QUALIFIED MEDICAL LABORATORY TECHNICIAN
HAEMATOLOGY SYLLABUS 2014
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Haematology QMLT Syllabus 2014
NZIMLS
Definition of a Medical Laboratory Technician
A Qualified Medical Laboratory Technician (QMLT) is a person employed to perform routine tasks by following established protocols under the supervision or direction and control of a Registered Medical Laboratory Scientist. A QMLT may only practise within their area of competence, in a health service that forms part of the medical laboratory science profession. During training, supervision would be direct but after suitable assessment of competency, it may be replaced with direction* by a Registered Medical Laboratory Scientist or another registered health practitioner with an appropriate scope of practice, other than a Medical Laboratory Technician The QMLT candidate has two syllabi to study:
The Common Syllabus which is common to all NZIMLS technician qualifications The Discipline Specific Syllabus which is common only to the discipline in which the candidate is sitting the QMLT exam.
The Common Syllabus and Discipline Specific Syllabus are assessed by one examination only.
Logbook - Haematology
The Haematology Special Interest Group (HSIG) has prepared both a syllabus and logbook for use by Trainee Medical Laboratory Technicians preparing for the NZIMLS QMLT examinations. The logbook found in the following section is compulsory and has been included to aid candidates preparing for the QMLT examinations and to be a record of training or practical competency, accomplished by mastery assessment. NOTE - The logbook is required to be presented as part of the examination process. The HSIG has taken a significant step in the review to limit the theoretical knowledge required, sufficient to perform bench procedures and understand the importance of recognising abnormal or anomalous results for referral to a supervisor. The request for specific numbers of points and the reduction in the number of tests to be performed in the logbook, is an endeavour to limit the quantity of information to learn and examine. This does not preclude employers training their laboratory assistants for their own needs
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 2 of 2
Haematology QMLT Syllabus 2014
1.
Role of the Haematology Medical Laboratory Technician
Learning outcome:
2.
2.2
The candidate will describe the scope and function of a Haematology Medical Laboratory Technician.
Refer to Common syllabus
Equipment - Haematology
Learning outcome:
2.1
NZIMLS
To be able to demonstrate the correct operation of laboratory equipment and understand the principles and quality assurance of the equipment as required.
a.
Outline the principle, maintenance and operation of the following: Improved Neubauer counting chamber Erythrocyte Sedimentation Rate (ESR) apparatus staining machine automated cell counter coagulation analyser - (including standard curve)
b.
Outline quality assurance procedures where relevant.
Microscopy: a.
Outline Kohler illumination.
b.
Identify the basic components of a standard light microscope.
c.
Outline the maintenance required for optimal performance of a microscope.
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 3 of 3
Haematology QMLT Syllabus 2014
3.
NZIMLS
Specimens and Specimen Handling - Haematology
Learning outcome:
To be able to process requests and analyse samples as prescribed in the candidate’s laboratory protocols.
3.1
Outline the selection, preparation, handling during testing, storage, transport and disposal of biological specimens used in Haematology.
3.2
Outline the use of anticoagulants and specimen containers for the Haematology procedures listed in the Logbook.
4.
Blood Films
Learning outcome:
To be able to prepare, stain and examine blood films for white cell differential counts and define and use supravital stains.
4.1
Outline the methods for preparing blood films.
4.2
Identify the features of a quality blood film acceptable for microscope examination.
4.3
Outline procedures for examining a stained blood film.
4.4
List the principle of Romanowsky stains.
4.5
Name examples of Romanowsky stains.
4.6
Outline preparation and use of a Romanowsky stain.
4.7
Outline the procedure for performing manual white cell differential counts.
4.8
Identify errors involved in manual white blood cell differential counting.
4.9
Define supravital staining.
4.10
Outline the preparation and use of a supravital stain.
5.
Test Procedures
Learning outcome: Revised by: Date Revised:
To have an understanding of methods as prescribed in the candidate’s workplace protocols including specimen requirements, reagents, methods and quality
Haematology SIG 2011
Date of Next Review:
2014 Page 4 of 4
Haematology QMLT Syllabus 2014
NZIMLS
control.
The student should have an understanding of the test method procedures listed below (test Procedures in Logbook):
Haemoglobin Estimation Haematocrit - Packed Cell Volume (PCV) Mean Cell Haemoglobin (MCH) Mean Cell Volume (MCV) Mean Cell Haemoglobin Concentration (MCHC) White Cell Count (manual) Platelet Count (manual) Full/Complete Blood Cell Count Blood Film Preparation Romanowsky Stain - Blood Films Blood Film Examination - 1 Blood Film Examination - 2 Blood Film Examination - 3 (Morphological Identification) White Cell Differential - 1 White Cell Differential - 2 (Involving nucleated red cells) White Cell Differential - 3 (Recognition of normal and abnormal absolute values) Erythrocyte Sedimentation Rate Supravital Staining Reticulocyte Count Bleeding Time Prothrombin Time Activated Partial Thromboplastin Time Test for Fibrinogen
5.1
List specimen requirements.
5.2
Outline the principle of the procedure.
5.3
Identify reagents, apparatus and/or equipment used.
5.4
Outline the method for preparation of reagents where relevant.
5.5
Outline the quality assurance procedures where relevant.
5.6
Describe the test method procedure.
5.7
Outline the steps to calculate the test result where relevant.
5.8
Identify the reference range(s).
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 5 of 5
Haematology QMLT Syllabus 2014
6.
NZIMLS
Quality Control
Learning outcome:
To be able to outline how controls and standards are used in Haematology.
6.1
Outline the role and use of controls and standards in Haematology.
7.
Haemopoiesis
Learning outcome:
To define and understand haemopoiesis, including the role of bone marrow.
7.1
Define haemopoiesis.
7.2
Outline the function of bone marrow relevant to haemopoiesis.
8.
Haemoglobin
Learning outcome:
To understand and outline the structure and function of haemoglobin.
8.1
Identify the structure of normal haemoglobin molecule, include HbA, HbA2 and HbF.
8.2
Outline how haemoglobin functions as an oxygen carrier and its role in carbon dioxide transport.
8.3
List the reference values for Haemoglobin for an adult male and female.
9.
Nutritional Requirements
Learning outcome:
9.1
Revised by: Date Revised:
To have an understanding of the role of haemotinics in cell production and growth.
Outline the importance of iron, vitamin B12 and folate in cell production and growth.
Haematology SIG 2011
Date of Next Review:
2014 Page 6 of 6
Haematology QMLT Syllabus 2014
10.
NZIMLS
Red Cell Destruction
Learning outcome:
To be able to explain the life cycle, including the destruction, of a red cell.
10.1
Outline the normal red cell life span and identify normal sites of red cell destruction.
11.
Cell Morphology and Function
Learning outcome:
To be able to identify and outline the function of red cells, white cells and platelets.
11.1
Identify the morphological features of a Romanowsky stained red cell and nucleated red cell.
11.2
Identify the morphological features of a supravitally stained reticulocyte.
11.3
Outline the function of red cells.
11.4
Identify the morphological features of the following Romanowsky stained cells: neutrophils and band neutrophils eosinophils basophils lymphocytes monocytes
11.5
Outline the functions of the following cells: neutrophils and band neutrophils eosinophils basophils lymphocytes monocytes
11.6
List the reference values for total white cell count for an adult.
11.7
Outline the morphology of Romanowsky stained platelets.
11.8
Outline the function of platelets.
11.9
List the reference value for an adult’s platelet count.
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 7 of 7
Haematology QMLT Syllabus 2014
12.
NZIMLS
Haemostasis
Learning outcome:
To be able to understand the physiology of haemostasis and outline the coagulation pathways.
12.1
Give an overview of haemostasis including the role of blood vessels, platelets, coagulation proteins, physiological inhibitors and fibrinolysis.
12.2
List the coagulation proteins numerically and by name, identify their sites of production.
12.3
Outline the coagulation cascade, identify the extrinsic and intrinsic coagulation pathways.
13.
Clinical and Laboratory Haematology
Learning outcome:
13.1
To have an understanding of the following disorders and to be able to identify the abnormalities.
Anaemia a. Define anaemia. b.
c.
Define the following: Anaemia of Chronic Disorders Iron Deficiency Anaemia Megaloblastic Anaemia Normocytic Normochromic Anaemia Haemolytic Anaemia Outline the basic genetic abnormality in alpha and beta thalassaemias.
d. Identify the following morphological features of red cells in Romanowsky stained blood films: hypochromia polychromasia microcyte macrocyte (oval and round) acanthocyte echinocyte cell fragment spherocyte target cell tear drop cell elliptocyte / oval cell Howell Jolly bodies Basophilic stippling agglutination rouleaux dimorphic population stomatocytes pappenheimer bodies pencil cells
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 8 of 8
Haematology QMLT Syllabus 2014
NZIMLS
e. Identify the presence of malarial parasites in Romanowsky stained blood films (species identification not required). 13.2
13.3
White Cell Disorders a.
Define the following terms: acute leukaemia chronic leukaemia
b.
List clinical causes for an increase in the absolute numbers of neutrophils, eosinophils, basophils, lymphocytes and monocytes.
c. d.
List clinical causes for a decrease in the numbers of neutrophils. Identify the following white cell morphological changes in a Romanowsky stained blood film: neutrophil toxic changes hypersegmented neutrophils smudge/smear cell variant (atypical/reactive) lymphocyte
Haemostatic Disorders a.
Define haemostasis.
b.
Define the following terms: Thrombocytopenia thrombocytosis
c.
List clinical causes of thrombocytopenia.
d.
Distinguish between primary and secondary thrombocytosis.
e.
Congenital Coagulation Disorder: Outline the defect occurring in Haemophilia A and B
f.
Acquired Coagulation Disorder: Outline the effect of liver disease on the coagulation system. Outline the effect of Vitamin K deficiency on the coagulation system.
g.
Anticoagulant Therapy: Outline the role of heparin including low molecular weight Heparin (LMWH) and oral anticoagulants in anticoagulant therapy. Define INR.
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 9 of 9
Haematology QMLT Syllabus 2014
13.4
NZIMLS
Blood Films and Haematological Disorders a.
List the typical blood film findings for the following haematological disorders: iron deficiency anaemia megaloblastic anaemia liver disease post-splenectomy infectious mononucleosis microangiopathic haemolytic anaemia infection bacterial and viral
b.
List typical blood film findings for the following: Acute Lymphoblastic Leukaemia (ALL) Chronic Lymphocytic leukaemia (CLL) Acute Myeloid Leukaemia – FAB M2 (M2 AML) Chronic Myeloid Leukaemia (CML)
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 10 of 10
Haematology QMLT Syllabus 2014
14.
NZIMLS
Reference Texts
‘Dacie and Lewis Practical Haematology’ SM Lewis, BJ Bain, I Bates 10th Edition, 2006 , Churchill Livingstone Elsevier ‘Essential Haematology’ Hoffbrand A.V. Moss P.A.H. & Pettit J.E. 5th Edition, 2007, Blackwell Publishing ‘Principles of Laboratory Instruments’ Schoef L.E. & Williams R.H. 1993 Mosby - ISBN 08016749-1 ‘Standardised Reporting of Haematology Laboratory Results’ Third Edition 1997 HISG of the NZIMLS
Revised by: Date Revised:
Haematology SIG 2011
Date of Next Review:
2014 Page 11 of 11
