Haematology
Royal Infirmary – Department of Medicine
Professor Leslie J Davis was appointed to the Muirhead chair of Medicine (1945-1961) primarily to introduce clinical science into Glasgow Royal Infirmary, starting with haematology. The main focus of the Department, within Haematology, became Haemostasis and Thrombosis.
A Stuart Douglas (1921-1998) was a registrar in the Department from 1949 to 1951, when he won a Medical Research Council Research Fellowship to work at its Blood Coagulation Research Unit in Oxford, with Professor R G Macfarlane and Dr Rosemary Biggs. There he developed a test to further elucidate the mechanisms of the normal pathways of blood coagulation (the thromboplastin generation test).
This resulted in the finding that the genetic bleeding disorder, haemophilia, could be divided into two distinct types.
While coagulation Factor VIII was deficient in 90% of patients, the other 10% were deficient in Factor IX. This second type was called Christmas Disease, after the first patient studied, and the article was published in the Christmas 1952 edition of the British Medical Journal.
Douglas returned to Glasgow in 1953 as Lecturer in Medicine, subsequently promoted to Senior Lecturer, Reader, and Titular Professor (1964-1970). During the 1950s, he developed the West of Scotland Haemophilia Reference Centre, in the Department’s Ward 3 for males in the Royal Infirmary, and a Coagulation Research Laboratory within the Department’s St Mungo building. This was a regional clinical and diagnostic service, to which patients across the West of Scotland were referred for diagnosis and registration of genetic bleeding disorders including haemophilia, Christmas Disease, and von Willebrand’s Disease.
He brought families to the Centre for detailed family histories and blood tests to establish the diagnosis, kept meticulous notes (many of which are still kept at the Centre), and had an encyclopaedic knowledge of the family trees of his “bleeders”.
Treatment of these disorders with blood transfusions was often ineffective, because of the low concentrations of the missing coagulation factors, especially in stored blood or plasma. In 1969, Dr Judith Pool in the United States published the method of making concentrates of Factor VIII and Von Willebrand Factor by freezing, then thawing, plasma to make cryoprecipitate.
Drs Charles Forbes recalled that he and John Davidson, registrars with Professor Douglas, bled each other a pint of blood, made the cryoprecipitates, mixed them, and infused the “soup” into a moderately affected patient with haemophilia requiring surgical removal of a toenail. No bleeding occurred after surgery, and the age of effective treatment of haemophilias in the West of Scotland began.
Dr John Davidson and I bled each other of a ‘pint’ of blood, made the cryoprecipitates, mixed them and infused the ‘soup’ into a moderately affected haemophilic patient who required the removal of a toenail: no bleeding at all was recorded after surgery.
Douglas also pioneered study of the fibrinolytic system, which breaks down both the haemostatic plugs of fibrin (which form poorly and slowly in haemophilias, causing bleeding), and the larger fibrin plugs in arteries and veins (which form thrombi – the causes of most heart attacks and strokes).
He and his colleagues performed clinical trials of fibrinolytic inhibitor drugs (aminocaproic acid and tranexamic acid) in patients with haemophilias undergoing dental extractions.
These drugs greatly reduced the risk of bleeding, and also the need for clotting factor transfusions, and became standard clinical practice.
Douglas also researched on anticoagulant drugs, authoring a standard textbook, and played a leading role in the UK Medical Research Council’s clinical trials of secondary prevention in coronary heart disease.
He was joined in the 1960s by George McNicol, who’s special interest was the development of thrombolytic drugs. In 1963, he and colleagues published the first case of successful lysis of a peripheral arterial thrombus (see Vascular Surgery). McNicol moved to become Professor of Medicine at the University of Leeds (General Infirmary; 1971 – 1983). In 1970, Douglas left to become Professor of Medicine at Aberdeen University (until 1985).
Colin Prentice succeeded Douglas in 1971 as Co-Director of the Haemophilia Reference Centre and Director of the Coagulation Research Laboratory. With Charles Forbes, he continued research in haemophilia, haemostasis and thrombosis, including participation in major international studies not only of anticoagulant drugs (low molecular weight heparins, ancrod) but also of antiplatelet drugs (aspirin, dipyridamole and sulphinpyrazone) in treatment and secondary prevention of coronary heart disease, stroke, peripheral arterial disease and venous thrombosis. The West of Scotland Haemophilia Reference Centre became the Haemophilia and Thrombosis Centre.
Prentice and Forbes developed the clinical Haemophilia Centre on Wards 2 and 3, as out-patient treatment with factor VIII and factor IX concentrates (including home treatment by patients and relatives) reduced the need for in-patient treatment of bleeds. The team was expanded to include specialist nurses (staff nurse then sister grades), dentists, physiotherapists and rheumatologist colleagues in the Department for treatment of arthritis from previous joint bleeds, orthopaedic surgeons (for knee replacements) and social workers.
Dr Prentice left in 1983 to succeed George McNicol as Professor of Medicine at the University of Leeds (General Infirmary). Forbes succeeded Dr Prentice as Haemophilia Centre Co-Director and Director of the Coagulation Research Laboratory. He was Chair of the UK Haemophilia Directors Organisation (1985-1987) and was much involved at this time with the development of Acquired Immune Deficiency Syndrome (AIDS) due to transmission of the Human Immunodeficiency Virus (HIV) to patients with haemophilias through human blood-derived factor concentrates. He left to become Professor of Medicine at the University of Dundee in 1987.
Forbes was succeeded as Centre Co-Director and Director of the Coagulation Research Laboratory by Gordon Lowe (Senior Lecturer 1985, then Titular Professor of Vascular Medicine 1993-2009). He continued research in thrombosis and vascular diseases, including clinical trials, and epidemiological studies of the roles of thrombotic and inflammatory factors (see Cardiovascular Disease). Prentice, Forbes and Lowe all served as President of the British Society for Haemostasis and Thrombosis.
Professor Gordon Lowe
Royal Infirmary Department of Haematology
In 1962, the NHS Department of Haematology was established at Glasgow Royal Infirmary by George McDonald, who moved from Aberdeen. Until the late 1960’s, haematological diagnostics were usually provided by a subdivision of departments of Pathology, with general physicians providing the patient care. In a crucial stage, it was decided nationally that haematology would be a clinical speciality supervised by the Royal College of Physicians under a Joint Committee Specialist Training (JCHMT). McDonald played an important role in this development which led to the present day services provided by consultant Clinical Haematologists. John Davidson was Consultant Haematologist (1972-1996) and Head of Department (1990-1996).
Isobel Walker was appointed Consultant Haematologist in 1978 with a remit to introduce specialist haematology to Glasgow Royal Maternity Hospital. She served as Head of the NHS Department of Haematology at GRI from 1996-2009.
George McDonald and Stuart Douglas were founder members of the British Society of Haematology and George McDonald, John Davidson and Isobel Walker all served as both Secretary and President of the Society. All three also served the Royal College of Pathologists in a variety of roles including membership of the Council.
Haemostasis and Thrombosis
Davidson was responsible for the Blood Transfusion and Blood Products laboratory and Walker was responsible for perinatal haematology. Supported by Jim Conkie (Medical Scientist), they shared responsibility for laboratory haemostasis, and developed research interests in haemostasis and fibrinolysis. In the early 1970s, they were founder members of the International Society for Fibrinolysis (later the International Society for Fibrinolysis and Proteolysis) and were founding co-editors in chief of the International Journal of Fibrinolysis (later the International Journal of Fibrinolysis and Proteolysis)
Having been introduced by Stuart Douglas to the emerging topic of thrombophilia (predisposition to thrombosis), Walker developed a particular interest in the potential impact of thrombotic disorders on pregnancy. She was awarded a personal Chair in Perinatal Haematology by the University in 2003.
George McDonald and Stuart Douglas were Co-Directors of the West of Scotland Haemophilia Reference Centre. When McDonald retired in 1990, Walker became Co-Director of the West of Scotland Haemophilia Reference Centre (renamed Comprehensive Care Centre in 1993) with Gordon Lowe.
Services at the Centre were expanded to include -
- data management systems
- genetic counselling (with the West of Scotland Centre for Medical Genetics)
- disorders of platelet function
- bleeding disorders in women
- treatment of hepatitis C (like HIV, acquired from previous transfusion with human blood products) in collaboration with hepatologists.
From the mid-1990s, human blood products were replaced with recombinant factor concentrates across NHS Scotland. The Haemophilia and Thrombosis Centre pioneered the out-patient diagnosis and management of venous thrombosis in the West of Scotland by specialist thrombosis nurses.
When Davidson retired in 1996, Campbell Tait joined the NHS department of Haematology as Consultant Haematologist and with Lowe and Walker, became a Co-Director of the Haemophilia and Thrombosis Centre. The Centre moved in 1999 to larger and improved facilities in Ward 1 at the Royal Infirmary (previously the Bone Marrow Transplantation Unit), and received a Greater Glasgow Health Board Patient-Initiated Award in 2003.
Professors Lowe and Walker both retired in 2009, but continued their research activities in haemostasis and thrombosis. Tait, together with his Co-Director Catherine Bagot (appointed in 2010) continue research in haemostasis and thrombosis, in collaboration with the University’s School for Cardiovascular and Metabolic Health, where Bagot was appointed Honorary Senior Lecturer in 2014 and Tait appointed Honorary Professor in 2016.
In 1990, Walker with the help of Jim Conkie, co-founded and for 5 years co-directed (with Dr Frits Haverkate, Leiden, The Netherlands) the European Concerted Action against Thrombosis External Quality Assurance Scheme (ECAT EQAS). In 2005, she was appointed Director of the UK National External Quality Assessment Scheme for Blood Coagulation (NEQAS BC). Following her retiral from GRI, she has been employed by Sheffield Teaching Hospitals and continues to be responsible for overseeing the development and provision of a wide range of NEQAS BC EQA programmes for both laboratory and point of care haemostasis testing in the UK and worldwide.
Professor Isobel D Walker
Haemato-oncology
From the 1970s, haemato-oncology (the study of haematological malignancies including leukaemias, lymphomas and myeloproliferative disorders) developed as a sub-specialty of haematology. Major advances occurred in treatment, first with the success of combinations of chemotherapeutic drugs and eventually with bone marrow transplantation. The Department was a large recruiter to the MRC Leukaemia trials with Dr McDonald being an influential member of the MRC Working Party for several years. District Hospitals appointed Consultants in Haematology which enabled patients to receive treatment closer to home.
Alan Burnett was appointed as a consultant in 1978, having spent a year in the University of Chicago working on experimental leukaemogenesis under Charles Huggins (Nobel Laureate). McDonald and Burnett provided the leukaemia service in association with Alec Brown, who as a general physician, focused on lymphomas, and Martin Rowan who specialised in myeloma, as well as providing the service in Belvidere Hospital. Mike Soukop succeeded Brown as Consultant Physician with an interest in Medical Oncology.
Firsts in transplantation
Burnett undertook the first bone marrow transplant in Scotland in 1980 in a young man with aplastic anaemia, (who survived for many years). Following a major fundraising activity by the public through the Sunday Mail Newspaper, and a generous donation from the Walton Foundation, a specialist transplant ward was constructed at the Royal Infirmary.
A particular feature of the programme was the development of “autologous transplantation” for leukaemia in disease remission, which was the first in the world. The technique was also applied, in collaboration with Dr Steve Banham, to some cases of lung cancer.
The Scottish Government funded the first Bone Marrow Transplantation Centre in Scotland in Ward 1 (The Walton Unit). The Unit was formally opened in 1984 by HRH Diana Princess of Wales, subsequently moving in 1999 to a refurbished Oncology/ Haemato-oncology unit in the St Mungo building with 18 beds (8 specialist transplant beds), and a dedicated space for the apheresis unit and day care patients.
Burnett was appointed Chair of the MRC Adult Leukaemia Working Party in 1989, and went on to coordinate many MRC Leukaemia trials, which became the largest trial group in the world. He was appointed Professor of Haematology at the University of Wales College of Medicine, Cardiff in 1992. He became President of the British Society for Haematology, was awarded the Society’s Gold Medal, was honoured by the American Society of Hematology in 2012 with the Ham Wasserman Award, and was appointed MBE in 2008.
Ian Franklin was appointed as Bone Marrow Transplant Director in 1992. He continued to develop bone marrow transplant services with the establishment of an allogeneic peripheral blood stem cell transplant programme and a new treatment regimen for myeloma. He was subsequently appointed as Regional Director of the West of Scotland Blood Transfusion Service in 1996 (see below), and became Professor of Transfusion Medicine in the University Department of Medicine at Glasgow Royal Infirmary.
The main thrust of his research work at this time was the use of cellular therapies for treatment of cancers, and basic translational research. Professor Franklin set up the Academic Department of Transfusion Medicine within the Scottish National Blood Transfusion Service, which actively collaborated in research with the University of Glasgow, particularly in the field of myeloma.
His colleague Dr Tessa Holyoake was appointed Senior Lecturer in 1992, then Professor of Experimental Haematology in 2004.Her research included experimental haematology and haematological malignancies.
Professors Franklin and Holyoake worked with NHS colleagues Anne Parker and Grant McQuaker, both appointed in 1999, in the Regional Adult Bone Marrow Transplantation Centre, which moved to new premises in the old Surgical Block of the Royal Infirmary in 1999, then to join the new West of Scotland Blood Transfusion Centre, Paul O’Gorman Leukaemia Research Laboratories and Beatson Oncology Centre at Gartnavel Hospital in 2008 (see below).
Professor Franklin retired in 2010, and Professor Holyoake died in 2017. She achieved an international reputation for the study of chronic myeloid leukaemia and other blood cancers. This work continues by Professor Mhairi Copeland and colleagues.
As Professor Franklin and Holyoake reduced their clinical commitments, additional consultant support was required with Andy Clark appointed in 2006. The adult allogeneic transplant service was awarded National Service Division designation in 2006 to provide alternative donor transplants for adult recipients for the whole of Scotland. It moved to the Beatson West of Scotland Cancer Centre in 2009 with a significant increase in bed numbers to 10 transplant beds and 10 haemato-oncology beds supporting the east end of Glasgow, based on ward B8 and B9.
The NSD support was extended to all allogeneic adult transplants in 2015 following a national review and two further consultants were appointed, namely - David Irvine in 2014 and Igor Novitzky-Basso in 2015, while Annie Latif replaced Dr Andrew Clark in 2017. The unit had planned to move to the new Queen Elizabeth University Hospital in 2015 with an increase in bed numbers to 24, but unfortunately the environment was not suitable at the time of the QEUH opening and so the BMT unit remained at the Beatson without patient services from the QEUH.
The Haematology and Bone Marrow Transplant Unit in the Beatson West of Scotland Cancer Centre, Gartnavel Hospital, is the largest Blood Cancer unit in Scotland, and the national allogenic bone marrow transplant centre. It also has a teenager Cancer Trust unit for 16-25 year olds. The clinical unit is supported by the regional haemato-oncology laboratory which has an international expertise in flow cytometry.
Professor Alan K Burnett
Western Infirmary
The Western Infirmary gave over to its new Department of Haematology in 1958 the premises previously known as the Chemical Laboratory. The University created a post of Senior Lecturer, first occupied by Harry E Hutchison, who was promoted to Reader in 1960. His research interests were mainly in the haemoglobinopathies and included the discovery of a new variant haemoglobin which would have been Haemoglobin Glasgow, but unfortunately he was pipped to the publishing post by the discovery of the identical haemoglobin in Cologne, Haemoglobin -Köln. He was joined by Dr, later Professor Fred Lee, who returned to his first love pathology in 1973 at Glasgow Royal Infirmary where he became a national expert in lymphoma pathology.
Until 1973 clinical haematology was largely separate from the laboratory services. Patients with blood disorders were mainly managed in the Department of Medicine by Professor Abe Goldberg until appointment of John Dagg in 1967. In 1973, Norman Lucie and in 1974 Ian Evans were appointed as consultant haematologists and over the next two decades the clinical and laboratory services gradually merged. John Dagg had a national reputation in iron metabolism. The department became a local centre for management of acute leukaemias and lymphomas with special interests in autologous bone marrow procedures - and later leukaemia and lymphoma diagnosis by surface marker analysis.
After Hutchison’s death in 1975, he was succeeded by Dr Martin Rowan, who moved from the Royal Infirmary. His interests were primarily in laboratory haematology with research interests in evaluation of automatic blood cell counters. Following his retiral, Edward Fitzsimons became Head of Department and Senior Lecturer in 1996. His research interests were in red blood cells and iron metabolism. He established peripheral blood stem cell transplantation as a consultant haematologist at Monklands Hospital in 1992; which was joined by the Royal Infirmary in 1995; until SNBTS established their apheresis unit in 2000. He collaborated with Professor Holyoake and colleagues on ex vivo stem cell transplantation; and with colleagues in the Department of Medicine on haematological and iron metabolism.
Drs Norman Lucie and Edward Fitzsimons
Southern General Hospital
Two physicians, John Adams and Robert Hume, had an interest in Haematology at the Southern General Hospital. Adams was interested in Vitamin B12 metabolism and was instrumental in having a Whole Body Isotope Scanner installed which eliminated the problems with the Schilling test, e.g. insufficient urine collection. Hume’s area of expertise was polycythaemia, both primary and secondary. Together they devised and published a method to calculate the dose of radioactive phosphorus to be given to a patient with primary polycythaemia based on the individual’s red cell mass result, thus eliminating the possibility of over or under dosing.
In 1975, Iain McNeil was appointed as a Consultant Haematologist and he developed a full range of haematological managements excluding bleeding disorders and marrow transplant. He was especially interested in honest communication with those with malignancy and in supplying psychological support. Inspired by Cecily Saunders he developed ‘end of life’ care for haematology patients at the hospital.
Dr Iain McNeil
Victoria Infirmary
Until the 1960s, haematology laboratory work in the Pathology Department was headed by Jock Craik, assisted by William McNab. Clinical care was provided by physicians with an interest in haematology, Drs Ian Wang and Norman Mackay, who became chair of postgraduate education in the West of Scotland, and President of the Royal college of Physicians and Surgeons of Glasgow. The first laboratory medical haematologist was Richard Payne, who was replaced by Margaret Hutton who oversaw expansion of the specialty with new treatments for haematological malignancies and backup for surgery, obstetrics and major trauma. She was joined by Elizabeth Riddell and training of juniors was expanded. Dr Hutton resigned to specialise in patient and palliative care. Rory O’Donnell became head of department in 1981 and was joined by Pat Tansey. O’Donnell returned to his native Dublin in 1988 and was replaced by Tommy Sheehan, who was succeeded in 1992 by R A (Sandy) Sharp. By this time, clinical and laboratory services were unified.
Over the next 20 years Drs Sharp and Tansey developed inpatient and outpatient treatment of haematological cancers using an integrated team approach, entering patients into national studies, and including autologous stem cell support, initially harvested in the Victoria Infirmary from bone marrow. They also provided clinical cover for Drs Burnett and Franklin in the early years of the Bone Marrow Transplantation unit at the Royal Infirmary (see above).
Drs Norman Mackay and Patrick Tansey
Stobhill Hospital
John L Markson was the first physician with an interest in haematology at Stobhill Hospital. He studied pernicious anaemia and established a lymphoma service, continued by his successors Brooke Hogg and Michael Leitch who transferred to the Western Infirmary.
Centralisation of Haematology Services
Following the closures of Stobhill Hospital, the Victoria Infirmary and the Western Infirmary 2011-2015, haematology services were concentrated at the Royal Infirmary (haemophilia, thrombosis and obstetrics), Gartnavel Hospital (Cancer and Bone Marrow Transplantation) and the new Queen Elizabeth University Hospital on the Southern General site.
Royal Hospital for Sick Children
Michael Willoughby was appointed as consultant haematologist (1963-1982) to establish a haematology department in the Royal Hospital for Sick Children and the Queen Mother’s Maternity Hospital, Yorkhill. His main focus of interest was childhood leukaemias and related clinical trials. He also introduced home treatment with clotting factor concentrates for children with haemophilias in the West of Scotland. He left for Perth, Australia in 1982 and was replaced by Dr Ian Hann.
Following Dr Hann’s return to the Great Ormond Street Children’s Hospital, London, Brenda Gibson and Elizabeth Chalmers became consultant haematologists. Dr Gibson’s main interests were in childhood leukaemias and related clinical trials. She was President of the British Society for Haematology, and was awarded an OBE in 2017. Dr Chalmers’s main interests were in haemophilia, haemostasis and thrombosis.
Professor Gordon Lowe
Blood Transfusion
The first descriptions of human to human transfusion date back to the 17th century with William Harvey. However, such transfusions were often fatal, and it was not until the work of Karl Landsteiner and the discovery of the major blood group system (ABO) that Transfusion started to take on importance as a potential lifesaving procedure. The first Blood Bank was established by the British Army in 1917 when glass bottles were used with preservative to allow the blood to be stored refrigerated for up to two weeks.
The origins of a blood transfusion Service in Scotland can be traced back to 1930 when a service was established in Edinburgh Royal Infirmary. It was at first rudimentary, run and organised by volunteers who recruited donors. However, the need to expand due to increasing demand was recognised and in 1936 the Lord Provost of Edinburgh formed a committee to take over the responsibility for the service.
In 1939, with the imminent outbreak of war, the Department of Health for Scotland set up a Blood Transfusion Sub-committee which recommended that stores of blood should be made available across the country. In June of that year, the Lord Provost of Glasgow called a meeting to enlist the public interest in the establishment of a Blood Transfusion Service for Glasgow and the West of Scotland. At that meeting a resolution was passed to approve in principle the cooperation between the hospital authorities and other interested bodies to establish this service.
Professor Noah Morris, Regius Professor of Materia Medica (1937-48) at the University of Glasgow was asked to be the convenor of the technical Committee (see Materia Medica). Blood storage centres were set up in Glasgow Royal Infirmary, Western Infirmary, Victoria Infirmary, Stobhill Hospital and the Southern General Hospital. The St Andrews Ambulance Association offered the administrative headquarters of this organisation be housed in their headquarters in North Street, and they also provided the transportation of donors, blood and plasma within the city and wider area. The service was very successful in attracting donors and at the accounts for the first year of operation, 12,500 volunteer donors were already recruited.
On the 1st of March 1940 the Scottish National Blood Transfusion Association was formed, to which all regional services became affiliated. A first act of this new body was to bring consistency to the practice of recruiting donors and to establish the voluntary nature of such donations. In the early 1940s, it became apparent that freeze dried plasma was as useful as fresh blood, and large scale production of blood products manufacture commenced. A separate depot for manufacturing the plasma was set up in the Pharmacy department of the Royal Technical College (now part of Strathclyde University) under the supervision of Professor James Prior Todd (Professor of Pharmacy). In this way donors were bled in the centres across the hospital sites, and the blood was separated and then distributed from the Royal Technical College. In the first year of operation, already some 4500 transfusions had been performed.
When the NHS was established in 1947, the Secretary of State for Scotland took over the control of the regional transfusion centres, equipment, vehicles and staff. 
A protein fractionation centre was established by the Scottish National Blood Transfusion Service in Edinburgh in 1970 to manufacture the growing requirements for albumin, rhesus D antibody, clotting factors for treatment of haemophilias, and immunoglobulin.
Due to the financial implications of precautions against variant Creutzfeld-Jacob disease, this centre ceased manufacturing in 2008.
In 1950, the West of Scotland Blood Transfusion Centre was moved to purpose built accommodation at Law Hospital in Lanarkshire, as part of the Civil Contingencies relating to the cold war. A central store was opened in Glasgow city centre in St Vincent Street in 1979, and remained the main dispatch hub for city centre hospitals until 2001, when all the West of Scotland Blood Transfusion activities moved to the Gartnavel General Hospital Site in the west end of the city of Glasgow.
By this time, the Transfusion Centre had a well established Research and development department which collaborated with both the Universities of Glasgow and Strathclyde. Dr Ian Franklin was appointed as Regional Director of the West of Scotland Service in 1996, and became Professor of Transfusion Medicine in the University Department of Medicine at Glasgow Royal Infirmary. The main thrust of the research work at this time was the use of cellular therapies for treatment of cancers, and basic translational research. Professor Franklin set up the Academic Department of Transfusion Medicine within SNBTS, which actively collaborated in research with the University of Glasgow, particularly in the field of myeloma.
He retired in 2010. His colleague, Dr Tessa Holyoake was appointed Senior Lecturer in 1992, then Professor of Experimental Haematology in 2004. Her researches included experimental haematology and haematological malignancies. She died in 2017 (read more).
Dr Rachel Green
Images unless otherwise noted, provided by Dr Green