PERSONS with haematological (blood) diseases are among those most at risk of severe illness and complications from Covid-19, says Trinidad-born, UK-based consultant haematologist and clinical senior lecturer Dr Keith Wilson.

Blood diseases are conditions that impact the bloods ability to function correctly. They can affect any of the three main components of blood.

Our bodies naturally respond to any infection by raising an immune response however people with haematological conditions have an impaired immune system either due to the condition itself or the treatment of the condition.

Most patients with haematological malignancies are immunosuppressed as a result of their baseline condition, treating such ones with chemo or radiotherapy will cause immunosuppression so you have immunosuppression upon immunosuppression. That would explain why those patients are at high risk of infection,says Wilson who is the Director of the South Wales Blood and Marrow Transplant Programme.

In a zoom interview with the Express, the haematologist also referred to preliminary results from recent studies in the UK which have revealed that people with haematological malignancies respond poorly to the vaccine. The studies show that even if such ones have been vaccinated their bodies may not mount an adequate response should they come into contact with the virus. Nevertheless, Wilson stresses that such highly vulnerable persons should take the vaccine.

Our advice to our patients is that they should be vaccinated. But that advice comes with a caveatwe cannot guarantee that they would respond adequately to the vaccine. So the advice is a double barrel oneget the vaccine but continue the protective measures that we have instituted over the years,he says.

Since the start of the pandemic, Wilson has been working longer hours. He and his colleagues had to change the way they work in a variety of settings. Their patients are vulnerable at the best of times so in order to protect them, Wilson and his department had to institute different zones in the hospital. Maintaining the zonal arrangement meant spacing out appointments and spacing patients out physically.

To get through the workload meant working for much longer periods than we were accustomed to and that has continued until now. The UK is experiencing its third wave and therefore the protective measures have to remain in place, those requirements havent been modified since we adopted them in March/April 2020, says Wilson.

The haematology unit also introduced telephone clinics for patients who do not need to be seen face to face.

Over the years, Wilsons hard work and dedication to his profession has won him recognition. In 2017 he was awarded Health Care Professional of the Year and was praised for being an extremely hard working individual with extremely high standards. He was also commended for supporting patients throughout their journey and being open and honest about their treatment options.

His commitment to improving treatment for patients came to the fore in the late 90s when Wilson and his colleagues at the South Wales Blood and Marrow Transplant Programme conducted a collaborative study on a method of transplantation called reduced intensity allogeneic stem cell transplantation. Stem cell transplantation has been around for decades however in the beginning the results were uniformly poor. Generally people received high doses of chemotherapy with radiation therapy, which meant that patients had to be young enough to tolerate the treatment, however patients who bore the greatest burden of the diseasepatients 60 years and olderwere excluded from these therapies, explained Wilson. During the collaborative study Wilson and his colleagues observed that the stem cells used in allogeneic or donor transplants actually have anti-leukaemic potential, much the same way the immune system can detect a cancer cell as foreign and attack it the same way it fights infection. That opened up the possibility of reducing the dose of chemotherapy and radiotherapy given as part of the stem cell transplant process. This method is not only available to younger patients who were too sick to have the full blown version but more importantly the reduced intensity approach has made it possible for Wilson and his team to treat older patients who were once largely excluded.

Today three quarters of all allogeneic or donor transplants are now done with this new method called reduced intensity conditioning. If we didnt have this method at our disposal it means that the vast majority of patients with haematological malignancies would not have this treatment optionwhichfor many cancers, is the only means of cure,explains Wilson.

Long before he began his journey to become a doctor and specialist, Wilson held several leadership positions as a pupil at Presentation College. He was head college prefect and sang in the school choir and was also platoon sergeant (Cadets). He learned to play the steelpan and was also actively involved in many sports organisations. He went on to study medicine at the University of the West Indies St Augustine and at UWI Mona, Jamaica. Wilson practised internal medicine at the San Fernando General Hospital before migrating to the UK in 1991.

There was one particular patient who motivated Wilson to specialise in haematology. At that time there was only one trained haematologist - the late Dr Waveney Charles serving T&T. The patient presented with a rare condition aplastic anaemia where the bone marrow shuts down. Wilson communicated with Charles about possible treatment options. But the patient wasnt suitable for any of the options which were available, instead he was given supportive care.

He did survive for about five years which was a feat in itself given that without proper treatment someone with severe aplastic anaemia would have a life expectancy of six to 18 months. He was young, mischievous, playful. Not being able to offer him what he needed best stirred in me a desire to do haematology, I remember saying to myself I must learn how to treat this condition and I must be able to do transplantation, so I credit my decision to do haematology and transplantation in particular to this young man who entered my life so many years ago,he says.

Wilson once had a dream of starting a stem cell transplant unit in the Caribbean but those plans never materialised for a number of reasons. There would need to be a combination of qualified physicians, infrastructural adjustments and support services to make it possible to do it safely but it is within reach if there is sufficient appetite to do it, he says.

The consultant haematologist has not forgotten his roots, over the years he has visited Trinidad at different intervals. He would embrace the opportunity to repay some of the investment that was made in him many years ago when he began his career in medicine.

Im always open to the possibility of helping the haematology community particularly with regards to haematological malignancy where I would be most equipped to make a contribution, he says.

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Covid-19 and the blood - Trinidad & Tobago Express Newspapers