1. Haematology and Blood Transfusion STP post Blood Sciences Newcastle Upon Tyne Hospitals NHS Foundation Trust (NUTH)

2. Why Haematology and Transfusion? Diverse subject Highly scientific in background, continually at forefront of development of diagnostic tests Immediate relevance to patients Well established links between clinicians and scientists

3. Why Haematology and Transfusion? Diverse subject Highly scientific in background, continually at forefront of development of diagnostic tests Immediate relevance to patients Well established links between clinicians and scientists

4. Why Haematology and Transfusion? Diverse subject Highly scientific in background, continually at forefront of development of diagnostic tests Immediate relevance to patients Well established links between clinicians and scientists

5. Why Haematology and Transfusion? Diverse subject Highly scientific in background, continually at forefront of development of diagnostic tests Immediate relevance to patients Well established links between clinicians and scientists

6. For example… Sample received from Emergency Department (ED) Patient is Mrs Smith, aged 32 Clinical details “Bruising ?cause”

7. For example… Sample received from Emergency Department (ED) Patient is Mrs Smith, aged 32 Clinical details “Bruising ?cause”

8. For example… Sample received from Emergency Department (ED) Patient is Mrs Smith, aged 32 Clinical details “Bruising ?cause”

9. Full blood count and film Analysis demonstrates anaemia, low white cell count and low platelet count (pancytopenia) Lab staff make blood film

10. Full blood count and film Analysis demonstrates anaemia, low white cell count and low platelet count (pancytopenia) Lab staff make blood film

11. Preparation of blood film Drop of blood placed on slide Spreader used to draw back blood drop Drop spread to make monolayer of cells Film ready for staining

12. Full blood count and film Normal blood film

13. Full blood count and film

14. Haematology BMS phones the haematology doctor on call Doctor on call examines the film. Acute promyelocytic leukaemia

15. Full blood count and film Haematology BMS phones the haematology doctor on call Doctor on call examines the film. Acute promyelocytic leukaemia

16. Full blood count and film Haematology BMS phones the haematology doctor on call Doctor on call examines the film. Acute promyelocytic leukaemia

17. Full blood count and film Doctor phones ED, Mrs Smith admitted urgently to the regional leukaemia treatment unit. Once there…

18. Next step Mrs Smith has urgent tests to 1)Confirm the diagnosis 2)Look for evidence of complications

19. Next step Mrs Smith has urgent tests to 1)Confirm the diagnosis 2)Look for evidence of complications

20. To confirm the diagnosis… Bone marrow aspirate samples taken for - aspirate film - flow cytometry - cytogenetic analysis

21. Aspirate film

22. Flow cytometry http://www.clinicalflow.com/Cases/Introduction_to_Flow_Cytometric_Analysis

23. Flow cytometry http://www.clinicalflow.com/Cases/Case_List/Acute_Myelogenous_Leukemias_with_Recurrent_ Cytogenetic_Abnormalities/Acute_Promyelocytic_Leukemia_-_AML_with_t(15%3B17)(q22%3Bq12)

24. Flow Cytometry The reporting flow cytometry doctor sees features consistent with APML But the diagnosis cannot be confirmed by flow, only supported.

25. Cytogenetic analysis From Journal of Cancer Therapies DOI:10.4236/jct.2011.22014DOI:10.4236/jct.2011.22014

26. Karyotyping

28. Diagnosis confirmed Acute promyelocytic leukaemia with t(15;17)(q22;q12) Time from initial blood test to confirmation of diagnosis is about 6 hours

29. Tests looking for complications Mrs Smith came to ED with bruising A sample was taken for blood coagulation analysis Grossly abnormal – 2 screening tests, APTT and PT both prolonged, levels of fibrinogen very low D-Dimer initiated by lab due to abnormal screening results – very high result

30. Tests looking for complications Mrs Smith came to ED with bruising A sample was taken for blood coagulation analysis Grossly abnormal – 2 screening tests, APTT and PT both prolonged, levels of fibrinogen very low D-Dimer initiated by lab due to abnormal screening results – very high result

31. Tests looking for complications Mrs Smith came to ED with bruising A sample was taken for blood coagulation analysis Grossly abnormal – 2 screening tests, APTT and PT both prolonged, levels of fibrinogen very low D-Dimer initiated by lab due to abnormal screening results – very high result

32. Coagulation testing http://www.practical-haemostasis.com/Screening%20Tests/aptt.html

33. The APTT

34. Coagulation testing Mrs Smith’s blood is virtually unclottable. D-Dimer initiated by lab due to abnormal screening results Disseminated Intravascular Coagulation - a medical emergency The BMS phones Mrs Smith’s doctor urgently!

35. Coagulation testing Mrs Smith’s blood is virtually unclottable. D-Dimer initiated by lab due to abnormal screening results – very raised. Disseminated Intravascular Coagulation - a medical emergency The BMS phones Mrs Smith’s doctor urgently!

36. Coagulation testing Mrs Smith’s blood is virtually unclottable. D-Dimer initiated by lab due to abnormal screening results – very raised. Disseminated Intravascular Coagulation - a medical emergency. The BMS phones Mrs Smith’s doctor urgently!

37. Coagulation testing Mrs Smith’s blood is virtually unclottable. D-Dimer initiated by lab due to abnormal screening results – very raised. Disseminated Intravascular Coagulation - a medical emergency. The BMS phones Mrs Smith’s doctor urgently!

38. Patient Support and Treatment Blood transfusion

39. The future for Mrs Smith… APML is eminently treatable if identified and treated properly.

40. The future for Mrs Smith… http://www.newevidence.com/oncology/entries/Advances_in_the_Management_of_Acute_Promyelocytic /

41. The future for Mrs Smith… APML is eminently treatable if identified and treated properly. But it is deadly if not identified and treated promptly.

42. The future for Mrs Smith… http://www.bloodjournal.org/content/118/5/1248?sso-checked=true

43. The future for you… In the diagnosis of Mrs Smith’s leukaemia, several different BMSs and clinical scientists were working on different aspects of her case at the same time. Her doctor was taking blood and bone marrow samples, prescribing drugs, looking at marrow samples and most importantly talking to Mrs Smith and her family

44. The future for you… In the diagnosis of Mrs Smith’s leukaemia, several different BMSs and clinical scientists were working on different aspects of her case at the same time. Her doctor was taking blood and bone marrow samples, prescribing drugs, looking at marrow samples and flow and talking to Mrs Smith and her family.

45. Could you help? In the future, haematology STP scientists will co- ordinate the laboratory analysis of Mrs Smith’s samples, and make the time to diagnosis even quicker. We’d like you to join us! Any questions?

46. Could you help? In the future, haematology STP scientists will co- ordinate the laboratory analysis of Mrs Smith’s samples, and make the time to diagnosis even quicker. We’d like you to join us! Any questions?

47. Could you help? In the future, haematology STP scientists will co- ordinate the laboratory analysis of Mrs Smith’s samples, and make the time to diagnosis even quicker. We’d like you to join us! Any questions?