Specialist Haematology —
Training activity: 6

Details

Select and interpret the appropriate tests for screening for a micro angiopathic haemolytic anaemia for example DIC and TTP

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 the identification of appropriate investigations, the interpretation of results within a specific clinical context, and the performance of quality assurance tasks for haemostasis?
• What do you need to know about the aetiology and pathogenesis of microangiopathic haemolytic anaemia (MAHA) and thrombotic disorders before you begin selecting and interpreting tests?
• How will this activity help you develop the detailed practical knowledge required to distinguish between different causes of red cell fragmentation and haemostatic failure?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain from engaging with the laboratory investigation of MAHA, particularly regarding the correlation between morphological findings (e.g., schistocytes) and coagulation profiles?
• Based on what you already know about the coagulation cascade and red cell disorders, what new understanding do you expect to gain about the clinical urgency and management of conditions like TTP and DIC?
• How do you anticipate this experience will improve your ability to draw conclusions about assay performance when applying internal quality control (IQC) to specialised haemostasis testing?
• In what ways will this activity prepare you for the high-level analytical and interpretive responsibilities required for your future role as a Healthcare Scientist?

What actions will you take in preparation for the experience?

• How will you discuss the specific screening protocols for MAHA with your training officer to ensure you have a clear understanding of the expected diagnostic pathway?
• What possible challenges have you identified—such as the difficulty in interpreting equivocal results or managing urgent turnaround times—and how do you plan to handle them?
• Which clinical guidelines (e.g., BSH guidelines for DIC or TTP) will you gather beforehand to ensure your interpretations are robust and evidence-based?
• How do you feel about embarking on this training activity, given the critical and high-stakes nature of these diagnoses, and what areas have you identified as requiring the most focused preparation?

In action

What are you doing?

• As you identify appropriate investigations for haemostasis, what specific rationale are you using to select tests such as a coagulation screen, fibrinogen, D-dimer, and blood film morphology?
• How are you approaching the performance of these tests—why are you following certain procedural steps, and what decisions are you making as the data begins to emerge?
• What aspects of MAHA screening feel intuitive due to your experience, such as spotting red cell fragmentation, and what requires more conscious effort, such as correlating subtle coagulation abnormalities with a complex clinical history?
• Are the steps you are taking in the moment logically addressing the need to differentiate between DIC and TTP?

How are you progressing with the activity?

• How effective are your current actions in interpreting results that may indicate an urgent clinical condition?
• What challenges are you facing as the activity unfolds, such as managing urgent turnaround times for life-threatening diagnoses or interpreting ambiguous morphological features on a blood film?
• How are you applying the principles of internal quality control (IQC) and quality assurance in real-time to ensure the performance of your assays is reliable before you report any results?
• How does this practical activity connect to your existing knowledge of the aetiology and pathogenesis of microangiopathic disorders?

How are you adapting to the situation?

• Based on the emerging laboratory data, are there alternative investigations or reflex tests (such as ADAMTS13 assays or LDH levels) that you should be considering to clarify the clinical context?
• What support or guidance do you need in this moment—for instance, should you consult a senior scientist or haematologist if you suspect a case of TTP?
• Are you confident that your real-time interpretations and reporting decisions remain within your defined scope of practice as a trainee?
• How are you adapting your communication of these findings to ensure the clinical urgency is understood by the medical team?

On action

What did you notice?

• How would you summarise the key procedural steps you took in selecting and interpreting the screening panel for MAHA, such as the FBC, blood film examination, and coagulation assays (PT, APTT, Fibrinogen, D-dimer)?
• What were the significant findings in the case—for instance, the presence of schistocytes on the film or a specific pattern of consumption in the coagulation profile—that stood out during your analysis?
• How did you evaluate the internal quality control (IQC) and external quality assessment (EQA) data to ensure the assay performance was reliable before you interpreted the results in a clinical context?
• What did you notice about the urgency of the case, and how did this affect the speed and focus of your laboratory investigations?

What did you learn from the activity?

• What new skills did you develop regarding the selection of laboratory investigations to differentiate between causes of microangiopathy like DIC and TTP?
• How has your ability to interpret and report results within a specific clinical context improved, particularly when identifying life-threatening features?
• Were there any unexpected challenges (such as ambiguous morphology) or successes (such as identifying a rare diagnostic clue), and what did they teach you about the limitations of the screening tests?
• In what ways did your reflection-in-action (the decisions you made while looking at the film or data) influence the final diagnostic conclusion or the decision to escalate findings?
• How does this activity relate to the high-level professional and interpretive responsibilities you will hold as a post-programme Clinical Scientist?

What will you take from the experience moving forward?

• What specific areas for continued development have you identified in your ability to manage complex haemostasis investigations or troubleshoot assay performance?
• How will you apply the learning from this activity to your routine laboratory practice, particularly when integrating morphological findings with coagulation results for a differential diagnosis?
• What specific ‘next steps’ will you take—such as reviewing the BSH guidelines for DIC or TTP—to further support the assimilation of what you have learned?
• What support or resources, such as a specialist haematology workshop or mentoring from a consultant haematologist, would help you further develop your expertise in this area?

Beyond action

Have you revisited the experiences?

• How has your understanding of the pathophysiology and diagnostic pathways for DIC and TTP evolved since you first began selecting and interpreting these screening panels?
• Have you reviewed the actions for improvement identified in your previous reflections, such as refining your rationale for test selection or improving your turnaround times for these urgent investigations?
• When reviewing this activity as part of the broader Specialist Haematology (S-HT-S2) module, how has your ability to differentiate between various acquired bleeding and thrombotic disorders grown?
• Have you engaged in professional storytelling with peers or senior scientists regarding the challenges of interpreting “borderline” MAHA results, and has this mutual exchange changed your perspective on complex diagnostic cases?

How have these experiences impacted upon your current practice?

• How has the cumulative learning from investigating DIC and TTP cases supported your ability to interpret results in the correct clinical context, particularly in high-pressure or emergency scenarios?
• In what ways has this experience improved your proficiency in performing quality assurance and control tasks across a range of haemostasis investigations to ensure assay performance is reliable?
• How has your training in MAHA screening supported your preparation for observed ‘in-person’ assessments, such as a DOPS on investigating unexplained bleeding or an OCE presenting a case to other healthcare professionals?
• How has your practice evolved to more clearly recognise the boundaries of your scope of practice when managing these high-risk investigations?

How might these experiences contribute towards your future practice?

• What transferable skills, such as the ability to rapidly integrate clinical history with laboratory data or the critical evaluation of assay performance, will be most essential in your future career?
• Based on these reflections, what clear actions for continued development have you identified, such as deepening your knowledge of BSH guidelines or the genetic basis of thrombotic disorders?
• How does the learning from this activity provide the foundation for the high-level analytical and interpretive responsibilities required of a post-programme Clinical Scientist in the field of Specialist Haematology?

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.