Specialist Haematology —
Training activity: 10

Details

Select and interpret the appropriate tests for easy bruising, bleeding or menorrhagia

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.

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 intended outcomes of the training activity?

• How will you focus your attention on identifying investigations, interpreting results in a clinical context, and performing quality assurance for patients with bleeding symptoms?
• What foundational knowledge do you need regarding the coagulation cascade and the differentiation between platelet disorders and factor deficiencies before you begin selecting tests?
• Is your primary goal to master the systematic diagnostic pathway for unexplained bleeding or to focus on the technical performance of screening tests like PT, APTT, and Fibrinogen?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the selection of subsequent test panels when initial screening results are equivocal or normal despite significant clinical symptoms?
• Based on your prior knowledge of full blood counts (FBC) and morphology, how do you anticipate this activity will deepen your understanding of the correlation between test abnormalities and specific bleeding disorders?
• How will this experience improve your ability to perform quality assurance tasks, ensuring that pre-analytical variables and assay limitations are accounted for before reporting results?
• In what ways will this activity prepare you for the high-level analytical responsibilities required to provide specialist advice to clinical teams for patient management?

What actions will you take in preparation for the experience?

• How will you discuss the investigation strategies and local protocols with your Training Officer to ensure your selection of tests aligns with departmental Standard Operating Procedures (SOPs)?
• What possible challenges have you identified—such as identifying mild factor deficiencies or managing acquired inhibitors—and how do you plan to handle these during the interpretation phase?
• Which national guidelines (e.g., BSH guidelines for investigating bleeding disorders) will you review to ensure your interpretations are evidence-based and aligned with current best practice?
• How do you feel about investigating these clinical presentations, and does acknowledging the potential impact on patient diagnosis help focus your attention on technical and interpretive precision?

In action

What are you doing?

• As you select and perform the tests, are the investigations you are choosing clinically appropriate for potential causes of easy bruising or menorrhagia based on the patient’s history?
• Why are you performing each specific test in this particular way, and how does your approach align with the scientific basis of analytical procedures for bleeding disorders?
• What decisions are you making as the laboratory investigation progresses, particularly when deciding which secondary tests (such as specific factor assays) are required?
• Which aspects of your practice currently feel intuitive—such as recognising a prolonged clotting time—and which require more conscious effort, such as the precise technical handling required for factor assays?

How are you progressing with the activity?

• How effective are your actions in achieving a clear diagnostic picture, and are you correctly identifying the necessary investigations for haemostasis?
• What challenges are you facing during this activity, such as a mild phenotype that produces borderline results or a complex clinical history that makes interpretation difficult?
• What can you learn from the case as it unfolds regarding the spectrum of bleeding disorders and how laboratory findings correlate with patient symptoms?
• How does this activity connect to your existing knowledge of the coagulation cascade and the clinical presentation of primary versus secondary haemostasis defects?

How are you adapting to the situation?

• When you encounter unexpected results or inconsistencies between different tests, what decisions are you making about planning the next steps in the investigation?
• How are you incorporating quality assurance tasks in the moment, such as verifying that internal quality control (IQC) results are within range before interpreting patient data?
• Are you working within your defined scope of practice, and are you considering when to ask for immediate assistance from a more experienced colleague if you are unsure about a pattern of results?
• How are you adapting your interpretive approach to ensure the final report is delivered in the correct clinical context?

On action

What did you notice?

• How would you summarise the key points of the investigation, starting from the clinical presentation (easy bruising, bleeding, or menorrhagia) to the selection of the initial screening panel (e.g., FBC, PT, APTT, Fibrinogen)?
• What specific reagents and controls were used, and did you verify that the internal quality control (IQC) was within acceptable limits before you proceeded with the interpretation?
• Which moments or interactions during the process felt most significant—for example, interpreting a borderline result or discussing the patient’s clinical history with a senior colleague?
• Were there any ‘reflect-in-action’ moments where you had to adapt your testing strategy, such as adding a specific factor assay or von Willebrand screen because the initial results were normal despite the clinical history?

What did you learn from the activity?

• What new knowledge did you develop regarding the tiered approach to laboratory investigation and the range of potential causes for primary and secondary haemostasis defects?
• How did this experience improve your ability to interpret and report results in the correct clinical context, such as distinguishing between a mild inherited disorder and a temporary acquired state?
• What unexpected challenges did you encounter (e.g., technical interference or vague clinical symptoms), and what did they teach you about the limitations of current assay methodologies?
• How did your real-time decisions (reflect-in-action) influence the final outcome—did your ability to be responsive and intuitive improve the efficiency of the diagnostic pathway?
• In what ways does the ability to manage these complex investigations relate to the high-level interpretive requirements you will face in post-programme practice as a Clinical Scientist?

What will you take from the experience moving forward?

• What specific areas for continued development have you identified, such as a need to better understand the genetic basis of functional defects or the interpretation of complex factor panels?
• How will you apply the learning from this activity to your routine practice, particularly when providing guidance to clinical teams on the most appropriate ‘next steps’ for a bleeding patient?
• What specific actions will you take to support your learning, such as reviewing BSH guidelines or local Standard Operating Procedures (SOPs) for the investigation of menorrhagia?
• What support or resources would be beneficial for your further development—perhaps observing a specialised haemostasis clinic or seeking mentoring on the investigation of rare factor deficiencies?

Beyond action

Have you revisited the experiences?

• How has your understanding of the differential diagnoses for easy bruising and menorrhagia changed since you first reviewed your reflections for this activity?
• Have you reviewed the specific actions identified in your previous reflections to enhance your test selection and interpretation skills (e.g., applying BSH guidelines), and have you successfully implemented these in more recent cases?
• Have you engaged in professional storytelling with peers or senior colleagues regarding challenging cases of unexplained bleeding? How did their perspectives on the laboratory’s role in the diagnostic pathway transform your own approach?
• When revisiting this training activity as part of a broader review of the Specialist Haematology (S-HT-S2) module, how does it connect with other activities, such as investigating prolonged clotting times or platelet disorders?

How have these experiences impacted upon your current practice?

• How does the cumulative learning from investigating these diverse clinical presentations support your preparation for relevant observed ‘in-person’ assessments, such as the DOPS for ‘investigating a patient with unexplained bleeding’ or the OCE for ‘communicating the risk of bleeding to a surgical team’?
• In what ways has your expertise in tailoring investigations based on clinical history and reporting in the correct clinical context developed and evolved over time?
• How has your ability to perform quality assurance and control tasks become more integrated into your routine practice to ensure the reliability of complex haemostasis results?
• How effectively can you now recognise when a case is particularly complex or rare and requires escalation to a senior colleague, ensuring you are always working within your defined scope of practice?

How might these experiences contribute towards your future practice?

• What transferable skills have you developed—such as the systematic integration of clinical data with laboratory results or advanced report writing—that will be essential in your future career?
• Based on these reflections, what clear actions for continued development have you identified, such as pursuing deeper expertise in the genetic basis of functional defects or specialised factor assays?
• How does your mastery of these investigations provide the foundation for the high-level analytical and interpretive responsibilities you will hold as a post-programme Clinical Scientist?

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.