Module - Immunodeficiency and Immunotherapy (SLS137)

STP

Aim of this module

This module will provide the trainee with knowledge and understanding of the causes of immunodeficiency. They will understand the clinical presentation and investigation of a range of immunodeficient conditions and the principles and practice of immunotherapy. They will become familiar with methods and strategies to investigate immunodeficiency and gain experience of the interpretation of patient results in a variety of clinical settings.

Work-based learning outcomes


  1. Select immunology tests for the diagnosis and management of immunodeficiency and monitoring of immunotherapy.
  2. Perform clinical and laboratory investigation of immunodeficiency.
  3. Interpret and report results of investigation of immunodeficiency in the correct clinical context.
  4. Apply immunotherapeutic strategies for inpatients with a range of primary and secondary immunodeficiencies.
  5. Work in partnership with other clinical specialisms in the investigation of immunodeficiency and immunotherapy.

Work-based Competencies


Learning outcome Title Knowledge
1 1

Select the appropriate immunological assay to investigate whether the immune system of the patient is immunocompetent or immunodeficient. To include all of the following:

  • immunoglobulins and subclasses
  • neutrophil function tests
  • lymphocyte function tests
  • specific antibody responses to vaccine antigens
  • complement activity
  • cytokine production
  • molecular assays to define immunodeficiencies.
  • The range of immunological assays used to investigate the specified range and their selection.
  • Factors influencing the selection of assays.
  • The requirements of both internal and external quality control and assessment for immunodeficiency disease in an immunology laboratory.
2 2

Perform the appropriate investigation of immunodeficiency to include all specified. To include all of the following:

  • immunoglobulins and subclasses
  • neutrophil function tests
  • lymphocyte function tests
  • specific antibody responses to vaccine antigens
  • complement activity
  • cytokine production
  • molecular assays to define immunodeficiencies.
  • Relevant protocols and procedures and their application.
  • Factors influencing the possible outcomes of investigation and relevant control measures.
3 3

Interpret immunological data in the light of clinical details on patients with primary immunodeficiency, including:

  • deficiencies of innate immunity
  • B lymphocyte deficiencies
  • T lymphocyte deficiencies
  • combined T and B cell defects.
  • The correct interpretation of each assay and the importance/implications of incorrect interpretation.
4 3

Interpret immunological data in light of clinical details on patients with secondary immunodeficiency, including all of the following:

  • iatrogenic
  • neoplasia
  • infection.
  • The correct interpretation of each assay and the importance/implications of incorrect interpretation.
5 3

Interpret immunological data in light of clinical details.

  • The process of authorising written reports on patients with a variety of immunodeficient conditions.
  • Correct interpretation of immunological data relating to immunodeficient disorders.
  • The requirements of interpretive reports.
  • The responsibility and level of authority for production and authorisation of reports.
6 4

Apply the appropriate immunotherapeutic strategies/treatment regimens for patients with a range of primary and secondary immunodeficiencies.

  • Options for clinical management of a range of immunodeficiencies and their application to the identified immunodeficiency.
  • Factors influencing the selection of immunotherapeutic strategies/regimens for both primary and secondary immunodeficiences.
7 3,4

Interpret, assess the effectiveness of and report results from patients receiving a range of immunotherapies, including at least three of the following:

  • antibodies as immunosuppressive agents
  • immunosuppressive drugs
  • physical methods of immunosuppression
  • cytokines and anti-cytokines
  • intravenous immunoglobulins
  • immunisation against infection
  • novel approaches to autoimmunity, i.e. infliximab and rituximab
  • stem cell therapies, specifically for immunodeficiencies.
  • The full range of immunotherapies available to patients who are immunodeficient, either primary or secondary immunodeficient.
  • Current methods for assessing the effectiveness of immunotherapies.
  • Factors that may influence the effectiveness of immunotherapies.
8 5

Identify relevant clinical investigations from other disciplines that will impact on the interpretation of the immunological investigation.

  • Appropriate assays from biochemistry, microbiology and haematology that will impact on interpreting the immunology results.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Perform analysis of a patients serum to determine levels of immunoglobulins IgG IgM IgA
DOPS Perform the flow cytometric assay to determine the number of CD4 T cells
DOPS Perform the assay to determine the level of anti tetanus Or anti pneumococcus Or anti Hib IgG antibodies in a patient serum sample
DOPS Perform the assay to determine the C3 and C4 levels in a patient sample
DOPS Perform a lymphocyte proliferation assay
DOPS Perform a neutrophil functional assay
DOPS Perform the C100 or C50 assay to see if the classical pathway of complement is working in a patient
DOPS Perform the AP50 AP100 assay to see if the alternative pathway of complement is working in a patient
DOPS Perform TCR V beta analysis
OCE Take a history where the patient is suspected of having an immunodeficiency disorder
OCE Describe to a patient with CVID XLA other antibody deficiency why you need to take EDTA blood to examine the B and T cells or measure immunoglboulins
OCE Observe and then report to the clinician on taking blood for immunoglobulin measurement or for B and T cells from a patient
OCE Discuss with a patient undergoing intravenous subcutaneous immunoglobulin therapy about this treatment and how it is helping them
OCE Attend an MDT meeting of clinical immunologists and present the results of patient testing
OCE Attend an outpatient clinic within any discipline gastro rheumatology dermatology renal etc where the patient may have an immunological dysfunction as part of their disease
OCE Obtain a patient history from a normal volunteer or typical patient referred to your service and present the findings to a colleague or peer