Home blood testing service keeps vulnerable patients out of hospital

Friday 18 December 2020

Tim Bonallack and daughter Sophie one year after Tim's second transplant.

A home blood testing service which prevents extremely vulnerable patients from having to come to hospital has been launched at Guy’s and St Thomas’.

The service is the first of its kind in London and among the first in the UK for patients who have received an organ transplant. This group of patients, who need regular blood tests, is among those classed as extremely clinically vulnerable to COVID-19.

With Guy’s Hospital being one of the country’s largest transplant centres, performing the most kidney transplants in the UK last year, it has a large group of patients who are situated across southern England. The new home blood testing service means that adult patients do not need to travel for long distances to come into hospital for their tests.

Tim Bonallack, 78 from Salisbury, is one of the first patients to have benefitted from the home testing. The grandfather-of-five has had two kidney transplants, the most recent one being two years ago after his daughter Sophie, 48, donated her kidney to him.

Tim, a retired solicitor, said: “I was found to have a problem with my kidney function in the 1980s and I was lucky enough to have a transplant at Guy’s Hospital in 1997, which lasted 21 years and meant my life could go completely back to normal.

“When that started to fail my wife Gaye, son Charles and daughter Sophie all put themselves forward as potential donors. Sophie was the best match and I was fortunate to receive a transplant in November 2018. This meant that I did not need haemodialysis which would have involved very frequent hospital visits, so I consider myself to be very blessed and lucky to be able to live a full and active life in the country.

“It’s hard to put into words just how grateful I was to Sophie. Within a few days of the surgery at Guy’s, I had made a good recovery and was bouncing around.”

Transplant patients like Tim need immunosuppressant medication to prevent their body rejecting the new organ. They need regular blood tests to check levels of the medication in their system, to ensure that it is not too high as that can affect kidney function, and that it is not too low so it does not risk organ rejection. They also need levels of creatinine, a waste substance usually removed by the kidneys, tested frequently as this is an indicator of kidney function.

Tim usually makes the four-hour return journey to Guy’s Hospital every three to four months for tests but since the COVID-19 pandemic he has had blood tests at his local hospital and virtual consultations with the team from Guy’s and St Thomas’.

He is one of the first 23 adult patients to use the home blood testing service and received a kit in the post from Guy’s and St Thomas’, containing a device for blood collection and instructions about how to use it.

Patients use the finger-prick method and a Mitra® device to collect a small sample of blood on the device’s tip, which absorbs the blood. The sample is sent back to the Biochemical Sciences lab at St Thomas’ Hospital for analysis in a pre-paid envelope, included in the pack, which can be sent in the normal post. Once received, results are issued by the lab, which is run by Guy’s and St Thomas’ pathology provider Viapath, within 72 hours.

Tim said: “Because I’m classed as being extremely clinical vulnerable to coronavirus, I was really worried about travelling to Guy’s.

“It’s a huge positive to be able to do the blood test at home rather than needing to go to hospital during the pandemic as I’m not comfortable travelling to London at the moment. It also saves a lot of time and money.

“It’s very easy to use. You just prick the side of a finger, scoop the blood up with the device then put it in a bag and send it off, just as simple as that – it’s child’s play! It’s a brilliant idea. I can only see every advantage in doing it this way.”

Dr Dimitrios Moutzouris, renal consultant at Guy’s and St Thomas’, said: “Due to COVID-19 we are trying to reduce hospital visits especially for those classed as extremely clinically vulnerable, which includes solid organ transplant recipients. After an organ transplant, usually patients need blood tests twice a week for the first month, then the frequency gradually decreases over time.

“We wanted to find a way to monitor kidney function and anti-rejection medication levels at home without compromising the quality of the service.”

Teams at Guy’s and St Thomas’, which includes Evelina London Children’s Hospital, collaborated with colleagues from Nottingham University Hospitals NHS Trust, where the home blood testing service using the Mitra device, made by Neoteryx, was first established, having been set up for children who had received transplants. They also worked with biochemists at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust, who shared their methods of processing the tests in the labs.

Around 100 samples were analysed and then more than 50 adults and children were observed using the devices in clinic to ensure they were able to use them easily and effectively.

Dr Rachel Carling, consultant scientist at Viapath, said: “We wanted to help clinical teams find a good solution for adults and children who have had transplants to get the blood tests they need without coming into hospital.

“We worked hard to set up an effective method for use with the Mitra devices and to process the samples taken with them. Through collaborative working with the renal teams at Guy’s and Evelina London, as well as with the teams in Nottingham and Manchester, we were able to get the service up and running for patients as soon as possible. It was a big team effort.”

Dr Moutzouris added: “There are a number of benefits to the home blood testing service. It keeps vulnerable patients home and avoids the need for them to travel.

“We need to check levels of medication 12 hours after patients have taken their last dose, and it’s very hard to do a blood test at exactly the right time in clinic, while finger-prick sample collection can be done at any time at home. The Mitra device also keeps the blood sample stable for up to 14 days.

“The home testing creates more capacity in clinic for other patients who need to come in, while reducing overall numbers. Kidney patients often have difficult veins, so the finger-prick tests preserve veins more than standard blood tests do.”

He said that the team hopes to expand the service to include many more transplant patients, although it is not suitable for newly-transplanted patients who need two blood tests a week.

The home blood testing service will also soon be offered to a number of young transplant patients cared for at Evelina London. This will start once their parents have received training on how to use the finger-prick tests effectively.

Results of the tests are entered onto the Trust’s Electronic Health Record where they can be accessed by clinicians and patients. An advantage of all of the samples being analysed in the Viapath labs at Guy’s and St Thomas’, rather than being taken at other NHS trusts, is that the readings are easy to compare.

Dr Moutzouris added: “We are not completely replacing hospital visits as some other things need to be checked in clinic, so we are trying to alternate visits with doing blood tests at home, reducing the number of overall visits each patient needs to make in the process.”

Last updated: March 2022

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