Hematopathology/Hematology/Coagulation/Flow Cytometry/Body Fluids
- Ashish Bains, MD (Director, Hematopathology, Temple University Hospital)
- Mohamed Alsammak, MD
- Mohammed Reza Nejati, MD (Rotation and Resident Supervisor, Fox Chase Cancer center)
The general goal of the Hematopathology/Coagulation rotation is to enable the residents to become knowledgeable and acquire competency in general hematology, hemostasis/coagulation, including normal hematopoiesis and hemostasis/ coagulation involving the various disorders of the red blood cells, white blood cells, lymphoid tissue, coagulation, and the performance of bone marrow aspiration/biopsy. The resident learning experience consists of a combination of service responsibilities, self-instruction, technical instruction, formal conferences and informal teaching during rounds with the faculty. The primary resources available to the residents include: daily sign-out activities, independent reading, review of study sets, laboratory rotations, clinical rotations/conferences, and departmental and interdepartmental conferences. Competency is assessed in each of these areas at various times throughout the hematopathology rotation. The residents acquire graduated responsibility as they advance their critical thinking skills/process; interpretation and analysis of the data, considering additional studies for work up, expanding their differential diagnosis and developing competency in advanced hematopathologic cases.
The initial residents training process begins with the review of hemoglobin synthesis, iron/B12/folate metabolism, differentiation of hematopoietic cells (red blood cell, white blood cell, platelet), the principles of laboratory instrumentation (red blood cell analyzer, white blood cell immunophenotyping by flow cytometry or immunohistochemistry, and platelet aggregometry) the gross evaluation of hematopoietic specimens (bone marrows, lymph nodes and spleens) and recognition of normal hematopoietic cells (red blood cells, white blood cells and platelets). As the residents progress through their training, they learn to integrate the clinical history/presentation, recognize abnormal cell populations by morphology (microscopy), general analytical techniques (red blood cell analyzer) and special ancillary tests (immunohistochemical and cytochemical stains, etc.) and analytical techniques (white blood cell flow cytometry, etc.). By the middle of the training, most residents should be capable of diagnosing the most common hematopoietic disorders through the integration of clinical history, morphology, cytochemistry, immunophenotyping, molecular diagnostic and cytogenetics. During this continuing process, the residents expand their differential diagnosis. By the end of the training, most residents should be capable of working up and listing a complete differential diagnosis for most advanced hematopoietic disorders. Residents will gain knowledge sufficient for satisfactory performance on the Residents In-Service Examination (RISE) and Clinical and Anatomic Pathology Board Examinations.
Resident Responsibilities/Rotation Structure
Residents spend two blocks at Temple University Hospital and three blocks at FCCC Hospital. The training responsibilities are divided into two separate rotations “Wet” Hematology and Hematopathology at Temple University Hospital and Hematopathology at FCCC Hospital. Residents rotate through the general hematology/coagulation, special hematology including flow cytometry and special coagulation laboratories at Temple University Hospital. Residents learn the principles of laboratory instrumentation used in general hematology/hemostasis including the methodologies, limitations of specific instruments and evaluation of quality control. Residents acquire skills in general hematology and hemostasis/coagulation, including experience in evaluation of general morphology and normal hematopoiesis of hematopoietic cells of the peripheral blood, bone marrow bone and lymphoid organs and normal hemostasis/coagulation. Residents learn about the various disorders involving the red blood cells, white blood cells, platelet disorders and coagulation disorders including pathophysiology, morphologic findings, laboratory findings and clinical features associated with specific conditions. Residents rotate at Temple University Hospital and FCCC Hospital for exposure to hematopathology cases including abnormal peripheral blood smears, bone marrow aspiration/biopsies, lymph node biopsies and internal and external consultations.
Residents have the opportunity to rotate with the inpatient hematology consultation service. Residents are expected to learn/observe how to perform bone marrow aspirates/biopsies. Residents are also expected to improve teaching and communications skill by reviewing cases with attending physicians, house staff, medical students, and participating in intra-and interdepartmental conferences.
Additional instruction in hematopathology is given by way of didactic talks covering core topics in coagulation/hematopathology in the core clinical pathology Core Curriculum given by the faculty. In addition, several interdepartmental conferences provide an excellent setting for understanding the clinical correlations of hematopathology.