FELLOWSHIP PROGRAMME

IN PATHOLOGY

Department of Pathology

Postgraduate Centre College of Medicine

Jointly by: King Khalid University Hospital.

King Faisal Special Hospital and Research Center.

Riyadh Armed Forces Hospital. King Fahad National Guard Hospital.

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1. INTRODUCTION The Department of Pathology at the College of Medicine, King Saud University, the Department of Pathology and Laboratory Medicine at the King Faisal Specialist Hospital and Research Centre, and the Department of Pathology, Riyadh Armed Forces Hospital, have initiated a joint collaborative postgraduate training programme in Pathology. The three institutions have agreed on a broad spectrum of collaboration in order to improved a first rate education for residents. The resources available in these tree institutions with regard to staffs, equipments and specimens will be utilized for the training programme. The programme is intended to provided well trained General and Special Pathologists for the larger number of medical laboratories in hospitals and clinics throughout the Kingdom. A committee with representatives from the three institutions entitled “ the Joint Pathology Fellowship Committee” will supervise the overall implementation of the programme. The training programme is structured to provide a good balance of the technical and theoretical aspects of pathology and the interpretative skills, investigation and management inherent in the modern practice of laboratory medicine. A certificate entitled “Fellowship” in pathology will be awarded by King Saud University to those successfully completing the programme that requires a period of 5 years full time postgraduate training and education.

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2. OBJECTIVES 2.1 General Objectives The Pathologists’ knowledge of the causes, natural history and manifestations of disease in terms of altered anatomy, biochemistry, physiology and immunology is the basis for his or her important role in the diagnosis and prevention of diseases. The pathologist is involved in the evaluation of specimens, and is concerned with the production and assessment of sate used in the diagnosis and management of diseases. He or she is involved with clinical colleagues in interpreting the results of laboratory investigations and correlating these results with the clinical courses of the patient. To fulfill this role broad role, the Pathologist must have an adequate back-ground of basic science and clinical medicine, and he or she needs extensive knowledge of, and technical ability in, laboratory methods. To be effective, the Pathologist must also possess management and communication skills, and should develop and maintain a scientific inquisitiveness about pathologic progresses. Hence, the fundamental objectives of the pathology Fellowship programme are to provide training and guidance which will allow the resident to acquire the knowledge and develop the skill needed to practice as a Pathologist assisting with patient care through the use of laboratory investigation and date interpretation. 2.2 Specific Objectives The Pathology Fellowship Programme places the following expectations on the resident: 2.2.1 An understanding of the basis of pathology processes. 2.2.2 Knowledge about the technical, mechanical aspects and management of various pathology

laboratories. 2.2.3 Investigative skills needed to interpret laboratory data and to make clinico-pathological

correlation as they apply to the patients. 2.2.4 Ability to communicate so as to affectively share expertise, particularly with regard to

assistance with the diagnosis, management and prognosis of patient illness. 2.2.5 Involvement in the education of other residents, physicians and allied health professional. 3

3. ADMISSION REQUIREMENTS 3.1 Applicants are expected to fulfill the requirements stated in the rules and regulations of King

Saud University Fellowships in Medical Fields. 3.2 The applicant must be holding a Bachelor Degree in Medicine and Surgery with a minimum

grade of “Good”. 3.3 Applicants must have completed satisfactorily one year of rotating clinical appointments ( internship), and attained a standard of “Very Good” at the end of the rotations. 3.4 Applicants are required to attend an interview and a selection examination. 3.5 Each applicant should secure a letter of approval from his sponsor/employer that he/she will be

a full resident all through the course of his/her training in this programme. 3.6.1 Residents who have satisfactorily completed the first year of the M.Sc. in Pathology of

King Saud University (KSU) may apply for admission in the Residency Programme. if accepted, they will be credited with one year of this

five- year programme. 3.6.2 Residents who obtained M.Sc. in Pathology from King Saud University and wish to join the

Fellowship Programme in Pathology should meet the admission requirements mentioned above. If accepted, the study period in their programme shall be as outline in 4.9. below.

4. TRAINING PROGRAMME 4.1 Unless otherwise stated, residents in this Programme shall abide by the rules and regulations

of the fellowship of King Saud University in Medical Fields. 4.2 The Programme will require successful completion of 5 years 4.3 The aim of the Programme is to train residents in order to qualify either as general of special

pathologists. 4.4 Candidates from the beginning of the first year of the programme will be assigned to his /her

subspeciality of Pathology (Anatomical Pathology, Medical Microbiology, Haematology and Chemical Pathology) - They will attend lectures.

4.5.1 Candidates in General Pathology should study a combination of 5 disciplines (Anatomical Pathology, Microbiology, Haematology, Chemical Pathology and Immunology). The distribution of time among these subjects will be worked out devoted for the minor/elective subjects. 4.5.2 Candidates in Special Pathology will choose one discipline during the admission selection examination. They will spend at the whole five years in that particular discipline, according to the detailed training scheduler for each discipline as shown in the book. 4

4.6 At all time candidate will be under the supervision of a qualified pathologist. Regular supervisor’s report will be provided to the co-ordinator of the programme by end of each rotation. 4.7 Candidates will rotate between the laboratories of the contributing institutions according to schedules worked out by the Joint Fellowship Training Committee. 4.8 During the training, students will be required to present cases, seminars and share it the clinico-pathological activities pertaining to various fields in pathology. 4.9 M.Sc. in Pathology;

In addition to the above-mentioned guidelines (3.6.1 and 3.6.2), students holding M.Sc. in Pathology from KSU shall be treated as follows:

4.9.1 Residents who want to continue in the same speciality as that of the second year of his/her M.Sc in Pathology would need at least 2 more years of training in the same discipline and the rest of study period may be devoted for minor/elective subjects.

4.9.2 Residents who want to take a different speciality would need at least 3 more years of training

in the chosen discipline. 4.9.3 Residents who want to be general pathologists would need 3 more years of training in

disciplines not covered in the second year of the Msc. In Pathology.

5. HOLIDAYS, EMERGENCY LEAVE, MATERNITY LEAVE.

All residents, demonstrators and expatriate physicians who are admitted to any Residency Training Programme agree to abide to the general policy, rules and regulations of the King Saud University Fellowship Training Programmes. 5.1. Holidays

5.1.1. All residents are entitled to one month holiday plus one Eid holiday per year of training. 5.1.2. The holidays should be approved by the Programme Director and the Head of the Department.

5.1.3. The one Eid holiday should be subject to the approved of the Residency Training Committee. The Department concerned should only allow 5 working days off.

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5.2. Emergency Leave.

Any emergency leave will be deducted from the holidays. Emergency Leave should be arranged internally in the Department concerned.

5.3. Sick Leave.

Any sick leave incurred by the resident shall be also deducted from the holidays. Sick leave should be submitted officially.

5.4. Maternity Leave.

A resident may apply for maternity leave. However, the resident will not be allowed to take her exams unless she fulfills the total number of days required for the programme completion. Thus the resident has to compensate for the number of days absence in her maternity leave.

5.5. Forms Completion.

A duly accomplished leave form should be filled up. This form should be: 1. Signed by the Programme Director and the Department Chairman. 2. Copy should be sent to the Postgraduate Centre. 3. Copy should be sent to the Personnel Director of the KKUH.

6. INTERRUPTION OF TRAINING. A resident may apply for interruption of training however, the maximum period of interruption should not be more than one year over the training period. The following procedures should be followed;

6.1. Interruption can only be made for specific reasons which not include period of training abroad fulfill training requirement of other programme.

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6.2. An official letter addressed to the Director of the Programme stating the specific date of absence and return to the programme. 6.3. Application should be approved by the Residency Training Committee of the Department.

6.4. The department forwards the application of interruption of training to the Director of the Residency Training Programmes.

6.5. The Director of the residency Training Programmes forwards the application to the Residency Board for consideration. 6.6. The Programme Director will than inform the resident

concerned officially of any decision taken by the Residency Board. 6.7. Failure of the resident to return to the programme on the date

specified in his application would result in dismissal from the programme.

6.8. Extension of training interruption may be obtained by writing to the Programme Director prior to the date of application. Approval of extension will then follow the same procedure numbers 1-7.

7. PERIOD OF ELECTIVE. The following are the procedures for the period of elective.

7.1. Residency Programs should make provis ion of elective period during the senior residency training (final year). 7.2. The elective period is subject to the approval of the Residency Training Committee in accordance with the needs of the program and the performance of the resident. 7.3. The elective period aims to encourage senior residents to pursue advanced training, subspeciality training and to improve their skills and further their knowledge. 7.4. The department will decide about areas of deficiency which the resident may study in other institutions locally or abroad. 7.5. It is expected from the resident in the program to consult the program Director well- in advance, rather than just inform about intention to travel aboard for training. This signifies that electives should be approved before any arrangements are taken. 7

7.6 The resident should be aware that the program is only responsible for

training within the Kingdom on a full- time basis for study during the whole program period. No periods of absence are allowed more that that specified in the University Regulations for the fellowship programs.

7.7 Any resident to fulfill the requirements to travel abroad for training periods: 7.7.1. Should be senior resident (R4 for program of four years and R4 or R5 for program of five years.) 7.7.2. The program should specify an elective period during the final year. 7.7.3. The location for training should be acceptable by the Residency Training Committee of the program. 7.7.4. The theme for training should be validated by that committee. 7.7.5. The training authorities aboard should be willing to make final evaluation of the resident after training and give feed back to the local program authorities. 8. CLINICAL ATTACHMENT. The following are procedures for doctors who applying for clinical attachment.

8.1. The applicant must write a letter to the Chairman of the Department stating his intentions for clinical attachment specifying the Period of training.

8.2. The Residency Training Committee (RTC) of the programme concerned must approve and discuss the application for clinical attachments.

8.3. After approval of the RTC, the matters have to be forwarded to the Director of the Residency Training Programmes. 8.4. The Residency Board will then be informed of any clinical attachment Approved by the Director of the Residency Training Programmes. 9. Evaluation: 9.1. Examinations will follow the rules and regulations of King Saud University Fellowships in Medical Fields. 9.2. Residents will be evaluated regularly at the end of each rotation. 8

10. Examinations: 10.1: The dates of the written examinations for all disciplines at all levels of the program. 10.1.1. R1 Examination * 1st part will be held on the last Monday of January every year. Unless otherwise announced.

* 2nd part will be held on the last Monday of June every year. Unless otherwise announced.

10.1.2. R2, R3 & R4 Examinations

• The written exam. Will be on the last Monday of October every year. Unless otherwise advertised & announced

• The practical, oral & clinical (if applicable) should be held within one

month of the written exam. 10.1.3. R5 Examination

• Written exam. Will be on the 2nd Monday of November every year. Unless otherwise announced.

• Practical, oral and clinical (if applicable) will be held within one month of

the written exam. This period of one month can be extended according to the availability of the external examiners. Such period should by no means exceeds 3 months.

10.2. The details and regulations of the Annual Examinations in the various subspecialties of pathology at various levels of the Programme from R1-R5:

10.2.1. R1 Exam: The R1 written exam will carry 70% of the total marks and 30% will be

assigned for the professional evaluation during the resident’s rotations . 10.2.2 The R2 and R4 examinations will be assessed as following: 10.2.2. A. Continuous Assessment 40% 10.2.2. B. Final Examination 60% 10.2.2. C. Only written examination – R2 MCQs – R4 Essay questions 9

10.2.3. The continuous assessment should involve the evaluation of the

practical training, seminars, tutorials, journal clubs, case discussion/ presentation as well as attendance and punctuality besides the attendance and participation in the Riyadh specialized Pathology group meetings.

10.2.4. The candidates must have two recommendation reports from two Consultants who have been recently involved in his/her training, so that he/she can appear for the R3 or the R5 examination, (one of the reports will have to be for the latest immediate supervisor.)

10.2.5. R3 and R5 examinations should be assessed out of 100.

10.2.6. R3 examination, at the end of the 3rd year of the programme; will consist of the following:

10.2.6.A. Written Examination 40% of the total marks - Essay - MCQs

10.2.6.B. Practical Examination 40% of the total marks. 10.2.6.C. Oral examination 20% of the total marks

10.2.7. R5 Examination, at the end of the fifth year of the programme, will consist of the following:

10.2.7.A. Written Examination 40% of the total marks Two Essay type papers (each for 3 hours) 10.2.7.B. Practical Examination 40% of the total marks

10.2.7.C. Oral Examination and - 20% of the total Clinical Examination (if applicable) marks. 10.2.8. The written parts of both the R3 and R5 examinations are mandatory

and the candidate will not be allowed to sit for the practical and oral parts unless he/she passes the written part. 10.2.8.A The pass marks of > 60% in written exam will allow the resident to sit for the practical, oral and clinical examinations (if applicable). 10.2.8.B. Only > 70% score in the written exam will exempt the resident from

repeating the written exam in case of failure in the whole exam. 10

10.2.8.C. The candidates have to pass with a score of not less than 60% in each part of the examination (including the subdivisions of the practical exam such as morphology, coagulation and blood transfusion in case of haematology or similar status in the other disciplines according to the view of the joint training committee of that discipline). But the resident has to score a total of 70% in the whole examination in order to be considered as pass. 10.2.9. A period of not more than one month should be there between the written part and the other parts of examination (Practical, oral and clinical) 10.2.10. Candidates should pass each component of the examination (written,

Practical, oral/clinical) independently, in order to be considered as pass in the examination as a whole.

10.2.11. Grading of residents ought to be either fail or pass. Pass means that the

resident has satisfied the examiners. A pass can then be translated as 70% marks as per the University regulations.

10.2.12. The examiners panel in each subspeciality should meet prior to the

Examination, chaired by the Chairman, Dept. of Pathology, College of Medicine, KSU to decide on the format of the examination as well as the marking system and evaluation within the above mentioned regulations.

* 10.2.13. A small research project ought to be carried out during the training in the 4th or 5th year. This will help the resident to be familiar with research.

The residents should have that research project completed preferably by the end of the R4 but will not be permitted to sit for the R5 final exam unless they complete their projects.

10.2.14. A log book is designed by every subspeciality Joint Training Committee,

for every resident to have. The items of this book will have to be ticked out by the candidate with the help of his immediate training supervisor to keep a record of the resident’s training and professional activities.(The Australian Royal College of Pathology’s check list is used as a guide).

* This item will be strictly applied for those residents who are in the 3rd year of training (R3) for the academic year 1424/1425 on ward. The R4 & R5 residents before that can do a research project subjected to the subspeciality joint training committee decision.

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11. DISCIPLINE OF RESIDENTS AND PROGRAMME DISMISSAL 11.1. All the general rules and regulations of the King Saud Fellowship Programme should be adhered to in discipline residents. 11.2. Implementation of these general rules and regulations has been transferred of the Residency Training Programme concerned.

11.3. The Deanship of Admissions and Registrations provide the student Registration numbers. These student numbers should be used in any communication pertaining to the residents. (e.g. communication Between Department, Residency Board and other). 12. Continuous Communication with the Deanship of Admissions and Registrations. The Deanship of Admissions and Registrations has to be notified and informed of the following: 12.1. Temporary interruption of training specifying the dates.

12.2. Withdrawal from the programme of residents. 12.3. Annual results of exams specifying if the resident has been promoted to the next level of training or not.

12.4. Final results of and completion of training of residents. Such results Should also be forwarded through the Department Board to the College Board and to the University Board for the issuance of the original diploma certificate. 13. FILE REQUIREMENT OF EACH INDIVIDUAL RESIDENT. A complete resident file should consist of :

13.1. Complete application form for the programme concerned, copies of the graduate application form, copies of all other requirements earlier state and a joining report.

13.2. End year evaluations of residents. Such evaluation should also be forwarded to the sponsors of the candidates.

13.3. Results of the end of year exams. 12

For further information, please contact the secretary of the Residency Training Programme at: Medical Education Centre Residency Training Office P.O. Box 2925 Riyadh 11461 Telephone Number 467-1551/1564/1556/2459 www.mecksu.org 13

HAEMATOLOGY

HAEMATOLOGY SECTION

Scheme of rotation for Residents training in Haematology speciality (R1 to R5). During the rotation in R1-R5 the resident is expected to acquire knowledge and practical experience of the items in the attached check list which is adopted by the Royal College of Pathologist ( Australasia).

The residents will have to cover routine general Haematology work beside the specialized training all through, except when they are doing blood transfusion, 1. The 1st year of the programme (R1). 1. The residents will be rotating mainly in Haematology, beside spending specified times of rotation in the other relevant disciplines of Pathology as following: a. Histopathology 4 Weeks b. Medical Biochemistry 3 Weeks c. Medical Microbiology 3 Weeks d. Immunology 5 Weeks e. Cytogenetics 4 Weeks 2. The residenct is excepted to indulge himself/herself, under supervision, in the general haematology training with no emphasis on a specific subspeciality in haematology. 3. The resident would attend all various relevant haematological activities both clinical and laboratory e.g. grand rounds, clinical presentations, CPCs, cyto- haematology sessions, etc. Haemat 1 4. The resident will have to attend the theoretical lectures which are usually given in the on Tuesdays. 5. During and at the end of this year the resident will sit for a two parts examination, which will carry 70% of the total marks, on the theoretical lectures (35% for each) and 30% on the rotations assessment, as have been approved by the Department of Pathology Residency Training Committee. II. The 2nd year of the programme (R2) 1. The training will continue in general haematology as in the 1st year (R1) 2. The resident is excepted to gain knowledge and practical experience in isotope, electron microscopy and immunohisto and cytochemistry in relation to haematology for a period of one and half month, one month and half a month respectively beside the routine haematological work coverage. The place for this training will be decided by the joint training committee. 3. HLA typing and flow cytometry are expected to be covered for a 3 months during R2

beside the routine haematology workload. 4. The resident at the end of R2 will have to sit for a written (MCQ Format) examination as per the regulation. III. The 3rd year of the programme (R3) During this year the resident should have a rotation scheduled as following:

1. The candidate is expected to spend 3 months in a hospital based blood transfusion service together with some experience in blood component pharesis.

2. Beside being involved in the routine haematology work, the resident is excepted to give

strong emphasis and acquire comprehensive knowledge and practical experiencein coagulation for a period of six months.

3. The resident will spend 3 months period in clinical haematology together with the

Related relevant laboratory work.

4. The resident by the end of R3 is expected to sit for a comprehensive examination as per the regulations.

Haemat 2 1V. The 4th year of the programme (R4).

1. During this year and for 3 months the resident is expected to acquire knowledge and practical experience in all aspects of lymphoma work up, beside the routine haematology work coverage.

2. Six month mainly devoted to clinical haematology together with the related relevant

laboratory work coverage.

3. It is very strong recommended that for a resident to become a haematologist, he/she will have to spend at least 3 months in a national blood transfusion center abroad until the time comes and a center is established in the kingdom.

4. The resident is expected to start and complete a research project during this year.

5. The resident at the end R4 will have to sit for a written (Essay Format) exanination as per the regulations.

V. The 5 th year of the programme (R5).

1. The year is expected to be a period for training in elective subspecialities and completion of the research project as well as compensating for any training gaps, the resident may need to fullfil in the field of haematology.

2. The resident is also expected to continue doing routine haematology work coverage. 3. The resident will have to finish with his/ her research project in order to sit for the R5 graduation examination.

4. The examination will be a graduating comprehensive one at the end of this year (R5) as per the regulations.

VI.. Evaluation 1. Examination and evaluation of residents at the end of each year will abide with the KSU and Pathology Fellowship examination regulations and any modification thereafter. 2. The resident after each rotation has to be evaluated and provided with a log book to show the extent of the practical experience he/she already covered, before going to the next rotation. 3. The supervisors are supposed to send to the haematology coordinator, a full detailed report as well as the filled official evaluation reports on the residents performance at the end of each rotation. Haemat 3 VII. Place of Training

1. The place of the above mentioned training periods will be decided by the Joint Training Committee and will always take the trainees best interest into consideration, so that they can get the best training available.

2. The rotation periods for the resident’s training will be on a 12 months basis in each of the participating hospitals, subjected to modifications at any time according to the decision of the Joint Training Committee and the availability of a specialized service in any of the participating hospitals.

Haemat 4 KING SAUD UNIVERSITY FELLOWSHIP

IN PATHOLOGY ROTATION SCHEME (DIAGRAM)

FOR RESIDENCY TRAINING

IN HAEMATOLOGY HISTO (4 Weeks) IMMUNO (4 Weeks) CYTOGENETICS ( 3 Weeks) CHEM (3 Weeks) MICRO (3 Weeks)

GENERAL HAEMATOLOGY

R1

R2 R3 R4

Graduation R2 : A = Flowcytomelry C = Immunohistochemistry B = HLA Typing E = Isotopes D = Electron Microscopy R3 : A = Hospital Blood Transfusion Service B = Clinical Haematology R4 : A = Lymphoma workup B = National Blood Transfusion (Abroad) Haemat 5

R2C

R2D

R2A

R2B R3A

R2E

+ GENERAL HAEMATOLOGY + RESEARCH PROJECT

R4B

R4A

+ GENERAL HAEMATOLOGY

+ GENERAL HAEMATOLOGY

COAG R3B CLINICAL HAEMAT

HAEMATOLOGY CHECKLIST (Note that this is not a syllabus)

(Adopted from the Royal College of Pathologists -Australasia) A) General Trainees General trainees are expected to acquire knowledge and experience in the following aspects of the laboratory practice of haematology: (i) LABORATORY ASMINISTRATION The organization and management of a routine haematology laboratory with emphasis on: - handling of specimens (including collection, indentification, preservation and disposal) - work flow procedures - recording and reporting systems - handling of urgent and out -of- hours work - laboratory safety (biologic and other) - assessment of appropriate technology - inventory control (ii) BASIC LABORATORY PROCEDURES - preparation of solutions - performance of sterile procedures - calibration and use of diluters and pipettes - principles and usage of SI unit

(iii) LABORATORY INSTRUMENTATION * Light microscopy Knows principle of light microscopy. Is able to adjust instrument for most effective use and perform minor maintenance, e.g. replace lamp and clean lenses. Keeps microscope clean and in good working order during routine work. * Phase-contrast microscopy. Knows principle of phase-contrast microscopy. Is able to set-up and adjust phase- contrast microscope. Haema 6 * Photo-electric colorimeter Knows principles of colorimetry. Is able to calibrate instrument with dilutions of a standard solution of cyanmethaemoglobin and operate and maintain it satisfactorily. * Automated cell counter Knows principles of various types of automated cell counters. Is able to calibrate, operate and maintain instruments. Understands principles and application of instrument quality control. * Automatic staining machine Is able to operate and maintain instrument to obtain satisfactory staining of blood and marrow films. * Electrophoresis Knows principal of electrophoresis. Is a able to interpret cellulose acetate electrophoresis of haemoglobin solution. * pH meter Knows principles of pH measurement . Is able to operate instrument to determine pH of unknown solution. * Weighing Is able to weigh samples using the appropriate balances. * Centrifuge Knows principles of centrifugation. Is able to calculate centrifugal fields and maintain and operate instrument satisfactorily.

Haema 7 (iv) HAEMATOLOGY TESTS It is essential for trainees to understand the theoretical basis of the following common Haematology tests and to gain practical “ hands-on” experience in their performance and interpretation. Basic tests and procedures. * Preparation of satisfactory blood films * Performance of bone marrow aspiration and trephine biopsy * Performance of satisfactory bone marrow aspirate films * Staining of blood and bone marrow aspirate films with Romanowsky stains * Interpretation of blood and bone marrow aspirate films and bone marrow trephine histological sections of common haematological disorders, including recognition of malarial parasites. Performance of: - haemoglobin estimation (P.E. colorimeter) - P.C.V., using microhaematrocrit centrifuge - calculation of red cell “absolute values” - manual leucocyte count - differential count on blood and bone marrow aspirate films - E.S.R - sickling test - N.A.P. score - Infectious mononucleosis screening test - LE cell test Haemolysis tests

Performance of: - reticulocyts count - direct antiglobulin test - Schumm’s test - Heinz body preparation - heat instability test - screening test for G-6-PD deficiency - test for urinary haemosiderin - planning of the investigation of a patient with haemolytic anaemia - Recognition of electrophoretic mobility of common abnormal haemoglobins Haemt 8 Haemostasis tests Performance of: - whole- blood coagulation time - prothrombin time - Thrombotest - activated partial thromboplastin time - thrombin time - fibrin degradation product measurement - bleeding time Blood transfusion tests Performance of: - Blood grouping - crossmatching procedures: saline enzyme coombs * Planning of the investigation of a suspected transfusion reaction Miscellaneous tests The principles of the following tests should be known: * Serum iron, total iron binding capacity and ferritin measurements * Serum vitamin B 12 assay * Serum and red cell folate assays * Schilling tests Acid-serum (Ham and sucrose lysis tests Cold agglutinin titre Osmotic fagility * Autohaemolysis * Hb F and Hb A2 measurements * Acid -elution test * Plasma fibrinogen measurement * Platelet aggregation and adhesion studies

* Red cell antibody detection and identification using donor cell panels * Radioisotope studies- red cell mass - red cell survival * Detective of serum and urinary paraproteins using serum EPG, immunoelectrophoresis and immunofixation * Tests for Hepatitis B surface antigen/antibody Haemat 9 (v) QUALITY ASSURANCE - internal quality control - external quality assessment - basic statistics as applied to quality control (B) SPECIAL TRAINEES Special trainees are expected to acquire comprehensive knowledge and practical experience in the areas detailed in the General Trainees check list. In addition, the following should be covered: (i) LABORATORY ADMINISTRATION laboratory computer systems reference values and their application (ii) LABORATORY INSTRUMENTATION Spectrophotometer Knows principles of spectrophotometer. Is able to operate and maintain Instrument satisfactory Spectroscopy Knows principles of spectroscopy. Is able to use a hand spectroscope and Recognize the absorption bands of oxyhaemoglobin, reduced hadmoglobin, methaemoglobin and haemochrimogen. (iii) HAEMATOLOGY TES TS It is essential for trainees to understand the theoretical basis of the following Common haematology tests and to gain practical “hands –on” experience in their performance and interpretation. BASIC TESTS AND PROCEDURES - Staining of blood and bone marrow aspirate films with Romanowsky stains, manually and with staining machine - Staining of blood films with myeloperoxidase, Sudan Black, PAS, esterase and acid phosphatase stains, - Preparation of supravital –stained blood films using cresyl blue, new methylene blue and methyl violet - Preparation of thick blood films for demonstration of malarial parasites - Interpretation of blood and bone marrow aspirate films and bone marrow trephine

histological sections. Haemat 10 * Performance of - direct antiglobulin test using “broad spectrum” and monospecific reagents - Infectious mononucleosis screeing test and the classical Paul-Bunnell test - Schilling test - radioisotope studies - red cell mass - red cell survival - measurement of faecal blood loss - serum viscosity menasurement Haemolysis tests * Performance of - osmotic fragility - authohaemolysis - acid-serum (Ham) test - sucrose lysis test - cold agglutinin titre, thermal amplitude, 1-I specificity - tests for Hb-S - Hb-F measurement - Hb-A2 measurement - cellulose acetate electrophoresis of haemoglobin solutions - acid – elution test - isopropanol precipitation test - screening tests for G-6-PD and PK deficiency - Donath-Landsteiner test Haemostasis test * Performance of : - bleeding time Ivy or template method - plasma fibrinogen measurement - prothombin consumption test - fibrin monomer screening test - euglobulin lysis time - clot solubility in 5M urea - Factor VIII procoagulant assay - Factor VIII antigen measurement - platelet aggregation and adhesion studies - coagulation inhibitor tests

Haemat 11 Blood Transfusion Tests * Performance of : - anti –A and anti –B haemagglutinin titres - Rh genotyping - antenatal serology - antibody detection and identification using donor cell panels Miscellaneous tests Trainees should know the pr inciples of the following tests and procedures and have observed their performance: - Gamma counting using scintillation detector - Organ localization tests using in-vivo scintillation probes - Basic chromosomal analysis - Serum iron, total iron-binding capacity and ferritin measurements - Ferrokinetic studies using 59Fe - Serum vitamin B 12 assay (microbiological or isotope method) - Intrinsic factor antibody measurement - Oxygen dissociation curve measurement - Serum immunoglobulin measurement - Immunoeletrophoresis and immunofixation of serum and urine - Cryoglobulin and cryofibrinogen detection - Serum complement measurement - Antinuclear factor demonstration - Cell surface marker studies using rosette and immunofluorescence tests - Serum lysozyme measurement - Terminal deoxynucleotidyl transferase (Tdt) assay, - Plasma haptoglobin measurement - Factor VIII: WF measurement - Antithrombin III measurement - Tests for platelet factor 3 availability, - Tests for Hepatitis B surface antigen and antibody - Blood grouping and antibody screening by automated techniques - HLA typing - Elution of antibodies from red cells - Preparation of blood components for transfusion purposes Haemat 12

KING SAUD university FELLOWSHIP

IN PATHOLOGY

HAEMATOLOGY

Practical LOG BOOK

Performance of BASIC LABORATORY PROCEDURES

Number of times preformed

Technical Supervisor Signature

Consultant Signature

Remarks

Blood film preparation & staining

Bone marrow Aspirate preparation staining

Bone marrow Trephine Biopsy

Cyto Chemistry

Immuno histochemistry

Thick blood film For Malaria

Schilling test

Serum viscosity measurement

Radio isotope studies

Red cell mass

Red cell survival

Measurment of faecal blood loss

2 Performance of

Basic Laboratory Procedures

Number of time s preformed

Technical Supervisor Signature

Consultant Signature

Remarks

Preparation of solutions

Performance of sterile procedures

Calibration and use of diluters and pipettes

Principles and usage of SI unit

Haemoglobin estimation (P.E. colorimeter)

P.C.V., using microhaematrocrit centrifuge

Calculation of red cell “absolute values”

Manual leucocyte count

Differential count on blood and bone marrow aspirate films

E.S.R

Sickling test

N.A.P. score

Infectious mononucleosis screening test

LE cell test

1

Haemolysis Tests Number of times preformed

Technical Supervisor Signature

Consultant Signature

Remarks

Reticulocyts count

Direct antiglobulin test

Schumm’s test

Heinz body preparation

Heat instability test

Screening tests for G-6-PD and PK deficiency

Test for Urinary haemosiderin

Planning of the investigation of a patient with haemolytic anaemia

Osmotic fragility Authohaemolysis Acid-serum (Ham) test Sucrose lysis test Cold agglutinin titre, thermal amplitude, 1-I specificity

Recognition of electrophoretic mobility of Common abnormal haemoglobins

Tests for Hb-S Hb-F measurement Hb-A2 measurement Cellulose acetate electrophoresis of haemoglobin solutions

Acid – elution test Isopropanol precipitation test

Donath -Landsteiner test

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Haemostasis test Number of times preformed

Technical Supervisor Signature

Consultant Signature

Remarks

Whole- blood coagulation time

Prothrombin time

Activated partial thromboplastin time

Fibrin degradation product measurement

Thrombin time

Bleeding time Ivy or template method

Plasma fibrinogen measurement

Prothombin consumption test

Fibrin monomer screening test

Euglobulin lysis time

Clot solubility in 5M urea

Factor VIII procoagulant assay

Factor VIII antigen measurement

Platelet aggregation and adhesion studies

Coagulation inhibitor tests

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Blood Transfusion Tests

Number of times preformed

Technical Supervisor Signature

Consultant Signature

Remarks

Blood grouping

Crossmatching Procedures

* Saline Crossmatching Procedures * Enzyme

Crossmatching Procedures * Coomb

Planning of the investigation of a suspected transfusion reaction

Anti –A and anti –B haemagglutinin titres

Rh genotyping

Antenatal serology

Antibody detection and identification using donor cell panels

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Miscellaneous tests

Number of times preformed

Technical Supervisor Signature

Consultant Signature

Remarks

Gamma counting using scintillation detector

Organ localization tests using in -vivo scintillation probes

Basic chromosomal analysis Serum iron, total iron-binding capacity and ferritin measurements

Ferrokinetic studies using 59Fe Serum vitamin B 12 assay (microbiological or isotope method)

Intrinsic factor antibody measurement

Oxygen dissociation curve measurement

Serum immunoglobulin measurement Immunoeletrophoresis and immunofixation of serum and urine

Cryoglobulin and cryofibrinogen detection

Serum complement measurement Antinuclear factor demonstration Cell surface marker studies using rosette and immunofluorescence tests

Serum lysozyme measurement Terminal deoxynucleotidyl transferase (Tdt) assay,

Plasma haptoglobin measurement

Factor VIII: WF measurement

Antithrombin III measurement Tests for platelet factor 3 availability, Tests for Hepatitis B surface antigen and antibody

Blood grouping and antibody screening by automated techniques

HLA typing Elution of antibodies from red cells Preparation of blood components for transfusion purposes

Tests for HIT FISH techniques Cytogenetic studies PCR & Molicular genetic Procedure Quality Assurance

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