Hematology and Hematopathology Rotation

Hematology and Hematopathology Goals and Objectives

At the end of the Hematology and Hematopathology rotation in the Anatomic and Clinical Pathology Residency Program, the resident will have demonstrated competency in the following skills.

Hematology and Hematopathology Patient Care

  • Hemoglobinopathy interpretation (HPLC and electrophoresis, including correlation with CBC)
  • Joint fluid crystal exams
  • Performance of bone marrow aspirates and biopsies in clinical setting (by arrangement with Division of Hematology and Oncology)
  • Peripheral blood and body fluid reviews
  • Timely completion of bone marrow reports
  • Urinalysis including automated and microscopic exams

Hematology and Hematopathology Medical Knowledge

  • Approach the diagnosis of anemias, cytopenias, leukemias, lymphomas, myeloproliferative syndromes and myelodysplastic syndromes by combining the available morphological and historical information
  • Automated hematology, including complete blood counts, histogram interpretations and reticulocyte analysis
  • Be able to recognize mature and immature hematopoietic cells in order to perform a differential count on either peripheral blood or bone marrow specimens
  • Chemical and microscopic urinalysis
  • Evaluation of Wright-stained body fluids for inflammation and malignancy
  • Familiarity with automated hematology analyzer and information system
  • Form a meaningful differential diagnosis for commonly seen hematopoietic diseases
  • Have an appreciation and working knowledge of the utility and interpretation of ancillary studies such as flow cytometry, immunohistochemistry and cytochemical stains
  • Morphological examination of joint fluids for crystals
  • Morphological interpretation of peripheral blood smears and correlation with clinical information

Practice-Based Learning and Improvement

  • Indications and interpretation of special hematology tests, including hemoglobin electrophoresis, glucose-6-phosphate dehydrogenase screens, osmotic fragility tests and others
  • Correlation of Wright-stained body fluids with cytopathology results
  • Correlation of abnormal blood smear findings and bone marrow findings with flow cytometry results
  • Be able to compare current and previous pathology results to understand treatment effects on disease processes
  • Correlate bone marrow results with other pathology on patients
  • Understand the limitations of sub-optimal or inadequate bone marrow specimens

Interpersonal and Communication Skills

  • Ask appropriate questions of attendings and clinicians to improve understanding of clinical significance of pathologic findings
  • Communicate test results to clinicians
  • Communicate with attending pathologists about patient material
  • Communicate with clinicians to obtain history for interpretation of test results and/or appropriateness of tests ordered
  • Communicate with laboratory technologists about test methods, additional test requests and more
  • Effectively communicate bone marrow findings to clinicians
  • Present cases at weekly hematology lab rounds
  • Present journal articles on hematopathology/laboratory hematology topics at Journal Club
  • Present pathology at clinical conferences
  • Write bone marrow reports that provide appropriate descriptions and synthesize findings into a comprehensive diagnosis

Professionalism

  • Be available in hematology laboratory and sign-out area as required
  • Be responsible for obtaining bone marrow smears from Cancer Center lab
  • Demonstrate courteous and collegial behavior with peers and laboratory staff
  • Demonstrate self-motivation in pursuit of hematology rotation requirements
  • Follow up on all special stains and studies on assigned cases until the case is completely signed-out
  • Read independently on cases and search primary sources

Hematology and Hematopathology Systems-Based Practice

  • Be familiar with anatomic pathology information system (COPATH), including retrieval of pathology reports, ordering special stains and more
  • Be familiar with the Hospital Information System for retrieval of clinical information on patients
  • Be familiar with Laboratory Information System and entry/retrieval of laboratory results, including hematology information system
  • Understand cost-effective laboratory utilization in the evaluation of hematologic disorders
  • Understand how bone marrow examinations fit into the overall care and management of patients with hematological and malignant conditions

Hematology and Hematopathology Rotation Duration

The total requirement is six months.


Duties and Responsibilities of Residents by Year

  • Arrange and attend bench instruction with the technologists in each of the component laboratories
  • Attend clinical pathology conferences, coagulation conference, leukemia/lymphoma conference and lymphoma conference
  • Attend daily sign-out sessions, reviewing cases seen by all residents on the rotation
  • Be available in the hematopathology laboratory area to show cases to clinicians
  • Daily, review and sign-out the "Review queue" of abnormal smears with the attending pathologist
  • Enter Review queue results into LIS
  • Gather peripheral blood smears, clot specimens and core biopsies when available
  • Obtain pertinent clinical information about every bone marrow case
  • Order or gather additional studies, such as histochemical stains and immunophenotyping studies and bone marrow or lymph node biopsies
  • Perform the 100-cell differential count on the peripheral smear using the bone marrow evaluation form as a guide
  • Review and sign-out hemoglobin electrophoresis results with attending pathologist

Senior resident should take responsibility for more cases than junior resident on busy days and do the following:

  • Be assigned consult cases from outside institutions for evaluation and sign-out
  • Orient junior residents to the duties and responsibilities and review basic morphology
  • Sign-out and review queue cases independently at the discretion of the attending pathologist

Hematology and Hematopathology Teaching Staff

Howard Meyerson, MD - Rotation Director
Christine Dillman, MT (ASCP)
Rose Beck, MD, PhD
Kwadwo Oduro MD, PhD
Christopher Ryder MD, PhD


Hematology and Hematopathology Supervision and Evaluation

Residents meet on a regular basis with the director of the rotation and with the lead technologists for supervision. Evaluations are based on daily interaction with residents over multi-headed microscope and other "sign-out" activities. In this way, residents receive daily feedback on their interpretations of case material. Residents are assisted by attending staff in preparation of conferences and receive feedback on their presentations.

Residents are evaluated on a monthly basis with regard to competency areas. Evaluations are forwarded to the residency program director, where they are available for review.

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