There are many biomedical scientists working in clinical immunology labs in the UK but I suspect if you asked most people what we do, they will have no idea what role we fulfil in the NHS.
We rarely appear in medical drama programmes on television and the general perception is that the NHS consists solely of doctors and nurses. As a profession we are very reticent to put ourselves in the spotlight so perhaps the fault lies more with us than with anyone else.
Proper science – our day-to-day role
So, what do we do? We aid in the diagnosis and monitoring of any condition which is caused by a failure or dysregulation of the immune system. These conditions range from primary immunodeficiency, HIV, malignancy, allergy, vasculitis, connective tissue disease and numerous other autoimmune conditions including coeliac disease. In our lab we carry out both adult and paediatric immunology testing.
The tests we perform cover a range of test platforms from flow cytometry, enzyme immunoassay and indirect immunofluorescence to protein measurement and electrophoresis. As these techniques are very different it means that our job is varied and, unlike some laboratory disciplines, is not solely automated, giving us the opportunity to still do what we call ‘proper science’.
our job is varied and, unlike some laboratory disciplines, is not solely automated, giving us the opportunity to still do what we call ‘proper science’
The testing mechanisms we use vary widely; this means my day can consist of analysing various cell types using a flow cytometer, to looking at tissue immunofluorescence down a microscope or looking at serum immunofixation on a patient suspected of having multiple myeloma.
The main reason I enjoy working in clinical immunology compared with any other lab specialty is because we see the sample to an end point to provide the clinician with a complete answer to why they are testing the patient. A lot of our tests are screening tests followed on by further testing to give the clinician an aid in the diagnosis of the patient’s condition.
Typically, no immunology laboratory is the same; depending on which site the laboratory is on, they may all provide different services. There tend to be larger laboratories, based in teaching hospitals, which cover a full range of testing but there are also smaller satellite labs – usually situated in district general hospitals, which may only cover screening tests that are then sent to a referral laboratory (if required) for further analysis.
To become a biomedical scientist, we need to be educated to degree level and must be registered with the HCPC (Health and Care Professions Council), which checks that we are fit to practice as health professionals. There are various further education pathways that we can take after registration. This can include an MSc in biomedical science and the specialist and higher specialist diplomas in immunology, which are under the remit of the Institute of Biomedical Science (IBMS). All of these qualifications require a high standard of expertise in laboratory testing and an in depth knowledge of the specialty.
We are obliged to participate in continuous professional development throughout our career in order that we keep up to date in our skills and knowledge to reassure the public that we can perform our job to the highest standard. As we can be audited by the HCPC randomly, we have to be able to provide them with a portfolio of evidence to show that we can perform our role at the appropriate level.
Our laboratories are regularly assessed by the United Kingdom Accreditation Service (UKAS) which specifies requirements for quality and competence in medical laboratories.
Every day, no matter what technique we may be doing, we are obliged to make sure that every test platform we use is properly and safely controlled to ensure that the results we give to clinicians are accurate and pose no risk to the patient. This means that we participate in both internal and external quality control procedures. If issues arise from either of these we then use our skills to find out the source of the problem and to correct it so that our tests remain of the highest quality.
Behind the scenes
We regularly interact with clinicians and nurses to give out results and suggest further laboratory testing where appropriate but, as we tend to be remote from the front end of the NHS, our role is less visible to the general public.
Since virtually all conditions require some form of laboratory testing to diagnose, it remains a mystery why we do not regularly pop up in Casualty or Holby City so I hope that from this small insight into the professional life of a biomedical scientist you are better informed of what the mysterious person working in a clinical laboratory actually does.
Biomedical scientist, NHS Greater Glasgow and Clyde
Christina is the biomedical scientist representative on the BSI’s Clinical Committee and the Chair of the UK Immunology Managers Group.