Hematology Services

Here are the four most common hematologic conditions that we see and treat in our community:

Multiple Myeloma

Healthy white blood cells help you fight infections by making antibodies that recognize and attack germs. Multiple myeloma is When cancer forms in a type of white blood cell called a plasma cell, the condition is called multiple myeloma. These cancerous plasma cells accumulate in a person’s bone marrow and overpower healthy blood cells. Instead of producing helpful antibodies like normal plasma cells, the cancerous cells produce abnormal proteins that may lead to various complications.

The good news is that treatment for multiple myeloma isn't always needed right away. If a slow-growing multiple myeloma isn't causing signs or symptoms, Dr. Miranda may recommend close monitoring instead of immediate treatment. For those who do require treatment, there are several options available to help control the disease.

Symptoms of multiple myeloma can vary from patient to patient. When the disease is in its early stages, there may be no signs or symptoms at all. If signs and symptoms do occur, they may include:

  • Bone pain (especially in spine or chest)
  • Nausea
  • Constipation
  • Lost appetite
  • Weight loss
  • Mental fog, confusion
  • Fatigue
  • Frequent infections
  • Weakness, numbness in legs
  • Excessive thirst

Researchers and physicians are still not clear about what causes myeloma. Doctors do know that myeloma begins with one abnormal plasma cell in your bone marrow. Bone marrow is soft blood-producing tissue that fills in the center of most bones. That one abnormal cell then multiplies rapidly. Since cancer cells don't mature and die like normal cells, they accumulate and eventually overwhelm production of healthy cells. This leads symptoms such as fatigue and an inability to fight infections.

Those most likely to get multiple myeloma tend to be in their 60s or older or have a family history.


Leukemia is a relatively rare malignant cancer of blood-forming tissues, including bone marrow and the lymphatic system. There are about 60,000 new cases of leukemia each year in the U.S. and over 24,000 deaths. Leukemia makes up only about 3.7% of all new cancer cases and strikes adults and children.

Leukemia typically involves white blood cells, which are potent infection fighters. White blood cells normally grow and divide in an orderly way as your body needs them. People with leukemia, however, have bone marrow that produces excessive abnormal white blood cells, which do not function properly.

There are four main types of leukemia, based on whether they are acute or chronic, myeloid or lymphocytic. They are:

  • Acute myeloid or myelogenous leukemia (AML)
  • Acute lymphocytic or lymphoblastic leukemia (ALL)
  • Chronic myeloid or myelogenous leukemia (CML)
  • Chronic lymphocytic leukemia (CLL)

Unlike the fatigue that healthy people experience occasionally, this primary symptom of leukemia is more severe. Patients often describe it as overwhelming exhaustion that cannot be relieved with rest or a good night's sleep. Some people may also describe muscle weakness or difficulty concentrating. Patients with slow-growing leukemias often have no symptoms. However, rapidly growing forms of leukemia may cause many symptoms including:

  • Fever, chills
  • Persistent fatigue, weakness
  • Frequent or severe infections
  • Unplanned weight loss
  • Swollen lymph nodes
  • Enlarged liver or spleen
  • Easy bleeding, bruising
  • Recurrent nosebleeds
  • Tiny red spots in your skin (petechiae)
  • Excessive sweating, especially at night
  • Bone pain or tenderness

Leukemia is a cancer of blood-forming tissues, including bone marrow and the lymphatic system. There are about 60,000 new cases of leukemia each year in the U.S. and over 24,000 deaths. Leukemia makes up only about 3.7% of all new cancer cases and strikes adults and children.


Lymphoma is cancer of the lymphatic system, a critical part of your body's germ-fighting arsenal. The lymphatic system includes the lymph nodes or lymph glands, spleen, thymus gland and bone marrow. Lymphoma can affect those areas and other organs throughout the body. There are many types of lymphoma, but the two main subtypes are:

  • Hodgkin's lymphoma (formerly Hodgkin's disease)
  • Non-Hodgkin's lymphoma

Signs and symptoms of lymphoma may include:

  • Painless swelling of lymph nodes in your neck, armpits or groin
  • Persistent fatigue
  • Fever
  • Night sweats
  • Shortness of breath
  • Unexplained weight loss
  • Itchy skin

Factors that may increase tour risk of contracting lymphoma include:

  • Age: Some types of are most common in young adults, while others are most common in people over 55.
  • Gender: Males are slightly more likely to contract lymphoma than females.
  • Impaired immune system: Lymphoma is more common in people with immune system diseases or those who take medications that suppress their immune system.
  • Certain infections: Some infections, including Epstein-Barr virus and Helicobacter pylori (H pylori) infection come with an increased risk of lymphoma.

Treatments for lymphoma may include:

The goal of treatment is to destroy as many cancer cells as possible and bring lymphoma into remission. Lymphoma treatments that are right for you will depend on the type and stage of your disease, your overall health and your personal preferences. Treatments include:

  • Active surveillance: Some lymphomas are very slow growing. You and your doctor may decide to wait until your lymphoma causes signs and symptoms that interfere with your daily activities. Until then, you may undergo periodic testing to monitor your condition.
  • Bone marrow transplant: A bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow.
  • Chemotherapy: Chemotherapy uses drugs to destroy fast-growing cancer cells. These drugs are usually administered intravenously but can also be taken orally in pill form.
  • Radiation therapy: Radiation therapy uses powerful beams of energy, such as X-rays and protons, to kill cancer cells.
  • Other treatments: Drugs used to treat lymphoma include those that focus on specific abnormalities in your cancer cells. Immunotherapy drugs use your own immune system to kill cancer cells. There is also a specialized treatment called chimeric antigen receptor T-cell therapy that engineers your body's germ-fighting T-cells to fight cancer then infuses them back into your body.

If you have questions about lymphoma or other hematologic conditions, make an appointment to see Dr. Miranda.


Anemia is a very common condition in which you lack sufficient healthy red blood cells to carry enough oxygen to your body’s tissues. People with anemia often feel tired and weak. There are many forms of anemia, from mild to severe. Anemia can be temporary or long term and treatment depends on the type, severity and duration of the condition. The most common types of anemia we see in our community:

  • Iron deficiency anemia
  • Anemia from chronic kidney disease
  • Myelodysplasia
  • Anemia from cancer therapy
  • Hemolytic anemia

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