Despite advances in immunochemotherapy for haematological malignancies, for many diseases, especially at relapse, allogeneic stem cell transplant still represents the only potentially curative option for those patients fit enough to undergo this and for whom a suitable donor has been identified. You will spend 4 months on the transplant team, learning how to manage inpatients going through the transplant process, following up post-transplant patients in the outpatient clinics, learning about transplant-related complications, undertaking pre-assessment and consent for allogeneic stem cell transplant, and producing the individual patient transplant timetables that define each individual's conditioning regimen, transplant date, medications and post-transplant course. The patients are profoundly immunosuppressed and are suscpetible to many opportunistic pathogens including disseminated fungal infection. They also have a risk of graft-versus-host disease, sinusoidal obstructive syndrome and other chemotherapy-related organ damage. BMT rotation can be emotionally demanding but provides an excellent learning opportunity.

Malignant haematology encompases myeloid disorders, such as acute and chronic leukaemias, myelodysplastic syndromes and myeloproliferative neoplasms; lymphoma, of which there are many subtypes; and myeloma and other plasma cell dyscrasias. You will manage patients with these conditions both in the inpatient and outpatient setting, dealing with complications relating to the disease process itself and treatment. Many of these patients will be receiving intensive chemotherapy and require close monitoring, particularly for complications such as neutropenic sepsis. Several myeloma and lymphoma patients will also undergo autologous stem cell transplantation, a process that always requires an inpatient stay.

You will also attend MDT meetings in which patients with new or relapsed diagnoses are discussed and treatment plans put in place. Presenting patients at these meetings is an excellent way to learn and to appreciate the options available for treatment at different stages of the disease process.

Many of the haematological conditions that occur in the adult population present and behave differently in infants, children and teenagers and young adults. Treatment modalities are different, as is prognosis. In addition there are many first presentations of hereditary disorders such as haemophilia A and B and other bleeding disorders, haemophagocytic lymphohistiocytosis and congenital bone marrow failure syndromes such as Diamond-Blackfan anaemia and Schwachman-Diamond syndrome. This is also an opportunity to see haemoglobinopathy patients as children, providing vital insight into their experiences and how this can impact them as they transition to adulthood.

Whether you want to be a specialist in coagulation or not, many of the general on call haematology questions and cases that you will be contacted about relate to problems with haemostasis and thrombosis. Whether it is a patient with congenital haemophilia A who needs an elective hip replacement, a pre-op cancer patient found to have sheet bruising and a severely prolonged APTT, a baby with purpura fulminans, a pregnant female with type 2B von Willebrand's disease, a 63 year-old lady who is anticoagulated following an acute PE but who now needs urgent surgery, or an elderly man taking rivaroxaban who has a traumatic subdural haemorrhage, you will need to understand the issues involved and be able to formulate an effective management strategy. Having a good understanding of the laboratory aspects of the coagulation assays is vital to being able to correctly interpret results and request the appropriate investigations.

You will gain considerable coagulation epxerience as part of your day-to-day haematology training and on calls.  In addition there is a placement or secondment to the specialist coagulation services, providing further opportunity to learn about specialist laboratory coagulation and review patients with particularly complex clotting problems.