Please consider taking a couple of minutes to give as little as £1 as a thank you for our time contribution (>400 hours) and to keep the app running (running costs are £768 per year and we have no formal funding) at www.bukuhaematology.co.uk. We are not-for-profit so all money goes back into the App (Apple pay now enabled!) Thanks, Alex and Steve
Buku haematology is a quick reference for the initial investigation and management of common haematology problems. It is for all grades of generalist and specialist doctors, specialist nurses, physician assistants and has links to key references and guidelines. We have made it to answer the commonest questions that haematologists are asked, to improve patient care, the understanding of haematology tests (such as tests required for a myeloma diagnosis for example) and more.
Data collected from users shows that it can prevent a call to haematology completely for 21% of clinical queries, and start further investigations to expedite care for up to 60% more. This reduces the on-call burden on haematologists and improves patient care by improving clinician efficiency. See our website for testimonials of how it has helped users.
The information included is concise to make it easy to use, and further reading should be undertaken to gain a full understanding of the topics covered
'Buku' is the Chichewa word for book or reference. Chichewa is spoken in Malawi where our pathology project MPathE is running
Common causes are listed by frequency from general medical literature and our clinical experience
Links at the bottom of each section offer resources for further reading including national guidelines or review articles
This app contains general information tailored for UK practice and is not advice. It should be used in conjunction with clinical judgement. The responsibility for care lies with the clinician. Use your local haematology on-call service for advice for individual cases.
For those with an interest in haematology follow #teamhaem on twitter for clinical cases and educational resources
Governance - Our content is written by registrars in their respective fields. Per specialty, there are 2-3 registrars to write content, and a consultant to review that content. This is monitored through a database of active modules, with review dates set for each module. Modules are reviewed every 6 months. Content is general information as would be expected knowledge of a registrar in the specialty. No content is taken into the App from patients, and therefore Buku Haematology is not a medical device as per the MHRA definition.
Copyright Dr Alex Langridge, Professor Stephen O'Brien (as directors of Buku Tech Limited) 2020
We regularly put out 'Tweetorials' on Twitter to teach about certain topics. For those that do not Tweet/Twit, we will copy them in below so you can see what we have written.
15/4/20. Red blood cell (RBC) antibody tweetorial
There are over 700 known RBC antigens. Every time someone is exposed to a red cell antigen that they don’t express, usually through transfusion, they may produce a corresponding antibody. This can cause haemolytic transfusion reactions immediately, or with future blood transfusions. Therefore every time you send a ‘group and save’ the transfusion lab will 'group' the patient red cells (usually for ABO, Rh and Kell antigens) and check an antibody screen. The clinical significance of any antibody detected will depend on the antibody type, concentration and known clinical behaviour of that antibody. The exceptions in terms of antibodies are Anti-A and Anti-B which we all have if we do not have the corresponding antigen. For example I am A+, and although I have never been transfused I will have anti-B (thought to be from protein exposure as neonate).
Antibodies are a particular issue in pts. who are chronically transfused e.g. pts with haemoglobinopathies (esp. sickle cell anaemia) and haem cancers, because the more blood is transfused, the more antibodies may develop, and more difficult it is to find appropriate blood. To minimise the chance of this, patients who are expected to have many transfusions will have ‘extended phenotyping’ performed. This identifies more of the clinically significant antigens (than standard ABO/Rh/K) to allow better matched transfusions. It also allows better identification of antibodies in the future, as if the patient is known to be FyA positive for example, we know that they cannot generate an anti-FyA antibody and this makes it easier to 'find' significant alloantibodies when testing in the lab. Extended phenotyping cannot be used if a pt. has had transfusion in the last 3 months (life of an RBC), as it may identify donor RBC groups instead/as well as recipient. In that case, genotyping can be performed (for most of the same antigens).This is more expensive however.
If a patient does have a red cell antibody and is planned for surgery – plan in advance. Let the transfusion lab know and provide a fresh G&S a few days in advance so they can stock the blood. Think about blood saving strategies e.g. minimally invasive surgery, tranexamic acid, cell salvage. Remember – no patient with an antibody should ever die due to blood being withheld – in an emergency the lab will provide the best matched blood possible. It is better to deal with a haemolytic transfusion reaction than a patient to suffer morbidity or die from delayed transfusion. The SHOT annual transfusion report consistently reports cases of patients who have died waiting for the ‘right’ blood.
If in doubt, ask the transfusion lab biomedical scientists about the blood available- they have a wealth of knowledge about it. Haematology on-call can also always offer advice. #blooducation
If you would like to donate to support our ongoing work, and to keep the App free for all users, please go to our website and use the 'Donate' Tab. Apple Pay now enabled for ease for Apple users (will add Android Pay when our online payment company enables it!).
We are grateful for any support,
Alex and Steve