Children's haemostasis and thrombosis

About

Our children’s haemostasis and thrombosis specialist service aims to provide timely assessment of all children who are suspected to have disorders of excessive bleeding or blood clotting, including those with bleeding due to immune disorders (ITP). Imperial College Healthcare NHS Trust has fully accredited laboratories experienced in specialised tests of haemostasis and thrombosis to establish a prompt diagnosis.

The service is led by Dr Helen New, who has a joint consultant post with NHS Blood and Transplant (NHSBT) and is one of the few paediatric transfusion specialists in the country, promoting best practice in paediatric transfusion at local and national levels. Dr New leads on national audits and guidelines, and she is a member of the national haemovigilance scheme ‘Serious Hazards of Transfusion’ working expert group. At Imperial she is co-investigator for the Planet-2 (Platelets for Neonatal Transfusion) study and provides specialist paediatric transfusion support as part of the Trust transfusion team.

The service also benefits from joint clinics with Dr Nichola Cooper, an adult haematology consultant at Imperial who specialises in ITP. In addition, other paediatric specialties including surgery, ear, nose and throat (ENT) and rheumatology services at St Mary’s provide advice and management for children with haematological disorders when needed.

Conditions and treatments

The children’s haemostasis and thrombosis service treats neonates, infants and children who are suspected to have disorders of excessive bleeding or blood clotting, including those with bleeding due to immune disorders, primarily immune thrombocytopenia (ITP). It is embedded within the wider paediatric haematology and bone marrow transplant (BMT) service at St Mary's Hospital, which also specialises in the management of children with haemoglobinopathies and red cell disorders, stem cell transplantation, bone marrow failure syndromes and Level 2 Shared Care for children with malignancies.

Our children’s haematology clinics benefit from the support of a clinical nurse specialist and of the paediatric haematology service as a whole, including a dedicated haematology day care unit and inpatient facilities if required. Children with other general haematological problems may also be investigated in the clinic.

Patients with ITP may require treatment with a short course of steroids or intravenous (into the vein – IV) immunoglobulin if they have significant bleeding symptoms, but these are not usually required for patients coming to routine clinic appointments.

For adolescent transition of children with ITP and joint review of complex patients there is a clinic every three months in conjunction with Dr Nichola Cooper, with additional multidisciplinary input as required. The children's haemostasis and thrombosis service has managed in excess of 80 children with ITP over the last eight years.

The team also provides a paediatric anticoagulation service, including a home monitoring programme with the aim of improving the patient experience. Children who are diagnosed with disorders such as ITP may require urgent treatment for bleeding, and this is supported by our children's accident and emergency (A&E) department, which is open 24 hours a day, seven days a week, and also by access to the paediatric haematology day care and inpatient facilities, with 24-hour paediatric haematology consultant cover.

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