Haematologist in Latviawhere to get treatment, how to verify certification, what this doctor does

Haematology is the field specialising in the diagnosis and treatment of blood disease. It studies blood cells, meaning white cells, platelets and red cells, along with bone marrow, lymph nodes, the spleen, and the proteins responsible for bleeding and clotting.

• Lymphomas, chronic and acute leukaemias, myeloma
• Myelodysplastic syndromes
• Inherited clotting disorders such as haemophilia and von Willebrand disease
• Autoimmune blood disease: autoimmune thrombocytopenia, haemolytic anaemia
• Deficiency anaemias
• Unexplained blood test changes where no other cause can be found

Changes in blood counts are often secondary to another illness, and the family doctor or specialist then judges whether a haematology consultation is needed. Where no cause can be found but blood disease is suspected, the patient should be seen by a haematologist.

Haematology in Latvia has no separate sub-specialties. In practice the field splits into oncohaematology, meaning treatment of blood cancers, and non-oncological haematology covering clotting disorders and anaemias. Paediatric haemato-oncology is a separate sub-specialty with its own requirements.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• Residency in haematology. The RSU programme runs 5 years, 330 ECTS, tuition 5,120 EUR per year, led by Prof. Sandra Lejniece and Asist. Daiga Auziņa. Programme page: RSU residency programme.
• The programme covers chemotherapy, radiotherapy, replacement and palliative therapy, autologous and allogeneic stem cell transplantation, transfusion medicine and immunohaematology, plus paediatric haematology, rheumatology, endocrinology, oncology and infectious disease.
• The resident must learn to examine the haematology patient, perform bone marrow aspiration and trephine biopsy, build differential diagnoses, and set treatment plans.
• The state examination tests theory and requires defence of a scientific, clinical or applied study.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points, at least 60 per cent tied to the base specialty, plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• In practice the choice is narrow. Oncohaematology care is concentrated in Rīga, and stem cell transplantation happens at a single clinic.
• A state-funded visit for reimbursed medicines. Prescriptions for reimbursed medicines may only be issued by doctors under contract with the National Health Service, so obtaining them requires a state-funded appointment.
• Type of disease. Clotting disorders and blood cancers are handled in different wards, so it helps to state the diagnosis when booking.
• Languages. Consultations run in Latvian and Russian, with some doctors also working in English.
• Second opinion. Patients may freely choose the doctor and institution.

• Bring all earlier blood results: in haematology the trend matters more than a single measurement.
• Hospital discharge summaries and the results of earlier bone marrow studies and imaging are useful.
• Bring a full list of medicines, including blood thinners and supplements.
• At the visit the doctor reviews the trend in results and examines the patient, including lymph nodes, liver and spleen, then orders further laboratory or imaging tests as needed.
• Bone marrow aspiration and trephine biopsy may be needed to establish the diagnosis, and these are done separately.
• Patients with clotting disorders should always tell healthcare staff their diagnosis and make sure it is recorded in their e-health profile.

In the public system, with a referral, a specialist visit costs 4.00 EUR, day hospital treatment 7.00 EUR per day, and inpatient treatment 10.00 EUR per day from the second day. Inpatient co-payments are capped at 355.00 EUR per illness episode and 570.00 EUR per calendar year overall. The Latvian Haemophilia Society notes that a haematology appointment requires a family doctor referral for ongoing monitoring, valid for one year.

• Patient co-payment for a specialist visitPrice EUR: 4.00Source: NVD
• Patient co-payment for day hospital treatmentPrice EUR: 7.00 per daySource: NVD
• Patient co-payment for inpatient care from day twoPrice EUR: 10.00 per daySource: NVD
• Inpatient co-payment cap per illness episodePrice EUR: 355.00Source: NVD
• Annual co-payment capPrice EUR: 570.00Source: NVD

The specialty body is the Latvian Association of Haematologists.

On the patient side, the Latvian Haemophilia Society is a patient organisation that does not give medical advice but explains where to seek outpatient care.

Certificates are issued by the Certification Council of the Latvian Medical Association, founded in 1988. The sector regulator is the Health Inspectorate.

If you have doubts about the quality of care, raise them first with the institution's management, which must operate a complaints and suggestions system. If that does not resolve it, a written submission goes to the Health Inspectorate no later than two years after the alleged infringement, and is reviewed within 30 days, extendable to four months in complex cases. The procedure is set out on the Health Inspectorate site.