Specialist Haematology Copy —
Training activity: 14

Details

Select, perform and interpret diagnostic techniques for the investigation of myeloproliferative neoplasms (MPN) and chronic myelogenous leukaemia (CML)

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

• 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 MPNs and CML is needed, including the significance of the BCR-ABL1fusion gene?
• What insights do you hope to gain regarding the specific diagnostic approaches for these conditions, including the role of morphology, cytogenetics, and molecular analysis5? What is your current understanding of the key diagnostic features and molecular markers for MPNs and CML?
• 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 chronic myeloid disorders?

In action

• Given the clinical suspicion of MPN or CML, which diagnostic tests are you prioritising and why?
• As you perform and analyse the results (e.g., blood counts, molecular tests), are they aligning with the expected findings for these conditions? If not, what alternative diagnoses or further investigations are you considering in real-time?
• Are you encountering any difficulties in interpreting complex molecular results or distinguishing between different MPN subtypes? What resources or support might you need in the moment?
• Are you considering the importance of integrating clinical and laboratory findings for accurate diagnosis as the activity unfolds?

On action

• What were the key clinical and peripheral blood findings that raised suspicion for MPN or CML in the case(s) you investigated?
  • What specific diagnostic techniques (morphology, cytogenetics, molecular) were selected and (where applicable) performed?
  • What were the key morphological features observed in the bone marrow and peripheral blood?
  • What were the significant cytogenetic findings (e.g., Philadelphia chromosome in CML) and molecular mutations (e.g., JAK2, CALR, MPL in MPN) identified?
  • How did these contribute to the diagnosis?
• What are the diagnostic criteria for different types of MPN (e.g., essential thrombocythaemia, polycythaemia vera, primary myelofibrosis) and CML according to current guidelines (e.g., WHO classification)?
  • What are the characteristic morphological, cytogenetic, and molecular features of these disorders?
  • How do these findings inform prognosis, risk stratification, and treatment in MPN and CML?
  • What are the challenges in differentiating between different types of MPN and distinguishing them from other myeloid disorders?
• How will this experience enhance your ability to investigate and interpret results for suspected MPN and CML?
  • 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, including molecular and cytogenetic data, in the context of MPN and CML?

Beyond action

• Have you been involved in the investigation of other cases of MPN or CML since this training activity, potentially encountering different driver mutations or disease phases? How did your diagnostic strategy vary?
• Have you reviewed your reflect-on-action notes from this training activity? Has your understanding of the diagnostic criteria and the role of molecular markers (e.g., BCR-ABL1, JAK2, CALR, MPL) in MPN and CML evolved?
• Can you recall MDT discussions where the diagnosis or monitoring of MPN or CML was a focus? What were the key laboratory findings and their clinical implications?
• Have you reviewed current guidelines (e.g., WHO classification, BSH guidelines) related to the diagnosis and management of MPN and CML since this training activity?
• Has this training activity enhanced your ability to select and interpret the relevant laboratory tests for diagnosing and monitoring MPN and CML?
• Do you now have a better understanding of the diagnostic criteria, including the integration of clinical, morphological, and molecular findings?
• Has this experience influenced your understanding of the importance of molecular monitoring in patients with CML and certain MPNs?
• Have the analytical and interpretative skills applied in this training activity been beneficial in other areas of molecular haematology or diagnostics?
• How will your experience in diagnosing and monitoring MPN and CML prepare you for managing these chronic haematological malignancies and staying abreast of therapeutic advancements?
• Will your ability to accurately interpret molecular and cytogenetic data contribute to optimal patient management and response assessment?
• How might this experience support your potential involvement in research or the implementation of new molecular diagnostic techniques for MPN and CML?

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.