Training activity information
Details
Perform an inhibitor screen and calculate the level in Bethesda units
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 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 prior knowledge of coagulation factors, inhibitors, and the Bethesda assay is required?
- What do you anticipate learning about the practical aspects of performing an inhibitor screen and the calculation of Bethesda units, including potential pitfalls?
- What is your current understanding of the principles behind inhibitor screens and the Bethesda assay?
- How will you prepare for this activity (e.g., reviewing relevant SOPs, understanding reagent preparation)?
- What challenges might you encounter during the procedure or the calculation (e.g., technical errors, data interpretation), and how will you approach them?
- What are your initial feelings about performing this complex assay?
In action
- What steps are you currently taking to perform the inhibitor screen assay? Are you meticulously following the protocol?
- As you obtain the assay results, are you noting any unusual patterns or values? How are you immediately checking for potential errors?
- When calculating the Bethesda units, are you double-checking your calculations at each step? Are you considering any potential sources of error in your calculation?
- If the results are unexpected, are you considering repeating any part of the process or seeking guidance?
On action
- What were the steps involved in performing the inhibitor screen?
- What reagents and controls were used in the assay?
- What were the results of the initial screening test? Was there evidence of an inhibitor?
- If an inhibitor was detected, what were the dilutions performed for the Bethesda assay?
- What was the calculated inhibitor level in Bethesda units?
- What is the clinical significance of factor inhibitors in haemostasis?
- What are the principles behind the Bethesda assay for quantifying factor inhibitors?
- What technical challenges can be encountered when performing inhibitor screens and Bethesda assays?
- How does the incubation of patient plasma with normal plasma help to identify and quantify inhibitors?
- How will this experience enhance your understanding of inhibitor testing and its role in diagnosing and managing bleeding disorders?
- What factors can affect the accuracy of inhibitor assays, and how can these be minimised?
- How will you ensure that results are reported accurately and in a clinically meaningful way?
- Where can you find relevant guidelines or standard operating procedures for inhibitor testing?
Beyond action
- Have you performed inhibitor screens and Bethesda assays in other cases since this training activity? Did you encounter similar or different types of inhibitors?
- Have you reviewed your reflect-on-action notes for this training activity? Has your understanding of inhibitor screening and quantification deepened?
- Can you recall instances where the results of an inhibitor screen and Bethesda assay influenced patient management or further investigations?
- Have you discussed inhibitor testing with colleagues or senior staff? Did these discussions provide new insights into the clinical significance of these tests?
- Has this training activity improved your technical skills in performing inhibitor screens and calculating Bethesda units? Do you now have a better understanding of the clinical relevance of factor inhibitors in bleeding disorders?
- Has this experience influenced your interpretation of coagulation results, particularly in cases of unexpected bleeding or treatment failure?
- Have the skills developed in this activity, such as precise pipetting and data analysis, been beneficial in other laboratory procedures?
- How will your experience with inhibitor testing prepare you for managing complex coagulation cases in the future?
- Will your ability to accurately perform and interpret these assays contribute to effective patient diagnosis and management of bleeding disorders?
- How might this experience support your potential involvement in specialised coagulation testing or research?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Identify appropriate clinical and laboratory investigations for the investigation of haemostasis. |
| # 2 |
Outcome
Interpret and report results of investigations of haemostasis in the correct clinical context. |
| # 7 |
Outcome
Perform quality assurance and control tasks across the range of investigations. |