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The lab where blood tests are helping to save lives

By Exeter Express and Echo  |  Posted: June 19, 2012

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THE lab is a blur of white coats, blue aprons and maroon scrubs. There are people everywhere inputting information, filling up industrial sized machines with blood samples and analysing results. There's a constant whir as mechanical arms continuously sort through samples and drums spin around, separating the blood.

At first glance it's like a cross between an insanely busy launderette and Dr Evil's lair. Fortunately, for thousands of patients across the region, the work they do here is not fanciful – it's groundbreaking.

The team's recent diabetes research, which transforms diabetes screening in young people, saw Tim win the Young Healthcare Scientist of the Year award. Tim developed a urine test which can help identify the two per cent of young people with a type of diabetes called MODY (Maturity Onset Diabetes of the Young) and results from a single faulty gene.

As a result of his innovative work, thousands of children and young people will benefit from this non-invasive treatment which could see patients with MODY treated with tablets instead of lifelong insulin injections.

Tim said: "Usually with a blood test it has to be measured rapidly and they had to be in hospital when it was done, now we can do the test with no needles and from a urine sample, which can be done out in the community. We have translated clinical research into practice."

He added: "With the right diagnosis the patient could be put on tablets, which will make a huge difference to their quality of life."

Tim splits his time between the pathology laboratories at Royal Devon & Exeter Hospital and the research team at the Peninsula Medical School, which is on the same site. About 60 staff are employed in the pathology department and they receive blood work from 80 GPs and 12 community hospitals across the region.

With such a huge workload, machine power is crucial to manage the sheer numbers of samples; but manpower is essential to check, analyse and interpret the results. Interestingly, the process of tagging and labelling and sorting the samples has been adapted from luggage sorting systems found in airports.

Tim said: "We try to get all of the results back on the same day, so we have a four or five-hour turnaround. In order to do this we have to make the lab processes highly automated. It's about getting the best care for the patient. When the samples come in we put a bar code on them and scan it, this automatically fills in a computerised form which is then checked against the paper document.

"The tests are carried out on the blood serum which means this has to be separated from the blood."

The red blood cells are separated from the serum using a huge blood sorting machines (imagine a top-loading tumble dryer), which literally spins the blood samples around at high speed until the blood and serum separate out. These samples are then stored in a fridge for seven days. Tim explained: "If a GP forgets to do a test or they want to do another one then they can phone up and we can go back to the fridge." The busy lab runs 24 hours a day, 365 days a year and they deal with everything from routine blood tests to blood work from Accident and Emergency patients.

"Any blood samples we get from A&E are given priority and get back to the doctor in 30 minutes. When we get bloods from A&E we are normally looking for evidence of a cardiac arrest or if a person has been crushed in an accident then they might have a problem with the oxygen levels in their blood and the damaged muscles might be releasing things into their circulation, which could damage the kidney. "We can also see if people have taken drugs, if they are in a diabetic coma or if they are drunk."

Each machine can carry-out 800 tests per hour.

Tim said: "We need that amount of analytical capacity to get the results back to GPs every day. Every year the number of samples goes up by 10 per cent because of more diagnostic tests, the population growing older and in general doctors request more bloods.

"We can test for most things – emergency medicine, liver and renal function, endocrine disorders, newborn screening. If we get things like a metabolic disorder then we would refer it to a specialist."

Lab assistants, medical assistants and biomedical scientists operate with startling efficiency to manage the daily workload, because on top of that the RD&E is the control hub for a large EU-funded project called Direct.

Tim, who was responsible for gaining the £2m grant, said: "We collect samples from patients with type two diabetes from 12 countries in the EU. We coordinate the collection from around the EU and we act as a bio bank."

Tim is one of four clinical scientists who work in the lab. "Our job role is to bridge the gap between science and medicine. We have to know the technical aspects of how the machines work and the intrinsic limitations of the tests and the pathology of the tests. Eighty per cent of all clinical diagnosis relies on pathology – without it medicine would come to a grinding halt.

"We can monitor, diagnose and give a prognosis. Pathology plays a huge part in medicine – every care pathway is involved with it, from oncology to maternity."

Tim and the team are also on hand when a GP needs help interpreting a result or they need to know what tube to put the test in or how to interpret a complex case. Blood results can pick up undiagnosed cancers, which if caught quickly can be successfully treated.

They also regularly screen during pregnancy for rubella all the way up to a non-invasive blood test to look for Down's Syndrome.

Tim said: "We are so used to looking at sets of results that when something isn't right it jumps out at you.

"A quicker diagnosis means the patient can avoid complications, their disease can be monitored appropriately, their discomfort can be decreased and their prognosis outcome can be improved. All of this leads to a better equality of life." Tim's intellect, his enthusiasm and passion for science is apparent in his accolades, his rapport with his colleagues – and his tendency to speak at 100mph. A former Exmouth College pupil, Tim is the son of a police officer and a baker.

He said: "I liked science from a young age. I like to be able to see rational outcomes. I like things that are black and white and I like to be able to figure out how things work. Medicine and pathology is probably an extension of that – looking at patterns of results and fitting them into a clinical picture."

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