Becoming a Classical Hematologist
A Dream Come True
She fell in love with hematology on her first day of medical school. Hematologist May Chien, MD, remembers feeling that she had “found her dream.”
Chien, who is clinical assistant professor, pediatrics–hematology & oncology, and medicine–hematology, recalls that “I loved all the mechanisms of blood diseases and all the thought processes hematology involves.” Today, she’s living her dream.
Chien is board-certified in both internal medicine, hematology, and pediatric hematology-oncology, which gives her an unusually broad perspective from which to manage patients with classical (nonmalignant) blood disorders.
“Until recently, patients with blood diseases such as hemophilia and thalassemia did not survive past childhood,” she notes. “But today, with improved treatment options, many children born with these diseases grow into adulthood.” And since hematologists who treat adults don’t always have a lot of training in childhood diseases, her breadth of skills enables her to care for patients with blood disorders and follow them from birth through adulthood.
For example, she may help a woman with a bleeding disorder get through pregnancy and birth, and then find that the child has inherited the same disease. Chien can help them both manage their conditions and has done so numerous times.
“In the world of medicine, we arbitrarily place people in one of two groups: under age 18 and over age 18...Dr. Chien occupies a unique space from which to care for patients with genetic blood diseases, from both sides of that age equation.” – Ravi Majeti, MD, PhD
Or a child may be diagnosed with hemophilia with no known relatives who have the disease. By widening the family circle in which genetic mutations can be viewed, an unsuspecting family member can be identified as also having the disease. This is also part of Chien’s practice.
“This is often the case with women who have had very heavy menstrual bleeding their entire lives,” says Chien. “Having a child with hemophilia can bring focus to the mother’s genetic makeup and discover that she, too, has the disease.”
To Chien, working with families in this way enhances her joy of working in classical hematology.
It’s unusual for physicians to be subspecialty-trained to care for both children and adults, states Ravi Majeti, MD, PhD, division chief for hematology. “In the world of medicine, we arbitrarily place people in one of two groups: under age 18 and over age 18. How we assign physicians and resources is driven by that dividing point,” he says.
“But,” Majeti says, “the disease doesn’t care how old you are; what matters is how you navigate the healthcare system to find the best care possible whatever age you are. Dr. Chien occupies a unique space from which to care for patients with genetic blood diseases, from both sides of that age equation.”
Charting Her Own Course
Looking back on her training, Chien comments that “the people you meet often present options you didn’t know existed. I went to medical school at the University of Southern California Keck School of Medicine. Some colleagues I most admired there were doing a combined internal medicine (IM) and pediatrics residency. I applied for that program and got in.”
Four years later, she came to Stanford for fellowship training. “Stanford was wonderful for allowing me to create my own combined fellowship program in both IM and pediatrics. It was the perfect answer to finding a place where my intellectual and clinical interests could intersect,” she says.
Chien was the first fellow in the Stanford Department of Medicine to complete two fellowships concurrently. “One of the best things about Stanford is that if you dream it, people can make it happen,” she says. “I had an idea and found complete support for it here.”
Not only did she need faculty approval for the combined fellowship, but also she had to secure consent from the two board-certifying organizations involved: the American Board of Internal Medicine and the American Board of Pediatrics, both of which approved her proposed fellowship program.
A native of Southern California, Chien graduated from Amherst College in Massachusetts before returning home to pursue what she thought would be a career in laboratory research. “I was not living my best life at a laboratory bench,” she says. “I realized I was more interested in working directly with people.” So, she applied to medical school and found her “best life.”
One of the best things about Stanford is that if you dream it, people can make it happen. I had an idea and found complete support for it here.
– May Chien, MD
Research in Classical Hematology
“Classical hematology is about intricate pathways,” says Chien. “Finding the correct diagnosis is like solving a fascinating puzzle, since there are numerous mechanisms for coagulation and other beneficial events to occur and possibly go wrong.”
Stanford researchers are pursuing new and novel treatments for conditions classified as classical hematological disorders, including hemophilia, thalassemia, pyruvate kinase deficiency, and sickle cell disease. Some of these involve gene therapy or stem cell transplantation.
“Inherited blood diseases are especially amenable to treatments like these,” says Chien. “Some are currently in clinical trials, but we have a way to go before they can be universally applied.”
For example, hemophilia A is an inherited genetic disease that results from a gene mutation that prevents the liver from making enough of a clotting factor called factor VIII. The result is excessive bleeding.
“Research in hemophilia is very exciting right now,” says Chien. “Gene therapy is starting to show promise in providing a potential cure for the disease.” Hemophilia is an ideal candidate for gene therapy because it arises from mutations of a single gene and because a patient doesn’t need a lot of the clotting factor to bring about a change from severe disability to wellness.
“Unlike stem cell replacement, successful gene therapy would entail one infusion into the liver to stimulate production of factor VIII,” Chien explains. “This not only would add years to patients’ lives but also could actually cure the disease.”
She is also interested in thalassemia, a type of anemia in which the entire hemoglobin portion of the blood is abnormal. Currently, blood transfusions are the main therapy used to treat thalassemia. The challenge with this approach is the possibility of overloading the liver with more iron than it can handle. A clinical trial underway at Stanford is exploring the potential of an oral drug that could extend the lifespan of a red blood cell, thereby boosting red blood cell levels and reducing or possibly eliminating the need for transfusions.
Looking forward, Chien is eager to continue her work in decreasing the burden of inherited blood disorders such as hemophilia, thalassemia, and sickle cell disease. “My goal is to continue to improve life expectancy and quality of life for adults and children with these conditions,” she says.