Haematology and Transfusion

A day in the life of a Biomedical Scientist - Haematology and Transfusion

Biomedical scientists investigate the formation, composition, function and diseases of blood. Some of the diseases diagnosed in haematology are leukaemia, malaria and anaemia. They also identify blood groups for blood donation, ensures the correct grouped blood is matched to the patient due to receive the donation and makes sure blood stocks are adequate for critical incidents such as road traffic accidents, operations and cancer treatments.

 

Name

Nic Fowler

Job title

Biomedical Scientist

Discipline

Haematology / Blood Transfusion

Career to date

I’ve worked in the NHS since 1996 and started as a lab assistant in Microbiology at Frimley Park Hospital.  I left Frimley to complete a Biomedical Science Degree at Brighton University as a mature student. 

I then trained to be a Specialist in Microbiology at Worthing Hospital and worked there for 7 years, before transferring to the Queen Alexandra Hospital in Portsmouth where I stayed for nearly 5 years. 

In November last year, I decided to change disciplines and I’m now working back at Worthing Hospital in Haematology and Blood Transfusion. 

 

At the start of my shift

I start work at 9am.  The department covers 24 hours, 7 days a week and once I am trained I will participate in the out of hours service. 

Currently, I am working in Blood Transfusion. The lab is split into three areas – sample reception, the antibody bench and the crossmatch bench, and we all work very closely together.   I’m on the antibody bench at the moment.  It’s all very new to me as it’s my first rotation into Transfusion, but I love it already!

My first job of the morning is to make sure there is nothing urgent from the on-call shift – e.g. a patient who needs antibody identification before a transfusion, or any verification of urgent samples that may have just arrived which will need loading onto the analyser. 

My next job is to perform bench controls and stock level checks.  I check that all reagents used manually are in date and perform as expected, and check that all the stock levels are adequate.  The medical laboratory assistants in the department maintain the analysers, and we all make sure they are running smoothly throughout the shift, performing quality controls regularly.

Batch acceptance is a huge part of the role too – making sure that everything we receive is performing as expected as transport conditions cannot always be guaranteed.  All the checks are essential to ensure correct patient results and compliance with CPA/ISO and MHRA.

During the shift

Throughout my day I verify the samples that have been booked in by our fabulous medical laboratory assistants. The patient details in Blood Transfusion are checked, checked and checked again!  We have very strict acceptance criteria to ensure the safety of our patients, as the consequences of an error could cause a potential transfusion reaction.  The majority of our samples are for ‘group and screens’. This involves testing the patients’ red blood cells for their ABO and RhD group antigens and testing their plasma for any alloantibodies they may have formed. A patient may form an alloantibody if they have received a transfusion (from foreign antigens present on the donor red cells), or if they have been pregnant or are currently pregnant (from foreign antigens present on the babies red blood cells that are paternal in origin). Patients can also make antibodies against their own red cells, and in this case, the antibody is an autoantibody.

The majority of the work is done by automated methods, but occasionally we may have to check manually if an analyser is unable to give a definitive result – e.g. weak reactions or discrepant results.

If any antibody screens are positive, I would investigate further by testing their plasma against an extended panel of RBCs with known antigens – this helps me determine the specificity of their antibody(s). Correct identification of an antibody(s) is crucial to ensure that we transfuse the patient with the correct blood, should it be required.  If a patient has an antibody, or a mixture of antibodies I can’t identify, I refer the sample to a specialist unit.

I also issue anti-D prophylaxis, working closely with the antenatal clinic.  Every expectant Mum that is RhD negative will need to receive anti-D prophylaxis to ensure they don’t develop an allo anti-D in the event their baby is RhD positive. Prophylaxis is given routinely at 28/40 and after delivery, and also during the pregnancy if there is a potentially sensitising event (PSE), where there could be leakage of foetal blood into the Mums circulation.  In addition, if the Mum is over 20 weeks pregnant and has a PSE, I would perform a Kleihauer test. This test is also performed routinely after delivery. The results of this test will determine whether the Mum needs any additional prophylactic anti-D to prevent her from potentially forming an allo anti-D. Allo anti-D can cause severe haemolytic disease of the foetus and newborn in any future pregnancies.

At the end of my shift

At 17.30pm, I hand over any outstanding work to the late shift, to ensure that anything urgent is dealt with.  

I love the variety of the bench, you never know from one day to the next what will present itself, and each day I have to prioritise my duties.  Time management is essential on this bench!  In two weeks I will be moving to the crossmatch bench where I will be issuing blood. 

The transfusion department plays a critical role in cases of major haemorrhage, where blood is required urgently to save lives and also to help in the management of patients with chronic haematological conditions.  I feel proud to be a part of the Blood Transfusion and Haematology team who help make a difference every day.