OVERVIEW

Orientation – on the first day of rotation, the resident will meet with the Laboratory Director or Laboratory Manager for a general overview of the rotation.  In addition, within the first week, the resident should sit with the Lab Director and go over the details of expectations and rotation structure (a standardized checklist will be provided).

Immunophenotyping of Leukemias and Lymphomas – The resident will begin by observing the process of data analysis performed by the attending or fellow for one to several days.  This will be followed by independent analysis of a teaching set of normal specimens.  This set is maintained on the flow lab server, and is accompanied by step-by-step instructions for the analysis of each tube.  Finally, the resident will begin to independently analyze clinical cases in real time.  The resident will work closely with the fellow and covering pathologist in selecting antibody panels for specimen testing, interpretation and write-up of analyzed cases, photographing cases, relaying approved interpretations to the requesting physicians, and learning the basics of data analysis using Paint-a-Gate software.  The level of responsibility assigned to the resident will increase as competence is demonstrated.

CD34( ) cell quantification – the covering pathologist will review with the resident representative cases submitted for CD34( ) cell quantification.

Lymphocyte subset enumeration – the covering pathologist will review with the resident representative cases submitted for lymphocyte subset enumeration.

Technical procedures – the resident will coordinate with technologists to observe all technical aspects of flow cytometry laboratory testing, reviewing the procedure manuals as procedures are observed.  A checklist of procedures will be provided.  This should ideally begin during the second week of a 1-month rotation and continue through out the rotation till all procedures are observed and “signed off” by the techs.

FACULTY

Nitin Karandikar, M.D., Ph.D. (Director)

Brian Levenson, MD (hematopathology and flow cytometry)

Weina Chen, M,D., Ph.D. (hematopathology and flow cytometry)

Arnaldo Arbini, M.D. (hematopathology and flow cytometry)

Franklin Fuda, D.O (hematopathology and flow cytometry)

DURATION: 1 month

PREREQUISITES:

A prior hematopathology rotation is highly desirable.

OBJECTIVES:

Patient Care

Medical knowledge

Practice-based learning and improvement

Interpersonal and communication skills

Professionalism

Systems-based practice

CONFERENCES

Residents will be expected to attend the following conferences:

• Mon-Friday morning consultant sign-out.
• Updates in Pathophysiology
• CMC Tumor Board
• Clinical Pathology Rounds*
• Heme-Onc Rounds
• Multimodality Tumor Board (when applicable)
• Flow Cytometry Case Reviews**
• Any other mandatory conferences, as directed by the residency program

*The resident will be expected to present periodically and to actively participate in this conference.

**The resident may be asked to assist the flow fellow, who has primary responsibility for compiling cases and presenting at this conference.  After the last conference of the rotation, the resident may also be asked to give a short presentation to the flow cytometry technologists, based on a specific case or issue that was encountered during the rotation

LEARNING RESOURCES

“Information for Residents” notebook – contains the basic information about flow cytometry, relevant articles and instructions for analyzing and writing up cases.

Recent positive cases can be obtained from the transcriptionists and will provide a quick review of a large number of cases by looking at the morphology and immunophenotype depicted in the picture pages for each case, formulating a diagnosis, and then checking the diagnosis against the copy of the report. The resident may bring to the fellow or covering pathologist any case that the resident wishes to discuss.

RECOMMENDED TEXTS FOR REFERENCE

Practical Flow Cytometry, 4th edition.  Shapiro HM. Available in flow lab.

Flow Cytometry in Clinical Diagnosis, 3rd edition.  Keren et al. Available in flow lab.