Haematology

For Haemotology test directory click here.

Haematology specialises in the diagnosis and treatment of disorders of the blood.

We offer a full and comprehensive range of modern diagnostic and therapeutic services treating all diseases of the blood, including acute and chronic leukaemias, myeloma, lymphoma, aftercare of bone marrow transplant patients, myeloproliferative disorders, haemoglobinopathies, anaemias, bleeding disorders and blood clotting abnormalities.

The department liaises closely with many other specialities within the trust providing haematology advice and support to a wide range of patients. In particular we offer specialist clinics for pregnant woman with haematological disorders and for patients with haemoglobinopathies, e.g. sickle cell disease. We provide a full range of general haematology clinics and advice for patients with benign blood disorders including red cell diseases, anaemia, white cell and platelet problems.

General information

scientist The haematology department provides a 24-hour quality diagnostic and advisory service to the hospital clinical staff and general practitioners.

A full list of the tests available during the working day and during the Out of Hours (on-call period) can be found in the Pathology test directory.

The laboratory holds training status with Health Professions Council and has training programmes in place for technical staff and specialist nurses.

The laboratory liaises with the community to provide a neonatal screening service for the diagnosis of sickle disease and other abnormal haemoglobins. 

Routine Haematology

Haematology involves the study of the morphology and physiology of red cells blood to identify abnormalities within the different types of blood cells. Such tests are necessary to diagnosis different types of anaemia, leukaemia, haemoglobin-opathies and other diseases of the blood.

Many results are auto-authorised if they fall within preset ranges (which have been set and approved by senior laboratory staff.) Results outside these ranges are scrutinised and authorised by qualified BMS or Scientific/Medical staff. Certain critical results will be telephoned to the requesting clinician or ward (please see attached guidance for critical phone limits.) 

Blood films are typically used by the laboratory to resolve unusual red cell indices, white cell differential and/or platelet findings seen upon initial (FBC) analysis. When interpreting blood films the age of the patient is important: viral illnesses can produce bizarre looking films in children. The myelodysplastic syndromes (MDS) and malignancies tend to occur in older people. If the patient is well, it may be worth repeating the film to see if any abnormalities seen initially have resolved. If the patient is unwell (or has lymphadenopathy or hepatosplenomegaly) then disease has to be excluded. Click here for more information about Blood Film Morphological Descriptions.

Haematology staff also study disorders of the blood coagulation system and monitor anticoagulant therapy in addition to discharging the Trust's Blood transfusion service.

The transfusion service provides a range of blood and blood products in addition to performing antenatal screening and other specialist testing for the Trust and external healthcare professionals. As part of it's training remit, the department also advises clinicians on the appropriate use of this limited resource.

Blood Transfusion is assessed by the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure compliance to the Blood Safety and Quality Regulations (BSQR) 2005 (for more information on the BSQR click here.)

Haemoglobinopathy laboratory

distribution of hb variants The Haemoglobinopathy service is responsible for investigations of anaemia due to red cell haemolysis. In the majority of cases these include investigations for disorders of both hereditary (intrinsic) red cell disorders of the membrane, metabolism and haemoglobin, along with acquired (extrinsic) red cell disorders.

The majority of the laboratory's workload is taken up by the screening and diagnosis of hereditary disorders of haemoglobin synthesis, collectively termed haemoglobinopathies in addition to quantitation of HbA1C for monitoring of diabetes. The two most commonly encountered haemoglobinopathies are Sickle Cell disorders i.e. Haemoglobin S (yellow in diagram above) and Thalassaemia (green.) A variety of tests are performed to initially screen for and subsequently confirm disease or hameoglobinopathy traits; these include High Performance Liquid Chromatography (HPLC) and haemoglobin electrophoresis and isoelectric focusing. The laboratory also offers G6PD and Pyruvate Kinase red cell enzyme analysis.

The Trust offers universal screening for all antenatal patients as part of the NHS Sickle Cell and Thalassaemia Screening Programme. Haemoglobinopathies are found principally in certain ethnic populations. Sickle Cell disorders are most commonly found amongst Afro-Caribbeans and West Africans and to a lesser extent in those of Eastern Mediterranean and Asian origin. Thalassaemia is found mainly in individuals originating from the Mediterranean, Asia, and the Middle East and to a lesser extent Africa (see diagram above.)

Since Haemoglobinopathies affect such a large population and encompass a wide spectrum of language, culture and social aspects, the laboratory works closely with the Haematology clinicians as well as counselors from the Hackney Sickle Cell Service.

Specialist Referral Haematology services 

Cytogenetic investigations for patients with haematological malignanciesHaematology and other cancers employ samples of bone marrow, peripheral blood or other infiltrated tissue using a range of cytogenetic and molecular cytogenetic tests to screen for acquired chromosomal abnormalities that establish the diagnosis and provide prognostic information (thus impacting on patient management,) in addition to allowing the assessment of treatment response for a range of conditions.

Immunophenotyping is used to diagnose and classify suspected haematological abnormalities involving leucocytes. Immunophenotyping is offered to supplement and complement the services provided by cytogenetics for diagnosing and staging malignancies of either myeloid or lymphoid origin in addition to Minimal Residual Disease (MRD)assessment for those undergoing therapy. Contact us for more information on Cytogenetic or Immunophenotyping testing available via our specialist Haematology service providers.

Specialist cytogenetic, coagulopathy or immunophenotyping investigations are typically occasioned by Haematology clinical staff to further resolve the clinical picture or otherwise follow-up patients in whom blood tests have already been processed by the department. It may be possible to request such investigations independently if there is a strong clinical suspicion with which to do so, however such requests must be submitted to the Consultant Haematologist(s) directly.