91358 Advanced Haematology

Warning: The information on this page is indicative. The subject outline for a particular semester, location and mode of offering is the authoritative source of all information about the subject for that offering. Required texts, recommended texts and references in particular are likely to change. Students will be provided with a subject outline once they enrol in the subject.

UTS: Science: Medical and Molecular Biosciences
Credit points: 6 cp
Result type: Grade and marks

Requisite(s): 91401 Introductory Haematology and Immunology

Handbook description

This subject covers disease processes related to hereditary, acquired, benign and malignant disorders of haematological systems; correlation of physiological processes, pathological states and diagnostic tools in haematology; light microscopic morphological examination of peripheral blood and bone marrow in disease and correlation of these findings with indices and cell counts obtained by automated laboratory equipment; procedures for detection and precise diagnosis of anaemias, haemostatic disorders, haemoglobin disorders and haematological malignancies; the World Health Organization classification of haematological malignancies; introduction to cytogenetics; prenatal diagnosis of genetic disease, genetic counselling and cancer cytogenetics.

Subject objectives/outcomes

On completion of this subject students are expected to be able to:

1. Understand normal physiology, structure and function of blood and bone marrow
2. Understand normal reference ranges relating to haematological parameters
3. Explain the influence of age, gender and location on haematological parameters
4. Understand the influence of hereditary and environmental factors in occurrence and progression of disease
5. Understand and explain pathophysiology of haematological disorders
6. Recognise and assess changes in blood and bone marrow in disease states
7. Correlate clinical laboratory results in order to suggest a most probable diagnosis
8. Understand and evaluate confirmatory testing to suggest a precise diagnosis
9. Understand the principles of transplantation
10. Understand the principles of treatment of acquired and congenital haematological diseases
11. Gather and critically assess information from data bases, scientific articles text books and reference books
12. Gain experience in working individually and in groups
13. Use haematological examples to improve written and/or oral communication skills

Contribution to course aims and graduate attributes

This subject contributes to the personal, professional and intellectual development of students by encouraging:

1. Development of the disciplinary, professional and technical knowledge of haematology;
2. Development of skills to analyse information critically and creatively
3. The development of generic skills desired in all graduates including computer literacy, working independently and as part of a group, ethical behaviour;
4. Scientific curiosity and the attitudes, knowledge and skills necessary for a commitment to life long learning in science;
5. The development of logical thought and problem solving skills;
6. The development of oral and written communication skills;
7. The gathering, evaluating and use of information from sources such as databases, research and review articles, textbooks, catalogues and technical reference books;
8. The management of workload required for scientific based practice and professional work.
    

Teaching and learning strategies

This subject involves an average of six contact hours per week comprising two hours of lectures and four hours of practical work over 13 weeks. This subject is taught on a lecture/tutorial/practical basis. It will include the following activities: lectures providing an introduction to key concepts; tutorial problems to support the learning from the lectures; laboratory experiments to extend the theory and help the students understand the key concepts. The practical/tutorial component will focus on the development of practical skills and the presentation of scientific material.

Content

The following topics are to be covered in lectures in the order listed, with each unit approximately equivalent to a semester week.

1. Introduction to bone marrow and red cell investigations

• functions of blood
• morphology of red cells: normal and abnormal; erythrocyte counts and indices
• structure and function of normal bone marrow
• haemopoiesis and its control
• malignant and non-malignant changes in bone marrow
• transplantation

2. Classification of anaemias and haemoglobin disorders.

• pathophysiology of anaemias with hyperactive and hypoactive bone marrow
• mechanistic diagnosis of anaemia; microcytic, macrocytic and normocytic anaemias
• impaired haemoglobin production; molecular basis of congenital haemoglobin disorders

3. Anaemias due to haemolytic processes, deficiencies and bone marrow hypoplasia.

• congenital and acquired haemolytic anemias
• anaemias due to nutritional deficiencies and malabsorption of nutrients
• anaemias due to suppression of haemopoiesis

4. Malaria. Paediatric haematology.

• life cycle of malarial parasite
• variations between species
• incidence, clinical and haematological presentation of malaria
• malaria diagnosis, treatment and prophylaxis
• haematological parameters of infants and children at different ages
• physiological anaemia of infancy, iron-deficiency anaemia, other anaemias
• malignancies of childhood .
• bleeding disorders

5. Introduction to haematological malignancies. Lymphoma. Myelodysplastic syndromes (MDS).

• overview of malignant processes
• Hodgkin’s disease: clinical features, histological classification, clinical staging, laboratory findings, course of disease and prognosis
• non-Hodgkin’s lymphoma: classification, clinical features and staging, course of disease and prognosis
• WHO classification of MDS, clinical, haematological and cytogenetic features, treatment and prognosis

6. Leukaemia.

• Acute and chronic leukaemias, WHO classification of leukaemias, leukaemias in children and adults, clinical and haematological features
• Diagnosis: history, immunophenotyping, cytogenetics, cytochemistry
• Treatment and prognosis

7. Myeloproliferative neoplasms (MPN). Myeloma.

• WHO classification of myeloproliferative neoplasms: polycythaemia vera, myelofibrosis and essential thrombocythaemia
• Clinical and haematological features of MPN, diagnosis, treatment and prognosis
• Myeloma and related conditions, Waldensrom macroglobulinaemia, benign monoclonal gammopathy, laboratory and clinical features, treatment and prognosis

8. Diagnosis and treatment of malignant diseases. Novel targeted treatments.

• laboratory diagnosis of haematological malignancies
• conventional treatments: chemotherapy, radiotherapy, stem cell transplants
• targeted treatments: all-trans retinoic acid for APML, glivec for CML, immunotherapies for B-cell malignancies, thalidomide analogues for myeloma

9. Acquired coagulation disorders. Inherited coagulation disorders.

• features of acquired and congenital coagulation disorders
• hereditary coagulation disorders: Classical haemophilia (A) - defect of F VIII, von Willebrand disease, Christmas disease - defect of F IX, deficiencies of factors III, V, VII, X, XI, XII, dysfibrinogenaemia
• acquired coagulation disorders; disseminated intravascular coagulation, circulating anticoagulants
• fibrinolysis, thrombophilia, diagnosis: laboratory investigations to identify deficient factors
• treatment and prognosis

10. Platelet disorders. Introduction to cytogenetics.

• Thrombocytosis and thrombocytopenia, acquired disorders: idiopathic – acute, chronic, drug-induced and secondary to other disease
• Congenital disorders: essential thrombasthenia, von Willebrand disease
• Introduction to cytogenetics: chromosomes and the normal karyotype, nomenclature, numerical variations

11. Cytogenetics.

• Human chromosome abnormalities: structural, fragile sites
• Clinical applications of cytogenetics: congenital and acquired abnormalities
• Prenatal diagnosis
• Genetic counselling, the family pedigree

12. Cytogenetics.

• Chromosomes in cancer, the classic Philadelphia chromosome in CML, acquired cytogenetic changes in human malignancies
• Molecular cytogenetics, genomic imprinting, uniparental disomy

Assessment

Assessment Item 1: Mid-semester theory test

Objective(s):	To assess students’ knowledge and understanding of all the work covered in lectures and practical classes during weeks 1 to 6.
Weighting:	10%
Criteria:	Students are expected to meet the stated learning objectives for this subject in relation to lectures and practical classes of weeks 1 to 6 inclusive.

Assessment Item 2: Mid-semester practical test

Objective(s):	To assess students’ performance of practical work and their knowledge and understanding of the practical work covered during weeks 1 to 6 and how that work relates to lecture material.
Weighting:	10%
Criteria:	Students are expected to perform practical work and to meet the stated learning objectives for this subject in relation to practical classes of weeks 1 to 6 inclusive and how they relate to lecture material for the same time period.

Assessment Item 3: Group presentation

Objective(s):	In small groups, students research a topic of current interest in haematology. Students prepare and present an oral presentation (usually in PowerPoint) to their practical class group, submit an abstract of the work and a reference list as detailed below.
Weighting:	10%
Criteria:	Quality of abstract Quality of oral presentation Coverage of topic Discussion and relevance Quality and accuracy of reference list

Assessment Item 4: Practical Examination

Objective(s):	To assess students’ performance of practical work and their knowledge and understanding of the practical work covered during the semester.
Weighting:	20%
Criteria:	Students are expected to perform practical work covered during the semester and to meet the stated learning objectives for this subject in relation to practical classes and how they relate to material covered in lectures.

Assessment Item 5: Theory Examination

Objective(s):	To assess students’ knowledge and understanding of all the work covered during the semester.
Weighting:	50%
Criteria:	Students are expected to meet the stated learning objectives for this subject in relation to lectures, practical classes and oral presentations.

Minimum requirements

The oral presentation, practical and theory mid-semester and end-of-semester examinations are all compulsory pieces of assessment.

Students are expected to attend all lectures and must attend at least 80% of the practical sessions.

In order to pass this subject students must receive at least 40% of the marks available for the final theory and practical examinations.
 

Recommended texts

Hoffbrand and Moss, Essential Haematology, 6th Edn, Blackwell Science, 2011 ISBN 978-1-4051-9890-5

Rozenberg, G, Microscopic Haematology: a practical guide for the laboratory, 3rd Edn, Elsevier ISBN 978072940728, 2011

Other resources

1. Dacie and Lewis, Practical Haematology

2. Williams et al., Haematology

3. Hoffbrand, Pettit and Moss, Haematology

4. De Grouchy, J. and Turleau, C., Clinical Atlas of Human Chromosomes

5. Fraser, Roberts and Pembrey, An Introduction to Medical Genetics

6. Therman, E., Human Chromosomes - Structure, Behaviour, Effects

7. Thompson and Thompson, Genetics in Medicine