Hemostasis

Module details

Title

Hemostasis

Type

Specialist

Module code

SLS132

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with the detailed knowledge and understanding of the pathophysiology and clinical presentation of a range of acquired and genetic bleeding disorders and thrombotic disorders. In the work-based module they will be expected to apply this knowledge as they learn to perform relevant laboratory methods and gain experience of the interpretation of patient results in a variety of clinical settings.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Identify suitable methods for the investigation of disorders of haemostasis and thrombosis including: platelet number, morphology and aggregation coagulation factor activity assays (FVIII, IX) prothrombin time activated partial thromboplastin time thrombin time fibrinogen d-dimer inhibitor screen anticoagulation therapy monitoring: warfarin, heparin.	Action View
# 2	Learning outcome 2	Competency Select and perform to specified quality standards methods for investigating and managing thrombosis, including: d-dimer molecular markers of thrombotic risk anticoagulation therapy monitoring International normalised ratio (INR) laboratory methods POCT.	Action View
# 3	Learning outcome 3	Competency Interpret haematology data in light of clinical details and authorise reports under supervision on patients with thrombophilia. This should include one congenital example and one acquired example: congenital, e.g. factor V Leiden prothrombin mutation, and MTHFR mutation acquired, e.g anti-cardiolipin antibodies lupus anticoagulants heparin-induced thrombocytopenia antithrombin, protein C and protein S.	Action View
# 4	Learning outcome 3	Competency Interpret haematology data in light of clinical details and authorise reports under supervision on patients’ disorders of the coagulation system including: haemophilia A, B von Willebrand disease disseminated intravascular coagulation (DIC).	Action View
# 5	Learning outcome 3	Competency Identify cases requiring urgent intervention and be able to offer clinical advice on follow-up and/or further management.	Action View

Assessments

You must complete:

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

Authorise report on haemostasis and thrombosis for platelet number morphology	DOPS
Authorise report on haemostasis and thrombosis for aggregation	DOPS
Authorise report on haemostasis and thrombosis for coagulation factor activity assays FVIII IX	DOPS
Authorise report on haemostasis and thrombosis for prothrombin time	DOPS
Authorise report on haemostasis and thrombosis for activated partial thromboplastin time	DOPS
Authorise report on haemostasis and thrombosis for thrombin time	DOPS
Authorise report on haemostasis and thrombosis of inhibitor screening	DOPS
Perform anticoagulation therapy monitoring warfarin heparin	DOPS
Authorise reports on patients with thrombophilia for congenital causes example	DOPS
Authorise reports on patients with thrombophilia with acquired causes	DOPS
Authorise reports on patients disorders of the coagulation system for Haemophilia A B	DOPS
Authorise reports on patients disorders of the coagulation system Von Willebrand disease	DOPS
Perform disseminated intravascular coagulation	DOPS
Authorise report on haemostasis and thrombosis for fibrinogen	DOPS
Attend an outpatient clinic for anticoagulation monitoring and observe near patient testing and take consent	OCE
Attend an outpatient clinic for patients with congenital and acquired thrombophilia and take a case history	OCE

Learning outcomes

1. Identify appropriate clinical and laboratory investigations for the investigation of haemostasis.
2. Perform the range of laboratory, molecular and point-of-care testing (POCT) techniques used in the workplace to diagnose and monitor treatment of bleeding disorders and thrombophilia.
3. Interpret and report results of investigations of haemostasis in the correct clinical context.

Learning outcomes

1. Explain congenital and acquired bleeding disorders.
2. Describe the design, operation and performance of laboratory, molecular and point-of-care techniques used in the investigation of bleeding disorders.
3. Discuss and justify the diagnosis and management of bleeding disorders.
4. Describe and evaluate the causes and risks, diagnosis and treatment options of thrombophilia.
5. Describe the partnership between the haematology laboratory and other clinical specialisms in the investigation of bleeding disorders and patient care.

Indicative content

• Hereditary and acquired primary and secondary bleeding disorders, including nature and sites of bleeding; risks associated with severity
• Hereditary and acquired thrombotic disorders, including structure and aetiology of thrombus formation; relative risk and environmental factors
• The genetic basis and functional defects of hereditary bleeding and thrombotic disorders
• Disseminated intravascular coagulation (DIC)
• Principles, scientific basis, range and selection of analytical procedures applied in the investigation of bleeding and thrombotic disorders
• Presentation and laboratory investigation of bleeding and thrombotic disorders, and BCSH guidelines relevant to this area
• Clinical interpretation of diagnostic results, treatment strategies and management (including clotting factor replacement therapy; anticoagulant therapy; prophylaxis); family studies

Activities

• Attend a haematology outpatients’ clinic (including anticoagulation clinics) and observe near patient testing and monitoring. Reflect on and review your experience, and discuss the patient experience, the key factors reflecting the importance of such clinics for patient management and key learning points for your future practice.
• Observe family counselling and report on your experience, including the role of this service and its integration with laboratory investigation of haemostasis.
• Critically appraise the internal quality control and external quality assessment of three methods used to investigate haemostasis and two methods used to investigate thrombosis. Report and discuss your findings, including key learning points for your future practice.