Resident Manual

Five Month Residency Rotation in Blood Bank and Transfusion Medicine

General Objectives

The resident should develop sufficient knowledge and experience to function as the Medical Director of the Blood Bank and Transfusion Medicine in a community or academic hospital.  This knowledge and experience will be gained by:  (1) daily service work; (2) rotations through various work-stations; (3) daily meetings with the Medical Director of the Blood Bank and Transfusion Medicine or the “attending of the day”; (4) specific assignments supervised by the Medical Director of the Blood Bank.

The minimum Blood Bank rotation is five months.  Advanced elective rotations can be arranged with approval of the Medical Director.  Objectives and responsibilities for advanced elective rotations will be planned in advance on an individual basis.

The resident will learn the essential administrative, laboratory, and clinical aspects of blood donor and hospital transfusion services.  Areas of knowledge to be addressed include:  blood donation/collection and procurement, plateletpheresis, infectious disease testing of donor (allogeneic) blood, preparation of blood components, autologous blood collection, therapeutic phlebotomy, typing and crossmatching of blood, detection and identification of atypical red blood cell antibodies, clinical utilization of blood and components, diagnosis and management of adverse reactions to blood transfusion, basic laboratory and clinical immunohematology, therapeutic apheresis, peripheral blood hematopoietic stem cell collection, and evaluation and management of therapeutic apheresis patients.

The resident will become familiar with quality control, quality assurance, resource (cost) analysis, and ethical issues as they relate to Blood Banking and Transfusion Medicine, and Clinical Pathology (Laboratory Medicine).  The resident will begin to assume the role of clinical consultant, as well as gain experience in the interpretative reporting of laboratory data.  The resident will also become familiar with the various regulatory agencies and requirements that impact on this unit of the laboratory.

ACGME Core Competencies

The ACGME Core Competencies will be incorporated into these goals and objectives and will also be the basis for resident evaluation during this rotation.  The following summarizes the core competencies.

Patient Care (PC):

• Resident demonstrates a satisfactory level of diagnostic competence and the ability to provide appropriate and effective consultation in the context of pathology services (specifically, Blood Banking/Transfusion Medicine services).

• Resident provides patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

• Resident works with health care professionals, including those from other disciplines, to provide patient-focused care.

Medical Knowledge (MK):

• Resident demonstrates knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care and to pathology (specifically, Blood Banking/Transfusion Medicine).

• Resident demonstrates an investigatory and analytic thinking approach to clinical and pathological situations (specifically, Blood Banking/Transfusion Medicine situations).

• Resident knows and applies the basic and clinically supportive sciences appropriate to pathology (specifically, Blood Banking/Transfusion Medicine).

Practice-Based Learning and Improvement (PBLI):

• Resident demonstrates the ability to investigate and evaluate their diagnostic and consultative practices, appraise and assimilate scientific evidence and improve their patient care practices.

• Resident locates, appraises, uses, and assimilates evidence and information from scientific studies related to their patients’ health problems.

• Resident applies knowledge of study designs and statistical methods to the appraisal of clinical studies.

• Resident uses information technology to manage information and support their own education.

• Resident facilitates the learning of students and other health care professionals.

Interpersonal and Communication Skills (ICS):

• Resident demonstrates interpersonal and communication skills that result in effective information exchange and teaming with other health care professionals, patients, and their families.

• Resident creates and sustains a therapeutic and ethically sound relationship with patients, colleagues, and other health care professionals.

• Resident uses effective listening skills.

• Resident works effectively with others (including faculty, other residents, and laboratory staff).

Professionalism (P):

• Resident demonstrates a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

• Resident demonstrates respect, compassion, and integrity; responsiveness to the needs of patients that supersedes self-interest; accountability to patients, colleagues, and the profession; and, a commitment to excellence and on-going professional development.

• Resident demonstrates a commitment to ethical principles pertaining to confidentiality of patient information, informed consent, and business practices.

• Resident demonstrates sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.

Systems-Based Practice (SBP):

• Resident demonstrates an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care and pathology services (specifically, Blood Bank/Transfusion Medicine services) that are of optimal value.

• Resident understands how their pathology services (specifically, Blood Bank/Transfusion Medicine services) and professional practices affect other health care professionals and organizations.

• Resident understands principles underlying the practice of cost-effective health care and resource allocation that does not compromise quality of service or patient care.

Goals for Cognitive Improvement

Goals and objectives for this rotation are based on the AABB Taskforce on Transfusion Medicine Resident Curriculum recommendations pertaining to curriculum content in Transfusion Medicine / Blood Banking education in pathology residency programs (September 10, 2006 draft (V8.4)).  These goals and objectives are divided into three areas (i.e. Transfusion Service, Blood Collection/ Blood Center/ Cell Processing, and Therapeutic Apheresis).  By achieving these goals and objectives the resident should achieve competency in these areas by the end of the fifth month of rotation.  The abbreviation of each ACGME Core Competency specific to each goal is noted in brackets at the end of each statement.

Transfusion Service:

1. Demonstrate knowledge of the principles of patient/unit identification and pre-transfusion testing, including ABO/Rh testing, RBC antibody screen, and antibody identification [PC, MK]

2. Choose appropriate crossmatching methods for various patients (e.g. electronic, immediate spin, antiglobulin) [PC, MK]

3. Recognize and appropriately refer serologic evaluations that are beyond the scope of a hospital-based transfusion service/blood bank [PC, SBP]

4. Describe the expected response to transfusion therapy in adult and pediatric patients [MK, PC]

5. Triage and screen requests for blood components appropriately during inventory shortages [PC, SBP]

6. Demonstrate the ability to perform blood utilization reviews [PC, SBP]

7. Demonstrate the ability to clinically evaluate a reported transfusion reaction and order and interpret appropriate initial laboratory testing [PC, MK, PBLI]

8. Recognize the symptoms and signs of hemolytic and non-hemolytic transfusion reactions, and demonstrate knowledge of the pathophysiology, treatment, and prevention of these complications [MK, PC]

9. Identify the major infectious complications of blood transfusions, the current risk of these infections, and explain how these infections can be prevented [MK]

10. Identify the major non-infectious complications of blood transfusions, including transfusion-related acute lung injury (TRALI), the risk of these complications, and strategies to prevent them [MK]

11. Demonstrate knowledge of the indications for CMV-negative blood, leukocyte reduction, irradiation, and washing of blood components [MK]

12. Choose appropriate blood components and derivatives based on a thorough knowledge of the indications for transfusion [PBLI, PC, MK]

13. Demonstrate knowledge of the pathophysiology, prevention, and treatment of hemolytic disease of the fetus and newborn.  Recognize those antibodies in pregnant patients that are clinically significant, and make appropriate recommendations for blood products [MK, PBLI, PC]

14. Demonstrate knowledge of the potential side effects of neonatal whole blood exchanges and massive transfusions in neonates associated with extracorporeal circuits such as used in extracorporeal membrane oxygenation (ECMO) or in cardiac surgery [MK, PC]

15. Demonstrate knowledge of the pathophysiology and treatment of neonatal alloimmune thrombocytopenia [MK, PC]

16. Demonstrate proficiency in the evaluation and appropriate transfusion therapy of adult and pediatric thrombocytopenic patients secondary to both immune and non-immune etiologies [PC, PBLI]

17. Apply the principles of a massive transfusion protocol [PBLI, ICS, SBP, MK]

18. Demonstrate a working knowledge of the principles of hemostasis and coagulation and proficiency in the initial treatment of patients with bleeding disorders [MK, PC]

19. Demonstrate knowledge of the transfusion requirements of special patient populations (e.g. hematology/oncology, pediatrics, geriatrics, transplantation, burn/trauma) [MK, PC]

20. Demonstrate knowledge of options for preventing volume overload in pediatric transfusion therapy [MK, PC, SBP]

21. Identify clinically significant RBC-specific antibodies from an antibody panel, determine how difficult it will be to obtain blood for this patient, and effectively communicate these results to clinicians [PC, ICS]

22. Demonstrate ability to distinguish clinically significant from clinically insignificant RBC-specific antibodies [MK]

23. Demonstrate proficiency in evaluating and recommending treatment plans for complex transfusion reactions [MK, ICS, SBP, PC]

24. Demonstrate familiarity with the requirements of all applicable regulatory and accrediting agencies (e.g. JCAHO, CAP, AABB, FDA, FACT) [SBP]

25. Demonstrate competence in managing blood inventory and ability to communicate effectively the hospital’s needs to the blood supplier [ICS, SBP]

26. Demonstrate knowledge of various methods of blood conservation, including pre- and peri-operative autologous blood collection, and approaches to “bloodless” surgery [MK, PBLI, SBP]

27. Demonstrate proficiency in evaluating patients refractory to platelet transfusions, including the principles of histocompatibility testing and the roles of HLA-matched platelets vs. platelet crossmatching, and apply this knowledge in selecting appropriate platelet products when indicated [PC, MK]

28. Demonstrate proficiency in evaluating patients with immune-mediated and non-immune-mediated hemolytic anemia and in the appropriate testing and transfusion management of these patients [PC, MK]

29. Demonstrate ability to communicate laboratory testing results, transfusion recommendations, and blood supply issues to clinicians, both verbally and in written form [ICS, SBP, PC]

30. Demonstrate ability to write an appropriate consult note for a patient who has an alloantibody, explaining the clinical significance of the finding to the treating physicians and the additional logistical requirements for obtaining compatible blood. [ICS, PC]

31. Demonstrate knowledge of landmark published studies in transfusion medicine [MK, PBLI]

32. Demonstrate proficiency in evaluating and presenting findings to professional colleagues from 1) recent peer-reviewed journal articles related to transfusion medicine and 2) research projects in which the resident may participate [PBLI, ICS]

33. Demonstrate proficiency at preparing educational presentations on transfusion medicine topics and the ability to adapt presentations to audiences of differing experience levels (e.g. pathologists, non-pathology physicians, technologists, nurses, and blood center workers) [ICS, MK]

34. Differentiate between plasma derived and recombinant factor products and demonstrate knowledge of on-label and off-label indications for these products [PC, MK, PBLI, SBP]

Blood Collection/ Blood Center/ Cell Processing:

1. Demonstrate knowledge of current eligibility criteria for blood donors [MK]

2. Compare and contrast the eligibility requirements for allogeneic and autologous blood donations [MK]

3. Perform a donor interview and exam, including obtaining consent to donate (e.g. risks, benefits, alternatives, and answer questions) [PC, ICS, P]

4. Demonstrate knowledge of the indications for therapeutic phlebotomy [MK]

5. Demonstrate proficiency in evaluating and treating adverse reactions associated with blood donation/phlebotomy (both whole blood and apheresis donations) [PC, P, MK]

6. Outline the assay principles (e.g. NAT, ELISA) of required donor blood tests and the associated confirmatory testing, and describe examples of donor re-entry algorithms [MK, SBP]

7. Demonstrate professionalism in interactions with prospective donors [P, ICS]

8. Demonstrate familiarity with the steps in blood component and blood derivative preparation [MK, SBP]

9. Describe the factors that influence the motivation of blood donors [MK, SBP]

10. Demonstrate knowledge of the advantages and disadvantages of directed blood donation and limited donor exposure programs [PC, MK, SBP]

11. Demonstrate knowledge of the techniques of safe, sterile venipuncture, and the associated methods to reduce bacterial contamination of products [PC, MK]

12. Demonstrate familiarity with the types and treatment of donor adverse events [PC, MK]

13. Outline the necessary steps in donor notification and counseling associated with positive infectious disease testing results and the donor look-back process [PC, SBP, ICS]

14. Demonstrate understanding of, and the ability to interpret, the major regulations and guidelines applicable to collection, processing, storage, and release of blood products and cellular therapy products [SBP, MK]

15. Demonstrate awareness of current concerns about emerging infections in the blood supply and describe ways that blood collection centers deal with these concerns [MK, PBLI]

16. Demonstrate familiarity with the operational logistics required to determine appropriate blood inventory for a geographic region, and the process of meeting daily, weekly, and monthly collection goals [SBP, ICS]

17. Demonstrate knowledge of the principles of hematopoietic stem cell transplantation, including collection, processing, and storage of these products, and the indications for use (e.g. bone marrow, peripheral blood, and placental/umbilical cord blood) [MK, SBP, PC]

18. Demonstrate proficiency in writing physician orders for peripheral blood hematopoietic stem cell collections and obtaining consent for the procedure and for blood product transfusion, if needed following the collection [PC, MK, ICS, P]

19. Demonstrate proficiency in evaluating and treating adverse reactions associated with peripheral stem cell collection [PC, MK]

Therapeutic Apheresis:

1. Summarize the principles of apheresis technology, including centrifugation, filtration, and immunoadsorption [MK]

2. Demonstrate knowledge of the major indications for therapeutic apheresis including the category of evidence for each of these indications as outlined by AABB/ASFA  [MK, PC]

3. Demonstrate knowledge of the appropriate replacement fluids to be used in an apheresis procedure [MK, PC]

4. Demonstrate knowledge of vascular access requirements and options for therapeutic apheresis [MK, PC]

5. Demonstrate proficiency in evaluating and preparing patients for therapeutic apheresis, including obtaining consent for the procedure and for transfusion of blood products during the procedure  [ICS, PC, P]

6. Communicate effectively with attending clinicians and housestaff regarding emergent or scheduled therapeutic apheresis procedures through conversations and writing of consult notes [ICS, SBP, P, MK]

7. Discuss the major indications for, and limitations of, therapeutic apheresis in children [PC, MK]

8. Demonstrate ability to triage requests for therapeutic apheresis [MK, PC, ICS, P]

9. Demonstrate proficiency in evaluating and treating adverse reactions associated with therapeutic apheresis [PC, MK, ICS]

10. Write appropriate physician orders for therapeutic apheresis procedures [PC, MK, ICS]

General Service Responsibilities

Routine Blood Donors

Resident responsibilities include:

1. Provide consultation to Blood Bank technical and clerical personnel concerning donor selection and acceptability.

2. Evaluate and manage blood donor reactions.

3. Provide consultation to clinical staff concerning selection and acceptability of donors for autologous transfusion.

4. Evaluate and follow-up donors with abnormal test results, including infectious disease testing.

Apheresis Donors

Resident responsibilities include:

1. Provide consultation to apheresis nursing and clerical personnel concerning donor selection and acceptability.

2. Perform routine donor evaluation and monitoring, including physical examinations and review of periodic laboratory testing.

3. Evaluate and manage apheresis donor reactions.

4. Provide medical direction of component collection via cell separator.  This includes:  evaluation and approval of requests for specific components from specific donors; selection of donors for specific patients; evaluation of donor acceptability; and donor monitoring.

Therapeutic Apheresis

Resident responsibilities include:

1. Provide initial evaluation of patients who are candidates for therapeutic apheresis.  This includes:  review of patient problem; prepare initial draft of consultation report and review with the Medical Director; select appropriate patients for therapeutic apheresis; determine the apheresis protocol to be used; determine methods to be used for evaluating patient response to therapeutic apheresis.

2. Obtain informed consent for therapeutic apheresis from patients.

3. Schedule therapeutic apheresis procedures with apheresis personnel.

4. Complete therapeutic apheresis worksheets and write the detailed orders for the apheresis procedure.

5. Write daily apheresis orders.

6. Evaluate patient pre-procedure and document procedure/”SOAP” note.

7. Evaluate and manage patient reactions during therapeutic apheresis.

8. Monitor and evaluate patient response to therapeutic apheresis.

Immunohematology

Immunohematology consists of Blood Bank testing on patient specimens, including:  blood typing; pretransfusion testing (compatibility testing); serum antibody screening; prenatal testing; and cord blood evaluations.  Resident responsibilities include:

1. Provide consultation and support to technical and clerical staff concerning specimen and requisition acceptability.

2. Review and interpret:  blood typing discrepancies; positive antibody screens; antibody panels; prenatal titers; positive direct antiglobulin tests.  Consult with the attending physician and resident staffs as necessary.

3. Provide consultation to technical staff concerning additional evaluation of patients with complex serologic problems.  Review clinical significance of serologic findings and decide on additional testing required prior to transfusion.

4. Determine risks of transfusion in:  patients with complex serologic problems; and, patients who require transfusion before routine serologic testing can be completed.  Provide consultation to attending physician and resident staffs as indicated.

Blood Component Preparation and Transfusion

Resident responsibilities include:

1. Evaluate and approve requests for selected and specialized blood components, including washed red cells, deglycerolized red cells, and HLA-matched platelet concentrate.

2. Evaluate and approve requests for components from specific donors, including directed whole blood donations and family-donor apheresis platelets.

3. Provide consultation to supervisory and technical personnel on maintaining adequate inventory of all blood components.  In times of limited inventory, provide interface to attending physician and resident staffs on requests for those components in short supply.

Transfusion Reaction Evaluation

All adverse effects of transfusion are investigated and evaluated by the medical staff of the Blood Bank and Transfusion Service.  Resident responsibilities include:

1. Review initial workup of all transfusion reactions reported to the Blood Bank.  Determine additional evaluation required and prepare a written interpretation for review and discussion with the Medical Director.  Provide consultation to attending physician and resident staffs as indicated.

2. Evaluate cases of suspected transfusion-associated hepatitis, Acquired Immunodeficiency Syndrome/HIV infection, and transfusion related acute lung injury (TRALI) and provide donor follow-up with determination of donor acceptability for future donations.

Recommended Reading

Because it is often necessary to learn Blood Banking and Transfusion Medicine "as problems arise," the Medical Director will in most cases suggest reading assignments based on "real life problems" encountered.  Suggested textbooks and references include:

Required Reading Textbook

1. Petrides M, Stack G:  Pratical Guide to Transfusion Medicine, Bethesda, MD:  AABB Press, 2001.

Other Introductory/Reference Textbooks

1. Simon T.L, Dzik WH, et al.:  Rossi’s Principles of Transfusion Medicine (3^rd  Ed.), Philadelphia:  Lippincott Williams & Wilkins, 2002.

2. Harmening DM: Modern Blood Banking and Transfusion Practices (5^th edition), F.A. Davis Co., 2005

3. McCullough J:  Transfusion Medicine (2^nd Ed.), New York:  Churchill Livingstone, 2004.

4. Klein HG, Anstee, DJ:  Mollison’s Blood Transfusion in Clinical Medicine (11^th Ed.), Blackwell, 2005.

5. McLeod BC, Price TH, Weinstein RA: Apheresis: Principles and Practice (2^nd Ed.), Bethesda, MD:  AABB Press, 2003.

6. Hillyer CD, Silberstein LE, Ness PM, Anderson KC, Roback JD: Blood Banking and Transfusion Medicine: Basic Principles and Practice (2^nd Ed.), Philadelphia:  Churchill Livingstone, 2007.

7. Mintz PD:  Transfusion Therapy: Clinical Principles and Practice (2^nd Ed.), Bethesda, MD: AABB Press, 2005.

8. Blackall DP, Helekar PS, Triulzi DJ, Winter J:  Transfusion Medicine: Self-Assessment and Review,  Bethesda, MD: AABB Press, 2002.

References

1. Standards for Blood Banks and Transfusion Services.  Bethesda, MD:  American Association of Blood Banks.  (A new edition is issued approximately every two years).

2. The "Standards" are the regulations under which the Blood Bank and Transfusion Service operates.  The resident should be familiar with the major regulations by the end of the basic rotation.

3. Technical Manual.  Bethesda, MD:  American Association of Blood Banks.  (The latest addition is available in the blood bank).

4. The Technical Manual is a compendium of technical suggestions and guidelines compiled by the American Association of Blood Banks.  This reference contains explicit instructions for most procedures and practical discussions of approaches to resolving serologic problems.  The resident should consult this reference frequently during technical instruction.

Code of Federal Regulations (Title 21 - Food and Drug Administration).

These are the federal regulations that apply to blood collection, storage and transfusions.  Although residents are not expected to become intimately familiar with these regulations – it will be necessary for the resident to consult this reference on occasion, especially concerning apheresis of donors.

Journals

Journals that the resident should be familiar with include:

1. Transfusion

2. Vox Sanguinis

3. Journal of Clinical Apheresis

4. Archives of Pathology & Laboratory Medicine

5. American Journal of Clinical Pathology

6. Blood

7. American Journal of Hematology

8. Journal of Pediatric Hematology and Oncology

9. Seminars in Hematology

All of these journals are available in the College of Medicine library and/or in the department.

Other Materials

Numerous other texts, monographs and journal articles are available. 

Technical Instruction

Resident technical instruction consists of educational sessions with senior Blood Bank personnel at the bench or in the donor areas.  The resident is expected to see all of the following procedures and to perform indicated procedures and practical exercises.  The resident should schedule these sessions through the Blood Bank Supervisor, in consultation with the Medical Director of the Blood Bank and Transfusion Medicine.

The resident is not expected to become expert in all of these procedures.  But in all cases, the resident is expected to learn principles, uses, and limitations.

Resident exercises are intended purely for the education of the resident, and the bench work of the resident will not be used for patient care under any circumstances.

Orientation

Topics to be covered:

1. Organization of Blood Bank and Transfusion Service
2. Introduction of Blood Bank personnel
3. Policies and procedures for patient identification, specimen collection, and specimen labelling
4. Specimen and requisition accession and processing

Routine Donor Area

Topics to be covered:

1. Criteria for donor selection
2. Donor recruiting
3. Donor interview
4. Arm preparation techniques
5. Blood collection techniques
6. Donor reaction evaluation and management

Donor Processing

Topics to be covered:

1. Donor ABO and Rh blood typing
2. Donor antibody screening
3. Testing for diseases transmitted by transfusion
   - Syphilis – RPR
   - Hepatitis – HBsAg, anti-HBc, anti-HCV
   - HIV/AIDS – antibody to HIV, HIV antigen
   - HTLV-I/II
4. Labelling and label recheck requirements
5. Blood group recheck requirements

Crossmatch Station

Topics to be covered:

1. Recipient ABO and Rh typing
2. Recipient antibody screening
3. Requirements for records of prior recipient testing, including blood types and problems
4. Compatibility testing
5. Type and screen procedures
6. Procedures for massive transfusion
7. Procedures for urgent transfusion
8. Direct antiglobulin testing
9. Prenatal evaluation and monitoring
10. Neonatal evaluation, including cord blood evaluation
11. Rh Immune Globulin evaluation - antenatal and postnatal

Special Studies Station

Topics to be covered:

1. Antibody identification techniques
2. Antibody elution techniques
3. Antibody absorption techniques
4. Antigen typing techniques
5. Approaches to evaluation of patients with complex problems
   - Multiple antibodies
   - Autoantibodies

Procedures:

1. Antibody panels
   - Routine panel
   - Prewarmed panel
   - Enzyme panel
   - Cold panel
2. Antibody elutions
   - Heat elution
   - Acid elution
3. Antibody absorptions
   - Warm autoabsorption
   - Cold autoabsorption
   - Rabbit erythrocyte (REST) absorption
4. Antigen typing
   - Direct agglutination
   - Antiglobulin typing
5. Antibody titration

Component Preparation Station

Topics to be covered:

1. Blood component preparation techniques
2. Pooling and combining components

Procedures:

1. Washing Red Cells
   - Automated
   - Manual
2. Fresh Frozen Plasma
   - Preparation
   - Thawing
3. Platelet Concentrate
   - Preparation
   - Quality Control
   - Pooling
   - Concentrating
4. Cryoprecipitate
   - Preparation
   - Quality Control
   - Thawing
   - Pooling
5. Preparation of syringes for neonates
6. Preparation of leuko-reduced blood components

Inventory Management Station

Topics to be covered:

1. Sources of blood components
2. Determination of desirable inventory levels
3. Optimization of inventory utilization through selection of units of blood or components for issue
4. Management of inventory shortages

Procedures:

1. Daily review of blood and component inventory
2. Planning blood and component acquisition to maintain adequate inventory

Clerical and Billing Station

Topics to be covered:

1. Blood Bank charges and credits
2. Hemophilia Program
3. Non-replacement fee (Responsibility fee)

Procedures:

1. Routine billing
2. Hemophilia program billing
3. Crediting for non-replacement fee

Therapeutic Apheresis Station

Topics to be covered:

1. Procedures available
2. Cell separator -- principles and use
3. Risks of therapeutic apheresis
4. Evaluation and management of patient reactions
5. Disposition of materials collected from patients
6. Management of apheresis resources

Procedures:

1. Therapeutic phlebotomy
2. Manual plasma exchange
3. Cell separator
   - Plasma exchange
   - Leukocyte reduction
   - Red cell exchange
   - Peripheral Blood Stem Cell collection

Stem Cell Cryopreservation Laboratory

1. Observe stem cell processing, freezing, and thawing procedures.

Viral Marker Testing

1. Observe routine viral marker testing as it relates to blood donors.

Procedural Skill Acquisition

The resident should understand and be able to perform:

1. ABO testing
2. Rh(D) typing
3. Red cell crossmatch
4. Identification of unexpected red cell antibodies
5. Direct antiglobulin test (DAT)

Conferences and Rounds

1. Blood Bank/Clinical Pathology Conference (weekly, Tuesdays and Thursdays) -- Attendance at this conference is expected (as clinical responsibilities allow).  This conference consists of informal didactic lectures on topics in Blood Banking and Transfusion Medicine, and other topics in Clinical Pathology.  The resident may be required to present at this conference.

2. Hematology/Oncology Grand Rounds (weekly) -- Attendance is expected (as clinical responsibilities allow).

3. Daily Rounds with the Medical Director of the Blood Bank and Transfusion Medicine, or the “attending of the day,” are typically devoted to:  sign-out of patient studies, clinical pathology rounds, and discussion of Transfusion Medicine topics.             

Resident Evaluation

During the first day of rotation, the Medical Director of the Blood Bank will review objectives with resident and provide an orientation to the section.

The Medical Director of the Blood Bank will discuss with the resident his/her progress toward meeting goals and objectives, and will make suggestions for improvement if problems are noted.  Any problems identified with the resident's performance will be addressed immediately rather than waiting until the end of the rotation.

If at any time the resident feels that there is a problem or deficiency with the rotation, the resident should immediately consult with the Medical Director, the Chief Resident, the Section Director, or the Residency Program Director.

The resident will be formally evaluated at the end of each month’s rotation or at the end of each “block” of rotations.

Miscellaneous

1. The resident will be encouraged and supported in the pursuit of a clinical research project of interest to the resident.  Publication in the peer-reviewed literature is supported and encouraged.

2. Formal or informal didactic teaching lectures may be required.

3. Fulfilling the important role and obligation of clinical consultant in the Unit of Blood Banking and Transfusion Medicine may require the resident to periodically consult directly with other housestaff and attending staff in a variety of clinical situations, evaluate patients in both in-patient and out-patient areas, write progress notes and formal consultations in the medical record, speak directly with patients and donors concerning transfusion medicine issues, as well as participate in clinical rounds, conferences, and other clinical and administrative meetings as necessary.

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