Hematology and Coagulation

Required Competencies:

Daily Dutys and Responsibilities

Hematology

The first week of the rotation will be under the direct supervision of the Director of the Laboratory.  During this time, the residents rotating through Clinical Pathology will review the On-Call Laboratory Manual with the director so all call responsibilities are covered adequately.  A pre-test in general hematology will be given by the director.  The director will instruct the residents, through glass slide review, how to recognize blood cells and urine cells and crystals.  Body fluid interpretation will be taught in the same fashion.  At the end of this week, the residents will be expected to interpret one peripheral blood smear, one body fluid slide and one urine sample, correctly and without error.

Weeks two through ten will allow the resident to rotate to each station in the Hematology laboratory.  The resident will begin by observing the technologist perform a certain function and conclude by actually performing that function at least once.  During this time, emphasis will be placed on specimen processing, specimen requirements, and operation of equipment.  The resident will familiar him/herself with the operating principle of the equipment and what tests can be performed.  Limitations of the equipment will also be stressed.  Quality control issues and quality assurance indicators will be explained and discussed with the resident.  Participation by the resident in Performance Improvement activities is required.

For each subdivision of the Hematology laboratory, the resident is responsible for teaching the technologists on any new update appropriate for that testing.

All physician call will be directed to the resident.  The resident is expected to answer these questions and investigate problems, if appropriate.

Residents will participate in Hematology Laboratory rounds conducted by Dr. Canfield each week.

During the rotation, the resident is expected to prepare one topic for presentation to the laboratory director and possibly at Pathology Grand Rounds.  This subject must be approved by the laboratory director.  In addition, a Case of the Month , or similar  paper is required before successful completion of the rotation.

During week eleven, the post test will be taken and a make-up test, if necessary.  An evaluation of the rotation and director will be prepared by the resident and an evaluation of the resident will be prepared by the director.  The rotation paper must be submitted to the director during this week.  The presentation for Grand Rounds may be completed before or during this week.

Demonstrations / Laboratory Testing
The resident is expected to arrange with the Hematology Manager or Tech Specialist when to do the various activities in the laboratory.  The resident is expected to observe as much as possible, ask questions and to capitalize on the opportunity to learn in the laboratory.

  1. The resident will observe tests performed on the Celldyn 4000 automated hematology analyzer
  2. The resident will observe urine samples tested on the automated urine a analyzer.
  3. The resident will observe and perform body fluid analysis including cell and differential.
  4. The resident will screen and interpret any peripheral blood smears requested By the technologists
  5. The resident will participate in Quality Control, Quality Assurance and performance Improvement Activities.
  6. The resident will review any Proficiency Testing performed by the lab during the rotation.

Goals and Objectives

  1. Be able to do test interpretations with some supervision by the end of the first week and with minimal direct supervision by the end of the second
    week.
  2. Discuss the basis of all automated testing performed in the Hematology Laboratory
  3. Explain the manual tests performed in the Hematology laboratory.
  4. Research and present to the technologists at least one new update on laboratory testing in the Hematology Laboratory.
  5. Discuss the pathophysiologic processes that affect test results in the Hematology laboratory.
  6. Present to the laboratory director and possibly at Pathology Grand Rounds on an appropriate Hematology subject.
  7. Write a Case of the Month or similar paper for publication on a Hematology patient.
  8. Successfully pass the post test administered by the director.

Coagulation

The major vehicle for instruction of a resident by the course director will be during test result interpretations.  During the first few days of the rotation, the resident will observe the laboratory director evaluate the interpretative test results.  By the end of the first week, the resident will be expected to do interpretations before presenting them to the faculty.  The resident will be expected to review all interpretive tests done in the laboratory and prepare the initial interpretative report for review with the laboratory director.  The interpretative reports are done on the laboratory computer database system.  The resident is expected to learn to efficiently use this system.  It is expected that the resident will do this within 24 hours of the test results being available.  During the first week, the resident will also be given a pre-test to help the director evaluate the resident’s preliminary knowledge of coagulation.

At the end of the second week, the resident will be expected to perform autonomously, however, no diagnosis will be given to the clinician without approval by the laboratory director.  Each Monday, the resident will meet with the laboratory director to discuss the prior week’s cases and to plan a strategy for the current week.

The resident is expected to be on site at all times (except when specific permission is granted by the laboratory director).  All special coagulation tests will be reviewed during that time for appropriateness, timeliness, and results.  Attendance at Heme/Onc rounds on Tuesday morning at 8am is required.

A specific case – selected by the resident - will be reviewed and worked up for presentation to the laboratory, director and possibly at Pathology Grand Rounds.  This case may qualify for the Case of the Month as well.

The resident will be expected to participate in the Clinical pathology resident call schedule.

Demonstrations / Laboratory Testing Participation

The resident is expected to arrange with the technologists when to do the various activities in the laboratory.  The resident is expected to observe as much as possible, ask questions and to make the most of the opportunity to learn in the laboratory.

  1. The resident will observe tests performed in-house and should run a lupus inhibitor test and a Factor VIII assay.
  2. The resident will observe platelet aggregation tests done as part of a bleeding workup and platelet screening tests.
  3. The resident will research the ELISA method, “rocket” immunoelectrophoresis, and crossed immunoelectrophoresis to understand the principles involved.
  4. The resident should observe chromogenic tests done in-house and be aware of the benefits and shortcomings of the tests.
  5. The resident will research the genetic tests used in special coagulation and be aware of the indications for use.

Goals and Objectives

  1. Test interpretation with some supervision by the end of the first week and with minimal direct supervision by the end of the second week.
  2. Explain the basis of all clotting based tests, which are primarily done on instruments.
  3. Discuss  the rare manual tests, including thrombin time.
  4. Discuss in detail the general methods for factor assays, lupus inhibitors, and platelet aggregation tests by the end of the first week.
  5. Explain the method for at least one ELISA test, one rocket immunoassay, and one crossed immunoelectrophoresis test by the middle of the second week.
  6. By the end of the second week, the resident should be able to explain the pathophysiologic processes that affect interpretation of test results for both bleeding and clotting tendencies.
  7. By the end of the second week, the resident will also be expected to discuss anti-phospholipid antibodies and lupus inhibitors.
  8. By the end of the rotation the resident will be expected to successfully complete the post-test indicating a sound understanding of coagulation