FAIMS Advanced Haemostasis Module

Transcription

1 Module Title: Module Code: Module Convenor: Advanced Haemostasis HAEM IV Mr Robert Short Haematology Department St Vincent's Hospital Darlinghurst NSW Discipline Committee: Mr Robert Short Dr Ross Brown Mr Michael Wheeler Date Module last reviewed: February Date Module last modified: May Page 1 of 6

2 A. Objectives This module covers advanced aspects of Haemostasis. The aim is to ensure that the candidate has a thorough working knowledge of the theoretical and practical aspects of coagulation testing and other related diagnostic tests which are performed in a medium to large sized routine haematology laboratory. As well as detailed knowledge of laboratory techniques the candidate should understand their application and the interpretation of results. The module is designed to encourage the candidate to further study of the theoretical and technical aspects of the tests performed every day in the laboratory. The candidate should ultimately demonstrate a knowledge level equivalent to that required to supervise and direct the activities of a laboratory processing a broad case-mix of patients and maintaining a high standard of work at all times. The module does not assume that the candidate has had any previous formal study of the discipline but does assume that the candidate has a good understanding of basic biological science. An undergraduate level knowledge of Haematology would be beneficial and current or previous employment/experience in a Haematology laboratory is assumed. B. Interrelationship of the Module to Other Modules For this discipline, the core modules cover basic haematology which has been divided into a cellular module and a haemostasis module. These two core modules cover aspects of testing encountered in a medium to large sized routine haematology laboratory. The elective haematology modules comprise an advanced cellular and an advanced haemostasis module. Additional to this, candidates may attempt a Transfusion Medicine core module as an elective. This module will be extended further in terms of both breadth and depth of knowledge in the elective module, Advanced Haemostasis. The advanced module will expect the candidate to know all aspects of the core module plus an extensive knowledge of specialised testing, physiology, clinical aspects and recent developments in haematology. The other modules in the Haematology discipline are listed: Core Module HAEM I Routine Cellular Haematology Core Module HAEM II Routine Haemostasis Elective Module HAEM III Advanced Cellular Haematology Elective Module HAEM V Transfusion Medicine either core module C. Brief Description This module requires demonstration of an extensive knowledge and understanding of the investigations which are performed in the haematology laboratory for the detection, diagnosis, classification and monitoring of haemostatic disorders. It also requires a thorough knowledge of normal and abnormal haemostatic physiology, clinical aspects relevant to routine coagulation testing and other technical procedures related to haemostasis. Page 2 of 6

3 D. Content 1. Haemostasis Objective: Demonstration of a thorough understanding of haemostasis. 1.1 Clotting factors and their inhibitors. 1.2 Fibrinolytic proteins and their inhibitors. 1.3 Vascular endothelium interactions. 1.4 Platelet function 1.5 Anticoagulant therapy 2. Routine Laboratory techniques Objective: Demonstration of sustained/ongoing knowledge of the techniques and technology used in coagulation investigations which were covered in the core module, Routine Haemostasis. 2.1 Principles and practice of automated and manual coagulation testing 2.2 Reagents used in coagulation testing 2.3 Equipment and instrumentation used to support coagulation testing. 2.4 Specimen collection and handling requirements. 2.5 Strategies and standards applied to reporting of laboratory results. 2.6 Units and reference ranges. 3. Advanced Laboratory techniques Objective: Demonstration of good working knowledge of the techniques and technology used in the comprehensive investigation of haemostasis related disorders including detection, diagnosis, classification and monitoring of these disorders. This knowledge should include an understanding of the principle and the performance of each technique, limitations of the techniques, common problems and the technical and clinical interpretation of results. 3.1 Coagulation factor assay plus related disorders including von Willebrand Disease, abnormalities of fibrinogen. 3.2 Coagulation inhibitor investigation - naturally occurring and acquired inhibitors. 3.3 Fibrinolytic proteins and their inhibitors. 3.4 Platelet function testing 3.5 Molecular studies related to haemostasis disorders 3.6 Immunoassay 3.7 Chromatography 3.8 Miscellaneous techniques 3.9 Recent advances 4. Clinical conditions and situations Objective: To support technical knowledge of laboratory investigations the candidate should demonstrate thorough knowledge of haemostasis disorders. This should include the initial laboratory presentation of each disorder plus comprehensive subsequent investigations and findings which contribute to diagnosis, classification and disease monitoring. A thorough knowledge of the physiology and clinical aspects of each disorder is necessary with a focus on an understanding of the relationship between clinical presentation, appropriate testing and the interpretation of results. 4.1 Bleeding disorders 4.2 Thrombophilia 4.3 Platelet function disorders Page 3 of 6

4 5. Miscellaneous Objective: Demonstration of an understanding of miscellaneous clinical issues and laboratory procedures related to haemostasis. 5.1 Anticoagulant therapy monitoring 5.2 Management of haemostatic disorders including coagulation factor therapy and factor replacement options. 5.3 Management of blood loss and massive transfusion. 5.4 Quality system and quality control issues relevant to haemostasis testing E. Rationale for content A scientist working in a Haematology laboratory will utilise a range of technical procedures to provide information for the management of patients in a wide variety of clinical settings. This module is designed to ensure an understanding of laboratory techniques, their application and the interpretation of results. 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 included in the question mix. The examination in this module will focus on knowledge of technical procedures, technical and clinical interpretation of results and understanding of the rationale for appropriate laboratory investigations. 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 for the short answer questions 100 marks; suggested time allocation five minutes per question total 100 minutes. Twenty minutes for re-reading and review There will be an initial reading time of fifteen minutes, during which no writing will be permitted. G. Texts and Supporting Material The following list of texts is intended as a guide. There is no single text recommended however candidates are encouraged to obtain their own copies or have ready access to at least two texts. Other texts, including new texts which become available, may also be of value. The candidate should peruse current haematology journals for relevant reviews and articles. Texts (Most recent editions) Coleman et al. Haemostasis and Thrombosis. (Lippincott, Williams and Wilkins.) Jespersen. J et al. (Ed). ECAT Assay Procedures. A Manual of Laboratory Techniques: European Concerted Action on Thrombosis and Disabilities of the Commission of the European Communities (Springer) Dacie and Lewis. Practical Haematology (Churchill Livingstone) Hoffbrand and Lewis. Postgraduate Haematology ( Butterworth) Page 4 of 6

5 Chanarin Laboratory Haematology (Churchill Livingstone) Journals Australian Journal of Medical Science Laboratory Hematology Clinical and Laboratory Haematology Thrombosis and Haemostasis Journal of Thrombosis and Haemostasis Blood Coagulation and Fibrinolysis Other Essential Reading NATA, ISO and NPAAC guidelines assorted documents CLSI Standards assorted documents Operating Manuals for instrumentation Other texts with suitable chapters (Most recent editions) O Shaugnessy D et al (Ed). Practical Hemostasis and Thrombosis (Blackwell) Hoffman R. Hematology, Basic Principles and Practices. Lee G (ed). Wintrobe's Clinical Hematology. (Williams and Wilkins) Lewis and Koepke. Haematology Laboratory Management and Practice. (Butterworth) Nathan et al. Nathan and Oski s Hematology of Infancy and Childhood. (WB Saunders) Beutler Williams et al. Hematology (McGraw Hill) American Society of Hematology Education Program Booklet Other Journals which should be reviewed American Journal of Clinical Pathology American Journal of Hematology Archives of Pathology and Laboratory Medicine Bailliere s Clinical Haematology Blood Blood Reviews British Journal of Haematology Hematology/Oncology Clinics of North America Journal of Clinical Pathology Lancet New England Journal of Medicine Seminars in Hematology CAP Today H. Appointment of a Mentor Each candidate is required to nominate a mentor 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. I. Module Communications Module Convenor: Mr Robert Short Haematology Department St Vincent s Hospital Darlinghurst Page 5 of 6

6 NSW Discipline Committee: Mr Robert Short Dr Ross Brown Mr. Michael Wheeler 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. Page 6 of 6