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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)
• Leukaemias (myeloproliferative Disorders and Myelodysplasia)
• Myeloma
• Haemolytic Anaemia
• Lymphoma
• Polycythaemia (Priority 3)
• Cancers of Blood and Lymph (Priority 3)

• General Outcomes for Haematology
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • 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 (GEP/CO2)
      2. List the major chemical components of plasma, and comment on the role of these in clotting, immunity, colloid pressure and buffering (GEP/CO2)
      3. Outline the production of blood cells from pluripotent haemopoietic stem cells and the regulation of erythropoiesis and myelopoiesis (GEP/CO2)
      4. Outline the response to anaemia (GEP/CO2)
      5. Define the parameters of a full blood count and give an outline classification of anaemia (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.
      2. Describe the difference between phenotypes and genotypes, and blood group inheritance, using ABO and Rh blood groups as examples.
    • 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)
      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)
    • Haemostasis and Thrombosis
      1. Describe the nature and function of platelets; explain what is meant by thrombocytopenia (GEP/CO2)
      2. Describe the normal coagulation pathway and how it is activated by: tissue damage, contact of blood with tissue collagen or glass. (GEP/CO2)
      3. Describe the roles of Vitamin K, platelets, calcium, serine proteases and modifier proteins in the clotting process (GEP/CO2)
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • 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.
  • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • Anticoagulation
      1. Explain the mechanism of action of Heparin, Warfarin, Aspirin and Stroptokinase; indicate under what circumstances it is appropriate to administer them (GEP/CO2)
  • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • 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. Recall the process of erythropoiesis and the function of erythropoietin (CR3)
    2. Recall the structure and function of the red cell and haemoglobin (CR3)
    3. Recall the normal process of red cell breakdown with recycling of components (CR3)
    4. Recall the basic causes of anaemia and the morphological classification of anaemia ie, microcytic, normocytic and macrocytic (CR3)
    5. Describe the symptoms and signs of anaemia and the compensatory physiological responses to anaemia (CR3)
    6. Explain the anaemia of chronic disease, and show how this can be differentiated from other types of anaemia.
    7. Explain the concept of the Anaemia of Chronic Disorder/Inflammation.
    8. Describe an approach to the investigation and management of a patient with anaemia (CR3)
    9. State the classification of anaemia based on red cell size, i.e. microcytic, normocytic and macrocytic
    10. Revise abnormal features in blood films characteristic of anaemias. (CR2)
    11. Outline the nutritional and metabolic aspects of iron (including dietary iron, iron absorption, body iron distribution and transport) and the concept of iron overload.
    12. Outline the clinical and laboratory aspects of iron deficiency.
    13. Differentiate, by laboratory tests, between the anaemia due to iron deficiency and the other causes of microcytic anaemia.
• Tropical Haematological Disorders (Priority 2)
  • General Outcomes for Haematological Tropical Disorders
    1. Draw the life cycle of malarial species in man and the mosquito (CR3)
    2. Know how to seek expert advice on the prevention and treatment of malaria (CR3)
    3. Learn about the different species of Plasmodium that cause malaria in humans (CR3)
    4. Understand the treatment of malaria (CR3)
    5. Know about the measures to be taken to prevent malaria (CR3)
• Haemoglobinopathies (Priority 2*)
  • General Outcomes for Haemoglobinopathies
    1. Understand the genetics of sickle cell disease and thalassaemia; define sickle cell disease and sickle cell trait (CR3)
    2. Understand how the genetic alterations affect the normal physiology of haemoglobin and the red cell and what the clinical consequences (CR3)
    3. Outline the laboratory diagnosis of sickle cell disease and thalassaemia (CR3)
    4. Outline the management of sickle cell disease and thalassaemia (CR3)
    5. Describe the genetics of beta-thalassaemia and sickle cell.
    6. Describe how these genetic alterations affect the normal physiology of haemoglobin and the red cell; and the clinical consequences.
    7. Describe the treatment of beta-thalassaemia and sickle cell, and explain their screening rationale and methodology.
  • 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. Learn 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. Learn 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 immune thrombocytopenia (CR3)
    5. Learn the differential diagnoses 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. Recall the key elements of the haemostatic mechanism (CR3)
    2. Understand how a balance is maintained between the opposing mechanisms of coagulation (CR3)
    3. Describe the symptoms and signs associated with bleeding disorders (CR3)
    4. Understand the basic screening tests used to investigate a bleeding disorder (CR3)
    5. Learn about some bleeding disorders which are inherited and acquired (CR3)
    6. Be aware of the therapeutic approaches used to manage bleeding disorders (CR3)
    7. Outline the action of anti-thrombotic drugs (CR3)
    8. 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
    9. Describe the categories of drug which may be used for therapeutic purposes to modify haemostasis.
    10. Discuss, in broad terms, the way in which problems may arise as a result of inherited or acquired pathology.
  • Haemophilia
    1. Identify the various treatment options for patients with haemophillia and Von Willebrand's Disease, and be aware of their complications (CR3)
    2. Learn about how haemophilia can be managed in the community with specialist help from a wide range of health care professionals (CR3)
• Venous Thromboembolism (VTE) Prevention and Thromboprophylaxis (Priority 2)
  • General
    1. Recall the pathological and physiological mechanisms leading to VTE (CR3)
    2. Understand the significance of venous thromboembolism (VTE) morbidity and mortality in the whole hospital setting and to 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, CR3)
    4. Describe methods and effectiveness of VTE prevention strategies along with their contraindications (CR3, CR3)
• Leukaemias (myeloproliferative Disorders and Myelodysplasia)
  • Leukaemias (myeloproliferative Disorders and Myelodysplasia): General
    1. Understand the nature of the malignant process and the concept of clonality; relate this to haematological malignancy - abnormal growth, differentiation, 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)
• Myeloma
  • Myeloma: General
    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)
• Haemolytic Anaemia
  • Haemolytic Anaemia: General
    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. Outline the laboratory diagnosis of a haemolytic process and understand the concept of extra-vascular and intravascular haemolysis (CR3)
    5. Describe the investigation and management of a patient with haemolytic anaemia (CR3)
    6. List common drugs which may induce haemolytic anaemia (CR3)
• Lymphoma
  • Lymphoma: General
    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)
• Polycythaemia (Priority 3)
  • General
    1. Define polycythaemia (CR3)
    2. Learn the basic mechanisms leading to the development of erythrocytosis (CR3)
    3. Give a differential diagnosis for polycythaemia (CR3)
    4. Describe the management of polycythaemia (CR3)
    5. Be able to make a diagnosis of polycythaemia from history and investigations (CR3)
• Cancers of Blood and Lymph (Priority 3)
  • General Outcomes for Cancers of Blood and Lymph
    1. The conditions: chronic myeloid leukaemia, polycythaemia rubra vera, essential thromocythaemia, myelofibrosis. (CSP3)
    2. Biology, clinical features, investigations, diagnosis, further tests, management & prognosis of the above conditions. (CSP3)
    3. Understand the role of the primary care team in the palliative care of terminal haematological disease.
  • Leukaemia
    1. Understand the nature of the malignant process and the concept of clonality; relate this to haematological malignancy - abnormal growth, differentiation and apoptosis
    2. Be able to classify leukaemia into acute (AML and ALL) and chronic (CML and CLL) based on the clinical and laboratory findings
    3. Compare and contrast the main differences between acute and chronic leukaemia
    4. Explain the clinical features of leukaemia
    5. Describe the diagnostic pathway required to confirm the diagnosis of leukaemia
    6. Outline the basic principles of the management and treatment of leukaemia
    7. Understand the concept of the myeloproliferative disorders
    8. Understand the concept of myelodysplasia
  • Lymphoma
    1. Define the term lymphoma
    2. The conditions: Non-Hodgkin's lymphoma, Hodgkin's lymphoma, Myeloma. (CSP3)
    3. Outline the clinical manifestations and investigation of a patient with lymphoma
    4. Understand the staging of lymphoma; list the criteria used for staging
    5. Discuss the pathology of lymphoma including Hodgkin's and non-Hodgkin's lymphoma
    6. Understand the approach to the management and treatment of lymphoma
  • Myeloma
    1. Understand the structure and function of the immunoglobulins
    2. Define the term paraproteinaemia
    3. Describe the biochemical and haematological abnormalities common in myeloma and their significance
    4. Understand the pathology and clinical manifestations of myeloma
    5. Outline the diagnosis, investigation and management of myeloma
    6. Distinguish myeloma from benign paraproteinaemia
    7. Be aware of the complications of myeloma and their treatment
    8. Discuss the management of myeloma

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