Bleeding and clotting disorders

Haemophilia

There are two scheduled haemophilia and bleeding disorder clinics running weekly at Hammersmith Hospital:

• Monday morning clinic run by Dr Ferras Alwan
• Tuesday morning clinic run by Dr Carolyn Millar

Individuals with inherited blood disorders such as haemophilia, von Willebrand disease and coagulation deficiency disorders are seen in addition to people with symptoms such as unexplained easy bruising or bleeding.

Each clinic has a haemostasis consultant, a specialised bleeding disorders physiotherapist and a haemostasis clinical nurse specialist in attendance.

Thrombosis

Imperial College Healthcare provides an integrated outpatient and inpatient specialist anticoagulation service for a wide range of conditions. These include blood clot in a vein (venous thromboembolism or VTE) – including deep vein thrombosis (DVT) and pulmonary embolism (PE).

We also provide complex anticoagulation advice and management for patients with renal (kidney) impairment, bleeding problems, active cancer, multiple thrombotic events, genetic thrombophilias and complex thrombotic disorders.

Clinics are run at both St Mary’s and Hammersmith hospitals and overseen by consultants with specific expertise in thrombotic disorders.

Von Willebrand Disease (VWD)

Within the bleeding disorder service at Imperial College Healthcare there is specialist care for patients with von Willebrand disease.

Based at Hammersmith Hospital, care is delivered by a team led by consultants with specific expertise in von Willebrand disease. We run specialist gynaecology clinics at Queen Charlotte's & Chelsea hospital for people with von Willebrand disease who experience heavy menstrual bleeding as well as a joint obstetric haematology clinic where women with von Willebrand disease are looked after during pregnancy. 

There is an active research programme at the Trust with opportunities for patients with von Willebrand disease to participate in clinical research and trials should they wish to do so.

Antiphospholipid syndrome (APS)

Antiphospholipid syndrome (APS) is an autoimmune disease associated with persistently positive autoantibodies called antiphospholipid antibodies (aPL). APS can occur on its own or along with other autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis.

These antibodies are responsible for the principal clinical problems of APS:

1. Blood clotting (thrombosis) affecting both and veins and arteries which is often present as stroke
2. Pregnancy complications resulting in miscarriage or fetal death
3. Other autoimmune and inflammatory complications affecting any organ in the body but most frequently the heart or kidneys

We are one of the few centres in the UK who provide a dedicated clinical service with weekly clinics for patients with APS.

Since establishing our clinics in 2016, we have been able to support many patients with APS through receive regular, prompt outpatient and inpatient care and a multidisciplinary team approach.

As APS is a multisystem disease which can affect virtually any part of the body, we work closely with acute medicine teams, hyper-acute stroke units, cardiologists, rheumatology and renal teams.

In addition to the clinical service, we have a growing research programme and an active patient and public involvement (PPI) group.

Pregnancy

An obstetric haematology clinic is held at Queen Charlotte’s & Chelsea Hospital on Friday mornings. A consultant haematologist and obstetrician together with a specialist midwife attend this clinic. Women with bleeding disorders or who are carriers or possible carriers of haemophilia and other inherited bleeding disorders are seen in this clinic before pregnancy as well as during and after pregnancy. 

Weekly haemophilia and bleeding disorders clinics

We hold weekly multidisciplinary clinics on Monday and Tuesday mornings which are attended by a haemophilia consultant, specialist nurse, specialist physiotherapist and junior doctor. These clinics are for patients with haemophilia and other inherited bleeding disorders.

A consultant clinic for new patients being investigated for possible bleeding disorders is held on Monday and Tuesday mornings.

Pregnancy clinic

An obstetric haematology clinic is held at Queen Charlotte’s & Chelsea Hospital on Friday mornings. A consultant haematologist and obstetrician together with a specialist midwife attend this clinic. Women with bleeding disorders or who are carriers or possible carriers of haemophilia and other inherited bleeding disorders are seen in this clinic before pregnancy as well as during and after pregnancy. 

Nurse-led haemophilia telephone clinic

Our specialist haemophilia nurses run a weekly phone clinic on Thursday mornings for patients with mild bleeding disorders.

Walk-in service for registered patients

The haemophilia centre at Hammersmith Hospital is open between 09.00 and 17.00, Monday to Friday. This service is for patients with a mild or severe bleeding disorder. Patients should contact the haemostasis clinical nurse specialist before using the walk-in service.

The nursing team will coordinate initial assessment and administer clotting factors if required. You will be reviewed by one of our registrar doctors with support from consultant haematologists.

Patients with other diagnoses who need urgent advice or support should call the renal and haematology triage unit: 020 3313 1255

For more information about the walk-in service, please contact the haemostasis team via:

Phone: 020 3313 4345

Email: imperial.haemostasiscns@nhs.net

Address

Haemophilia Centre
Second Floor Garry Weston Centre
Hammersmith Hospital
Du Cane Road
London
W12 0HS

Transition clinic for young patients with haemophilia

Whilst adult patients with haemophilia and other bleeding disorders are seen at Hammersmith Hospital, there is an established transition programme between the children and adult haemophilia services within the North London Adult Haemophilia Network. This supports young people transitioning to adult services from Great Ormond Street Hospital (GOSH) to Hammersmith Hospital.

The process of planning transition can start when the patient is around 12 years old. During transition to adult care, the clinical nurse specialist and/or consultant from Hammersmith Hospital will aim to attend the outpatient appointment at GOSH to meet the patient and their family to facilitate the handover. There will be an opportunity for the young person to visit the haemophilia centre at Hammersmith before their first clinic appointment. Written information including contact details will be provided to young people and their families.

For more information, please contact the haemostasis service via:

Phone: 020 3313 4345

Email: imperial.haemostasiscns@nhs.net

Haemostasis-vascular joint clinic

One consultant haematologist and the vascular surgical team see patients in the haematology vascular surgical clinic at Charing Cross Hospital for assessment and management of post-thrombotic syndromes. In addition, the anticoagulation strategy in patients after venous and arterial surgical revascularisation procedures is reviewed, and optimised.

For more information, please contact the haemostasis service via:

Phone: 020 3313 4331

Email: imperial.haemostasisadmin@nhs.net

Haemostasis and thrombosis clinic at Hammersmith Hospital

Address

Haemophilia Centre
Second Floor Garry Weston Centre
Hammersmith Hospital
Du Cane Road
London
W12 0HS

Hours

Mornings, Monday, Tuesday Wednesday, Friday

Phone: 020 3313 4331

Email: imperial.haemostasisadmin@nhs.net

Anticoagulation clinics at Hammersmith Hospital

Warfarin clinic

Pharmacist-led service for people who are being treated with anticoagulant therapy (warfarin).

Address

Main outpatients
Zone A, A Block
Hammersmith Hospital
Du Cane Road
London
W12 0HS

Hours

Thursday mornings

Phone: 020 3313 4345

Email: imperial.anticoagulationservice@nhs.net

New warfarin patient clinic

Pharmacist-led service for people who have recently started taking warfarin, such as patient patients recently discharged from hospital on warfarin.

Address

Haemophilia centre
Second Floor Garry Weston Centre
Hammersmith Hospital
Du Cane Road
London
W12 0HS

Hours

Tuesday afternoons 

Phone: 020 3313 4345

Email: imperial.anticoagulationservice@nhs.net

Anticoagulation telephone clinic

Pharmacist-led telephone clinic service for patients on anticoagulant therapy.

Hours

Wednesday mornings

Phone: 020 3313 4345

Email: imperial.anticoagulationservice@nhs.net

Anticoagulation clinic

Pharmacist-led face-to-face clinic service for patients on anticoagulant therapy.

Address

Haemophilia centre
Second Floor Garry Weston Centre
Hammersmith Hospital
Du Cane Road
London
W12 0HS

Hours

Thursday afternoons

Phone: 020 3313 4345

Email: imperial.anticoagulationservice@nhs.net

Cancer-VTE Clinic at Hammersmith Hospital

The cancer-VTE clinic is led by a consultant haematologist and supported by specialist pharmacists. The clinic offers face-to-face and telephone appointments for patients with a risk of developing a blood clot who are undergoing active cancer management.

Address

Haemophilia Centre
Second Floor Garry Weston Centre
Hammersmith Hospital
Du Cane Road
London
W12 0HS

Hours

Friday mornings

Phone: 020 3313 4331

Email: imperial.haemostasisadmin@nhs.net

Pulmonary embolism clinic at Hammersmith Hospital

Address

Haematology outpatient department
Ground Floor Catherine Lewis Centre
Hammersmith Hospital
Du Cane Road
London
W12 0HS

Hours

Mornings, the second Wednesday of each month

Phone: 020 3313 4331

Email: imperial.haemostasisadmin@nhs.net

Joint pharmacist and nurse-led anticoagulation service at St Mary's Hospital

Address

St Mary's Hospital
Praed Street
London
W2 1NY

Hours

Warfarin Monday mornings, Thursday afternoons warfarin clinical at St Mary's Hospital

Phone: 020 3312 6033

Email: imperial.anticoagulationservice@nhs.net

Thrombophilia clinic at St Mary's Hospital

Address

Clinic B, first floor
Main outpatients
St Mary's Hospital
Praed Street
London
W2 1NY

Hours

Wednesday mornings

Phone: 020 3312 6033

Email: imperial.anticoagulationservice@nhs.net

Meet the team

Consultants

Dr Ferras Alwan
Dr Deepa Jayakody Arachchillage
Dr Carolyn Millar
Dr Abdul Shlebak
Dr Philippa Woolley

Dr Marc Heller (locum)

Clinical nurse specialists

Louisa Icaro, St Mary’s Hospital
Karen Logan, Hammersmith Hospital
Eleanor Munoz, St Mary’s Hospital
Catherine Ryu, Hammersmith Hospital

Patient information

Key contact numbers

Contact	Phone number	Available
Specialist nurses, haemophilia centre	020 3313 4345	Monday - Friday 09.00 – 17.00
Renal and haematology triage unit (RHTU) helpline	020 3311 7755	Out of hours as well as weekends and public holidays
Clinic appointments (haemophilia data manager)	020 3313 4331	Monday - Friday 09.00 – 17.00
Central appointments booking office (for first appointments)	020 3313 5000	Monday - Friday 08.00 – 20.00
Social worker	075 8433 7510	Monday – Friday  09.00-16.00

Contacting the centre for clinical advice

The haemophilia centre is open Monday to Friday between 09.00 and 17.00 for appointments and emergency treatment. The centre is not open on weekends and bank holidays.

In hours

For any non-urgent and urgent advice between  09.00 and 17.00 Monday to Friday, you should contact the centre on 020 3313 4345. You will be assessed over the phone and if we need to see you, we will advise you to attend the haemophilia centre. The initial assessment and administration of clotting factors (if required) will be co-ordinated by the nursing team and you will be reviewed by one of our registered doctors with support from a consultant haematologist.

Emergencies

Emergency treatment

If you need emergency treatment outside of normal working hours, please contact the renal and haematology triage unit (RHTU) helpline by telephone: 020 3311 7755.

This helpline is open 24/7 including weekends and bank holidays. You will be advised on whether you should attend the triage unit or A&E as appropriate. The triage unit is located in B block on the Hammersmith Hospital site where a member of the haematology team will see you. All registered patients receive a patient access card that contains out-of-hours contact information; please bring this with you when you attend the triage unit. 

In the event of a potentially life-threatening emergency, you should call 999 and request an ambulance.

A haematology consultant is available 24/7 every day of the year. Any planned treatment that you may require will be take place in the haematology day care unit on the ground floor of the Catherine Lewis Centre, Hammersmith Hospital, below the haemophilia centre. Your specialist haemophilia nurse will tell you when you will be seen.

Emergencies in the UK

In the event that you require treatment whilst away from home, a directory of UK haemophilia treatment centres can be found on the United Kingdom Haemophilia Centres Doctors' Organisation (UKHCDO) website.

Emergencies abroad

A directory of haemophilia treatment centres around the world can be found on the World Federation of Haemophilia (WFH) website.

A directory of centres in Europe can be found on the European Haemophilia Safety Surveillance website.

Further guidance on travelling can be found on the WFH website under ‘tips for travellers’ and on the Haemophilia Society website.  

Patient passport (patient access card)

Some of our patients are issued access card ‘passports’ for our service. If you require urgent advice about your condition, please refer to the relevant phone number in your passport.

Travel letters

Our patients will often need a travel letter to explain to airport and customs staff why they are carrying treatment products (such as prescribed drugs, needles and syringes) and the serious implications of not carrying these. If your haemophilia consultant or specialist nurse has advised that you need a travel letter, please contact the centre at least two weeks before you travel.

Travelling with clotting factor

When travelling by air it is strongly advised that you carry your own treatment products, equipment and medication onto the aircraft as hand luggage. 

Vaccination advice

Some types of bleeding disorder require vaccinations to be given subcutaneously which means the injection is given just under the skin rather than deep into the muscle. This is because deeper injections into muscle can cause bleeding. If this is the case for you, you can still get your vaccinations via your GP practice nurse, including the annual flu vaccination and all travel vaccinations. Please check with the nurses whether the vaccination you require can be given under the skin or whether additional treatment will be needed.

Your doctor may recommend that you are vaccinated against hepatitis A and B if you need plasma-derived factor products (made from donated human blood) regularly as part of your treatment. These vaccinations should also be given subcutaneously at your GP practice.

If you have any questions regarding vaccinations please contact the haemophilia specialist nurses.

Dental care and treatment

Preventing dental disease is very important, particularly in patients with bleeding disorders for whom dental diseases and their treatment may cause serious bleeding. You should have regular dental reviews and see your dentist every six months.

You should tell us about any planned dental treatment at least two weeks before any dental procedure. In some cases, we may recommend that the treatment is carried out in hospital and refer you to a specialist unit so that your dental work and your bleeding disorder can be managed together. However, you may not need to attend a hospital for your dental treatment. We will be able to advise you on this, refer you as necessary and provide any treatment required for your bleeding disorder if you are receiving treatment from your dentist. 

Home delivery of clotting factor

Home delivery of clotting factor is available to all patients who are on the home treatment programme. If you are using the home delivery programme you need to record your clotting factor usage on the Haemtrack phone app. The app enables you to record all treatments as they occur and allows the haemophilia team looking after you to see up-to-date therapy information to help monitor and improve your care. The centre will explain how to use the app.

Please speak to one of the haemophilia specialist nurses if you have any queries about your home delivery.   

Planned surgery and procedures

You will need to tell us about any planned surgery or procedures. Please contact the haemophilia specialist nurses at least two weeks before the procedure date with details of the procedure.

Please speak to us if you are intending to have a procedure done in the private sector or abroad. 

Benefits and financial help

If you have been diagnosed with a bleeding disorder you may be entitled to financial help. The haemophilia centre will support patients who need to make applications for benefits. Our social worker is also able to support patients if they wish to appeal a decision where they have been refused a particular benefit. Find out more via the Haemophilia Society website.

Welfare support

We have a specialist social worker who can provide practical information and support as well as advising patients, relatives and carers about:

• finance
• benefits
• housing
• education and employment
• immigration
• social services

Please let one of the specialist haemophilia nurses know if you would like to speak to the social worker.

Counselling services

Patients with haemophilia can be referred to the psychologist. Please speak to your haematology consultant for more information.

Your appointment

Before your appointment

You will receive a letter before your appointment within seven days of your referral being received by the hospital. You are welcome to bring a relative, close friend or carer with you to your appointment. You are also welcome to ask for a chaperone and we will endeavour to provide one for you.

When you come to your first appointment, please bring any medication you are currently taking. If you are taking warfarin, please bring your 'yellow book'. Please also remember to check your appointment letter for anything specific you have been asked to take with you. In addition, it would be helpful if you could bring the following:

• Your full address and telephone number(s)
• Your appointment card and appointment letter
• Your GP’s name and address
• Money to pay for any prescriptions, or an exemption card
• A list of questions you may want to ask your consultant

During your appointment

When you arrive at the clinic specified in your appointment letter, please report to the administrator to check in. They will ask to see your appointment letter and check that your contact details are correct. You can expect to be seen within 30 minutes of your arrival time.

Please note that we are a teaching hospital, so medical students may be present for some appointments. If you do not wish to have them in the room please let the nurse or doctor know and the students will be asked to step outside.

At your first appointment you will be examined by one of our doctors who may need to conduct further tests. You can expect that a blood test(s) will be required during your appointment. Your doctor will tell you that they suspect the issue may be, and what the tests are aiming to establish. You can expect to receive a follow-up appointment to review the results and identify the best treatment for you, if any is required.

After your appointment

You should expect to have blood samples taken after your consultation. You will likely be given another appointment to discuss the results of the tests taken at your first visit. Your follow-up appointment will automatically be arranged for you. If required, please see the receptionist before you leave if you have any queries in relation to our appointment. 

If you have signed up to Patients Know Best app, you'll be able to get your results, clinic letters and any future appointment details by the app.

If we diagnose you with a bleeding disorder, we'll register you at our centre and with the National Haemophilia Database (NHD). We will also send you a bleeding disorder card. You should carry this with you at all times and show it to health professionals if you:

• go to hospital
• need surgery, dental work or any other procedures
• have an injury needing medical help

We aim to review all patients registered at our centre every 6 to 12 months, or as often as needed. Sometimes, if your condition is very stable, we'll ask if you want to be added to our list for patient initiated follow-up appointments. This allows you to decide if you need to see us again for an appointment.  

Refer to this service

GP referrals

Please use NHS e-Referrals (eRS) or via the REGO system for secondary care referrals.

On the NHS e-Referral service please send referrals to: haematology/thrombosis and bleeding disorders triage/ Hammersmith/Imperial College Healthcare NHS Trust.

Secondary care referrals

Please make secondary care referrals by letter to Dr Ferras Alwan

Dr Ferras Alwan
Haemophilia Centre
Second Floor, Garry Weston Building
Hammersmith Hospital
Du Cane Road
London W12 0HS

Service administrator: Gillian McMillan

Phone: 020 3313 4331

Email: imperial.haemostasisadmin@nhs.net