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CARDIORESPIRATORY: Haematology

Index

• General Outcomes for Haematology
• Anaemia (Priority 1)
• Tropical Haematological Disorders (Priority 2)
• Haemoglobinopathies (Priority 2*)
• Benign White Cell (Leucocyte) Disease (Priority 2)
• Platelet Disorders (Priority 2)
• Haemostasis (Priority 2*)
• Venous Thromboembolism (VTE) Prevention and Thromboprophylaxis (Priority 2)
• Blood Transfusion (Priority 2*)
• Cancers of Blood and Lymph (Priority 3)
• Polycythaemia (Priority 3)

• General Outcomes for Haematology
  • Medical knowledge: PHYSIOLOGY
    • Structure and Function of Blood
      1. List the cellular components of blood cells and outline their roles in the carriage of oxygen and carbon dioxide, immunity / allergy and haemostasis (CR1, GEP/CO2)
      2. List the major chemical components of plasma, and comment on the role of these in clotting, immunity, colloid pressure and buffering (CR1, GEP/CO2)
      3. Outline the production of blood cells from pluripotent haemopoietic stem cells and the regulation of erythropoiesis and myelopoiesis (CR1, GEP/CO2)
      4. Outline the response to anaemia (CR1, GEP/CO2)
      5. Define the parameters of a full blood count and give an outline classification of anaemia (CR1, GEP/CO2)
    • Blood Groups
      1. Explain the nature of blood group antigens and antibodies, and outline of how blood group antibodies develop, using ABO and Rhesus (Rh) blood groups as examples. (CR2, GEP/CO2)
      2. Describe the difference between phenotypes and genotypes, and blood group inheritance, using ABO and Rh blood groups as examples. (CR2)
    • Carriage of Oxygen in the Blood
      1. Describe the structure of haemoglobin and explain why it is uniquely suitable for the carriage of oxygen in the blood (CR1)
      2. Explain the significance of the subunit structure of haemoglobin and the consequences of mutations in the haemoglobin genes. (CR1, GEP/CO2)
      3. Comment on the significance of methaemoglobin in erythrocytes (CR1)
      4. Explain what is meant by haematocrit and how it is regulated. (CR1)
      5. Explain the ways in which carbon dioxide is transported by the blood (CR1, GEP/CO2)
    • Haemostasis and Thrombosis
      1. Describe the nature and function of platelets; explain what is meant by thrombocytopenia (CR1, GEP/CO2)
      2. Describe the normal coagulation pathway and how it is activated by: tissue damage, contact of blood with tissue collagen or glass. (CR1, GEP/CO2)
      3. Describe the roles of Vitamin K, platelets, calcium, serine proteases and modifier proteins in the clotting process (CR1, GEP/CO2)
  • Medical knowledge: PATHOLOGY
    • General Outcomes for Haematological Pathology
      1. Recognise abnormal features in blood films characteristic of white blood cell disorders. (CR2)
    • Pathology of Neonatal Disorders
      1. Explain the cause of haemolytic disease of the newborn, and how it may be prevented. (CR2)
  • Medical knowledge: THERAPEUTIC PRINCIPLES
    • Anticoagulation
      1. Explain the mechanism of action of Heparin, Warfarin, Aspirin and Stroptokinase; indicate under what circumstances it is appropriate to administer them (CR1, GEP/CO2)
  • Clinical skills: DIAGNOSIS and REASONING
    • General Outcomes for Haematological Diagnosis
      1. Understand how the patient’s presentation, examination findings and other investigations including blood counts, complement microscopic analyses of blood films. Begin to interpret such information to form likely diagnoses in common conditions (CR2)
• Anaemia (Priority 1)
  • General Outcomes for Anaemia
    1. State the classification of anaemia based on red cell size, i.e. microcytic, normocytic and macrocytic (CR2)
    2. Recall the process of erythropoiesis and the function of erythropoietin (CR3)
    3. Revise abnormal features in blood films characteristic of anaemias. (CR2)
    4. Recall the structure and function of the red cell and haemoglobin (CR3)
    5. Outline the nutritional and metabolic aspects of iron (including dietary iron, iron absorption, body iron distribution and transport) and the concept of iron overload. (CR2)
    6. Recall the normal process of red cell breakdown (CR3)
    7. Outline the clinical and laboratory aspects of iron deficiency. (CR2)
    8. Recall the basic causes of anaemia and the morphological classification of anaemia ie, microcytic, normocytic and macrocytic (CR3)
    9. Describe the symptoms and signs of anaemia and the compensatory physiological responses to anaemia (CR3)
    10. Differentiate, by laboratory tests, between the anaemia due to iron deficiency and the other causes of microcytic anaemia. (CR2)
    11. Explain the concept of the Anaemia of Chronic Disorder/Inflammation. (CR2)
    12. Explain the anaemia of chronic disease, and show how this can be differentiated from other types of anaemia. (CR2)
    13. Describe an approach to the investigation and management of a patient with anaemia (CR3)
  • Microcytic Anaemia (Iron Deficiency)
    1. Outline the nutritional and metabolic aspects of iron (including dietary iron, iron absorption, body iron distribution and transport) (CR3)
    2. Outline the common causes of iron deficiency anaemia (CR3)
    3. List the causes of microcytic anaemia. (CR2)
    4. Identify questions which, on history taking, help elucidate likely causes of iron deficiency anaemia (CR3)
    5. Describe the symptoms and signs of iron deficiency anaemia and diseases associated with this anaemia (CR3)
    6. Outline the investigation and management of a patient with iron deficiency anaemia (CR3)
    7. Differentiate, by laboratory tests, anaemia due to iron deficiency from other causes of microcytic anaemia (CR3)
    8. Understand the concept of anaemia of chronic disorder / inflammation (CR3)
  • Macrocytic Anaemia (B12 and Folate Deficiency) and Macrocytosis
    1. List the causes of macrocytic anaemia. (CR2)
    2. List the common causes of macrocytic anaemia and macrocytosis without anaemia (CR3)
    3. Outline the nutritional and metabolic aspects of vitamin B12 and folate (including dietary aspects, absorption, body distribution and transport) (CR3)
    4. Discuss the role of vitamin B12 and folate in red cell development, and causes of deficiency. (CR2)
    5. Understand the concept of megaloblastic anaemia and the effect of vitamin B12 and folate deficiency or inhibition on DNA synthesis (CR3)
    6. Outline the clinical and laboratory features of vitamin B12 and folate deficiency. (CR2)
    7. Outline the common causes of vitamin B12 and folate deficiency (CR3)
    8. Identify questions which, on history taking, help elucidate likely causes of macrocytic anaemia (CR3)
    9. Describe the symptoms, signs and laboratory diagnosis of megaloblastic anaemia (CR3)
    10. Outline the investigation and management of vitamin B12 and folate deficiency (CR3)
  • Normocytic Anaemia
    1. Give a differential diagnosis for normocytic anaemia (CR3)
    2. Discuss investigation and management of normocytic anaemia (CR3)
  • Haemolytic Anaemia
    1. Recall normal red cell metabolism and red cell breakdown (CR3)
    2. Construct a simplified classification for the haemolytic anaemias (CR3)
    3. Describe additional clinical signs in a patient with haemolytic anaemia and explain how these may differ from those of anaemia due to other causes (CR3)
    4. Describe the mechanisms leading to anaemia caused by decreased red cell lifespan – the haemolytic anaemias. (CR2)
    5. Outline the laboratory diagnosis of a haemolytic process and understand the concept of extravascular and intravascular haemolysis (CR3)
    6. Describe the investigation and management of a patient with haemolytic anaemia (CR3)
    7. Evaluate a patient with suspected haemolytic anaemia using clinical and laboratory assessment. (CR2)
    8. List common drugs which may induce haemolytic anaemia (CR3)
• Tropical Haematological Disorders (Priority 2)
  • General Outcomes for Haematological Tropical Disorders
    1. Know the presentation and management of patients with malaria
    2. Draw the life cycle of malarial species in man and the mosquito (CR3)
    3. Know how to seek expert advice on the prevention and treatment of malaria (CR3)
    4. Have basic knowledge of the epidemiology and pathogenesis of malaria and of the parasite life cycle
    5. Understand control methods for malaria including bednets and the use of chemicals
    6. List the different species of Plasmodium that cause malaria in humans (CR3)
    7. Recognise the features of trypanosomal infection and Leishmaniasis (CR3)
• Haemoglobinopathies (Priority 2*)
  • General Outcomes for Haemoglobinopathies
    1. Describe the genetics of beta-thalassaemia and sickle cell. (CR2)
    2. Understand the genetics of sickle cell disease and thalassaemia; define sickle cell disease and sickle cell trait (CR3)
    3. Describe how these genetic alterations affect the normal physiology of haemoglobin and the red cell; and the clinical consequences. (CR2)
    4. Understand how these genetic alterations affect the normal physiology of haemoglobin and the red cell and what the clinical consequences are (CR3)
    5. Describe the treatment of beta-thalassaemia and sickle cell, and explain their screening rationale and methodology. (CR2)
    6. Be aware of the clinical consequences of the genetic alterations (CR3)
    7. Outline the laboratory diagnosis of sickle cell disease and thalassaemia (CR3)
    8. Outline the management of sickle cell disease and thalassaemia (CR3)
  • Sickle Cell Disease
    1. Recognise the symptoms and signs of the different types of sickle cell crisis (CR3)
    2. Account for the vulnerability to infection that affects people with sickle cell disease (CR3)
  • Thalassaemia
• Benign White Cell (Leucocyte) Disease (Priority 2)
  • General Outcomes for Benign White Cell Disease
    1. Recall the basic structure and function of circulating leucocytes (CR3)
    2. Draw the proliferation and differentiation pathways of the different white cell lines (CR3)
    3. List the common causes of increases and reductions in the numbers of various leucocytes (CR3)
  • Neutropenia
    1. Define neutropenia and describe the causes and consequences of this condition (CR3)
    2. Describe the management of a patient with neutropenia on the ward (CR3)
• Platelet Disorders (Priority 2)
  • General
    1. Recall normal platelet structure and function (CR3)
    2. List the common causes of thrombocytopenia (low platelet count) (CR3)
    3. Describe the symptoms and signs of a patient with thrombocytopenia (CR3)
    4. Outline the investigation and management of a patient with autoimmune thrombocytopenic purpura (CR3)
    5. Give a differential diagnosis for thrombocytosis (raised platelet count) (CR3)
    6. Give examples of drugs that inhibit platelet function and explain when these are used (CR3)
• Haemostasis (Priority 2*)
  • General
    1. Describe the key elements of the haemostatic mechanism; relate these elements to the essential functions of the control of bleeding and the prevention of thrombosis (CR2)
    2. Recall the key elements of the haemostatic mechanism (CR3)
    3. Understand how a balance is maintained between the control of bleeding and thrombosis (CR3)
    4. Discuss, in broad terms, the way in which problems may arise as a result of inherited or acquired pathology. (CR2)
    5. Describe the symptoms and signs associated with bleeding disorders (CR3)
    6. Describe the categories of drug which may be used for therapeutic purposes to modify haemostasis. (CR2)
    7. Understand the basic screening tests used to investigate a bleeding disorder (CR3)
    8. Summarise how certain bleeding disorders are inherited, or are acquired (CR3)
    9. Be aware of the therapeutic approaches used to manage bleeding disorders (CR3)
    10. Outline the action of anti-thrombotic drugs (CR3)
  • Haemophilia
    1. Identify the various treatment options for patients with haemophillia and von Willebrand's Disease, and be aware of their complications (CR3)
    2. Recognise the condition known as thrombophilia (CR3)
    3. See haemophilia as a disease which can be managed by patients and their parents in the community with specialist help from a wide range of healthcare professionals (CR3)
• Venous Thromboembolism (VTE) Prevention and Thromboprophylaxis (Priority 2)
  • General
    1. Recall the pathological and physiological mechanisms leading to deep venous thrombosis (DVT) and pulmonary embolism (PE) (CR3)
    2. Understand the significance of venous thromboembolism (VTE) morbidity and mortality in the whole hospital setting and appreciate that much of this is preventable (CR3)
    3. Understand the process and justification for VTE risk assessment of hospitalised patients and alternative policy approaches to thromboprophylaxis (CR3)
    4. Describe methods and effectiveness of VTE prevention strategies along with their contraindications (CR3)
• Blood Transfusion (Priority 2*)
  1. Recognise the importance of the Blood Transfusion Service and identify the various blood components available for transfusion (CR3, CR3)
  2. Recall the indications for blood transfusion (CR3, CR3)
  3. Summarise the precautions and testing donated blood undergoes (CR3, CR3)
  4. Recall the ward procedures required for safe blood transfusion practice (CR3, CR3)
  5. Summarise the complications of blood transfusion (CR3, CR3)
  6. Develop a plan to investigate and manage a patient suspected of receiving an incompatible transfusion (CR3, CR3)
  7. Be able to identify the various blood components available for transfusion and their clinical indications (CR3, CR3)
  8. List the most important blood groups and their associated antibodies and antigens and their clinical importance (CR3, CR3)
  9. Know the benefits, risks, adverse effects, interactions and monitoring required when using: Whole blood, packed red cells, platelet concentrate, fresh frozen plasma, cryoprecipitate, human albumin solution, clotting factor concentrates, and immunoglobulin (CR3, CR3)
• Cancers of Blood and Lymph (Priority 3)
  • General Outcomes for Cancers of Blood and Lymph
    1. Understand the role of the primary care team in the palliative care of terminal haematological disease. (CR3)
  • Leukaemia
    1. Understand the nature of the malignant process and the concept of clonality; relate this to haematological malignancy - abnormal growth, differentiation and apoptosis (CR3)
    2. Be able to classify leukaemia into acute (AML and ALL) and chronic (CML and CLL) based on the clinical and laboratory findings (CR3)
    3. Compare and contrast the main differences between acute and chronic leukaemia (CR3)
    4. Explain the clinical features of leukaemia (CR3)
    5. Describe the diagnostic pathway required to confirm the diagnosis of leukaemia (CR3)
    6. Outline the basic principles of the management and treatment of leukaemia (CR3)
    7. Understand the concept of the myeloproliferative disorders (CR3)
    8. Understand the concept of myelodysplasia (CR3)
  • Lymphoma
    1. Define the term lymphoma (CR3)
    2. Be able to recall a simplified classification of lymphoma (CR3)
    3. Outline the clinical manifestations and investigation of a patient with lymphoma (CR3)
    4. Understand the staging of lymphoma; list the criteria used for staging (CR3)
    5. Discuss the pathology of lymphoma including Hodgkin's and non-Hodgkin's lymphoma (CR3)
    6. Understand the approach to the management and treatment of lymphoma (CR3)
  • Myeloma
    1. Understand the structure and function of the immunoglobulins (CR3)
    2. Define the term paraproteinaemia (CR3)
    3. Understand the pathology and clinical manifestations of myeloma (CR3)
    4. Describe the biochemical and haematological abnormalities common in myeloma and their significance (CR3)
    5. Outline the diagnosis, investigation and management of myeloma (CR3)
    6. Distinguish myeloma from benign paraproteinaemia (CR3)
    7. Be aware of the complications of myeloma and their treatment (CR3)
    8. Discuss the management of myeloma (CR3)
• Polycythaemia (Priority 3)
  • General
    1. Define polycythaemia (CR3)
    2. List the basic mechanisms leading to the development of erythrocytosis (CR3)
    3. Give a differential diagnosis for polycythaemia (CR3)
    4. Describe when and how polycythaemia should be managed (CR3)

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