Hematology

Rotation Director:

Name: Trisha Wong

Email: wong@ohsu.edu

Office: CDRC 1124

Phone: x8-3138

Pager: 12022

Overview:

You will become familiar and develop a general approach to the work-up, diagnosis, and basic management of children with quantitative and/or qualitative disorders of RBCs, WBCs, platelets or of hemostasis. You will develop these approaches through several activities: outpatient hematology clinics, inpatient consults, didactic sessions, literature searches, overnight call on 10S, visiting a research lab, reviewing peripheral smears, touring the core lab, and self-directed learning using a case problem set. There is also a priority to get you to do lumbar punctures in our procedure room.

Rotation goals and objectives:

1. To learn when to order and how to interpret fundamental hematologic labs, such as CBC with differential, reticulocyte count, coagulation labs, UA, iron panel, ferritin, and transfusion compatibility

2. To practice how to take an appropriate and thorough history for various hematologic disorders or symptoms

3. Based on labs and history, to practice formulating an exhaustive differential diagnosis

4. To familiarize you with common hematologic disorders (acute and chronic disorders) in order to recognize them, make basic treatment recommendations, and know when to refer

5. To become more aware of unconscious bias and how it can affect healthcare and how diversity/inclusion can improve healthcare

6. To have fun and love blood

Prior to the start of the rotation:

If Trish hasn’t reached out to you with instructions of where to go on your first day by 2 days before the start of your rotation, please reach out to her through email or page

First day of the rotation:

Meet with Trish as previously scheduled to review clinic schedule, rotation goal expectations, and, based on your special interests, create tentative customized schedule for the duration of your rotation

Resident Expectations:

· Inpatient non-malignant hematology consults as they come in: Based on clinic flow, your career goals, and urgency of consult, priority to be determined by you and hem fellow/attending

· ~3 overnight calls on 10S, typically on a Sun, Tues, Thurs, Fri, or Sat night as not to miss hem clinic the next day

· ~4-6 General Hematology Clinics

· ~1 Young Women/Girls Bleeding clinic (AKA: “Spot, Dots, and Clots Clinic”)

· ~1 hemophilia clinic

· ~ ½ day blood bank, lab tour, stroke clinic

· ~ ½ day with hematopathology fellow/attending (not including attending hem path rounds, see below)

· ~½ -full day exposure to lab research with Melinda Wu

· Present an interesting case at morning report during or soon after completion of hem rotation. Discuss case with your hem attending of choice

· Pediatric Hematology Problem Set. It is your responsibility to set a time to review these.

· Procedures: priority on lumbar punctures but bone marrow aspirates and biopsies too

· Hemophilia camp (Aug only) or outreach clinics (4 per year) as possible

General Schedule:

PHO Clinics (see below for locations):

Clinic Locations

General Hematology: DCH, 10th floor, 10C clinic and infusion center

Hemophilia, Hemophilia Consult, and Stroke Clinic: DCH, 7th floor, CDRC clinic

Spots, Dots and Clots: KPV, 7th floor, Center for Women’s Health

Vascular anomalies clinic: PPV, 3rd floor, ENT area

Blood Bank and Core Lab: HRC, 9th floor

Hematopathology: Dillahunt Hall, 5th floor

Linder Lab (Melinda Wu): RJH, 3rd floor

PHO Conferences:

Default to attending your residency AM report and noon conferences, but you are welcome to attend our conferences if it is of interest. Ask any PHO team member what the topic is so you can decide.

· Monday 8-9 AM: Complex and interesting case review (DCH 10400).

· Second Tuesday 8-9 AM: PHO Journal Club (DCH10400)

· Wednesday 8-9 AM: PHO Grand Rounds (DCH Collins-Goudy Conference Room)

· Thursday 1-2PM: Hematopathology rounds (Dillahunt 5th Floor multi-headed scope)

· Friday 8-9AM: 10S and hem consult sign out (DCH 10400). Highly recommend attending if you are on-call for 10S over the weekend

· Friday 12-1: Hemostasis & Thrombosis Conference with adult hematology and basic science researchers (HRC 14th floor conference room). Lunch served

If you are going to be absent for all or part of a day:

1. As soon as possible, inform the PHO attending who is on service the day(s) you will be absent so he/she can make arrangements as necessary.

2. Inform the chief residents and Mike Grubbs

Resident Resources, Helpful Tips, and Further Readings:

Hematology Box Folder

Although not helpful at all, here is the Gen Peds ABP Exam hematology content: https://www.abp.org/sites/abp/files/pdf/gp_contentoutline_2017.pdf

Actually useful resources:

1. Sills, R.H. (ed). Practical Algorithms in Pediatric Hematology and Oncology. S. Karger, Albany NY. 2003. A hard copy is in the PHO clinic workroom but good luck finding it. Available in BOX folder.

2. http://practical-haemostasis.com/. This site is designed to teach laboratory haemostasis and was written for laboratory staff, doctors in training and anyone who has an interest in haemostasis. (It is run out of Cambridge University so note the English spelling).

3. Guidelines:

· 2011 ASH Guideline on Immune Thrombocytopenia: http://www.bloodjournal.org/content/117/16/4190?sso-checked=true . Available in BOX folder.

· 2012 Chest Guideline on Antithrombotic Therapy in Neonates and Children, 9th Ed: https://journal.chestnet.org/article/S0012-3692(12)60137-8/fulltext Available in BOX folder.

· 2014 NHLBI Evidence-Based Management of Sickle Cell Disease: https://www.nhlbi.nih.gov/sites/default/files/media/docs/sickle-cell-disease-report%20020816_0.pdf Available in BOX folder.

4. High impact hematology journals (with impact factor) for any literature search:

· Blood (6.434)

· The Lancet Hematology (5.980)

· Blood Reviews (2.694)

· Journal of Thrombosis and Haemostasis (2.353)

· British Journal of Haematology (2.036)

· Pediatric Blood and Cancer (1.338)

5. Blood Bank Guy Podcast, an award-winning website that teaches the essentials of Transfusion Medicine to learners everywhere. Available at https://www.bbguy.org/podcast/. Pertinent pediatric podcasts are:

· 009: Awesome Presentations with Kristine Krafts: It’s easy to give a lousy presentation but doing it right is SO much better! Kristine Krafts has 5 tips for AMAZING presentations! (https://www.bbguy.org/2016/05/23/009/)

· 012: Pediatric Transfusion with Cassandra Josephson: Infants and children are NOT just “little adults!” Dr. Cassandra Josephson shares 5 principles you must know about pediatric transfusion. ((https://www.bbguy.org/2016/06/24/012/))

· 017: Transfusion Reactions with Mark Fung: “This patient is having a transfusion reaction!!” OK, take it easy! Dr. Mark Fung is here to give us a rational way to approach these panic-inducing events. (https://www.bbguy.org/2016/09/13/017/)

· 027: NAIT with Brian Curtis: Is Neonatal Alloimmune Thrombocytopenia (NAIT) just the platelet version of Hemolytic Disease of the Newborn? Not quite! Dr. Brian Curtis helps us not hate NAIT! (https://www.bbguy.org/2017/02/13/027/)

· 028: Who DAT? with Sue Johnson: The Direct Antiglobulin Test seems super-simple, but there’s more to it than meets the eye! Sue Johnson joins Dr. Chaffin to discuss. (https://www.bbguy.org/2017/02/27/028/)

· 034: Neonatal RBC Transfusion with Cassandra Josephson: Few things are sadder than when a baby needs a transfusion. Unfortunately, it happens often in those born too early and too small. “Friend of the Podcast” Cassandra Josephson returns to answer “Five Essential Neonatal RBC Questions” (https://www.bbguy.org/2017/07/10/034/)

· 037: How to Learn with Justin Kreuter: What if everything we think we know about how to learn is wrong? To improve ourselves, we really need to understand what does and doesn’t help us really learn new things. Dr. Justin Kreuter gets this, and he’s here to show all of us (not just those currently in training!) how we can get information into and out of our brains effectively! (https://www.bbguy.org/2017/08/21/037/)

· 038: HDFN with Greg Denomme: Hemolytic Disease of the Fetus and Newborn (HDFN) is not just a diagnosis from the history books! It still happens, and all involved must respond quickly. Dr. Greg Denomme guides us to better HDFN understanding and management. (https://www.bbguy.org/2017/09/05/038/)

· 053CE: Alloimmunization is a BIG Word! with Chris Tormey: A patient is waiting for a transfusion, but there’s a problem! “Alloimmunization” has occurred (gasp!), and the patient now “has an antibody.” Dr. Chris Tormey wants you to understand why some people make non-ABO antibodies and others just don’t. (https://www.bbguy.org/2018/07/16/053/)

· 062CE: Autologous and Directed Donation with Julie Karp: “I will only accept blood from my own veins or from my Aunt Margo! That’s it!” Autologous and directed blood donations happen much less often in 2019 than in the past, but should they still happen at all? (https://www.bbguy.org/2019/01/18/062/)

· 065: Transfusion and Jehovah’s Witnesses with Jed Gorl: Jehovah’s Witnesses refuse transfusion based on strong religious beliefs. Despite this, blood bankers must be prepared to assist in their care. (https://www.bbguy.org/2019/03/18/065/)

General Schedule