Blood Bank

GOALS AND OBJECTIVES

CODES FOR ACGME COMPETENCIES

C1. PATIENT CARE

C2. MEDICAL KNOWLEDGE

C3. PRACTICE-BASED LEARNING AND IMPROVEMENT

C4. INTERPERSONAL AND COMMUNICATION SKILLS

C5. PROFESSIONALISM

C6. SYSTEMS-BASED PRACTICE 

By the completion of this two-month laboratory experience, the pathology resident will have demonstrated competence in the following areas of knowledge and practice: 

BLOOD COMPONENTS

(C2, 3) Understand the principles and techniques of collection and processing of blood including apheresis procedures. Understand allogenic, autologous, and directed donation through problem/case-based discussion. 

(C2) Understand the storage and shipment requirements, as well as thawing, pooling, and special handling of components (i.e. irradiating, washing or deglycerolizing). 

IMMUNOHEMATOLOGY

(C1, 2, 3, 4, 5, 6) Apply the principles and techniques of pretransfusion testing by daily evaluation of patient samples that have grouping discrepancies, unexpected antibodies and positive direct antiglobulin tests, diagnosis of hemolytic disease of the newborn, and evaluation of a patient refractory to platelet transfusions.  As the resident gains appropriate experience, he/she will be required to process the interpretive reports explaining the significance of atypical antibodies to the patient's physicians. 

TRANSFUSION PRACTICES/QUALITY ASSURANCE

(C1, 2, 3, 4, 5, 6) Retrospectively evaluate the indications and appropriateness for transfusion of  components from the weekly Blood Utilization Review data. Review the administration of blood and blood components nursing policy (PPB-NSG-081). Prospectively evaluate and participate in consultation for specialty blood products (HLA matched platelets, washed RBCs). 

TRANSFUSION REACTIONS

(C1, 2, 3,6) Evaluate adverse reactions to transfusion, order an appropriate follow-up workup, and make clinical recommendations regarding these reactions and subsequent hemotherapy. Investigate all suspected post-transfusion infectious complications. Document transfusion reaction investigation by placing a Blood Bank note in Wake 1.

BONE MARROW TRANSPLANTATION

(C1, 2, 3) Participate in daily rounds in the BMT laboratory. Evaluate autologous and allogenic peripheral blood stem cell harvests for adequacy of collection, proper processing and storage.  Review at least one colony forming assay and distinguish between CFU-GM and BFU-E. By the end of the rotation, the resident should be able to make appropriate recommendations for stem cell processing and storage based on ABO, Rh, and infectious disease testing results on the patient and donor. Observe at least one stem cell infusion on the bone marrow transplant unit. Understand the benefits and clinical implications of dimethylsulfoxide (DMSO) infusion and its relevance to stem cell therapy. 

COAGULATION

(C2) During the rotation the resident will receive an introduction to the principles of coagulation and the application of coagulation to transfusion medicine. A knowledge of the clinical applications of coagulation will be enhanced through coordination of discussions and interactions with Dr. Andrew Farland and the hematology coagulation service. 

DETAILED OBJECTIVES

1.   (C2, 3) Understand the principles and techniques of collection and processing of blood including apheresis procedures. 

2.   (C2) Understand the storage and shipment requirements, as well as thawing, pooling, and special handling of components (i.e. irradiating, washing or deglycerolizing). 

3.   (C1, 2, 3) Apply the principles and techniques of pretransfusion testing by daily evaluation of patient samples that have grouping discrepancies, unexpected antibodies and positive direct antiglobulin tests. 

4.   (C6) Understand the quality assurance principles of the Blood Bank as relates to transfusion practices. 

5.   (C2, 6) Learn the indications for the appropriate use of blood products and apply this training to monitor the transfusion practices in the institution. 

6.   (C1, 2, 3, 4, 5, 6) Evaluate adverse reactions to transfusion, order an appropriate work-up, and make clinical recommendations regarding these reactions and subsequent hemotherapy. 

7.   (C1, 2, 3) Understand and evaluate donor center problems such as product withdrawal/recall and lookback. 

8.   (C1, 2) Evaluate bone marrow transplant patients and make appropriate stem cell processing and transfusion recommendations. 

9.   (C1, 2, 3) Describe typical symptoms of stem cell infusion reactions and recommend appropriate therapy. 

10. (C1) Observe one stem cell infusion on the bone marrow transplant unit. 

11. (C1, 2, 3) Evaluate autologous and allogenic peripheral blood stem cell harvests for adequacy of collection, proper processing, and storage.  By the end of the rotation the resident should be able to make appropriate recommendations for stem cell processing and storage based on ABO, Rh and infectious disease testing results on the patient and donor. 

12. (C1, 2) Understand the benefits and clinical implications of dimethylsulfoxide (DMSO) infusion and its relevance to stem cell therapy. 

13.  (C2) Review at least one colony forming assay and distinguish between CFU-GM and BFU-E. 

14.  (C2) Review the chapters on Donor Selection and Blood Collection, Autologous Blood Collection and Transfusion and Hemapheresis in the AABB Technical Manual, 14th edition. 

15.  (C1) Observe a therapeutic pheresis of a TTP patient in house. 

16.  (C2) Review the chapter on Blood and Components in the AABB Technical Manual and observe one cell washing/deglycerolization procedure. 

17.  (C1, 2, 3, 4, 5, 6) Review the chapters on Pretransfusion Testing, Identification of Alloantibodies to Red Cell Antigens, and the Positive DAT and Immune-Mediated Red Cell Destruction in the AABB Technical Manual. As the resident gains appropriate experience, he/she will be required to process the interpretive reports explaining the significance of atypical antibodies to the patient’s physician. 

18.  (C1, 2, 3, 6) Evaluate daily the indications and appropriateness for transfusion of all platelet components from the preceding day. 

19.  (C1, 2, 3, 6) All donor center problems will be referred to the resident for resolution. This will often require chart review to see if patients have developed post transfusion problems.

Staff

Emmanuel Fadeyi, MD
Director, Blood Bank

 

Quick Reference

Pathology Residency Training Program
Program Director:
Ryan T. Mott, MD

Tel: 336-716-4311
Fax: 336-716-7595

Wake Forest Baptist Medical Center
Medical Center Boulevard
Winston-Salem, NC 27157
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Last Updated: 01-22-2014
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