Mission, Aims, Goals and Objectives

Blood Banking and Transfusion Medicine Fellowship

Mission

To provide an outstanding education in all aspects of blood banking and transfusion medicine and prepare fellows for a career in a blood center or in a hospital transfusion service, either in an academic center or in a community hospital.

Program Aims

  • To ensure that the fellows are competent in evaluating clinical cases and solving problems in immunohematology, supporting organ and stem cell transplant patients
  • To serve as consultants to clinicians regarding evidence based blood management, patients with coagulopathies and apheresis procedures

We support fellows in their research projects and scholarly activities, we inspire them to become effective educators, life-long learners and contributing members of healthcare teams.

Goals and Objectives

The goal of the blood banking/transfusion medicine fellowship is to provide an outstanding education in all aspects of blood banking and transfusion medicine and prepare fellows for a career in a blood center or in a hospital transfusion service, either in an academic center or in a community hospital. This is achieved through acquiring experience in the six core competencies defined by the Accreditation Council for Graduate Medical Education, or ACGME.

Transfusion Goals and Objectives

  • Describe the principles of patient identification [PC, MK, ICS, SBP]
  • Describe how to perform ABO and/or Rh testing, red blood cell (RBC) antibody screen and antibody identification [ PC, MK]
  • Perform pre-transfusion testing, including ABO and/or Rh testing, red blood cell (RBC) antibody screen and antibody identification [ PC, MK]
  • Explain the different red cell antigen systems and their importance [PC, MK]
  • List the major noninfectious complications of blood transfusions, the risk of these complications and strategies to prevent them [MK, PC, PBLI, SBP]
  • List the major infectious complications of blood transfusions and the current risk of these infections and explain how these infections can be prevented [MK, PC, PBLI, SBP]
  • Discuss the different crossmatching methods and indications (e.g., electronic, immediate-spin, antiglobulin) [PC, MK]
  • Discuss specialized test methods used in immunohematology including elution, absorption and enzymes [MK]
  • Discuss the principles of apheresis technology, including centrifugation, filtration and immunoadsorption [MK]
  • Explain indications for therapeutic apheresis as outlined by AABB and/or American Society for Apheresis [MK, PC, PBLI]
  • Describe adverse reactions associated with therapeutic apheresis [PC, MK, ICS]
  • Discuss the appropriate replacement fluids in apheresis procedures for the different indications [MK, PC]
  • Discuss vascular access requirements and options for therapeutic apheresis [MK, PC]
  • Explain the symptoms and signs of hemolytic and nonhemolytic transfusion reactions [MK, PC]
  • Describe the pathophysiology of hemolytic and nonhemolytic transfusion complications [MK, PC]
  • Describe the treatment and prevention of hemolytic and nonhemolytic transfusion complications [MK, PC]
  • Discuss immune and non-immune causes of platelet refractoriness [PC, MK]
  • Explain the principles of hemostasis and coagulation [MK]
  • Discuss the pathophysiology, diagnosis and provide treatment recommendations for patients with the following bleeding disorders:
    • Von Willebrand disease
    • Hemophilia A and B
    • Acquired hemophilia
    • Platelet disorders
    • Coagulopathy of trauma [PC, MK, PBLI]
  • Describe areas of interest for research project [MK, PBLI, ICS]
  • Review literature for research project [MK, PBLI]
  • Prepare IRB application form [PBLI, ICS]
  • Prepare consent form and all attachments as needed for IRB submission [PBLI, ICS]
  • Recommend appropriate crossmatching methods (e.g., electronic, immediate-spin, antiglobulin) [PC, MK]
  • Evaluate transfusion reaction reports of clinicians and interpret appropriate initial laboratory testing [PC, MK, PBLI]
  • Recognize clinically significant from clinically insignificant RBC-specific antibodies [MK, PC]
  • 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, MK, ICS, SBP]
  • Discuss evidence-based indications for blood components and derivatives [PBLI, PC, MK]
  • Describe the expected response to transfusion therapy in adult and pediatric patients [MK, PC]
  • Recognize the symptoms and signs of hemolytic and nonhemolytic transfusion reactions [MK, PC]
  • Discuss the indications for cytomegalovirus-reduced-risk blood, leukoreduction, irradiation and washing of blood components [MK, PC]
  • Discuss the pathophysiology, prevention and treatment of hemolytic disease of the fetus and newborn [MK, PBLI, PC]
  • Recognize clinically significant antibodies in pregnant patients and make appropriate recommendations for blood products [MK, PBLI, PC]
  • Explain the pathophysiology and treatment of neonatal alloimmune thrombocytopenia [MK, PC]
  • Discuss the principles of a massive transfusion protocol [PBLI, ICS, SBP, MK, PC]
  • Discuss transfusion requirements of special patient populations (e.g., hematology-oncology, pediatrics, geriatrics, transplantation, burn and/or trauma) [MK, PC, SBP]
  • Assess patients for the correct indications for therapeutic apheresis [MK, PC, PBLI]
  • Facilitate requests from clinicians for therapeutic apheresis [MK, PC, ICS, P]
  • Evaluate and prepare patients for therapeutic apheresis, including obtaining consent for the procedure and for transfusion of blood products during the procedure [ICS, PC, P]
  • Communicate effectively with attending clinicians and house staff regarding emergent or scheduled therapeutic apheresis procedures [ICS, SBP, P, PC]
  • Recommend appropriate replacement fluids in apheresis procedures [MK, PC]
  • Recommend appropriate vascular access for therapeutic apheresis [MK, PC]
  • Write appropriate physician orders for therapeutic apheresis procedures [PC, MK, ICS]
  • Treat adverse reactions associated with therapeutic apheresis [PC, MK, ICS]
  • Discuss the major indications for and limitations of, therapeutic apheresis in children [PC, MK]
  • Explain specialized apheresis methods (e.g., photopheresis, immunoadsorption columns) [PC, MK]
  • Evaluate literature for therapeutic apheresis for which the data suggesting efficacy for a particular disease entity is limited and communicate effectively with primary care physicians to develop a plan of care [MK, PC, ICS, PBLI]
  • Explain the principles of histocompatibility testing and the differences between HLA-matched and crossmatched PLTs [PC, MK]
  • Evaluate patients refractory to platelet (PLT) transfusions [PC, MK]
  • Recommend appropriate PLT products for refractory patients [PC, MK, SBP, PBLI, ICS]
  • Describe the appropriate use of highly specialized blood products (e.g., granulocytes, donor lymphocyte infusions, HLA-matched PLTs, coagulation factor concentrates) [MK, PC]
  • Select appropriate factor replacement product(s) for bleeding patients [PC, MK]
  • Differentiate between plasma-derived and recombinant factor products and explain on-label and off-label indications for these products [PC, MK, PBLI, SBP]
  • Perform lookback investigations [SBP, PBLI, ICS]
  • Explain the appropriateness of transfusion of serologically incompatible blood in selected clinical circumstances [PC, MK]
  • Prepare educational presentations on TM topics for residents and technologists [ICS,MK]
  • List the congenital and acquired causes of thrombophilia [PC, MK]
  • Discuss the indications and testing for different anticoagulants [MK, PC]
  • Discuss the pathophysiology, diagnosis and treatment options for DIC [PC, MK]
  • Collect and organize data for research project [PBLI, ICS, P]
  • Write appropriate consult notes for patients who have alloantibodies, explain the clinical significance of the findings to the treating physicians and the additional logistical requirements for obtaining compatible blood [ICS, SBP, PC]
  • Choose appropriate blood components and derivatives based on a thorough knowledge of the indications for transfusion [PBLI, PC, MK]
  • Communicate laboratory testing results to clinicians, make transfusion recommendations, both verbally and in written form [ICS, SBP, PC]
  • Interpret difficult antibody panels including those containing multiple alloantibodies, autoantibodies and antibodies to high frequency antigens [MK, PC]
  • Justify the appropriateness of transfusion of serologically incompatible blood in selected clinical circumstances [PC, MK]
  • Evaluate and recommend treatment plans for complex transfusion reactions such as TRALI and TACO [MK, ICS, SBP, PC]
  • Apply the principles of a massive transfusion protocol [PBLI, ICS, SBP, MK, PC]
  • Select appropriate transfusion therapy for adult and pediatric thrombocytopenic patients secondary to both immune and nonimmune etiologies [PC, PBLI]
  • Evaluate patients with immune-mediated and non–immune-mediated hemolytic anemia, select the appropriate testing and manage transfusions of these patients appropriately [PC, MK]
  • Select appropriate transfusion therapy for bleeding patients on anticoagulant therapy [PC, MK]
  • Recommend blood component therapy for special patient populations (e.g., hematology-oncology, pediatrics, geriatrics, transplantation, burn and/or trauma) [MK, PC, SBP]
  • Assess patient with DIC [PC, MK]
  • Formulate treatment options for patient with DIC [PC, MK]
  • Describe the methods of blood conservation, including pre- and perioperative autologous blood collection and approaches to “bloodless” surgery [MK, PBLI, SBP]
  • Manage blood inventory and communicate effectively the hospital’s needs to the blood supplier [ICS, SBP]
  • Evaluate and present findings to professional colleagues from 1) recent peer-reviewed journal articles related to TM and 2) research projects in which the resident may participate [PBLI, ICS]
  • Prepare educational presentations on TM topics and adapt presentations to audiences of differing experience levels (e.g., pathologists, nonpathology physicians, technologists, nurses and/or blood center workers) [ICS, MK]
  • Describe neonatal whole-blood exchanges and massive transfusions in neonates associated with extracorporeal circuits such as used in extracorporeal membrane oxygenation or in cardiac surgery [MK, PC]
  • Perform blood utilization reviews, both prospective and retrospective [PC, SBP]
  • Prepare an abstract for publication [PBLI, IC, P]
  • Explain the requirements of different regulatory and accrediting agencies (e.g., JCAHO, CAP, AABB, FDA, FACT) [SBP]
  • Discuss the different methods used by regulatory or accrediting agencies during inspections [SBP, ICS, PBLI]
  • Compare and contrast the various methods of performing blood utilization review, including prospective versus retrospective review and the role of peer review as required by JCAHO and AABB standards [SBP, PBLI, ICS]
  • Write an error or deviation report and create a corrective and preventive action plan [ICS, PBLI, SBP]
  • Discuss ethical issues in BB and TM (e.g., confidentiality as it relates to the blood donor or patient, HIV testing and reporting, a patient’s right to refuse blood transfusion, the use of hematopoietic growth factors in normal donors and informed consent) [P, PC]
  • Participate in an accreditation inspection of a laboratory related to TM and/or BB (this may be either an official inspection or an unofficial and/or interim inspection) [SBP, P, ICS]
  • Describe landmark published studies in TM and BB [MK, PBLI]
  • Discuss the basic principles of blood conservation and bloodless medicine and surgery programs, including specific methods of preserving RBC mass, supporting hemostasis and adjunctive therapies that may be used when the oxygen supplied by the patient’s hemoglobin is insufficient [MK, SBP, PBLI]

OneBlood Goals and Objectives

  • Discuss current eligibility criteria for blood donors [MK, PC, PBLI]
  • Compare and contrast the eligibility requirements for allogeneic and autologous blood donations [MK, PC, PBLI]
  • Perform a donor interview and exam, including obtaining consent to donate (e.g., risks, benefits, alternatives and answer questions) [PC, ICS, P]
  • List the indications for therapeutic phlebotomy [MK, PC]
  • Evaluate and treat adverse reactions associated with blood donation and/or phlebotomy (both whole-blood and apheresis donations) [PC, P, MK]
  • Outline the assay principles (e.g., nucleic acid testing, enzyme-linked immunorbent assay) of required donor blood tests and the associated confirmatory testing and describe examples of donor reentry algorithms [MK, SBP, PBLI]
  • Communicate effectively with prospective donors [P, ICS]
  • Discuss the necessary steps in blood component and blood derivative preparation [MK, SBP]
  • Compare and contrast the advantages and disadvantages of directed blood donation and limited donor exposure programs [PC, MK, SBP]
  • Discuss techniques of safe, sterile venipuncture and the associated methods to reduce bacterial contamination of products [PC, MK]
  • Outline the necessary steps in donor notification and counseling associated with positive infectious disease testing results and the donor lookback process [PC, SBP, ICS]
  • Discuss the major regulations and guidelines applicable to collection, processing, storage and release of blood products and cellular therapy products [SBP,MK, PBLI]
  • Describe how blood collection centers deal with emerging infections in the blood supply [MK, PBLI, SBP]
  • Discuss 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]
  • Explain requirements and procedures for source plasma collection [MK, SBP, PC]
  • Discuss standards and regulations that apply to blood collection centers and clinical tissue banks (FDA, AABB, FACT, CAP) [MK, SBP, PC, PBLI]
  • Explain quality systems as they apply to blood collection centers (i.e., AABB Quality System Essentials, ISO 9000, lean manufacturing, Six Sigma) [SBP, PBLI]
  • Participate in quality review of the manufacturing or processing of products [PBLI, SBP]

Bone Marrow/Stem Cell Goals and Objectives

  • Explain the principles of HSC transplantation, including collection, processing and storage of these products [MK, SBP, PC]
  • Discuss the cell count targets and engraftment monitors used for different indications.
  • Discuss the different stem cell sources (e.g., marrow, peripheral blood and placental and/or umbilical cord blood), the risk and benefit of each source and indications for their use [MK, SBP, PC]
  • Obtain consent for the for peripheral blood HSC collections and for blood product transfusion, if needed after the collection [PC, MK, ICS, P]
  • Evaluate and treat adverse reactions associated with peripheral blood progenitor cell (PBPC) collection and infusion [PC, MK, P]
  • Review quality control data from the collecting, processing and storage of individual HSC products and actions needed when product or processing irregularities are identified [MK, SBP, PC, PBLI]
  • Discuss emerging areas of cellular therapy, including hematopoietic graft engineering and cellular immunotherapeutic [MK, PBLI, PC]
  • Describe the elements of current good manufacturing practices and current good tissue practices as they apply to the collection, processing, ex vivo manipulation and storage of all cellular therapy products (e.g., pancreatic islet cells, negative and/or positive selection and/or purging of HSCs, gene manipulation, donor lymphocyte infusions, dendritic cell vaccines, ex vivo expansion of progenitor cells) [MK, SBP, PC, PBLI]
  • Discuss standards and regulations that apply to PBPC processing laboratories (FDA, AABB, FACT, CAP) [MK, SBP, PC, PBLI]
  • Discuss quality systems as they apply to PBPC processing laboratories (i.e., AABB Quality System Essentials, ISO 9000, lean manufacturing, Six Sigma) [SBP, PBLI]

Immunology/Transplant Goals and Objectives

  • Describe the various testing methods used in creating an immune profile of a potential transplant recipient [PC, MK]
  • Discuss the testing necessary for screening of a potential donor as a donor for solid organ or hematopoetic transplant [PC, MK]
  • Describe the algorithms used to identify the appropriate donor for transplant [PC, MK, SBP]
  • Participate in the chart review process for identifying a donor - recipient pair [PC, MK, PBLI]
  • Explain the unique differences in the decision making processes according to the type of transplant needed [PC, MK, SBP]
  • Discuss the historical and unique development of the test methods used from the original discovery of histocompatibility by Karl Landsteiner with the recognition of the ABO system to the modern molecular methods applied to identifying donor – recipient compatibility [MK, PBLI]
  • Discuss nomenclature of the HLA system [MK]
  • Discuss the QA and QC systems in place in the laboratory and those that are unique and different from the hospital clinical laboratory [MK, PBLI, SBP]
  • Discuss the regulatory and accrediting agencies and their requirements for transplant laboratories and programs [MK, PBLI, SBP]
  • Synthesize diagnostic and technical skills gained from this experience to improve Transfusion Medicine/Blood Bank practice. [MK, PBLI, P]
  • Communicate effectively with phlebotomists and technologists regarding technical issues of sample collection and histocompatibility testing [ICS, SBP]
  • Communicate effectively with clinicians regarding sample collection and utilization of test results [ICS]
  • Recognize the limits of one’s expertise in order to avoid medical errors and appropriately use confirmatory studies and consultation services to ultimately provide optimal patient care [P, SBP, PBLI]
  • Practice resource allocation in a limited health care system without compromising quality of care as demonstrated by the appropriate use of transplant immunology testing [SBP, P]
  • Discuss the role of organ and stem cell donation in the larger context of the total health care system [SBP]
  • Explain issues related to donor resources including the problems and opportunities involved in donor recruitment, retention of donors and public relations [SBP, ICS, P]

Microbiology Goals and Objectives

  • Identify acceptable types of clinical specimens as well as proper collection and handling of specimens for serologic and molecular testing [MK, PC]
  • Correctly interpret results from serology and molecular testing in conjunction with other laboratory data and clinical presentation to be able to give an appropriate recommendation for donor eligibility [PC]
  • Gather essential and accurate clinical information when a testing pattern is in question [PC]
  • Actively participate in performing basic laboratory procedures with technologists, including specimen processing, serology manual and automated testing and molecular testing performance [PC, ICS]
  • Discuss the clinical significance of serology and molecular tests that may be found in blood donors [MK]
  • Describe the techniques used to detect viral antigens and antibodies, syphilis infection and amplify and quantify viral nucleic acids [MK]
  • Discuss the advantages and disadvantages of the methods used to detect organism antibodies and antigens and their role in determining donor eligibility [MK, PC, PBLI]
  • Discuss the advantages and disadvantages of the methods used to amplify and detect viral nucleic acid and their role in determining donor eligibility [MK, PC, PBLI]
  • Define proper specimen collection, methods for transportation and appropriate methods for optimum detection of viral agents in donor specimens [MK]
  • Describe the basic principles, procedures and application of serology procedures for the detection of hepatitis antigens and antibodies from donor specimens [MK]
  • Describe the basic principles, procedures, application and interpretation of nucleic acid amplification procedures for the qualitative and quantitative detection of viruses [MK]
  • Discuss the cost-effective and clinically relevant usage of serology and molecular tests including utilization controls used in clinical microbiology [MK, PC, SBP]
  • Discuss safety issues in the clinical microbiology laboratory, including handling of infectious agents, emerging pathogens and possible agents of bioterrorism [MK, PC]
  • Appropriately interpret hepatitis panel results [PC]
  • Appropriately interpret syphilis serology results [PC]
  • Appropriately interpret quantitative HIV and hepatitis C viral load results [PC]
  • Integrate clinical knowledge with serology and molecular data to improve practice [PC, PBLI]
  • Utilize current scientific literature to assist in determining the need to perform testing and interpret test results [PBLI]
  • Effectively utilize conferences, lectures, teaching cases and medical literature (texts, journals and other medical information systems) related to serology and molecular for optimal donor counseling, expansion of knowledge base and quality improvement [PBLI]
  • Critically evaluate the quality of the various sources of information and select those of the highest quality and reliability for use in medical decision-making [PC, PBLI]
  • Discuss quality control and quality assurance performed in the serology and molecular diagnostics laboratory and their impact on quality patient care [MK, PC, PBLI]
  • Demonstrate effective communication skills and the ability to consult on serology technical issues related to specimen collection, processing, testing and interpretation with microbiology staff [ICS, MK]
  • Demonstrate effective communication skills and the ability to consult on molecular diagnostics technical issues related to specimen collection, processing, testing and interpretation with microbiology staff [ICS, MK]
  • Effectively communicate with physicians and/or clinical support staff to obtain clinical information and discuss serology and/or molecular diagnostic test results [ICS, MK, PC]
  • Present organized and cogent case discussions during twice weekly case reviews [ICS, MK]
  • Maintain the strictest patient confidentiality with all clinical and personal information: diagnosis, prognosis, test results, etc. [PC, P]
  • Respond rapidly to pager and telephone calls by technical or clinical staff [P]
  • Demonstrate consistent and punctual attendance at the bench during rotations and at meetings with the Microbiology Director [P]
  • Complete assignments according to instructions in a timely manner [P]
  • Accept responsibility and appropriately follow through on assigned tasks [P, PC]
  • Recognize the limits of his/her abilities and the need to consult with others, as appropriate [P]
  • Assess the cost-effectiveness of serology and molecular tests for determining the eligibility of donors [PC, SBP]
  • Discuss the utilization controls used in serology and molecular diagnostic testing to minimize unnecessary testing [PC, MK, SBP]
  • Demonstrate the ability to work with other health care personnel in an interdisciplinary team to develop clinically advantageous and cost-effective care-delivery strategies [PC, SBP]
  • Practice cost-effective serology and molecular testing that does not compromise quality of care, considering the need for and cost of special studies, extended testing and send-out testing [P, PC, SBP]