Specialist Haematology Copy —
Training activity: 13

Details

Select, perform and interpret diagnostic techniques for the investigation of acute myeloid leukaemia (AML) and myelodysplastic syndromes (MDS)

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

• Morphological features associated with AML and MDS
• The sample type required and the preanalytical variables affecting results.
• Clinical presentations and other investigations
• National and international guidelines
• WHO classification
• Local SOPs
• Quality assurance
• Prioritisation and communication of results

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 background knowledge of the classification, diagnostic criteria, and relevant laboratory techniques for AML and MDS is needed?
• What insights do you hope to gain regarding the specific diagnostic approaches for these conditions, including the role of morphology, cytochemistry, immunophenotyping, and molecular analysis?
• What is your current understanding of the key diagnostic features and markers for AML and MDS?
• How will you prepare for this activity (e.g., reviewing diagnostic algorithms, familiarising yourself with relevant guidelines like WHO classification)?
• What potential difficulties might you face in selecting the most appropriate techniques or interpreting the results in the context of diagnostic criteria, and how will you plan to address these?
• How do you feel about investigating these complex haematological malignancies?

In action

• Based on the initial clinical presentation and/or screening results, what diagnostic techniques are you immediately choosing to perform? What is your reasoning?
• As you obtain results from different techniques (e.g., morphology, flow cytometry, cytogenetics), how are you integrating this information in real-time to build a comprehensive picture? Are any results unexpected? How are you addressing this?
• Are you encountering any challenges in differentiating AML from MDS based on the available data? What further steps are you considering in the moment?
• Are you aware of the relevant diagnostic criteria and classification systems as you interpret the findings?

On action

• What were the key clinical and peripheral blood findings that raised suspicion for AML or MDS in the case(s) you investigated?
  • What specific diagnostic techniques (morphology, cytochemistry, immunophenotyping, cytogenetics, molecular) were selected and (where applicable) performed?
  • What were the key morphological features observed in the bone marrow aspirate and trephine?
  • What were the significant findings from immunophenotyping, cytogenetic, and molecular studies? How did these contribute to the diagnosis?
• What are the diagnostic criteria for AML and MDS according to current guidelines (e.g., WHO classification)?
  • What are the characteristic morphological, cytochemical, immunophenotypic, cytogenetic, and molecular features of different subtypes of AML and MDS?
  • How do these findings inform prognosis and risk stratification in AML and MDS?
  • What are the challenges in differentiating between AML, MDS, and other haematological disorders?
• How will this experience enhance your ability to investigate and interpret results for suspected AML and MDS?
  • What are the key resources and guidelines you will refer to in future practice for the diagnosis and classification of these disorders?
  • How will you contribute to the integrated interpretation of results from different laboratory disciplines in the context of AML and MDS?

Beyond action

• Have you been involved in the investigation of other cases of AML or MDS since this training activity, possibly with different subtypes or clinical presentations? How did your diagnostic approach compare?
• Have you reviewed your reflect-on-action notes from this training activity? Has your understanding of the diagnostic criteria and techniques for AML and MDS evolved?
• Can you recall MDT discussions where the diagnostic work-up for AML or MDS was presented and debated? What were the key considerations?
• Have you reviewed relevant guidelines (e.g., WHO classification) since this training activity? How has your understanding of the diagnostic pathways for AML and MDS been informed by these guidelines?
• Has this training activity enhanced your ability to select the appropriate combination of morphological, immunophenotypic, molecular, and cytogenetic techniques for investigating suspected AML or MDS?
• Do you now have a better understanding of the diagnostic algorithms and the significance of specific findings in classifying these disorders?
• Has this experience influenced your interpretation of laboratory results in the context of clinical information and prognostic factors for AML and MDS?
• Have the critical thinking and problem-solving skills applied in this training activity been transferable to the investigation of other haematological conditions?
• How will your experience in diagnosing AML and MDS prepare you for managing complex cases and staying updated with advancements in this field?
• Will your ability to accurately interpret diagnostic data contribute to timely and appropriate treatment decisions for patients with AML or MDS?
• How might this experience support your potential involvement in research related to the pathogenesis, diagnosis, or monitoring of these myeloid neoplasms?

Relevant learning outcomes

#	Outcome
# 3	Outcome Perform a range of laboratory and molecular testing techniques to diagnose and monitor treatment of haematological malignancy in the correct clinical context, including the interpretation and reporting of results.
# 4	Outcome Interpret and comply with national and international guidelines on the diagnosis and management of haematological cancer.
# 7	Outcome Perform quality assurance and control tasks across the range of investigations.