Curriculum

You will receive comprehensive training in all aspects of transfusion medicine including:

• Apheresis and autologous transfusion techniques
• Blood component and bone marrow processing, storage, testing and administration
• Blood donation and collection
• Blood donor recruitment
• Histocompatibility testing
• Human cellular therapies, including dendritic cell vaccine and pancreatic islet cell preperation
• Immunohematological procedures
• Laboratory administration and management
• Medical decision-making

Clinical Training
During this fellowship, you will participate in all operations of the Division of Transfusion Medicine. An outline of a typical rotation schedule follows; it can be tailored to fit your specific career interests.

Rotation Descriptions

Introduction
On this rotation you will receive an orientation to the Division of Transfusion Medicine and its activities. Most of this month is spent on an intensive course in basic immunohematology, with extensive bench training provided by a teaching technologist. You will learn how to perform and interpret most of the basic, and many of the more sophisticated, techniques used in the red cell transfusion laboratory.

Transfusion and Serologic Reference Laboratory
During this rotation you will actively participate in the daily technical work in the transfusion laboratory, which includes clarification of red cell serological problems and evaluation of all adverse transfusion reactions. You will perform the specialized procedures that are conducted in the reference laboratory and diagnose certain patients with transfusion-related problems. All transfusion laboratory activities and all transfusion-related problems are reviewed at a daily conference.

Therapeutic Apheresis Unit
While in this laboratory, you will be involved in the performance of hemapheresis procedures. These procedures are performed as part of various therapeutic regimens and to acquire granulocytes and hematopoietic stem cells for transfusion purposes. You will receive training in rational approaches to therapeutic plasmapheresis, therapeutic plateletpheresis, therapeutic erythrapheresis, therapeutic leukapheresis, photopheresis, immunoadsorption, LDL apheresis, and peripheral blood stem cell collection. Unit activities are reviewed at a daily conference.

Tissue Typing Laboratory
HLA Class antigens are determined by serological and DNA techniques. You will learn about various applications and their limitations.

• Class I and Class II HLA typing and lymphocyte separation techniques
• Granulocyte and platelet antibody testing
• HLA molecular and serologic typing for the support of kidney, heart, lung,
  pancreas and liver transplant programs
• Lymphocyte crossmatching by cytotoxicity and flow cytometry
• HLA antibody testing by ELISA, cytotoxicity and Luminex
• CD34 testing for stem cell transplantation
• High resolution HLA typing for unrelated BMT Class I and Class II

Hepatitis/HIV Laboratory
You will participate in the activities of a large, comprehensive, transfusion-transmitted virus testing laboratory. During this rotation you will gain valuable experience in the practical management of patient-related problems, including "look-back" and post-transfusion disease detection.

Desk Coverage and Call
While on call, you will provide coverage for all medical problems that typically present themselves to a transfusion medicine physician. These include donor eligibility problems, component inventory management, donor reactions, transfusion reaction workups and emergency blood transfusion situations. This rotation covers the full range of transfusion medicine clinical experience and is one of the program's greatest strengths.

Component Laboratory
On this rotation you will participate in laboratory activities and become familiar with the technical and administrative aspects of blood component preparation.

Product Testing Laboratory
This rotation exposes you to the non-transfusion transmitted virus testing and QC testing performed on blood products.  This will include residual leukocyte counts, platelet product bacterial detection, and automated ABO and Rh testing.

Autotransfusion
This rotation gives you the opportunity to become familiar with one of the largest perioperative blood management programs in the United States , transfusing approximately 9,000 units annually. You will learn about perioperative blood salvage, hemodilution techniques, intraoperative component preparation and Mayo's comprehensive quality assurance program.

Transfusion and IV Service
You will observe the proper methods of transfusion therapy and spend time at both of Mayo's hospitals in Rochester . You will have direct patient contact while administering blood and blood components and conducting clinical investigations of suspected adverse transfusion reactions.

Quality Assurance/Quality Control and Management
During your fellowship you will spend time with the medical director and the administrative coordinator of transfusion medicine. You will gain valuable insights into many of the administrative tasks that confront a transfusion medicine physician. You also will spend extensive one-on-one time with quality assurance technologists so you become familiar with Mayo's quality assurance and quality control procedures. You will also help in preforming audits in the Division of Transfusion.

Human Cellular Therapy Laboratory
This rotation gives you the opportunity to observe the processing of autologous and allogeneic hematopoietic stem cell products for transplantation including peripheral blood derived stem cells and bone marrow.  Processing performed includes red cell reduction, cell selection, and cryopreservation.  You will also participate in the thawing and infusion of products.  You will also be exposed to flow cytometry for CD34+ cell enumeration and detection of fetal-maternal hemorrhage.  This laboratory also manufactures both autologous and allogeneic pancreatic islet cells for transplantation.  You will observe these processes.  Finally, this laboratory also participates in clinical research in regenerative medicine and autologous dendritic cell vaccines.

Donor Services
Donor Services is responsible for the collection of whole blood and apheresis products for transfusion at the Mayo Clinic.  Blood is collected at three fixed sites as well as mobile blood drives.  During this rotation, you will learn how donors are screened to determine donor eligibility, how blood is collected by both manual and automated methods, and how problems in donor eligibility are resolved.  The unique challenges of collecting blood at fixed sites and mobile blood drives will be discussed as will donor recruitment and donor pool management.

Minneapolis Memorial Blood Center
You will spend one day at this nationally known facility. Training at the Memorial Blood Bank will provide you with training in nucleic acid testing for transfusion transmitted diseases.

Coagulation
The Division of Hematology has an active coagulation research program and a Coagulation Clinic. It includes patient contact through the Coagulation Clinic and interaction with hematologist/coagulationist staff members.

Electives
There are five weeks of elective time during the Transfusion Medicine Fellowship. You can use this time to pursue professional activities related to transfusion medicine, gain additional experience in any of the areas in transfusion medicine, or complete a research project.

Didactic Training
During the Introduction rotation, a series of didactic lectures are given by the Transfusion Medicine staff physicians providing the basics of transfusion medicine.You will attend the Leadership and Management course offered by the Department of Laboratory Medicine and Pathology. This unique, interactive seminar series is aimed at developing those critical leadership and management skills that have often been neglected in pathology residency training programs. Invited speakers and in-house experts hold multiple all-day seminars on topics such as "Managing Change, Negotiation and Conflict Management, Principles of Motivation", "Leadership and Management Basics", "Quality School", "Informatics" and "Healthcare finance". The seminar series culminates in "Capstone Seminars" of team projects presented by the participants. You will also attend the Division of Transfusion Medicine Quality School. This week long interactive course for all Division employees provides basic training in Good Manufacturing Practices and Quality System Essentials, the foundations of blood banking. There is also a weekly education conference in Transfusion Medicine and periodically you will be expected to present material at this conference.

Research Training
The wealth of material at Mayo Clinic offers limitless opportunities for research projects. We also collaborate with large, active clinical groups in the various transplant programs. Core science laboratories are located in the same building as the pathology division, providing access to techniques such as microdissection, fluorescence in-situ hybridization and flow cytometry.

Within the Division of Transfusion Medicine, opportunities for research are present in many areas. Numerous active research projects are ongoing in the Tissue Typing Laboratory, Human Cellular Therapy Laboratory and Therapeutic Apheresis Unit.

Additional Training
With approval of the Transfusion Medicine medical director, you can add an additional year of training to your fellowship. This year may be spent in areas related to transfusion medicine, in additional experience within transfusion medicine, or in the development and completion of a research project.

Educational and Training Responsibilities
The Division of Transfusion Medicine is committed to the education and training of its entire staff and all trainees. During the fellowship, you will be given the opportunity to assist in the training of pathology residents and deliver formal lectures to co-workers, allied health professionals and students rotating through Transfusion Medicine.