All PGY levels have the similar goals and objectives except where noted throughout the document. However the expectation for the resident’s performance increases as they gain experience. More senior residents (PGY3-4) are expected to be involved in projects related to Blood Bank operations. These may be quality assurance projects, writing new procedures & policies, etc.
The following is an outline of expectations of residents during the Blood Bank/Transfusion Medicine rotation (adapted from Smith, et al. Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal. Clin Chem. 2006 Jun;52(6):917-49.)
The goals and objectives of the BB/TM experience is to prepare and enable residents to:
- Demonstrate competency in investigating, evaluating, and interpreting BB cases. This includes selecting appropriate blood products for transfusion and work-ups of positive antibody screens and panels and transfusion reactions.
- Demonstrate professional behavior regarding patients, other physicians and all clinical laboratory personnel.
- Demonstrate a commitment to reviewing and improving Blood Bank/Transfusion Medicine practice patterns and to life-long learning.
- Understand the scientific basis and pathophysiology of Blood Banking, which includes an understanding of immunohematology.
- Recognize the importance of utilizing the medical literature and modern techniques to provide optimal patient care.
- Communicate effectively in verbal and written form with their clinical colleagues, administrative, technical, and clerical personnel.
- Discuss the policies and regulations affecting health care (i.e., CAP accreditation, HIPAA, compliance to Medicare and billing regulations, etc.)
The specific objectives of the BB/TM rotations include:
- Demonstrate knowledge of the principles of patient/unit identification and pre-transfusion testing, including ABO/RhD testing, RBC antibody screen, and antibody identification.
- Recognize the symptoms and signs of hemolytic and nonhemolytic transfusion reactions and demonstrate knowledge of the pathophysiology, treatment, and prevention of these complications.
- Identify the major infectious complications of blood transfusions and the current risk of these infections, and explain how these infections can be prevented.
- Identify the major noninfectious complications of blood transfusions, including transfusion-related acute lung injury, the risk of these complications, and strategies to prevent them.
- Choose appropriate blood components and derivatives based on a thorough knowledge of the indications for transfusion.
- Demonstrate knowledge of the pathophysiology, prevention, and treatment of hemolytic disease of the newborn. Recognize those antibodies in pregnant patients that are clinically significant and make appropriate recommendations for blood products.
- Demonstrate knowledge of the pathophysiology and treatment of neonatal alloimmune thrombocytopenia.
- Demonstrate proficiency in the evaluation and appropriate transfusion therapy of thrombocytopenic patients (both adult and pediatric).
- Apply the principles of a massive transfusion protocol.
- Demonstrate a working knowledge of the principles of hemostasis and coagulation and proficiency in the initial treatment of patients with bleeding disorders.
- Demonstrate knowledge of the transfusion requirements of special patient populations (e.g., hematology/oncology, pediatrics, geriatrics, transplantation, and burn/trauma).
- Demonstrate knowledge of landmark published studies in transfusion medicine.
- Demonstrate proficiency in evaluating and presenting findings from recent peer-reviewed journal articles related to transfusion medicine.
- Identify clinically significant RBC antibodies from an antibody panel including multiple alloantibodies and mixtures of alloantibodies and autoantibodies; determine how difficult it will be to obtain blood for this patient, and effectively communicate these results to clinicians.
- Demonstrate proficiency in evaluating and recommending treatment plans for complex transfusion reactions.
- Demonstrate familiarity with the appropriate use of highly specialized blood products (e.g., granulocytes, donor lymphocyte infusions, HLA-matched platelets, and coagulation factor concentrates).
- Demonstrate familiarity with the requirements of all applicable regulatory and accrediting agencies [e.g., JCAHO, CAP, American Association of Blood Banks (AABB), and US Food and Drug Administration].
- Compare and contrast the various means of performing blood utilization reviews.
- Demonstrate competence in the management of blood inventory and the ability to communicate effectively the hospital’s needs to the blood supplier.
- Demonstrate knowledge of various methods of blood conservation, including pre- and perioperative autologous blood collection, and approaches to "bloodless" surgery.
- Demonstrate proficiency in evaluating patients refractory to platelet transfusions. Outline the principles of histocompatibility testing and platelet cross-matching and apply this knowledge in selecting appropriate platelet products when indicated.
- Demonstrate proficiency in the evaluation of patients with immune-mediated and non–immune-mediated hemolytic anemia and in the appropriate transfusion management of these patients.
Blood Collection/Blood Center/Cell Processing
- Compare and contrast the eligibility requirements for allogeneic and autologous blood donations.
- Demonstrate knowledge of the indications for therapeutic phlebotomy.
- Demonstrate proficiency in evaluating and treating adverse reactions associated with blood donation/phlebotomy (whole blood and apheresis donations).
- Outline the assay principles of required donor blood tests and the associated confirmatory testing and describe donor re-entry algorithms.
- Demonstrate professionalism in interactions with prospective donors.
- Summarize the steps in blood component and blood derivative preparation.
- Describe the factors that influence the motivation of volunteers to donate blood.
- Explain the operational logistics required in determining appropriate blood inventory for a geographic region and the process of meeting daily, weekly, and monthly collection goals.
- Outline the necessary steps in donor notification and counseling associated with positive infectious disease testing results, and the donor look-back process.
- Demonstrate knowledge concerning the requirements of all applicable regulatory and accrediting agencies.
- Demonstrate knowledge of the principles of hematopoietic stem cell transplantation, including collection, processing, and storage of these stem cell products, and the indications for use (e.g., bone marrow, peripheral blood, and cord blood).
- Demonstrate understanding of 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 therapeutic products (e.g., pancreatic islet cells, negative/positive selection/purging of hematopoietic stem cells, gene manipulations, donor lymphocyte infusions, dendritic cell vaccines, and ex vivo expansion of progenitor cells).
- Develop an understanding of emerging areas of cellular therapy, including hematopoietic graft engineering and cellular immunotherapeutics.
- Summarize the principles of apheresis technology, including centrifugation, filtration, and immunoadsorption.
- Demonstrate knowledge of the indications for therapeutic apheresis and of the appropriate replacement fluids to be used in various situations.