Presentations
- Abnormal coagulation tests
- Family history of life-threatening
bleeding or excessive bruising
- Heavy menstrual bleeding and/or
iron deficiency
- Kidney dysfunction
- Neurological dysfunction
- Prior history of life-threatening
bleeding after surgery or
postpartum haemorrhage
- Spontaneous bleeding or bruising
- Thrombocytopenia
Conditions
- Acquired bleeding disorders:
- coagulopathy associated with:
- liver disease
- kidney disease
- nutritional deficiency:
- disseminated intravascular
coagulation
- drug-induced bleeding,
including:
- anticoagulants
- antiplatelets
- antithrombotic therapy
- Bruton’s tyrosine
kinase inhibitors
- non-steroidal
anti-inflammatories
(NSAIDs)
- selective serotonin
reuptake inhibitors
- haemophilia
- immune thrombocytopenia (ITP)
- medication-related
thrombocytopenia
- microangiopathies, including:
- atypical haemolytic
uraemic syndrome
- thrombotic
thrombocytopenia purpura
- trauma-induced coagulopathy
- von Willebrand disease
- Bleeding disorder of unknown cause
- Inherited bleeding disorders:
- haemophilia:
- von Willebrand disease
- Pregnancy:
- differential diagnosis,
investigation, and management
of thrombocytopenia during
pregnancy
- management of bleeding
disorders during pregnancy
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Bleeding
- Bruising
- Epistaxis
Conditions
- Acquired or congenital platelet
function disorders, such as:
- Bernard–Soulier syndrome
- Glanzmann thrombasthenia
- storage pool diseases
- Cirrhosis
- Congenital disorders of fibrinogen –
number or function
- Connective tissue disorders,
such as vascular Ehlers–Danlos
syndrome
- Hereditary haemorrhagic
telangiectasia
- Nutritional:
- Rare congenital factor deficiencies:
- factor II
- factor V
- factor X
- factor XI
- factor XIII
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Aetiology, diagnosis, management, and natural history of congenital
and acquired disorders of platelet number and/or function
- Complement system relating to atypical haemolytic uremic syndrome
- Laboratory assessment of platelet number and function, including
limitations
- Mechanism of action and adverse effects of medications / compounds
with antiplatelet activity
- Platelet structure and function
Acquired bleeding disorders
- Adverse effects, indications for use, and mechanisms of action
of available haemostatic agents, including:
- anti-fibrinolytics
- blood and coagulation factor products
- desmopressin (DDAVP)
- other adjunctive agents
- Normal haemostasis and fibrinolytic mechanisms
- Pathophysiology of acquired bleeding disorders, including:
- acquired factor deficiency, especially factor VIII (FVIII) coagulant (FVIIIC) and von Willebrand factor (vWF)
- disseminated intravascular coagulation (DIC)
- hepatic disease
- kidney disease
- massive transfusion
- obstetric complications
Inherited bleeding disorders
- Complications, diagnostic strategies, natural history, and
presentation of:
- coagulation factor inhibitors
- inherited coagulation disorders, in particular deficiencies of:
- Diagnostic methods used in assessment of inherited coagulation
disorders, including specific assays
- Mechanism of action, indications for use, and side effects of available
coagulation factor concentrates and relevant haemostatic agents
- Molecular biological techniques to identify genetic disorders
- Pathophysiology of normal haemostasis
Clinical assessment tools
- Bleeding assessment tools, such as the International Society on
Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT)
- Other widely accepted pretest probability tools, such as the 4T score
and the PLASMIC score for life-threatening conditions affecting platelet
count
Investigations
- Anticoagulant medication levels
- Complement testing
- Heparin-induced thrombocytopenia screening and confirmatory testing
- Investigation of abnormal coagulation studies
- Platelet function assays, including light transmission aggregometry
and automated analysers, such as PFA100/200
- Viscoelastic testing, including:
- rotational thromboelastometry (ROTEM)
- thromboelastography (TEG)
Procedures and management
- Appropriate treatment for bleeding and thrombocytopenia, including
blood transfusion
- Complement inhibitors and supportive care
- Delivery of desmopressin and potential risks
- Factor replacement and use of haemostatic therapies
- Gene therapy for haemophilia and hemoglobinopathy
- Management of immune thrombocytopenic purpura (ITP), including:
- emergency interventions for life-threatening bleeding
- first- and second-line strategies
- Management of patients with bleeding disorders prior to and during
surgery
- Management of spontaneous bleeding
- Management of trauma in patients with bleeding disorders
- Reversal agents for anticoagulant therapies
