ROTATION INFORMATION
DEPARTMENT OF ANESTHESIA
RESIDENCY TRAINING PROGRAM
UNIVERSITY OF MANITOBA
TRANSFUSION MEDICINE
INTRODUCTION
The Transfusion Medicine Rotation is divided into two week periods. One of these will
be an Operating Room rotation and the other will be a Lab/consults rotation. The
objective of these rotations is to develop expertise in Blood Transfusions, Blood
Alternatives, and Transfusion Reactions, as well as clinical skills in massive transfusion
and dealing with the perioperative bleeding patient.
Along with the BCT year and other Internal Medicine and Subspecialty rotations, this
Transfusion Medicine rotation is designed to allow the resident to acquire the general and
specialty specific medical knowledge necessary to function as a competent perioperative
physician.
GOALS AND OBJECTIVES
The following Rotation Specific Goals and Objectives for Transfusion Medicine, provide
specialty specific emphasis to particular components of the general Program Goals and
Objectives. These Goals and Objectives are written in the CanMEDS format. The
resident will be expected to achieve the following goals and objectives in an
appropriately incremental manner, with increasing experience.
Please refer also to the National Curriculum for Canadian Anesthesia Residency for more
information on expected knowledge and skills.
All appropriate Program Goals and Objectives also apply to this rotation.
1. Medical Expert/Clinical Decision Maker
By the end of this rotation, the resident will be able to perform the following:
A. Explain the normal function of the hematological system including
coagulation
B. Explain the pathophysiology, diagnosis and treatment of common
hematology, coagulation and transfusion problems including:
i. Anemia and hemoglobinopathies
ii. Thrombocytopenia
iii. Hereditary and acquired coagulation disorders including:
iv. Platelet disorders
v. Coagulation factor disorders
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D.
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vi. Anticoagulation
vii. Transfusion reactions
viii. Massive transfusion
Apply an organized method of assessment of patients with hematological
disease and communicate a succinct evaluation and management plan to
Attending Staff.
Explain the indications for, and demonstrate interpretation of, the common
diagnostic tests (PTT, INR, Platelet count and Platelet function studies, Blood
group and cross match, antigen testing)
Explain the methods used to collect and test blood, process and store it’s
various components, and make it available at local institutions
Explain the principles of red cell and blood component transfusion and list the
indications and contraindications for red cell, platelet, fresh frozen plasma,
and specific factor concentrate transfusions
Discuss the complications, diagnosis, and management of blood and
component transfusion.
Describe the work done in the CBS laboratory relating to transfusion
List, identify and manage the complications of massive blood transfusion.
List the alternatives to blood products for patients with low hemoglobin states
including autologous blood transfusion, acute isovolemic hemodilution, and
current synthetic blood strategies.
Discuss use of blood product filters and blood warmers, and potential
problems associated with their use.
Discuss the assessment, management, and optimization of surgical patients
presenting with hematological disease and/or expected large volume blood.
Discuss the perioperative management of patients who refuse blood products.
Explain the clinical, ethical and legal issues involved in dealing with these
patients.
Formulate and implement an appropriate plan for patient management based
on understanding of the hematological problem, coexisting problems, and
patient factors such as anxiety, discomfort, culture, language, ethnicity, age,
and gender
Use the Level 1 fluid resuscitation equipment.
Set up and operate the cell saver.
Explain the indications and warnings of the antifibrinolytics, rFVIIa, and
parenteral iron.
Perform acute normovolemic hemodilution, phlebotomy, and transfusion of
blood products and provide a rationale that takes into account indications,
contraindications, alternatives, costs and complications
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2. Communicator
By the end of this rotation, the resident will be able to perform the following:
A. Establish a therapeutic relationship with patients emphasizing explaining,
trust, empathy, and confidentiality and elicit and synthesize relevant
information from the patient and/or family, and be able to assess and take into
account, the impact of a patient's age, gender, ethnocultural background,
social supports, and emotional influences on illness
B. Obtain sufficient information from the patient, family and/or surrogate(s) to
formulate a plan for management that will take into account all considerations
related to the patients medical and surgical issues as well as his/her personal
beliefs
C. Impart information to patients, families and/or surrogate(s) with sufficient
content and clarity to allow them to understand treatment decisions and give
informed consent
3. Collaborator
By the end of this rotation, the resident will be able to perform the following:
A. Communicate a succinct assessment and management plan to Attending Staff
and to other physicians requesting consultation
B. Discuss appropriate information with the director of the CBS, staff at the
CBS, other healthcare providers, and (physicians and surgeons), and patients
to facilitate optimal transfusion management for the patient
C. Effectively consult with other physicians and health care professionals and
demonstrate appropriate judgment regarding the assessment of hematological
disease
D. Coordinate patient care with other members of the care team, especially CBS
staff, or consultation requesting physicians
E. Manage urgent and crisis situations such as massive transfusion, as a team
member or leader
4. Manager
By the end of this rotation, the resident will be able to perform the following:
A. Manage time and assign priorities for:
i. Efficient use of time
ii. Changes in response to emergencies
B. Formulate treatment plans that take into account the cost-effective use of
medical resources such as transfusion therapy, drug, or alternative therapeutic
choices
5. Health Advocate
By the end of this rotation, the resident will be able to perform the following:
A. Demonstrate knowledge and recognition of broad health and societal issues
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with impact on the care of the patient with hematological disease including:
i. Risk factors and demographics which contribute to the development
of, and complications of hematological disease
ii. Factors that identify high-risk patients
iii. Short-term and long-term programs for health maintenance post
transfusion
B. Demonstrate the ability to intervene on behalf of patients regarding their care
and safety
6. Scholar
By the end of this rotation, the resident will be able to perform the following:
A. Develop, implement, and monitor a personal continuing education strategy
B. Search and critically appraise current hematology literature, and apply new
knowledge based on appropriate evidence
C. Demonstrate effective oral presentation of case reports, journal club, or rounds
with sound synthesis of pertinent information
D. Formulate questions for ongoing appraisal
E. Facilitate learning of patients, housestaff, students and other professionals
7. Professional
Throughout this rotation, the resident shall:
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B.
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Deliver highest quality care with integrity, honesty, and compassion
Demonstrate appropriate interpersonal and professional behavior
Practice medicine ethically consistent with the obligations of a physician
Be aware of the ethical and legal aspects of patient care including refusal of
blood products
Show recognition of personal limits through appropriate consultation (with
staff supervisors, other physicians, and other health professionals) and show
appropriate respect for those consulted
When appropriate demonstrate including the patient in discussions of care
management
Recognize potential conflict in health care situations, professional
relationships, and value systems, and demonstrate the ability to discuss and
resolve differences of opinion.
Accept constructive feedback and criticism and use it to improve his/her care
of patients
CLINICAL RESPONSIBILITIES
Daily Responsibilities
OR Component
During the OR component of the transfusion medicine rotation, the resident will be
expected to perform the following functions:
 Screen the list in PAC daily to identify patients who will be undergoing large
blood loss procedures.
 Assess all patients in PAC who will be undergoing large blood loss procedures
during the period of his/her rotation.
 Formulate a plan for the optimization of the perioperative transfusion risks of the
patient
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
Provide the Anesthetic plan and manage the intraoperative care of the above
patients that go to the OR within the period of time that the resident remains on
the rotation.
Consult component
While on the consult component of the Transfusion medicine rotation, the resident will be
expected to
 Answer all Blood Conservation/perioperative hematology consults (with Blood
Conservation Nurse/Dr. Muirhead or Dr. Maguire at HSC and Dr.Moltzan or Dr.
Bell at SBGH)
 Spend one day in SICU or ICS setting to learn the clinical management of blood
products in the high-risk patient.
OTHER RESPONSIBILITIES
While on the Transfusion Medicine rotation, the resident will be expected to perform the
following:
 Complete certification in Bloody Easy 2
 Prepare a 20-30 minute presentation on topics related to Transfusion Medicine
 Complete the required reading
a. Bloody Easy 2 Callum JL
b. Principles of Transfusion Medicine, Rossi, Simon, Gould Ch:11, 12, 14
LEARNING RESOURCES
During this rotation, the following resources will be available to residents in addition to those
available at all times through the University Department:
1) Clinical teaching- The most important learning resource during clinical rotations is
the direct teaching that occurs during discussion with staff of the management of
actual cases, and topics of interest. The quality of this discussion is enhanced by
communication in advance to generate a teaching plan.
2) Site Library- The University library has a collection of current textbooks relevant to
the pattern of practice of the site
3) Computer access- The Health Sciences Centre has computer access within the OR
for resident use in accessing literature
4) Anesthesia Toolkit – This resource may be accessed electronically by the residents
through the University of Manitoba Health Sciences Library. It contains a wealth of
links to useful books, journals, articles useful for clinical anesthesia but also making
effective presentations, teaching, providing patient resources, and understanding
evidence-based medicine. Anesthesia Toolkit can be accessed at
http://umanitoba.ca/faculties/medicine/anesthesia/
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