Haematology Guidance Material

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on haematology.

The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the haematology system.

Implementing Rules

Acceptable Means of Compliance

Guidance Material

MED.B.030 Haematology

(a) Applicants shall not possess any haematological disease which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).

(b) For a class 1 medical certificate, haemoglobin shall be tested at each examination for the issue of a medical certificate.

 

 

 

 

 

Class 1 Haemoglobin should be measured at every medical with appropriately maintained and calibrated testing equipment.  Abnormalities on near  patient testing should be confirmed with a full blood count assessed in a haematology laboratory.




(c) Applicants with a haematological condition, such as:
   (1) coagulation, haemorrhagic or thrombotic disorder;

Class 1
(e) Coagulation disorders
Applicants with a coagulation disorder should be assessed as unfit. A fit assessment may be considered if there is no history of significant bleeding episodes.

(f) Haemorrhagic disorders
Applicants with a haemorrhagic disorder require investigation. A fit assessment with a multi-pilot limitation may be considered if there is no history of significant bleeding.


Coagulation and Haemorrhagic Disorders 

Refer to Coagulation/Haemorrhagic Disorders for guidance.





Class 2
(e) Coagulation and Haemorrhagic disorders
Applicants with a coagulation or haemorrhagic disorder may be assessed as fit if there is no likelihood of significant bleeding.


Coagulation and Haemorrhagic Disorders 
Refer to Coagulation/Haemorrhagic Disorders for guidance.




Class 1
(g) Thrombo-embolic disorders
   
(1) Applicants with a thrombotic disorder require investigation. A fit assessment with a multi-pilot limitation may be considered if there is no history of significant clotting episodes.
   (2) An arterial embolus is disqualifying.

Class 2
(f) Thrombo-embolic disorders
   (1) Applicants with a thrombotic disorder may be assessed as fit if there is no likelihood of significant clotting episodes.


Aspirin
and Clopidogrel are acceptable anti-platelet medications.

Anagrelide inhibits platelet formation. Applicants requiring this medication should be assessed as unfit.  Medical certification for Class 1/OML can be considered by the Authority Medical Section no sooner than 2 weeks after commencing this treatment, subject to a satisfactory haematologist’s report to include comment on any side-effects.

Thrombocytosis requires referral to the AMS.

Refer to Pulmonary Embolism and Deep Vein Thrombosis for guidance.




Class 1
(h) Disorders of the lymphatic system
Applicants with significant localised and generalised enlargement of the lymphatic glands and diseases of the blood should be assessed as unfit and require investigation.  A fit assessment may be considered in cases of acute infectious process which is fully recovered or Hodgkin's lymphoma or other lymphoid malignancy which has been treated and is in full remission.


Disorders of the lymphatic system
Refer to UK CAA guidance on malignancies of the lymphatic system for guidance




Class 2
(g) Disorders of the lymphatic system
Applicants with significant enlargement of the lymphatic glands or haematological disease may be assessed as fit if the condition is unlikely to interfere with the safe exercise of the privileges of the applicable licence(s).  Applicants may be assessed as fit in cases of acute infectious process which is fully recovered or Hodgkin’s lymphoma or other lymphoid malignancy which has been treated and is in full remission.


Disorders of the lymphatic system
Refer to UK CAA guidance on malignancies of the lymphatic system for guidance




Implementing Rules

Acceptable Means of Compliance

Guidance Material

(2) chronic leukaemia; may be assessed as fit subject to satisfactory aeromedical evaluation.

Class 1
(i) Leukaemia
   (1) Applicants with acute leukaemia should be assessed as unfit.  Once in established remission, applicants may be assessed as fit. 
   (2) Applicants with chronic leukaemia should be assessed as unfit.  After a period of demonstrated stability a fit assessment may be considered.
   (3) Applicants with a history of leukaemia should have no history of central nervous system involvement and no continuing side-effects from treatment of flight safety importance.   Haemoglobin and platelet levels should be satisfactory.  Regular follow-up is required.

Class 2
(h) Leukaemia
   (1) Applicants with acute leukaemia may be assessed as fit once in established remission.
   (2) Applicants with chronic leukaemia may be assessed as fit after a period of demonstrated stability. 

   (3) In cases (1) and (2) above there should be no history of central nervous system involvement and no continuing side-effects from treatment of flight safety importance.   Haemoglobin and platelet levels should be satisfactory.  A regular follow-up is required.




Class 1
(j) Splenomegaly
Applicants with splenomegaly should be assessed as unfit and require investigation.  A fit assessment may be considered when the enlargement is minimal, stable and no associated pathology is demonstrated, or if the enlargement is minimal and associated with another acceptable condition.

Class 2
(j) Splenomegaly
Applicants with splenomegaly may be assessed as fit if the enlargement is minimal, stable and no associated pathology is demonstrated or if the enlargement is minimal and associated with another acceptable condition.




(d) Aero-medical assessment:
   (1) applicants for a class 1 medical certificate with one of the conditions specified in (c) above shall be referred to the licensing authority;
   (2) fitness of class 2 applicants with one of the conditions specified in (c) above shall be assessed in consultation with the licensing authority.




Implementing Rules

Acceptable Means of Compliance

Guidance Material

(e) Class 1 applicants with one of the haematological conditions specified below shall be referred to the licensing authority:
   (1) abnormal haemoglobin, including, but not limited to anaemia, polycythaemia or
haemoglobinopathy;
   (2) significant lymphatic enlargement;
   (3) enlargement of the spleen.

Class 1
(a) Abnormal haemoglobin
Applicants with abnormal haemoglobin shall be investigated.

Class 2
(a) Abnormal haemoglobin
Haemoglobin should be tested when clinically indicated.


Class 1 & 2 Abnormal Haemoglobin

Refer to UK CAA Guidance on Haemoglobin test results for guidance

Haemachromatosis

An applicant with a diagnosis of Haemachromatosis should be assessed as unfit.  Unrestricted medical certification can be considered by the Authority Medical Section (Class 1) or AME who performed the periodic medical examination (Class 2), once treatment is stabilised, on receipt of acceptable medical reports to include a haematology report.  Applicant should have normal serum Ferritin following treatment, normal Echocardiogram, Holter and Exercise ECG.  Follow up reports generated by the applicant’s treating haematologist should be copied to the AME who performed the periodic medical examination.  Applicants should not fly within 48hr of having venesection as treatment.




Class 1
(b) Anaemia
   (1) Applicants with anaemia demonstrated by a reduced haemoglobin level or haematocrit less than 32 % should be assessed as unfit and require investigation.  A fit assessment may be considered in cases where the primary cause has been treated (eg, iron or B12 deficiency) and the haemoglobin or haematocrit has stabilised at a satisfactory level.
   (2) Anaemia which is unamenable to treatment is disqualifying.

Class 2
(b) Anaemia
Applicants with anaemia demonstrated by a reduced haemoglobin level or low haematocrit may be assessed as fit once the primary cause has been treated and the haemoglobin or haematocrit has stabilised at a satisfactory level.




Class 1
(c) Polycythaemia
Applicants with polycythaemia should be assessed as unfit and require investigation.  A fit assessment with a multi-pilot limitation may be considered if the condition is stable and no associated pathology is demonstrated.

Class 2
(c) Polycythaemia
Applicants with polycythaemia may be assessed as fit if the condition is stable and no associated pathology is demonstrated.




Class 1
d) Haemoglobinopathy
   (1) Applicants with a haemoglobinopathy should be assessed as unfit.  A fit assessment may be considered where minor thalassaemia or other haemoglobinopathy is diagnosed without a history of crises and where full functional capability is demonstrated.  The haemoglobin level should be satisfactory.
   (2) Applicants with sickle cell disease shall be assessed as unfit.

Class 2
(d) Haemoglobinopathy
Applicants with a haemoglobinopathy may be assessed as fit if minor thalassaemia or other haemoglobinopathy is diagnosed without a history of crises and where full functional capability is demonstrated.


Class 1 & 2 Haemoglobinopathy

Applicants with thalassaemia trait may be assessed as acceptable for unrestricted certification subject to the receipt of a haematology report.

Applicants with sickle cell trait may be assessed as acceptable for unrestricted certification.