Clinical training

Through the Transfusion Medicine Fellowship, you receive comprehensive training in all aspects of transfusion medicine, including:

• Blood donor recruitment
• Blood donation and collection
• Blood component processing, storage, testing and administration
• Therapeutic and donor apheresis
• Intraoperative cell salvage and acute normovolemic hemodilution
• Histocompatibility testing
• Human cellular therapies, including hematopoietic stem cell processing, dendritic cell vaccine manufacture, regenerative medicine and pancreatic islet cell preparation
• Basic and advanced immunohematologic procedures
• Laboratory administration and management
• Medical decision-making in the context of patient care and clinical consultation

Rotation schedule

During the fellowship, you participate in all operations of the Division of Transfusion Medicine. The following is an outline of a typical rotation schedule. It can be tailored slightly to fit specific career interests.

Rotation	Length
Introduction and core training	4 weeks
Immunohematologic reference laboratory	2 weeks
Transfusion Laboratory	1 week
Therapeutic Apheresis Treatment Unit	4 weeks
Tissue Typing Laboratory	4 weeks
Sickle cell disease support (University of Texas Southwestern)	2 weeks
Desk coverage and call	6-8 weeks
Component laboratory	3 weeks
Product testing laboratory	1.5 days
Autotransfusion	1 week
Transfusion and IV service (inpatient and outpatient)	1 day
Quality assurance, quality control and management	1 week
Human Cell Therapy Laboratory	2.5 weeks
Donor services	1 week
Transfusion-transmitted disease testing (Memorial Blood Center)	1 day
Coagulation laboratory	2 weeks
Electives	5 weeks

Rotation descriptions

Introduction and core training

Fellows receive an orientation to the Division of Transfusion Medicine and its activities. Most of this month is spent on an intensive course in basic immunohematology, with extensive bench training provided by a teaching technologist. Fellows learn how to perform and interpret most of the basic, and many of the more sophisticated, techniques used in the red cell transfusion laboratory.

In addition, didactic lectures are provided covering all of the basic aspects of blood banking and transfusion medicine. These lectures are provided by the physician staff of the Division of Transfusion Medicine.

Transfusion and immunohematologic reference laboratory

During this rotation, fellows actively participate in the daily technical work in the transfusion laboratory, which includes clarification of red cell serological problems and evaluation of all adverse transfusion reactions.

You perform the specialized procedures that are conducted in the reference laboratory and diagnose certain patients with transfusion-related problems. All transfusion laboratory activities and all transfusion-related problems are reviewed at a daily teaching and patient care conference.

Therapeutic Apheresis Treatment Unit

While in this unit, fellows are involved in the performance of hemapheresis procedures. These procedures are performed as part of various therapeutic regimens and to collect granulocytes and hematopoietic stem cells.

You receive training in rational approaches to therapeutic plasma exchange, thrombocytapheresis, red cell exchange, leukocytapheresis, photopheresis, LDL apheresis and peripheral blood stem cell collection. Unit activities are reviewed at a daily teaching and patient care conference.

Tissue Typing Laboratory

High-resolution HLA typing is performed using molecular techniques. HLA antibody detection and identification is performed using Luminex and flow cytometric methods. Additional testing performed in this laboratory includes granulocyte and platelet antibody testing, flow cytometric crossmatching for organ transplantation, HLA disease association testing, and platelet crossmatching.

Desk coverage and call

While on desk coverage and night call, fellows provide consultation and guidance for all medical problems that typically present themselves to a transfusion medicine physician. These include:

• Donor eligibility problems
• Component inventory management
• Donor reactions
• Transfusion reaction treatment and workup
• Emergency blood transfusion situations
• Evaluation of therapeutic apheresis procedures
• Requests for assistance in determining appropriate transfusion medicine laboratory testing

This rotation covers the full range of transfusion medicine clinical experience and is one of the fellowship's greatest strengths.

Component laboratory

On this rotation, fellows participate in laboratory activities and become familiar with the technical and administrative aspects of blood component preparation and component modification.

Product testing laboratory

This rotation exposes you to the basic testing and quality control testing performed on blood products. This includes residual leukocyte counts, platelet product bacterial detection, and automated ABO and Rh testing.

Autotransfusion

This rotation gives you the opportunity to become familiar with one of the largest perioperative blood management programs in the United States, transfusing approximately 8,000 units annually. Fellows learn about perioperative blood salvage, acute normovolemic hemodilution techniques, intraoperative component preparation and Mayo's comprehensive quality assurance program.

Transfusion and IV service (inpatient and outpatient)

Fellows observe the proper methods of transfusion therapy and spend time at both campuses of Mayo Clinic Hospital — Rochester. You have direct patient contact while administering blood and blood components, and conducting clinical investigations of suspected adverse transfusion reactions.

Quality assurance, quality control and management

Fellows spend time with the medical director and the administrative coordinator of transfusion medicine. You gain valuable insights into many of the administrative tasks that confront a transfusion medicine physician.

Fellows also spend extensive one-on-one time with quality assurance technologists to become familiar with Mayo's quality assurance and quality control procedures. You also perform audits and quality improvement projects in the Division of Transfusion Medicine.

Human Cell Therapy Laboratory

This rotation gives you the opportunity to observe the processing of autologous and allogeneic hematopoietic stem cell products for transplantation, including peripheral blood derived stem cells and bone marrow. Processing performed includes red cell reduction, cell selection and cryopreservation.

Fellows also participate in the thawing and infusion of products. You are exposed to CD34+ cell enumeration and detection of fetal-maternal hemorrhage by flow cytometry. Fellows observe the process of manufacturing autologous pancreatic islet cells for transplantation. Finally, this laboratory participates in clinical research in regenerative medicine and autologous dendritic cell vaccines.

Donor services

Donor services is responsible for the collection of whole blood and apheresis products for transfusion at Mayo Clinic. During this rotation, fellows learn how donors are screened to determine donor eligibility, how blood is collected by both manual and automated methods, and how problems in donor eligibility are resolved.

The unique challenges of collecting blood at fixed sites and mobile blood drives are discussed as well as donor recruitment and donor pool management.

Transfusion-transmitted disease testing (Memorial Blood Center)

Fellows spend one day training at the nationally known Memorial Blood Center testing for transfusion-transmitted diseases and participating in the activities of a large, comprehensive, transfusion-transmitted virus testing laboratory.

You gain valuable experience in the practical management of patient-related problems, including "look-back" and post-transfusion disease detection.

Sickle cell disease support (University of Texas Southwestern)

Fellows spend two weeks at the University of Texas (UT) Southwestern Medical Center in Dallas, Texas, for training in the apheresis and transfusion management of sickle cell anemia. UT performs, on average, three to four red cell exchanges a week for sickle cell anemia, including exchanges for stroke prophylaxis.

The medical director of the therapeutic apheresis unit at UT Southwestern is a recognized expert in the treatment of sickle cell anemia and has published extensively on the use of red blood cell exchange in this disorder.

Coagulation laboratory

The Division of Hematology has an active coagulation research program and Coagulation Clinic. It includes patient contact and interaction with hematologist and coagulationist staff members. Fellows are exposed to basic and advanced coagulation testing, test result interpretation, and patient consultation.

Electives

There are five weeks of elective time during the Transfusion Medicine Fellowship. You can use this time to pursue professional activities related to transfusion medicine, gain additional experience in any of the areas in transfusion medicine, or complete a research project.

Didactic training

During the introduction and core training, a series of didactic lectures are given by transfusion medicine staff physicians, providing the basics of blood banking and transfusion medicine.

Fellows attend the Leadership and Management course offered by the Department of Laboratory Medicine and Pathology. This unique, interactive seminar series develops critical leadership and management skills that have often been neglected in pathology residency training programs.

Invited speakers and in-house experts hold multiple all-day seminars on topics such as:

• Managing change
• Negotiation and conflict management
• Principles of motivation
• Leadership and management basics
• Quality school
• Informatics
• Health care finance

The seminar series culminates in capstone seminars that include team projects presented by the participants.

Research training

The wealth of material at Mayo Clinic offers limitless opportunities for research projects. Within the Division of Transfusion Medicine, opportunities for research are present in many areas. Numerous active research projects are ongoing in the Tissue Typing Laboratory, Human Cell Therapy Laboratory and Therapeutic Apheresis Treatment Unit.

We also collaborate with large, active clinical groups in the various transplant programs. Core laboratories are located in the same building as the pathology division, providing access to techniques such as microdissection, fluorescence in-situ hybridization and flow cytometry.

It is expected that fellows have at least one peer-reviewed publication and one national presentation resulting from work done during their fellowship.

Teaching opportunities

The Division of Transfusion Medicine is committed to the education and training of its entire staff and all trainees. During the fellowship, you assist in the training of pathology residents and deliver formal lectures to co-workers, allied health professionals and students rotating through the division.

Conferences

There is a weekly education conference in the Division of Transfusion Medicine. Fellows are expected to present material at this conference periodically.

Additional training

With approval of the Division of Transfusion Medicine physician staff, the opportunity exists for an additional year of training. This year may be spent in areas related to transfusion medicine, in additional experience within transfusion medicine, or in the development and completion of a research project.

Evaluation

Fellows are provided with formal, written evaluations at the end of their core month, and at the end of each quarter (September, December, March and June) for all rotations completed within the quarter. Evaluations assess competence in patient care, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, and interpersonal and communication skills.

At least four times a year, the program director meets with each fellow to review the fellow's evaluations and discuss professional growth. In addition, allied health staff and residents are asked to evaluate the fellow's performance periodically. Fellows are able to view their evaluations electronically. Final written, summative evaluations are completed for each fellow upon completion of the program.

In addition, the fellows meet with the program director and division chair monthly for informal feedback and discussion. Finally, faculty members are expected to provide verbal feedback on performance to fellows on a daily basis.