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During the first year, Fellows rotate through the following Hematology services:
Heme 1 (IPOP)
This is an inpatient/outpatient service that manages a variety of patients receiving intensive outpatient therapy. IPOP functions as a day hospital. Most of the patients are being treated for hematologic malignancies (leukemia, lymphomas, MDS, plasma cell dyscrasias, myeloproliferative disorders etc.). Approximately half of the patients are bone marrow transplant patients and the rest are patients undergoing intensive outpatient chemotherapy. Fellows become proficient in managing GVHD, non-myeloablative BMT, donor lymphocyte infusions, blood and marrow stem cell procurement, and the outpatient management of intensive therapy for leukemia and lymphomas. Fellows also learn to read bone marrows with one-on-one attending supervision during this 1 month rotation. IPOP fellows average reading 6-8 bone marrows daily.
Heme 2 (Burke service)
This is an inpatient adult leukemia service with an average daily census of 18-22 patients. The service consists of approximately 60% AML patients, 30% ALL patients, 5% aggressive MDS and 5% other. Forty percent of the acute leukemia admissions are newly diagnosed and 60% are admitted for relapsed or refractory disease. There are usually 2 fellows a medical resident and a medical intern on the service. Most fellows spent 8 weeks of their first year on this service.
Heme 3 (Santos service)
This is an inpatient bone marrow transplant service with an average daily census of 18 patients. Fellows become facile with all types of BMT including autologous, allogeneic, matched-unrelated donors, haplo-identical donors, and T cell depletion. BMT for malignant, autoimmune, and genetic diseases are performed on this service. There is usually one fellow, a medical resident and a medical intern on the service. Most fellows spend 8 weeks of the first year on this service.
This is a an inpatient hematology/consult service with an average daily census of 5 inpatient hematology patients and 2-3 daily hematology consults from a variety of different services at Johns Hopkins Hospital. In addition to the fellow there is a medical resident and often 1 or more medical students on this service. Fellows see a wide-spectrum of hematologic diseases on this service. Roughly half of the patients have classic hematologic disorders (e.g., aplastic anemia, paroxysmal nocturnal hemoglobinuria, TTP, ITP, hemolytic anemia, sickle cell anemia, coagulation disturbances etc.) and half the patients have hematologic malignancies (e.g, plasma cell dyscrasias, myeloproliferative disorders, MDS, lymphomas). This service also performs adult inpatient hematology consults for Johns Hopkins Hospital, including the Departments of Medicine, Surgery, Obstetrics and Gynecology, Psychiatry, and Neurology. Fellows spend 10-12 weeks on this service and gain enormous experience in inpatient and consultative hematology. Fellows also spend every other week interpreting bone marrows, iron stains, and peripheral blood smears with one-on-one attending supervision.
Hematology fellows spend one month on a transfusion medicine rotation. This rotations provide exposure to both theoretical concepts and practical experience in blood bank administration, donor procedures, donor testing, reference immunohematology, platelet serology, transfusion consultations, cytapheresis, bone marrow processing and therapeutic apheresis. The faculty of the Division of Transfusion Medicine is internationally known for expert testing, diagnostic, and consultation services.
A one month rotation in laboratory Hematology is provided for all Hematology fellows. Fellows learn to interpret complex hemostasis panels, platelet function studies, hemoglobin variant evaluations, whole blood and plasma viscosity studies and peripheral blood smears and bone marrow smears from patients with adult and pediatric blood disorders.
A one month rotation is designed to augment the fellows’ skills in diagnosing lymphomas, leukemias, and bone marrow failure disorders. The fellows will have an opportunity to become proficient in interpreting bone marrow biopsies, peripheral blood smears, lymph node biopsies, special stains and flow cytometry. Hematology fellows received direct supervision from Johns Hopkins Hematopathologist.