AIMS FELLOWSHIP CURRICULUM TS I TRANSFUSION SCIENCE Core Module
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1 Module Code: TS 1 Module Title: Module Convenor: Patient Based Transfusion Science Dr T Cobain Discipline Committee: Ms Dianne Grey Dr D Roxby Ms D Stern Date Module Outline last reviewed: January 2016 Date Module Outline last modified January 2016
2 A. Objectives AIMS FELLOWSHIP CURRICULUM TS I This Module is designed to provide the candidate with a sound working knowledge of Transfusion Science as it pertains to the transfusion support of patients, and the investigation of immunohaematological states. The Module assumes a basic knowledge of immunohaematological techniques and principles. B. Interrelationship of the Module to Other Modules This Module provides the immunohaematological basis and management principles relating to the clinical use of blood products and a foundation for extending knowledge of the resolution of difficult immunohaematological problems. ModuleTS 2 Module TS3 Production, Clinical Use and Management of Blood and Blood Products. Reference Laboratory Immunohaematology C. Brief Description This Module will provide a sound working knowledge of the immunohaematological and management basis for the operations of a hospital transfusion laboratory. D. Content 1. Immune Response Mechanisms. 1.1 The functions of T cells & interaction between T cells, antigen presenting cells and B cells. 1.2 Role of associated chemokines & immune response genes. 1.3 Self recognition/tolerance and mechanisms of autoimmunity. 1.4 Factors influencing interaction between antigens, antibodies & complement. 1.5 The immunomodulatory effects of transfusion. Objective: To understand broadly the immune response mechanisms and impact of transfusion 2. Biochemical, Molecular and Genetic aspects and Nomenclature of blood group systems 2.1 Structural and functional features of the antigens of the major blood group systems. 2.2 The key biochemical features of the ABO, P, Le, Ii and MNSs blood group systems 2.3 The genetic basis for the major antigens of the identified red cell blood group systems, including their gene frequencies. 2.4 Molecular structure forming the basis for DNA based methods used for determining the commonly used phenotypes of the ABO, Rh, Kell, Fy, Jk, MNS systems
3 Objective: To establish a sound working knowledge of the established blood group systems, 3 Transfusion Laboratory Techniques 3.1 The principles and technical requirements of current methodology formats for blood grouping, phenotyping, antibody screening, crossmatching, including electronic. 3.2 The quality control and quality assurance requirements for the above serology testing. 3.3 The physicochemical properties of non serological reagents used in transfusion serology. 3.4 The principles, and technical requirements of methodologies and procedures for complex antibody identification, and blood grouping/typing problems. 3.5 Available automated systems for processing pretransfusion testing. Objective: To gain a comprehensive understanding of the technical and quality requirements for the performance of the full range of transfusion and blood group serological testing. 4 Blood Group Antibodies 4.1 The typical serological properties and assessment of the likely clinical significance of the antibodies directed at the major antigens of the known blood group systems. 4.2 The cellular assays used for assessing clinical significance of blood group antibodies. Objective: To be thoroughly familiar with the parameters that characterise blood group antibodies and their clinical significance in various clinical settings. 5 Investigation of Clinical States Transfusion Reactions 5.1 The serological, haematological and biochemical procedures which may be used to investigate suspected haemolytic transfusion reactions. 5.2 The causes of febrile non haemolytic transfusion reactions, relevant investigations that can be conducted and strategies to minimise recurrence. 5.3 The current concepts of the clinical and immunological basis for the occurrence of TRALI. Be able to briefly outline test procedures which can be applied to the investigation of this phenomenon. 5.4 The transfusion implications of IgA deficiency. test methods currently used for the quantitation of IgA and the detection of IgA antibodies.
4 5 (cont d) Investigation of Clinical States (cont d) Haemolytic Disease of the Newborn 5.5 The immunological basis for HDN & the factors that may influence the severity of the disease. 5.6 The antibody specificities most commonly responsible. Cellular assays and serological parameters that may be used to assess the clinical significance of implicated antibodies. 5.7 Techniques for antenatal determination of the blood group antigen status of the foetus. 5.8 Appropriate antenatal testing protocols for patients with and without known clinically significant antibodies. 5.9 Be familiar with current protocols for the administration of anti-d gammaglobulin, and test procedures for determining foetal cell numbers in maternal blood. Autoimmune Haemolytic Anaemias 5.10 The pathogenesis of autoimmune haemolytic anaemias & known triggers initiating these conditions The serological presentations of AHA, & techniques and procedures used for serological investigation, and for providing blood for transfusion. Drug induced haemolytic anaemia 5.12 Be familiar with the drugs most commonly implicated in drug induced haemolytic anaemia The mechanisms by which the different drugs induce haemolysis Techniques used to demonstrate the implication of drugs. Bone marrow / stem cell transplantation 5.15 The serological anomalies resulting from transplantation Selection of appropriate blood group for blood products transfused to patients transplanted from donors of different ABO group. Objective: To ensure a thorough knowledge of the diagnostic and investigative procedures and techniques surrounding immunohaematological and transfusion related disorders 6 Computing systems 6.1 The functional requirements for a comprehensive hospital based transfusion software programme. 6.2 Validation requirements for software.
5 Objective: To be able to evaluate and validate the function and integrity of transfusion software. 7 Transfusion Laboratory Management 7.1 Be familiar with the NPAAC Requirements for Transfusion Laboratory Practice and ANZSBT Guidelines for Pretransfusion Laboratory Practice. 7.2 Review and audit processes for monitoring blood and blood product usage and transfusion related practises. 7.3 Haemovigilance, and adverse event monitoring procedures. 7.4 Blood and blood product inventory management processes. 7.5 Workload management practises. 7.6 Hospital Transfusion Committee membership and functions. Objective: To gain a sound knowledge of regulatory requirements and transfusion service management principles and practice. E. Rationale for Content A comprehensive understanding of the scientific and management principles surrounding the operations of a hospital transfusion laboratory provides the foundation for the provision of an efficient, high quality transfusion service. F. Examination Under the Fellowship Regulations, a 3-hour written examination will be held at the completion 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 include in the question mix. Examination for this Module will focus on an overall understanding of the principles and procedures across the major topic themes : Immune Response Mechanisms Biochemical, Molecular and Genetic aspects of blood group system Transfusion Laboratory Techniques Blood Group Antibodies Investigation of Clinical States Computing Systems Transfusion 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 100 marks; suggested time allocation five minutes per question total 100 minutes. Twenty minutes for re-reading and review.
6 There will be an initial reading time of 15 minutes during which no writing will be permitted G. Texts and Supporting Material The following texts and reviews are recommended. In addition current volumes of the recommended journals should be consulted for relevant articles. 1 Issitt PD, Anstee DJ., Applied Blood Group Serology. Montgomery Scientific Publications 4 th Edition Technical Manual American Association of Blood banks current Edition 3 Guidelines for Pretransfusion Laboratory Practice. Australian & New Zealand Society of Blood Transfusion 5 th Edition Requirements for Transfusion Laboratory Practice. NPAAC ( National Pathology Accreditation Advisory Council), Australian Government Department of Health and Ageing, Canberra. 2 nd Edition Male D, Brostoff J, Roth D, Roitt I. Immunology, Elsevier, 8 th Edition, Klein HG, Anstee DJ, Mollison s Blood Transfusion in Clinical Medicine, Blackwell Publishing. 12 th Edition Texts and Supporting Material (cont d) Recommended Journals: Transfusion Vox Sanguinis Transfusion Medicine Transfusion Medicine Reviews Immunohaematology H. Appointment of a Mentor Each candidate is required to nominate a member 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.
7 I. Module Communications Module Convenor: Dr T Cobain trevor.cobain@health.nsw.gov.au Discipline Committee: Ms Dianne Grey Dr D Roxby Ms D Stern 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.
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