Specialty Content

Coagulation specialty

Coagulation often sits within a broader Haematology service but is its own specialist area with its own Specialist Portfolio and interview track.

Where the content lives

• Interview page — /coagulation-interviews — Band 2 through Band 8 questions
• Result Interpretation (coagulation) — open /result-interpretation and click the Coagulation card — PT/APTT patterns, mixing studies, factor assays, anti-Xa
• Specialist Portfolio (Coagulation) — /portfolio → Specialist Portfolio → Coagulation
• Cross-references — coagulation overlaps with Haematology (FBC + clotting screens) and Transfusion (TACO/TRALI workup, MHP coagulopathy)

Key competencies covered

• Routine clotting screen — PT, APTT, fibrinogen, D-dimer
• Mixing studies — 1:1, inhibitor screen, factor deficiency vs inhibitor
• Factor assays — single-factor activity (FVIII, FIX, etc.), chromogenic vs clotting-based
• Thrombophilia screening — antithrombin, protein C/S, factor V Leiden, prothrombin gene, lupus anticoagulant
• Anticoagulant monitoring — INR for warfarin, anti-Xa for LMWH and rivaroxaban/apixaban, dilute thrombin time for dabigatran
• DIC investigation — D-dimer, fibrinogen, platelet trend, schistocytes (link to morphology)
• Lupus anticoagulant — DRVVT, mixing, confirmatory
• Platelet function — light-transmission aggregometry (LTA), PFA

Bands progression

• Band 5 (£32,073-£39,043) — qualified BMS authorising routine coagulation, recognising flagged samples
• Band 6 (£39,959-£48,117) — specialist mixing studies, factor assays, complex case review, training, validation; usually requires Specialist Portfolio in Coagulation
• Band 7 (£49,387-£56,515) — section lead, advanced thrombophilia workup sign-off, on-call cover, clinical advice

Standards alignment

• British Society for Haematology (BSH) guidelines — current coagulation guidelines (LA, thrombophilia, anticoagulant monitoring)
• British Committee for Standards in Haematology for transfusion-related coagulopathy
• UK NEQAS Blood Coagulation
• ISO 15189:2022 quality framework
• MHRA for anticoagulant labelling
• NICE guidance on anticoagulation (CG144, NG196, etc.)

Common interview question themes (Band 5-7)

• "Walk me through your approach to a prolonged APTT"
• "How do you differentiate factor deficiency from an inhibitor?"
• "What is your thrombophilia screen workflow, and when is it appropriate?"
• "How would you investigate a sudden drop in fibrinogen post-partum?"
• "Describe how you would respond to an unexpectedly high INR"

A good preparation order: Result Interpretation → Practice Tests filtered to Coagulation + your Band → AI Interview Coach → mock interview with peers.

Note on terminology

• APTT vs aPTT — both refer to Activated Partial Thromboplastin Time; APTT is the more common UK usage
• DRVVT — Dilute Russell's Viper Venom Time (lupus anticoagulant test)
• LTA — Light Transmission Aggregometry (platelet function)
• TEG / ROTEM — viscoelastic point-of-care coagulation devices