Back Module: S-CI-S1

Immunodeficiency and Immunotherapeutics

Module information

Module details

Title
Immunodeficiency and Immunotherapeutics
Type
Specialist
Module code
S-CI-S1
Credits
20
Phase
2
Requirement
Compulsory

Aim of this module

This module aims to provide trainees with knowledge and understanding of the presentation, laboratory investigation, and clinical urgency of investigating patients with suspected immune deficiency or immune dysregulation. This module also aims to provide trainees with knowledge and understanding of the immunotherapeutic options, available for these and other patients with immunological conditions, and the interpretation of Immunological investigations in the light of these treatments.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 1 Training activities

Select the appropriate immunological assay(s) to investigate individuals with a history of recurrent, severe or protracted infections with the follow pathogen types:

  • Viral
  • Bacterial
  • Fungal
 Type ETA Action View
# 2 Learning outcome 1 Training activities

Select the appropriate immunological assay(s) to investigate an individual where the clinical history and the result of other investigations are suggestive of a severe, life threatening immunodeficiency

 Type ETA Action View
# 3 Learning outcome 1 Training activities

Select the appropriate immunological assay(s) to investigate individuals with immune dysregulation

 Type ETA Action View
# 4 Learning outcome 1 Training activities

Perform and technically validate investigation of immunodeficiency to include all of the following:

  • Immunoglobulins and IgG subclasses
  • Specific antibody responses to vaccine antigens
  • Complement levels and function
 Type ETA Action View
# 5 Learning outcome 1 Training activities

Perform and technically validate investigation of immunodeficiency to including all of the following:

  • Lymphocyte subsets
  • B cell memory phenotyping
  • Extended T cell phenotyping

And one of the following:

  • Neutrophil function tests
  • Lymphocyte function tests
 Type DTA Action View
# 6 Learning outcome 1,2 Training activities

Identify two cases that require molecular diagnostic follow up work and recommend appropriate assays

 Type DTA Action View
# 7 Learning outcome 2,3 Training activities

Interpret immunological data, in the light of patient history and associated laboratory results, for a patient with a B cell immunodeficiency

 Type DTA Action View
# 8 Learning outcome 2,3 Training activities

Interpret immunological data, in the light of patient history and associated laboratory results, for a patient with a deficiency in cellular innate immunity

 Type DTA Action View
# 9 Learning outcome 2,3 Training activities

Interpret immunological data, in the light of patient history and associated laboratory results, for a patient with a deficiency in humoral innate immunity

 Type DTA Action View
# 10 Learning outcome 2,3 Training activities

Interpret immunological data in the light of patient history and associated laboratory results for a patient with a combined T and B cell immunodeficiency

 Type DTA Action View
# 11 Learning outcome 2,3 Training activities

Interpret immunological data in light of patient history and associated laboratory results, patients with secondary immunodeficiency, including all of the following:

  • Iatrogenic
  • Neoplasia
  • Infection
 Type DTA Action View
# 12 Learning outcome 1,2 Training activities

Prepare a case for discussion at multidisciplinary team meeting for a patient with suspected immunodeficiency

 Type DTA Action View
# 13 Learning outcome 2,3 Training activities

Identify a paediatric patient with a primary immunodeficiency that requires urgent action and recommend next steps

 Type ETA Action View
# 14 Learning outcome 2 Training activities

Report results for a patient receiving an immunotherapy, review the effectiveness, including at least three of the following:

  • Monoclonal antibody therapy
  • Immunosuppressive drugs
  • Physical methods of immunosuppression
  • Cytokines and anti-cytokines
  • Intravenous immunoglobulins
  • Immunisation against infection
  • Stem cell therapies
  • Gene therapies
  • Cell therapy
 Type ETA Action View
# 15 Learning outcome 2 Training activities

Report results of a patient who has received an immunotherapy leading to potential secondary immunodeficiency for at least two of the following:

  • Monoclonal antibody therapy
  • Immunosuppressive drugs
  • Physical methods of immunosuppression
  • Cytokines and anti-cytokines
  • Cell therapy
 Type DTA Action View
# 16 Learning outcome 2 Training activities

Draft reports including interpretive clinical comments in light of clinical details and associated laboratory results for borderline abnormal immunological investigations including:

  • Immunoglobulins
  • Complement levels and/or function
  • Lymphocyte subsets
 Type ETA Action View
# 17 Learning outcome 4 Training activities

Resolve a technical issue with assays involved in measuring immune response for two of the following:

  • Acute phase reactants
  • Complement level or function
  • Measurement of immunoglobulins
  • Functional assays to detect humoral immune responses to pathogens
  • Cellular components and function
 Type DTA Action View
# 18 Learning outcome 4,5 Training activities

Interpret performance for EQA/interlaboratory comparisons for a range of assays involved in assessing potential immunodeficiency or immune response to pathogens, problem solve where required, including:

  • Immune monitoring
  • Interferon gamma release assays
  • Specific proteins
  • Assays not covered by EQA schemes
 Type DTA Action View
# 19 Learning outcome 4 Training activities

Perform an audit of a laboratory procedure(s) relating to investigations used in the diagnosis of immunodeficiency

 Type DTA Action View
# 20 Learning outcome 4,6 Training activities

Participate in a formal review of performance characteristics or perform a verification/validation of a procedure, for one assay involved in the investigation of the following:

  • Immunodeficiency
  • Immune response to pathogens
  • Immune dysregulation
 Type DTA Action View
# 21 Learning outcome 1,2 Training activities

Perform and interpret cellular immunological assays to establish exposure to a pathogen, for example TB

 Type ETA Action View

Assessments

Complete 4 Case-Based Discussions

Complete 4 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Perform and interpret flow cytometric assays for enumeration of lymphocyte subsets.
  • Perform and interpret functional assay to assess cellular immune function.
  • Perform and interpret assays used to assess humoral immune function.
  • Evaluate EQA of diagnostic assays for investigating Immunodeficiency.

Observed Clinical Event Title

  • Communicate results on a patient with an impaired immune system to the requesting clinician.
  • Select appropriate immunological investigations based on a patient history.
  • Summarise a multidiscplinary team meeting for a patient with suspected immunodeficiency.

Learning outcomes

# Learning outcome
1

Select and perform a range of assays for the investigation of primary and secondary immunodeficiency, including a range of flow cytometry assays.
2

Interpret and report on laboratory investigations that enumerate components of this immune system and its function in light of clinical details and other laboratory tests.
3

Identify and escalate urgent abnormal test results and report urgent abnormal results to the requesting healthcare professional, according to local protocols.
4

Practice in accordance with quality and accreditation standards, assess the performance of laboratory tests or procedures and take corrective action where required.
5

Evaluate methods of external quality assurance for assays investigating immunodeficiency.
6

Apply verification and validation procedures for diagnostic assays investigating immunodeficiency.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  1. Attend multidisciplinary team meetings for an appropriate clinical specialty.
  2. Observe assays performed in a specialist centre to assess the function of components of the immune system.
  3. Attend a clinic for patients with immunodeficiency.
  4. Attend an event where patients discuss their experiences, using reflective practice.
  5. Visit a histocompatibility and immunogenetics lab to observe and appreciate the process of assessing a patient for and performing a stem cell transplant.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Explain the coordination of the components of the immune system during an immune response.
  2. Discuss the role of the immune system in defence against infection and in response to cancer.
  3. Describe how the features of clinical presentation indicate immunodeficiency.
  4. Apply integrative knowledge of primary and secondary causes of immunodeficiency.
  5. Discuss how immune deficiencies help to define the function of components within the immune system.
  6. Critically evaluate the design, operation and performance of laboratory tests and assays used to investigate and define immunodeficiency.
  7. Explain the principles of immunotherapy with relation to the immune system.
  8. Describe and monitor the impact of immunotherapeutic treatments.
  9. Discuss and justify appropriate immunotherapeutic strategies and treatment regimens for patients with a range of immune disorders and cancer.

Indicative content

  • Fundamental immunological processes
    • Innate defence mechanisms and inflammation
    • Pathogen recognition
    • Complement
    • Innate lymphoid cells
    • Antigen presentation
    • B- and T-lymphocyte development, differentiation and activation
    • Immunoglobulins
    • Secondary lymphoid organs
    • Regulation and resolution of immune response
  • Contextualised immunity
    • Mucosal immunology (lung and gut)
    • Viral infections (immune defences; viral counter defences)
    • Bacterial infections (immune defences; bacterial counter defences)
    • Parasite infections (immune defences; parasite counter defences)
    • Fungal infections (immune defences; fungal counter defences)
    • Immunisation and vaccination (design, types, adjuvants)
  • Cancer immunology
    • Tumour markers and antigens
    • Cancer-immunity cycle and tumour surveillance
    • Tumour microenvironment
    • Immunoediting and tumour escape mechanisms
    • Cancer immunotherapy
  • Combined T- and B-lymphocyte defects
    • Severe combined immunodeficiency (SCID) (linked to defects in: common gamma-chain, JAK3, IL7Ra, RAG, Artemis. ADA, purine nucleoside phosphorylase, Zap70)
    • Wiskott-Aldrich syndrome
    • Primary HLH
  • B-lymphocyte (immunoglobulin) deficiencies
    • X-linked agammaglobulinaemias, hyper IgM syndromes, common variable immunodeficiency, selective IgA deficiency, IgG subclass deficiency, transient hypogammaglobulinaemia of infancy, selective specific antibody deficiencies
  • T-lymphocyte (cellular) deficiencies
    • Di George syndrome; bare lymphocyte syndrome, ALPS
  • Deficiencies of innate immunity
    • Phagocytic cell defects, leukocyte adhesion defects, complement system defects, TLR deficiencies
  • Primary immune regulatory disorders
    • TRAPS, CAPS, FMF, HIDS
  • Secondary immunodeficiencies
    • Iatrogenic, neoplasia, nutrition, infection
    • HIV – pathogenesis, epidemiology, prevalence, transmission, detection, monitoring, management
  • Laboratory assays used to assess immune function/concentration
    • Cellular assays, functional assays, flow cytometry
    • Genetic sequencing and gene panels
  •  Immunotherapy
    • Immunosuppression (corticosteroids, cyclosporin and tacrolimus, other anti-inflammatory agents
    • Biological therapies: monoclonal antibodies (structure and design, mono- and bi-specificity, antibody-drug conjugates)
    • Biological therapies: cytokines and related products
    • Immunogenicity of biological therapy
    • Therapeutic drug monitoring
    • Immunoglobulin products (pools, specific uses)
    • HSCT
    • Gene therapy & gene editing for immune conditions
    • Advanced cellular therapies (CAR-T, TILs, DC vaccines)

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SLS1-3-22 Specialty title Clinical Immunology [2022] Action View
Specialty code SLS1-3-23 Specialty title Clinical Immunology [2023] Action View
Specialty code SLS1-3-24 Specialty title Clinical Immunology [2024] Action View
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