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Curriculum

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

  • Blood donor recruitment
  • Blood donation and collection
  • Blood component processing, storage, testing and administration
  • Therapeutic and donor apheresis
  • Intraoperative cell salvage and acute normovolemic hemodilution
  • Histocompatibility testing
  • Human cellular therapies, including hematopoietic stem cell processing, dendritic cell vaccine manufacture, regenerative medicine, and pancreatic islet cell preparation
  • Basic and advanced immunohematological procedures
  • Laboratory administration and management
  • Medical decision-making in the context of patient care and clinical consultation

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.

Typical Rotation Schedule Length
Introduction/Core Training 4 weeks
Immunohematologic Reference Laboratory 2 weeks
Transfusion Laboratory 1 week
Therapeutic Apheresis Treatment Unit 4 weeks
Tissue Typing 4 weeks
Sickle Cell Disease Support
(University of Texas Southwestern)
2 weeks
Desk Coverage and Call 6 to 8 weeks
Component Laboratory 3 weeks
Product Testing Laboratory 1.5 days
Autotransfusion 1 week
Transfusion and IV Service
(Inpatient and Outpatient)
1 day
Quality Assurance/ Quality Control and Management 1 week
Human Cellular Therapy Laboratory 2.5 weeks
Donor Services 1 week
Transfusion Transmitted Disease Testing
(Minneapolis Memorial Blood Center)
1 day
Coagulation Laboratory 2 weeks
Electives 5 weeks

Rotation Descriptions

Introduction/Core Training

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. In addition, didactic lectures are provided covering all of the basic aspects of Blood Banking and Transfusion medicine. These lectures are provided by the physician staff of the Division of Transfusion Medicine.

Transfusion and Immunohematologic 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 teaching/patient care conference.

Therapeutic Apheresis Treatment 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 collect granulocytes and hematopoietic stem cells.

You will receive training in rational approaches to therapeutic plasma exchange, thrombocytapheresis, red cell exchange, leukocytapheresis, photopheresis, LDL apheresis, and peripheral blood stem cell collection. Unit activities are reviewed at a daily teaching/patient care conference.

Tissue Typing Laboratory

High resolution HLA typing is performed using molecular techniques. HLA antibody detection and identification is performed using luminex and flow cytometric methods.

Additional testing performed in this laboratory includes granulocyte and platelet antibody testing, flow cytometric crossmatching for organ transplantation, HLA disease association testing, and platelet crossmatching.

Desk Coverage and Call

While on desk coverage and night call, you will provide consultation and guidance 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 treatment and workup, emergency blood transfusion situations, evaluation of therapeutic apheresis procedures, and requests for assistance in determining appropriate transfusion medicine laboratory testing.

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 and component modification.

Product Testing Laboratory

This rotation exposes you to the basic 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 8,000 units annually. You will learn about perioperative blood salvage, acute normovolemic hemodilution techniques, intraoperative component preparation and Mayo's comprehensive quality assurance program.

Transfusion and IV Service (Inpatient and Outpatient)

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 perform audits and quality improvement projects 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 CD34+ cell enumeration and detection of fetal-maternal hemorrhage by flow cytometry.This laboratory also manufactures autologous pancreatic islet cells for transplantation.You will observe this process.

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.

Transfusion Transmitted Disease Testing (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 testing for transfusion transmitted diseases and 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.

Sickle Cell Disease Support (University of Texas Southwestern Medical Center, Dallas Texas)

You will spend two weeks at UT Southwestern Medical Center for training in the apheresis and transfusion management of sickle cell anemia. UT performs, on average, three to four red cell exchanges per week for sickle cell anemia, including exchanges for stroke prophylaxis.

The medical director of the therapeutic apheresis unit at UT Southwestern is a recognized expert in the treatment of sickle cell anemia; and has published extensively on the use of red blood cell exchange in this disorder.

Coagulation Laboratory

The Division of Hematology has an active coagulation research program and a Coagulation Clinic. It includes patient contact and interaction with hematologist/coagulationist staff members. You will be exposed to basic and advanced coagulation testing, test result interpretation, and patient consultation.

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/Core Training, 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 develops 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. 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 Treatment Unit. It is expected that the trainee will have at least one peer-reviewed publication and one national presentation resulting from work done during their fellowship.

Additional Training

With approval of the Transfusion Medicine physician staff, the opportunity exists for an additional year of training. 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 assist in the training of pathology residents and deliver formal lectures to co-workers, allied health professionals and students rotating through Transfusion Medicine.

Evaluation

Fellows are provided with formal, written evaluations at the end of their Core month, and at the end of each quarter (September, December, March, and June) for all rotations completed within the quarter. Evaluations assess fellow competence in patient care, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement; and interpersonal and communication skills.

At least four times per year the program director meets with each fellow to review their evaluations and discuss professional growth. In addition, allied health staff and residents are asked to evaluate the fellow's performance periodically.

Fellows are able to view their evaluations electronically. Final written, summative evaluations are completed for each fellow upon completion of the program.

In addition, the fellows meet with the program director and Division chair monthly for informal feedback and discussion. Finally, all faculty are expected to provide verbal feedback on performance to fellows on a daily basis.

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