“We must do more to address the sickle cell tragedy.”Dr Josh Wright, President, British Society for Haematology
“Better safe than sorry: could it be blood cancer?”Rachel Yarham, Senior Health Information Writer, Blood
The pandemic brought uncertainty, delays and disruption in care/ access to treatments for patients with a type of blood cancer — myeloma. During the pandemic, society became more aware of this vulnerable group. But as we have discarded our masks and restrictions — what does their future look like?
More than 11,000 people in the UK are diagnosed with von Willebrand disorder and yet, hardly anyone – including many GPs – has heard of it.
WRITTEN BY Sunny Maini von Willebrand Ambassador, The Haemophilia Society
is difficult to diagnose due to vague/common symptom presentation (eg. fatigue, back pain, infection).
In 2020–2021, over 500 fewer patients were diagnosed, and patients presented late with irreversible lifechanging complications (eg. spinal fractures, renal failure) resulting in increased morbidity and mortality.
Delays in diagnostic pathways resulted in a surge of activity after the lockdowns eased, increasing pressures on already overstretched NHS services. For myeloma patients, maintenance of strict infection control measures, streamlined care pathways and digital services have become the norm. Clinicians must challenge decisions on services provided to these vulnerable patients to reverse the negative impact of delayed diagnosis/treatment.
Myeloma patients have an elevenfold increased infection risk and eighteen-fold risk of viral infection in the first year after diagnosis due to the immunosuppression both by the disease and treatment. Infection risk continues throughout the patient’s lifetime.
Prophylactic antibiotics used in the first 12 weeks of treatment significantly reduce the risk of febrile episodes and death from infection. Reduction in viral infection risk requires vaccination and antiviral treatments.
Even with intervention, patients may not always respond optimally. Between January and March 2022, data from the Office of National Statistics showed that one in twenty-two patients who died with Covid-19 in England and Wales had blood cancer.
For blood cancer patients, it is paramount to ensure speedy vaccine rollout, timely access to Covid-19 treatments and testing and fast approval of new drugs/treatments.
The clinician-patient conversations regarding easing restrictions and risks of infections with the ability to sustain a good quality of life are essential.
Access to vaccination and treatments has helped, but careful consideration of potential risk and the use of masks in healthcare environments and crowded areas are also vital.
The last two years have seen significant increases in mental health disorders, and 72% of patients highlighted that myeloma had a moderate–high impact on their quality of life. Additionally, 30% reported a major impact on their mental health, rising to 40% when looking at the BAME (Black, Asian and Minority Ethnic) community.
As services return to normal, these patients need enhanced psychological support and access to specialist medical and nursing support.
Thislack of awareness about the most common inherited bleeding disorder in the UK means that up to 100,000 more could be living with the condition undiagnosed. Even those who are diagnosed can sometimes feel isolated and lack specialist care.
The Haemophilia Society, which supports anyone with an inherited bleeding disorder, is working with its members with von Willebrand disorder, also known as von Willebrand disease (VWD), to change this.
Recognising the symptoms of VWD VWD affects the blood’s ability to clot. People with VWD have low levels of a protein involved in blood clotting, called von Willebrand Factor (VWF), in their blood, or their VWF doesn’t work very well, so it takes longer for bleeding to stop. VWD affects men and women equally, although women often have more problems linked to periods, pregnancy and childbirth. There is no cure, but there is effective treatment. Symptoms include easy bruising, nosebleeds and heavy periods. It may also be hard to stop bleeding after injury or surgery.
However, there can be bleeding problems, and in occasional severe cases, internal bleeding to muscles and joints can occur in a similar way to haemophilia. This is why getting an accurate diagnosis is vital.
Lack of awareness and education
Sunny Maini is the Haemophilia Society’s VWD Ambassador. His goal is to bring people with the disorder together and to put more focus on their care. He says: “I have suffered for many years feeling alone and abandoned, not knowing much about my VWD. Now, as an ambassador, I hear many peoples’ stories and it is clear the root of the problem is a lack of education.
Too many people with VWD symptoms are being ignored by their GPs and this is causing trauma both physically and emotionally.
Too many people with VWD symptoms are being ignored by their GPs and this is causing trauma both physically and emotionally. Whatever the severity of someone’s bleeding disorder, it is really important that they get a diagnosis so they receive the right treatment from a team which understands VWD.”
For most people with VWD, the disorder causes little or no disruption to their lives except when there is a serious injury or need for surgery.
The Haemophilia Society recommends that anyone with potential VWD symptoms should ask their GP to refer them to a haemophilia centre so the right tests can be done to ensure an accurate diagnosis.
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Living without compromise Alison Newbolt, Haematology Business Unit Director, says: “Through our patient-focused campaign, Liberate Life, we have created tools and resources to support people with haemophilia to live life without compromise.
“A good example is Liberation Maps, an interactive, shared decisionmaking tool that we developed in collaboration with the patient advocacy community to support patients in their consultations with healthcare professionals to really get to the bottom of any difficulties or challenges they are facing.
“We are proud to work in partnership with haemophilia-focused advocacy groups across the UK and Ireland on a number of goals, both through collaborative projects and through the provision of sponsorship and grants.”
Sobi wants to see the pharmaceutical industry work more closely with the clinicians and patient organisations to co-create and focus on issues such as engaging patients consistently across the life cycle of medicine; improving patient care and outcomes and empowering patients to help them better understand their condition and get the most out of their medicine.
BY Sheree HannaSobi(Swedish Orphan Biovitrum AB) is dedicated to supporting people with rare diseases and specialises in treatments across haematology, immunology and speciality care. They recently launched a Patient Advisory Council which includes a diverse range of representatives from within the haemophilia community who are often the least heard.
Putting patients first Sam James, Director of Patient Access and Community Engagement, says: “While patient-centricity has been a bit of a buzzword in the industry for the past few years, we believe it’s vital to put the patient voice at the centre of everything we do.
“The council will act in an advisory capacity helping us to develop various education initiatives and tools. We hope this will help empower patients to continue to take a firm grip on their condition and support them to live a life without compromise.
“We are a smaller company, but because we have this dedicated focus
on rarer diseases, we feel it uniquely positions us to get very close to our communities and listen to our patients and clinicians.”
Over the past 30 or 40 years, great strides have been made to improve therapies for people with haemophilia who previously suffered from higher mortality rates and severe disabilities. The company is keen to get past a ‘good enough’ mentality that currently exists and help people with haemophilia live the best possible lives they can.
Inequity is one of the biggest challenges currently affecting patients, and this can vary across geographical regions where access to services can differ widely for holistic care, such as mental health and physiotherapy services, as well as long waiting times for surgery.
There are also several underrepresented groups within the haemophilia community. For example, women are less likely to have the disease but face unique challenges when they do.
Constantly changing landscape James says: “It’s really important we continue to engage with patients right across the life cycle of our medicines because things change. The treatment landscape is constantly changing, as do patients’ needs.
“Haemophilia is a condition that is not just treated by the clinician. There is a whole set of wraparound services, a broad multidisciplinary team as well as the patient and their family and loved ones; and we need to get our message across to all of them.”
Newbolt adds: “The industry has a critical role to play. We need to work in partnership as we can’t do any of it in isolation. We want to ensure that every person presenting — irrespective of what hospital they turn up at — has the same opportunities and access.”
“All of our stakeholders within the health trusts, comprehensive care centres, patient organisations and the policymakers all have a key role to play.”
The company is keen to get past a ‘good enough’ mentality that currently exists and help people with haemophilia live the best possible lives they can.
An innovative biopharmaceutical company committed to working with the haemophilia community to improve patient quality of life is mobilising various initiatives to bring about greater collaboration.
The clinician-patient conversations regarding easing restrictions and risks of infections with the ability to sustain a good quality of life are essential.
~Dr Afsana Elanko, Senior Educationalist and Healthcare Leader ~Dr Fenella Willis, Consultant Haematologist, St George’s University Hospitals, Trustee Myeloma UKWRITTEN BY Dr Josh Wright President, British Society for Haematology
Sickle cell disorder mainly affects people from African and Caribbean backgrounds. It’s an inherited blood condition that can shorten life and lead to severe unpredictable bone pain which blights many individuals’ lives.
Howwould you feel if from a young age, you knew what you were likely to die from? If you had witnessed friends or relatives die young from the same illness? If your life and routine were frequently punctuated by episodes of severe pain? Angry?
Frightened? Depressed? Desperate? Probably a combination of all of these. How about if the services the NHS offered you were patchily distributed, under-resourced and in some cases, frankly inadequate?
Sadly, this is the case for many patients in the UK with sickle cell disease.
Very strong painkillers can be required when someone is suffering what’s known as a sickle cell crisis. In addition to the pain, sickle cell disease can affect
of doctors, nurses and psychologists delivering good care to those with sickle cell disease, services for this group of patients are still underfunded and neglected.
So, what can be done? Most importantly, greater investment is needed in services for patients, in education about the condition for NHS clinicians and in research into new and better treatments. Some patients get good NHS treatment, but for others, it can be poor. We have to overcome that variation.
Accelerating progress in leukaemia diagnosis, treatment, care and research has the power to both save and improve lives.
In addition to the pain, sickle cell disease can affect almost every organ in the body, from strokes in childhood to kidney, lung and liver failure in later life.
All 42 integrated care systems (ICS) around the country should commission sickle cell services so that there is a uniformly high standard of care delivered everywhere. Hospital trusts need appropriate facilities where specialists can look after patients and have enough funding to employ those specialist
WRITTEN BY Fiona Hazell Chief Executive, Leukaemia UK
is a difficult disease to treat. It occurs when white blood cells develop in an uncontrolled way, dramatically reducing their ability to fight infection, but there is hope.
Acute leukaemias are fast developing and particularly hard to treat. Current treatments for acute myeloid leukaemia (AML) are incredibly harsh on the body, and the five-year survival rate is still devastatingly low. Stem cell transplantation is a life-saving treatment and is currently one of the only effective options available. Yet, patients will often relapse following a stem cell transplant.
Dr Pramila Krishnamurthy is researching how relapse can be prevented through exploring the possibility of using immune cells from the stem cell donor and giving these to the patient after their original transplant. She says: “When patients relapse or fail to respond to treatment, it’s heart-breaking – especially when we only have limited treatment options in this scenario.”
Dr Krishnamurthy’s research may be able to help correct a patient’s immune response, eliminating the remaining leukaemia cells and preventing relapse.
Encouragingly, research breakthroughs are happening all the time. Some of these include completely new ways of treating leukaemia, like Dr Konstantinos Tzelepis’ important discovery during his Leukaemia UK John Goldman Fellowship in 2021.
Looking at a particular protein, METTL3, and its role in how leukaemia cells develop, Dr Tzelepis investigated whether inhibiting the action of one particular protein could eliminate leukaemia – with minimal side effects. In doing so, Dr Tzelepis and his group at the University of Cambridge identified a new targeted drug with the potential to treat AML.
Dr Tzelepis says, “This is the result of many years of research and could mean the beginning of a new era for cancer therapeutics. We are at an exciting stage with clinical trials about to begin. The first AML patients to access the drug will be adults who haven’t responded well to current treatment options such as chemotherapy. If the results are as expected, we also hope the drug will offer an important treatment option for childhood AML.”
Dr Tzelepis’ breakthrough has the potential to provide a vital new treatment option for AML patients. Leukaemia UK is funding work like this to bring hope for kinder and more effective treatments to those who receive this diagnosis and crucially, to stop leukaemia from devastating lives.
Diagnostic tests are playing a critical role in the fight against sepsis and bloodstream infections and enabling clinicians to give patients the correct antibiotic treatments for recovery.
Reviews of blood culture practices, new technologies and antimicrobial stewardship are seen as critical steps to support the management of bloodstream infections, such as sepsis. Closer partnerships between industry, government, infection control experts, NHS policymakers and frontline staff are also important in the fight against such infections, according to experts in the field.
Sepsis is a life-threatening reaction to infection and happens when your immune system overreacts and starts to damage your body’s own tissues and organs. It affects 245,000 people and claims 48,000 lives a year in the UK. An NHS England (NHSE) review is currently looking to improve antibiotic prescribing and patient safety to improve outcomes from sepsis.
Early detection BD continues to advance the world of health efficiently, safely, and sustainably by applying its heritage and broad portfolio to support healthcare systems across the UK and Ireland. The organisation manufactures a range of diagnostic and medical devices which are used daily within the NHS; these include BD Vacutainer® blood collection devices, BD FACSLyric™ flow cytometers and BD BACTEC™ blood culture instruments to diagnose and determine treatments.
Blood cultures expert and Consultant Medical Microbiologist Dr Michael Weinbren is working with the NHSE blood culture pathway review to deliver key performance indicators for better management of patients with sepsis.
Having optimised blood culture pathways at Chesterfield Royal Hospital, he was involved in the 2018–2019 survey, which found clear room for improvement in blood culture practices. Inconsistencies were found in the three phases of the pathway: collection and transportation of the specimen, laboratory processing and the post-analytical phase used to determine treatment.
Only 3% of UK sites analysed blood cultures within four hours of collection. In 40% of cases, it took more than 24 hours — enough time for some specimen organisms to die and affect readings — and 87% of sites took one set, rather than the recommended two sets, of blood.
With 20% of bloodstream infection or sepsis patients on ineffective antimicrobial therapy, Weinbren notes that speeding up testing would mean patients are quickly prescribed the correct narrow-spectrum antibiotics, improving antimicrobial stewardship.
Weinbren says failure to act and optimise the blood culture pathway will see a “vicious spiral” of increasing mortality from sepsis and fewer effective antibiotics by 2050.
Access to diagnostic tools and processes that ensure blood samples are correctly taken and tested within a designated timeframe is pivotal in tackling sepsis.
We must ensure people access healthcare at the right time, empower health professionals to act and better integrate diagnostics into clinical systems.
Bruce Caldwell, Country Business Leader for Integrated Diagnostic Solutions (UK and Ireland) for global medtech supplier BD (Becton, Dickinson and Company), reinforced the importance of industry–healthcare collaboration, explaining: “The correct use of accurate diagnostics enables bloodstream infections to be detected and allows microbiologists and physicians to determine the right antibiotic to use. Late intervention could result in poor patient outcomes at increased costs.”
The NHS conducts millions of bloodrelated tests, and this delivers rapid treatment for patients but also makes the best use of antimicrobials at a time of a ‘hidden pandemic’ of antimicrobial resistance.
Dr Ron Daniels, Executive Director of the UK Sepsis Trust and Vice President of Global Sepsis Alliance, believes thousands of deaths could be avoided with a heightened awareness of sepsis and rapid treatment.
“We must ensure people access healthcare at the right time, empower health professionals to act and better integrate diagnostics into clinical systems.
“Placing such technologies closer to the patient, rather than in centralised laboratories, will enable clinicians to respond rapidly and accurately, saving patients’ lives and slowing the spread of antimicrobial resistance,” he adds.
T’sharne is one of the 15,000 people in the UK living with a sickle cell disorder (SCD), the term used to describe a range of inherited blood disorders affecting the haemoglobin in the red blood cells.
Sixteen year-old T’sharne just wants people “to understand that sickle cell is a thing — that it exists,” and to understand the impact it can have upon his dayto-day life. T’sharne has the most serious form of SCD, known as sickle cell anaemia.
Sickle cell disorder is inherited. If both parents carry the sickle cell gene, there is a one in four chance of their child having sickle cell. It qualifies as a rare genetic illness (defined by the European Union as one that affects fewer than five people in every 10,000), and its impact on an individual’s life — and their family and friends — can be significant.
T’sharne’s mother Clementina, a teacher and campaigner, says that finding out T’sharne had sickle cell was initially difficult to accept and that she felt guilty for ‘giving’ him the condition. “Despite having sickle cell in our family, neither I nor my husband were aware that we had the sickle cell trait or of the risks involved when having a child.”
The main symptoms of sickle cell disorder are anaemia and episodes of severe pain, known as a sickle cell crisis. Pain occurs when red blood cells mutate from a round,
doughnut-like, shape to sickleshaped, inhibiting the flow of oxygen around the body and causing the cells to stick together, resulting in blockages in the small blood vessels.
People with sickle cell are at risk of a range of complications including leg ulcers, sight loss and a serious condition called acute chest syndrome (when blood flow to the lungs is blocked).
It was a chest crisis that first saw T’sharne receive donated blood at only 10 years old; he now receives regular blood transfusions every four weeks via a process called Automated Exchange Blood Transfusion. This is a highly successful treatment where a machine is used to remove up to a third of a patient’s blood and replace it with blood from healthy donors.
Since starting on regular blood transfusions in 2018, T’sharne has had no emergency admissions to the hospital — a remarkable achievement given he had previously missed a whole school term due to his illness.
Importance of ethnically matched blood Anyone can have SCD. However, due to its geographical origins, most people affected are of African or Caribbean backgrounds. To ensure that the treatment T’sharne and many others rely on can continue without delay, we need many more
Black and mixed race people to regularly give blood.
Transfused blood needs to be ethnically matched to avoid further health complications, and there is an ongoing challenge to encourage more people from these backgrounds to come forward.
The Sickle Cell Society’s Give Blood, Spread Love project raises awareness of the need for more people with African or Caribbean heritage to donate blood and involves volunteers, such as Clementina, to help us share our message.
Since joining us, Clementina has become a regular blood donor and has found out she has a rare subtype of blood, known as Ro, which is 10 times more common in people with African and Caribbean heritage and is especially needed to provide matched blood to people with sickle cell.
Clementina has become a powerful advocate for blood donation.
The Sickle Cell Society needs people from all communities to help us raise awareness of sickle cell and the lifesaving impact of blood donation on those affected.
Find out more at sicklecellsociety.org
People with Black African or Caribbean heritage living in England can register to be blood donors at bit.ly/scsgiveblood
New scientific developments are making what once seemed impossible possible for people living with this serious disease.
WRITTEN BY Tony Greenway
The last 30 years have brought dramatic advances in human health through the discovery of new medicines; people now live with HIV, cancers are being cured and the risk of developing heart disease can be significantly reduced.
But as companies look to the future to drive new developments in human health, they tend to focus working on diseases that impact a specific organ — like the lung — or they focus on one type of therapeutic approach.
Our goal is to create transformative medicines for people with serious diseases. To achieve this, we target serious diseases where we have strong insight into the biological mechanism and where there is significant need for new treatments. It is only once we have fully understood the biological problem we are trying to solve that we invent, partner or acquire a potential therapeutic solution. We believe this approach maximises our chances of success of translating science and research into medicines for patients who need them.
Sickle cell – the ‘first molecular disease’
Sickle cell is a serious, lifethreatening inherited disease affecting the red blood cells. People who have sickle cell are frequently anaemic and can suffer from regular sickle crises. Crises occur when the red blood cells block blood vessels resulting in severe and debilitating pain which can happen anywhere in the body at any time. This has a significant impact on their life; people who have more sickle crises per year are more likely to report high impact on their daily activities, school attendance, job retention, family and social life, and stress levels.
Yet, despite sickle cell being described as the ‘first molecular disease’ in 1949, the current
treatment landscape has remained focused on addressing symptoms of the disease rather than the underlying cause.
At Vertex, our insight into how to treat the disease comes from natural variations in the DNA of a small number of people with sickle cell. Normally, the symptoms of sickle cell would begin approximately three months after birth as the haemoglobin in red blood cells changes from foetal haemoglobin to adult haemoglobin. However, in some people, this switch never happens. Studies have shown us that people with sickle cell who continue to produce foetal haemoglobin have few or no symptoms of their disease.
Scientists at Vertex therefore hypothesised that targeting the processes in our body that enable foetal haemoglobin to be produced again could provide a possible therapeutic solution for people with sickle cell. Clinical trials are ongoing to validate this hypothesis to potentially create treatments to improve the lives of people living with this disease.
Deep understanding of the mechanisms of disease allows us to focus our resources into potential solutions to biological problems. And we take this seriously, investing approximately 70% of our operating expenses into research and development year on year. But on top of science and drug discovery, we also have a commitment to partnership with all stakeholders as we look to bring treatments to people living with sickle cell.
Deep understanding of the mechanisms of disease allows us to focus our resources into potential solutions to biological problems.
Dr Phillip Monaghan, PhD, FRCPath
Head of Service, Consultant Clinical Scientist, The Christie Pathology Partnership, Clinical Director of Pathology, The Christie NHS Foundation Trust
Everypatient deserves a timely diagnosis — particularly for a serious haematological disorder such as leukaemia. The specialist discipline of cytogenetics can report results quickly and efficiently, leading to earlier interventions, targeted treatments and better patient outcomes.
Working with its four NHS partnerships across the UK, medical diagnostics provider SYNLAB is leading the way in this innovative and increasingly critical field of healthcare.
Speed and quality: making a difference to patients
Dr Phillip Monaghan is Head of Service, Consultant Clinical Scientist and Clinical Director of Pathology at SYNLAB’s Christie Pathology Partnership with the NHS in Manchester — a specialist provider offering cytogenetics services to hospitals in Greater Manchester and North West England.
“The rapid diagnostic protocols offered by cytogenetics make a huge difference to patients in terms of the speed and quality of their diagnosis,” he explains.
The cytogenetics team tests around 5,000 blood and bone marrow samples a year, primarily for the diagnosis of haematological malignancy. Specialist tests for solid tumour diagnosis are also performed.
“For many haematological diseases, cytogenetics is still the gold standard genetic diagnostic test,” explains Dr Nick Telford, Consultant Clinical Cytogeneticist at The Christie Pathology Partnership. “The tests allow us to inform the clinician about the severity of the disease; whether the patient is likely to fare well — or not so well — with conventional treatments; and whether they require more specialised and experimental treatment or none at all.”
Cytogenetics is a branch of biology that was introduced as a diagnostic tool in the late 1980s. Over the last 30 years, it has expanded to cover a wide range of haematological malignancies. A cytogenetic test involves scientists studying chromosomes from blood or bone marrow samples to detect numerical or structural abnormalities, which reflect underlying molecular genetic changes in the cells’ DNAs.
They may also apply fluorescent DNA labels to look for specific genetic abnormalities (an advanced technique known as ‘fluorescence in situ hybridisation’ or FISH).
Identifying specific genetic abnormalities means that patients can receive targeted therapies — or ‘personalised medicine’ — as the best treatment for their needs, which aids the diagnosis of clinically relevant leukaemia subtypes.
Cytogenetics is just one area where major advancements are being made by SYNLAB across its NHS partnerships, which provide pathology services for a combined population of more than 5.4 million people in the UK.
The business transforms and provides extensive, state-of-the-art, accredited pathology services to hospitals, GP practices, community services and other healthcare organisations, enabling the NHS to realise a range of benefits.
As technology has evolved, cytogenetics and molecular genetics techniques are merging increasingly.
Robert Dunn from Synnovis, another SYNLAB / NHS pathology partnership, says: “Examples include our more recent and emerging tools such as DNA and RNA-based molecular panels, optical genome mapping and whole genome sequencing for structural variant detection.”
One example at The Christie is Acute Promyelocytic Leukaemia (APL). Clare Hodgson, Principal Clinical Cytogeneticist, says: “APL is a disease often classed as a clinical emergency because of the risk of catastrophic blood clotting, which is why FISH for detection of PML::RARA gene fusion offers a same-day turnaround for urgent clinical management, to ensure the patient receives appropriate treatment with all-trans retinoic acid (ATRA).”
A service is only as good as its staff. “Our team is extremely experienced and dedicated,” notes Clare Hodgson. After tests are run, an integrated report produced by a specialist integrated haematological malignancy diagnostic service is shared with the haemato-oncology multidisciplinary team so that treatment can start as quickly as possible.
“In the field of cancer diagnostics, it’s a critical service, and we are very proud to be among the lead providers here at The Christie,” says Dr Monaghan.
The field of cytogenetics offers rapid diagnosis to patients with serious haematological disorders and the opportunity to deliver targeted therapies for optimal care.Paid for by Synlab More information about SYNLAB and its groundbreaking work with the NHS is available at synlab.co.uk