Pediatric Hematology Elective
Rotation director
Name: Trisha Wong
Email: wong@ohsu.edu
Pager: 12022
Phone: 503-418-3138
Office: CDRC 1150
Number of residents: 1-2
Key Faculty: Michael Recht MD, PhD, Trisha Wong MD, MS, Kristina Haley DO, MCR, Melinda Wu MD
Introduction:
The pediatric hematology rotation is a 2-3 week elective rotation. This rotation is designed to equip the general pediatrician with the tools to recognize possible presentations for hematologic disorders and to make appropriate referrals. The resident will become familiar and develop a general approach to the work-up of children with anemia, thrombocytopenia, neutropenia, thrombophilia and coagulopathies. The residents will develop these approaches through several activities: outpatient hematology clinics, inpatient consultations, didactic sessions, inpatient and outpatient clinical sign-outs, performing literature searches for patient care, interacting with the medical team and providing patient follow-up, and through self-reading.
The first day of rotation: Meet with rotation director and set tentative clinic and supplemental activities schedule
Requirements:
Attend:
· Minimum of 4-6 General Hematology Clinics
· Minimum of 1-2 spots & dots clinic
· Minimum of 1-2 hemophilia clinic
· Schedule a ½ day blood bank experience, ½ core lab experience- Contact Trish Wong to schedule
· Schedule ½ with hematopathologist (Thursday afternoons?)
· Complete requested inpatient consults- discuss prioritization with fellow
Complete:
· Pediatric Hematology Problem Set. It is your responsibility to set a time to review these.
· Brief (10 min) presentation on Hematology topic related to your future career goals
Optional Clinical Experiences to add
· Survivor-ship (Fridays)
· Non-malignant BMT (Tuesday afternoons)
Conferences:
***Attending pediatric residency morning report & noon conference unless below conference interferes***
Tuesday 8-9 AM: General hematology meeting or Journal Club
Location: PHO clinic conference room /DCH 10th-floor conference room (DCH10400)
Wednesday 8-9 AM: PHO Grand Rounds
Location: DCH Collins-Goudy Conference Room
Thursday 1-2PM: HemePath Case Conference
Location: Dillahunt 5th Floor
Friday 12-1: Hemostasis & Thrombosis Conference
Location: Hatfield Research Building Floor 14 conference room
Clinic Locations
Hemophilia: DCH CDRC 7th floor
Spots, dots, and clots: Center for Women’s Health-Kohler Pavilion F
General Hematology: DCH 10S clinic and infusion center
Blood Bank: Hatfield 9th floor
Hematopathology: Dillahunt 5th Floor
Lab medicine: Hatfield 9th floor
Lab Research- Contact Melinda Wu if interested
Goals & Objectives:
Goal: Pediatric residents develop the knowledge, attitudes and skills necessary to detect, diagnose, manage and appropriately refer patients who present to the primary care setting with hematologic needs or complaints.
1. Describe & interpret the initial approach to a child with anemia.
a. Interpret clinical and laboratory tests to identify hematologic disease (CBC, including indices and blood smear review, reticulocyte count, ESR, PT, PTT, hemoglobin electrophoresis, iron, iron binding capacity, ferritin, transferring, lead, uric acid, LDH, electrolytes, renal function, urinalysis)
b. Describe the changes that occur over time in the hematologic indices of the normal infant and child (e.g. hemoglobin, hematocrit, MCV)
c. Explain the findings on clinical history and examination that suggest a hematologic or disease that requires further evaluation and treatment.
d. Develop a strategy to determine if the following presenting signs and symptoms are caused by a disease process and determine if the patient needs treatment or referral:
i. 1. Fatigue/malaise
ii. 2. Fever
iii. 3. Bruising/bleeding
iv. 4. Lymphadenopathy
v. 5. Hepatomegaly and/or splenomegaly
vi. 6. Swollen extremity
2. Describe the management & complications of sickle cell disease.
a. Provide preventive counseling to parents and patients with specific hematology/oncology conditions, addressing: 1. In a child with a sickle hemoglobinopathy, the importance of antibiotic prophylaxis, pneumococcal and routine immunizations, folic acid supplementation, and urgent need for evaluation for fever
b. Compare and contrast the different sickle cell syndromes, including presentation, treatment and complications. These syndromes include sickle cell anemia, hemoglobin SC, and hemoglobin S beta thalassemia
c. Discuss the common complications seen in a child with sickle cell disease. These include: hemolysis, hand-foot syndrome, anemia, aplastic crises, bone infarction, stroke, skin ulcers, pain episodes, priapism, sepsis and infections, cholelithiasis, chest syndrome, retinopathy, renal failure, and sequestration crises
d. Outline the management of a patient who presents with a sickle crisis. These should include discussion and proper use of IV fluids, analgesics, antibiotics, oxygen, blood transfusions, and indications for hydroxyurea and stem cell transplant.
e. Develop a preventive care plan for a patient with a sickle disease. These should include use of folate, prophylactic antibiotics, immunizations, prompt evaluation of febrile episodes and stroke screening
3. Describe & interpret the initial approach to a child bleeding signs/symptoms.
a. Recognize physical exam findings associated with primary versus secondary hemostasis (define wet bleeding)
b. Generate a differential diagnosis and initial work-up for thrombocytopenia in a neonates vs infants vs children vs adolescents
c. Generate a differential diagnosis for inherited vs. acquired coagulopathies.
4. Describe & interpret the initial approach to a child hypercoagulable signs/symptoms.
a. Generate a differential diagnosis for inherited vs. acquired hypercoagulable states.
b. Describe appropriate evaluation of patients with possible hypercoagulable states.
5. Understand indications for and complications related to use of blood products
a. Explain the appropriate indications for and potential risks of various blood products (e.g., red blood cell products, platelet concentrates, coagulation factors).
b. Describe the indications for leukofiltration, irradiation of blood products, and use of CMV negative blood products
6. Describe and demonstrate the role of Consultant
a. Demonstrate sensitivity and respect for the knowledge and skill differences among pediatricians and other professionals involved in health and related services for children
b. Demonstrate respect for and commitment to the pre-existing relationship between a referring physician and the patient/family, providing expertise without undermining the role of the primary care provider who offers the medical home for that patient.
c. Communicate clearly with a referring provider in written, electronic or oral form, clearly answering the questions to be answered and, when possible, the rationale for your response.
d. During consultations, educate other health professionals on issues important to the care of the pediatric patients.
e. As a consultant, demonstrate awareness of issues related to cost, billing, and referral authorization.
7. Provide exemplary patient care
a. Demonstrate personal accountability to the well-being of patients (e.g., following up on lab results, writing comprehensive notes, and seeking answers to patient care questions)
b. In cases of serious or life-threatening disease, counsel the patient’s families with sensitivity to their desire to need to know about:
i. 1. Prognosis and possible impact of disease
ii. 2. Likely steps in immediate and future treatment
iii. 3. Decisions about treatment options which they may face