Training Program

Medical Director, Apheresis and Cellular Therapy, Fred Hutch
Associate Member, Clinical Research Division, Fred Hutch
Professor, Division of Hematology, Department of Medicine, UWSOM

Fellows learn about the presentation, pathophysiology, clinical manifestations, diagnostic approaches and treatment of a wide variety of benign and malignant hematologic disorders. Fellows attend multidisciplinary clinics in hematology and hematologic malignancies. Fellows participate in a variety of ambulatory care clinics, including lymphoma, MDS, myeloma and hematology.

This rotation also provides an opportunity to observe in the Apheresis Unit and Cellular Therapy Lab to gain an understanding of the technical and clinical aspects of peripheral blood stem cell mobilization and collection, processing and cryopreservation. Fellows also participate in consultations for patients who may be candidates for blood and marrow transplantation (BMT), as well as see long-term BMT follow-up patients.

Medical Director, Adult Blood and Marrow Transplant Program, Fred Hutch
Associate Member, Clinical Research Division, Fred Hutch
Associate Professor, Division of Medical Oncology, Department of Medicine, UWSOM

The BMT ambulatory care rotation pairs fellows with foremost experts in the BMT field. The goal of this rotation is to learn the theory, indications, treatment approaches, complications and outcomes of autologous and allogeneic bone and marrow transplantation and to develop confidence and clinical expertise in the care and management of transplant recipients. BMT patients are followed pre- and post-transplant for a period of approximately 100 days, after which they are referred back to their referring physician. Fellows see patients admitted for stem cell infusion in preparation for non-myeloablative transplants and unrelated “mini” transplants.

Fellows have the opportunity to conduct a patient care conference of his/her choosing:

• arrival (a summary of the major issues to be addressed during pre-transplant evaluation);
• data review (a summary of the pre-transplant evaluation results and upcoming transplant treatment plans, goals, risks and potential adverse events); or
• discharge (a summary of post-transplant events and recommendations for further therapy after discharge from the BMT service).

Clinical Associate Professor, Division of Hematology, Department of Medicine, UWSOM
Associate Medical Director, Inpatient Hematology/Oncology Service, Fred Hutch

The fellow works as an active consultant on this inpatient rotation and works directly with the residents, nursing staff, pharmacists, social workers, and the attending physician to assure appropriate workup and care of patients. The fellow supervises the resident who is responsible for primary medical management. The inpatient unit includes patients with new diagnoses of leukemia, lymphoma, aplastic anemia, sickle cell disease, and many solid tumor cancers including renal cell, colorectal, breast and melanoma. The UWMC is a referral center for the five WWAMI states (Washington, Wyoming, Alaska, Montana, Idaho) as well as a local primary care site.

Associate Professor, Division of Hematology, Department of Medicine, UWSOM

This rotation provides the opportunity to learn about the work-up, laboratory assessment and treatment of a wide variety of hematologic consultative issues. The focus is benign hematology. Hematology consults often involve evaluation of adenopathy, splenomegaly, and cytopenias, and the management of complex bleeding abnormalities or thrombotic complications, especially in surgical and obstetrical settings.

The UWMC is a referral center for the five WWAMI states (Washington, Wyoming, Alaska, Montana, Idaho), and thus, is an active site for both basic medical care and for tertiary referral issues, such as liver transplantation, complex surgery, and high-risk obstetrics. The use of flow cytometry and immunocytochemistry methods are important focuses of this rotation.

Medical Director, Adult Blood and Marrow Transplant Program, Fred Hutch
Associate Member, Clinical Research Division, Fred Hutch
Associate Professor, Division of Medical Oncology, Department of Medicine, UWSOM

The BMT inpatient rotation at UWMC pairs fellows with foremost experts in the BMT field. The goal of this rotation is to learn the theory, indications, treatment approaches, complications and outcomes of autologous and allogeneic stem cell transplantation and to develop confidence and clinical expertise in the care and management of transplant recipients. Fellows provide primary care of patients with the assistance of the attending physician, nursing, pharmacy, social services, transition team, and the outpatient clinic providers. The fellow is responsible for the intake, daily management, diagnostic and therapeutic decision-making, documentation (paper and electronic), and coordination of discharges. Supportive care includes platelet and granulocyte transfusions, reverse-isolation techniques, Hickman catheters, nutrition research, plasma exchanges, ex vivo immunoabsorption, infection prevention and treatment in granulocytopenic and immunosuppressed patients. Basic principles of intensive chemoradiotherapy are emphasized.

Medical Director, Transfusion Services
Division Head, Transfusion Medicine
Associate Professor, Department of Laboratory Medicine and Pathology
Adjunct Associate Professor, Division of Hematology, Department of Medicine

Transfusion medicine training includes instruction in the theory and practical application of transfusion medicine, immunohematology, cellular therapies and therapeutic management of bleeding disorders. The focus is on developing consultative and primary skills in these systems-based subdisciplines of hematology. Training sites include the Transfusion Services at UWMC and Fred Hutch with additional experiences at BWNW and WACBD. Fellows are exposed to testing, procurement and selection of blood products, including crossmatch and antibody identification, HLA and platelet immunology. Additional experiences include therapeutic and donor apheresis, transfusion consultations, case management in support of the bleeding patient, transfusion reactions and antibody-related clinical issues.