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13 October 2018

Today (13 October) is World Thrombosis Day and to mark the occasion we spoke with BSH member and thrombosis & haemostasis expert Professor Beverley Hunt. Beverley talks about her career and achievements in haematology, including setting up the Charity Thrombosis UK.

What led you to a career in haematology?

I qualified early in the spring of the final year as a medical student, by doing the “Conjoint exam”, which I don’t think is possible anymore. This meant I could do locum house officer jobs while everyone else was studying for finals. My favourite locum was covering “Tropics”- a ward where patients with tropical illnesses and haematological disorders had beds and run by Professor Alaistair Bellingham (later President of RCPath), who was a mentor and an inspiration to me.

I was also a House officer for Professor Bellingham on 7Y ward at the new Royal Liverpool Hospital at a time when 120 hours a week was the norm. One Saturday morning after a near sleepless night I overslept my alarm and came late to the ward to find “Prof “ had come in and done all my jobs - all the phlebotomy for the ward, and given all the cytotoxics and antibiotics to the patients.

After house jobs I spent many years in general medicine and gradually realised Haematology was my favourite subject - the ability to do the laboratory diagnosis as well as clinically manage the patient seemed a very holistic approach so I finally chose specialist training in Haematology.  

Can you tell us more about how you came to specialise in thrombosis?

I spent my time in London rotating between a specialist hospital such as the Royal Postgraduate Hospital and district generals. I found the emotional trauma of caring for patients with leukaemia very harrowing. I was intellectually drawn to non-malignant haematology and spent a sabbatical organised by Professor Dame Marcela Contreras, looking at haemolysis in patients after solid organ transplantation.  

It was here I met Professor Sir Magdi Yacoub who offered me space and funds to look wider at unstudied field of haematological issues in solid organ transplantation at the NHLI/Harefield. I jumped at this unique chance and can remember the exciting day when my very own Portacab (my future lab and office) was craned into the Harefield grounds! I got sucked into solid organ transplantation care and studied thrombotic, bleeding and transfusion problems in my lab.

I became interested in the basic haemostatic mechanism of the endothelial response to rejection and Prof used to call me to surgical theatre when a patient was bleeding, asking me to “sort it out”. Crazy but happy times, although I was a lone Haematologist in a world of Immunologists and Transplantors & had to learn to talk their language as they could not speak mine. Eventually I realised the science of thrombosis and haemostasis was the area where I wanted to spend a lifetime’s work.  

What advances have you seen in the delivery of care to thrombosis patients during your career?

Where to start!

As a house officer we used to give bleeding patients with Haemophilia A transfusions of cryoprecipitate, then we had Factor VIII concentrates and then recombinant Factor VIII which was used to prevent bleeding and now we have a successful programme in London where patients are producing their own Factor VIII again through gene therapy.

In thrombosis we have enormous understanding of who gets venous thromboembolism (VTE), notably 60% are due to hospital admission and we can prevent much of this by giving thromboprophylaxis.

Tranexamic acid. My favourite drug. How many hours of my life have I spent working on it - incalculable! But it must be mentioned on World Thrombosis Day because nearly a million patients have been in studies of tranexamic acid and it reduces bleeding and bleeding deaths WITHOUT increasing with venous or arterial events - the near perfect haemostat.

Of course I can’t forget to talk about Thrombosis UK. In 2002 I was working on a new technique to diagnose DVT (now known as MR direct thrombus imaging) with Professor Alan Moody. We applied for grants to advance the technique, but no one would fund us. To paraphrase the responses: “this is a good grant but we don’t fund work on venous thromboembolism. So we set up Lifeblood: the thrombosis charity – now known as Thrombosis UK to increase awareness of VTE and raise research funds. Alan subsequently emigrated to Canada and I was left to soldier on and the charity slowly grew on. We all worked hard out of hours for free, and I can remember the multi-tasking we did, for example one summer I actually wrote all the content for our website.

Thrombosis UK campaigned on the postcode prescribing of thromboprophylaxis in the UK and precipitated a Health Select committee in 2005 with many experts giving evidence. One of my suggestions was that each hospital had a “thrombosis & thromboprophylaxis committee” which was one of the recommendations when the report was published. But the biggest demand of the final report was to mandate VTE risk assessment. This took another 4 years campaigning with many health professionals and the All Party Parliamentary Thrombosis Group. This became a reality in 2010 in NHS England when they introduced a target of 90% risk assessment with a financial penalty if Trusts did not reach it. and a fresh infrastructure developed with NICE guidelines and Quality Standards and the Exemplar network. This radical change led to a reduction on VTE events and a 9% reduction in death due to pulmonary embolism.

In 2018 Thrombosis UK has grown to a medium size charity with multiple functions including office staff supporting patients and their care.

But it doesn’t stop there, because the International Society of Thrombosis & Haemostasis on the back of the success of Thrombosis UK have set up World Thrombosis Day to increase global awareness of thrombosis. World Thrombosis Day is on Virchow’s birthday - the 13 October and is now in its 5th year. Last year we had 2.7 billion hits on social medial and thousands of events globally.

Part of World Thrombosis Day’s agenda is to improve global thrombosis care and engage with the World Health Organisation especially as regards to patient safety and the need to reduce thrombosis deaths. I currently lead the latter and am using the NHS England’s systematic approach to VTE prevention as a model of how other countries could go forward. 

What advances in our understanding of thrombosis and delivery of care do you expect to see in the future?

Genetic engineering in the next 10 years will hopefully “cure” many of the rare bleeding and thrombotic disorders - from Haemophilia to antithrombin deficiency.

The hunt for the perfect anticoagulant will continue.

What advice would you give to someone considering a career in haematology?

Do it! It is such an exciting time, and the ability to run a laboratory to support clinical work is very seductive.

What is the most rewarding part of your job?

Patient contact always has been and will remain my number 1, but doing a study or clinical trial to answer a research question and campaigning to improve thrombosis and haemostasis care nationally and internationally, are tied jointly as number 2.

What is the most challenging part of your job?

Admin, bureaucracy and IT. Our IT systems are so clunky, they use up energies that would be more profitably spent elsewhere.

What do you get out of your BSH Membership, and what would say to someone who is thinking about joining BSH as a member?

As a British haematologist the BSH is your organisation and wants to support you in your training and education. It’s also a great place to meet like-minded people.


More: World Thrombosis Day 

BSH Guidelines: Thrombosis & Haemostasis

 

*The contents of this article do not reflect an official BSH position. We would value your thoughts on this article and hope it provokes discussion within the haematology community.