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Last Updated: Saturday, 6 October 2007, 23:16 GMT 00:16 UK
Inside Medicine: The haematologist
Phil Darbyshire
Dr Phil Darbyshire wants to see inequalities ironed out
In a series focusing on medical specialisms, BBC News meets Dr Phil Darbyshire, a consultant paediatric haematologist.

Haematology deals with problems with blood and blood forming tissues, such as leukaemia, thalassaemia and sickle cell disease.

WHAT IS YOUR JOB?

I am a consultant paediatric haematologist based at the Birmingham Children's Hospital and my main role is dealing with children with blood disorders.

WHAT IS THE MOST COMMON CONDITION?

The most common conditions I deal with are leukaemia, thalassaemia and sickle cell disease.

The number of children with leukaemia has remained fairly static in our area, about 50 children in the West Midlands are affected each year.

If these were disorders that mainly affected the Caucasian population, such as leukaemia, I think there would have been more funding available over the years
Dr Phil Darbyshire

But we are now dealing with more and more cases of thalassaemia and sickle cell disease (haemoglobin disorders).

This increase is partly because there is now universal screening for sickle cell disease in England and partly because there are more children moving into the area from minority communities which have a high prevalence of these disorders.

Those with sickle cell - an inherited genetic condition in which there is an abnormality in haemoglobin, the oxygen-carrying protein found in red blood cells - are mainly of African or Caribbean descent, although it can affect those from India, the Middle East and the eastern Mediterranean.

Those with thalassaemia - also an inherited condition, which requires regular blood transfusion because of a build-up of iron in the blood - are mainly from Mediterranean and South Asian communities.

Both haemoglobin disorders are lifelong and sometimes life-limiting conditions which often produce disability in adult life.

WHAT IS THE MOST COMMON PROCEDURE?

For children with leukaemia this is mainly treatments such as chemotherapy and, more rarely, bone marrow transplant.

Those with thalassaemia need regular blood transfusions and drug therapy to remove the excess iron in their liver, heart and endocrine glands which accumulates as a result of the transfusions.

Those with sickle cell often have periods when they are well, but they have what we call "crises". They can be admitted to hospital for days or even weeks usually with severe pain in bones, abdomen or chest.

Treatment is usually symptom relief but there are now anti-sickle drugs which can reduce the risk of painful crises.

In both thalassaemia and sickle cell disease, bone marrow transplant offers the prospect of cure.

Not all choose to have this option as there is a small risk of fatality and it will leave the child infertile in the future.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

Seeing the inequalities in access to and provision of services between, for instance, leukaemia and bone marrow transplant and conditions like haemoglobin disorders.

There are a variety of reasons for this.

Unlike leukaemia, haemoglobin disorders are not evenly distributed around the UK but are usually clustered around our inner-cities where the resources of primary care trusts are already very stretched.

An additional factor is, I think, the fact that these minority communities do not have a high degree of awareness of these conditions and do not have a strong political voice to lobby for improvements in services.

Sickle cell sample
The sickle cell has a distinctive shape

There is at present a great deal of practical work going on to assess what is needed to improve services, to lobby those commissioning services and to set up standards and appraisal systems similar to those developed several years ago in the cancer arena.

However if these were disorders that mainly affected the Caucasian population, such as leukaemia, I think there would have been more funding available over the years.

In fairness, there does now seem to be a recognition that improvements must be made rapidly.

WHAT IS YOUR MOST SATISFYING CASE?

I think this would have to be some of those with thalassaemia and sickle cell disease who have had successful transplants.

They can go from lives requiring regular transfusion or pain relief to leading normal lives.

WHY DID YOU CHOOSE THIS SPECIALTY?

I am getting so old I can hardly remember!

No, really, I think it was serendipity. I just spent longer in paediatric haematology during my training and enjoyed it as I had a very enthusiastic teacher.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

I don't think I would. I do like working as part of a team dealing with children and families.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

I think maybe obstetrics as this is a very practical specialty and I enjoyed that as a junior doctor.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

I would like to see more funding and better services being provided for thalassaemia and sickle cell disease. These disorders are now the commonest genetic disorders in England and at present they do not get the recognition they need.

If children with these conditions are treated optimally they would, as adults, avoid long-term disabling complications. This is clearly sensible from both a medical and economic standpoint.

CV - Dr Phil Darbyshire
1975: Qualified as a doctor in Birmingham
1987: Appointed paediatric consultant haematologist at Birmingham Children's hospital
Present: Chair of the haemoglobinopathy forum




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