Specialist Haematology —
Training activity: 15

Details

Select and interpret testing for the diagnostic techniques used for the investigation of acute lymphoblastic leukaemia (ALL) in paediatric and adult populations

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 ALL?
• In what ways will exploring the curriculum considerations—such as the WHO classification, aetiology, and pathogenesis of lymphoid malignancies—help guide your preparation?
• What background knowledge is required regarding the importance of immunophenotyping and cytogenetics in the classification and risk stratification of paediatric versus adult ALL?
• How will this activity help you define success in provide a diagnostic report that supports both the initial diagnosis and the monitoring of treatment in the correct clinical context?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the differences in diagnostic approaches and the significance of specific markers in paediatric versus adult populations?
• Based on your current knowledge, how do you anticipate this activity will deepen your understanding of prognostic factors and the use of molecular markers for monitoring treatment response?
• How do you expect this experience to improve your ability to comply with BSH, WHO, and NICE guidelines when navigating the diagnostic algorithms for lymphoblastic leukaemia?
• In what ways will this activity prepare you for the high-level analytical responsibilities required to ensure reliable results through the performance of quality assurance and control tasks?

What actions will you take in preparation for the experience?

• How will you discuss the diagnostic protocols and workflow for ALL with your Training Officer to ensure you have a clear understanding of departmental expectations?
• What possible challenges have you identified—such as interpreting results considering age-related differences or reconciling complex cytogenetic data—and how do you plan to handle them?
• Which national and international guidelines (e.g. WHO classification and age-specific diagnostic guidelines) 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 the weight of responsibility regarding paediatric diagnoses help you focus on the technical precision required?

In action

What are you doing?

• Considering the age of the patient and initial findings (e.g. a high white cell count or lymphoblasts on a blood film), which specific diagnostic techniques (morphology, immunophenotyping, or molecular tests) are you immediately selecting to perform?
• How are you ensuring that your approach to selecting these tests complies with national and international guidelines, such as the WHO classification, for the diagnosis of ALL in both paediatric and adult populations?
• What decisions are you making as the activity progresses, for example, how does the paediatric context change your priority for specific genetic markers compared to an adult case?
• Which aspects of your practice feel intuitive, such as recognising lymphoid morphology, and which require more conscious effort, such as integrating complex cytogenetic and molecular data into a final classification?

How are you progressing with the activity?

• As you obtain results from various platforms (e.g. flow cytometry alongside morphology), how are you integrating this information in real-time to refine your interpretation and identify prognostic markers?
• How are you performing quality assurance and control tasks while the investigation is underway, such as verifying that IQC and EQA parameters for the immunophenotyping panels are within acceptable limits before you interpret the patient’s results?
• What challenges are you facing during this activity—such as resolving conflicting results between morphology and molecular data—and what are you learning from these as they unfold?
• How does this investigation connect to your existing knowledge of the aetiology and pathogenesis of ALL?

How are you adapting to the situation?

• If you encounter unexpected results or urgent findings, how are you adapting your strategy to ensure the clinical team is informed promptly for immediate patient management?
• Are there alternative approaches you should consider, such as requesting additional fish probes or molecular markers, if the initial data does not allow for a clear WHO classification?
• Are you working within your defined scope of practice, and at what point do you recognise that you need support or guidance from a senior colleague or the multidisciplinary team (MDT)?
• How are you adapting your interpretive strategy to ensure the results provide the necessary baseline data for monitoring treatment response moving forward?

On action

What did you notice?

• What were the key clinical features and peripheral blood findings (e.g. lymphocytosis, cytopenias, or circulating blasts) that initially raised suspicion for ALL in the paediatric or adult cases you investigated?
• Which specific diagnostic techniques did you select, such as morphology, immunophenotyping, cytogenetics, or molecular studies?
• What were the significant findings from the bone marrow aspirate and immunophenotyping (e.g. B-cell vs T-cell lineage), and how did they contribute to the definitive diagnosis?
• Regarding Quality Assurance, did you verify that the internal quality control (IQC) and external quality assurance (EQA) results for the flow cytometry and molecular assays were within acceptable limits before you interpreted the patient data?
• Were there any notable reflection-in-action moments where you had to adapt your testing strategy based on the patient’s age or initial results?

What did you learn from the activity?

• How did this activity improve your ability to apply the diagnostic criteria for ALL according to current WHO classifications and national guidelines for both paediatric and adult populations?
• What did you learn about the characteristic immunophenotypic and cytogenetic features (e.g. BCR::ABL1 or KMT2A rearrangements) that distinguish subtypes of ALL and influence prognosis and risk stratification?
• In what ways did you learn to use laboratory findings to monitor treatment response (e.g. minimal residual disease assessment) in the correct clinical context?
• What challenges did you identify in diagnosing and classifying ALL, and how did these challenges differ between the paediatric and adult cases you encountered?
• How does the ability to perform these integrated investigations relate to the high-level analytical requirements of 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 lymphoid malignancies?
• What specific resources or guidelines (e.g. BSH, WHO, or NICE) have you identified as essential references for navigating age-specific diagnostic considerations?
• How will you ensure you continue to contribute effectively to the integrated interpretation of results across different laboratory disciplines?
• What actions or ‘next steps’ will you take, such as attending a multidisciplinary team (MDT) meeting to observe how laboratory data influences clinical management decisions?
• How can you apply your learning regarding quality assurance and control to maintain the reliability of complex diagnostic and monitoring reports in your routine practice?

Beyond action

Have you revisited the experiences?

• Since completing this training activity, have you been involved in further cases of ALL, specifically comparing the diagnostic work-up and prognosis between paediatric and adult patients?
• How has your understanding of the immunophenotypic and molecular characteristics (e.g. B-cell vs T-cell lineage and associated genetic markers) used to classify ALL subtypes evolved?
• Can you recall Multidisciplinary Team (MDT) discussions where the laboratory’s role in risk stratification was debated?
• How has professional storytelling with peers or senior colleagues changed your perspective on the complexities of diagnosing aggressive lymphoid malignancies?
• As part of a module review for Specialist Haematology (S-HT-S2), how does this experience with ALL connect to your learning regarding other haematological malignancies, such as AML or MPN?

How have these experiences impacted upon your current practice?

• How has this training activity enhanced your ability to select and interpret laboratory and molecular testing in the correct clinical context, particularly for monitoring treatment through methods like minimal residual disease (MRD)?
• In what ways do you now more consistently comply with national and international guidelines (e.g. WHO classification or MRC clinical trial protocols) when classifying lymphoid neoplasms?
• How has your focus on quality assurance and control matured, such as ensuring IQC and EQA for flow cytometry and molecular assays are robust before finalising reports?
• How has this cumulative learning supported your preparation for observed ‘in-person’ assessments, such as a DOPS for investigating acute leukaemia or a Case-based Discussion (CBD)?
• Are the analytical and interpretative skills developed here—such as synthesising multi-parameter data—now being applied across other areas of your diagnostic practice?

How might these experiences contribute towards your future practice?

• How will your experience in the integrated investigation of ALL prepare you for managing aggressive leukaemia and understanding the rationale behind risk-adapted therapy?
• Will your ability to accurately interpret complex diagnostic data contribute to informed clinical decision-making, ultimately improving outcomes for both paediatric and adult patients?
• What actions for continued development have you identified, such as staying updated on emerging molecular markers or advancements in MRD monitoring technologies?
• How might this experience support your progression towards a specialist role, where you may be responsible for implementing new diagnostic protocols or leading quality improvement initiatives?

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.