Clinical Immunology in Histocompatibility and Immunogenetics (SLS122)

10 credits

Aim of this module

This module will provide the trainee with the practical application of knowledge and skills relating to a range of immunological conditions, including immunodeficiencies, hypersensitivities and allergies and haematological malignancies. This module will provide the trainee with knowledge and understanding of the scientific basis of organ transplantation. They will understand the clinical preparation of patients for organ transplantation and the principles and practice of immunogenetics. They will become familiar with methods that support transplantation and gain experience of the interpretation of patient results in a variety of clinical settings. The trainee should be based in or spend extended time in a histocompatibility and immunogenetics department.

  1. Select appropriate methods for the diagnosis and management of a range of immunological conditions.
  2. Interpret and report results of clinical investigations undertaken in patients with:
    • immunodeficiency
    • hypersensitivity and allergy
    • haematological malignancies
    • a transplantation procedure
  3. Work in partnership with other clinical specialisms in the investigation and therapy for a range of immunological conditions and, where appropriate, with service users and support staff.
Number Work-based learning outcome Title Knowledge
1 1

Select the appropriate immunological assay to investigate whether the immune system of the patient is immunocompetent or immunodeficient and have the laboratory skills to undertake at least two of the following laboratory analyses:

  • assay of immunoglobulins and subclasses
  • neutrophil function tests
  • lymphocyte function tests
  • specific antibody responses to vaccine antigens
  • complement activity
  • cytokine production
  • molecular assays to define immunodeficiencies.
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2 2

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.
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3 1

Select the appropriate immunological assay to investigate whether the immune system of the patient is producing an allergic response.

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4 2

Interpret allergy test data in the light of clinical details and on patients with a range of common allergies including:

  • food allergy
  • inhalant allergy
  • drug allergy.
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5 1

Select the appropriate immunological assay to investigate the immune system of patients with haematological malignancies such as:

  • Chronic lymphocytic leukaemia
  • Acute leukaemia
  • Lymphomas
  • Multiple myeloma
  • Waldenstrom’s macroglobulinaemia
  • Post BMT lymphocyte levels (immune reconstitution).
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6 2

Interpret data from immunological investigations, such as:

  • Flow cytometry
  • Morphological assays
  • Relevant molecular techniques
  • Electrophoresis
  • Free light chains
  • Immunoglobulin measurement.
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7 3

Work in partnership with other clinical specialisms in the investigation of a range of immunological conditions and, where appropriate, with service users and support staff.

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8 3

Communicate effectively with the healthcare team recognising and responding appropriately to situations where it is necessary to share information to safeguard service users or the wider public.

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You must complete
2 Case-based discussion(s)
2 of the following DOPS / OCEs
Assessment Title Type
Perform a test to measure IgE to an allergen DOPS
Perform the test to determine total IgE levels in the serum of a patient DOPS
Prepare DNA from a patient with a suspected haematological malignancy. DOPS
Perform flow cytometric immunophenotyping on a patient following bone marrow reconstitution to determine whether lymphocyte subsets are returning. DOPS
Perform analysis of a patients serum to determine levels of immunoglobulins IgG, IgM IgA 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 flow cytometric assay to determine the number of CD4 T cells DOPS
Perform the assay to determine the C3 and C4 levels in a patient sample DOPS
Undertake a skin prick test on a patient and explain to the patient how it is used by the lab OCE
Observe a patch test on a patient and explain to the patient how it is used OCE
Take a patient history for a patient with a suspected allergic reaction. OCE
Attend an adult haematology clinic where haematological patients with myeloma may or may not have secondary immunodeficency and specifically note the types of laboratory assays that may be requested to assist in their management OCE
Attend a paediatric haematology clinic where haematological patients with acute leukaemias will be assessed and specifically note the types of laboratory assays that may be requested to assist in their management OCE
Take a history where the patient is suspected of having an immunodeficiency disorder 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

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

  1. Define and explain ‘atopy’ and the factors involved in the development of atopic disease.
  2. Define and explain allergy, distinguishing it from hypersensitivity
  3. Explain and distinguish between the four types of hypersensitivity.
  4. Explain the production of immunoglobulin E (IgE) by B cells in response to allergen
  5. Explain how IgE triggers mast cells to deregulate and describe the clinical features of mast cell degranulation
    in the allergic patient.
  6. Discuss the important features of allergic rhinitis, atopic eczema and anaphylaxis
  7. Describe the design, operation and performance of hypersensitivity skin testing, including contraindications,
    limitations and precautions to be taken
  8. Describe the design, operation, use and limitations of immunology laboratory tests for specific IgE.
  9. Discuss the important causes of and explain the mechanism of allergic contact dermatitis.
  10. Describe the partnership between the clinical immunology laboratory and other clinical specialisms in the
    investigation of hypersensitivity and allergy and patient care.

Indicative Content

  • Type I Immediate hypersensitivity
    • Pathogenesis
    • Allergic diseases (asthma; allergic rhinitis; allergic eczema; urticaria)
    • Anaphylaxis
    • Desensitisation
  • Type II Antibody-dependent cytotoxic hypersensitivity
    • Organ-specific autoimmune diseases
    • Autoimmune cytopenias
    • Haemolytic disease of the newborn
  • Type III Immune complex-mediated hypersensitivity
    • Serum sickness
    • Allergic alveolitis
    • Lepromatous leprosy
    • Systemic lupus erythematosus (SLE)
    • Cutaneous vasculitis
    • Arthus reaction
  • Type IV Delayed cell-mediated hypersensitivity
    • Contact hypersensitivity
    • Tuberculous reactions
    • Granulomas
    • Graft rejection and graft versus host disease (GVHD)
  • Type V Stimulatory hypersensitivity
    • Autoantibodies against cell receptors (thyroid stimulatory autoantibodies)