Introduction
What do we mean when we say “classical hematology”? The phrase has become part of the everyday vocabulary of our field. It appears in fellowship tracks, conference programs, and journal titles. Yet for all its familiarity, the term is surprisingly slippery. What exactly makes hematology “classical,” and does using that label help or hinder the field it describes?
This essay looks at both sides of the question. On the one hand, “classical hematology” offers a useful way to define a vital branch of practice centered on non-malignant blood disorders. On the other, it risks suggesting that some parts of hematology belong to the past rather than the future.
What does “classical” mean?
The word classical comes from the Latin classicus, meaning “of the highest class” or “exemplary.” Over time it came to evoke the art and learning of ancient Greece and Rome, works regarded as models of balance, order, and proportion. In modern usage, the word has several familiar associations: classical music, with its emphasis on form and harmony; classical architecture, with its columns and symmetry; and classical physics, which describes the pre-quantum understanding of the natural world. Across these examples, classical suggests something foundational and enduring, but also something bounded by tradition and hierarchy.
What “Classical Hematology” Tries to Capture
In modern usage, classical hematology refers to the study and care of non-malignant blood disorders such as anemia, hemoglobinopathies, cytopenias, thrombosis, and hemostatic diseases. It also encompasses clonal conditions like polycythemia vera and essential thrombocythemia that, while technically neoplastic, have long been managed within the same clinical tradition.
The field integrates physiology, morphology, and molecular genetics. Mutations in hemoglobin, JAK2-driven erythrocytosis and thrombocytosis, and genetic defects in iron or hepcidin metabolism all fall within its purview. What distinguishes classical hematology is not an absence of molecular science but its synthesis of molecular mechanisms with physiologic reasoning and clinical judgment.
The term emerged as malignant hematology evolved alongside oncology through genomics, targeted therapy, and cellular engineering. As that branch became increasingly defined by therapeutic innovation, the physiology-based and diagnostically oriented side of the discipline sought a name to preserve its identity and training pipeline. Hence, classical became the shorthand.
The difference, however, is not molecular so much as clinical and cognitive. Classical hematologists often begin with an unexplained abnormality such as anemia, cytopenia, hemolysis, thrombosis, or bleeding, and must navigate a wide differential that spans nutritional, inflammatory, genetic, and clonal causes. Malignant hematologists share part of that diagnostic work, particularly when evaluating blasts in the blood or marrow or interpreting a lymph node biopsy that suggests malignancy, but the range of presentations they encounter is narrower. Their diagnostic process also depends more heavily on other specialists, including surgeons, radiologists, and hematopathologists, who perform or interpret key biopsies and imaging studies. The focus is therefore more often on confirmation, classification, and longitudinal treatment of an already suspected or established malignant process. The two domains differ in scope and emphasis rather than in intellectual rigor, and both depend on the same habits of observation, synthesis, and physiologic reasoning that have always defined hematology.
History of the Term
The term classical hematology entered formal use in the early 2020s. A 2022 Lancet Haematology viewpoint by Hanny Al-Samkari and colleagues, The case for classical haematology: the impact of a name and the future of a field, argued that older descriptors such as “benign” and “non-malignant” diminished the field’s seriousness and might discourage trainees from entering it.1 The authors proposed that “classical hematology” would better reflect the discipline’s heritage and intellectual rigor.
The term gained traction following that publication and now appears with growing frequency in professional and training contexts. The American Society of Hematology uses classical hematology alongside benign hematology in some of its educational and career materials, and several academic centers, including UCSF, Penn, and Dana-Farber/Mass General, refer to classical or classical (benign) hematology tracks within their fellowship programs. Although formal adoption remains uneven, the terminology has clearly entered the professional vocabulary as part of a broader effort to strengthen the identity of non-malignant hematology.
Yet not everyone accepts the premise that language alone can elevate the field. In professional usage, terms such as benign and non-malignant continue to appear in ASH program descriptions, fellowship titles, and journal editorials, suggesting that many clinicians regard them as serviceable, if imperfect, descriptors rather than dismissive labels.
The Case for Keeping the Term
1. A Name That Works
From an administrative standpoint, classical hematology performs the same work as benign or non-malignant hematology: it defines a recognizable domain, helps divisions organize clinics and fellowships, and signals to trainees what kind of patients and problems they will encounter. In that sense, it is no better than the terms it supplanted. Its advantage lies only in tone. Benign hematology can sound dismissive, and non-malignant hematology feels awkward and negative. Classical sidesteps both, not by expressing something truer, but by sounding more neutral and professional. The term’s persistence reflects habit and linguistic drift more than any deliberate choice, a placeholder that works well enough while the field decides whether it needs a better one.
2. Continuity and Craft
The word classical reminds us that hematology began as a morphological science, the study of cells under the microscope, of color, size, and shape. It honors a craft honed over generations: reading a smear as one might read a text. These observational skills remain central to our identity, even as the tools change.
3. A Distinct Intellectual Style
Beyond its clinical content, classical hematology represents a way of thinking that is synthetic, pattern-based, and integrative. It values physiology and proportion, just as classical architecture values symmetry. The satisfaction of diagnosis, of reconstructing the story behind a laboratory abnormality, remains one of the field’s enduring appeals.
4. A Flexible Boundary
The boundary between benign and malignant hematology is increasingly porous. Clonal hematopoiesis, immune dysregulation, and inflammation cross those borders with ease, and the same molecular processes underlie disorders once deemed distinct. Labels that depend on this binary, such as benign or non-malignant hematology, no longer reflect biological reality. The word classical, though imperfect, avoids that false division. It acknowledges continuity between the two realms without defining one against the other — a small but meaningful advantage in a field where science has blurred the boundaries.
The Case Against Keeping the Term
The case against classical hematology draws on language, history, and professional identity. The word itself carries cultural and temporal baggage, evoking an earlier era of medicine and hierarchy. It also reflects an uneasy attempt to define a field by contrast rather than by content. The following sections explore how the term, even as it gains currency, risks reinforcing old boundaries and obscuring the discipline’s modern character.
1. The Risk of Connoting the Past
In everyday speech, classical can imply old-fashioned. Just as classical music evokes beauty tinged with nostalgia, classical hematology may sound like a museum of once-useful knowledge. This perception risks marginalizing benign hematology as less dynamic or “less scientific” than its molecular counterpart, even as advances in gene therapy and RNA-based treatments are transforming the field.
2. A Lingering Hierarchy
The term classical also carries cultural overtones that extend beyond chronology. It evokes the authority of toga-wearing Romans and Greek philosophers such as Galen and Hippocrates, whose teachings shaped the foundations of Western medicine. It also recalls the early twentieth century, when figures like Cabot, Minot, Castle, and Lee, all men working within elite institutions, established the modern study of blood. Those worlds, ancient and modern alike, were marked by hierarchy, privilege, and limited access. To some ears, classical hematology inherits that aura of pedigree and elitism. It can make the field sound inward-looking at a time when medicine aspires to be more inclusive, interdisciplinary, and forward-looking.
3. A Generational Divide
To younger hematologists raised in the genomic era, the label can feel anachronistic. They may see all hematology, benign and malignant alike, as molecular, dynamic, and integrated. For them, “classical” risks implying a past they never inhabited rather than a living tradition to which they belong.
4. Fragmented Advocacy
One unintended consequence of replacing benign and non-malignant hematology with classical hematology was confusion rather than cohesion. Advocacy depends on clarity of identity, yet the field has long operated under multiple overlapping labels that differ across institutions and professional societies. For a time, this linguistic pluralism diluted the voice for underfunded and overlooked disorders.
Whether that remains true depends on where the pendulum now stands. As classical hematology gains currency, the risk of fragmentation may be giving way to the risk of resistance, since continuing to debate terminology could prolong uncertainty rather than resolve it. The goal of advocacy, as always, is unity of purpose more than uniformity of language. If the term classical hematology is now widely recognized, that shift may itself turn a once-negative argument into a positive one: what began as fragmentation may have become the foundation for cohesion.
Other Names, and Why They Fall Short
For decades, hematologists described the non-oncologic side of the field as benign or non-malignant. Those terms long preceded classical hematology and still appear in conference programs, journal titles, and departmental websites. The shift toward classical came later, born of a wish to find language that sounded more neutral and unified. Each term, however, brings its own appeal and its own liabilities.
Benign hematology was once the default label. It served a clear practical purpose, distinguishing non-cancerous disorders from malignant disease. Yet the adjective benign has always been uneasy in this context. Many of the disorders it describes (thrombotic thrombocytopenic purpura, severe hemophilia, sickle cell disease) are anything but mild. To patients and trainees alike, the word can sound dismissive, even minimizing the gravity of the illnesses it seeks to classify.
Non-malignant hematology arose as a corrective. It avoided the problem of tone but created another: it defines the field only by negation, as everything that is not malignant. That framing subtly subordinates one half of hematology to the other, implying that malignant disease is the norm and everything else the exception. The phrase also carries an awkward rhythm that never caught on conversationally, which may partly explain its gradual replacement.
The inadequacy of both terms opened the door for a new label. Classical hematology entered the vocabulary as an alternative that promised to sound more neutral and self-contained. Whether it succeeds in doing so is another question, but its rise is best understood as a response to the limits of what came before.
Rethinking the Divide
The challenge of defining classical hematology reflects a broader uncertainty about how hematology itself should be divided. The traditional boundary between “benign” and “malignant” disease has become increasingly porous. Clonal hematopoiesis, immune dysregulation, and inflammation link conditions once thought to occupy separate realms. The same mutations, cytokines, and signaling pathways appear across disorders that used to sit on opposite sides of the line.
As a result, none of the current terms (benign, non-malignant, or classical) has a consistent or universally accepted scope. Each institution draws the borders differently, revealing how our language lags behind the evolving science.
The term classical hematology may also carry an unintended contrast, implying that malignant hematology is somehow less classical, though cancers of the blood have always been part of the discipline’s history. What has changed is not their existence but the frameworks through which they are studied and treated.
Still, the divide retains operational value. It helps organize training, allocate resources, and sustain a community of specialists focused on non-oncologic blood disorders. Classical hematology does not claim to redefine malignancy; it simply provides a name for the broad diagnostic and physiologic side of hematology (anemias, cytopenias, coagulopathies, and even select myeloproliferative disorders) that might otherwise be overshadowed by oncology’s larger footprint. The question, then, is not whether we need two halves of hematology, but how to describe them in ways that reflect both shared biology and distinct professional focus.
Beyond Labels
Why do we feel the need to use classical at all? Perhaps because hematology is a discipline in motion, stretching from the microscope to the genome, from physiology to engineering. The term reflects our attempt to balance continuity with change, to protect the roots of hematology even as the branches multiply.
Seen this way, classical is not a judgment about age but a reminder of origin and proportion. It signifies a mode of thought that values structure, relationship, and reasoning. The challenge is to keep it open, to ensure that classical describes not an era but an ethos.
At some point, every debate about naming comes up against the same question: does any of this really matter? Should time and energy be spent arguing over words when the work of caring for patients and advancing science continues regardless of what we call it? Perhaps not. The biology of disease does not change with the title of the division or the letterhead on a fellowship certificate.
And yet, words shape thought. They influence how trainees imagine a career, how institutions allocate resources, and how patients understand what their doctors do. A name signals identity and belonging. If it is too vague, the field risks invisibility; if it is too narrow, it risks exclusion. The vocabulary of medicine does more than describe; it organizes.
So while the term classical hematology may never feel entirely right, the conversation around it matters because it reveals how we see ourselves. The act of naming is a form of self-definition. Even when the labels are imperfect, they force us to clarify what we stand for and why the work remains worth doing.
A Living Tradition
If classical hematology is to endure — as both a term and a field — it must be understood as living, not static. It should evoke not nostalgia but continuity, describing a discipline that adapts and renews itself. Today’s classical hematologist may order next-generation sequencing for a red cell membrane disorder, use CRISPR-corrected stem cells for sickle cell disease, or prescribe hepcidin analogs for iron overload. The tools evolve; the principles remain.
The field’s continuity lies in its attention to the patient’s story, the physiology behind the numbers, and the humility to question assumptions. These qualities are not relics of the past; they are the very skills that molecular medicine still depends on.
Closing Reflection
So should we keep the term? Probably, if only because it seems to be heading toward common use, and resisting that trend is a battle not worth fighting. The phrase classical hematology is imperfect, historically weighted, vaguely elitist, and semantically untidy, but it is taking root in the language of our field. The more important task is not to stop it from becoming standard, but to strengthen the discipline itself: to attract new trainees, advance science, and care for patients with the same curiosity and humility that defined hematology from the start. Names will evolve, but the work endures.