Application of Techniques, Interpretation and Differential Diagnosis —
Training activity: 6

Details

Perform and interpret the appropriate techniques for the investigation of:

• Thrombotic disorders

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Local SOPs
• Guidelines and standards, including EQA and IQC
• Maintenance and basic troubleshooting
• Reference intervals
• Limitations of the methods

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What are the main laboratory assays used in the investigation of thrombotic disorders (e.g., D-dimer, thrombophilia screen including AT, PC, PS, Factor V Leiden, Prothrombin gene mutation)?
• What are the clinical indications for requesting these tests, and how should the results be interpreted in the context of patient history and risk factors?
• What are the limitations of these tests, and when are further or alternative investigations required?
• Consider the specific insights you hope to gain, such as understanding the role of laboratory testing in the diagnosis and management of thrombotic disorders.
• Reflect on your current knowledge of thrombosis and its laboratory investigation, and how this DTA will expand your understanding.
• Discuss with your training officer which specific thrombophilia tests and other relevant investigations you will be involved in performing and interpreting.
• Review the principles and procedures for these thrombotic disorder investigations.
• Consider potential challenges, such as interpreting complex panels of results or understanding the clinical significance of borderline findings, and think about how you might address them (e.g., reviewing clinical guidelines, discussing case studies).
• Reflect on your confidence in interpreting thrombotic disorder investigations and identify areas for focused preparation.

In action

• When selecting and performing tests relevant to thrombotic disorders (e.g., tests for hypercoagulability), what is your rationale for choosing these specific assays?
• What steps are you currently performing, and are you adapting your technique based on observations (e.g., during sample processing or instrument operation)?
• How satisfied are you with the quality of the data you are generating? What technical issues are you encountering?
• What practical knowledge are you gaining about investigating thrombotic disorders? How does this relate to your understanding of the mechanisms of thrombosis?
• Are there other relevant tests you could consider at this stage? Do you need to consult with a supervisor regarding the testing strategy?
• Are you following the correct laboratory procedures for these investigations?
• During interpretation, what markers of thrombotic risk are you primarily evaluating?
• What potential diagnoses are you considering based on the results?
• How sure are you about your initial interpretation of the thrombotic risk?
• What unusual or conflicting results are you noticing?
• What are you learning about the interpretation of thrombotic disorder investigations?
• Are there alternative ways to interpret these findings?
• Should you discuss these results with a clinical colleague? Are you interpreting within the scope of your training and established guidelines?

On action

• Describe the specific techniques you used and interpreted to investigate thrombotic disorders. What were the critical steps for each? What were the expected outcomes for these techniques in a normal state? What were the key observations in the samples you analysed? Did you face any challenges or unexpected findings during the performance or interpretation of these techniques? How did you correlate the results of the different techniques to form an interpretation related to potential thrombotic disorders?
• What new skills or knowledge did you gain or improve regarding the investigation of thrombotic disorders? Did you encounter any unexpected results or patterns? What did you learn from analysing these? How did this activity deepen your understanding of the laboratory investigation of thrombotic risk and events?
• What areas within the investigation of thrombotic disorders have you identified for further learning and development? How will you utilise the knowledge and skills acquired from this activity in future investigations of potential thrombotic conditions? What specific steps will you take to enhance your expertise and understanding in this area? Are there any resources or support you believe would be helpful for your continued development in investigating thrombotic disorders?

Beyond action

• Re-evaluate your previous engagement with the techniques used to investigate thrombotic disorders. Has your understanding of the interplay between different assays (e.g., lupus anticoagulant testing, factor V Leiden mutation analysis) and clinical presentations deepened with further experience?
• Compare your reflections from this training activity with those from training activities focusing on coagulation or inherited bleeding disorders. What similarities or differences in the investigative approaches have you noted over time?
• Review your initial reflections on this training activity. Have any aspects of the investigation of thrombotic disorders become clearer or more nuanced as you have gained more experience in the field?
• Recognise how this training activity fits into your overall understanding of haemostasis and thrombosis. How has your learning from this activity informed your current interpretation of thrombotic risk assessments or investigations?
• Can you recall specific instances where your understanding gained from this training activity has helped you to understand the rationale for specific downstream or reflex tests in current cases?
• Identify the transferable skills you honed through this training activity, such as critical evaluation of complex test panels or the ability to integrate clinical information with laboratory findings. How will these skills be valuable in your future professional development?
• What ongoing learning needs related to thrombotic disorder investigations have you identified through revisiting this training activity?

Relevant learning outcomes

#	Outcome
# 1	Outcome Select techniques for the investigation of clinical presentations in haematology, haemostasis and transfusion science and medicine.
# 2	Outcome Perform the laboratory techniques required for the investigation of clinical presentations in haematology, haemostasis and transfusion science and medicine.
# 3	Outcome Interpret the results of the laboratory investigations for cases including red and white cell disorders and haemostatic and platelet disorders, haematological malignancy and transfusion serology.
# 4	Outcome Describe the limitations of techniques applied in the investigation of clinical presentations in haematology, haemostasis and transfusion science.
# 5	Outcome Apply the principles of internal quality control and external quality assessment and draw conclusions about assay performance.
# 6	Outcome Demonstrate appropriate communication skills to present the results of investigations and cases clearly to healthcare professional colleagues.