Clinical Immunology in Histocompatibility and Immunogenetics

Module details

Title

Clinical Immunology in Histocompatibility and Immunogenetics

Type

Specialist

Module code

SLS122

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with the practical application of knowledge and skills relating to a range of immunological conditions, including immunodeficiencies, hypersensitivities and allergies and haematological malignancies. This module will provide the trainee with knowledge and understanding of the scientific basis of organ transplantation. They will understand the clinical preparation of patients for organ transplantation and the principles and practice of immunogenetics. They will become familiar with methods that support transplantation and gain experience of the interpretation of patient results in a variety of clinical settings. The trainee should be based in or spend extended time in a histocompatibility and immunogenetics department.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Select the appropriate immunological assay to investigate whether the immune system of the patient is immunocompetent or immunodeficient and have the laboratory skills to undertake at least two of the following laboratory analyses: assay of immunoglobulins and subclasses neutrophil function tests lymphocyte function tests specific antibody responses to vaccine antigens complement activity cytokine production molecular assays to define immunodeficiencies.	Action View
# 2	Learning outcome 2	Competency Interpret immunological data in the light of clinical details on patients with primary immunodeficiency including: deficiencies of innate immunity B Lymphocyte deficiencies T Lymphocyte deficiencies combined T and B cell defects.	Action View
# 3	Learning outcome 1	Competency Select the appropriate immunological assay to investigate whether the immune system of the patient is producing an allergic response.	Action View
# 4	Learning outcome 2	Competency Interpret allergy test data in the light of clinical details and on patients with a range of common allergies including: food allergy inhalant allergy drug allergy.	Action View
# 5	Learning outcome 1	Competency Select the appropriate immunological assay to investigate the immune system of patients with haematological malignancies such as: Chronic lymphocytic leukaemia Acute leukaemia Lymphomas Multiple myeloma Waldenstrom’s macroglobulinaemia Post BMT lymphocyte levels (immune reconstitution).	Action View
# 6	Learning outcome 2	Competency Interpret data from immunological investigations, such as: Flow cytometry Morphological assays Relevant molecular techniques Electrophoresis Free light chains Immunoglobulin measurement.	Action View
# 7	Learning outcome 3	Competency Work in partnership with other clinical specialisms in the investigation of a range of immunological conditions and, where appropriate, with service users and support staff.	Action View
# 8	Learning outcome 3	Competency Communicate effectively with the healthcare team recognising and responding appropriately to situations where it is necessary to share information to safeguard service users or the wider public.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform a test to measure IgE to an allergen	DOPS
Perform the test to determine total IgE levels in the serum of a patient	DOPS
Prepare DNA from a patient with a suspected haematological malignancy.	DOPS
Perform flow cytometric immunophenotyping on a patient following bone marrow reconstitution to determine whether lymphocyte subsets are returning.	DOPS
Perform analysis of a patients serum to determine levels of immunoglobulins IgG, IgM IgA	DOPS
Perform the assay to determine the level of anti-tetanus Or anti-pneumococcus Or anti-Hib IgG antibodies in a patient serum sample	DOPS
Perform the flow cytometric assay to determine the number of CD4 T cells	DOPS
Perform the assay to determine the C3 and C4 levels in a patient sample	DOPS
Undertake a skin prick test on a patient and explain to the patient how it is used by the lab	OCE
Observe a patch test on a patient and explain to the patient how it is used	OCE
Take a patient history for a patient with a suspected allergic reaction.	OCE
Attend an adult haematology clinic where haematological patients with myeloma may or may not have secondary immunodeficency and specifically note the types of laboratory assays that may be requested to assist in their management	OCE
Attend a paediatric haematology clinic where haematological patients with acute leukaemias will be assessed and specifically note the types of laboratory assays that may be requested to assist in their management	OCE
Take a history where the patient is suspected of having an immunodeficiency disorder	OCE
Attend an outpatient clinic within any discipline gastro rheumatology, dermatology, renal etc where the patient may have an immunological dysfunction as part of their disease	OCE

Learning outcomes

1. Select appropriate methods for the diagnosis and management of a range of immunological conditions.
2. Interpret and report results of clinical investigations undertaken in patients with:
   • immunodeficiency
   • hypersensitivity and allergy
   • haematological malignancies
   • a transplantation procedure
3. Work in partnership with other clinical specialisms in the investigation and therapy for a range of immunological conditions and, where appropriate, with service users and support staff.

Learning outcomes

1. Define and explain ‘atopy’ and the factors involved in the development of atopic disease.
2. Define and explain allergy, distinguishing it from hypersensitivity
3. Explain and distinguish between the four types of hypersensitivity.
4. Explain the production of immunoglobulin E (IgE) by B cells in response to allergen
5. Explain how IgE triggers mast cells to deregulate and describe the clinical features of mast cell degranulation
   in the allergic patient.
6. Discuss the important features of allergic rhinitis, atopic eczema and anaphylaxis
7. Describe the design, operation and performance of hypersensitivity skin testing, including contraindications,
   limitations and precautions to be taken
8. Describe the design, operation, use and limitations of immunology laboratory tests for specific IgE.
9. Discuss the important causes of and explain the mechanism of allergic contact dermatitis.
10. Describe the partnership between the clinical immunology laboratory and other clinical specialisms in the
    investigation of hypersensitivity and allergy and patient care.

Indicative content

• Type I Immediate hypersensitivity
  • Pathogenesis
  • Allergic diseases (asthma; allergic rhinitis; allergic eczema; urticaria)
  • Anaphylaxis
  • Desensitisation
• Type II Antibody-dependent cytotoxic hypersensitivity
  • Organ-specific autoimmune diseases
  • Autoimmune cytopenias
  • Haemolytic disease of the newborn
• Type III Immune complex-mediated hypersensitivity
  • Serum sickness
  • Allergic alveolitis
  • Lepromatous leprosy
  • Systemic lupus erythematosus (SLE)
  • Cutaneous vasculitis
  • Arthus reaction
• Type IV Delayed cell-mediated hypersensitivity
  • Contact hypersensitivity
  • Tuberculous reactions
  • Granulomas
  • Graft rejection and graft versus host disease (GVHD)
• Type V Stimulatory hypersensitivity
  • Autoantibodies against cell receptors (thyroid stimulatory autoantibodies)

Activities

• Actively participate in out-patient clinics involving patients with a range of immunodeficiency conditions. Critically reflect on the efficacy of each treatment strategy, the side effects and effect of quality of life and prepare a series of case reviews to describe your learning and how this will impact on your future practice.
• Identify patients with immunodeficiency, hypersensitivities and allergies and/or haematological malignancy in order to gain an understanding of the care pathway of the patient from the initial consultation, investigations, follow-up appointment and treatment. Where possible, undertake discussions with patients to gain a better understanding of the contribution of clinical immunology in care pathways.
• Actively participate in a range of clinics and multi-disciplinary team meetings (MDTs) where patients are being investigated for immunodeficiency, hypersensitivity and allergy and/or haematological malignancy and discuss the mechanisms and potential treatments/outcomes for each patient with your training supervisor.
• Critically reflect on your own experience of supervision and mentoring and identify how you will use these in your learning training, supervising and mentoring of others.
• Prepare a series of case reports on newly diagnosed patients and follow-up patients in an immunodeficiency, hypersensitivity and allergy and/or haematological malignancy outpatient clinic and critically appraise the process of diagnosis, treatment and management.