Module - Introduction to Haematology and Transfusion Science (SLS102)

STP

Aim of this module

This module will provide the trainee with the knowledge and understanding of the formation of blood cells, the mechanism of haemostasis and the relevance of blood group antigens and antibodies. They will understand the principles and practice of common methods used in haematology, haemostasis and blood transfusion and perform some of them in the laboratory. They will understand common clinical disorders associated with abnormal haematology and haemostasis and gain experience of the interpretation of patient results in a variety of clinical settings. They will gain knowledge of blood transfusion in a variety of settings, and understand how to provide patients with safe and effective transfusion support.

Work-based learning outcomes


  1. Perform a range of laboratory techniques used in screening and investigating haematological disorders.
  2. Perform the range of laboratory and point-of-care techniques (POCTs) used in the investigation of disorders of haemostasis.
  3. Perform blood group serology in the context of pre-transfusion testing.
  4. Select safe and appropriate blood and blood components for patients with a range of clinical conditions.
  5. Apply the principles of internal quality control and external quality assessment and draw conclusions about assay performance.
  6. Use laboratory IT systems for handling, processing and storage of patient data.

Work-based Competencies


Learning outcome Title Knowledge
1 1,2,5,6

Receive, process and store common  haematology specimens.

  • Minimum data set required for identification of samples and the importance of ensuring that this is complete and correct.
  • Factors affecting sample integrity and appropriate corrective action.
  • Procedures for handling samples which may contain category 2, 3 and 4 pathogens.
  • Types and implications of hazards and risks associated with handling of specimens and relevant control measures.
  • The quality management process that ensures the correct location and storage of documentation and specimens at each stage of the process.
  • Infection risk from blood samples.
  • Safe laboratory practices, including principles of decontamination of equipment and work areas.
  • Quality assurance procedures and their application.
  • Local and national health and safety policies and procedures and their application.
  • Relevant records, their importance and how to complete these correctly.
2 1,2,3,5,6

Interpret request forms and recommend the most appropriate investigation strategy to investigate:

  • basic haematological disorders
  • haemostasis
  • patients for blood transfusion.
  • The repertoire, specimen requirements, referral patterns and storage, ordering, reference ranges and turnaround times of the methods used to investigate the specified range of disorders and requests listed.
  • Principles, scientific basis and clinical application of commonly performed analytical procedures in haematology.
  • Significance and importance of bottle and anticoagulant types.
  • The major clinical users of the haematology and transfusion service for the following core investigations:
    • full blood counts
    • coagulation testing
    • pre-transfusion testing and requests for blood components.
3 1,2,3

Interpret laboratory data in light of clinical details and prepare basic interpretive written reports on patients with at least two of the following:

  • iron deficiency anaemia and iron overload
  • haemolytic anaemia
  • megaloblastic anaemia/folate deficiency
  • polycythaemia
  • abnormal haemoglobin and thalassaemia (initial tests)
  • haematological malignancy (blood cell abnormalities).
  • The clinical features and haematological characteristics of:
    • iron deficiency and iron overload
    • the anaemia of chronic disease
    • abnormal haemoglobin and thalassaemia
    • haematological malignancy.
  • Relevant specific national/international guidelines.
  • The information to be included in an interpretative report.
  • How to construct an interpretative report and the format required for presentation.
  • The lines of communication and responsibility for reporting reactions or complications both in the clinical management of the reaction and the documentation and reporting of the incident.
  • Limits of responsibility in the authorisation and issue of interpretative reports.
  • Normal and abnormal results and their significance to the clinical question or condition
  • Importance of pre-analytical variables.
  • Reference values and the significance of abnormal results.
  • Limitations of interpretation and reporting.
  • How to deal with out-of-range quality control values.
4 1

Identify one case requiring urgent intervention and describe relevant clinical advice on follow-up and/or further management.

  • Clinical conditions that may require urgent action and how to instigate such action.
  • Critical values in haematology.
5 1,2,5

Perform at least three of the following methods to specified quality standards:

  • automated analysers to quantify erythrocytes, leucocytes, platelets, reticulocytes and white cell differentiation
  • erythrocyte sedimentation rate
  • prepare blood and bone marrow aspirate films
  • peripheral blood cell microscopy
  • recognition of malarial parasites.
  • Principles and scientific basis of automated analysers.
  • Point-of-care testing in haematology.
  • Principles and methods of laboratory investigations and clinical findings in testing of suspected inherited platelet disorders.
  • The effect of medication on results of testing.
  • Bone marrow aspiration, trephine biopsy, preparation and staining techniques for the morphological identification of cells in bone marrow in normal and pathological conditions.
  • Collection of trephine and bone marrow aspirates and their correct application.
  • Methods and techniques for preparation of bone marrow cells for microscopy.
  • Principles of microscopy.
  • The principles of staining and the application of staining techniques.
  • The pre-analytical variables that will affect the appearance of cells.
6 1,5,6

Interpret laboratory data in light of clinical details and prepare written reports on patients with one of the following:

  • common bleeding disorders
  • common thrombotic disorders
  • lupus anticoagulation.
  • Principles and correct use of the instrumentation, reagents and methodology to assess a specific coagulation factor deficiency.
  • Reference values and the significance of abnormal results.
  • Interpretation of lupus results and the importance of confirmation test.
  • Relevance and significance of linearity and parallelism.
  • Common clinical findings and laboratory investigation of suspected haemophilia A, B and von Willebrand disease.
  • Laboratory findings in acquired coagulation disorders.
  • Laboratory investigations of suspected factor inbibitors.
  • Principles of replacement therapy.
  • Effects of liver disease and vitamin K deficiency on coagulation factors.
7 1,2,5,6

Perform the following range of investigations:

  • prothrombin time (PT)
  • activated partial thromboplastin time (APTT)
  • anticoagulation therapy monitoring (INR)
  • POCT for INR
  • d-dimer
  • Appropriate time to investigate following a thrombotic event.
  • Laboratory investigations of venous thromboembolism (VTE) and arterial thrombosis.
  • The effect of medication on results of testing.
  • The principles of anticoagulant therapy, therapeutic ranges and laboratory monitoring of warfarin, unfractionated heparin and low molecular weight heparin.
  • The use of d-dimer for the investigation of a suspected VTE.
  • The relationship between abnormal anticoagulation screening and other laboratory tests such as full blood count and liver function tests.
8 3,5,6

Apply sample acceptance criteria for samples for pre-transfusion testing.

Perform routine transfusion tests, including:

  • indirect antiglobulin test (IAT) and ‘immediate spin’ cross- match
  • ABO and RhD typing
  • antibody screening
  • simple antibody identification by IAT and enzyme (single specificity)
  • Rh and K red cell phenotyping.
  • Basics of blood group systems – genes, antigens and antibodies.
  • The range of manual and automated routine serological tests, their underlying principles and appropriate use in pre-transfusion testing.
  • Clinical significance of red cell antibodies.
  • Antibody-mediated intra- and extravascular red cell destruction and the role of complement.
  • Selection of controls for serological testing, recognising control failures and further actions required.
  • The limitations of the testing repertoire available in-house and options for referral.
  • Principles of, and current guidelines relating to, pre-transfusion testing.
9 3,5,6

Issue appropriate blood components for patients with a range of clinical conditions. 

Store blood components used locally in correct conditions.

  • Use of IT systems to issue blood components, and the need for security/traceability.
  • Awareness of the range of blood components / products available, their correct storage conditions and clinical use.
  • Awareness that there are categories of patients requiring components with additional specifications, e.g. neonates, patients with sickle cell disease (SCD).
  • Awareness that some patients are not suitable for electronic issue (EI).
  • Aetiology, pathophysiology and clinical features of conditions requiring transfusion support.
  • Overview of legislation/guidelines relevant to blood transfusion practice.
10 1,2,3,5

Produce a basic interpretative report on haematological investigations.

  • The information to be included in an interpretative report.
  • How to construct an interpretative report and the format required for presentation.
  • Limits of responsibility in the authorisation and issue of interpretative reports.
  • Clinical conditions that may require urgent action and how to instigate such action.
  • Normal and abnormal results and their significance to the clinical question or condition.
11 1,2,3,4

Control infection risks in accordance with departmental protocols.

  • Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation.
  • Protocol for hand washing and how effective hand washing contributes to control of infection.
12 1,2,3,4

Minimise risks and hazards in compliance with health and safety policies.

  • The relevant health and safety regulations for laboratory and clinical investigations.
  • The specific health and safety regulations for the specialism, type of specimen/sample  and investigation.
  • The potential hazards and risks and the actions to be taken to minimise these.
  • Responsibilities and scope of practice of laboratory personnel involved in performing investigations and reporting those investigations to users.

Work-based assessment


Complete 1 Case-Based Discussion(s)
Complete 1 of the following DOPS and/or OCEs
Type Title
DOPS Perform ABO and RH grouping on 3 patient samples
DOPS Perform an manual WBC differential on 2 prepared blood films
DOPS Perform either glandular fever screen or malaria RDT
OCE Observe the obtaining a blood sample
OCE Observe an outpatient appointment with patient with haematological disorder