Bacteriology Section:
The general training rotation should concentrate on acquiring practical (hands on) skills in various procedures and tests in addition to applying the practical knowledge in interpretation of tests results and their impact on patient care.
A summary of overal objectives are as follows:
1. Exposure to overall operation flow of work at various sections.
2. Acquire knowledge about the different and proper types of specimens needed and used in investigation by different test.
3. Acquire technical skills in lab procedures performance and interpretation.
4. Identification of commonly occuring organisms.
5. Understanding basis of test and media reactions.
6. Be able to perform & interpret antimicrobial susceptibility tests.
7. Perform & interpret rapid procedure for detection and identification of organisms.
8. Have an insight on the interpretation and limitation of tests
9. Be able to advise physicians on different tests and procedures related to lab aspects and their interpretation as well as to answer their inquires.
The methods of training should involve different aspects as follows:
- Each trainee should be available in the section all through the duration of his training and should perform tests himself after adequate time of observation.
- Use of unknowns.
- case discussions.
- Involvement in projects and/ or development of tests/ procedures.
The duration of training is suggested as follows:
- 2 1/2 months in Bacteriology section covering procedures and/or identification for aerobic and anaerobic bacteria, mycobacteriology, mycology, antimicrobial susceptibility testing and non cultural detection methods (1 1/2 months first year, i month second year).
- 1 1/2 months in serology section ( 1 month first year, 1/2 month second year)
- 1 1/2 months in parasitology/microscopy section (1 month first year, 1/2 month second year)
- 1/2 in media preparation (1st year)
Note: Detailed guidelines of more specific rotation objectives are available to those currently rotating in clinical microbiology.
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Blood Banking and Transfusion Medicine:
Practical Training with Theoretical Interpretation:
ABO blood group & Rh (D) typing
Resolution of ABO discrepancies
Direct Antiglobulin Test-Polyspecific and Monospecific AHG
Indirect Antiglobulin Test
Antibody Identification (Quantitative & Qualitative)
Compatibility Testing: Major Crossmatch and Immediate spin crossmatch
Cord blood studies
Neonatal testing: Immune anti-A and anti-B
Component preparation and preservation
Blood Donor selection and blood collection: allogeneic and autologous
Apheresis procedures (Adult & Pediatric):
Plateletpheresis
Granulocyte collection
Red cell exchange
Stem cell collection
Therapeutic plasmapheresis
Therapeutic plateletpheresis
Therapeutic leukapheresis
12. Collection & Processing of donor blood units
13. Gel test & Tube test tech niques
14. Quality control: reagents
15. Blood Utilization Review (Audits)
Theoretical:
1. Component Therapy
2. Transfusion Reactions: Types, Prevention, and Work-up
3. Hemolytic Disease of the Newborn (HDN): Types and Work-up
4. Types of transfusion (massive transfusion, exchange transfusion, intrauterine..)
5. Elution & Autoadsorption procedures: principles and interpretation
6. Extensive and Selective Phenotype of the other major blood group antigens
7. Preparation of least incompatible RBC unit (titers)
8. ABO discrepancies and resolution techniques
9. Variations of the Rh (D) antigen (the Du antigen)
10. Other major blood groups antigens
11. Irradiation, Filtration, washed RBCs: Indications
12. Enhancement techniques: Albumin, LISS, and Enzymes
13. Polyclonal and Monoclonal reagents
14. Quality control: reagents, instruments, and records
References:
American Association of Blood Banks: Technical Manual, 14th edition. AABB, Bethesda, 2002.
American Association of Blood Banks: Standards for Blood Banks and Transfusion Services, 21st edition. AABB, Bethesda, 2002.
Harmening D. Modern Blood Banking and Transfusion Practices, 4th edition. F.A.Davis Company. Philadelphia, 1999.
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Chemistry Section:
1. Specimen acessioning and laboratory information system.
2. Automation (principle, maintenance, operation, trouble shooting):
· Hitachi 912
· Axsym
· Elecsys 2010
· Vitros 250
· BN ProSpec Nephelometer
3. Semi-automation (principle, maintenance, operation, trouble shooting):
· TDXFLX
· IMX
· Delfia
4. Proteins: Quantitation, electrophoresis & immunofixation, oligoclonal banding analysis and interpretation.
5. High Performance Liquid Chromatography - Amino Acids analysis and interpretation.
6. Special urine tests.
7. Trace metals analysis by ICP-MS.
8. Neonatal and prenatal screening.
9. Biochemical genetics and organic acids by GC-MS.
- Quality Control (QC)/ Quality Assurance (QA)/ Performance Improvement (PI):
a- Daily surveillance of Chemistry results.
b- Understanding and review of Chemistry QC and maintenance records.
c- Review proficiency testing records.
d- Other QC activities: Intermethod comparisons, Instrument carryover indicators for PI activities.
e- Review of incident reports and collection of raw data for certain indicators for PI activities.
f. Knowledge of Safety policies and procedures.
g- Review personnel records: training, competency, continuing medical education.
- Special projects- method development, valuation, and writing standard operating procedure (SOP).
- Research - abstracts, reviews, original projects, etc ...
- Duration: 1 1/2 months in Chemistry and 1/2 month in Endocrinology each in the first and second years.
- During all rotations residents will be involved in presenting continuing medical education for technological staff, follow up of unusual results, and trouble shooting activities when problems are encountered.
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Cytogenetics Section:
During their rotation in the Cytogenetics Laboratory, the Residents can observe the following techniques:
Sample set-up: Blood samples
Amniotic Fluid samples
Chorionic Villi or Products of conception
Bone marrow or lymph node samples
Solid tumors
Culture maintenance
Harvesting and slide making
Chromosome banding techniques
In addition, they are introduced to chromosome analysis, by looking at photographed metaphases, prepared karyotypes and chromosomes under the light microscope.
They are encouraged to look at specific referrals in our log book and the corresponding result of chromosome analysis to establish correlations between the phenotype and the karyotype of the patient. Specific cases and their follow up can be discussed.
The Residents can also observe and discuss the technique of Fluorescence In Situ Hybridization (FISH) and view the results under the Fluorescent microscope.
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Hematology Section:
Hematology and Coagulation Rotation:
I. Hematology Rotation:
A. Procedures
1. Peripheral blood smear:
-Preparation and stain -Interpretation and assessment
2. Microhematocrit 3. Manual cell counts 4. Body fluids: Count and differential 5. L.E. preparation 6. Inclusion bodies 7. Hemoglobin electrophoresis 8. Acid elusion test 9. PNH screen 10. Spherocyte screen 11. Bone marrow aspirate:
-Preparation and stains including cytochemical stains -Interpretation and differential
B. Instrumentation:
1. Hematology analyzers 2. Sedi system 3. Quality control
C. Flow cytometry:
1. Principle 2. Antibody panel selection
II. Coagulation:
A. Bleeding screen: (PT, a-PTT, Fibrinogen) B. Hypercoaguble state screen: (protein C, protein S, Antithrombin III, Lupus Anticoagulant, and APCR) C. Hypocoaguble State: (Factors quantitationlqualitation (FXIII) and inhibitors) D. DlC screen: (D-Dimer) E. Platelets aggregation and v. W .cofactor/antigen
III. BLA testing
A. Serotyping B. Serologic crossmatching
IV .Duration:
A. First year resident:
-2 months hematology -2 months coagulation/special
B. Second year
-2 months hematology -2 months coagulation/special
V. Research:
Each resident is encouraged to work on establishing new procedures whenever available and participate in research activity.
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Molecular Diagnostics Laboratory
During their rotation in the Molecular Diagnostics Laboratory at AUBMC, the Pathology and Laboratory Medicine Residents, Medical Laboratory technology and elective students will have the opportunity to get exposed to the following aspects of the facility:
A brief introduction on �Why and How?� to establish and use a Molecular Laboratory with emphasis on role of research in Medicine and progress in treatment of several diseases.
A tour in the Lab to show them the equipment and different partition sections with emphasis on the flow of work from the minute a specimen reaches our section till its application on a thermocycler.
Introduction to the various tests performed (HLA typing, Leukemia panels, Molecular Coagulation Profile, Molecular Microbiology testing�.etc) and explanations of the technical principles and procedures.
A live demonstration for the various phases of a procedure (extracted and processed samples, PCR amplification in progress, a gel running, an X-rayed gel, and a stored final data for the patient) and interpretation of the corresponding result.
Problem solving: Participation of the students and residents in interpreting some tests on their own after performing the tests, thus will be acquiring hands-on-experience throughout their rotation. This is usually done under direct supervision of the Senior technologist in charge of the section or the Director of the section.