Category: core rotation
introductory to advanced
(the first month is taken within the initial
eight months of residency training)
Length of rotation: 3 months, taken in 1-month increments
Location: MHH hematology lab, 1st floor Robertson
Rotation director: Andy Nguyen, M.D.
Working hours: The resident is expected to be on duty from to .
Service duties: After the morning conference, the resident reviews all pending materials (bone marrow aspirate/biopsy, peripheral blood, body fluid, coagulation, flow cytometry) and prepares a draft for interpretation using all laboratory and clinical data including those from CERNER LIS and EMR. Cases with complete data are signed out with the attending. Note that if bone marrow procedures are scheduled, the sign-out schedule will be changed accordingly. Different residents will be assigned different tasks depending on level of training.
The attending will edit and release reports while the resident reviews unknowns (taken from study sets) if time permits (unknowns may not be given on a very busy day). The resident meets with the attending at or (depending on bone marrow slide availability) to review bone marrow aspirates obtained in the morning & other pending cases, and also to review the unknowns. The resident meets with the attending at or (depending on coagulation data availability) to sign out coagulation cases.
Note that the resident needs to check on all pending cases in the laboratory (hemepath, coagulation cases) throughout the day and to prepare drafts for the reports before signing out with the attending.
Lymph node cases that are referred from Surgical Pathology and UT-Outreach Laboratory for consultation are also reviewed and signed out with the attending in the Hematology Laboratory.
Typically, two pathology residents are on the rotation each month. The resident will also work with other trainees on the rotation (one or two MDACC hematology-oncology fellow/month, 1-3 fourth-year medical students/month, 4-5 MDACC hemepath fellows/year, 2 TMH hemepath fellows/year).
After hours/weekends: Residents take night and weekend call per the global DPALM CP call schedule.
Conferences: Residents are required to participate in UTHMS teaching conferences, CP conferences, and the once-monthly CAP lab management audio conference, unless prohibited from doing so by urgent service duties. Selected cases will be chosen for presentation by the resident in the CP Conferences. Hematopathology journal articles of interest are also selected and presented once a month in one of the Wednesday CP Conferences. Residents are expected to critically appraise the article and assess its contribution to the existing literature. Selected cases are also presented by the residents in the Texas Medical Center Wide Hematopathology Conferences.
Goals and Objectives of Rotation
A breakdown according to the six ACGME competencies is listed within the section Goals and Objectives for Rotations Incorporating Hematopathology.
The resident is to acquire knowledge for the practice of hematopathology and coagulation. The resident is expected to acquire skills in procuring hematopoietic tissues, examining hematopoietic specimens/coagulation results, and rendering diagnoses, recommending further diagnostic studies and assisting in treatment decisions. To accomplish this, the resident must acquire expertise in:
1 Evaluate the patient's clinical history and physical findings.
2 Perform bone marrow biopsies and aspirations
3 Prepare bone marrow specimens of high quality for examination.
4 Examine hematopathology specimens (peripheral blood smear, bone marrow aspirate and biopsy, lymph node), render diagnosis using additional techniques as needed, and give appropriate recommendations to the primary physician.
5 Skills in interpreting special studies: flow cytometry, immunoperoxidase stains.
6 Knowledge about treatments for various hematologic disorders.
7 Work closely with other consulting physicians to assist the primary physician in each patient's care.
8 Utilize nonscheduled time for review of case materials (hemepath study sets) filed in the Hematology sign-out room, as well as other tutorial materials.
9 Read hematology procedure manuals to be familiar with testing methodology and interpretation of hematology tests.
10 Quality control program in hematology.
1 Urinalysis (chemical and physiochemical tests; microscopy of urine sediment).
2 Pleural and peritoneal fluid/cerebrospinal fluid/synovial fluid.
1 Read coagulation procedure manuals to learn methods of performing the tests for investigating patients with coagulation and platelet disorders.
2 Investigation of hemostatic disorders, using information obtained from laboratory tests and clinical information obtained directly from medical records or by consulting with patients' primary physicians.
3 Knowledge of clotting factors/inhibitors, their physicochemical properties, and their relationship to the rational use of blood components and other blood derivatives in coagulopathy.
4 Quality control program in hemostasis.
Graduated responsibilities by level of training:
Month 1: (a) learn the routine activities, (b) with help from senior residents and the attending, learn to complete interpretation drafts for clinical reports to be input into CERNER LIS, (c) complete reading topics for month 1 (see core curriculum)
Month 2: (a) help junior residents to review clinical cases and to complete interpretation drafts, (b) complete reading topics for month 2 (see core curriculum)
Month 3: (a) acting as attending to render preliminary diagnosis and to help junior residents to complete interpretation drafts, (b) work with the attending on laboratory issues such as QC/QA, correlation studies, (c) complete reading topics for month 3 (see core curriculum)
Andy Nguyen, M.D.; and other hematopathology faculty
(A) Self-study materials:
-Malignant hematopathology: http://www.uth.tmc.edu/pathology/faculty/pages/nguyen-nghia/WHO-Review/List.htm
-Benign hematopathology: http://www.uth.tmc.edu/pathology/faculty/pages/nguyen-nghia/Heme-Review/List.htm
Residents on hemepath rotation need to read the following topics (arranged month-by-month)
Reading Topics for Month 1 (indicated with * in list of topics shown in web pages above)
Peripheral Blood Examination
Microcytic Hypochromic Anemia
Infectious Agents in Peripheral Blood Examination
Autoimmune Hemolytic Anemia
Urine Crystals and Joint Fluid Crystals
Chronic Myelogenous Leukemia
Acute Myeloid Leukemia with Recurrent Cytogenetic Abnormalities
Precursor B Neoplasm
Precursor T Neoplasm
Introduction, Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma
Introduction to Lymph Node Pathology
Reading Topics for Month 2 (indicated with ** in list of topics shown in web pages above)
· Benign Lymph Node Pathology
Polycethemia Vera, Essential Thrombocythemia
Chronic Idiopathic Myelofibrosis, Myeloproliferative Disorders-unclassified
Chronic Myelomonocytic Leukemia, Atypical Chronic Myelogenous Leukemia
Acute Myeloid Leukemia, not otherwise categorized (M0, M1, M2, M4, M5, M6, M7)
Hairy Cell leukemia
Plasma Cell Myeloma, Plasmacytoma
Extranodal Marginal Zone B-Cell Lymphoma (MALT)
Nodal Marginal Zone B-Cell Lymphoma, Follicular Lymphoma, Mantle Cell Lymphoma
Diffuse Large B Cell Lymphoma
Peripheral T-cell Lymphoma-unspecified, Hepatosplenic T-cell Lymphoma, Extranodal NK/T-cell Lymphoma-Nasal Type
Reading Topics for Month 3 (indicated with *** in list of topics shown in web pages above)
Flow Cytometry Cases
QC and Method Evaluation
T-cell Large Granular Lymphocytic Leukemia, Aggressive NK-cell Leukemia
Adult T-cell leukemia/Lymphoma
Mycosis Fungoides / Sezary Syndrome
Angioimmunoblastic T-cell Lymphoma
Anaplastic Large Cell Lymphoma
Post-transplant Lymphoproliferative Disorders
(B) Coagulation elective:
This elective is offered twice a year (in combination with Hematopathology rotation) for residents to obtain further training in coagulation. Trainees are exposed to principles of instrumentation, testing methodologies and interpretation. Daily conference is held to cover key topics and a series of case studies involving various coagulation disorders.
1. Coagulation Testing Principles
2. Coagulation Essentials
5. Thrombotic Thrombocytopenic Purpura
17 cases to be discussed together in group, facilitated by faculty
Kjeldberg C: Practical Diagnosis of Hematologic Disorders. American Society of Clinical Pathologists
World Health Organization
Classification of Tumours: Pathology and Genetics, Tumours
of Haematopoietic and Lymphoid Tissue.
Jandl JH: Blood: Textbook of Hematology. Little Brown
Knowles D: Neoplastic Hematopathology. Williams & Wilkins
Foucar K: Bone Marrow Pathology. American Society of Clinical Pathologists
Kjeldberg C and Knight J: Body Fluids. American Society of Clinical Pathologists
Goodnight SH Jr and Hathaway WE: Disorders of Hemostasis & Thrombosis: a Clinical Guide. McGraw-Hill
Kottke-Marchant K (Ed): An Algorithmic Approach to Hemostasis Testing. CAP Press
Supplemental Learning Materials:
Hemepath study sets (14 sets): approximately 1,400 microscopic slides (peripheral blood, bone marrow aspirate and biopsy, body fluids, lymph nodes) covering a wide spectrum of malignant and non-malignant disorders. The study-set slides are also used as unknowns for didactic teaching.
Web-based Pathology Programs at University of Texas-Houston: various self-study programs covering malignant hematopathology, non-malignant hematopathology, coagulation, flow cytometry, hemoglobin electrophoresis, and PowerPoint files of interesting Hemepath cases
Hematopathology Virtual Slide Box at
(University of Medicine & Dentistry of
Atlas of Genetics and Cytogenetics in Oncology
and Haematology (Editor: Jean-Loup Huret, Genetics DIM,
Syllabus of Human Hemoglobin Variants (Titus H.J. Huisman
et al, published by The Sickle Cell Anemia
Additional Materials in Residents Manual
Goals and Objectives for Rotations Incorporating Hematopathology
The resident will have opportunities during this rotation to get exposure to research in hematopathology and coagulation. The scholastic activities will be greatly beneficial to the resident in future clinical practice as well as for credentials in applying for fellowship and job positions. Clinical cases of pathologic interests seen during the rotation can be written up as case reports for presentation in local/national pathology meetings as well as for publication in pathology journals. More elaborate research experience may be explored by talking to the hematopathology staff. This may require extra amount of time to be taken as Clinical Pathology electives. Research activities must not take priority over clinical activities during the 3-month core rotation.
Andy Nguyen, M.D.: 713-500-5337; pager 23699; Nghia.D.Nguyen@uth.tmc.edu
MHH Hematology Lab: 713-704-1693
Cy Ambalathumkal, Hematology Manager: 713-704-1662