Transfusion Medicine Pathology Fellowship

Overview

The mission of our ACGME-accredited training program is to prepare physicians for the specialized practice of transfusion medicine.

Upon completion of our program, trainees 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:

  1. Understanding the donor selection and phlebotomy process
  2. Knowledge of specific tests performed on donated blood
  3. General knowledge regarding component preparation, manipulation, and storage insuring compliance with regulatory requirements; overview of inventory management
  4. Knowledge of the HLA system
  5. 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.

The Transfusion Service provides teaching for pathology residents, adult and pediatric Hematology/Oncology fellows, Anesthesiology residents, 3rd and 4th year medical students, and Transfusion Medicine fellows

The trainees, residents and fellows rotating on the Service will be an integral part of the Transfusion Service/Blood Center operations.

They will have substantial responsibilities for patient care and usually serve as the primary link between the clinical services and the Transfusion Service/Blood Center.

Training Objectives

During the year long rotation, the resident/fellow will:

  1. Learn the basic immunologic and genetic principles of transfusion medicine and will have hands-on experience with the bench work
  2. Work on transfusion reactions under the close supervision of the service director, including chart review and patient examination as necessary
  3. Become familiar with blood donor questionnaire, donor deferral, and blood collection, preparation, storage and shipment
  4. Become familiar with typical consultative questions from clinical staff, including special needs, blood inventory management, massive transfusion guidelines and other matters
  5. During the return rotations, the resident/fellow will function with increasing independence in the evaluation of transfusion reactions and in consultative responsibilities with clinical staff, as deemed appropriate by the service director

The Transfusion Medicine Fellowship accepts applicants from qualified candidates.

To be eligible you must be board certified or eligible in a primary specialty (Clinical Pathology, Hematology, Internal Medicine, Pediatrics, Surgery, or Anesthesiology) for certification by the American Boards of Pathology.

Deadlines

We accept applications for the Fellowship in the fall, approximately 18 months preceding the start of the fellowship.

 

To apply, contact:

Lawrence T. Goodnough, MD
Transfusion Medicine Fellowship Program Director
300 Pasteur Drive, Room H1402
Stanford CA 94305

Tel: (650) 723-6037
Email: ltgoodno@stanford.edu

Applications will consist of your current CV, a one-page cover letter, three letters of recommendation, and a completed CAP application, which you can be downloaded via the "Download Applicattion" button.

 

 

Fellowship Program Coordinator

Gabby Barela
300 Pasteur Dr., R204
Stanford, CA 94305
Email: gbarela@stanford.edu
Phone: (650) 721-5755

CURRENT FELLOWS

Mrigender Virk, MD
Georgetown University

 

Yazan Migdady, MD, MSc
MHRI/Alpert Medical School of Brown University