The service has target turnaround times for investigative processes. The majority of cases will be dealt within the target times but in some situations it may prove impossible to meet these by reason of technical or complicated diagnostic pathways.

Bristol Haemato-Oncology Diagnostic Service Reporting Times

1. Includes haematological morphology, immunophenotyping and trephine histopathology

2. Includes lymph node morphology and immunohistochemistry

3. Where supplementary tests are required the target reporting times are as detailed below

Haematological morphology

Immunophenotyping

Histopathology

Cytogenetics

Molecular Pathology

Investigative techniques: Morphology/Cytology
Consideration of the clinical information, blood count results and conventional light microscope morphology of marrow or blood helps to determine the most appropriate panel of investigations form a number of techniques.

Investigative techniques: Flow Cytometry
Provides a method of rapidly enumerating and characterising the antigen expression of cells in suspension using a panel of antibodies labelled with florochromes.

In the haematopathlogy field the technology can be used to distinguish chronic lymphoproliferative disorders and separate these from reactive states; define acute leukamias, identify prognostic markers and monitor minimal resisdual disease; count specific cells types and identify condition associated with aberrant antigen expression.

Investigative techniques: Histopathology
The assessment of fixed tissue prepared as tissue sections is used for the examination of lymph nodes, marrow trephines as well as potential tumours from any body site. Histopathology of lymph nodes is the best method to diagnose and classify lymphoma. Fresh node sent to the laboratory allows the use of flow cytometry to facilitate the diagnosis. Frozen, fixed or paraffin embedded can be assessed by morphology and immunohistochemistry. If appropriate clonality of lymphoid populations can be assessed by IgH and TCR gene rearrangement or FISH on paraffin embedded tissue can identify characteristic chromosome translocations.

Investigative techniques: Cytogenetics
Conventional cytogenetics requires the culture of cells to provide metaphases. For this reason it takes longer to produce results than some other technologies but is a well-established technique able to provide results that are critical in the classification and prognostication of haematological disorders.

Investigative techniques: Fluorescence in-situ hybridisation (FISH)
FISH provides a method to identify changes that help define or provide prognostic information for lymphoid and myeloid disorders. The ability to use metaphase or interphase preparations is powerful and results are confirmed by subsequent conventional assessment whenever possible.

Investigative techniques: Molecular Genetics
The use of sensitive molecular techniques to assess DNA and RNA provide important and evolving tools. A range of techniques may be used for identifying mutations or molecular markers for diagnosis, prognosis and monitoring response to therapy and remission status. Examples of technologies used are qualitative and quantitative polymerase chain reaction assays, fragment analysis, methylation assays, and direct sequencing. Increasingly molecular ghenetic tests are moving across to next generation sequencing (NGS) technologies which allow the parallel investigation of multiple genes at increased sensitivity and resolution.

Investigative techniques: Whole Genome Analysis (WGA)
Following on from the 100K Genomes Project patients with acute leukaemia or any childhood patient with an Haematological cancer will be able to access WGA.  WGA is an incredibly powerful technique which uses NGS to enable the simultaneous investigation of molecular genetic, FISH and cytogenetic diagnostic targets in a single, high resolution, assay.  WGA requires simultaneous assessment of tumour (somatic) and normal (germline) material and therefore provides the additional benefit of identifying germline changes which may be contributing to the patient’s clinical presentation or have implications for treatment and management.

Results that fall outside the ranges below will be telephoned to the clinical area indicated on the request details except when they are not significantly different from previous values for a current admission.

Haematology 

Coagulation Studies  

Blood Transfusion

Errors 

A variety of patient information leaflets are available for free from NHS Blood and Transplant and should be given to the appropriate patients prior to transfusion as listed below:

N.B. Patient information leaflets should be given retrospectively prior to discharge if not given to patient prior to transfusion

• Will I need a blood transfusion? – to be given to every patient who may require a red blood cell transfusion
• Information for patients who have received an unexpected blood transfusion – to be given to any patient who did not provide consent for transfusion prior to administration or may not be aware they received a transfusion
• Will I need a platelet transfusion? – to be given to every patient who may require a platelet transfusion
• Will your child need a plasma transfusion? – information for parents of babies and children under the age of 16 who may require fresh frozen plasma
• Information for patients needing irradiated blood – to be given to every patient requiring any irradiated blood product
• Children receiving a blood transfusion? – information for parents of children who may require a blood transfusion (also contains comic / sticker book for the child)
• Will my baby need a blood transfusion? – information for parents of babies who may require a blood transfusion
• Iron in your diet – should be given as appropriate in pre-op assessment clinics

The above leaflets are available in a variety of different languages and may be downloaded here.

Please contact the Blood Transfusion Laboratory (ext: 48350) or Karen Mead (ext: 48358) for more information and ordering details.

North Bristol NHS Trust Specific Leaflet:
NBT specific patient information leaflets are available and should be given to the appropriate patients as listed below:

• Advice Following a Blood Transfusion – information for patients who are transfused and discharged on the same day.
• Declining a blood transfusion - information for patients about their right to decline a blood transfusion.

Sometimes it is necessary to refer work to other laboratories. Those laboratories to which work is routinely referred are listed below:

• University Dept. of Diabetes Metabolic Research, Southmead Hospital, North Bristol NHS Trust, Bristol
• Vaccine Development Dept., Medical Microbiology Partnership, Clinical Sciences Building 2, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WZ
• IMF Department, St Johns Institute of Dermatology, St Thomas’s Hospital, Lambeth Palace Road, London SE1 7EH
• Immunology Department, Churchill Hospital, Headington, Oxford, OX3 7LJ
• PRU, Dept. of Immunology, PO Box 894, Sheffield, S5 7YT
• Clinical Immunology Department, Royal Free Hospital, Pond Street, London, NW3 2QG
• National Amyloidosis Centre, Division of Medicine, University College London Medical School, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF
• Cambridge Life Sciences Ltd., 14 St Thomas Place, Cambridgeshire Business Park, Ely, Cambridgeshire, CB7 4EX
• Purine Research Laboratory, 4th Floor, North Wing, St Thomas' Hospital, London, SE1 7EH
• Clinical Immunology, Level 4 Camelia Botnar Laboratories, Great Ormond Street Hospital, London, WC1N 3JH
• Neuroimmunology, University of Birmingham, Vincent Drive, Birmingham, B15 2TT
• Medical Biochemistry and Immunology Department, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW
• Institute of Neurology, Queens Square, London, WC1N 3BG
• Reflab, PO Box 590, DK.2200, Copenhagen N, Denmark
• Neuroimmunology Laboratory, Laboratory Medicine and Facilities Building,  Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF
• Immunology Department, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2QQ
• Blood Sciences Laboratory, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW
• Red Cell Immunohaematology Department, Trent Regional Transfusion Centre, Longley Lane, Sheffield, S5 7JN
• Clinical Immunology and Allergy, Viapath Analytics, Kings College Hospital, Denmark Hill, London, SE5 9RS
• Transplantation and Renal Research Laboratories, Manchester Royal Infirmary, Manchester, M13 9WL
• Haematology and Immunology, Royal United Hospital Bath, BA1 3NG

Last Updated 01/02/2018

Bisphosphonates have been widely used to treat osteoporosis for over twenty years.

Though they generally have a good safety record, various concerns have been expressed. Some of these, such as increased risk of osteonecrosis of the jaw, have been exaggerated considering how tiny the absolute risk is. Of greater clinical relevance is the risk of so-called atypical hip fractures, which appear to be associated with prolonged treatment with bisphosphonates, particularly in those with relatively normal bone mineral density (BMD). Atypical hip fractures are rare, and any increased risk associated with bisphosphonates is outweighed by their protection against other types of fracture. Nevertheless, these risks are taken seriously, and have led to recommendations regarding prolonged treatment with these agents (see www.shef.ac.uk/NOGG/NOGG_Executive_Summary.pdf).

In essence, it is advised that following five years oral treatment with bisphosphonates (ie alendronate, risedronate and ibandronate), the need for continued treatment should be re-evaluated. This should be take the form of a repeat fracture risk assessment using a tool such as FRAX (www.shef.ac.uk/FRAX), possibly informed by a repeat DXA scan. If for example fracture risk has increased to below or close to the intervention threshold (eg 5% ten year risk of hip fracture, 20% ten year risk of major fracture), or BMD is above or close to the T-2.5 threshold of osteoporosis, a ‘drug holiday’ is recommended. Accordingly, treatment is discontinued, to be recommenced one to two years later if still indicated. In those patients who remain at high risk of fracture in spite of five years’ treatment with bisphosphonates, for example patients with multiple vertebral fractures or very low BMD, it is recommended that treatment continues indefinitely on the basis that any risks are outweighed by the benefits.

There are many services that provide help and support to carers to help you better cope with your caring situation. These range from sitting services and self-help groups to financial and practical advice. 

Carers Support Centre provide an information, advice and support line called CarersLine where you can get more information about help you can get. They will also be able to talk to you about any benefits to which you may be entitled.  You can contact CarersLine on 0117 965 2200 or find information at www.carerssupportcentre.org.uk

For those caring for someone with a dementia, the Alzheimer’s Society has a range of helpful information for carers.  You can contact them on 0117 9610 693 or find information at www.alzheimers.org.uk

Macmillan Cancer Support also provide support to carers who support someone with cancer.  You can contact them on 0808 808 0000 or find information at www.macmillan.org.uk

The Red Cross provides a number of helpful services including Home from Hospital where volunteers help newly discharged patients with day-to-day tasks such as getting prescriptions and shopping. 

Support is also available from GP practices in Bristol and South Gloucestershire.  Please speak to your practice about being added to their carers register to find out what support is available to you as a carer.

You are now able to access a Trust provided public WiFi service for using your own mobile device or laptop.

You can bring in your own devices and access your own providers internet network. However, we cannot accept responsibility for the safety or signal strength of your device.

Using our Patient & Visitor Wi-Fi

Terms and Conditions for use of NHS WiFi Network