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 

Parameter	Telephone Ranges
White Cell Count	> 100.0 x 10*9/L
Neutrophils	< 0.5 or > 50.0 x 10*9/L
Haemoglobin	< 70 or > 190 g/L
Platelets	< 30 or > 1000 x 10*9/L
Plasma Viscosity	> 5.0 mPa
Malaria Parasite	Always telephone a positive result
Sickle Screen	Urgent positive results

Coagulation Studies  

Parameter	Telephone Ranges
Fibrinogen	< 0.5 g/L
Warfarin Monitoring	INR > 6.5
Heparin Monitoring	APTT > 135 secs

Blood Transfusion

Parameter	Telephone Ranges
Neonatal DAT	Always telephone a positive result
Positive Antibody screen	Positive antibody screens will be phoned to the clinical area if it will impact on the provision of red cells.
Foetal Leak	>4 ml bleed

Errors 

Wrong Blood In Tube	These will be communicated to the clinical area. Repeat samples are required.
Rejected Crossmatch Requests	The lab will make reasonable attempts to make contact with the clinical area to request a repeat.

 

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.

Disorder	Tests to request in primary screen	Notes
Arthralgia or arthritis	Rheumatoid factor, Antinuclear Antibody (ANA)	The laboratory will instigate more specific tests if indicated by the screen. A measure of the acute phase response may also be helpful.
Anti-phospholipid syndrome	Anti-cardiolipin (ACA)	If ACA negative and clinical suspicion high worth checking for lupus anticoagulant. If ACA positive result needs to be confirmed 12 weeks later.
Coeliac disease	Anti-tissue transglutaminase	The laboratory will confirm positive results by anti-endomysium and check for IgA deficiency as required.
Allergy	Allergen Specific IgE (formerly ‘RAST’)	History is paramount in making the diagnosis. The test helps only to confirm the diagnosis.
Autoimmune thyroid disease	TSH (to assess dysfunction)	Anti TPO helpful in the context of subclinical hypothyroidism i.e. when TSH 5-10mU/L.
Myeloma	Serum Electrophoresis, Urine for Bence Jones protein	Need to check both serum and urine.  Immunofixation will be performed if indicated by screen.
Possible immunodeficiency	Immunoglobulins, Immunophenotyping	History is paramount. Please discuss with laboratory to direct testing.
Persistent raised plasma viscosity	Immunoglobulins, autoimmune profile, liver function tests
Abnormal liver function/jaundice	Autoimmune liver screen (includes ANA, anti-smooth muscle, anti-mitochondria, anti-LKM)	Immunoglobulins may provide additional supporting information.

 

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

All patients undergoing mastectomy surgery will be offered breast reconstruction either as an immediate (at the same time as the initial mastectomy surgery) or delayed approach (following completion of chemotherapy/radiotherapy)  where appropriate.

At Bristol Breast Care Centre, we can offer you:

• Implant based reconstructive surgery (using tissue expanders/implants and/or ADM – acellular dermal matrix grafts)
• Tissue based reconstructive surgery (latimmus dorsi reconstruction – using tissue and muscle from the back to recreate a breast)
• Or; we can refer directly to our plastic surgery colleagues   for DIEP reconstructive surgery where they use the muscle and fatty tissue from the tummy to create a breast.  ( a referral from your own breast surgeon can be made directly from clinic)

All patients must be assessed at the reconstructive surgery clinic prior to undergoing surgery as not all options may be suitable or available/appropriate  for all patients. There are several factors that need to be taken into consideration.

Some women choose not to have reconstruction, but are informed this is available to them at any time in the future if they wish.

Nipple reconstruction is also available within the BBCC and is generally performed as a daycase procedure by either our breast surgeons or the plastic surgeons.

The BBCC run reconstruction clinics where both new and follow-up patients are seen and given the opportunity to talk things through in more detail with the consultant and/or CNS.

Patients undergoing DIEP reconstructions are seen and followed up by the plastic surgeon and the reconstruction nurse Caroline Oates.

The Clinical Nurse Specialist (CNS) Clinic (Nurse Led Results Clinic) is run on a Thursday afternoon by the Clinical Nurse Specialists; Naomi, Angie and Helen.

It is a results clinic specifically for patients that have been operated on in the previous week to 10 days.

 

We will go through the results with you step by step and discuss your individual treatment. Your individual treatment plan would have been discussed at the previous Multi-Disciplinary Team (MDT) meeting where we would talk about the chemotherapy, the radiotherapy, and hormone therapy suitable for you.

At this clinic we would also check your wound and give you your follow-up appointment to talk with the Oncologist.

This clinic also offers you the opportunity to ask us more questions if you need to.