Blood Sciences


Welcome to the home page of the Blood Sciences department at the Royal Devon & Exeter NHS Foundation Trust, UK.

The Exeter Blood Sciences Laboratory is a modern, high quality service generating >25,000 results everyday for both NHS and research patients. Along with our partner disciplines, we share the vision that a clinical diagnostic facility is  underpinned by research, modern laboratory processes, and clinical expertise for differential diagnosis, result interpretation and treatment advice.

The combined laboratories provide a full range of Clinical Biochemistry, Hematology, Immunology and  Blood Transfusion within the custom designed laboratories at the Royal Devon and Exeter NHS Foundation Trusts.

Information about sample requirements and reference ranges for specific test can be found on the test catalogue. General information regarding opening times and making requests can be found here

Blood Sciences is a vibrant training laboratory with over 25 biomedical scientists and 4 clinical scientists receiving their training here over the last 10 years.

Clinical Biochemistry

General chemistry services are provided by the Department of Blood Sciences and a 24 hour, 7 day acute service available.

The Chemical pathology laboratory provides a comprehensive diagnostic service which includes general screening  for renal, liver, bone, cardiac and other disease groups through the use of highly automated analytical platforms. In addition we provide an extensive disease monitoring service for anaemia, endocrine, tumour related, lipid and other metabolic disorders.

The laboratory also provides specialist assay services to support research and clinical trials carried out in the Peninsula medical School and Exeter University. We welcome referral work from other laboratories to support:

For any enquiries regarding clinical advice, please contact the Duty Biochemist who is available 09.00 – 17.30  Monday to Friday and by bleep through the switch board 24 hours a day.

Haematology

Haematology provides a comprehensive screening and diagnostic service using a range of state-of-the art technologies and manual laboratory procedures. The laboratory provides Full Blood Count investigations, blood cell morphology and haemoglobinopathy assessment.

The clinical consultant leads are involved in day-to-day diagnosis, being responsible not only for clinical advice but also consultative support for complex blood cell morphology, and provide bone marrow aspirate and trephine assessment.

Blood Transfusion

The MHRA accredited laboratory provides the full range of immuno-haematological services, including antenatal screening for the prevention of haemolytic disease of the newborn and supports the trust programme for routine antenatal anti-D prophylaxis. The blood bank provides both standard and highly specialised blood and blood components to meet the diverse requirements of patients.

Haematology and Blood Transfusion  laboratory service is provided on a 24 hour a day, 365 days a year basis.

Click here to visit the main Blood Transfusion page.

Immunology

The Immunology laboratory provides allergy testing, flow cytometry, protein electrophoresis, a wide range of immunology tests and a stem cell bank for autologous haematopoietic stem cell transplantation. The Allergy service covers perennial rhinitis / conjunctivitis, seasonal rhinitis, asthma, bee & wasp stings and food allergy.

A range of flow cytometry is undertaken in the Immunology laboratory covering immune monitoring , immune deficiency, lymphocytosis,  acute leukaemia and CD34+ stem cells.

Details of  immunology tests for autoimmune disease can be found in our test catalogue.

Stem Cell Bank

The Stem Cell Bank at the Royal Devon and Exeter Hospital offers an autologous stem cell transplant service for patients with haematological malignancies. The service is overseen by a Consultant Haematologist. The Stem Cell Bank is licensed by the Human Tissue Authority (HTA) and accredited by the Joint Accreditation Committee-ISCT & EBMT (JACIE).

Click here to visit the main Stem Cell Processing Laboratory page.

 

Departmental Publications

.         O’Connor J.Reducing Post Analytical Error: Perspectives on New Formats for the Blood Sciences Pathology Report v36(1) Feb 2015 Pubmed PMC: 4402949

·        Oram RA, McDonald TJ, Shields BM, Hudson MM, Shepherd MH, et al. Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors. Diabetes Care. 2015 Feb;38(2):323-8. PubMed PMID: 25519449.

·         Myngheer N, Allegaert K, Hattersley A, McDonald T, Kramer H, et al. Fetal macrosomia and neonatal hyperinsulinemic hypoglycemia associated with transplacental transfer of sulfonylurea in a mother with KCNJ11-related neonatal diabetes. Diabetes Care. 2014 Dec;37(12):3333-5. PubMed PMID: 25231897.

·         Flanagan SE, Haapaniemi E, Russell MA, Caswell R, Lango Allen H, et al. Activating germline mutations in STAT3 cause early-onset multi-organ autoimmune disease. Nat Genet. 2014 Aug;46(8):812-4. PubMed PMID: 25038750; PubMed Central PMCID: PMC4129488.

·         McDonald TJ, Warren R. Diagnostic confusion? Repeat HbA1c for the diagnosis of diabetes. Diabetes Care. 2014 Jun;37(6):e135-6. PubMed PMID: 24855169.

·         Oram RA, Brooks AM, Forbes S, Eckoldt S, Smith RM, et al. Home urine C-peptide creatinine ratio can be used to monitor islet transplant function. Diabetes Care. 2014 Jun;37(6):1737-40. PubMed PMID: 24623023.

·         Koivula RW, Heggie A, Barnett A, Cederberg H, Hansen TH, et al. Discovery of biomarkers for glycaemic deterioration before and after the onset of type 2 diabetes: rationale and design of the epidemiological studies within the IMI DIRECT Consortium. Diabetologia. 2014 Jun;57(6):1132-42. PubMed PMID: 24695864; PubMed Central PMCID: PMC4018481.

·         Jones AG, McDonald TJ, Hattersley AT, Shields BM. Effect of the holiday season in patients with diabetes: glycemia and lipids increase postholiday, but the effect is small and transient. Diabetes Care. 2014 May;37(5):e98-9. PubMed PMID: 24757253.

·         Thong KY, McDonald TJ, Hattersley AT, Blann AD, Ramtoola S, et al. The association between postprandial urinary C-peptide creatinine ratio and the treatment response to liraglutide: a multi-centre observational study. Diabet Med. 2014 Apr;31(4):403-11. PubMed PMID: 24246138.

·         Hamilton AJ, Bingham C, McDonald TJ, Cook PR, Caswell RC, et al. The HNF4A R76W mutation causes atypical dominant Fanconi syndrome in addition to a β cell phenotype. J Med Genet. 2014 Mar;51(3):165-9. PubMed PMID: 24285859; PubMed Central PMCID: PMC3932761.

·         Oram RA, Jones AG, Besser RE, Knight BA, Shields BM, et al. The majority of patients with long-duration type 1 diabetes are insulin microsecretors and have functioning beta cells. Diabetologia. 2014 Jan;57(1):187-91. PubMed PMID: 24121625; PubMed Central PMCID: PMC3855529.

·         Oram RA, Rawlingson A, Shields BM, Bingham C, Besser RE, et al. Urine C-peptide creatinine ratio can be used to assess insulin resistance and insulin production in people without diabetes: an observational study. BMJ Open. 2013 Dec 18;3(12):e003193. PubMed PMID: 24353253; PubMed Central PMCID: PMC3884748.

·         Hope SV, Jones AG, Goodchild E, Shepherd M, Besser RE, et al. Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes. Diabet Med. 2013 Nov;30(11):1342-8. PubMed PMID: 23659458; PubMed Central PMCID: PMC4154136.

·         Nowak N, Szopa M, Thanabalasingham G, McDonald TJ, Colclough K, et al. Cystatin C is not a good candidate biomarker for HNF1A-MODY. Acta Diabetol. 2013 Oct;50(5):815-20. PubMed PMID: 22350134; PubMed Central PMCID: PMC3898131.

·         Oram RA, McDonald TJ, Vaidya B. Investigating hypokalaemia. BMJ. 2013 Sep 24;347:f5137. PubMed PMID: 24065427.

·         McDonald TJ, Ellard S. Maturity onset diabetes of the young: identification and diagnosis. Ann Clin Biochem. 2013 Sep;50(Pt 5):403-15. PubMed PMID: 23878349.

·         Besser RE, Shields BM, Hammersley SE, Colclough K, McDonald TJ, et al. Home urine C-peptide creatinine ratio (UCPCR) testing can identify type 2 and MODY in pediatric diabetes. Pediatr Diabetes. 2013 May;14(3):181-8. PubMed PMID: 23289766.

·         Flanagan SE, Mackay DJ, Greeley SA, McDonald TJ, Mericq V, et al. Hypoglycaemia following diabetes remission in patients with 6q24 methylation defects: expanding the clinical phenotype. Diabetologia. 2013 Jan;56(1):218-21. PubMed PMID: 23111732; PubMed Central PMCID: PMC3982857.

·         Besser RE, Jones AG, McDonald TJ, Shields BM, Knight BA, et al. The impact of insulin administration during the mixed meal tolerance test. Diabet Med. 2012 Oct;29(10):1279-84. PubMed PMID: 22435709.

·         Besser RE, Jones J, McDonald TJ, Smith R, Shepherd MH, et al. Using highly sensitive C-reactive protein measurement to diagnose MODY in a family with suspected type 2 diabetes. BMJ Case Rep. 2012 Jul 11;2012PubMed PMID: 22787179; PubMed Central PMCID: PMC3416990.

·         Thomas NJ, Shields BM, Besser RE, Jones AG, Rawlingson A, et al. The impact of gender on urine C-peptide creatinine ratio interpretation. Ann Clin Biochem. 2012 Jul;49(Pt 4):363-8. PubMed PMID: 22568974.

·         Jones AG, Besser RE, Shields BM, McDonald TJ, Hope SV, et al. Assessment of endogenous insulin secretion in insulin treated diabetes predicts postprandial glucose and treatment response to prandial insulin. BMC Endocr Disord. 2012 Jun 8;12:6. PubMed PMID: 22681724; PubMed Central PMCID: PMC3405447.

·         McDonald TJ, McEneny J, Pearson ER, Thanabalasingham G, Szopa M, et al. Lipoprotein composition in HNF1A-MODY: differentiating between HNF1A-MODY and type 2 diabetes. Clin Chim Acta. 2012 May 18;413(9-10):927-32. PubMed PMID: 22360925.

·         Shields BM, McDonald TJ, Ellard S, Campbell MJ, Hyde C, et al. The development and validation of a clinical prediction model to determine the probability of MODY in patients with young-onset diabetes. Diabetologia. 2012 May;55(5):1265-72. PubMed PMID: 22218698; PubMed Central PMCID: PMC3328676.

·         McDonald TJ, Perry MH, Peake RW, Pullan NJ, O’Connor J, et al. EDTA improves stability of whole blood C-peptide and insulin to over 24 hours at room temperature. PLoS One. 2012;7(7):e42084. PubMed PMID: 22860060; PubMed Central PMCID: PMC3408407.

·         Bowman P, McDonald TJ, Shields BM, Knight BA, Hattersley AT. Validation of a single-sample urinary C-peptide creatinine ratio as a reproducible alternative to serum C-peptide in patients with Type 2 diabetes. Diabet Med. 2012 Jan;29(1):90-3. PubMed PMID: 21883437.

·         McDonald TJ, Perry MH, Jones AG, Donohoe M, Salzmann MB, et al. A novel case of a raised testosterone and LH in a young man. Clin Chim Acta. 2011 Oct 9;412(21-22):1999-2001. PubMed PMID: 21756889.

·         Jones AG, Besser RE, McDonald TJ, Shields BM, Hope SV, et al. Urine C-peptide creatinine ratio is an alternative to stimulated serum C-peptide measurement in late-onset, insulin-treated diabetes. Diabet Med. 2011 Sep;28(9):1034-8. PubMed PMID: 21843301.

·         McDonald TJ, Colclough K, Brown R, Shields B, Shepherd M, et al. Islet autoantibodies can discriminate maturity-onset diabetes of the young (MODY) from Type 1 diabetes. Diabet Med. 2011 Sep;28(9):1028-33. PubMed PMID: 21395678.

·         McDonald TJ, Shields BM, Lawry J, Owen KR, Gloyn AL, et al. High-sensitivity CRP discriminates HNF1A-MODY from other subtypes of diabetes. Diabetes Care. 2011 Aug;34(8):1860-2. PubMed PMID: 21700917; PubMed Central PMCID: PMC3142017.

·         Besser RE, Ludvigsson J, Jones AG, McDonald TJ, Shields BM, et al. Urine C-peptide creatinine ratio is a noninvasive alternative to the mixed-meal tolerance test in children and adults with type 1 diabetes. Diabetes Care. 2011 Mar;34(3):607-9. PubMed PMID: 21285386; PubMed Central PMCID: PMC3041191.

·         Besser RE, Shepherd MH, McDonald TJ, Shields BM, Knight BA, et al. Urinary C-peptide creatinine ratio is a practical outpatient tool for identifying hepatocyte nuclear factor 1-{alpha}/hepatocyte nuclear factor 4-{alpha} maturity-onset diabetes of the young from long-duration type 1 diabetes. Diabetes Care. 2011 Feb;34(2):286-91. PubMed PMID: 21270186; PubMed Central PMCID: PMC3024335.

·         Campeotto I, Bolt AH, Harman TA, Dennis C, Trinh CH, Phillips SE, Nelson A, Pearson AR, Berry A, “Structural insights into substrate specificity in variants of N-acetylneuraminic Acid lyase produced by directed evolution”, J Mol Biol. 2010, 404, 56.

·         McDonald TJ, Knight BA, Shields BM, Bowman P, Salzmann MB, et al. Stability and reproducibility of a single-sample urinary C-peptide/creatinine ratio and its correlation with 24-h urinary C-peptide. Clin Chem. 2009 Nov;55(11):2035-9. PubMed PMID: 19713273.

·         Bolt AH, Berry A and Nelson AS, “Directed evolution of aldolases for exploitation in synthetic organic chemistry”, Arch. Biochem. Biophys. 2008, 474, 318-330.

·         Allen D, Bolt AH, Chapman G, Knight R, Meissner H, Owen D, Watson R “Identification and structure-activity relationships of 1-aryl-3-piperidin-4-yl-urea derivatives as CXCR3 receptor antagonists”, Bioorganic & Medicinal Chemistry Letters, 2007, 17, 697-701.

·         Barrett S, Bartlett S, Bolt AH, Ironmonger A, Joce C, Nelson A and Woodhall T, “Configurational stability of bisindolylmaleimide cyclophanes: From conformers to the first configurationally stable, atropisomeric bisindolylmaleimides”, Chem. Eur. J. 2005, 11, 6277.