Graduate Medical Education (GME): Transfusion Medicine/Blood Banking
National Institutes of Health - Bethesda, MD

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Transfusion Medicine/Blood Banking

Graduate Medical Education (GME): Transfusion Medicine/Blood Banking

Cathy Conry-Cantilena, MD
Entry Id: TP-78

Eligibility Criteria
Qualified candidates must have board certification or eligibility in internal medicine (hematology) or clinical pathology.

Overview
The Department of Transfusion Medicine of the Clinical Center offers a comprehensive two-year fellowship program in blood banking and immunohematology. This patient-oriented transfusion program provides specialized training for the hematologist and clinical pathologist. In the first year the fellow is trained in clinical and laboratory immunohematology, apheresis techniques, tissue typing, donor recruitment, blood component preparation and therapy, and bone marrow processing. Involvement in a clinical or basic research project is the essence of the second year of this program. As a focal point for the provision of blood components and specialized patient care procedures, the Department of Transfusion Medicine provides a unique opportunity for collaborative research with the various institutes at the NIH.

Structure of the Clinical Training Program
The first year of this program prepares the fellow in every aspect of transfusion medicine. The year begins with a two-month formal rotation through the major functional areas of the department, where the trainee is exposed to the primary components of transfusion medicine and immunohematology. Actual "hands-on" laboratory experience is supplemented with a series of lectures by the senior staff.

At the conclusion of this two-month introduction, the senior staff has gained an appreciation of the strengths of the first-year trainee, and has identified areas where further training is necessary. The first- year fellow assumes increasing responsibility for the management of the clinical service of the department. This requires daily patient care rounds with senior staff, and consultation as necessary. The fellow becomes the primary intermediary between the clinical care physicians and the Department of Transfusion Medicine staff, and participates fully in the variety of training experiences described below.

Bench Technical Procedures
The fellow performs or observes the indicated procedures in each of the laboratories listed:

Main Laboratory. All primary blood banking serological procedures, including group and type, antibody screen and antibody identification, direct antiglobulin test, and compatibility testing.

Reference Laboratory. Advanced serological procedures such as adsorptions and elutions, phenotyping, and difficult antibody identifications.

HLA Laboratory. HLA ABC, and DR typings, HLA antibody screens, cell freezing, and molecular (DNA) typing techniques.

Component Preparation Area. Preparation of platelets, plasma, cryoprecipitate, granulocytes, lymphocytes, and frozen deglycerolyzed red cells.

Transfusion Transmitted Virus Laboratory. HBsAg, anti-HBs, ALT, anti- HBc, anti-HIV, anti-HTLV I, anti-HCV, NAT for HIV, HCV, and WNV.

Radiolabeling Laboratory. Radionuclide labeling and infusion of cell elements labeled with chromium-51 and indium-111.

Cell Processing Laboratory. Processing and storage of bone marrow and peripheral blood stem cells. Support of gene therapy protocols.

Donor Collection
This aspect of the fellow's training includes recruiting donors, taking their medical histories, participating in standard donor phlebotomy, and recognizing and treating donor reactions. Familiarity with the AABB Standards and Technical Manual is acquired. The fellow also supervises automated apheresis procedures for the procurement of platelets, lymphocytes, and granulocytes, and gains an intimate working knowledge of the different apheresis instruments.

Therapeutic Phlebotomy
There are numerous protocols in which patients undergo therapeutic apheresis procedures. The fellow evaluates these patients under the supervision of the senior staff, writes appropriate notes in the patient's chart, and supervises the therapeutic procedure.

Transfusion Reactions
In the event of a transfusion reaction, the fellow evaluates the patient, supervises the laboratory and clinical management of the patient, and writes consultation notes in the chart.

Emergencies
Department of Transfusion Medicine technologists and nurses call the fellow when emergencies arise. The fellow decides on the appropriate course of action and consults with a member of the senior staff if necessary. Often the fellow will be present in the operating room to assist the surgeon and anesthesiologist in the management of difficult or crisis situations.

Utilization of Blood Components
The fellow is in charge of blood bank inventory, and works with the laboratory technical supervisor and the supervisor of the component issue area in the management of the blood resource. The fellow attends meetings of the Transfusion Committee and presents summary data on blood utilization.

Conferences and Education
The fellow organizes the Department of Transfusion Medicine Friday conference, presents clinical case studies at the laboratory review rounds, and lectures at the nursing orientation course in transfusion medicine. Presentation of scientific data at regional and national meetings is encouraged and supported.

Teaching
The fellow has formal teaching responsibilities for the Department of Transfusion Medicine Specialist in Blood Banking students, visiting physicians and scientists, and the Department of Transfusion Medicine nurses and technologists.

After Hours Coverage
The fellows rotate after-hours and weekend coverage, with senior staff support, and are the first called when physician consultation is required.

Patient Consultation
Consultation is often requested for management of difficult coagulation problems and for therapeutic apheresis, and is automatic if certain transfusion guidelines are not met. The fellow sees and examines the patient, consults with the appropriate clinical staff, writes consultation and progress notes in the chart, and reports on clinical cases to the Department of Transfusion Medicine senior staff at patient care rounds.

Administrative
The fellow participates in weekly departmental administrative meetings at which budgetary and staffing issues are discussed.
Structure of the Research Training Program

In the latter half of the first year of training, the fellow identifies an area of research interest. It is one of the distinct advantages of the NIH that a variety of research opportunities are available. During the second year the fellow is able to concentrate on the research project under the supervision of a member of the senior staff. The fellow has access to a state-of-the-art facility with ample laboratory space and equipment.

Current research programs include investigations in:
Transfusion-transmitted viral disease

Development and evaluation of innovative techniques for blood cell and bone marrow collection and separation

Applications of cellular radiolabeling techniques to studies of platelet preservation and kinetics, red cell compatibility, and leukocyte kinetics

Molecular (DNA) tissue typing

Blood component preservation and storage

Therapeutic apheresis.
Program Faculty and Research Interests

David Stroncek, MD. Granulocytes and red blood cell serology, TRALI, Peripheral blood stem cell mobilization, molecular methods in HLA, and red cell phenotyping

Harvey G. Klein, MD. Clinical applications of blood product apheresis; gene therapy; bone marrow processing

Harvey J. Alter, MD. Transfusion-transmitted viruses, hepatitis C and HIV

Susan F. Leitman, MD. Radiation of blood products; adoptive immunotherapy; therapeutic apheresis

CD Bolan, MD. Hemochromatosis, Apheresis, NMDP

Cathy Conry-Cantilena, MD. Education, Apheresis, Hepatitis C Virus

Francesco Marincola, MD. Immunogenetics

Examples of Papers Authored by Program Faculty

Davey RJ, McCoy NC, Yu M, Sullivan JA, Spiegel DM, Leitman SF. The effect of prestorage irradiation on posttransfusion red cell survival. Transfusion 1992;32:525-528.

Cottler-Fox MF, Spitzer T. Immunoglobulin preparations, acute graft- versus-host disease, and infection after marrow transplant. Lancet 1993;341:1592.

Klein HG. Immunohematology and blood transfusion. In: Isselbacher KJ et al., eds. Harrison's principles of transfusion medicine. New York: McGraw-Hill, 1993;2337.

Leitman SF, Klein HG, Melpolder JJ, Read EJ, Esteban JI, Leonard EM, Harvath L, Shih JW, Nealon R, Foy J et al. Clinical implications of positive tests for antibodies to HIV-1 in asymptomatic blood donors. N Eng J Med 1989;321:917-924.

Alter HJ. The hepatitis C virus and its relationship to the clinical spectrum of NANB hepatitis. J Gastroenteroland Hepatol1990;1:78-90.

Program Graduates
The senior staff assists the fellow in securing appropriate employment at the end of the second year. Graduates of the Transfusion Medicine Program have moved into positions of leadership across the country; the most recent are listed below:

Completed Program 2002

Victoria Moncada, MD. Center for Drug Evaluation and Research, Food and Drug Administration, Bethesda, MD

Completed Program 2003

Hanh Ma Khuu, MD. Cell Processing Section, Dept. of Transfusion Medicine, Warren G. Magnuson Clinical Center, NIH, Bethesda, MD

Salim Haddad, MD. Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD

Firoozeh Alvandi, MD. Assistant Director, Blood Bank, Temple University, Philadelphia, PA

Completed Program 2004

Ashok Nambiar, MD. Assistant Director, Blood Bank, UCSF, San Francisco, CA

Completed Program 2005

W. Tait Stevens, MD. Associate Director, Blood Bank, Loma Linda University Medical Center, CA

Completed Program 2006

Minh Ha Tran, DO. Assistant Director, Institute of Transfusion Medicine, Pittsburgh, PA
Application Information

The Transfusion Medicine Fellowship Program is accredited by the Residency Review Committee for Pathology of the Accreditation Council for Graduate Medical Education. The first year of training prepares the fellow for the examination in blood banking offered by the American Board of Pathology.

Qualified candidates must have board certification or eligibility in internal medicine (hematology) or clinical pathology. There are 2 positions available per year, and candidates should apply nine to twelve months in advance. The fellowship assignment is for two years.

Electronic Application
The quickest and easiest way to find out more about this training program or to apply for consideration is to do it electronically.

The NIH is dedicated to building a diverse community in its training and employment programs.

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