Transfusion Medicine In The Department of Pathology

Transfusion Medicine Fellowship

The mission of our ACGME-accredited training program is to prepare physicians for the specialized practice of transfusion medicine.  Upon completion of our program, they will be qualified and ready to take on the responsibilities of Medical Director of a transfusion service, either hospital-based or at a regional blood center.  Transfusion medicine has evolved into the clinical practice of a multi-dimensional field that incorporates elements of blood banking, immunohematology, coagulation, and hematology. 

Two hospital-based transfusion services provide a full exposure to adult, pediatric, and neonatal patients.  Thus, practical experience is gained through daily exposure to red cell type and screen procedures, antibody identification and complex serologic evaluations; transfusion reaction reports; daily blood component inventory analysis; special needs consultations (CMV specific, leukoreduced, irradiated, washed, fresh, HLA-matched platelets, etc.); massive transfusion protocol support; outpatient services such as antenatal screens; and reference lab cases.  The core of the learning comes from serving as part of our transfusion medicine consultation team, with trainees serving as first call for all problems.  The physician calls are initiated either from requesting clinicians or from our own technical staff, as determined directly from our own laboratory policies.  The team also consists of residents in clinical pathology, residents in anatomic/clinical pathology, adult hematology fellows, and pediatric hematology fellows.

The clinical caseload reflects the patient mix at both the Stanford Hospital and Clinics for adult patients and the Lucile Packard Children’s Hospital for pediatric patients, which comprise approximately 50% respectively, of the time-related workload.  Each are level I – designated trauma centers with tertiary level care including complex cardiovascular caseloads and transplantation programs.  The supervision of the transfusion medicine team is under the direction of an attending faculty member, who serves to carry on a continuing case-oriented learning process throughout the year.  The trainees also interact in a more limited fashion with the other residents and fellows in our Pathology Department via joint conferences and interactions in the area of hematopathology.  Additional interactions occur through consultations with other services including hematology, oncology, anesthesiology, surgery and maternal-fetal medicine.
    
The second entity to incorporate instruction and training into our transfusion medicine program is the Stanford Blood Center, which is a regional blood center uniquely situated within our Department of Pathology.  This arrangement allows a truly integrated structure in which our transfusion medicine faculty are not only colleagues, but several have dual administrative appointments at both the regional blood center and the hospital transfusion service.  All medical faculty participate regularly in management, teaching and clinical conference, as well as share service call for both the blood center and the transfusion service.  The two entities also have administrative links:  The transfusion service reference laboratory serves as the Stanford Blood Center’s regional reference laboratory, and medical faculty participate in weekly administrative conferences at each entity.

An important component of the transfusion medicine-training program, both in practical experience and in core curriculum, occurs at the Stanford Blood Center and through its medical and technical staff.  During their Transfusion Service rotations, trainees also take first call for issues relevant to donor screening and testing.  Relevant cases of the week are discussed at our combined blood center/transfusion service conference for beeper report.  Attending physicians on-call include both the blood center and transfusion service-based faculty.

The core curriculum reflects the objectives of the training program at the blood center:  understanding the donor selection and phlebotomy process; knowledge of specific tests performed on donated blood; general knowledge regarding component preparation, manipulation, and storage insuring compliance with regulatory requirements; overview of inventory management; knowledge of the HLA system; and management of transfusion medicine consultations, in complex situations such as autoimmune hemolytic anemias, hemolytic disease of the newborn, platelet refractoriness, complex serologies, massive transfusions, etc.  These goals are accomplished through didactic sessions by medical and technical staff, laboratory or section rotations, and case based instruction during clinical service rotations.  Time blocks for instruction at the Stanford Blood Center are organized during the rotation through our transfusion medicine service.  Additional rotations through the Stanford Blood Center to concentrate on special areas are made available to all trainees.

Current Fellow
Samantha Gomez, MD, University of Texas San Antonio


Tho Pham, MD, Univ. of CA, San Diego

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