Bleeding and clotting disorders

About

We provide a full range of diagnostic and management services for patients with bleeding disorders including severe hereditary disorders such as haemophilia, blood coagulation, thrombosis (clotting), von Willebrand disease and platelet disorders. The service extends over all three Trust sites (Hammersmith Hospital, St Mary’s Hospital and Charing Cross Hospital) and is part of the North London Adult Haemophilia Network. A complementary service for diagnosis and management of patients with acquired or hereditary thrombotic disorders is provided in parallel.

We provide a service for monitoring of anticoagulation therapy; principally warfarin. We also provide advice on duration of anticoagulation, a choice of several new anticoagulants and management around surgery.

Conditions and treatments

Haemophilia

There are two scheduled haemophilia and bleeding disorder clinics running weekly at Hammersmith Hospital:

• Monday morning clinic run by Dr Ferras Alwan
• Tuesday morning clinic run by Dr Carolyn Millar

Individuals with inherited blood disorders such as haemophilia, von Willebrand disease and coagulation deficiency disorders are seen in addition to people with symptoms such as unexplained easy bruising or bleeding.

Each clinic has a haemostasis consultant, a specialised bleeding disorders physiotherapist and a haemostasis clinical nurse specialist in attendance.

Thrombosis

Imperial College Healthcare provides an integrated outpatient and inpatient specialist anticoagulation service for a wide range of conditions. These include blood clot in a vein (venous thromboembolism or VTE) – including deep vein thrombosis (DVT) and pulmonary embolism (PE).

We also provide complex anticoagulation advice and management for patients with renal (kidney) impairment, bleeding problems, active cancer, multiple thrombotic events, genetic thrombophilias and complex thrombotic disorders.

Clinics are run at both St Mary’s and Hammersmith hospitals and overseen by consultants with specific expertise in thrombotic disorders.

Von Willebrand Disease (VWD)

Within the bleeding disorder service at Imperial College Healthcare there is specialist care for patients with von Willebrand disease.

Based at Hammersmith Hospital, care is delivered by a team led by consultants with specific expertise in von Willebrand disease. We run specialist gynaecology clinics at Queen Charlotte's & Chelsea hospital for people with von Willebrand disease who experience heavy menstrual bleeding as well as a joint obstetric haematology clinic where women with von Willebrand disease are looked after during pregnancy. 

There is an active research programme at the Trust with opportunities for patients with von Willebrand disease to participate in clinical research and trials should they wish to do so.

Antiphospholipid syndrome (APS)

Antiphospholipid syndrome (APS) is an autoimmune disease associated with persistently positive autoantibodies called antiphospholipid antibodies (aPL). APS can occur on its own or along with other autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis.

These antibodies are responsible for the principal clinical problems of APS:

1. Blood clotting (thrombosis) affecting both and veins and arteries which is often present as stroke
2. Pregnancy complications resulting in miscarriage or fetal death
3. Other autoimmune and inflammatory complications affecting any organ in the body but most frequently the heart or kidneys

We are one of the few centres in the UK who provide a dedicated clinical service with weekly clinics for patients with APS.

Since establishing our clinics in 2016, we have been able to support many patients with APS through receive regular, prompt outpatient and inpatient care and a multidisciplinary team approach.

As APS is a multisystem disease which can affect virtually any part of the body, we work closely with acute medicine teams, hyper-acute stroke units, cardiologists, rheumatology and renal teams.

In addition to the clinical service, we have a growing research programme and an active patient and public involvement (PPI) group.

Pregnancy

An obstetric haematology clinic is held at Queen Charlotte’s & Chelsea Hospital on Friday mornings. A consultant haematologist and obstetrician together with a specialist midwife attend this clinic. Women with bleeding disorders or who are carriers or possible carriers of haemophilia and other inherited bleeding disorders are seen in this clinic before pregnancy as well as during and after pregnancy. 

Additional information

Clinical trials and research

We have an active research programme in haemophilia A, haemophilia B, von Willebrand disease, antiphospholipid syndrome and other clotting and thrombosis disorders.

We manage a diverse portfolio of phase 1 to 3 studies, including numerous others in set-up/feasibility stages. Our portfolio is composed of academic and commercially sponsored drug studies.

We invite all our patients to participate in national and international registries and tissue banks – participation is completely voluntary.

If you would like more information about our clinical trials, please ask your doctor in clinic or contact our clinical trials team:

• Bridget Chivers, lead clinical research nurse: b.chivers@nhs.net
• Camelia Vladescu, lead clinical research practitioner: camelia.vladescu@nhs.net

Office phone: 020 3313 1195

We are passionate about educating and encouraging healthcare professionals, patients and the wider public about clinical research. Please follow us on X @NMHaem_Research for more updates about our team!  

Education

If you are interested in an elective placement with our service, please contact imperial.Electives@nhs.net.

Further online resources

• The Haemophilia Society
• Thrombosis UK
• APS Support UK | APS - antiphospholipid syndrome (aps-support.org.uk)
• Haemophilia – NHS.uk