Each pathology resident completes two two-month rotations in Transfusion Medicine. The first rotation occurs in the first year of pathology training and is prerequisite for the pathology resident “on-call”. The resident plays a very active, hands-on role throughout the rotation, this includes evaluating patients and making decisions regarding appropriate diagnostic testing, transfusion therapy or therapeutic apheresis. At any given time, there are at least two residents on the rotation. A fellow in transfusion medicine is present to guide and assist the residents with their duties. In addition, one or more faculty members are always available to answer any questions.
The clinical material for the blood bank rotation is very diverse. It includes a large level 1 trauma center, one of the largest obstetrics services in the country with nearly 17,000 annual deliveries, a pediatric hematopoietic transplant service, pediatric liver and heart transplant service, a regional burn service and one of the largest independent blood donor collection centers in the nation.
In addition to daily “chalk-board” lectures during the rotation, there is also a series of 17 didactic transfusion medicine and hemostasis lectures given as part of the Clinical Pathology lecture series. This series is repeated every two years; thus, each resident has at least two opportunities to hear each lecture.
The first two months of the rotation consist of basic instruction on the following areas: donor eligibility, component preparation, autologous and directed donations, donor and therapeutic apheresis, compatibility testing, appropriate use of blood components, adverse reactions to transfusion, hematopoietic stem cell transplantation, blood derivatives, accreditation and licensing, look back procedures and hemolytic disease of the newborn. The resident will perform exercises on donor eligibility, paternity testing, Rh nomenclature and red cell antibody identification panels. At the beginning of the rotation each resident will be given a checklist of laboratory activities that they are expected to observe at the bench. At the end of the rotation each resident is given an exam covering all of the topics covered over the previous two-months. The results of the exam are factored into the resident's overall performance evaluation for the rotation.
Each resident must also complete a second two-month rotation sometime during their second to fourth year of training. The rotation is predominantly in the area of hemostasis. However, the resident also has the added responsibility of dealing with more complex transfusion medicine problems as well as assisting the junior residents on the rotation.
Residents spend one week of their first two-month rotation at the blood donor center, one week at a pediatric hospital blood bank and one day at an HLA-typing laboratory. The remainder of the rotation is spent at a hospital transfusion service. Residents take daytime call on a rotational basis. They are required to document all calls in the hospital computer system. In addition, they are required to generate written consultations for new red cell antibodies, transfusion reactions and other special testing situations. Residents must be available to evaluate any new patients for whom therapeutic apheresis is requested. In addition, they monitor every patient undergoing therapeutic apheresis to assess progress and efficacy of the treatment.
Additional requirements of the rotation include (1) attendance at a biweekly Transfusion Medicine journal club, where each resident briefly present a peer-reviewed journal article, (2) attendance of a hospital blood utilization review committee (BURC) and (3) participation in a blood drive while at the donor center.
