Coagulation Rotation

The one-month coagulation rotation allows the resident to:

• Develop competency in evaluating patients with congenital and acquired bleeding and thrombotic disorders at the general pathologist level
• Gain experience in interpreting laboratory tests
• Integrate the test results with clinical findings into the coagulation consult report

The one-month service is very active for the resident, with the volume of testing including 300 coagulation consults, 200 thromboelastograms (TEGs), and 100 hemoglobin evaluations by high performance liquid chromatography (HPLC).

During the first week of the rotation the resident will be given a pre-test to help the rotation director evaluate the resident's preliminary knowledge of coagulation. The major method of instruction is by one-on-one didactics and test-result interpretation. At the beginning of the rotation, the resident will work closely with the attending to interpret the coagulation tests. Within a week, the resident begins to interpret and write up cases independently, with graduated responsibility as the rotation progresses. The resident is expected to review all interpretive tests done in the laboratory, prepare the initial interpretative report within one day, present the findings to the attending and be prepared for additional discussion of case interpretation.

Specifically, the resident is responsible for:

• Reviewing assigned coagulation cases before rounds, obtaining clinical data, and providing preliminary interpretation
• Handling questions from clinical laboratory scientists regarding cases
• Calling positive results to the attention of clinicians, and explaining HIT diagnosis and management
• Ordering as necessary any additional reflexive testing for consult panels
• Discussing reading assignment topics
• Writing brief updates on coagulation topics

Residents carry out a mock inspection using the College of American Pathologists’ laboratory checklists, which are extremely valuable for learning Clinical Laboratory Improvement Amendments (CLIA) and other regulatory requirements relative to coagulation. At the end of the rotation, the resident is expected to successfully complete the post-test, indicating a thorough understanding of coagulation.

• 8 a.m. to 10 a.m.
  • Write up preliminary interpretations of coagulation consults
• 10 a.m. to noon
  • Reading assignment discussion
  • Patient rounds, if necessary
• Noon to 1 p.m.
  • Lunch and conference
• 1 p.m. to 4 p.m.
  • Read scheduled topic assignments
  • Write up coagulation cases
  • Coagulation bench activities
• 4 p.m. to 6 p.m.
  • Coagulation cases sign-out

Coagulation quality assurance and laboratory management meeting.

The director of coagulation is actively engaged in many collaborative research projects with the pharmacy, transfusion medicine, cardiothoracic surgery and trauma surgery programs.