destruction complex that regulates Wnt/I(2)-catenin and p53 pathways. The concluding study focuses on the mutations in epigenetic modifiers occur which myelodysplastic syndromes and drive this disease, such as: DNA methylation, histone acetylation, and RNA interference that alters gene expression.

'The test cases are particularly variable, including pertinent management tips in the answers. The book also contains a set of useful self-assessment questions. Being pedantic, this could now benefit from an increase in the proportion of 'Single Best Answer Questions', now ubiquitous in undergraduate assessment. This will continue to be on my local recommended reading list, particularly for those students wanting a thorough understanding of Haematology, from the laboratory through to basic management. It would also be a good text for those starting a career in Haematology, such as Physician Associates and doctors early in their training.'British Journal of HaematologyThis second edition of Haematology: A Core Curriculum is written by a haematologist with more than forty-five years of experience in teaching haematology to medical students and whose pedagogical and writing skills are widely admired within the field.The textbook takes a useful, practical approach, incorporating self-evaluation questions and learning objectives that give students the information needed to understand the topic and clear indications of the core knowledge required to progress within the field of haematology. Themes covered include clinical haematology and the scientific basis of the discipline and the causes and pathogenesis of haematological disorders as well as how conditions are diagnosed and treated.Haematology closely follows the Imperial College London curriculum but medical students, trainee nurses and biomedical science students from other institutions will find the textbook equally suitable, since it includes the core student haematology curriculum as recommended by the Royal College of Pathologists.Related Link(s)

A unique point-of-care guide to clinical hematology-oncology Hematology-Oncology Clinical Questions answers the questions most frequently asked by medical students or residents on rotations. The answers provided are concise, specific, evidence-based, and supported by recent references and clinical practice guidelines. Readers will find Hematology-Oncology Clinical Questions to be single-best resource for quickly translating the most current knowledge into practical, diagnostic real-time solutions. * Coverage includes both solid tumor and hematology malignancies, cancer screening and genetic and familial cancer syndrome, supportive care and end of life, chemotherapy agents (including immunotherapy)* The content arrangement is designed to simulate the consultation process: data collection, synthesis of data, solution

Handbook of Benign Hematology is a practical guide to the diagnosis and management of benign hematologic conditions. The book begins with a chapter on normal hematopoiesis and follows with chapters devoted to different groups of blood disorders and syndromes including neutrophil disorders, non-malignant myeloid disorders, bone marrow failure syndromes, myeloproliferative disorders, hypoproliferative anemia, hemolytic anemia, iron metabolism disorders and porphyria, platelet disorders, hemostasis and coagulation defects, and thrombosis. Each subtype of the disorder covered within the chapters features a clinical case, an introduction to the condition, details on diagnosis including applicable criteria and lab work needed, key diagnostic dilemmas when conducting a differential diagnosis, prognosis, treatment options, details on clinical trials and emerging clinical strategies, and bulleted key points which highlight clinical pearls and common pitfalls. Important seminal and practice-changing references conclude each chapter. The final chapters provide best practices for transfusion medicine and a guide to pharmacologic agents and their uses in clinical practice for adult and pediatric patients. The handbook is filled with tables and illustrations which highlight FDA-approved drug information, clinical trials data, hematopathologic characteristics of different disorders, important management criteria and more. The result is a uniform and engaging approach that clinicians and practitioners can easily follow and use in practice or for review.The Editors and chapter authors are experienced academic practitioners from Baylor College of Medicine in the fields of adult and pediatric hematology, pathology, blood banking and pharmacology. Emphasizing best practices for patient management, this handbook is essential for oncologists, hematologists, trainees, and other practitioners who regularly or increasingly receive referrals to diagnose and treat adults or children with non-malignant hematologic conditions. Key Features: Includes dozens of clinical cases covering all non-malignant blood disorders Emphasizes patient management and best practices for disorders seen in adults and children Contains over 40 color images and numerous tables for quick reference Presents important details of all pharmacologic agents used to treat or manage hematologic disorders and their complications Purchase includes access to the ebook for use on most mobile devices or computers

The acclaimed full-color review of the underlying principles of blood diseases and disorders - based on a Harvard Medical School hematology course A Doody's Core Title for 2021! LANGE Pathophysiology of Blood Disorders, Second Edition is a well-illustrated, easy-to-absorb introduction to the physiological principles underlying the regulation and function of blood cells and hemostasis, as well as the pathophysiologic mechanisms responsible for the development of blood disorders. Featuring a strong emphasis on key principles, the book also covers diagnosis and management primarily within a framework of pathogenesis. The organization and content of this book are based on a 3-week hematology course given to students in their second year at Harvard Medical School. All of the authors are lecturers in this course and many of the figures have been taken directly or adapted from their lectures. FEATURES OF THE SECOND EDITION: NEW summary boxes with high yield points to remember All figures have been redrawn by a single artist for quality and consistency A more user-friendly presentation Each chapter includes learning objectives, and self-assessment questions with detailed explanations Numerous tables and diagrams encapsulate important information Hailed for its uniformity of style, clarity, brevity, and high level of scientific rigor and clinical relevance, LANGE Pathophysiology of Blood Disorders, Second Edition will prove valuable to medical students, as well as physicians at all stages of their training.

This is an essay by the Japanese hematologist who is an international member of American society of hematology and now works in Japan. The kindle edition of "Byouki nannte yattsukero" has already been published by Amazon co. jp (https: //www.amazon.co.jp/dp/B00IGUT6GK). Many issues of "Byokinannte yattsukero" have been downloaded since its publication. Because there are also many requests for paperback edition, the author has published this book through createspace com. This essay is written in Japanese.