Specialist Haematology —
Training activity: 13

Details

Select and interpret testing for the diagnostic techniques used 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.

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 selecting techniques, complying with national/international guidelines, and performing quality assurance specifically for AML and MDS?
• What specific knowledge do you need regarding the diagnostic criteria and the role of different laboratory modalities (e.g., morphology, immunophenotyping, and molecular analysis) before you begin?
• Is your primary goal to master the systematic diagnostic pathway for differentiating between high-grade MDS and AML, or to focus on the technical performance and interpretation of specific molecular markers?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding how morphology, cytochemistry, and molecular data (such as specific gene mutations) contribute to the classification and risk stratification of these cancers?
• Based on your prior knowledge, how do you anticipate this activity will deepen your understanding of the clinical context required to monitor the treatment of a patient with AML?
• How do you expect this experience to improve your ability to comply with BSH, WHO, and NICE guidelines when navigating the diagnostic algorithms for myeloid neoplasms?
• In what ways will this activity help you master quality assurance tasks, such as evaluating IQC and EQA performance for specialised molecular or flow cytometry assays?

What actions will you take in preparation for the experience?

• How will you discuss the diagnostic protocols and workflow with your Training Officer to ensure you have a clear understanding of departmental expectations for AML/MDS investigations?
• What possible challenges have you identified—such as interpreting borderline blast counts or reconciling conflicting data between morphology and cytogenetics—and how do you plan to handle them?
• Which national and international guidelines (e.g., WHO classification and BSH guidelines for MDS) will you review to ensure your interpretations are evidence-based?
• How do you feel about embarking on this investigation? Does acknowledging feelings of curiosity or anxiety regarding these complex malignancies help focus your attention on the precision required for patient diagnosis?

In action

What are you doing?

• Based on the initial clinical presentation or screening results (such as a full blood count or blood film), which specific diagnostic techniques (e.g., morphology, flow cytometry, or molecular tests) are you immediately choosing to perform, and what is your reasoning?
• How are you ensuring that your approach to selecting these tests complies with national and international guidelines (e.g., WHO classification or BSH guidelines) for the diagnosis of AML and MDS?
• What decisions are you making as the investigation progresses regarding which specific molecular markers or antibody panels are required?
• Which aspects of your practice feel intuitive—such as spotting dysplastic features—and which require more conscious effort, such as precisely identifying blast percentages in a borderline case?

How are you progressing with the activity?

• As you obtain results from various platforms (e.g., morphology, flow cytometry, and cytogenetics), how are you integrating this information in real-time to build a comprehensive diagnostic picture?
• How are you performing quality assurance and control tasks while the activity unfolds, such as checking internal quality controls (IQC) for molecular assays or ensuring the technical quality of bone marrow aspirate films?
• What challenges are you facing, such as differentiating high-grade MDS from AML based on available data, and what can you learn from this as the case develops?
• How does this activity connect to your existing knowledge of the aetiology and pathogenesis of myeloid malignancies?

How are you adapting to the situation?

• If you encounter unexpected results (e.g., a molecular marker that does not align with the morphology), how are you addressing this in the moment to ensure an accurate classification?
• Are you considering alternative approaches or further investigations—such as specific cytogenetic probes—if the initial results are equivocal or do not meet standard diagnostic criteria?
• Are you working within your defined scope of practice, and do you recognise the moment when you might need to seek immediate support or guidance from a senior colleague?
• How are you adapting your interpretive strategy to ensure results are reported in a way that effectively monitors the patient’s treatment progress?

On action

What did you notice?

• What were the key clinical features and peripheral blood findings (e.g., cytopenias, circulating blasts, or dysplastic features) that initially raised suspicion for AML or MDS in the case you investigated?
• Which specific diagnostic techniques did you select and perform, such as morphology, cytochemistry, immunophenotyping, cytogenetics, or molecular studies?
• What were the significant findings from the bone marrow aspirate and trephine, and how did the results from immunophenotyping or molecular testing (e.g., specific mutations) contribute to the definitive diagnosis?
• Regarding Quality Assurance, did you verify that all internal quality control (IQC) results for the molecular and flow cytometry assays were within acceptable limits before interpreting the patient data?
• Were there any notable reflection-in-action moments where you had to adapt your testing strategy based on unexpected initial findings?

What did you learn from the activity?

• How did this activity improve your ability to apply the diagnostic criteria for AML and MDS according to current WHO classifications and national guidelines?
• What did you learn about the characteristic morphological and molecular features that distinguish different subtypes of AML and MDS?
• In what ways did you learn to use these laboratory findings to inform prognosis and risk stratification for the patient?
• What challenges did you identify in differentiating between high-grade MDS and AML, and what did these difficulties teach you about the limitations of single-modality testing?
• How does the ability to perform these integrated investigations prepare you for the high-level analytical responsibilities required in post-programme practice?

What will you take from the experience moving forward?

• How will this experience enhance your future approach to selecting and interpreting results for suspected myeloid malignancies?
• What specific resources or guidelines (e.g., BSH, WHO, or NICE) have you identified as essential references for your future practice in this area?
• How will you ensure that you continue to contribute effectively to the integrated interpretation of results across different laboratory disciplines, such as cytogenetics and molecular haematology?
• What actions or ‘next steps’ will you take to further develop your expertise, such as using bone marrow atlases or textbooks to improve your recognition of subtle dysplastic features?
• How can you apply your learning regarding quality assurance and control tasks to ensure the ongoing reliability of complex diagnostic reports in your routine practice?

Beyond action

Have you revisited the experiences?

• Have you been involved in the investigation of other cases of AML or MDS since this training activity, perhaps encountering different subtypes or clinical presentations?
• How has your understanding of the diagnostic criteria and techniques for AML and MDS evolved since you first recorded your reflect-on-action notes?
• Can you recall specific Multidisciplinary Team (MDT) discussions where the diagnostic work-up for these myeloid neoplasms was presented? What were the key laboratory considerations debated by the team?
• Have you reviewed updated national and international guidelines, such as the WHO classification, to see how your diagnostic pathways for AML and MDS have been informed by current standards?
• Have you engaged in professional storytelling with peers or senior colleagues regarding these cases? Has this mutual exchange of experience transformed your view of complex diagnostic situations?

How have these experiences impacted upon your current practice?

• How has this training activity enhanced your ability to select the appropriate combination of morphology, immunophenotypic, molecular, and cytogenetic techniques for investigating suspected myeloid malignancies?
• Do you now have a better understanding of diagnostic algorithms and the clinical significance of specific findings—such as genetic mutations—in classifying these disorders?
• How has this experience influenced your ability to interpret results within the correct clinical context and account for essential prognostic factors?
• In what ways has the cumulative learning from this activity supported your preparation for observed ‘in-person’ assessments, such as the DOPS for ‘performing the initial morphological investigation for an acute leukaemia and determining confirmatory testing’?
• How consistently are you now performing and verifying quality assurance and control tasks across the full range of investigations to ensure result reliability?

How might these experiences contribute towards your future practice?

• How will your experience in diagnosing and monitoring AML and MDS prepare you for managing complex cases and staying updated with rapid advancements in the field?
• Will your ability to accurately interpret integrated diagnostic data contribute to more timely and appropriate treatment decisions, ultimately impacting patient care and outcomes?
• How might this experience support your development in a specialist role or your potential involvement in research related to the pathogenesis, diagnosis, or monitoring of myeloid neoplasms?
• What transferable skills, such as critical thinking and problem-solving in the context of multi-parameter data, will you carry forward into other areas of haematological diagnostics?

Relevant learning outcomes

#	Outcome
# 3	Outcome Select and interpret a range of laboratory and molecular testing techniques to diagnose and monitor treatment of haematological malignancy in the correct clinical context.
# 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.