Module information
Details
- Title
- Autoimmunity and Haematological Oncology
- Type
- Specialist
- Module code
- S-CI-S5-0
- Credits
- 20
- Requirement
- Compulsory
Aim of this module
This module aims to provide trainees with knowledge and understanding of the presentation, diagnostic tests and clinical urgency of investigating patients with suspected autoimmune disease and haematological malignancies.
Work-based content
Competencies
| # | Learning outcome | Competency | Action |
|---|---|---|---|
| # 1 | Learning outcome 1,3 |
Competency
Select the appropriate immunological assay to investigate individuals with a history of autoimmunity for the following conditions:
|
Action View |
| # 2 | Learning outcome 1,3 |
Competency
Select the appropriate immunological assay to investigate individuals with a history of autoimmunity for the following conditions:
|
Action View |
| # 3 | Learning outcome 1,2,3,4 |
Competency
Identify requests for a patient who requires urgent autoimmune serology that requires investigation and implement appropriate actions |
Action View |
| # 4 | Learning outcome 2,3,4 |
Competency
Report/communicate results for investigations of autoimmunity that require urgent action, and make recommendations on further actions where appropriate |
Action View |
| # 5 | Learning outcome 1,2,3,4,5 |
Competency
Perform and interpret the following immunofluorescence patterns in the light of the clinical history suggest further investigations:
|
Action View |
| # 6 | Learning outcome 1,2 |
Competency
Perform and interpret appropriate investigations for the detection of antibodies in coeliac disease |
Action View |
| # 7 | Learning outcome 1,2 |
Competency
Perform and interpret indirect immunofluorescence for the detection of organ specific autoantibodies such as skin or adrenal antibodies |
Action View |
| # 8 | Learning outcome 1,6 |
Competency
Perform appropriate solid phase methods and interpret results for the investigations of autoimmune disorders, including:
|
Action View |
| # 9 | Learning outcome 1,2,3 |
Competency
Draft reports including interpretive clinical comments in light of clinical details and associated laboratory results to include five of the following:
|
Action View |
| # 10 | Learning outcome 2,6 |
Competency
Interpret and problem solve EQA for assays, included in general autoimmune serology EQA scheme including an example of investigating concerns with EQA performance |
Action View |
| # 11 | Learning outcome 6 |
Competency
Perform an audit on a diagnostic assay for investigating autoimmunity and participate in the ongoing monitoring of an assays performance to that verified standard |
Action View |
| # 12 | Learning outcome 7, 8, 9 |
Competency
Select the appropriate immunological assay to investigate individuals with potential plasma cell dyscrasia |
Action View |
| # 13 | Learning outcome 7, 8, 9 |
Competency
Perform and analyse the following immunological investigations:
|
Action View |
| # 14 | Learning outcome 7, 8, 9 |
Competency
Identify potential haematological malignancies from routine flow cytometry immunology investigations |
Action View |
| # 15 | Learning outcome 8, 9 |
Competency
Recommend appropriate actions following the identification of an aberrant population on routine immunology flow cytometry, and determine further testing where suitable and escalate as appropriate |
Action View |
| # 16 | Learning outcome 8 |
Competency
Interpret flow cytometry data for an initial diagnostic screening panel for the following conditions:
|
Action View |
| # 17 | Learning outcome 10 |
Competency
Identify relevant clinical investigations for myeloma from other disciplines that will impact on the interpretation of the immunological investigation |
Action View |
| # 18 | Learning outcome 8. 9, 10 |
Competency
Draft reports including interpretive clinical comments in light of clinical details and associated laboratory results for the following immunological investigations:
|
Action View |
| # 19 | Learning outcome 7, 8, 9 |
Competency
Interpret and problem solve EQA for a range of assays involved in assessing potential plasma cell dyscrasia including an example of investigating concerns with EQA performance |
Action View |
| # 20 | Learning outcome 7, 9 |
Competency
Resolve a technical issue for two of the following:
|
Action View |
| # 21 | Learning outcome 8, 10 |
Competency
Determine clinical urgency of new abnormal findings for haematological malignancies and appropriate methods of communication with the clinical team |
Action View |
Assessments
Complete 4 Case-Based Discussions
Complete 4 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Prepare and read indirect immunofluorescence for the detection of autoantibodies
- Perform and read an immunoblot for an autoimmune disease
- Perform and read a solid phase assay for an autoimmune disease
- Perform and/or interpret a neuroimmunology assay
- Interpret a returned EQA report for a scheme relevant to laboratory tests used for autoimmune serology
- Perform and analyse serum electrophoresis and/or capillary zone electrophoresis on patients with suspected haematological malignancies.
- Perform and analyse a cryoglobulin test.
- Perform the serum free light chain assay.
- Interpret a returned EQA report for a scheme relevant to laboratory tests used for haematological malignancies.
Observed Clinical Event Titles
- Gather a patient history from another healthcare professional
- Communicate results on a patient with ANCA associated vasculitis or GBM disease to the requesting healthcare professional and document according to local procedures, under supervision
- Appraise ANCA requests for their clinical appropriateness in accordance with guidelines
- Communicate results to another healthcare professional and recommend next steps for a patient with a sample that has an aberrant population detected on routine flow.
- Gather a patient history from another healthcare professional.
- Communicate results to another healthcare professional and recommend next steps on a patient with new monoclonal gammopathy.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Select and perform appropriate methods for the investigation of organ specific and systemic autoimmune disease. |
| 2 | Interpret and report results for autoimmune investigations in the light of clinical details and other laboratory tests. |
| 3 | Evaluate, triage and advise on requests for autoimmunity investigations. |
| 4 | Identify and escalate urgent abnormal test results and report urgent abnormal results to the requesting healthcare professional and document according to local protocols. |
| 5 | Generate and interpret appropriate second line test requests following abnormal autoimmune serology results. |
| 6 | Practice in accordance with quality and accreditation standards. |
| 7 | Perform laboratory investigations on samples from patients with suspected haematological malignancies. |
| 8 | Analyse, interpret and report on laboratory investigations for haematological malignancies, including recognition of abnormal results. |
| 9 | Summarise the limitations of methods used to aid diagnosis of haematological malignancies. |
| 10 | Practice in partnership with other clinical specialisms in the investigation of haematological malignancies. |
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:
- Describe the key features used to classify autoimmune disorders.
- Discuss the processes of immunological self-tolerance and immune regulation.
- Explain the causes and immunopathological mechanisms of autoimmune disorders and relate these features to the clinical presentation.
- Apply integrative knowledge of the role of autoantibodies and autoreactive T-lymphocytes in the progression of autoimmune disease.
- Compare and contrast the indications and performance of laboratory tests used to investigate autoimmune disorders.
- Critically appraise the pharmacological treatments available in the management of autoimmune disorders to the immunopathological mechanisms of disease.
- Demonstrate a critical awareness of classification of haematological malignancies as defined by WHO international guidelines.
- Describe and explain the underlying pathogenesis of named haematological malignancies.
- Critically evaluate the design, operation and performance of diagnostic assays used in the investigation and monitoring of haematological malignancies.
- Critically appraise the therapeutic approaches used in clinical management of haematological malignancies.
- Explain the importance of integrated diagnosis and the implementation of national and international guidelines on the diagnosis and management of haematological malignancies.
Indicative content
Spectrum of autoimmune diseases:
- Multifactorial; genetic factors (HLA and non-HLA); hormonal factors; environmental factors, infection
- Monogenic autoimmune disorders
- Classification features (proof of immune component, hypersensitivity reactions)
- Autoimmunity vs. autoinflammation
Regulation of immune tolerance:
- Central tolerance mechanisms
- Peripheral tolerance mechanism
- Countering self-tolerance and immune regulatory mechanisms
- Pathogenic effects (autoantibodies; autoreactive cells; immune complexes)
Pathogenesis, epidemiology, diagnosis, treatment and management of:
- Rheumatic and connective tissue diseases (SLE, Sjogrens, rheumatoid arthritis, myositis, antiphospholipid syndrome)
- Autoimmune renal disorders (anti-GBM disease, membranous nephropathy)
- ANCA-associated vasculitis
- Autoimmune skin disorders (pemphigoid, pemphigus, psoriasis)
- Autoimmune endocrine disorders (thyroid, pancreas, adrenal, autoimmune polyglandular syndromes)
- Autoimmune liver disorders (autoimmune hepatitis, primary biliary cholangitis)
- Autoimmune GI disorders (coeliac disease, pernicious anaemia)
- Autoimmune neurological disorders (paraneoplastic syndrome, autoimmune encephalitides, myasthenia gravis, multiple sclerosis)
Introduction to the classification of haematological malignancies according to the WHO.
- Current understanding of the clinical features, pathogenesis, molecular mechanisms, diagnosis and management of:
- Myeloid and lymphoid leukaemias
- Myeloma and plasma cell disorders
- Lymphoplasmacytic lymphoma.
- Specific to the above list of Haematological malignancies:
- Characteristic morphology and/or immunophenotype of each disease.
- Molecular and genetic techniques for the detection of pathogenetic variants.
- Approaches for the monitoring of response to therapy including residual disease.
- Current approaches to treatment of haematological malignancies and their mechanism of action to include: chemotherapy, immunotherapy, targeted therapy and stem cell transplant.
- National and international guidelines for diagnosis and management (NICE, BCSH, ELN, WHO).
- Role of the Specialist Integrated Haematological Malignancy Diagnostic Service, including the contribution of Clinical Immunology.
Clinical experiences
Important information
Clinical experiential learning is the range of activities trainees may undertake in order to gain the experience and evidence to demonstrate their achievement of module competencies and assessments. The list is not definitive or mandatory, but training officers should ensure, as best training practice, that trainees gain as many of these clinical experiences as possible. They should be included in training plans, and once undertaken they should support the completion of module assessments and competencies within the e-portfolio.
Activities
- Attend multidisciplinary team meetings for an appropriate clinical specialty to appreciate the impact of diagnostic tests on patient care.
- Attend a clinic for an appropriate clinical specialty.
- Attend an event where patients discuss their experiences such as a patient day or group to appreciate the patient perspective.
- Observe input into an integrated report at a haematology diagnostic service.