By George Buchanan, MD
2009-09-01
Dr. Buchanan is
Children’s Cancer Fund Distinguished Chair in Pediatric Oncology and
Hematology, and Director of Pediatric Hematology-Oncology at the University of Texas Southwestern Medical Center.
One of the most common
clinical problems that hematologists deal with is diagnosis and management of
patients with prolonged, excessive, or unusual bleeding. As a pediatric
hematologist interested in hemorrhagic disorders for three decades, I thought
until recently that I had “seen it all.” But I was wrong. This past January, I
was asked by the ASH Communications Department staff to consider working with
the National Geographic Channel in filming a story about a 13-year-old girl in India
who was said to “cry tears of blood.” Somewhat hesitantly, I agreed to become
involved. Little did I then imagine what was to follow. My odyssey during the
subsequent months started with discussions involving the prospective film’s
producer/director and his crew, based in London.
They described an unusual patient named Twinkle, whose story had surfaced in
press reports and on the Internet. They shared with me some of her medical
records. Several years earlier she had begun having unexplained, spontaneous
bleeding from her eyes, scalp, hands, and feet on almost a daily basis. Several
evaluations at medical centers in Northern India
resulted in no specific diagnosis. As a result of the unusual bleeding, the
girl was expelled from school and shunned by her friends.
It was felt by the National Geographic Channel that telling
Twinkle’s story and attempting to find the cause of her bleeding and identify a
“cure” would be of widespread interest. The plan was to have a hematologist
from America travel to India
to observe her bleeding, assist with making a correct diagnosis, and deliver
effective treatment. I wasn’t sure whether ASH was honoring me or punishing me
by recommending that I be that hematologist! But in late March, I traveled to India
with the film crew, met the patient and her family, and — working
collaboratively with a hematologist and other staff at a hospital in Mumbai —
reviewed the existing medical records and ordered tests. I also observed
Twinkle’s bleeding … well, more specifically, observed Twinkle after she
bled.
The bottom line of this adventure is that the
National Geographic Channel documentary was successfully filmed and will be
internationally televised beginning on Sunday, September 13. Does Twinkle
really cry tears of blood? What is her diagnosis? To find out, you’ll have to watch
the program! Although it may not fully clarify what is wrong with Twinkle, I am
hopeful that it will inform the thousands of viewers about the diagnosis and
management of bleeding disorders — and the important role of hematologists in
that process — as well as provide a fascinating overview of a girl and her
family in rural India whose life has been changed by a perplexing problem.
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