STP Specialisms | Haematology

Haematology – something to do with blood.

When I tell people that I am training to become a clinical scientist in haematology and transfusion science, the reply I often get is; ‘Haematology – that’s something to do with blood, right?’

Well, to put it simply; haematology is the medical speciality responsible for the diagnosis and management of a wide range of benign and malignant disorders of the blood and bone marrow (the spongy interior of bone where blood cells are made). So yes, you could say that haematology is something to do with blood…

The Four Disciplines

Hundreds of routine and urgent tests are performed in haematology and transfusion laboratories which operate on a 24/7 basis. There are also specialised labs that normally run on weekdays, with an on-call scientist for emergencies. Haematology is an incredibly broad discipline and to describe each and every aspect in detail would require many a blog post and a lot of time to write. So, in a nutshell, clinical haematology can be categorised into the following four disciplines:

• Diagnostic haematology – sometimes known as routine haematology, this is the section that mainly deals with benign conditions of red and white blood cells such as anaemia, infections including glandular fever and malaria, and haemoglobin disorders, for example; sickle cell disease. Tests such as the full blood count (one of the most common blood tests requested, this measures the size and number of different types of cells in a blood sample), blood film morphology, haemoglobin electrophoresis and erythrocyte sedimentation rate are performed here.

• Haematological malignancy – as the name suggests, this section focuses on cancers of the blood. My training is based at Addenbrooke’s hospital in Cambridge, which has a department called the Haematopathology and Oncology Diagnostic Service (HODS). The HODS laboratory is highly specialised and receives numerous referrals from other hospitals. Not only are cancers diagnosed in this lab,  they are also ‘typed’ as this helps clinicians to decide the best treatment plan for the patient as well as provide information on the likely prognosis. Cancers are also monitored here to see if treatment is effective or not. Some of the methods that we use to diagnose, type, and monitor blood cancers include molecular techniques, NGS, and flow cytometry.

• Haemostasis – this section of haematology is responsible for diagnosing and monitoring patients with inherited and acquired bleeding and thrombotic disorders by performing coagulation screens and other tests such as factor assays, platelet (cells that allow blood to clot) function tests, and antibody testing. Some hospitals – including Addenbrooke’s – have special centres that focus on specific disorders such as haemophilia.

• Blood transfusion – the blood transfusion department (also known as blood bank) is responsible for performing routine blood grouping, antibody identification, red cell phenotyping, crossmatching, and other pre-transfusion tests. The main priority of the lab is to provide blood and blood products to patients in need of a blood transfusion in a safe and timely manner. It is vital that patients receive the correct blood for a safe transfusion as patients who receive incompatible blood units are at risk of having life-threatening reactions. The most important pre-transfusion test is ABO grouping. Other products that are issued to patients include platelets, fresh frozen plasma, and prophylactic anti-D to expecting mothers.

STP Structure

STP trainees undertake three years of training in order to become a clinical scientist which is broken down into the following structure:

Year 1 – Haematology is just one area that comes under the umbrella term; blood sciences. The different blood science departments work very closely together and more often than not, a patient will require tests from more than one department in order to gain a diagnosis of a condition. The first year of training is essentially an introduction to blood sciences as a whole and trainees rotate through the Haematology (yay!), Biochemistry, Immunology, and Genetics departments in order to gain an overview of how they work and to appreciate how they all interlink to maximise patient care. Trainees are expected to demonstrate a basic understanding of the theories and principles of each department by completing competencies, DOPS and (the dreaded) case based discussions.

Years 2 & 3 – This is where trainees are exposed to the real nitty-gritty side of haematology.

Haematology and transfusion STP trainees are required to complete competencies to a specialist standard in all of the aforementioned disciplines (HINT: stay calm and try to focus on one at a time). The structure of the STP programme aids this by splitting competencies into the following modules:

• Disorders of red and white blood cells
• Core transfusion
• Haemostasis
• Haematological malignancy
• Specialised transfusion

I have just started my second year of training (how am I in Year 2 already?!) and I can already feel my knowledge and skills being expanded as I begin my specialist modules; I am currently learning to analyse blood films and interpret blood cell morphology which is a major skill that I will require in my future role as a clinical scientist.

Although a clinical scientist is not a patient-facing role, I have really enjoyed and benefited from observing a range of haematology clinics and attending multidisciplinary team meetings, and would encourage other trainees to arrange as much clinical experience as possible as our role involves working closely with clinicians.

On a final note, I would like to add that September is Blood Cancer Awareness Month. There are over 100 types of blood cancer, the most common being leukaemia, lymphoma and myeloma. Collectively, they are the fifth most common type of cancer in the UK, with 40,000 diagnoses made each year. Like with all cancers, it is beneficial to diagnose the condition as early as possible as this greatly improves a person’s chance of having a better prognosis. Unfortunately, the symptoms of blood cancer are non-specific and as a result, a huge number of people are unaware of the signs and symptoms of blood cancer. Below is a link to the Bloodwise charity website which provides very good and accurate information on blood cancer, including signs and symptoms, advice on how and when to get tested, treatment options, support services, etc. Please take a look if you would like to familiarise yourself with this information and feel free to share if you would like to raise awareness and educate others.

https://bloodwise.org.uk/

I hope you found this blog post enjoyable and informative. Thanks for reading!

Tara