Blood Bank / Transfusion Medicine (CP-1 and CP-2)
Transfusion Medicine is comprised of the Blood and Tissue Bank, the Apheresis and Transfusion Service, and the Cellular Processing Laboratory. A full range of routine and special transfusion medicine services are provided. There are especially close interactions with the hematology/oncology program, the bone marrow and solid organ transplantation programs, the trauma and cardiac surgery service. An approved Transfusion Medicine Fellowship is funded for those wishing to pursue Transfusion Medicine as a career.
During the rotation the resident will learn the principles and skills involved in the workup of transfusion reactions, interpreting of antibody panel workup, the indications for and the performance of apheresis procedures, the indications for use of various blood products, and the interpretation of tests for transfusion transmitted diseases. The fundamentals of blood typing and screening, antibody identification, cross matching, etc., are learned through a comprehensive series of laboratory exercises designed to introduce the trainee to safe transfusion practice. Clinical rounds are held daily in the Blood Bank with the discussion of the use of uncrossmatched blood, massive transfusions, serology problems, transfusion reactions, special blood product management, positive transfusion transmitted disease testing, stem cell processing and infusion, and other relevant issues. Patient rounds are held daily in the Apheresis and Transfusion Service to discus all patients who receive apheresis treatments including peripheral blood stem cell collection and therapeutic apheresis, and patients who receive transfusion, phlebotomy, or medication infusion and have adverse reactions, deferral, and other issues.
Attending on-call coverage is available at all times; please refer to the on-call schedule. The Medical Director MUST be called when any of the following conditions are suspected or proven: acute intravascular hemolytic transfusion reaction, septic transfusion reaction, TRALI, new apheresis patient referral, incompatible blood is given to any patient, death as a result of transfusion, anaphylactic reaction to blood, seizures in a blood donor, inadequate blood inventory or Red Cross supply available as back-up, disagreement with members of the medical staff regarding blood ordering or transfusion reaction work-up, cardiac arrest in an apheresis patient, need to switch component blood type for a patient, patient has multiple antibodies and a limited number of RBCs are available, or simply if you think maybe you should.
Additional Resident Duties and Responsibilities
- Work up transfusion reactions
- Determine and approve indications for blood products
- Audit the use of uncrossmatched blood and massive transfusions
- Provide consultation and follow-up for the use of factor concentrates
- Interpret tests for positive antibody screen and identification, and positive DAT
- Learn blood typing and screening, antibody identification, and cross matching procedures through bench exercise
- Determine indications for the performance of apheresis procedures, the need for central line, consent patients, write orders for the procedures and related medications, write procedure notes, and coordinate activities for the procedure
- Determine deferral and manage adverse reactions for autologous blood collection, transfusion, phlebotomy, or medication infusion
- Interpret tests for transfusion transmitted diseases and provide consultation and notification
- Determine and approve indications for the work-up for platelet alloimmunization and management of matched platelets
- Provide consultation on calculation and dose for RhIg
- Other clinical consultations and follow-up as determined by clinical needs
Additional Goals and Objectives for the Blood Bank Rotation
- Correctly classify transfusion reactions and give appropriate treatment recommendations.
- Choose appropriate cross-matching methods for various patients (e.g., electronic, immediate spin, and antiglobulin).
- Recognize and appropriately refer serological evaluations that are beyond the scope of a hospital-based transfusion service/blood bank.
- Correctly choose (or recommend) the appropriate blood product for patients with special needs.
- Triage and screen requests for blood components appropriately during inventory shortages.
- Demonstrate the ability to perform blood utilization reviews.
- Perform a donor interview and exam.
- Evaluate and perform initial management of whole blood and apheresis donor reactions.
- Write physician orders for peripheral blood hematopoietic stem cell collections and therapeutic apheresis procedures.
- Appropriately manage reactions that occur during peripheral blood hematopoietic stem cell collections or therapeutic apheresis procedures.
- Acquire a fund of knowledge necessary to function as an independent practitioner in the field of transfusion medicine. We follow the CP curriculum proposed by the ACLPS, for details, please see: Curriculum Content and Evaluation of Resident Competency in Clinical Pathology (Laboratory Medicine): A Proposal. Clinical Chemistry52:6 (2006)
- Demonstrate understanding of and ability to interpret major regulations and guidelines that are applicable to collection, processing, storage, and release of blood and other cellular therapeutic products.
Practice-Based Learning and Improvement:
- Demonstrate the ability to develop new policies and procedures or change existing policies and procedures based on a review of the literature or issuance of new guidelines by regulatory agencies.
Interpersonal and Communication Skills:
- Demonstrate the ability to discuss the process of therapeutic apheresis and transfusion reactions with patients, and/or family members where appropriate; answer their questions; and obtain informed consent. Residents should show compassion and patience to patients and their families.
- Develop or improve communication skills in the course of carrying out their clinical responsibilities as first-line consultants for the transfusion service, by communicating with other physicians in multiple specialty areas, with technical staff members in the transfusion service, with apheresis nurses, and with other caregivers.
- Learn how to communicate efficiently, coherently, and understandably
- Learn how to organize and present complex information
- Demonstrate compassion: be understanding and respectful of patients, their families, and the staff and physicians caring for them.
- Interact with others without discriminating on the basis of religious, ethnic, sexual, or educational differences.
- Demonstrate positive work habits, including punctuality, dependability, and professional appearance.
- Demonstrate a responsiveness to the needs of patients and society that supersedes self-interest.
- Demonstrate principles of confidentiality with all information transmitted both during and outside of a patient encounter.
- Demonstrate knowledge of regulatory issues pertaining to the use of human subjects in research.
- Demonstrate a commitment to excellence and ongoing professional development.
- Demonstrate interpersonal skills in functioning as a member of a multidisciplinary healthcare team
- Gain an appreciation regarding the impact of transfusion medicine on the totality of health care; the role that transfusion services play in patient care in a wide range of medical specialties.
- Gain a perspective on how the local provision of transfusion services depends on regional and even national cooperative efforts to obtain and assure the availability of an adequate blood supply.