Volume 5, Number 4

Prayna Patel DipCom MRPharmS Anticoagulant Pharmacist and Co-ordinator of inpatient and outpatient anticoagulation treatment and monitoring; John Luckit BSc MRCP MRCPath Haematology Consultant, North Middlesex Hospital, London

An anticoagulant audit carried out at North Middlesex Hospital (NMH) in 1996 showed that there was a clear need for improvement in the quality of the service. In response, a pharmacist-co-ordinated anticoagulation service was set up. This, the first in a two-part article, looks at the outpatient protocol introduced as a feature of the new service. The second part of the article will describe the use of the new service to monitor inpatients on warfarin and intravenous heparin.

Niamh M O’Connell MB MRCPI MRCPath Clinical Research Fellow in Haemostasis; David J Perry MD PhD FRCP FRCPath Senior Lecturer in Haemophilia and Haemostasis, Royal Free Hospital, London

Appreciation of the role of inherited risk factors in the development of venous thromboembolism (VTE) has revolutionised the approach to the management of thromboembolic conditions. In addition, it has long been known that exogenous factors – such as immobility, surgery, malignancy and pregnancy – can influence the development of VTE, both in the presence and absence of thrombophilia. However, the relative contributions of inherited and acquired risk factors for the development of VTE are difficult to elucidate, and it is clear that the development of VTE in younger patients often requires the presence of more than one risk factor.1

Barry Hill FIBMS Chief Biomedical Scientist Blood Transfusion Department, Wigan Royal Infirmary, Wigan

Near-patient testing (NPT) is by no means a new phenomenon. It dates back to well over one hundred years ago, when clinicians would taste patients’ urine at the bedside to help diagnose diabetes mellitus. Fortunately, such crude methods are no longer required today. However, the demand for accurate, simple-to-use NPT equipment to aid the control and treatment of a variety of conditions is increasing.

Michelle Taylor RN; Sue Rhodes RN; Sarah Bond MRPharmS MSc Clin Pharm; Kirsty Sansum RN Anticoagulant Practitioners; E Sarah Green MA FRCP FRCPath, Consultant Haematologist Anticoagulant Service, Department of Haematology, Princess Margaret Hospital, Swindon

An anticoagulant practitioner service was established at the Princess Margaret Hospital, Swindon, in 1996. Initially, this service comprised a pharmacist and a clinical nurse specialist (as one whole time equivalent), who provided an outpatient deep vein thrombosis (DVT) service and ran the hospital’s outpatient anticoagulant clinics. Five years on, the service has evolved to include discharge planning, the management of over-anticoagulated patients, the supervision of pregnant patients requiring anticoagulation, community anticoagulant care and, most recently, the management of inpatients receiving oral anticoagulant therapy.

Peter Rose, Editor

Haemolytic uraemic syndrome (HUS) is characterised by a micro-angiopathic haemolytic anaemia, thrombocytopenia and renal failure. The disease usually presents with a prodromal period of bloody diarrhoea and is most likely to produce illness in young children and the elderly. In recent years, infection with verotoxin (VT)-producing organisms, in particlular Escherichia coli O157:H7, has been reported to account for the vast majority of cases of HUS. Most recently, an outbreak in Eccleston, Lancashire, has been causing considerable concern. Currently, over 1,200 cases of E coli O157:H7 are reported annually in Britain.