Training & Curriculum
This one-year program provides comprehensive training in all facets of transfusion medicine, including the technical, administrative and clinical aspects of blood donor collection, immunohematology, transfusion practices, therapeutic apheresis, tissue banking and stem cell processing. On-site and mobile blood collection provides fellows with invaluable experience in donor center operations. A state-of-the-art immunohematology laboratory, including molecular typing to determine extended red cell phenotype and identify variant red cell alleles, provides the fellow with numerous research opportunities and experience with leading-edge laboratory testing methods. The transfusion service supports numerous clinical services such as comprehensive cancer care, multi-organ transplantation and blood and marrow transplantation, as well as trauma, neonatal and cardiac surgical services, allowing the fellow an opportunity to manage complex clinical cases. The fellow also gains experience with inpatient and outpatient standard apheresis therapies, as well as low-density lipoprotein apheresis, photopheresis, and peripheral blood progenitor cell collection and processing. Supplemental rotations with the Pathology and Laboratory Medicine Department’s Coagulation and HLA/Immunogenetics Laboratories, as well as outside rotations at Children's Hospital Los Angeles and the American Red Cross reference laboratory can be arranged.
Training
Cedars-Sinai is home to a blood donation facility that has 13 donor chairs, as well as 3 mobile units, used to collect approximately 25,000 blood components annually, including autologous and directed donations. The transfusion service is composed of a state-of-the-art compatibility and immunohematology testing laboratory, including molecular typing to increase red blood cell matching capabilities. Approximately 55,000 units of blood and blood components are required each year for patient treatment and care at Cedars-Sinai, including CS Cancer, Smidt Heart Institute, Ruth and Harry Roman Emergency Department, transplant services and related facilities. The coagulation service helps to guide appropriate use of blood components. The Therapeutic Apheresis Unit consists of 6 beds and provides a variety of procedures, including plasma exchange, red blood cell exchange, low-density lipoprotein apheresis, stem cell collection, photopheresis and platelet/white blood cell depletion to both inpatients and outpatients. Approximately 2,300 therapeutic apheresis procedures are performed annually.
Curriculum
The Transfusion Medicine Fellowship teaching service includes direct patient and medical staff interaction via daily patient rounds and clinical consultation for all matters related to transfusion support of the complex medical and surgical patients in our tertiary care center. The fellow has graduated responsibility for performing apheresis consults, managing donor and patient care issues, and consulting with clinicians regarding appropriate blood component utilization.
Transfusion Medicine Fellow Responsibilities
- Review donor notification letters.
- Review daily blood utilization report.
- Complete immunohematology workups and consultative reports.
- Complete transfusion reaction workups and consultative reports.
- Write orders, consultations and progress notes for therapeutic apheresis patients.
- Advise the donor facility regarding donor suitability and deferral.
- Advise the transfusion service regarding component utilization.
- Perform monthly blood administration audits.
- Coordinate rotating resident activities, including bench rotations.
- Participate in one week of Blood Bank call per month.
- Presentation and/or participate at conferences (see Conferences section below).
- Assist with education of pathology residents (see Teaching Responsibilities section below).
- Execute administrative functions (see Administrative Responsibilities section below).
Daily Schedule
- 8-10 a.m. — Attend to urgent patient care issues and prepare therapeutic apheresis orders
- 10 a.m.-12 p.m. — Round with attending
- 12-1 p.m. — Lunch or Noon Conference
- 1-5 p.m. — Cover transfusion service, donor room and therapeutic apheresis
Conferences
Mandatory Transfusion Medicine Conferences
The fellow is expected to attend and/or present at the below conferences.
- Transfusion Medicine Journal Club, quarterly
- Resident clinical pathology (CP) didactic, at least 1/year
- Resident CP Case Presentation, monthly
- Resident CP Call Review, monthly
- Transfusion Medicine Quality Assurance (QA)/Management meeting, monthly
- Hematopoietic Progenitor Cell Transplant (HPCT)/Transfusion Medicine QA meeting, quarterly
- Transfusion Committee, quarterly
Optional Conferences/Activities
The below conferences and educational endeavors are optional, but the fellow may want to participate to maintain competence in all aspects of transfusion medicine.
- HPCT Patient Management meeting, weekly
- HPCT QA meeting, monthly
- CP Performance Improvement Committee meeting, quarterly
Administrative Responsibilities
The transfusion medicine fellow has administrative responsibilities as part of the program structure, affording an opportunity to learn skills required for academic and private practice.
Administrative quality assurance activities in which the fellow participates include:
- Blood administration audits
- New method assessment and validation
- College of American Pathologists checklist assessment
- Foundation for the Accreditation of Cellular Therapy checklist assessment
- At least one quality improvement project
- Review of proficiency testing results
- Transfusion Medicine and HPCT QA meetings attendance
Teaching Responsibilities
Cedars-Sinai has an Anatomic and Clinical Pathology Residency with 20 residents. The fellow is expected to take an active role in resident education, honing teaching skills during the year. The fellow teaching activities include:
- Overseeing resident therapeutic apheresis orders and notes
- Reviewing resident transfusion reaction and immunohematology consultative reports
- Advising the residents regarding donor suitability and blood component utilization
- Coordinating rotating resident activities, including bench rotations
- Organizing quarterly Transfusion Medicine Journal Club
- Preparing and presenting at least one resident CP didactic
Research Responsibilities
Research is considered an important aspect of education and has strong departmental and institutional support. State-of-the-art research techniques are available.
- At least one clinical or translational research project is expected, typically resulting in an abstract and publication.
- Research must be in the Division of Transfusion Medicine.
The department provides funds for the purchase of books and/or attendance at national meetings. If an abstract is presented at a meeting, additional funds and time off are provided.
Additionally, Cedars-Sinai fosters and trains fellows, residents and junior faculty who wish to conduct clinical and translational research upon graduating from the program. The Clinical Scholars Program provides funding, career guidance, education and skill acquisition for aspiring clinical scientists.
Evaluations and Mentorship
The program director meets with the fellow at the beginning of the academic year to identify the fellow’s goals and career aspirations, create an individualized development and learning plan, and tailor training as needed. The program director also meets with the fellow at least biannually to review the fellow’s evaluations, ensuring that the fellow is on track to meet all appropriate milestones, make considered career choices and engage with local and national pathology organizations. In addition, the fellow has open access to the program director to discuss any issues that may arise throughout training.
Evaluations are based on Accreditation Council for Graduate Medical Education Milestones, incorporating the six competencies into the curriculum (medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice). Assessment tools include direct observation, faculty evaluations, 360 evaluations, fellow in-service examinations, educational and research activities, quality assurance and patient-safety activities, and conference presentations. The fellow will also become a member of the fellowship Program Evaluation Committee, reviewing the fellowship program and offering insight regarding areas in need of improvement.
Have Questions or Need Help?
If you have questions or would like to learn more about the Blood Banking/Transfusion Medicine Fellowship Program at Cedars-Sinai, please call or send a message to Senior Academic Program Coordinator, Carrie Domagas.
Blood Banking/Transfusion Medicine Fellowship
Pacific Theater Building, 5th Floor
116 N. Robertson Blvd.
Los Angeles, CA 90069