VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
Transfusion Medicine Rotation
Description of Rotation or Educational Experience
The Hematology-Oncology fellowship transfusion rotation is designed to provide the fellow with an overview of topics
pertinent to the hematologist regarding transfusion medicine and cellular therapies. Fellows are afforded the opportunity to
participate in the clinical activities and patient care pertaining to transfusion medicine, including direct experience in both the
blood donor service and transfusion medicine service aspect of the discipline. It is expected that the fellow will have hands-on
experience with the process of blood typing and crossing, including the evaluation and identification of both allo and auto
antibodies directed against blood components. The fellow is provided opportunities to observe blood product preparation
and an expectation of gaining an understanding of the various blood products and the indications for their use. Additionally,
the fellow should become familiar with the complications of blood product administration and participate in the investigation
of possible transfusion reactions and other related complications. The fellow is expected to gain an understanding of the
clinical uses of apheresis therapy and the procedures involved in such. All of this activity occurs under the supervision of the
transfusion medicine trained attending physicians, the blood bank/apheresis technologists/staff, and the residents within the
Department of Pathology.
Location:
VCUHS MCV Hospital Blood Bank and Apheresis Center
VCUHS MCV Hospital inpatient nursing units
Length of Experience:
2-4 week block – weekdays with no in-house overnight call on this rotation.
Educational Goals
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Describe and perform a blood type and crossmatch using samples provided by lab personnel
Evaluate and identify allo and auto antibodies directed against blood components, particularly focused on the
performance and interpretation of the direct agglutination test (DAT)
Discuss the various blood products available and the indications for the administration of each
Recognize, compare and contrast the complications associated with the administration of the various blood products
Manage effectively a patient having a transfusion–related complication
Discuss the steps and processes involved it the investigation of a suspected transfusion-related complication
Discuss the clinical uses, indications, and procedure of apheresis therapy
Write apheresis orders
Educational Activities
The following specific activities should be performed during the course of this rotation:
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Perform a type and screen, antibody identification, DAT, and crossmatch.
o The fellow will work with the technologist at the bench to perform and interpret basic serologic tests
o The fellow will work with the pathology resident to learn how to interpret antibody identification panels and
then write consultation reports with the resident.
Observe how orders are processed and products prepared for transfusion
o Observe the workflow in the blood bank
o Observe or discuss irradiation, thawing and pooling of frozen products and platelets
o Discuss with the blood bank physicians and staff the differences among component therapy transfusion
products and their appropriate uses (red blood cell, white blood cell, platelet, plasma, and cryoprecipitate).
o Review pertinent sections of Apheresis/Blood Bank textbooks (available in TM)
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Be able to describe the basis of blood management programs and their role in promoting patient safety and patient
care quality
o Discussions regarding the proper use of blood components
o Describe the role of the Blood Utilization Committee
Assess patients undergoing apheresis therapy
o Read current ASFA guidelines (available in TM)
o Perform literature sources
o Review pertinent sections of Apheresis/Blood Bank textbooks (available in TM)
o Work with the senior resident
o Observe at least one consent
o Assist in writing consultations
o Assist in the development and ordering apheresis plans
Be able to write orders/calculate volumes/select the appropriate replacement fluid
o Write therapeutic apheresis orders including the calculations or volume and selection of the replacement
fluids
Be able to manage patients undergoing apheresis
o Understand electrolyte and fluid shifts (use texts, as above)
o Write daily progress notes
Be able to describe the function of the cell separator
o Work with nurses
o Reading, as above
o Use of equipment manuals
Be able to assess patients for red blood cell exchange transfusion
o Read current ASFA guidelines (available in TM)
o Perform literature sources
o Review pertinent sections of Apheresis/Blood Bank textbooks (available in TM)
o Work with the senior resident
o Write therapeutic exchange transfusion orders including the calculations or volume and selection of the
exchange products.
o Accurately assess the adequately of the exchange once performed and reconcile the differences between
the expected and actual results.
Patient Care
Goal
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health. Please refer to overview of the fellowship curriculum for competencies/objectives for
patient care.
The fellow will work as part of a multi-disciplinary team involved with the safe evaluation and administration of blood products
and managing cellular therapies.
Competencies
Fellows are expected to:
 Gather appropriate clinical information
 Synthesize information into a care plan and transfusion consultation report
 Coordinate care plans with the multi-disciplinary team of health professionals
Objectives
Fellows are expected to:
 Develop and provide the rationale for the use of blood products and cellular therapies in both malignant and benign
hematology conditions and understand.
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 Recognize the indications for and the risk of the following therapies in patients with hematologic disorders:
o Exchange transfusion therapy
o Simple transfusion therapy
o Apheresis therapy
 Recognize the symptoms and signs of a transfusion reaction and distinguish among the common and less common
causes of these reactions
 Integrate clinical data in the formation of a comprehensive care plan for a patient with identified RBC antibodies or
undergoing pheresis, including the ability to determine the appropriate product, dose, and duration
 Document the encounter in the medical record in sufficient detail to communicate to other physicians and meet
billing requirements
Medical Knowledge
Goal
Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral
sciences, as well as the application of this knowledge to patient care.
Competencies
Fellows are expected to demonstrate skills in:
 Acquisition of knowledge
 Analysis of information
 Application of knowledge
Objectives
All fellows are expected to:
 Demonstrate the ability to perform a comprehensive and accurate physical examination; demonstrate the ability to
arrive at an appropriate differential diagnosis; outline a logical plan for specific and targeted investigations pertaining
to the patient’s complaints; and formulate a plan for management and follow-up treatment of the patient
 Demonstrate their knowledge by presenting the results of a consultation orally and in writing and by defending the
clinical assessment, differential diagnosis, and diagnostic and management plans
Rotation-Specific Objectives
All fellows are expected to:
 Describe and perform a blood type and crossmatch
 Describe the preparation of blood products selected for patient administration
 Evaluate and identify allo and auto antibodies directed against blood components, particularly focused on the
performance and interpretation of the direct agglutination test (DAT)
 Discuss the various blood products available and the indications for the administration of each
 Recognize the complications associated with the administration of the various blood products
 Manage effectively a patient having a transfusion–related complication
 Discuss the steps and processes involved it the investigation of a suspected transfusion-related complication
 Discuss the clinical uses, indications, and procedure of apheresis therapy
Practice- Based Learning and Improvement
Goal
Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific
evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. The fellow is
expected to present primary scientific and medical evidence to support their conclusions and care plans in the diagnosis,
prognosis, management, and monitoring of the patients on the service. The fellow is expected to recognize their areas of
deficiency. Depending upon the acuity of the care situation, the fellow is expected to be able to effectively utilize their
resources to arrive at necessary information and to apply the information to their patient care. Moreover, the fellow is
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expected to recognize conditions and circumstances requiring escalation.
Please refer to overview of the fellowship curriculum for competencies/objectives for practice based learning and improvement.
Systems Based Practice
Goal
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the
ability to call effectively on other resources in the system to provide optimal health care. Fellows will work within a
multidisciplinary team of health professionals including midlevel providers, pharmacists, nurses, physical therapists,
occupational therapists, social workers, care coordinator, and pastoral care. This will provide the fellow experience and
feedback in effectively working within a multi-disciplinary team of health professionals. Additionally, working with the context
of a broader health system includes the importance and necessity to recognize conditions and circumstances requiring
consultation and/or escalation for the effective and safe delivery of patient-centered medical care.
Please refer to overview of the fellowship curriculum for competencies/objectives for systems based practice.
Rotation specific objectives include
 Discuss the important transfusion therapy procedures and their benefit and cost and how to facilitate these lifesaving
therapies
 Describe the potential risk and toxicities that accompany the various procedures and component therapy in the
transfusion and cellular therapy arena.
 Work within the transfusion medicine teams to enhance patient safety and
 improve patient care quality, for the various procedures being accomplished
 Describe the basis of blood management programs and their role in promoting patient safety and patient care quality
Professionalism
Goal
Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
The fellow is expected to model professional and courteous behavior in the treatment of the patient and in working with the
entire health care team. The fellow is expected to complete documentation of their patient care, of their communications with
the patient and health care providers, and of their procedures in a timely fashion within the medical record. The fellow is also
expected to recognize the critical importance of their own education and the importance of life-long learning as part of their
professional responsibility. As such, it is the obligation of the fellow to themselves, their profession, and their patients to
attend and complete in a timely fashion all of fellowship training program’s expected educational activities.
Please refer to overview of the fellowship curriculum for competencies/objectives for professionalism.
Interpersonal and Communication Skills
Goal
Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and
teaming with patients, their families, and professional associates.
Please refer to overview of the fellowship curriculum for competencies/objectives for interpersonal and communication skills.
Rotation specific objectives include
 Maintain comprehensive records in the course of performing blood banking procedures (e.g. apheresis therapy)
 Demonstrate effective communication with patient and families across a broad range of socioeconomic and cultural
backgrounds
 Communicate effectively and respectfully with laboratory personnel and faculty during this rotation.
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Teaching Methods
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Patient care/clinical experience
Modeling of observed behaviors of attending physicians
Case-based interactive discussions
Wet Laboratory Sessions: required
o Perform blood group
o Perform antibody screen/panel
o Perform antigen typing
o Perform DAT
Didactic sessions with Attendings:
Required Sessions:
o ABO blood groups and compatibilities
o Incompatible blood transfusion journal article with questions and discussion
o Warm autoantibody lecture with SAMS questions
o Introduction to Apheresis
Optional sessions:
o Donath Landsteiner antibodies
o Lewis antigen system and antibodies
o Rh antigen system and antibodies
o Transfusion Reactions
o Blood Safety
Performance feedback
Self-directed learning
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End-of-rotation evaluation of the fellow by the supervising attending physicians
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Assessment of Rotation
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End-of-rotation evaluation of the supervising attending physicians by the fellow
Annual program review
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision
Indirect supervision with direct supervision by the faculty and the professional blood bank/apheresis staff immediately
available
Educational Resources
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Apheresis/Blood bank textbooks (available in TM)
ASFA guidelines
Hoffman Hematology: Basic Principles and Practice (4th Edition)
UpToDate
ASH-SEP
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