Laboratory skills 1

Details

Title

Laboratory skills 1

Type

Stage One

Module code

HLS019

Requirement

Compulsory

Module objective

By the end of the training period trainees will, in respect of laboratory clinical immunology and a range of analytical techniques, their performance, comparative usefulness and applications in the clinical immunology laboratory, be able to:

• analyse, synthesise, evaluate and apply knowledge
• perform a range of technical and clinical skills and procedures
• demonstrate the attitudes and behaviours necessary for professional practice as a consultant clinical scientist dealing with the complexities, uncertainties and tensions of professional practice at this level.

Knowledge and understanding

By the end of the training period the trainee will be able to demonstrate the ability to analyse, evaluate and synthesise relevant knowledge and its application to their professional practice in relation to:

• appropriate laboratory investigations
• therapeutic interventions:
  • putative mechanisms of action of various immunological therapies
  • principles of the various therapeutic options to guide the most appropriate treatment for an individual patient.

Technical and clinical skills

By the end of the training period the trainee will be able to demonstrate a critical understanding of current relevant research, theory and knowledge and its application to the performance of the following technical procedures and laboratory skills:

• the benefits and limitations of IT systems including laboratory information management systems, patients administration systems, electronic patient records
• sample management, initiation of request by clinician, demand management and pre-analytical, analytical and post analytical processes
• write standard operating procedures and is aware of the importance of following them
• the principles of laboratory testing in diagnostic immunology:
  • perform certain designated laboratory tests without supervision
  • be fully conversant with the diagnostic utility and limitations of laboratory tests, e.g. sensitivity, specificity, predictive values
  • understand the principles of the operation of automated analysers
  • interpret the results generated
  • identify invalid results
  • be aware of the limitations of automated analysers
• be familiar with the functions of pathology reception, the phlebotomy service and immunology specimen reception
• comprehend the problems associated with 24-hour urine collections
• know universal laboratory precautions
• understand COSHH
• be conversant with risk assessments
• be familiar with fundamental aspects of computing within the laboratory, databases, spreadsheets, internet.

Use on a day-to-day basis:

• document control e.g. Q-pulse, i-passport.

Basic understanding of quality control and quality assurance.

• understand the use of External Quality Assurance (EQA) and National External Quality Assurance Service (NEQAS)
• evaluate of internal/external quality assurance data so as to identify the possible cause of aberrant data, e.g. Levy Jennings plot and Westgard rules
• have the ability to investigate and take remedial action for poor IQC and EQA situations,

Basic understanding of the methods of standardisation and calibration:

• practicability
• optimisation of reaction conditions
• recognition of critical parameters (robustness)
• bias
• imprecision
• sensitivity
• specificity
• investigation of common interferences
• range
• criteria for acceptability
• identification of common method interferences.
• use of pipettes
• preparation and storage of reagents
• use and maintenance of centrifuges.
• Experience of techniques, and conversant with the performance and limitations of widely used methods in clinical immunology
• Ability to detect errors and sources of error

Taking responsibility for assays:

• ensure analytical competence.
• understand the mechanisms by which common interferents affect laboratory assays (haemolysis, jaundice, antigen excess, etc. )
• practical experience of investigating assay interference.
• experience of random access, immunoassay analysers robotics and modular systems.

Basic laboratory techniques and centrifugation

• Methods of standardisation and calibration.
• Identification of common method interferences.
• Use of pipettes.
• Preparation and storage of reagents.
• Use and maintenance of centrifuges.
• Experience of techniques, and conversant with the performance and limitations of widely used methods in clinical immunology
• To detect errors and sources of error.
• Taking responsibility for assays.
• Ensuring analytical competence.

Assay interference

Understands the mechanisms by which common interferents affect laboratory assays (haemolysis, jaundice, antigen excess, etc.
Practical experience of investigating assay interference.

Automated instrumentation

Random access, immunoassay analysers robotics and modular systems.
Understand the technology and design of immunology/biochemistry analysers and appreciate their limitations and benefits.

Spectrometric methods

• Spectrometry: visible, ultra-violet (UV).
• Turbidimetry, nephelometry.
• Experience of the application of these methods.

Immunochemical techniques (general)

• Immuno-assay, labels enzyme, fluorimetric, and chemiluminescent.
• Experience of the application of these methods.
• Bead- and chip-based serological techniques.

Gel phase and electrophoresis

• Principles of technique.
• Experience of the application of these methods.
• Basic interpretation of the electrophoretic patterns and quantification of monoclonal proteins by densitometry or directly by CZE.

Flow cytometry

• Principles of technique.
• CD4 counts for HIV monitoring, TBNK counts for immunodeficiency monitoring, DHR to aid CGD diagnosis.
• Knowledge of all core tests used in the Flow and experience of the application of some of these methods.

Isoelectric focusing

• Principles of technique, used in multiple sclerosis diagnostic workup.

Elispot technique

• Principles of technique.

Double immunodiffusion

• Principles of technique.

Light and immunofluoresence microscopy

• Principles of technique, esp ANA, ANCA, AABs inc: antimitochondrial smooth muscle, gastric parietal cells.

Molecular techniques, DNA/ RNA preparations and extraction and PCR

• Principles of technique.
• Amplification and characterisation for mutation detection, polymorphism, TCR/BCR restriction.

Isotopic techniques

• Principles of technique.

Proteins

• Principles of measurement.
• Properties and functions of the principal plasma proteins including:
  • albumin
  • ceruloplasmin
  • clotting factors
  • complement
  • immunoglobulins.
• Hypoalbuminaemia and investigation.
• Paraproteinaemias and investigation.
• Cryoglobulinaemia.
• Proteins of inflammation.
• Plasmapheresis.
• Immunoglobulin deficiencies.
• Alpha-1-antitrypsin deficiency.
• Cytokines.

MHC, HLA and tissue typing

By the end of the training period the trainee will be able to apply knowledge of laboratory clinical immunology to perform the clinical skills necessary to manage under supervision:

• familiarity with national guidance on appropriate test selection and use where relevant, e.g. NICE.