Tom Butler

Consultant, Barts Health NHS Trust

Perhaps one of the most exciting jobs in medicine is liaison haematology. What is it, and why do practitioners regard it as interesting?

Liaison haematology is the bridge between the laboratory and the clinician. As well as identifying and treating blood disorders, we’re responsible for interpreting blood test results and communicating them effectively to GPs. In hospitals, we work with multiple healthcare professionals, advising on everything from blood clotting and transfusions to immune system disorders — from pregnancy and newborns to end-of-life care.

Liaison haematology must access all areas

The job has an appealing aspect of having to ‘access all areas.’ Liaison haematologists are busy bodies. On any day, we can get a phone call from maternity one minute and then, the next, have to ensure the right blood goes to a patient who needs a liver transplant. We’ve got an important part to play right across the board in the functioning of a good hospital.

Flexible roles from lab to bedside

Haematologists are both laboratory specialists and clinicians — we have to pass the exams of both the Royal College of Pathologists and the Royal College of Physicians. We fill a gap between specialists and generalists.

These days, there’s a tendency to become more and more specialist, but you also need people who can use their specialist training to help diagnose and treat people — whatever the problem is. That’s what liaison haematologists do. We work across boundaries with GPs, nurses, healthcare scientists and other specialists — and there’s a real joy to walking in other people’s shoes. There’s an educational element to it, too.

Interpreting blood films and why it’s important

When patients have a blood test, computers quickly generate blood counts. If there’s something unusual, the liaison haematologist steps in, often looking at blood films under a microscope and detecting unexpected diseases such as leukaemia.

Part of our role is understanding how those laboratory tests are performed; the possible pitfalls; how errors can occur and then interpreting those results in a meaningful way — considering a patient’s medical history and examination.

These days, GPs can usually communicate with liaison haematologists using web-based systems. Nine times out of ten, we can reassure them about the results. If not, we advise on what other tests might be useful or whether the patient should come and see us. Liaison haematology has often been overlooked by NHS job planners, but it is finally coming to be recognised as a role that lies at the heart of good medical care.

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UK Sepsis Trust Founder & Joint CEO Dr Ron Daniels calls for a new approach to Infections Management, to tackle sepsis deaths and threat of antimicrobial resistance (AMR).

Sepsis is the final common pathway to death from most infectious diseases worldwide according to the WHO – the agency which also report that in 2019 an estimated 5 million deaths worldwide were attributed to antimicrobial resistance (AMR). Sepsis most commonly complicates bacterial infections such as UTIs and pneumonia, but can also complicate viral infections including COVID-19 and Ebola.

A complex interrelationship

Sepsis is a life-threatening condition in which the body’s response to an infection causes organ damage. In 2020, it was reported to claim an estimated 11 million lives globally among 49 million people affected every year – for context (and without diminishing the impact of the pandemic), in the more than three years to March 2023, COVID-19 claimed 6.9 million lives.

Antimicrobial resistance is causing harm to patients in our hospitals including in developed countries today, rather than it being a perceived future threat. However, it is not antimicrobial resistance in and of itself which brings about harm, but rather the infections which are rendered untreatable. The final common pathway to death, whether an infection is readily treated with antibiotics or not, is sepsis.

Therefore as the spectre of antimicrobial resistance grows, so will the death toll of sepsis. Simple infections which do not respond to antimicrobials will become life-threatening. Perhaps perversely, efforts to improve outcomes from sepsis which centre around heightening public awareness, resilient healthcare systems and health professional education might increase consumption of antimicrobials which might itself fuel AMR – thankfully data from the UK, Ireland and the USA suggest that this unintended harm of large-scale sepsis improvement efforts is not the reality.

Sepsis most commonly complicates bacterial infections such as UTIs and pneumonia, but can also complicate viral infections including COVID-19 and Ebola.

A new approach to Infections Management

Several governments around the world have initiated, and to varying degrees acted upon, national action plans regarding AMR. Whilst this progress is important, it isolates but one facet of the problem of infections management. We must improve the way in which we use antimicrobials in humans to treat and prevent disease, as well as in agriculture.

Dame Sally Davies has reminded us that AMR presents a more immediate threat to humanity than climate change. Addressing this existential threat requires a similarly coordinated approach.

If we are to envisage a future in which we can reasonably expect that our infections remain treatable, we have to change the paradigm with which we approach infection. Infections Management must address with equal figure four pillars: outbreak surveillance and pandemic preparedness, infection prevention and control, antimicrobial stewardship and the rapid recognition and treatment of sepsis. Until we do so robustly, we risk our existence.

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Lymphoma develops when white blood cells, called lymphocytes, grow out of control. Lymphocytes are part of the lymphatic system, which helps to fight infection.

“I hadn’t even heard of lymphoma before.” I have heard this statement many times in my work with Lymphoma Action, supporting people affected by the UK’s fifth most common cancer. When reflecting on their diagnosis, many people tell me how their initial response to being told they had lymphoma was a mixture of shock and confusion in learning that it is a type of blood cancer.

Lymphoma causes and symptoms

There are no known causes of lymphoma, and the symptoms can be quite general — making it tricky to spot. Common symptoms include swollen lymph nodes (commonly felt as lumps in the neck, armpit or groin); unexplained weight loss; drenching night sweats; itching without a rash; fatigue and fevers; difficulty getting over infections.

Lymphoma is a complex condition with over 60 different subtypes.

As these symptoms can also occur in other illnesses, having one or more doesn’t necessarily mean someone has lymphoma. However, it is important to be aware and always contact a GP with any concerns.

The most common type of blood cancer

Lymphoma is a complex condition with over 60 different subtypes. Treatment, therefore, depends on the type of lymphoma they have, its ‘stage’ and the general health of the person affected. Most treatments aim to send the lymphoma into remission.

Every 26 minutes, someone is diagnosed with lymphoma in the UK. It is the most common cancer in teenagers and young adults aged 15 to 24. Yet, 66% of people recently surveyed through the Charity Awareness Monitor did not know that lymphoma is the most common type of blood cancer.

September is Blood Cancer Awareness Month, and we, at Lymphoma Action, aim to raise awareness of the condition through our ‘Let’s talk lymphoma’ campaign. It is hard enough being told that you have cancer, but when it is little-known and difficult to explain to others, it only adds to the challenges of a diagnosis. We hope to open up the conversation about lymphoma and invite everyone to join us in raising awareness so that we can help more people.  

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