AIMS FELLOWSHIP CURRICULUM GENERAL/CORE LABORATORY IV

Transcription

1 AIMS FELLOWSHIP CURRICULUM GENERAL/CORE LABORATORY IV Module Code: GENERAL IV (Compulsory Module) Module Title: Haematology Module Convenor: Mr David Condie, B. App.Sci (QUT), FAIMS,MASM, MBA Senior Scientist QHPSS Mackay West Mackay Mail Centre, QLD 4740 Phone FAX (W) david_condie@health.qld.gov.au E.mail (H) mco03185@bigpond.net.au Discipline Committee: Mr David Condie Mr Peter Fayle Data Module Outline last reviewed: May 2005 Data Module Outline last modified: May

2 A Objectives This module covers the basics of haematology including haemostasis and thrombosis. The aim is to ensure that the candidate has a thorough working knowledge of the theoretical and practical aspects of all of the cellular and other related diagnostic tests, including coagulation testing but not transfusion testing, performed in a routine haematology laboratory. As well as detailed knowledge of laboratory techniques the candidate should understand their application and the interpretation of results. In addition the module requires an understanding of the Laboratory Quality System including the requirements imposed on laboratories by regulatory bodies and laboratory management practices including laboratory safety. The module is designed to encourage the candidate to study the theoretical and technical aspects of the tests performed every day in the laboratory. The candidate should ultimately demonstrate a knowledge level equivalent to that required to supervise and direct the activities of a laboratory processing a broad case-mix of patients and maintaining a high standard of work at all times. The module does not assume that the candidate has had any previous formal study of the discipline but does assume that the candidate has a good understanding of basic biological science. An undergraduate level knowledge of Haematology would be beneficial as would current or previous employment/experience in a Haematology laboratory. B. Interrelationship of the Module to Other Modules This module provides the basic knowledge needed to underpin both the normal routine testing, and critical care analytes. Module Haematology is a compulsory module that includes haemostasis. The other modules represent distinct disciplines, which comprise the major disciplines represented in most clinical laboratories. Module General I Module General II Module General III Microbiology Biochemistry Transfusion Science C. Brief Description This module requires demonstration of an extensive knowledge and understanding of the haematological investigations performed in the routine haematology laboratory. This requires a reasonable knowledge of normal and abnormal cell physiology, clinical aspects relevant to routine haematological testing and other technical procedures related to cellular haematology. Additionally, it also requires a reasonable knowledge of normal and abnormal haemostatic physiology, clinical aspects relevant to routine coagulation testing and other technical procedures related to haemostasis and thrombosis.

3 D. Content 1. Haematology Laboratory techniques 1.1 Automated cell counting - knowledge of the major instruments in use. - knowledge of recent developments and innovations - an understanding of the technical and clinical role and value of specific technologies 1.2 Other automation used in the routine Haematology laboratory - Flow cytometry - staining machines, slide makers, ESR analysers etc. 1.3 Staining and microscopy - staining techniques in routine use. e.g. Romanowsky, supra-vital and cytochemical staining. - components and use of the microscope Morphology - morphology of all normal and abnormal haemopoietic cells found in blood, bone marrow and body fluids. - practices used in the examination and reporting of cell morphology. 1.5 Manually performed tests Haematology Laboratory - ESR, reticulocytes, Heinz bodies, rapid screening tests for IM, malaria etc. - manual cell counting and associated techniques 1.6 Investigation of blood borne parasites - microscopic techniques - rapid screening tests 1.7 Strategies and standards applied to reporting of laboratory results 1.8 Units and reference ranges 1.9 Specimen collection - anticoagulants in use - handling, specimen stability, storage and transport - special requirements Objective: Demonstration of comprehensive knowledge of the techniques and technology used in the cellular investigations and related procedures performed in the routine haematology laboratory. This knowledge should include an understanding of the principle of each technique, the performance of each technique, limitations of the techniques, problem detection, troubleshooting and the technical and clinical interpretation of results.

4 2. Coagulation Laboratory techniques 2.1 Principles of coagulation testing - PT, INR, APTT, TT, correction methods. - Fibrinogen, Fibrin/fibrinogen degradation products - Mixing studies - Inhibitors - DIC screening - Clotting based factor assays - Platelet Function testing 2.2 Reagents used in coagulation testing The candidate should demonstrate knowledge of the suitability and selection of reagents including understanding of sensitivity of reagents to various technical and clinical factors - Thromboplastins including calculation of ISI - Partial thromboplastins including determination of sensitivity to heparin, lupus anticoagulant and coagulation factor levels. - Buffers, activators, inhibitors of fibrinolysis 2.3 Manual performance of coagulation tests - PT, INR, APTT, TT, correction methods. - Fibrinogen, Fibrin/fibrinogen degradation products - Mixing studies - DIC screening 2.4 Automated coagulation testing - knowledge of the major instruments in use. - knowledge of recent developments and innovations - an understanding of the technical and clinical role and value of specific technologies 2.5 Other automation techniques used in or in association with the routine coagulation laboratory. - Centrifugation. - Refrigeration and freezers their role in management of reagents and specimens. 2.6 Pre-analytical variables and their effect on laboratory results. Specifically, specimen collection including: - anticoagulants in use - specimen handling, stability, storage and transport - special requirements. 2.7 Strategies and standards applied to reporting of laboratory results 2.8 Units and reference ranges Objective: Demonstration of comprehensive knowledge of the techniques and technology used in coagulation investigations and other related procedures performed in the routine haematology laboratory. This knowledge should include an understanding of the principle of each technique, the performance of each technique, limitations of the techniques, problem detection, troubleshooting and the technical and clinical interpretation of results.

5 3. Haemopoiesis 3.1 The development, morphology and function of all normal and abnormal haemopoietic cells found in bone marrow and blood. 3.2 The role of haemopoietic growth factors, especially those in clinical use. 3.3 The role, distribution and physiology of haematinics; specifically iron, vitamin B12 and folic acid in both health and disease. Objective: A comprehensive understanding of Haemopoiesis. 4 Haemostasis 4.1 Clotting factors and their inhibitors. 4.2 Fibrinolytic proteins and their inhibitors. 4.3 Vascular endothelium interactions. 4.4 Platelet function Objective: Demonstration of a comprehensive understanding of normal haemostasis. 5. Clinical conditions and situations 5.1 Haematological non-malignant conditions - Anaemias macrocytic, microcytic, haemolytic, hypoplastic, blood loss - Thalassaemia and haemoglobinopathies - Erythrocytosis reactive and malignant - Red cell breakdown/degradation - Cytophilias, cytopenias and other benign disorders of white blood cells - Thrombocytosis and thrombocytopenia. - Haematology of conditions including pregnancy, the neonate, childhood, the elderly, infection. 5.2 Haematological malignancies. - Acute leukaemia - Myeloproliferative disorders - Myelodysplastic syndrome - Lymphoproliferative disorders - Immunoproliferative disorders 5.3 Miscellaneous Coagulopathies - Acquired coagulation disorders including those seen in DIC, Liver disease, trauma, post surgery, infection. - Hereditary coagulation factor deficiencies - Acquired and hereditary thrombophilias - Platelet dysfunction (basic knowledge required) - The haemostasis seen in pregnancy, the neonate, childhood. 5.4 Anticoagulant therapy. - Knowledge of traditional and emerging anticoagulants.

6 - Monitoring of the anti-coagulated patient. A detailed knowledge is required of tests used, factors affecting results and the interpretation of results including therapeutic ranges. Objective: To support technical knowledge of laboratory investigations the candidate should demonstrate thorough knowledge of the laboratory presentation of specific clinical situations. A good knowledge of the physiology and a basic knowledge of clinical aspects and subsequent laboratory investigation of these situations is also required. While the candidate need have no more than a basic knowledge of clinical aspects, an understanding of the relationship between clinical presentation and the interpretation of results is essential. 6 Point of Care Testing (Near Patient Testing) 6.1 Indications for usage 6.2 Range of testing available 6.3 QC 6.4 Equipment maintenance Objective: Demonstrated understanding of the application of POCT in the haematology laboratory. 7 The Laboratory Quality System 7.1 QC and QA 7.2 Standardisation 7.3 Laboratory accreditation 7.4 The role of regulatory bodies Objective: Thorough knowledge of the laboratory Quality System and its application in the diagnostic laboratory. 8. Laboratory Management 8.1 The establishment and validation of new methods. 8.2 Statistical analysis used in the clinical laboratory 8.3 Laboratory safety Objective: Good working knowledge of laboratory management practices and their application E. Rationale for content A scientist working in a Haematology laboratory will utilise a range of technical procedures to provide information for the management of patients in a wide variety of clinical settings. This module is designed to ensure an understanding of laboratory techniques, their application and the interpretation of results. F. Examination Under the Fellowship Regulations, a 3-hour written examination will be held at the completion

7 of each Module. Each examination will contain a mixture of short answer questions and essay style questions. In some examinations, clinical and laboratory management case based scenarios will be included in the question mix. The examination in this module will focus on knowledge of technical procedures, technical and clinical interpretation of results, understanding of the rationale for appropriate laboratory investigations and the application of the principles of the laboratory quality system and laboratory management. The examination will consist of: Two essay questions, each with a total value of 35 marks; suggested time allocation 30 minutes per essay total 60 minutes. Twenty short answer questions, each worth five marks total value for the short answer questions 100 marks; suggested time allocation five minutes per question total 100 minutes. Twenty minutes for re-reading and review There will be an initial reading time of fifteen minutes, during which no writing will be permitted. G. Texts and Supporting Material The following list of texts is intended as a guide. There is no single text recommended however candidates are encouraged to obtain their own copies or have ready access to at least two texts. The candidate is not expected to have read the more extensive large texts, however certain chapters in these texts would provide good study material. Other texts, including new texts which become available, may also be of value. The candidate should peruse current haematology journals for relevant reviews and articles. Texts (Most recent editions) Bain B. Blood Cells: A Practical Guide (Blackwell) Bain et al Bone Marrow Pathology. (Blackwell) Coleman et al. Haemostasis and Thrombosis. (Lippincott, Williams and Wilkins.) Dacie and Lewis. Practical Haematology (Churchill Livingstone) Hoffbrand and Lewis. Postgraduate Haematology ( Butterworth) Chanarin Laboratory Haematology (Churchill Livingstone) Rozenburg Microscopic Haematology (Martin Dunitz) Journals Australian Journal of Medical Science Laboratory Hematology Clinical and Laboratory Haematology Thrombosis and Haemostasis Other Essential Reading NATA, ISO and NPAAC guidelines assorted documents NCCLS Standards assorted documents Operating Manuals for instrumentation Other texts with suitable chapters (Most recent editions) Hoffman R. Hematology, Basic Principles and Practices. Lee G (ed). Wintrobe's Clinical Hematology. (Williams and Wilkins) Lewis and Koepke. Haematology Laboratory Management and Practice. (Butterworth) Nathan et al. Nathan and Oski s Hematology of Infancy and Childhood. (WB Saunders) Smith H. Diagnosis in Paediatric Haematology (Churchill Livingstone) Beutler Williams et al. Hematology (McGraw Hill)

8 American Society of Hematology Education Program Booklet Other Journals which should be reviewed American Journal of Clinical Pathology American Journal of Hematology Archives of Pathology and Laboratory Medicine Bailliere s Clinical Haematology Blood Blood Reviews British Journal of Haematology Hematology/Oncology Clinics of North America Journal of Clinical Pathology Lancet New England Journal of Medicine Seminars in Hematology CAP Today H. Appointment of a Mentor Candidates are strongly advised to nominate a mentor for the Module at the time of application for entry and into the Fellowship Program. If a candidate is unable to nominate a mentor then the candidate should contact the Module Convenor for assistance. The appointment of a mentor is made by the Examinations Council. I. Module Communications Module Convenor: Mr David Condie, B. app.sci (QUT), FAIMS,MASM, MBA Senior Scientist QHPSS Mackay West Mackay Mail Centre, QLD 4740 Phone FAX (W) david_condie@health.qld.gov.au E.mail (H) mco03185@bigpond.net.au Discipline Committee: Mr David Condie Mr Peter Fayle J. Candidate Feedback Immediately following notification of the examination result each candidate will be asked to complete a feedback questionnaire on the Module. However, feedback at anytime during the study of the Module is encouraged through the mentor or directly to the Module Convenor.