I needed somewhere to write about my work experience, so I thought I may as well do it here, feel free to ignore it. I did a week shadowing biomedical scientists, registrars and junior doctors in Haematology; in the lab, ward and outpatients clinic.
Monday- I was in coagulation and learned about the balance that your body maintains (haemostasis) between clotting and bleeding. Thrombophilic factors cause you to clot too much, and the converse is true for bleeding factors. The clotting cascade shows the order that the factors in your blood are activated to form a clot (thrombus) made of cross linked fibrin polymers.There are many reasons that haemostasis is disturbed, such as in haemophilia A, where the sufferer has a Factor VIII deficiency, or Von Willebrand disease (the most common hereditary bleeding disorder) where the sufferers platelets do not “clump together” because they lack Von Willebrand Factor.
I carried out INR tests which measure the ratio of prothrombin time to a normal person, (normally 2.5-3.0 in patients taking warfarin). I also did APTT tests which measures the intrinsic and common pathways of clotting.
Tuesday+Friday- I spent Tuesday and Friday in the haematology wards with junior doctors and their registrar. These days were the most relevant to my future aspirations of being a doctor, hence I spent the greatest proportion of my work experience on the wards. Generally, patients in haematology have malignant diseases. These are usually of the bone marrow (e.g. all of the leukemias), or of the lymph gland (lymphomas) and can spread to the spleen, bones and other areas. The degree of spreading of these cancers can be defined from stages I-IV, and can either be symptomatic (B) or asymptomatic (A). Most of the patients are on Chemo, so they are neutropenic, and are waiting for their neutrophil levels to go above 1.0 before they can go home, and are given blood/platelets/ffp until this so happens. The wards are generally about rehabilitation rather than general care so the patients should theoretically only stay in short term rather than long term, although one gentleman had been there for 2 or 3 months (he should be going to the macmillan unit soon for end of life care because he is on palliative treatment, however he REALLY doesn’t want to go, because he feels it is admitting defeat, so the doctors are trying to think of a way to make him see that this is what is required, because the ward is short of beds).
Wednesday- I was in Bloodbank on Wednesday, where they cross-match blood, group it, check for antibodies that the blood has before transfusions, before they distribute bags of blood/platelets/FFP around the hospital to those who need it. It’s busy in blood bank, like really busy. The way to do cross matching and antibody tests is to use panels that have AHG (Anti Human Globulin) in, which sticks igG-erethrocyte complexes together to form a globule which can be detected by the naked eye. More info can be found here. If the test is positive for certain antibodies, e.g. Anti-D , then only D-negative blood can be given.
Thursday-I had a short day on thursday, doing clinics with a haematology registrar (or possibly a consultant) where we spoke to haematology outpatients, who generally had benign or less serious conditions, such as anaemia, nuetropenia, thrombocytopenia or MGUS. I enjoy clinics because to me, it’s seems like you’re just having a chat with people, but you’re obviously using it to work out why they’re having the symptoms they have, because most patients don’t know anything about the illness they suffer from, so they aren’t particularly useful.