History of Clinical Hematology at the Faculty Hospital in Pilsen

In the 1950’s, the Department of Internal Medicine began to perform the first hematological examinations along with the biochemical tests. The leading physician of this central laboratory was not established. At first, the laboratory was informally overseen by Assoc. Prof. Mecl, who was especially interested in hematology, and later by Prof. Bobek, the head of the Department of Internal Medicine.

Hemoglobinometer according to Sahli

Since the beginning of 1954, the laboratory had been attended by Václav Čepelák, a fellow student of the Department of Internal Medicine, who worked at the laboratory as an assistant research worker after 1955. Later, he became the first head of the independent Department of Clinical Hematology. The laboratory of the Department of Internal Medicine had a special hematological workplace. Among the first laboratory tests performed were blood cell counts using a microscope, measurement of hemoglobin according to Sahli, and determination of bleeding and clotting time with a capillary method (Lee White method in patients with hemophilia was used by a laboratory technician Kubát at the transfusion unit). Václav Čepelák, at that time a fresh graduate of Doctor of Medicine, was entrusted by Prof. Bobek with the leading the hematological workplace; he was able to work as a team with Jindřiška Martínková, a laboratory technician previously forced to interrupt her study of medicine (after 1989 she was subsequently graduated as Doctor of Medicine). As the focus of Department of Internal Medicine was on the diagnostics and treatment of thromboembolic states, the main stress of the laboratory was placed on introduction and development of coagulation methods; at first, the focus was on thrombotic, later also on hemorrhagic states. The laboratory staff was supplemented with more laboratory technicians, specialized in clinical hematology. As one of the first facilities in the nation, the laboratory introduced coagulation examination using thromboelastograph and prepared its own thromboplastin, kephalin, and other reagents necessary for examination of hemorrhagic states, especially hemophilias. Patients with hemorrhagic states from the entire West Bohemian Region were examined and, in 1959, the first scientific paper describing their dispensarization was published.

When the leading physician of the central laboratory, Luboš Jadrný, M.D., left the Department of Internal Medicine in 1959, the independent Central Biochemical Laboratory was established. In 1962, the laboratory’s name was changed to the Department of Clinical Biochemistry (DCB) of the Faculty Hospital. Thus the disciplines of clinical biochemistry and hematology were separated and their further development was independent.

The leadership of the hematological unit was delegated to V. Čepelák, M.D., who was still working at the Department of Internal Medicine. The laboratory examined blood cell counts as a routine method and was supplied with hematocrit centrifuges. Hemoglobin began to be measured photometrically with a Drabkin solution and hematological examinations were gradually centralized from dislocated laboratories. Once the new facility for the Department of Blood Transfusion was opened, the hematological unit gained its own space in the building No 11. A regional specialist of internal medicine, Dr. Pokorný, included Dr. Čepelák into his team as an expert for hematology. Along with the leading physicians of DCB and the Department of Blood Transfusion, Dr. Čepelák was regularly visiting regional laboratories with the aim of unification of hematologic methods.

In 1964, Dr. Čepelák completed his qualification in hematology during his three-month stay at the Institute of Hematology and Blood Transfusion in Prague and, subsequently, he was appointed as a specialist for clinical hematology at the Department of Internal Medicine. In the frame of this function, he was above all committed to the leadership of the hematological laboratory. In 1967, the hematological laboratory became independent and the Department of Clinical Hematology (DCH) was established; its first head became V. Čepelák, M.D. Shortly after, new instruments appeared at the department: Faculty Hospital in Pilsen obtained one of the first celloscopes; DCH became the first department in the nation introduced to an automatic counting of platelets and examination of platelet aggregation. From the Department of Blood Transfusion came Terezie Hošková-Štuksová, M.D., who at first gained a specialization in clinical hematology and later became the deputy head of DCH.

Another memorable personality in the history of hematology in Pilsen is František Tomší, M.D., for whom hematology became a lifelong mission and love. Although he never worked at the laboratory and was not in any connection with it, since the beginning of his function as a medical deputy of the Department of Internal Medicine, he had evaluated smears of blood marrow as well as pathological smears of peripheral blood and thus assured a high standard of hematological morphology. In this branch, Dr. Tomší was a devoted teacher of other clinical hematologists in Pilsen –Jiřina Čandová-Jarošková, M.D., and Mája Švojgrová, M.D. He was also at the beginning of further development of clinical hematology in Pilsen when – already retired – he accepted a function of a specialist for hematology at the Department of Internal Medicine; this function was later executed by Mája Švojgrová, M.D., and Vladimír Koza, M.D., who is currently the head of the Hemato-Oncological Department of the Faculty Hospital.

In the beginning of the1970’s, clinical pharmacology started its development in the frame of DCH, especially thanks to Hana Čepeláková, M.D., Ph.D.; for that reason, the name of the department was changed in 1974 to Department of Clinical Hematology and Pharmacology (DCHP) of the Faculty Hospital. After Assoc. Prof. Čepelák became the head of the Department of Internal Medicine in 1977, DCHP was divided: Dr. Čepeláková became the leading physician of a newly conceived Department of Clinical Pharmacology and Terezie Štuksová, M.D., was appointed the leading physician of DCH. Assoc. Prof. Čepelák’s interest in hematology continued also at the Department of Internal Medicine, where he established a scientific laboratory for the research of thrombosis (the methods of the study of fibrinolysis, introduced by Ing. Ladislav Vít, became a basis for the list of health care services of the MH CR) and initiated formation of the hematological intensive care unit as well as the development of hematological oncology.

Throughout the more than ten-year long leadership of Dr. Štuksová, the laboratory equipment of DCH further improved. Besides the blood cell counting machines, other instruments such as computer-controlled aggregometer, fluorescence microscope, and spectrophotometer were installed. A substantial emphasis was placed on standardization of laboratory methods and control system. As a regional expert, Dr. Štuksová continued sending control samples, including blood marrow smears, to the laboratories of the entire West Bohemian Region. Cytochemical methods for staining the blood marrow smears and peripheral blood of patients with acute hemoblastosis were developed. Control samples of different levels were produced at the DCH. Since the middle of the 1980’s, the anticoagulation treatment within the entire West Bohemia Region was controlled according to INR.

The number of physicians working at the DCH increased and a new position of biochemist was established. Besides the laboratory activities, consultation activities also developed in the frame of the entire Faculty Hospital; hematological department for outpatients gradually enlarged as well. DCH ensured the dispensarization and treatment of all patients with hemophilia and von Willebrand disease for the whole West Bohemian and partially for the South Bohemian Region. Evaluation of bone marrow punctures was provided for the entire West Bohemian Region. Participation of clinical hematologists in diagnostics and treatment of serious states such as DIC was significant; for patients with a threatening DIC, the clinical hematologists were able to justify the need for the administration of heparin mini-doses. Within the frames of complex care for patients with hemophilia and in a close cooperation with Prof. Hrodek, head of the 2^nd Department of Pediatrics of the Faculty Hospital in Prague-Motol, DCH FH in Pilsen organized recuperation camps for children with hemophilia from the entire Czechoslovakian Republic; the focus of this initiative was on prevention of the disorders of locomotion, psychological condition, and treatment of severe deficit of coagulation factors during growth. A closely related research activity was also in the process of development. New methods for diagnostics of hemophilias, including determination of inhibitors, and progressive methods of anemia diagnostics were introduced.

At the beginning of 1989, after Dr. Štuksová left the hospital, the leading physician of DCH became Ivana Martínková, M.D.

Counting of RBCs in Bürker´s chamber

In 1985, the workplace of DCH was relocated to a new area of the Faculty Hospital in Lochotín. At the beginning of the 1990’s, it temporally became a part of the Hemato-Oncological Department (HOD) of the Faculty Hospital, which was excluded from the Department of Internal Medicine. Its leading plysician Vladimír Koza, M.D., who began his work at the DCH under the leadership of Dr. Štuksová, became a specialist for hematology at the Department of Internal Medicine.

Under direction of prof. Čepelák and later as the head of the independent HOD, Dr. Koza created a health centre of a great significance, focused especially on the treatment of patients with hematological malignancies and the application of methodology of bone marrow transplantation. HOD closely cooperates with the Foundation for Bone Marrow Transplantation. Besides the inpatient section (which includes hematological ICU) and the outpatient department, HOD contains a specialized laboratory providing cytological, immunological, and molecular-biological diagnostic services to fulfill the needs associated with marrow transplantations.

In 1997, the laboratory of routine diagnostics of HOD, covering basic morphological and hemocoagulation examinations for the area of Faculty Hospital Lochotín, became a component, and an independent department, of the newly constituted Institute of Clinical Biochemistry and Laboratory Diagnostics (ICBLD) of the Medical Faculty UK and Faculty Hospital. Only now the first computer was installed in the laboratory and a laboratory information system was introduced. The laboratory was also equipped with the first automated analyzer, which was able to evaluate differential count of white blood cells and, thanks to the acquirement of a coagulation analyzer, the stop-watch and glass-hook method could be abandoned. In 2000, the hematological department was excluded from ICBLD and merged with the central workplace of DCH at the premises of Faculty Hospital Bory.

After the revolution in 1989, the Czech market was opened to the world. New, more efficient and precise automatic analyzers appeared along with new commercial reagents and reagent kits. The advances in technology and research brought new, until now unknown, diagnoses, including antiphospholipid syndrome and defined thrombophilic states; naturally, the new diagnoses were accompanied by new diagnostic procedures.

The care for patients with hemophilia has significantly changed – it became interdisciplinary. Committed patients were introduced to home health care. Consequently, the number of deforming arthropathies gradually decreased in younger patients. In cooperation with experts in orthopedics, radiation synovectomy was provided to patients suffering from painful ankylosing arthropathy, and the Department of Orthopedics made available hip joint replacement procedure for these patients. During the regular dispensary examinations of patients with hemophilia, additional hematological parameters were used for the monitoring of most serious infection diseases (HIV, HBV, HCV infections etc.).

DCH became the centre for the treatment of patients with both hereditary and acquired disorders of hemostasis. A daily stationaire with two beds, used for ambulatory application of blood, blood derivatives, cytostatics and other drugs, and for performing diagnostic and other therapeutic procedures, became a regular component of DCH. DCH never had its own ward with beds, but it offered a complex outpatient hematological care on its own daily beds; consultations and examinations were also done for the patients during their stay at other departments of the Faculty Hospital. DCH provided a continuous medical care and emergency supply of blood derivatives and some of the less common preparations, necessary for the treatment of acute hemocoagulation disorders.

We must not forget the leading technicians of DCH; they were: Zdena Hafnerová, Irena Píchová, Milena Jochmanová, Hana Machová, and Libuše Tučková.

At the beginning of 2003, the management of the Faculty Hospital decided to consolidate the ICBLD and DCH of the Faculty Hospital. Thus the Institute of Clinical Biochemistry and Hematology (ICBH) of the Medical Faculty Charles University and Faculty Hospital was constituted, where both disciplines kept their autonomy, and, by the application of the principles of consolidation of laboratory departments, it is strictly cared about the professional management and work, both in clinical biochemistry and hematology.

Prof. MUDr. Jaroslav Racek, DrSc. became head of the ICBH on the basis of a a selection procedure, the senior technician remained Jaroslav Kubínová; she was replaced by Mgr. Peter Lajoš in 2007. Dr. Ivana Martínková became the first deputy head of the ICBH for hematology. In the following year she went to the private sector and was replaced by MUDr. Jitka Šlechtová. After her retirement, MUDr. Zdeňka Hajšmanová became deputy head for hematology.

On 1^st January 2022 MUDr. Danil Rajdl, Ph.D. was appointed head of the ICBH.