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Haemoglobin C carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin C, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis.   Information for fathers on haemologlobin C carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Sickle Cell Disease (haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin C”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Haemoglobin D carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin D, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on haemoglobin D carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • There are 7 different types of haemoglobin D. The only clinically relevant variant is haemoglobin DPunjab.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Sickle Cell Disease (haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin C”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Haemoglobin E carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin E, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on haemologlobin E carrier screening, can be downloaded or ordered via PHRD. 

Actions

If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.

  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Sickle Cell Disease (haemoglobin S) or Beta Thalassaemia, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin E”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Haemoglobin Lepore carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin Lepore, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. 

Information for fathers on haemoglobin Lepore screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing,
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin E”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Haemoglobin OArab carrier

What does this mean to the patient?

When a patient is identified as a carrier of haemoglobin OArab, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on haemologlobin OArab carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of beta thalassaemia or sickle cell disease. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of haemoglobin OArab ”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Beta Thalassaemia carrier

What does this mean to the patient?

When a patient is identified as a carrier of beta thalassaemia, information on their implications can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on Beta Thalassaemia carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If the partner is a carrier of Beta Thalassaemia, Sickle Cell Disease (Haemoglobin S), Haemoglobin E, Haemoglobin Lepore, Haemoglobin OArab or Delta-Beta Thalassaemia, refer urgently to Clinical Genetics for appropriate counselling on their reproduction options.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of a haemoglobin variant. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of beta thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Alpha Plus Thalassaemia carrier

A haemoglobinopathy screen cannot differentiate between alpha thalassaemia carriers and iron deficiency. For this reason, it is important to interpret the patient’s results in combination with ferritin levels.

What does this mean to the patient?

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis.

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of alpha plus or alpha zerothalassaemia, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of alpha zero thalassaemia. Children diagnosed with Haemoglobin H disease should be referred to Haematology. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of Alpha zero Thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Alpha Zero Thalassaemia carrier

A haemoglobinopathy screen cannot differentiate between alpha thalassaemia carriers and iron deficiency. For this reason, it is important to interpret the patient’s results in combination with ferritin levels.

What does this mean to the patient?

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis.

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of alpha plus or alpha zerothalassaemia, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple.
  • If the couple has other children, only test them if the partner is a carrier of alpha zero thalassaemia. Children diagnosed with Haemoglobin H disease should be referred to Haematology. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of Alpha zero Thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Delta Beta Thalassaemia carrier

What does this mean to the patient?

When a patient is identified as a carrier of delta beta thalassaemia, information can be found in the following leaflet and ordered via PHRD.

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. Information for fathers on delta beta thalassaemia carrier screening, can be downloaded or ordered via PHRD. 

Actions

  • If patient is found to have reduced MCV and MCH indices, iron supplementation is not required unless the patient’s ferritin levels are reduced.
  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variants, the couple have a 1 in 2 chance (or 50%) to have children who are healthy carriers.
    • If partner is a carrier of Beta Thalassaemia or Sickle Cell Disease (Haemoglobin S), refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
    • If partner is a carrier of any other haemoglobin variant, reassure the couple as there is no other relevant interaction with any other haemoglobin variant.
  • If the couple has other children, only test them if the partner is a carrier of a haemoglobin variant. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Give the appropriate information leaflets. (“You are a carrier of delta beta thalassaemia”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Sickle Cell Carrier

What does this mean to the patient?

When a patient is identified as a carrier of sickle cell, information on their implications can be found in the following leaflet:

It is important to offer testing to the partner to make sure there is no risk to have a baby with a haemoglobin disorder. Ideally, results from both parents’ results should be available before week 12 of pregnancy to enable decisions regarding prenatal diagnosis. 

Actions

  • Test partner, if not done previously (that includes: haemoglobin screen, full blood count and ferritin levels). This can be done in primary care.
    • If partner is not a carrier of any haemoglobin variant, the couple has a 1 in 2 chance (or 50%) to have children who are carriers.
    • If partner is a carrier of any haemoglobin variant, refer urgently to Clinical Genetics for appropriate counselling and to discuss further testing.
  • If the couple has other children, only test them if the partner is a carrier of a haemoglobin variant. Otherwise, there is no need to test them unless they present with health problems. It is normally recommended to postpone testing until the age of 16, to enable them to make their own informed decision.
  • Stress that other family members can be carriers, so it is advisable to circulate the information to first-degree relatives (parents and siblings). They can request a test called “haemoglobinopathy screen” via their GP.
  • Make sure the patient understands the rare health issues associated with being a carrier. They should therefore be advised to:
  • Avoid situations where there may be a shortage of oxygen (deep-sea diving, unpressurized aircrafts, etc).
  • Inform the anaesthetist if they are going to require an anaesthetic.
  • Keep well hydrated.
  • Refer children and adults with haematuria.
  • Refer children and adults urgently if they present with symptoms suggestive of renal medullary cancer. Symptoms include: haematuria, weight loss, loin pain, fever and abdominal pain.
  • Give the appropriate information leaflets. (“You are a carrier of sickle cell.”)
  • Make sure the patient had received his/her haemoglobinopathy card.
  • Explain that it is still important to have malaria prophylaxis if visiting an area where malaria is endemic.

More Information

If you would like more information about haemoglobinopathies and testing, please do not hesitate to contact:

Telephone: 0141 354 9201 (receptionist)/0141 354 9229 (secretary)

Email:  geneticsreferrals@ggc.scot.nhs.uk

Pregnancy Screening Results – Further Information and Resources
More information on haemoglobin and disease

Haemoglobin is a protein that is carried by red blood cells. Its main function is to pick up oxygen in the lungs and deliver it to the peripheral tissues to maintain the viability of cells. Haemoglobin is made from two similar proteins, usually referred to as subunits, which “stick together”. Both subunits must be present for the haemoglobin to function normally. One of the subunits is called alpha, and the other is beta. Inside each subunit, there is a small iron-containing molecule called heme, to which oxygen is bound. Before birth, the beta protein is not expressed. Instead, a chain called gamma is produced.

Like all proteins, the “instructions” to synthesise haemoglobin are found in DNA (the material that makes up genes). Normally, an individual has four genes that code for the alpha protein, or alpha chain. Two other genes code for the beta chain. The alpha chain and the beta chain are made in precisely equal amounts, despite the differing number of genes. The protein chains join in developing red blood cells, and remain together for the life of the red cell.

The composition of haemoglobin is the same in all people. The genes that code for haemoglobin are identical throughout the world. Occasionally, however, one of the genes has a change or variant. Although the changes that produce abnormal haemoglobins are rare, several hundred haemoglobins variants exist. Most variant haemoglobins function normally, and are only found through specialized research techniques. Some haemoglobin variants, however, do not function normally and can produce clinical disorders, such as sickle cell disease.

Usual types of haemoglobin

Haemoglobin A: This is the designation for the most common haemoglobin variant that exists after birth. Haemoglobin A is a tetramer with two alpha chains and two beta chains (a2b2).

Haemoglobin A2: This is a minor component of haemoglobin found in red cells and consists of two alpha chains and two delta chains (a2d2). Haemoglobin A2 generally comprises less that 3% of the total red cell haemoglobin.

Haemoglobin F: Haemoglobin F is the predominant haemoglobin during foetal development. The molecule is a tetramer of two alpha chains and two gamma chains (a2g2).

Clinically significant haemoglobin variants

Haemoglobin S: This is the predominant variant in people with sickle cell disease. The disease-causing gene change is found in the beta chain. The highest frequency of sickle cell disease is found in tropical regions, particularly sub-Saharan Africa, tribal regions of India and the Middle-East. The carrier frequency ranges between 10% and 25% across equatorial Africa.

Haemoglobin C: Haemoglobin C results from a gene change in beta globin. It can cause sickle cell disease when it is inherited with haemoglobin S. It can also cause haemoglobin C disease when two haemoglobin C variants are inherited. Haemoglobin C is most prevalent in Western Africa, especially in Nigeria and Benin.

Haemoglobin E: This variant results from a gene change in the haemoglobin beta chain. It can cause thalassaemia major or intermedia hen coinherited with beta thalassaemia. Haemoglobin E is extremely common in Southeastern Asia (Thailand, Myanmar, Cambodia, Laos, Vietnam, and India) where its prevalence can reach 30-40%.

Haemoglobin D: There are different types of haemoglobin D variants, but the most vlinically significant is haemoglobin DPunjab (also called DLos Angeles). It results from a gene change in the beta globin chain. It can cause sickle cell disease if coinherited with haemoglobin S. As the name indicated, it is most frequent in the Punjab Area (Northwestern India), where the carrier frequency can be around 2%.

Haemoglobin OArab: This variant results from a gene change in the beta globin chain. It can cause sickle cell disease when it is inherited with haemoglobin S. It is more frequent in North Africa, Middle East and Eastern Europe.

Haemoglobin Lepore: Haemoglobin Lepore is an unusual variant that is th product of the fusion of the beta and delta globin genes. It can cause thalassaemia major/intermedia when a person inherits two copies of haemoglobin Lepore, or when it is inherited with beta thalassaemia. It can also cause sickle cell disease when inherited with haemoglobin S. It occurs most frequently in patients originating from the Mediterranean region.

More information on sickle cell

Sickle cell disease is the name for a group of inherited conditions that affect the red blood cells. The most serious type is called sickle cell anaemia. Sickle cell disease mainly affects people of African, Caribbean, Middle Eastern, Eastern Mediterranean and Asian origin. In the UK, it’s particularly common in people with an African or Caribbean family background. People with sickle cell disease produce unusually shaped red blood cells that can cause problem because they don’t live as long as healthy blood cells and they can become stuck in blood vessels. Sickle cell disease is a serious and lifelong condition, although long-term treatment can help manage many of the problems associated with it.

Information on Sickle Cell – NHS Inform

Sickle Cell Anaemia (HbSS)

Sickle cell disease is an inherited blood condition. Babies with sickle cell disease are usually well at birth but may start to develop symptoms from around 4 months of age. The symptoms of SCD are:

  • Chronic anaemia: long term decreased number of red blood cells and/or the amount of haemoglobin they carry.
  • Infections: people with SCD, especially infants and children, are more likely to experience infections such a flu, meningitis, and hepatitis.
  • Sudden pain crisis: this happens when the sickle blood cells obstruct a blood vessel. This can be triggered by different situations, such as intense exercise, stress, infections, sudden temperature changes and not drinking enough water.
  • Hand-Foot Syndrome: swelling in the hands and feet, often along with a fever, is caused by the sickle cells getting stuck in the blood vessels and blocking the blood from flowing freely through the hands and feet.
  • Acute Chest Syndrome (ACS): blockage of the flow of blood to the lungs can cause acute chest syndrome. ACS is similar to pneumonia; symptoms include chest pain, coughing, difficult breathing, and fever.

Because of the sickling, the patients suffer a chronic haemolytic anaemia and the usual 120 half life of erythrocytes falls to 20 days for patients with sickle disease. The chronic haemolysis results in a rapid production of erythrocytes and a FBC that contains reticulocytes, occasional nucleated erythrocytes, target cells and sickle cells. As the spleen becomes compromised with repeated infarctions, Howell-Jolly bodies are also seen.

Several factors can lead to crises in sickle cell disease: hypoxia, dehydration, vascular stasis, fever, cold and acidosis. Anything that leads to hypoxia will promote sickling. Therefore, patients with respiratory compromise due to infection or chronic respiratory diseases are prone to develop sickle crisis.

There is no single best treatment for all people with SCD. Treatment options are different for each person depending on the symptoms. Treatments can include receiving blood transfusions, maintaining a high fluid intake (drinking 8 to 10 glasses of water each day), receiving intravenous therapy (fluids given into a vein) and medications to help with pain. Nowadays, with the proper treatment, most people affected with SCD live normal long lives.

Other types of sickle cell disease

The different forms of sickle cell disease are:

Severe sickle cell disease: symptoms and management similar to that in sickle cell anaemia.

  • HbS/ß thalassaemia
  • HbS/OArabModerate sickle cell disease:
  • HbS/C
  • HbS/DPunjab
  • HbS/LeporeMild sickle cell disease: clinically non relevant
  • HbS/E
  • Hbs/HPFH
More information on beta thalassaemia

Beta Thalassaemia is generally caused by point mutations or chromosome 11, following a recessive inheritance pattern (meaning that a mutation in each allele is needed to develop the disease). The symptoms of beta thalassaemia differ greatly from one patient to another, depending mostly on the severity of the mutation. Beta thalassaemia includes:

  • Thalassaemia minor: this usually occurs in patients who are heterozygous for one beta thalassaemia mutation (beta thalassamia carriers or bête thalassaemia trait). Individuals will suffer from mild microcytic hypochromic anaemia, whih is usually asymptomatic and it is not expected to cause any health issue.
  • Thalassaemia intermedia: Patients with symptoms that range from those observed in thalassaemia minor and those in thalassaemia major. Patient’s require frequent medical check ups and usually require sporadic blood transfusions.
  • Thalassaemia major: also called Mediterranean anemia or Cooley anemia. It is caused by severe mutations in both alleles. No functional ß chains are produced, and thus no haemoglobin A can be assembled. This is he most severe form of ß-thalassemia: those with thalassaemia major need to have regular blood transfusions from infancy onwards in order to survive. Long term transfusions can lead to iron overload, so this patients also need iron chelating therapy.
More information on alpha thalassaemia

Alpha globin is made by four genes, two on each strand of chromosome 16. Alpha thalassaemia usually occurs by deletion of some of these four genes. Depending on the total number of alpha genes that a patient has, there are different outcomes:

Alpha globin genes:

4 alpha globin genes: most common scenario, person is not a carrier.

3 alpha globin genes: silent alpha thalassaemia carrier. There is overlap between the red blood cell indices of these individuals and those with 4 gene copies, although the MCV may be slightly lower.

2 alpha globin genes: alpha thalassaemia carrier (also called alpha thalassaemia trait). Individuals who have alpha thalassaemia trait are identified by microcytosis, erythrocytosis, hypochromia and mild anaemia. Individuals with a thalassaemia trait will experience no significant health problems except a possible slight anaemia which cannot be treated with iron, with consequent mild fatigue symptoms.

  • When the two copies are in different alleles (also called in trans), the person is an alpha + carrier. It is most commonly detected in people with African ancestry.
  • When the two copies are in the same allele (also called in cis), the person is alpha 0 carrier. It is most commonly detected in people with Southeast Asian ancestry.

1 alpha globin gene: the person will be affected with haemoglobin H disease. Haemoglobin H disease is characterized by mild to moderate anaemia, hypochromia and microcytosis. Individuals who have haemoglobin H disease generally have a persistent stable state of anemia, which may be accentuated by increased haemolysis during viral infections and by exposure to oxidant medications, chemicals and foods such as sulfa drugs, benzene, and fava beans (similar to individuals who have G6PD deficiency).

As the red cells mature they lose their ability to withstand oxidant stress and haemoglobin H precipitates, leading to haemolysis. Therapy for individuals who have haemoglobin H disease includes folate, avoidance of oxidant drugs and foods and frequent medical check ups.

No alpha globin genes: the absence of alfa chains causes severe anaemia and leads to hydrops foetalis. This diagnosis is frequently made in the last months of pregnancy when fetal ultrasound indicates a hydropic fetus. The mother frequently exhibits toxemia and can develop severe postpartum hemorrhage. These infants are usually stillborn. There can be other congenital anomalies, though none are pathognomonic for alpha thalassaemia major. If the diagnosis is made early, intrauterine transfusions can be performed.

More uncommonly, alpha thalassaemia can also be caused by point mutations in any of the four alfa globin genes. Some examples of these haemoglobin variants are: Constant-Spring, Icaria, Seal Rock, Pakse, Quong Sze, Sun-Praire and Adana.

Information to give to patients and relatives

Information Leaflets

Patient associations and information sources

Resources for healthcare professionals

Screening information for the transgender community is available via the NHS inform website

NHS GGC Public Health Resources Directory is an easy to use online ordering facility for a range of public health and health improvement resources, available free of charge to clients across Greater Glasgow and Clyde –  www.phrd.scot.nhs.uk

Public Health Scotland – Publications – Public Health Scotland

Acute Hospitals and Community Health Care

The key aims of this strand of work are to modernise services and improve health through innovative and cost-effective approaches to person-centred care and by providing leadership to enable delivery of art and therapeutic design strategies into new capital builds, green spaces and refurbishments and a programme of year-round exhibitions and performing arts.

Hospitals

Therapeutic Design and Art Strategies have been successfully delivered in new Acute Hospitals developments at:

New Stobhill Hospital

New Stobhill Ward Block including waiting room in the park, the New Neo Natal and Maternity Extension)

GROVE

The New Stobhill Hospital provides an attractive and welcoming environment for patients and visitors with light, airy public spaces, comfortable waiting areas and fresh, modern consulting rooms. It is located on the north side of the city, adjacent to Springburn Park.

Patients will not only benefit from modern new facilities. The way care is provided from the hospital has also changed for the better. Services have been redesigned around the needs of the patient to enhance the quality of care and speed up diagnosis and treatment.

The hospital will treat about 400,000 patients every year.

In addition to outpatient clinics, day surgery and diagnostic services, the hospital provides a number of specialist services such as cardiology, renal dialysis and gynaecology.

Concept

It is our understanding that art in a hospital should contribute to a healing environment.

The new hospital is set within an apparently random planting of silver birch trees. Open courtyards are planted with larch trees and surfaced with natural larch boarding. The theme of woodland light and shade is continued within the building by means of installed painting, video and poetic texts.

It is a grove of larch in a forest of birch.

The New Stobhill Hospital GROVE project has resulted in the installation of groups of works by five artists across the Hospital.
 
Thomas A Clark, poet and artist, working closely with Reiach & Hall Architects, wrote a number of short poems which have been installed throughout the Hospital.  In response to these poems four visual artists have created artworks. 

Kenneth Dingwall painted a series of abstract designs in the corners in surgical and endoscopy waiting areas, and placed a sequence of shapes above eye level in the Imaging Waiting Area. 

Olwen Shone, Andreas Karl Schulze and Thomas A Clark created a series of works within the main clinic waiting areas comprising 14 films of natural scenes installed on monitors and projectors and 130 small abstract compositions, juxtaposed with Clark’s poems. 

Donald Urquhart and Clark created a series of works entitled Six Landscapes in specialist clinic waiting areas.  Urquhart also created Alphabet, a series of drawings of indigenous trees which are also keys to the ancient Gaelic alphabet.  Urquhart worked with Reiach and Hall, Clark and Schulze to create the Sanctuary.  Urquhart had previously developed the award winning Sanctuary at Edinburgh Royal Infirmary

In parallel, and as a direct result of the work in the New Stobhill Hospital, a public art scheme has been developed for the adjacent entrance to Springburn Park.  Developed by Alec Finlay from work with staff and patients in the Hospital as well as with users of the Park, this extends the ideas embedded in the Hospital.

The aim has been to create another Waiting Area in the Park, encouraging walking (even short distances) as well as connecting the natural themes of the artworks in the hospital to the natural environment of the Park.

It has been implemented through a partnership between Glasgow City Council Land Services, Culture & Sport Glasgow and NHSGGC Endowments.

Team

Architects: Reiach & Hall Architects
Curator and Lead Artist: Thomas A Clark

Artists (some web sites are indicative rather than personal sites):
Kenneth Dingwall
Andreas Karl Schulze
Olwen Shone
Donald Urquhart

Project Manager: Chris Fremantle

Funders

Scottish Arts Council, NHSGGC Staff Lottery, NHSGGC Endowments, many Glasgow Faith Groups.

Key Dates

Project Completed Spring 2009

Awards

Prime Minister’s Better Public Building Award 2010
RIBA Stirling Prize 2010 Midlisted
Design & Health International Academy Awards Best International Project under 40,000 sqm 2010
RIBA Award 2010
Scottish Design Awards Best Public Building 2010 Commendation
Public Private Finance Awards Best Designed Project 2010
Civic Trust Awards 2010 Commendation
Glasgow Institute of Architects Awards Best Healthcare Building 2009
Building Better Healthcare Awards Best Designed Hospital 2009
Roses Design Awards Best of the Best 2009
Grand Prix Roses Design Awards Best Public Building 2009 Gold
RIAS Andrew Doolan Best Building in Scotland 2009 Finalist
Building Design Healthcare Architect of the Year 2009 Finalist

Links

Architecture & Design Scotland – Case Study 

New Victoria Hospital

The Hospital and the Park

The New Victoria Hospital is located on the Southside of Glasgow, near Queens Park.  It provides an attractive and welcoming environment for patients and visitors with light, airy public spaces, comfortable waiting areas and modern consulting rooms.

Patients will not only benefit from modern new facilities. The way care is provided from the hospital has also changed for the better.  Services have been redesigned around the needs of the patient to enhance the quality of care and speed up diagnosis and treatment. About 400,000 patients attend the hospital every year.

In addition to outpatient clinics, day surgery and diagnostic services, the hospital provides a number of specialist services such as cardiology and gynaecology.  There is also a new Minor Injuries Unit with its own dedicated entrance for rapid access to a highly skilled clinical team.

And for the first time, patients from south-east Glasgow, Rutherglen and Cambuslang requiring an MRI scan, renal dialysis or chemotherapy are able to get this locally at the New Victoria Hospital.

Concept

The New Victoria Art & Environment project has delivered permanently installed artworks by five artists, and an initial programme of residencies and projects within the Hospital.  The curatorial concept for the project focused on The Hospital and the Park, linking the new hospital with Queens Park.

Ally Wallace was appointed as Lead Artist.  He developed an integrated coloured glazing scheme working closely with HLM Architects, and also developed a number of wall paintings for the basement car parking area.

Ronnie Heeps worked closely with the Spiritual Care Committee to develop the Sanctuary in the New Victoria Hospital, drawing on the concept of ‘Squaring the Circle’.  The Friends of the Victoria worked with Glasgow Metropolitan College to commission furniture for the space.

A key part of the New Victoria Art & Environment project focused on Waiting Areas where Jacki Parry and Hanneline Visnes created works permanently installed in five locations.  Calum Stirling was commissioned to create the work, Sculpture Park, adjacent to the Hospital.

In addition HLM Architects developed the concept of a multimedia projector in the Atrium showing a range of artists’ film and video.  An initial work drawing on the New Victoria, the Victoria Infirmary, Queens Park and the local area has been created by Ronnie Heeps.

Team

Architects: HLM Architects
Curator: PACE
Lead Artist: Ally Wallace

Artists

Ronnie Heeps
Jacki Parry 
Calum Stirling
Hanneline Visnes

Project Manager: Chris Fremantle

Funders

Scottish Arts Council, NHSGGC Staff Lottery, NHSGGC Endowments, many Glasgow Faith Groups.

Key Dates

Completed: Spring 2009

Queen Elizabeth University Hospital Campus
Art on the QEUH Campus
Community Health Centres

Therapeutic Design and Art Strategies have been successfully delivered within new Community Health and Social Care Centres at:

Barrhead Health and Care Centre

The overarching vision demonstrated in the Barrhead Health and Care Centre Art Strategy recognises the benefits of art and creativity in the healthcare environment. As a result, the strategy delivers high quality artwork in parallel with a positive model of participation, creating opportunities for the local community to engage with the artists, impacting on the artist’s research and the final artwork for the centre.

Barrhead Health and Care Centre

Patricia Fleming Projects are delighted to announce: Barrhead Health and Care Centre wins Public Building of the Year 2012 at the Scottish Design Awards.

We would like to take this opportunity to congratulate Avanti Architects, Artists Iain Kettles, Susie Hunter, David Zérah, our clients NHS Greater Glasgow and Clyde, and East Renfrewshire Community Health and Care Partnership (CHCP).

We are very proud of the thought-provoking, sensitive and beautifully executed artwork created specifically for the Barrhead Health and Care Centre. The art in the centre acts as a conduit between people and ideas. It raises questions about the importance of wellbeing, design and location. External (above) and internal permanent sculpture by Iain Kettles and Susie Hunter create not only a marker for new public space in a busy main street, but also begins a dialogue about art and health out into the wider community. The photography of French artist David Zérah can be seen throughout the building. Thirty works were selected from thousands taken during a residency in the area. Based in Barrhead the series instigates an on-going conversation with the community, patients and staff about the space we share. As part of the art strategy a new collection of artworks was started which we hope will continue to grow. Works by leading Scottish contemporary artists Jacqueline Donachie, Katy Dove and new talents Mary Wintour and Lisa Ure.  Residents from across Barrhead and Neilston took part in a series of workshops exploring the project themes with Glasgow-based designer Anna Sheard.

The overarching vision demonstrated in the Barrhead Health and Care Centre Art Strategy recognises the benefits of art and creativity in the healthcare environment. As a result, the strategy delivers high quality artwork in parallel with a positive model of participation, creating opportunities for the local community to engage with the artists, impacting on the artist’s research and the final artwork for the centre.

The arts strategy was created with support from the Barrhead Arts Team. The aim is to put the new centre, health and wellbeing at the heart of the community and promote the imaginative role that artists can play in the creation of inspiring places.

http://www.scottishdesignawards.com/

Credits:

Barrhead Health and Care Centre Project Manager: NHS Greater Glasgow & Clyde
Architect: Avanti Architects Ltd
Main Contractor: Graham Construction
Civil & Structural and Mechanical & Electrical Engineer: Cundall
CDM Coordinator: Turner & Townsend
Quantity Surveyor: Cyril Sweett
Curator: Patricia Fleming Projects
Artists: Iain Kettles, Susie Hunter, David Zerah
Artwork Fabricator: Scott Associates
Landscape Consultant: Fiona Robertson

For images of the artworks, artists cv’s or further info contact

ruth@patriciaflemingprojects.co.uk

The West Centre

The West Centre is a new purpose built Centre for Children’s Community Health and Care.

The Centre offers a ‘one stop shop’ combination of services for children, young people and their families who are affected by a wide range of difficulties such as developmental, emotional, behavioural and mental health problems, communication difficulties, Autistic Spectrum Disorders, Physical Disabilities and Neurological Disabilities.

The Centre supports a whole new way of integrated working for those providing services with social workers, community child health staff, educational psychologists, mental health professionals and more, all having bases within the building and working together.

The Centre also provides services to patients and clients not only from West Glasgow but also East Dunbartonshire and West Dunbartonshire. The Centre also features integrated art and design features throughout the building, both inside and out.

The West Centre by Anderson Bell Christie

Concept

The integral art and architecture programme was introduced into the final design process, and developed in collaboration between a Lead Artist, Architect and an arts support team drawn from Centre staff.

The final programme was designed to offer an aesthetic logic running throughout the building, respecting and engaging its users. The aim was for a definite sense of uniqueness and place, with a light touch, but rewarding repeated visits with layered meanings and discoveries: more elements to search out and find familiar details to return to.

The artworks tread a delicate path with care and respect, aiming to reconcile a high standard of professionalism with the often conflicting demands of different ages and abilities of children and adults. The outcomes offer a sense of childlike wonder and engagement without ever being patronising or childish.

Funders

The artworks programme was made possible with a grant of £250,000 from the Yorkhill Children’s Foundation

Awards

The West Centre has picked up the Glasgow Institute of Architects Design Award (Healthcare), and was also short listed for the highly prestigious Royal Incorporation of Architects in Scotland – Doolan Award.

Key Dates

July 2008 – appointment of Lead Artist
November 2008 – start of building work on site
June 2010 – completion of building and artworks programme

Team

Linda Mallett, lead artist and curator
Tassy Thompson, external artworks
Tim Taylor, internal niche artworks
Graven Images, design and graphics
Anderson Bell Christie, architects

Links

Architecture & Design Scotland – Case Study
Atrium Screen by Graven Images
Cloud by Tim Taylor
Fence by Tassy Thompson
Floor niche by Tim Taylor
Flying Saucers by Tim Taylor
Harp by Tim Taylor
Interactive Ship niche by Tim Taylor
Peephole view by Tim Taylor
Reception desk by Tim Taylor
Totem by Tim Taylor

The Vale Centre for Health and Care

Location

The site is located on the A82, the main road from Glasgow to Loch Lomond and is adjacent to the Vale of Leven Hospital.

The VHCC, currently under construction is designed to be a state-of-the-art community health and care facility within which will be based a variety of key services including General Practices; General Dental Practice; Dietetics; Podiatry; Speech and Language Therapy; Primary Care Mental Health; Physiotherapy and Community Dental Services. It will also provide a local base for district nursing, health visiting, prescribing support as well as teaching and studying facilities.

VHCC users will be from a wide catchment area, encompassing both urban and rural communities.

Framework

Two workshops were held, bringing together four creative thinkers with members of the VHCC Art and Design Strategy Group, as part of the initial research. The following concepts were investigated and will inform each of the therapeutic art and design commissions:

The journey;

Thresholds, welcome and departure;
Interaction in public spaces;
Relationships between the built environment and the rural environment.
The aim for each commission is to deliver specified projects to support the patient experience and the working day for staff through reference to the local natural environment by bringing the outside into the Centre and by leading the gaze beyond the walls of the building into the wider landscape.

Therapeutic Art and Design at the Vale of Leven Centre for Health and Care

Unique artworks made by four of Scotland’s leading artists commissioned to reflect the local natural environment are permanently installed in the building and grounds of an inspirational new health and care centre for the Vale of Leven West Dunbartonshire

By focusing on the surrounding locality each artist tells a different story about people and place through a range of media including textiles, painting, photography and wood.

Working with staff and the community, each artist has produced integrated artworks designed to support orientation, to bring the outside into the building and to promote a sense of wellbeing for patients, visitors and staff.

Artist Jephson Robb was tasked to create seating from the trees felled on site during the building process, to be situated in the atrium and at the two approaches to the building. Five sculptural benches are now permanently in place offering both resting points and beautiful objects to enjoy which work in harmony with the design of the new building itself.

Scotland’s foremost environmental artists Dalziel and Scullion have made four beautiful light emitting artworks which explore the wild and cultivated plants growing on allotments in the patient catchment area, bringing a sense of the domestic into the healthcare environment.

Donald Urquhart developed two works which focused on the near and far. The first piece was influenced by the pot shards found on the site during the excavation process for the new building. Dating back to the Bronze Age their beautiful geometric markings informed the design for the manifestation for the gym window, offering privacy for staff and patients in the gym yet allowing views out whilst letting plenty of light in.
The second work was inspired by the stunning mountain scenery so close to the Vale of Leven and designed to integrate seamlessly into the new building. Painted as a modernist pixilated frieze around the first floor of the atrium are colours capturing the soft autumn and winter beauty of the Loch Lomond and the Trossacks, offering a contrast to the close up detail of the allotment images by Dalziel and Scullion.

Textile artist Deirdre Nelson worked with pupils at the Vale of Leven academy to research the history of the area within living memory and create artworks from the gathered stories which were incorporated into a design printed onto healthcare curtains for the couches in the GP consulting rooms.

The design and build of the Centre was commissioned by West Dumbartonshire Community Health and Care Partnership and managed by NHS Greater Clyde and Glasgow. The Therapeutic Art and Design strategy was managed and delivered by Wide Open.

West Dumbartonshire Community Health and Care Partnership would like to thank the dedicated involvement of the staff and pupils at the Vale of Leven Academy, the patient focus groups and NHS staff, without whom his project would not have been possible.

Accordion item 1

Planning treatment in a European Country   

If you are thinking about any sort of planned medical or dental treatment outside the UK, please discuss this fully with your GP, hospital consultant or dentist. Make sure you are fully informed as it is important to have the information you need to make the right choices. You will need to be fully informed about your European healthcare provider and the details of the treatment you are planning to have. You may also need to consider:

  • when you will be able to travel
  • how your medical notes will be exchanged between teams
  • arrangements for after-care or follow-up treatment either abroad or at home
  • how you would deal with any complaint or problem should something go wrong following your treatment abroad
S2 Scheme

All treatment under the S2 scheme requires Health Board approval before treatment can commence. Please click on the linked heading above for more information. 

EU Cross Border Healthcare Directive

The arrangements for reimbursing health care costs to people who live in Scotland and receive treatment in EEA states stopped on 31 December 2020 (EU Exit Implementation Period completion day). Click on link above for more information

Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients and about 90% of the adult population visit a community pharmacy at least once a year. This presents an important opportunity for pharmacists and their staff to motivate and empower their customers to improve their health.

Health Improvement covers a wide range of topics some examples are discussed below and the topics boxes give a little more detail.

Health Improvement targets for Scotland can be found by linking into the Scottish Executive’s website

For further information for pharmacy staff in NHSGGC click here

Stopping smoking

Stopping smoking is one of the most important health improvement interventions. Community pharmacy can supply nicotine replacement therapy or varenicline with behavioural support to help patients stop smoking.

Advice on healthy living

Pharmacists can provide the right advice on healthy living and signpost patients to the best resources to achieve their health improvement goals.

Reduce health inequalities

Community pharmacy offers the Pharmacy First Service (PFS) which encourages people to go to their local pharmacy for support with minor and acute health conditions. Pharmacies undertake a NHS PFS consultation and provide advice, treatment or referral to another healthcare professional if appropriate. 

Managing long term conditions


Many long term conditions require health improvement interventions in addition to medicines which might be prescribed.

Mental health

Good mental health is of key importance to maintaining good general health. Pharmacists should know where to signpost patients for appropriate support as they may need more assistance in managing their daily living requirements. Also patients suffering from poor mental health may need more support to make important lifestyle changes.

For any enquiries regarding Pharmacy Public Health Improvement please contact pharmacyhit@ggc.scot.nhs.uk

Alcohol Awareness

Approximately 1 in 8 men and 1 in 24 women have some degree of alcohol dependence. Excess drinking puts long term health at significant risk. Excessive alcohol consumption is associated with an increased risk of a range of illnesses that collectively contribute to a massive impact on morbidity and mortality.  Please see Alcohol Consumption Questions and the Fast Alcohol Screening Test (FAST) 

For more information visit

  • Drinkaware A Charity promoting responsible drinking.
  • Alcohol Focus Scotland – is the national charity working to reduce alcohol harm.
  • DrinkSmarter  A Scottish Government practical website with many handy tools, supporting healthier drinking habits. 
  • Glasgow Council on Alcohol (GCA) Providing support, counselling, advice, information, group work and training for those affected by alcohol misuse. 
  • Alcohol Concern   A charity campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems. 
  • Al-Anon Family Groups provide support to anyone whose life is, or has been, affected by someone else’s drinking, regardless of whether that person is still drinking or not.

 Key points for community pharmacy

  • Offer advice on sensible drinking
  • Give advice on prescription and Over the Counter (OTC) medicines about interactions with alcohol.
  • Signpost patients to local services offering support
  • Further Information, Resources and Support (including “Alcohol Before, During and After Leaflet) Alcohol and Pregnancy Leaflet 

Some pharmacies may

  • Offer alcohol brief interventions using a FAST tool
Cancer

It is estimated that 1 in 3 people in Scotland will develop some form of cancer during their lifetime.

This is a wide ranging topic and there are many different types of cancer. Some are more likely to occur in females e.g. cervical and breast cancer while others in men e.g. prostate cancer.

Many forms of cancer can now be successfully treated if they are identified in their early stages and we now have screening for the commonly occurring breast, bowel and cervical cancers.

Some cancers such as melanoma (skin cancer) may be prevented by health protection measures such as avoiding the sun and using sunscreens. Smoking cessation remains one of the most important health improvement measures to avoid developing cancer.

For more information visit

  • Scottish Cancer Index provides links to cancer related websites specific to Scotland.  
  • Cancer Research UK  Helpline 0808 800 4040  Mon – Fri 9-5pm
  • Bowel cancer UK providing support and advice. Telephone: 020 7940 1760
  •  Encourage completion and return of Bowel Screening Kits information at this website
  • Breast Cancer Care providing information and assistance for those affected by breast cancer. Freephone Helpline 0808 800 6000.  
  • Cancer Support Scotland  Cancer Support Scotland offers counselling, support groups and complementary therapies to anyone affected by cancer, including family members and carers: before, during and after treatment.
  • Sun Smart   This Cancer Research UK website provides a wealth of information including, information on skin cancer, sunburn and how it damages your skin, advice on protective measures to take – applying sunscreen, staying in the shade, wearing protective clothing and sunglasses, and advice on protecting children from the sun.    
  • British Lung Foundation provides advice on all diseases affecting the lungs including lung cancer. 
  • Leukaemia Care provides support for people with leukaemia, lymphomas and related disorders. Tel: Helpline: 08088 010 444 or chat via WhatsApp on 07500068065
  • Lymphoma Action provides support for those affected by Hodgkin’s disease and non-Hodgkin’s lymphoma. Tel. Helpline no: 0808 808 5555
  • Macmillan Cancer Support is a national charity providing expert care and support for people living with cancer. Tel. Helpline: 0808 808 0000
  • Maggies Centre provides support organisation for those affected by cancer. One of the centres is in Glasgow.   
  • Marie Curie Cancer Care. Dedicated to the cure of people affected by cancer and the enhancement of their quality of life through its caring services, research and education.  Telephone Support Line: 0800 090 2309
  • Oesophageal Patients Association Telephone: 0121 704 9860 (Mon – Fri 9am – 5pm)
  • Orchid: Fighting Male Cancer  Good range of leaflets on testicular and prostate cancer.  National male cancer helpline: 0808 802 0010
  • Prostate Cancer UK Telephone:  Helpline: 0800 0748383 

 Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Many quality, free resources can be ordered to support from Quick Guide for Community Pharmacies on where to access Patient Resources 
  • Be alert to red flag symptoms such as a persistent cough which might suggest a patient should be referred to their GP for investigation.
  • Encourage patient’s participation in national screening programmes e.g. cervical screening whenever possible.
  • Only sell a minimum of SPF 15 sun protection products. 
Healthy Lifestyle… at any age

Many factors go together to improve an individual’s health. Their health needs change through life as they get older and different issues might impact on men’s and women’s health. However, a healthy lifestyle is important at any stage of an individual’s life.

Diet and nutrition, exercise, smoking cessation and managing alcohol intake are modifiable lifestyle factors that can be addressed to improve health.

Other factors may not be readily addressed by individuals but rely upon society working together to promote healthy living and working environments.

Health inequalities arise when individuals or communities are not empowered to make healthy lifestyle choices.

For more information visit

 Child Health

 Health in older age

 Healthy Living 

Community Pharmacy – Signpost patients to appropriate support organisations.

Beware of your patients particular needs. Check out your locality’s health profile.

Long Term Health Conditions

The effective management of long term health conditions (LTHC) can greatly improve a patient’s health and wellbeing. Examples of these conditions include epilepsy, cardiovascular disease, diabetes asthma and chronic obstructive pulmonary disease (COPD).

In addition to taking appropriate medication LTHC patients are often asked to make lifestyle changes such as smoking cessation or alcohol reduction. But at the same time they may be struggling with psychological issues caused by the impact of their diagnosis.

So in addition to understanding the clinical management of patients and the guidelines that are in place for these it is important to consider the patient as a whole and understand their attitudes to their condition and its management.  

For more information visit

Key points for community pharmacy

  • Signpost patients to appropriate support organisations.
  • Know when to call for medical assistance in the event of a heart attack and how to deliver basic resuscitation (CPR) for patients who have collapsed. Details of suitable courses may be found at St Andrews Ambulance Brigade
  • Advise on use of inhaler devices for asthma and COPD patients

 Some pharmacies may

  • Offer health screening such as blood pressure or glucose monitoring
Mental Health

Mental health is a complex topic affecting a significant percentage of people in the UK at any one time. Issues might include depression (including postnatal depression) bipolar affective disorders, stress, anxiety disorders, phobias, eating disorders, schizophrenia and others. Some individuals may suffer from a combination of symptoms.

The management of patients suffering mental health problems may range from self help approaches to in patient care at a psychiatric specialist hospital or facility.

Regardless of how patients are managed, good mental health is underpinned by a healthy lifestyle. Good diet, smoking cessation, exercise, sleep hygeine and alcohol management will not necessarily cure a patient but they will significantly contribute to their recovery.

For more information visit

  • Heads Up – Mental Health Support – NHSGGC For extensive information on mental health care available in Greater Glasgow and Clyde.   
  • NHS24 Tel 111. Can provide or source help for a patient in crisis when their GP is not available
  • Breathing Space Scotland Tel: 0800 83 85 87. Free, confidential phone and web based service for people in Scotland experiencing low mood, depression or anxiety.
  • Mind Tel 0300 123 3393. Mental Health Charity aimed to ensure anyone with a mental health problem has somewhere to turn to for advice and support, and offer useful leaflets and publications.
  • Samaritans Provide confidential emotional support 24/7 to those experiencing despair, distress or suicidal feelings.


Key points for community pharmacy

Palliative Care Services

This service is provided by a network of 70 pharmacies across the NHS Greater Glasgow & Clyde area. These pharmacies maintain

  • a stock of specific core medicines
  • provision of advice and useful contact numbers for specialist palliative care advice
  • a support network to other pharmacies within their localities. 

Some participating pharmacies are available to dispense out-of-hours urgent prescriptions. This can be arranged through NHS 24. A courier service protocol is available to ensure timely supplies of medicines to palliative care patients in emergencies. The aim is for the first pharmacy contacted (regardless of being a part of the Palliative Care network or not) to ascertain the urgency of the prescription and resolve any supply issues, in order to avoid patients, carers, or nurses needing to phone or visit multiple pharmacies. All community pharmacies are provided with a list of the network pharmacies for this purpose and the specific core medicines list. For more details on the Palliative Care Service, click here  or contact: Palliative Care Specialist Pharmacists on the below telephone numbers: 07876 478140 or 07880 786659 or 07775 012560

Quit Your Way

NHSGGC are responsible for a wide range of tobacco projects including the “Quit Your Way” Pharmacy Service.

Suitable pharmacotherapy (Nicotine Replacement Therapy [NRT] or varenicline) together with personalised advice and support is provided from the community pharmacy for usually up to 12 weeks.

For further details, please contact any participating pharmacy or the Quit Your Way Pharmacy Team (T:0141 201 4945 or e: pharmacyhit@ggc.scot.nhs.uk)

Resources

View and order resources

Public Health Resources Directory

This aspect of Pharmacy Public Health deals with the planning for, and managed introduction of new medicines. The Scottish Medicines Consortium  is responsible for providing advice on the clinical and cost-effectiveness of all new medicines and important new indications for existing medicines.

The NHS GGC prescribing website provides useful links to the local Medicines Formulary, medicines policies and associated resources.  

Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients. This is particularly important for those issues which can have high media attention e.g. introduction of a new vaccine or an outbreak of an infectious disease.

Further information and advice can be found in the Health Protection Topics section of this website.  Examples of topics included are:-

Infection Control

Knowledge of infection control principles is important to protect yourself and your patients.

And

Immunisation and Storage of Vaccines

Advice on safe storage of vaccines which must be stored in the ‘cold chain’ between  2oC and 8oC at all times.

Communicable Disease, Outbreak Control and  Emergency Planning

Pharmacists can recognise symptoms of a notifiable disease in order to appropriately refer patients

Understand how an outbreak is being managed to be able to offer appropriate advice and reassurance to the public.

Maintain Business Continuity Plans to ensure minimal impact on the delivery of patient care in the event of an emergency situation.

Screening for Health Protection  

Pharmacists can encourage uptake of screening programmes against several cancers e.g. cervical, breast cancer and  bowel. More information may be found on the Screening – Health topics – Public Health Scotland website.   

For any enquiries regarding health protection please contact:

PharmacyPublicHealth@ggc.scot.nhs.uk

Blood Borne Virus

Three blood borne viruses are the main cause for concern in Scotland, Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C.

There is an effective vaccine only for Hepatitis B.  However, there are few effective treatments for Hepatitis C and HIV.  

More information

Key points for community pharmacy

 Some pharmacies may

  • Offer support for dried blood spot testing for Hepatitis C and HIV.
  • Dispense antiviral medicines for Hepatitis C.
  • Provide ‘Injecting Equipment’ to prevent spread of disease.
Communicable Disease

Public Health Protection Unit – NHSGGC in NHSGGC has a key role in monitoring and responding to the incidence of notifiable diseases e.g. meningitis.

For more information visit

 Key points for community pharmacy

  • Recognise and refer patients with symptoms suggesting a serious or notifiable disease to the GP or acute services as necessary.
  • Compliance with prophylactic therapy e.g. tuberculosi
Community Pharmacy & Infection Control

The NHS GGC Community Pharmacy Infection Control Guidelines  provide basic advice.

To reduce the incidence of infection due to antimicrobial resistance in the population, NHSGGC has launched https://clinicalguidelines.nhsggc.org.uk/adult-infection-management/ to be followed in primary care and the prescribing support team has developed a non-prescription pad to encourage patients to seek non antibiotic remedies for viral infections.

More Information

 Key points for community pharmacy

  • Provide antibiotic stewardship.
  • Offer advice to patients on appropriate infection control techniques to reduce spread of disease such as norovirus or influenza.
Health Screening

The NHS GGC Public Health Screening Unit is responsible for a range of health screening programmes.

  Key points for community pharmacy

  • Encourage patients to participate in screening programmes.
Immunisation Programmes

Immunisation is one of the most effective health interventions.

There are several formal immunisation progammes in the UK. They are Childhood, Adult and Seasonal Influenza.

More Information

 Key points for community pharmacy

  • Encourage patients to engage with national and childhood programmes.  

 Some pharmacies may

  • Offer travel and influenza vaccination clinics.
Outbreak Control

Public Health Specialists from NHS GGC Public Health Protection Unit – NHSGGC are involved in identifying and managing outbreaks of disease. They will liaise with infection control teams for example in the case of a norovirus outbreak in an institution or with local authorities if an outbreak is linked to a food supplier in an E. coli outbreak. 

Chemical Biological Radiological and Nuclear (CBRN) outbreaks

Local authorities and health boards are required to have plans in place to manage accidental events such as major oil or chemical spills or deliberate terrorist acts. A specialist on line training module is available from TOXBASE

More Information

  Key points for community pharmacy

  • Provide reassurance to patients.
  • Keep Business Continuity Plans up to date.
Patient Group Directions (PGDs)

Patient Group Directions (PGDs) are legal documents that enable suitably qualified healthcare professionals to administer and supply medicines (P or POM) in a defined clinical situation where the patient may not be individually identified before presenting for treatment. The individual using the PGD must have signed and been authorised to use the PGD prior to administering or supplying any medicines named in the document.

NHS GGC uses PGDs to allow nursing staff and Health Visitors to administer vaccines for the routine child immunisation programme and travel in specialist clinics. 

More Information

  • Information about working under PGDs National health Education Scotland NES

 Key points for community pharmacy

  • Community pharmacy PGDs authorised for use in NHS GGC may be obtained from the Community Pharmacy Development team or GGC PGD administration at Clarkston Court, 56 Busby Road, Clarkston, Glasgow G76 7AT
    Telephone No. 0141 232 1728.
Seasonal Influenza

Individuals are most likely to catch influenza in the winter months. The season runs from October to the end of February occasionally into March, peaking in December/January.

Seasonal influenza can affect anyone. It is an acute viral infection of the respiratory tract. There are three types of influenza virus: A, B and C. Influenza A and influenza B are responsible for most clinical illness.

It is difficult for an individual to develop long term immunity to influenza as the make up of the viral strains change slightly on a regular basis. So vaccination against seasonal influenza has to be undertaken annually.

More Information

The government resource Immunisation against infectious disease – ‘The Green Book’

In the United Kingdom immunisation for influenza for certain groups including ‘at risk’ patients is provided on the NHS and in Scotland the Chief Medical Officer (CMO) will send a letter detailing which groups are eligible for vaccination. Letters from the CMO are available here. 

Egg allergy isn’t always an absolute contraindication for receiving flu vaccine. The British Society for Allergy and Clinical Immunology website advises on managing individuals with egg allergy

An e learning course for healthcare professionals undertaking immunisation is available. Registration is required to undertake this course.

NHS Inform has key patient information on all types of immunisation

NHS GGC: Immunisation – NHSGGC

 Key points for community pharmacy

  • Encourage at risk patients to attend for vaccination
  • Advise on management of symptoms
  • Some pharmacies offer private flu vaccination clinics
Sexual Health

Sandyford co-ordinates a wide range of sexual health services in NHS GGC.

The Free Condoms web-site provides, support for practitioners involved in condom distribution, information on how to sign up as a distribution point, where to find condom distribution points and general advice on condom use and products offered

It is important that pharmacists and their staff understand what they should do if they have any concerns about a child and sexual health issues. Access information at NHS GGC Child Protection Unit’s website 

More Information

  Key points for community pharmacy

  • Be able to recognise and differentiate between symptoms of sexually transmitted diseases.
  • Refer all men consulting with symptoms of discharge or thrush infections to Sandyford or their GP.
  • Be aware that there is no charge for vaccine supplied by a Sandyford Clinic.
  • Supply of emergency hormonal contraception or bridging contraception under PGD.
Substance Misuse

Pharmacists play an important part in providing information and advice about substances liable to misuse controlling the availability of medicines, and the associated risks and in providing harm reduction programmes e.g. methadone and the supply of injection equipment.  

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 Key points for community pharmacy

  • Give advice on wound care and management, safer injecting practices and remind clients of the importance of safe disposal of syringes.
  • Know which pharmacies are ‘Injecting Equipment Providers’
  • Be able to sign post clients to other services as necessary.
  • Know how to deal with needle stick injuries
Travel

Two websites are highly recommended for those living in Scotland seeking travel health guidance. Fit for Travel which gives the most up to date information for the public and the professional site TRAVAX.

Access to TRAVAX requires registration but it is free for Community Pharmacists in Scotland to register.

More Information

Key points for community pharmacy

  • Provide patients with pre-travel advice.
  • Encourage the use of sunscreen with a minimum SPF15. 
  • Advise on the carriage and storage of medicines abroad e.g. insulin. 
Vaccine Storage

NHS GGC Guidelines on Vaccine Storage and Handling are available in the NHSGGC Guidelines Repository

More Information

 Key points for community pharmacy

  • Remind patients collecting travel vaccine of the storage requirements. It is preferable that they collect vaccine immediately before their appointment for administration.

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