Module - Hemostasis (SLS132)

STP

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.

Work-based 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.

Work-based Competencies


Learning outcome Title Knowledge
1 1

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.
  • The clinical significance and the laboratory presentation in relation to the disorder chosen.
  • The methods used to investigate disorders of haemostasis.
  • The use of methods in the monitoring of anticoagulant therapy in both primary care (POCT) and secondary care settings.
  • The need for internal and external quality assessment and how to remedy poor performance.
2 2

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.
  • The methods used to investigate thrombotic disorders, and factors affecting their selection.
  • Anticoagulation therapy, including both conventional anticoagulants and the new oral anticogulants.
  • The need for internal and external quality assessment and how to remedy poor performance.
3 3

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.
  • The aetiology and clinical presentation of thrombophilia disorders.
  • The clinical significance and the laboratory presentation in relation to the disorder chosen.
  • Factors affecting results, e.g. oral contraceptive pill, pregnancy, liver disease.
4 3

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).
  • The aetiology and clinical presentation of coagulation disorders.
  • The clinical significance and the laboratory presentation in relation to the disorder chosen.
5 3

Identify cases requiring urgent intervention and be able to offer clinical advice on follow-up and/or further management.

  • Coagulation abnormalities that require urgent intervention, management and further investigations.
  • The need for urgent intervention in certain cases and range of follow-up testing.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS 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
OCE 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