Back Module: S-HT-S1

Application of Techniques, Interpretation and Differential Diagnosis

Module information

Module details

Title
Application of Techniques, Interpretation and Differential Diagnosis
Type
Specialist
Module code
S-HT-S1
Credits
20
Phase
2
Requirement
Compulsory

Aim of this module

This module will provide the trainee with detailed practical knowledge, understanding and experience of the application of techniques used in haematology, haemostasis and transfusion science for the screening investigation and interpretation of a range of clinical disorders.

Trainees will be expected to apply techniques and interpretation of results relevant to the clinical investigation by use of case studies and where applicable generate a differential diagnosis and identify appropriate downstream and/or reflex tests to aid diagnosis and disease classification.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret morphology for:

  • Peripheral blood
    • Normal
    • Red cells and platelets
    • Reactive white cells
    • Malignant
    • Malaria
  • Normal bone marrow populations
 Type ETA Action View
# 2 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret a full blood count and at least one other flow cytometry method

 Type ETA Action View
# 3 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret electrophoresis including:

  • HPLC
  • Gel electrophoresis
 Type DTA Action View
# 4 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret all of the following coagulation investigations:

  • PT
  • APTT
  • TT
  • Fibrinogen
  • D dimer
  • Anticoagulation monitoring
 Type ETA Action View
# 5 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret the appropriate techniques for the investigation of:

  • Haemostatic and platelet disorders
 Type DTA Action View
# 6 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret the appropriate techniques for the investigation of:

  • Thrombotic disorders
 Type DTA Action View
# 7 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret the appropriate techniques for the investigation of an acquired anaemia

 Type DTA Action View
# 8 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret the appropriate techniques for the investigation of an enzyme or red cell membrane disorder

 Type DTA Action View
# 9 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret the appropriate techniques for the investigation of an inherited disorder of haemoglobin

 Type DTA Action View
# 10 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret two of the following molecular methods:

  • FISH
  • PCR
  • Sequencing/high throughput sequencing
  • Copy number assessment (e.g. cytogenetics, MPLA, SNP array)
  • Expression analysis
 Type DTA Action View
# 11 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret serology for all of the following:

  • DAT
  • IAT
  • Serological cross matching
  • Electronic issue
  • ABO blood grouping
  • Rh phenotyping
 Type ETA Action View
# 12 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret the appropriate techniques for the investigation of a transfusion reaction

 Type DTA Action View
# 13 Learning outcome 1,2,3,4,5,6 Training activities

Perform and interpret the appropriate techniques for the investigation of haemolytic disease of the Fetus and newborn

 Type DTA Action View
# 14 Learning outcome 1,3,4 Training activities

Prepare a case study for an inherited bleeding disorder or thrombotic disorder which uses two or more appropriate multidisciplinary techniques

 Type DTA Action View
# 15 Learning outcome 1,3,4 Training activities

Prepare a case study for an acquired anaemia which uses two or more appropriate multidisciplinary techniques

 Type DTA Action View
# 16 Learning outcome 1,3,4 Training activities

Prepare a case study for an inherited disorder of haemoglobin which uses two or more appropriate multidisciplinary techniques

 Type DTA Action View
# 17 Learning outcome 1,3,4 Training activities

Prepare a case for an enzymopathy or red cell membrane disorder which uses two or more appropriate multidisciplinary techniques

 Type DTA Action View
# 18 Learning outcome 1,3,4 Training activities

Prepare a case study for a blood borne parasitic infection which uses two or more appropriate multidisciplinary techniques

 Type DTA Action View
# 19 Learning outcome 1,3,4 Training activities

Prepare a case study for haemolytic disease of the fetus and newborn which uses two or more appropriate multidisciplinary techniques

 Type DTA Action View
# 20 Learning outcome 1,3,4 Training activities

Prepare a case study for a transfusion reaction which uses two or more appropriate multidisciplinary techniques

 Type DTA Action View

Assessments

Complete 4 Case-Based Discussions

Complete 4 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Perform and interpret a full blood count.
  • Spread a blood film and perform a Romanowsky stain, set up the microscope and perform a manual WBC differential on a peripheral blood smear.
  • Select, set up, analyse and interpret a panel for flow cytometry.
  • Prepare and assess a malaria parasite screen.
  • Interpret an HPLC plot.
  • Set up and run a gel electrophoresis.
  • Set up, perform and interpret a coagulation screen and suggest further actions.
  • Set up and interpret FISH.
  • Set up and interpret PCR.
  • Set up and interpret an antibody screen and antibody panel.
  • Select appropriate units, set up and interpret serological cross match.
  • Set up and interpret additional red cell serology testing required during pregnancy.
  • Set up, perform and interpret factor assay.
  • Perform a manual PT and calculate INR.

Observed Clinical Event Titles

  • Provide results over the phone.
  • Discuss testing appropriateness with a healthcare professional.
  • Advise a healthcare professional on a technical issue with a sample which may cause limitations in testing.
  • Advise a healthcare professional on the appropriate sample type for a course of investigation.

Learning outcomes

# Learning outcome
1

Select techniques for the investigation of clinical presentations in haematology, haemostasis and transfusion science and medicine.
2

Perform the laboratory techniques required for the investigation of clinical presentations in haematology, haemostasis and transfusion science and medicine.
3

Interpret the results of the laboratory investigations for cases including red and white cell disorders and haemostatic and platelet disorders, haematological malignancy and transfusion serology.
4

Describe the limitations of techniques applied in the investigation of clinical presentations in haematology, haemostasis and transfusion science.
5

Apply the principles of internal quality control and external quality assessment and draw conclusions about assay performance.
6

Demonstrate appropriate communication skills to present the results of investigations and cases clearly to healthcare professional colleagues.

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 an multidisciplinary team meeting to appreciate how the multidisciplinary team works together and the discussion of results in relation to patient management.
  2. Attend clinics including a community-based clinic, for example an anticoagulation clinic, or a clinic for haematological malignancies.
  3. Observe a bone marrow biopsy being taken to appreciate the difficulties that can occur when taking a sample and implications for sample acceptance criteria.
  4. Attend or access a haematology or transfusion patient forum or local support group to appreciate the patient experience and context.
  5. Attend a bBlood donor session to appreciate the application of near patient testing and the relationship with the service users (donors).
  6. Observe thromboelastography (TEG) or ROTEM in use to appreciate its role in patient management.

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. Evaluate the principles and limitations of the techniques used for the investigation of clinical presentations in haematology, haemostasis and transfusion medicine.
  2. Critically interpret data generated from laboratory investigations of cases including red and white cell disorders, haemostatic and platelets disorders, haematological malignancies and transfusion serology.
  3.  Critically appraise current literature in haematology, haemostasis and transfusion medicine.

Indicative content

The principles and application of laboratory techniques and clinical investigations in haematology and transfusion science, to include:

  • Bone marrow and normal cell populations.
  • Trephine biopsy – normal architecture of cell populations.
  • Staining and visualisation of bone marrow cell populations.
  • Capillary electrophoresis and HPLC applications.
  • Flow cytometry and its applications in haematology and transfusion.
  • Coagulation investigations including PT, APTT, TT, fibrinogen, D dimer and anticoagulation monitoring.
  • Electrophoresis techniques and their applications.
  • Molecular techniques and their applications (FISH, PCR, sequencing, cytogenetics, MPLA and SNP).
  • Techniques relevant to red cell serology (DAT, IAT, crossmatching and blood grouping).

Knowledge of the aetiology, pathogenesis, diagnostic strategy and treatment of haematological and haemostatic disorders, including:

  • Inherited and acquired anaemias.
  • Haemoglobinopathies.
  • Red cell enzymopathies.
  • Thalassaemias.
  • Haemostatic and platelet disorders.
  • Thrombotic disorders.
  • Parasitic infections (malaria).

Understanding of red cell serology, transfusion reaction investigation and the BSH guidelines relevant to red cell investigations.

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SLS1-2-22 Specialty title Haematology & Transfusion Science [2022] Action View
Specialty code SLS1-2-23 Specialty title Haematology & Transfusion Science [2023] Action View
Specialty code SLS1-2-24 Specialty title Haematology & Transfusion Science [2024] Action View
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