Presentations
- Anaemia
- Bleeding
- Bruising
- Joint haemarthrosis
- Menorrhagia
- Neurological symptoms
- Renal dysfunction
- Sepsis
Conditions
- Acquired bleeding disorders:
- coagulopathy associated with liver and renal disease
- drug-induced bleeding, including:
- anticoagulants
- antithrombotic therapy
- haemophilia
- heparin-induced thrombocytopenia
- massive bleeding in:
- obstetrics
- surgery
- trauma
- von Willebrand disease
- Disseminated intravascular coagulation
- Inherited bleeding disorders:
- congenital platelet disorders
- haemophilia:
- von Willebrand disease
- Thrombocytopenia:
- immune
- medication-related
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
- Kidney dysfunction
- Neurological symptoms
Conditions
- Haemolytic uraemic syndromes
- Inherited bleeding disorders:
- other (rare) congenital clotting factor disorders
- Microangiopathies:
- thrombotic thrombocytopenic purpura (TTP)
- Pregnancy-related bleeding disorders and effects on neonate:
- maternal and fetal carrier status
- thrombocytopenia
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
Acquired bleeding disorders
- Adverse effects, indications of 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, such as:
- acquired factor deficiency, especially:
- factor VIII (FVIII) coagulant
- von Willebrand factor (vWF)
- disseminated intravascular coagulation (DIC)
- hepatic disease
- immune thrombocytopenia
- 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:
- factor II (FII)
- factor VII (FVII)
- factor VIII (FVIII)
- factor IX (FIX)
- factor X (FX)
- factor XIII (FXIII)
- vWF
- Diagnostic methods used in assessment of inherited coagulation disorders, including specific assays
- Indications for use, mechanisms of action, and side effects of available coagulation factor
concentrates and relevant haemostatic agents
- Physiology of normal haemostasis and changes that occur with age
- Use of molecular biological techniques to identify genetic disorders
Platelet disorders
- Aetiology, diagnosis, management, and natural history of congenital and acquired disorders of
platelet number and/or function
- Importance of the complement system relating to atypical haemolytic uremic syndrome
- Mechanism of action and adverse effects of compounds / medications with antiplatelet activity
- Platelet structure and function
- Techniques for, and limitations of, measuring platelet number and function
Investigations
- Coagulation and inhibitor studies
- Factor levels:
- chromogenic studies
- one-phase studies
- Heparin-induced thrombocytopenia screen and confirmation
- Imaging
- Kidney function
- Liver function tests
- Molecular testing for factor deficiencies, platelet disorders, and other inherited
bleeding disorders
- Platelet:
- count and haemoglobin
- function tests
- glycoprotein analysis
Procedures
- Blood transfusion
- Complement inhibitors:
- Delivery and potential risks of desmopressin
- Factor replacement and use of other haemostatic therapies
- Management of patients with bleeding disorders prior to and during surgery
- Management of spontaneous bleeding
- Management of trauma in patients with bleeding disorders
- Plasmapheresis
- Treatment of idiopathic thrombocytopenic purpura (ITP) and platelet disorders
- Use of reversal agents for anticoagulant therapies
- Appropriate prophylaxis and treatment of inherited coagulation disorders
- Appropriate use of haemostatic agents in acquired bleeding disorders
- Clinical advice on the use of antiplatelet agents in medical and surgical contexts
- Clinical and laboratory evaluation of patients with possible bleeding tendency
- Impact of the condition on patients and their families
- Management plans for patients with inhibitors, including liaison with the clinical team
