Training activity information
Details
Select, perform and interpret diagnostic techniques for the investigation of dietary-related anaemia
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- The sample type required and the preanalytical variables affecting results
- Clinical presentations and other investigations
- National guidelines
- 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 does success look like?
- Identify what is expected of you in relation to investigating dietary-related anaemia.
- Consider how the learning outcomes apply, specifically what constitutes an appropriate panel of tests for diagnosing dietary causes of anaemia.
- What does accurate performance and interpretation look like in this context, including understanding the key nutrients involved in red cell production that might be deficient due to diet?
- Discuss with your training officer to gain clarity on expectations regarding the range of dietary deficiencies you should focus on and the expected tests.
What is your prior experience of this activity?
- Think about what you already know about the causes and laboratory features of dietary-related deficiencies, such as:
- Iron deficiency anaemia
- B12 deficiency
- Folate deficiency
- What are the common laboratory tests used to investigate these deficiencies e.g., FBC, ferritin, serum iron, TIBC, transferrin saturation, B12, folate?
- Consider possible challenges you might face in selecting, performing, or interpreting these tests, and think about how you might handle them, for example:
- Mixed deficiencies
- Confounding factors like inflammation
- Assay limitations
- Recognise the scope of your own practice for this activity, i.e., know when you would need to seek advice regarding complex anaemia investigations or interpretation.
- Acknowledge how you feel about investigating anaemia, a common but sometimes complex condition.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in selecting and interpreting tests for different types of anaemia.
- Identify specific insights you hope to gain into the laboratory diagnosis and differentiation of dietary causes of anaemia.
What additional considerations do you need to make?
- Consult actions identified following previous experience with FBC, morphology, or specific biochemical tests relevant to nutrient levels.
- Identify important information you need to consider before embarking on the activity, such as:
- Sample requirements for specific test
- Local protocols for anaemia investigation
- The importance of correlating results with clinical history
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst investigating dietary-related anaemia?
- Are you encountering situations such as:
- Observing FBC indices suggesting macrocytosis (B12/folate deficiency) but iron studies also indicating severe iron depletion, confirming a complex mixed deficiency
- Receiving abnormal B12/folate results where non-dietary absorption issues (e.g., pernicious anaemia) must be differentiated from simple dietary insufficiency
- The FBC film showing dysplastic features alongside nutritional deficiencies, suggesting an underlying myelodysplastic syndrome (MDS) complicating the diagnosis
How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your approach to differentiating causes or sequencing subsequent testing in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately ordering subsequent, specific tests e.g., intrinsic factor antibodies, methylmalonic acid (MMA) to definitively establish the cause of B12 deficiency
- Reviewing the FBC morphology with a consultant haematologist or senior scientist due to suspicion of underlying primary bone marrow pathology (e.g., MDS)
- Reviewing the clinical history for concurrent inflammatory conditions which might falsely elevate ferritin or complicate the interpretation of iron studies
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your knowledge to interpret concurrent deficiencies or non-dietary causes? Is it affecting your confidence in determining the primary cause of the anaemia?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice (e.g., successfully directing the laboratory investigation to differentiate dietary causes, or needing support because the morphological features suggest a haematological malignancy that is beyond your current interpretation scope)?
- What are you learning as a result of the unexpected development? For example, are you gaining crucial insight into the need for second-line tests to distinguish dietary causes from malabsorption, or mastering the interpretation of FBC parameters in the context of mixed pathology?
On action
What happened?
- Begin by summarising the key points of the experience of selecting, performing, and interpreting diagnostic techniques for a patient with suspected dietary-related anaemia e.g., iron, B12, folate deficiency. Which specific tests did you focus on e.g., FBC, iron studies, B12/folate levels?
- Consider specific events, actions, or interactions which felt important, such as specific results that confirmed or contradicted the initial suspicion. How did you feel during the interpretation process?
- Include any ‘reflect-in-action’ moments where unexpected results e.g., normal B12/folate in a suspected case prompted you to reconsider the diagnosis or look for alternative explanations.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the specific laboratory markers for different dietary deficiencies (iron, B12, folate). What skills in selecting appropriate tests and interpreting the pattern of results did you develop? Were there knowledge gaps about the metabolism or causes of deficiency beyond diet?
- Compare this experience against previous engagement with similar activities. Has your ability to investigate nutritional anaemias improved? Are you more confident in differentiating causes based on lab results?
- Identify any challenges you experienced (e.g., interpreting mixed deficiencies, limited clinical history) and how you reacted to these. How did you try to overcome them?
- Identify anything significant about the activity, such as whether you needed to seek advice on interpreting complex results or recommending further tests. Did you ensure your interpretations and suggestions were within your scope of practice?
- Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in investigating dietary-related anaemia.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt. For example, identifying specific areas related to nutritional anaemias you need to study further e.g., impact of inflammation, B12/folate metabolism.
- What will you do differently next time in your approach to interpreting FBC and related tests when dietary causes are suspected?
- Do you need to practise any aspect of the activity further, such as interpreting iron studies or assessing B12/folate status?
Beyond action
Have you revisited the experiences?
- Reviewing your past experiences investigating dietary-related anaemia, have you reflected on your previous learning points? What specific aspects did you aim to improve, such as understanding different nutritional deficiencies or applying diagnostic algorithms?
- Have you successfully applied these improvements in subsequent investigations? Are you now more proficient in this area?
- Have you discussed cases of dietary anaemia or challenges in their investigation with peers or supervisors? Did these discussions provide new insights into the laboratory features or differential diagnoses associated with these conditions?
How have these experiences impacted upon current practice?
- How does the cumulative learning from investigating dietary-related anaemia, and your reflections, contribute to your overall preparation for assessments that may involve interpreting FBCs or discussing anaemia cases?
- How has your ability to select appropriate tests and accurately interpret results for dietary anaemias evolved over time? Are you more skilled at identifying patterns suggestive of specific deficiencies (e.g., iron, B12, folate) and recommending appropriate further action?
- How confident are you now in recognising when a case of anaemia may have complex or multifactorial causes requiring senior input?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 5 |
Outcome
Perform a range of laboratory-based techniques to investigate anaemia, red cell disorders and white cell disorders. |
| # 6 |
Outcome
Identify appropriate clinical and laboratory investigations and outline the management of acquired and hereditary red cell disorders. |
| # 7 |
Outcome
Perform quality assurance and control tasks across the range of investigations. |