Ask a Haematologist: Dr Lim Zi Yi from Mount Elizabeth Novena Hospital Singapore

Ask a Doctor ForumCategory: HaematologyAsk a Haematologist: Dr Lim Zi Yi from Mount Elizabeth Novena Hospital Singapore
Avatar photoDr Lim Zi Yi asked 2 years ago
I am Dr Lim Zi Yi, Haematologist based in Mount Elizabeth Novena Hospital Singapore and Gleneagles Hospital Singapore. Ask Me Anything! I am a specialist in Haematology, with special interests in Haemato-oncology and Haematopoietic Stem Cell Transplantation. I received my medical degree from The University of Edinburgh, UK and subsequently underwent specialist training in haemato-oncology at King's College Hospital, London. I am passionate about approaching patient care in a holistic manner, utilising state of the art diagnostic tests together with novel treatment protcols to develop personalised treatment strategies for my patients. I have equally worked hard to create a centre where the medical team is focussed on giving patients and their families the time, support and strength they need to recover. I worked at King's College Hospital for almost a decade, during which I helped develop the department into one of the largest haematopoietic stem cell transplant centres in Europe. I am experienced in various forms of autologous and allogeneic haematopoietic stem cell transplantation and have personally overseen the management of more than 300 bone marrow transplants since 2006. I was the lead for adult leukaemia service at the National University Hospital Institute from 2011-2013 and the lead for adult haematopoietic stem cell transplant service at Parkway Cancer Centre from 2013-2019. Learn more about me here I am happy to share/discuss any haematological issues. I will be actively answering questions. Whether you've got questions about blood cancers, benign blood conditions or stem cell transplantation, ask me anything! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
17 Answers
Ms Koh answered 2 years ago

My 13 years old daughter often has nosebleeds with a large amount of blood. We have also noticed that whenever she has a fall, the wound takes very long to recover and during the recovery period, she gets joint pains and fever. Otherwise, she seems like a normal teenager. How do we know if she has a blood disorder?

Dr Lim Zi Yi replied 2 years ago

Nosebleeds are not uncommon in teenagers and can often come from bleeding in the membranes in the nostrils, usually from irritation, dry air, allergies, or blowing the nose too hard. If it is persistent, it may be good for her to see an ENT specialist for a review.

It is generally less common for a blood disorder to cause nose bleeding alone. Bleeding disorders are not common, but if your daughter has excessive nose bleeds as well as other symptoms such as easy bruising or bleeding, then she should get an assessment with a specialist, particularly given her associated history of joint pains and fever.

Hayley answered 2 years ago

I’ve heard that anemia cannot be cured. Is this true? I am a 22 year old female and I often feel weak because of it. I have done transfusions quite a few times already. If anemia really cannot be cured, what can I do to improve my life? Are there any food or lifestyle recommendations?

Dr Lim Zi Yi replied 2 years ago

Anaemia is due to a low red cell count in the body. Red cells help to carry oxygen to our tissues and when low, it can cause tiredness, shortness of breath,

The most common cause of anaemia for females in your age group is due to deficiency of nutrients, particularly iron deficiency. This is often due to an iron poor diet or heavy menstrual periods.

Some forms anaemia are due to bone marrow problems. Thalassemia for example is an inherited condition affecting red cell production in the bone marrow, and patients with severe thalassemia may need regular blood transfusions. For patients with severe thalassemia, a bone marrow transplantation may be the only form of cure.

Likewise, other forms of blood disorders (such as blood cancers) can also cause anaemia, and while rare, these conditions will need to be assessed by a haematologist to determine the most appropriate treatment.

For your condition, it is important to discuss with your doctor as to the cause of your anaemia, and that will help to guide suitable diet and lifestyle adjustments.

Eric Ho answered 2 years ago
My good friend had a blood clot in his lungs recently. What causes these clots, and how can you prevent them from happening?
Dr Lim Zi Yi replied 2 years ago

It is likely that your friend suffered from a pulmonary embolus. This is when a blood clot travels to the lungs and affects the supply of blood to the lungs. This can cause breathing problems, chest pain, and sometimes patients can start coughing blood. In some cases, patients can collapse due to the blood clots, and it can be fatal in serious cases.

Most of these blood clots arise from clots in the legs, known as deep vein thrombosis (DVT). These clots can break off and travel to the lungs to cause a pulmonary embolus.

Blood clots are often caused by immobility, after long haul flights, during pregnancy or after surgery. Some patients may have immune or genetic factors that can increase their risk of blood clots forming. Occasionally, conditions such as cancer can also trigger the formation of blood clots.

The main treatment of blood clots is via the use of blood thinners. To prevent blood clots, it is advisable to stay mobile and well hydrated in at risk situations such as long haul flights. Compression stockings during flights or post-surgery can also reduce the risk of blood clot formation.

Mike answered 2 years ago

My father was diagnosed with stage 1 lymphoma. What are the recovery chances for him if he undergoes chemotherapy? He is 66 years old.

Dr Lim Zi Yi replied 2 years ago

This in part depends on the subtype of lymphoma your father has. However, stage 1 (or localised) lymphoma carries a high chance of cure for many patients.

Even in older patients above the age of 60, most of them can tolerate some form of chemotherapy or targeted therapy. Some patients with localised lymphoma may benefit from radiotherapy too. It is best to discuss the specific details of treatment and the expected response rates with the doctor managing your father.

Victor Kwang answered 2 years ago

When does bleeding gums indicate a blood disorder? My 17 year old sister gets bleeding gums almost twice a month. How do we know it’s only a mouth condition and not a blood disorder? Does she need to see a doctor?

Dr Lim Zi Yi replied 2 years ago

Most causes of gum bleeding are related to issues such as oral hygiene or gum disease. As a first point of assessment, your sister may benefit from an assessment by her dentist.

Blood disorders such as low platelet counts or bleeding disorders can sometimes manifest as bleeding gums, but often patients may have other symptoms such as easy bruising or bleeding elsewhere (such as nose bleeding). If she has these symptoms then she may need to be assessed by a haematologist.

Very rarely, some types of blood disorders such as acute leukaemia can cause gum bleeding, but this is usually associated with swelling of the gums, as well as other symptoms such as lack of energy, bruising elsewhere, and infections.

Xuan Shi answered 2 years ago

I have recently taken up long-distance running. While everything seemed great in the beginning - i felt more healthier than i’ve felt in a long time, I now often feel lethargic and my muscles feel extremely tight even though I let them rest in between runs. I read online that it could be something called runner’s anemia. How do I know if I have it?

Dr Lim Zi Yi replied 2 years ago

Runners anaemia is an uncommon condition which happens in long distance runners, and occurs when pounding of the feet on the ground causes destruction of the red blood cells in the blood vessels in the feet. This may present with lethargy, and anaemia, but also sometimes passing darker urine as the broken down products of the red cells are discharged in the urine.

To be fair your symptoms are non specific and may not be related to runners anaemia, but if you are in doubt you can have a blood test done to see if you have anaemia as a first screen. Do note though that there can be other causes of anaemia too, so your results will need to be interpreted with the assistance of your doctor.

Azmi answered 2 years ago

For stage 3 multiple myeloma, is a stem cell transplant necessary? And will it be safe if my grandfather is already 73 years old?

Dr Lim Zi Yi replied 2 years ago

Multiple myeloma is a blood cancer which affects the bone marrow but also can affect the kidneys and the bone.

Not all patients with multiple myeloma (even stage 3) may need an autologous bone marrow transplant – this depends on a variety of factors including the age and fitness of the patient, the underlying disease risk of the condition (guided by the cytogenetics and baseline characteristics of the myeloma), as well as the response of the patient to initial treatment.

Fitness for autologous stem cell transplant is determined by the overall status of the patient, looking at age, as well as the fitness of the patient, and the organ status of the patient. Patients in the age group of 70-80 are also offered transplants, but they will need to be very carefully evaluated in advance by the treating physician.

Lydia answered 2 years ago
Why was CA125 cancer test not positive when there is cancer? Does a malignant tumour need to rupture or advance in stage for positive result?
Dr Lim Zi Yi replied 2 years ago

Tumour markers like CA125 need to be used with caution and with an understanding of what they represent. Tumour markers are not always specific – that means that they are not elevated in all cancers, and sometimes other conditions can cause it to be raised

For example CA125 is associated with ovarian cancers, but other non cancerous conditions such as menstrual cycle changes, and uterine fibroids can cause the levels to be high. Likewise, CA125 would not be elevated in conditions such as blood cancers for example.

No, the CA125 and other tumour markers can be elevated in the presence of a tumour, and not only if there is advanced disease or rupture.

Aileen answered 2 years ago

Whenever she is on her period, my 17 year old daughter experiences nosebleeds that make her dizzy and weak. There are also bluish bruises appearing all over her body, especially on the neck and behind the ear. Could this possibly be a haematology disorder, Doctor?

Dr Lim Zi Yi replied 2 years ago

Nosebleeds and concurrent bruising if significant could be a reflection of a platelet disorder or other clotting issue. There could be other causes related to hormonal or autoimmune issues. It would be sensible for her to be assessed by a haematologist to make sure there are no underlying issues.

Kevin answered 2 years ago

My wife has high levels of white blood cells. But we haven't observed any physical changes in her. How do we further check to know if it's leukemia or something else?

Dr Lim Zi Yi replied 2 years ago

High levels of white blood cells are commonly a reaction to stress, inflammation or infection. Some drugs such as steroids can also cause a raised white cell count.

Leukaemia or other blood disorders can cause a raised or a lower white cell count. Sometimes this can be associated with abnormalities in other counts such as the haemoglobin or platelet count. Your doctor should be able to advise you as to whether your wife’s blood count changes necessitate further investigation by a haematologist.

If there is a suspicion of a blood disorder, addition blood tests will help to clarify the situation. In certain cases patients will need a bone marrow assessment test to diagnose or exclude leukaemia or other blood cancers

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