Biomedical Science is absolutely vital to healthcare. Here members of our #1BigTeam tell their stories of being a Biomedical Scientist at UHP:
BMS Band 5 Overnight Shift, by Harvey Ransom
The lab never sleeps. A weekday night begins at 10pm and finishes at 8am. During this time there is one Biomedical Scientist (me) in charge of running Blood Transfusion, Haematology and Coagulation.
This particular night when I came in most of the routine GP work had finished be analysed with ‘just’ a couple of blood films to look at for morphological interpretation. One looked like iron deficiency so I added further tests to confirm this observation; the other patient had a low platelet count. As these are useful to stop bleeding, a low platelet count needs to be reported to the ward- one phone call later and I was back to the routine work from ED and other wards. I find it best to clear the blood films early in the night as looking down a microscope at 4am can make the cells dance before your eyes.
At midnight, the controls need to be run on the full blood count analysers, three out of four passed. An automated clean and flush of the analyser and the control still failed so I had to get a new control sample from the fridge, leave it to reach room temperature then try running it for a third time. Success, it passed. Now all four analysers can be used for running patient samples. This is a good thing because while I was sorting out the controls more samples were coming into reception from the air tube system and being hand delivered.
The bleep has been sounding with it’s normal regularity but this time it is ED activating the Massive Haemorrhage pack, not too much of a problem as we have four units of emergency blood ready to give out along with four units of plasma. This trauma pack will usually restore the balance of oxygen carrying red cells as well as replacing the volume of plasma lost in a large bleed. The routine is to immediately allocate four more red cells and four more plasma packs for the next trauma. On this occasion a second pack was needed almost immediately, this can be a problem as the plasma is stored at -40C and requires defrosting. Luckily I could ‘borrow’ some from a patient that had it ready but not used it yet- I will replace this with plasma I am defrosting.
So back to full blood counts and coagulation samples, the centrifuge was beeping away as I had spent so much time dealing with the ED trauma patient. Sometimes we never know the name of the patient or if they have survived but each patient gets the products they need in a timely manner- even if it does delay the routine work.
More samples, more re-runs to confirm results, more authorising, do the patient details on the sample match those on the computer system? Is the sample signed? Is it the first or second sample? Where is my pen? Where are my glasses? I’ll give them a clean in a minute. Have I put the correct comment on the result? Are they suitable for electronic issue of red cells if needed?
Then a RhD negative Mum gives birth. The RhD status of the baby can have fatal consequences for any subsequent pregnancies if anti-D is not given within 72 hours of delivery. This means running the baby sample to find out their blood group, making a blood film on Mum’s sample, making positive and negative control slides to ensure the staining has worked properly. Once I have the results of Baby, they are RhD positive so Mum will need anti-D to protect any future babies she may have. So now in the early hours I am looking at stained red cells to see how many if any foetal red cells have found their way into the maternal blood system during the trauma of birth. On this occasion none were seen and Mum will be fine with the routine does of anti-D via injection. Once this is issued another bleep sounds for me to reply to.
The sky is brightening as the sun starts to slowly rise and a slightly bleary sounding Haematology registrar is calling from their mobile phone regarding a patient with extremely low platelets (not the same patient as earlier though). Can I look at a film to confirm the reading is genuine? As I said previously platelets love to stick together and stop you bleeding but when this happens in a blood sample tube the analyser can only count what is there and gives a falsely low result. In this case the count was genuine- the patient had a high grade infection and was either verging on sepsis or undergoing DIC (disseminated intravascular coagulation) – where the blood starts to clot throughout your body not just from the site of a wound. Incidentally this can eventually lead to the patient bruising and bleeding due to using up the clotting proteins from the DIC.
We have a protocol to determine if there is active DIC which involves looking for damage to the red cells in a blood film, send off urgent sample to Bristol for specialist testing and performing a non-routine screening test in-house. Around seven phone calls later and the ward know which samples I need to perform the in-house assay, and send the correct samples to Bristol. While waiting for the samples to arrive I take out the relevant reagent kits to perform our assay, find the instructions for how to send the samples to Bristol and who to warn they are on their way.
Still have the routine maintenance to do on the coagulation analysers, make up and run the controls before the morning Biomedical Scientist (BMS) arrives at 8am. The samples arrive, I centrifuge the one I need to, perform the maintenance, run routine samples in the three sections and before I know it my saviour arrives in the shape of the bright and breezy early morning BMS. We have a slightly longer than normal hand over, where I apologise for leaving more work than normal as well as the samples to send away even though I know I could not have done anymore and my colleague tells me to get home to bed.
So there it is, an example of a ‘normal’ night shift. There is no such thing, some are busier than others, sometime the analysers really play up, sometimes it seems that every sample is abnormal and needs extra attention to make sure you are reporting the correct result. No mention of breaks in all the above because there is no set time when I can close the lab and usually end up with a few cold cups of tea and snacking on whatever I brought with me that night- it’s never quite what I fancy though.
With thanks to Harvey Ransom
A Typical Day in the life of a Haematology Biomedical Scientist by Carol Ricketts
Thursday 24 June 2021 is National Biomedical Science Day. Take a moment to celebrate this little known group of laboratory professionals who come under the umbrella of Allied Health professionals (along with Radiographers for example).
Have you ever stopped to think how a blood sample gets from the patient to producing a set of results on which a patient is treated or diagnosed? Of course there are several steps involving different key roles in this process, but the Biomedical Scientists (BMS) are pivotal in analysing the sample to produce quality, accurate results in a timely fashion, often with staff shortages and equipment issues. Which also brings me to an essential part of our job role, not only do we analyse results but these days you are expected to be an ‘expert’ in quality management, IT and troubleshoot analysers, in addition to mentoring and training trainees.
BMS’s work in diverse specialities such as Biochemistry, Molecular Biology, Immunology, Haematology, Blood Bank and Microbiology, with various types of sample: blood, serum, urine, faeces, swabs etc. We are highly regulated by our profession, employment requiring state registration with the Health Care Professions Council (HCPC). We also have our own professional body, the Institute of Biomedical Science (IBMS) which is well recognised by employers both in the public and private sectors.
So, you have gone to your GP, complaining of tired and shortness of breath. The nurse has taken a Full Blood Count and the surgery courier has brought your sample in to the Combined Labs reception. The sample is booked in, checking the sample is labelled correctly with any paperwork. The reception is the central hub where all samples are receipted from in patients, outpatients and GP surgeries. It is a very busy area and samples are numbered and separated according to the required test(s). For example, on 21 June 2021 the labs processed a total of 6482 samples, of which 1999 were full blood counts. The labs are open 365 days a year, 24/7 as people don’t just get sick 9-5pm!
A full blood count is the basic test in haematology (but we also look at blood films, perform Plasma viscosities, Infectious mononucleosis (IM), malaria screening and Special Investigations including haemoglobinopathies. Coagulation forms part of haematology where we can test for clotting abnormalities, perform heparin and warfarin monitoring and screen for haemophilia and Von Willebrand’s disease to mention but a few of the tests available.
All blood counts go on to one of four analysers which give information on white cell count, haemoglobin, platelets and white cell differential. Incidentally, we were the pilot site, the first in the UK to have installed these analysers and it has been an interesting journey which is still work in progress. The results of your blood count have been validated by a BMS and shows you have low haemoglobin and you could be iron deficient. A blood film is made of your blood and it is stained. A BMS will look at the film to see if numbers of cells are normal and what morphological changes there are. Based on the film assessment, the BMS may decide to request further tests, in this case, to check the ferritin level. Once the FBC and any other tests are completed, a report goes out to the GP surgery. The GP can see you are anaemic and have a low ferritin and may recommend a course of iron.
Even though the lab is performing the same basic tests, no two days are the same and you never know what patients are going to present with. Sadly we do pick up new leukaemias and other malignancies and our work plays an important role in monitoring these patients during chemotherapy and treatment. There is never time to be bored, we are expected to write/revise SOPS, write non-conformances and keep up to date with many competencies (renewed annually). Good communication skills are an asset as we are required to deal with medics, GP’s, nurses, engineers and company reps.
I have been a BMS for 20 years and it has never been busier or more demanding, especially the last 12 months with COVID 19. Despite this, despite staff shortages and equipment issues that require manual intervention, the haematology team really pull together as a team, one of which I am proud to be a part of. I always knew I wanted to be involved in science in some way. It gives me a great sense of satisfaction and achievement to play a small but vital role in patient care. How many people can say their job can make a difference to the life of others?
With thanks to Carol Ricketts
How I became a Biomedical Scientist working in Immunology, By Tara Knill
I have worked in the Immunology Department for 19 years. I came here as a trainee but as my degree was not IBMS accredited the Hospital sent me to Bristol to do a top-up degree. A few years later they then paid for me to complete my Master’s degree.
I was always interested in science especially working in the Hospital but was not aware of the role of a Biomedical Scientist. It sounded very proper, and I was not sure if I was clever enough. I am an average student at best, and I did a BTEC in Science NOT A levels. The on-the-job training is so thorough it does not need an A grade student and it is a job for life.
Working for the NHS is rewarding but I also get to work with all staff in the hospital. This is extremely exciting and interesting. Its never a dull day! And I am immensely proud of where I work and what we do. Our hard work means patients get there results in a timely fashion and to a high quality.
A huge part of the role is ensuring machines are working and the biggest challenges we face is when they break down. This is also a rewarding part of the job as we must work out what went wrong and how to not affect delivery of patient results. Its an amazing feeling when you troubleshoot and get it back to working order.
The NHS is so much more than Doctors and Nurses and whilst I respect the amazing work they do; they need the support staff working so hard behind the scenes. Together we work to deliver the best care for patients in our region.
Whilst most of our work is diagnostic, we are also involved in developing new methods. There is so much behind the scenes work on bringing in new tests. These tests will improve diagnosis and speed up delivery of results. We work with the service improvement team to ensure we keep up-to-date with methods used in industry to make sure we are working as efficient as we can and reduce waste. We constantly review and strive to improve the delivery of results whilst sometimes with staffing and financial pressures, but this is the part of the job I really enjoy.
I would recommend this job to anyone with an interest in science. Immunology is an ever-changing discipline and new technologies, and methods keeps it interesting and challenging. Lab work is hard but extremely rewarding.
With thanks to Tara Knill
We’re also sharing photos of the teams in the Combined Labs over on our Instragram channel. Follow us and see the photos here. This is a day to unite with other biomedical science professionals by using the hashtags: #AtTheHeartOfHealthcare or #BiomedicalScienceDay2021