Maharashtra University of Health Sciences Courses

M.D. (Blood transfusion & Immunohaematology)

Objectives:

At the end of the course a candidate must be able to

• (i) Understand and explain about the scientific basis of blood transfusion.
• (ii) Understand the processes of blood collection, processing and component preparation.
• (iii) Understand and explain the basis of pre transfusion testing.
• (iv) Should be able to explain and diagnose the adverse effects of blood transfusion.
• (v) Should be able to perform apheresis technique independently.
• (vi) Should be able to carry out the antenatal and neonatal transfusion practice.
• (vii) Should be able to plan, perform and report specific research projects.
• (viii) Should be able to give advice on haemotherapy including stem cell transplantation and solve the immunohaematological discrepancies in blood transfusion.

Course Content (Syllabus)

Duration of Course:

The minimum period of training shall be three calendar years and the candidates can be admitted to this training after their full registration with the Medical Council. No  exemption shall be given from this period of training of three years either for doing housemanship or for any other experience or diploma.

Training Programme:

The candidates joining the course must work as full time residents during the whole period of their postgraduate training. They will be required to attend a minimum of 80% of training period. Candidate shall be given full time responsibility and assignments and their participation in all facets of the educational process assured. Postgraduate students must maintain a record book of the work carried out by them and the training undergone by them during the period of training. These record books shall be checked and assessed by the faculty.

Teaching/Learning Methods:

Learning in M. D. (Immunohaematology & Blood Transfusion) will essentially be self-learning.

Following teaching-learning methods shall be followed-

Group teaching sessions:

• Journal review
• Subject seminar presentation
• Group discussion
• Clinical case presentations pertaining to transfusion therapy.
• Presentation of the findings of an exercise on any of the sub-specialties
• Participation in CME programs and conferences

Hands on experience (practical training)

Practical training shall be imparted by posting the students in various sub-specialties (sections) as detailed in the intrinsic and extrinsic rotation. Student shall be actively involved in day to day working of all the sections. He/she will be trained under the guidance of teachers in all the aspects of practice of transfusion therapy and basic blood banking techniques including blood collection, processing, storage of blood products, component preparation, pre transfusion testing, apheresis, screening of blood products and haemotherapy. Including stem cell transplantation.

Suggested schedule of rotation:

Intrinsic rotation:

The candidates will be rotated through various sections of the department as under:

• A) Blood donor management (6 months)
  • Donor recruitment & motivation
  • Blood donor selection
  • Phlebotomy
  • Post donation care of donor
  • Outdoor blood donation camps
• B) Component preparation, Aphereis & Quality Management (6 months)
  • Preparation of various blood components
  • PRBC, FFP, PC, Cryo, Leuco – poor
  • Irradiation of blood components
  • Storage & quality control
  • Apheresis
  • Donor apheresis
  • Therapeutic plasma exchange
• C) Transfusion transmitted infection screening (5 months)
  • Screening of various markers
  • HIV, HCV, HBsAg, Syphilis Methodology
  • ELISA, Spot, Rapid, Automated analyzer
  • Molecular techniques
• D) Immunohematology (6 months)
  • Diagnosis & Transfusion support in
  • AIHA
  • PNH
  • Transfusion reaction
  • Antenatal serology
  • Multi – transfused patients
  • Secretor status
  • Minor red cell antigen typing
  • Antibody screening
• E) Pre transfusion testing & Cross matching (6 months)
  • ABO grouping & Rh typing
  • Du testing, genotyping
  • Irregular antibody screening & identification
  • Cross – matching
• F) Quality control / computers / records (1 month)
• G) PBSCT, Umbilical cord stem cells, Bone marrow stem cells (1 month)
  • Harvest
  • CD 34 counts
  • Cryopreservation

Training in allied departments

• A) Dept of Pathology (Haematology division) (1 month)
  • Complete haemogram
  • Reading of peripheral smear
  • Coagulation work up
• B) Dept of Virology (1 month)
  • Isolation of lymphocytes
  • CD4 / CD8 counts
  • Special molecular techniques
• C) Dept of Microbiology (2 weeks)
  • Bacterial culture
  • Grams staining
• D) Dept of Anesthesiology (2 weeks)
  • Intra-operative haemodilution
  • Operation of cell saver
  • Intra operative transfusion
• E) Dept of Clinical Haematology & BMT (2 weeks)
• F) Institute of Immunohaematology, Mumbai (1 month)
  • HLA typing
  • Immunophenotyping incl flowcytometry
  • Immunofluoresence
• G) National Plasma Fractionation Centre, Mumbai (2 weeks)
  • Fractionation
  • Advanced Serology

Emergency duty:

Student shall be posted for managing emergency transfusion services in the department. He/she will deal with all the emergency investigations in transfusion medicine.

Training in research methodology:

Training in research methodology shall be imparted by planning of a research project by the student under the guidance of a recognized guide to be executed and submitted in the form of a dissertation. The dissertation is aimed at training the candidate in research methods and techniques. It will include identification ofa research question, formulation of a hypothesis, search and review of relevantliterature, getting acquainted with recent advances, designing of research study,collection of data, critical analysis of the results and drawing conclusions. The topic shall be communicated to the university within six months of registration and at least 12 months should be spent on the research project. The dissertationshall be completed and submitted by the student six months before appearing for the final university examination.

Teaching experience:

Student shall be actively involved in the teaching of undergraduate students/paramedical staff. He/she will be trained in teaching methods and use of audiovisual aids.

Broad Areas of Study

I. History of Transfusion Medicine

• 1.1. Scientific landmarks in its development
• 1.2. Impact of world wars on its development
• 1.3. Development of PVC bags

II. Scientific Basis of Transfusion

• Biochemistry & Physiology of elements of blood
  • 2.0 Process of cell production and life span
    • 2.1 Red cells
    • 2.2 White blood cells
    • 2.3 Platelets
  • 3.0 Red cells
    • 3.1 Haemoglobin structure & function
    • 3.2 Metabolic pathways
    • 3.3 Membrane structure & function
  • 4.0 White cells
    • 4.1 Structure, function & kinetics
  • 5.0 Platelets
    • 5.1 Structure, function & kinetics
  • 6.0 Physiology of Haemostasis
    • 6.1 Role of platelets
    • 6.2 Coagulation pathways
    • 6.3 Fibrinolysis
  • 7.0 Hemodynamics of blood flow & volume
  • 8.0 Iron metabolism
  • 9.0 Bilirubin metabolism
• Immunology
  • 10.0 Principles of Basic Immunology
    • 10.1 Antigen, Antibody, Complement, Immunoglobulin
    • 10.2 Antigen/antibody reaction
    • 10.3 Lymphocytes in Humoral & Cellular immunity
  • 11.0 Role of Hybridoma technology in Immunology
  • 12.0 Immunology of transplantation
  • 13.0 HLA & genetic control of immune response
• Genetics
  • 14.0 Principles of basic genetics
  • 15.0 Genetics of Blood groups
    • 15.1 Phenotypes & genotypes
    • 15.2 Principles of blood group inheritance
    • 15.3 Population genetics of blood groups

III Antigen Systems In Formed Elements Of Blood

• 16.0 Red cell antigens
• 17.0 Leucocyte antigens
• 18.0 Platelet antigens

IV Blood Collection, Processing, Component Preparation

• 1. Management of blood donation
  • 19.0 Donor recruitment
    • 19.1. Voluntary blood donation system
    • 19.2. Categories of blood donors
    • 19.3. Education & awareness of prospective donors
  • 20.0 Acceptability criteria of blood donor
  • 21.0 Care of blood donors
    • 21.1 Pre-donation
    • 21.2 Mid-donation
    • 21.3 Post-donation
    • 21.4 Prevention & management of complications of blood donation
  • 22.0.Blood collection
    • 22.1. Anticoagulants & preservatives
      • 22.2.1 Procedure
      • 22.2.2 Blood donation camps
• 2. Blood Components
  • 23.0. Components
    • 23.1 Types
    • 23.2 Methods of preparation
    • 23.3 Indications, dosage & administration
    • 23.4 Leuco-depletion
      • 23.4.1.Various Methods
      • 23.4.2.Quality Control
  • 24.0 Storage of blood & components
    • 24.1. Whole blood
    • 24.2. Red cell concentrate
    • 24.3. Plasma
    • 24.4. Granulocyte
    • 24.5. Cryoprecipitate
    • 24.6. Stem cells
      • 24.6.1.Peripheral blood stem cells
      • 24.6.2.Cord blood stem cells
  • 25. 0 Plasma fractionation

V Pre-Transfusion Testing

• 26.0 Compatibility testing
  • 26.1 ABO grouping & Rh typing
  • 26.2. Antibody screening
  • 26.3. Methods of cross matching
  • 26.4. Newer methods of cross matching
    • 26.4.1. Solid phase
    • 26.4.2. Gel technology
• 27.0 Screening for Transfusion Transmitted Infections
  • 27.1. Methodology
  • 27.2 Nucleic acid amplification techniques
  • 27.3 Newer emerging pathogens
    • 27.3.1.1 Prions
    • 27.3.1.2 C J disease
    • 27.3.1.3 Lyme disease
    • 27.3.1.4 Others
• 28.0 Selection of blood, components & plasma products for transfusion

VI Adverse Effects of Blood Transfusion

• 29.0 Clinical presentation, pathophysiology, investigations, management
  • 29.1. Hemolytic transfusion reaction
  • 29.2. Non hemolytic transfusion Reaction
• 30.0. Transfusion Transmitted Infections
• 31.0. Transfusion Associated- Graft versus Host Disease(TA-GVHD)
• 32.0. Transfusion Related Acute Lung Injury (TRALI)
• 33.0 Others
  • 33.1. Haemosiderosis
  • 33.2. Volume overload

VII Apheresis

• 34.0. Technology of apheresis and various machines
• 35.0 Haemapheresis (platelets, granulocytes, plasma)
  • 35.1. Donor selection
  • 35.2. Procedure
  • 35.3. Complications
• 36.0 Therapeutic apheresis
  • 36.1 Indications, procedure & Complications
  • 36.2 Plasma exchange, red cell Exchange
  • 36.3 Newer methods of Immunoadsorption

VIII Autologous Transfusion

• 37.0. Basic principles, indications, contra-indications
  • 37.1. Pre-deposit
  • 37.2. Haemodilution
  • 37.3. Intra-operative blood salvage including equipment
  • 37.4. Directed donation

IX Antenatal & Neonatal Transfusion Practice

• 38.0 Pathophysiology, diagnosis & management 1
  • 38.1. Rh incompatibility
  • 38.2. ABO & other blood group incompatibility
• 39.0 Exchange transfusion
  • 39.1. Indications, methodology & complications
  • 39.2. Intrauterine transfusion
• 40.0. Neonatal transfusion practice

X Immunohematology

• 41.0 Classification, diagnosis and management
  • 41.1 Immune haemolytic anaemia
  • 41.2 Immune thrombocytopenia
  • 41.3 Immune neutropenia
• 42.0. Immunohaematological problems in multi-transfused patients

XI Hemotherapy

• 43.0. Pathophysiology, diagnosis and management of anaemia
  • 43.1 Anaemia
  • 43.2 Iron deficiency anaemia
  • 43.3 Megaloblastic anaemia
  • 43.4 Aplastic anaemia
  • 43.5 Haemolytic anaemia including fragmentation syndrome
  • 43.6 Anaemia of chronic diseases – liver disease, uremia, thyroid disease
• 44.0. Haemoglobinopathies
  • 44.1 Thalassaemia
  • 44.2 Sickle cell anaemia
  • 44.3 Other haemoglobinopathies
• 45.0. Pathophysiology, diagnosis and management of haemostatic disorders
  • 45.1 Haemophilia
  • 45.2 Von willebrands disease
  • 45.3 Platelet disorders
  • 45.4 Qualitative disorders
  • 45.5 Quantitative disorders
  • 45.6 DIC
• 46.0. Pathophysiology, diagnosis and transfusion support in acute blood loss
  • 46.1 Shock
  • 46.2 Massive transfusion
• 47.0. Transfusion support in cardiac surgery
• 48.0 Classification & transfusion support in Oncology
  • 48.1 Leukaemia
  • 48.2 Lymphoma
  • 48.3 Marrow failure

XII Transplantation

• 48.0 Transfusion support in transplantation
  • 48.1 Peripheral blood stem cell transplantation
    • 48.1.1 Harvesting
    • 48.1.2 Cryopreservation
    • 48.1.3 CD34 counting
  • 48.2 Bone marrow transplantation
    • 48.2.1 Processing
    • 48.2.2 Harvesting
    • 48.2.3 Immunohaematological problems in ABO mismatched BMT
  • 48.3. Transfusion support in specialized conditions
    • 48.3.1. Renal transplantation
    • 48.3.2. Liver transplantation
    • 48.3.3. Umbilical cord blood transplantation
      • 48.3.3.1. Collection
      • 48.3.3.2. Processing
      • 48.3.3.3. HLA typing & cross matching
• 49.0 Irradiation of blood products
• 49.1. Indications, dosage, adverse effects 1
• 50.0 Tissue banking

XIII Blood Substitute & Hemoooietic Agents

• 51.0 Crystalloids & colloids
• 52.0 Oxygen carrying compounds
• 53.0 Haemopoietic growth factors
• 54.0 Albumin

XIV Medicolegal Considerations In Transfusion

• 55.0 Ethical & legal considerations pertaining to transfusion practice
• 56.0 Identification of blood stains
• 57.0 Paternity testing
• 58.0 Donor notification and counselling
• 59.0 Look back programme
• 60.0 Drugs & Cosmetics act, Accreditation

XV Total Quality Management

• 61.0 Development of Standard Operating Procedures (SOP) manual
• 62.0 Quality control
  • 62.1. Reagents
  • 62.2. Instruments
  • 62.3. Personnel
  • 62.4. Blood & Components
• 63.0 Quality assurance
  • 63.1. Internal quality control
  • 63.2. External quality control
• 64.0 Medical audit
• 65.0 Hospital transfusion committee
• 66.0 Good manufacturing practice (GMP)
• 67.0 Turnaround time
• 68.0 ISO 9000

XVI Organisation & Management Of Transfusion Services

• 69.0 Organisation & function of blood services & hospital transfusion practice
  • 69.1. Donor recruitment & motivation
  • 69.2 Operation of blood mobile units
  • 69.3 Development of transfusion services
  • 69.4 Inventory control
  • 69.5 Development of forms, labels, records etc.
  • 69.6 Reports & Returns
• 70.0 National Blood Transfusion Policy

XVII Blood Safety

• 71.0 Sterilization
• 72.0 Disposal of bio-hazardous material

XVIII Modern Biological Techniques

• 73.0 Principles, methods, relevance in transfusion medicine
  • 73.1 Western blot
  • 73.2 Polymerase chain reaction
    • 73.2.1 SSCP
    • 73.2.2 SSOP
• 73.3 Dot blot hybridization

XIX Automation & Computerization

• 74.0 Automated blood grouping & processing
• 75.0 Instrumentation & use of bar codes
• 76.0 Use of computers in blood banking including Implementation of blood banking software