Daily Duties and Responsibilities
With the faculty member, the resident is the primary contact from 8:00 a.m. to 5:00 p.m. for all clinical transfusion problems and consultations. Typically, the resident will meet with the Transfusion Medicine faculty member and Blood Bank specialist every morning to discuss patients and other issues within the Blood Bank. The resident is then expected to be available to laboratory personnel, either in person or by pager, throughout the working day. Calls are received several times a day from blood bank staff and usually result in the need for the resident to directly contact our clinical colleagues. The resident often interacts by phone and directly on the patient care unit with the clinicians taking care of the patient.
During the rotation, the resident correlates laboratory results with clinical findings to determine whether special components are needed, often on a daily basis. The resident will correlate patient signs and symptoms with laboratory data in evaluating transfusion reactions. In plasma exchange patients, the resident will follow the clinical status daily, correlating with laboratory tests to determine effectiveness of therapy.
Residents have the responsibility, under faculty supervision, of discussing the interpretive consultative reports on BB/TM cases with appropriate members of the clinical/surgical teams. Through their discussions with the clinical team members, the residents have the opportunity to directly impact patient care.
Under faculty supervision, the resident interacts with clinicians, nurses, and technologists to ensure that blood components are used appropriately balancing risk, benefit and availability, evaluates transfusions and transfusion requests that are out of established guidelines, approves initial requests for less commonly used blood components and special blood products (e.g. washed RBCs, coagulation factors, crossmatched platelets, etc.), advises about difficult crossmatches, antibody problems and selection of compatible red cells, approves release of least-incompatible blood when fully compatible blood is not available (after attending approval) and assures that clinician is aware of risk for a risk-benefit analysis. Residents also provide medical direction to ensure an adequate supply of blood components.
Residents are able to explain and perform basic tests, solve antibody problems and correlate laboratory findings with clinical significance such blood grouping (ABO, RH, inheritance, clinical significance of pregnancy or transfusion, and resolution of blood typing problems), pre-transfusion testing (i.e., type and screen, compatibility tests including a complete crossmatch through the antiglobulin phase, IgM and IgG antibodies, mechanisms of immune hemolysis, direct and indirect antiglobulin testing, alloantibody identification using panels), red cell serological studies (autoantibody evaluation, evaluation and treatment of cold and warm, autoimmune hemolytic anemias and drug-related antibodies, purpose methods, and interpretation of elution, complex antibody problems such as multiple, high frequency antigens, selection of appropriate components, prenatal screening and intrapartum monitoring, evaluation of hemolytic diseases of the newborn, fetal maternal hemorrhage, Rh immune globulin dose, exchange transfusion and/or intrauterine transfusion), and platelet/neutrophil serology.
Senior residents (PGY3-4) are given the opportunity to visit a large blood collection/processing facility (ARC Johnstown) to observe blood collection and processing. A basic understanding of blood donation will be learned (including performance of donor interview and physical examination, donor safety issues, recipient safety issues, the phlebotomy process, evaluation and treatment of donor reactions and injuries, autologous donation, and directed donation), blood component preparation and donor testing.
The resident should be able to discuss standard laboratory and clinical practices, investigate problems and questions, and assess transfusion therapy for blood components including guidelines for safe administration of blood and blood products (identification, pooling, transport time, temperature and filtration for red blood cells, platelet concentrates, cyro-poor plasma, cryoprecipitate, etc.), appropriateness of transfusion of blood and blood products (including audit requirements, methods, and committee activities), use of modified components (washed, irradiated, leukocyte-reduced, frozen/thawed deglycerolized red cells, HLA-matched platelets, cross matched platelets) and transfusion support for bone marrow transplant patients.
The resident will be able to identify and discuss pathophysiology, treatment, and prevention of the following: febrile, allergic, acute hemolytic, delayed hemolytic, anaphylactic, septic, transfusion-associated graft-versus-host disease, transfusion-related acute lung injury, and circulatory overload, be able to manage massive transfusion including the appropriate and timely ordering of laboratory tests for monitoring the patient and recognizing the metabolic and hemostatic consequences of massive transfusion, have a working knowledge of the effects of stored blood on recipients, including pediatric patients, infections, and help minimize the risk of transfusion related diseases such HIV, hepatitis B and C, HTLV, CMV, protozoa, and bacterial contaminants.
Opportunities to Function as Consultant to Other Physicians
As stated above, the resident is the primary contact from 8:00 a.m. to 5:00 p.m. for all clinical transfusion problems and consultations. The resident often interacts by phone and directly on the patient care unit with the clinicians taking care of the patient. The resident serves as the interface between the clinical team and the clinical laboratories.
Residents have the responsibility, under faculty supervision, of discussing the interpretive consultative reports on BB/TM cases with appropriate members of the clinical/surgical teams. Through their discussions with the clinical team members, the residents have the opportunity to directly impact patient care. Other departments on the WVUH campus, with ACGME approved post graduate training programs include, but are not limited to the following: Anesthesiology, Internal Medicine, Family Practice, Neurosurgery, Obstetrics & Gynecology, Ophthalmology, Otolaryngology, Orthopedic Surgery, Pediatrics, Radiology, Surgery, and Urology.