|Laboratory tests can be used for multiple clinical purposes: screening, risk assessment, establishment of a diagnosis, support of a diagnosis, exclusion of a diagnosis, prognosis, determination of individualized therapy, and assessment of disease progression or response to therapy.
The primary objective of the transfusion medicine (TM) elective is to teach the future clinician the optimal way of using the transfusion service, including related laboratory testing, in patient management. The general learning objectives will apply regardless of training location; site-specific learning objectives will apply when the student is scheduled to rotate through the various training sites—Ben Taub Hospital, Baylor St. Luke’s Medical Center, and Texas Children’s Hospital.|
|General Learning Objectives:
1. Manage patients:
(a) with massive bleeding and active bleeding.
(b) on ECMO – optimal anticoagulation and hemostasis
(c) with severe liver failure and coagulopathy
(d) with abnormal coagulation test results pre-surgery
(e) for granulocyte transfusion
(f) with transfusion reaction
2. Explain the following:
(a) the blood components available for clinical use
(b) the recommended and evidence-based thresholds and indications for transfusion of the various blood components
(c) the appropriate evidence-based dosing of blood components
(d) the types of recombinant and other “blood component substitutes” available
(e) the alternatives to allogeneic blood product infusion (eg, hematopoietic cytokines, autologous donations, and intraoperative blood salvage).
3. Define the lifespan of transfused platelets, red blood cells, and the coagulation factors present in plasma and how the efficacy of transfusion is monitored by laboratory testing (eg, expected hemoglobin and platelet count increments).
4. Compare and contrast the pathophysiology, presentations, and acute management (and prophylaxis) of the different types of transfusion reactions.
5. Define common infectious disease risks of blood products that remain despite donor screening and blood product testing, including current data on transfusion-transmitted disease incidence and prevalence.
6. Explain the importance of blood specimen labeling, with an emphasis on the impact transfusion errors have on patient morbidity and mortality; and the process of issuing and administering blood products, including required patient safety checks, required infusion times, and appropriate blood product storage limitations once products are issued from the blood bank.
7. Define the meaning of and rationale for type and screen (type and crossmatch) for blood products and the time limits of such testing; explain the appropriate settings and processes for emergency release of blood and the use of “universal donor” blood.
8. Define “massive transfusion,” and describe the special needs of the patients in terms of metabolic derangements and the administration of blood products.
9. Explain the pathophysiology of hemolytic disease of the newborn and the role of prenatal compatibility testing; explain the role of Rh immune globulin prophylaxis in preventing hemolytic disease of the newborn.
10. Compare and contrast the types of blood product modification (eg, leukoreduction, irradiation, etc.) and the rationale and clinical use for each.
11. Define the various kinds of blood donors (eg, autologous, directed, altruistic) and the important elements of screening predonation.
12. Explain the clinical use of therapeutic phlebotomy; list the various types of apheresis procedures, and give examples of how each is used.
13. Explain the HLA system’s role in transfusion and transplantation.
14. Discuss the physiology of coagulation, including the mechanisms of action of naturally occurring and therapeutic anticoagulants; list the laboratory tests used to diagnose common bleeding and thrombotic disorders, including the hemophilias, platelet disorders, von Willebrand disease, and acquired bleeding diatheses; describe appropriate testing strategies for monitoring hemostatic and anticoagulant therapies
15. Describe the various clinical situations that may require therapeutic apheresis.
16. Explain the process of evaluating and preparing patients for therapeutic apheresis, including elements of informed consent for the procedure and for transfusion of blood products during the procedure.
Texas Children’s Hospital Learning Objectives:
1. Describe the role of the clinical pathologist in patient care.
2. Observe procedures and clinical consultations such as therapeutic apheresis, intrauterine transfusions, intraoperative/bedside coagulopathy/bleeding management, ECMO management, etc.
3. Interpret several common blood bank and coagulation laboratory tests. Describe a factor for each which may impact laboratory results.|