The transfusion medicine specialist as a coagulation consultant: a new variant of therapeutic pathology

Abstract

Practitioners in transfusion medicine, long involved in consultations emphasizing clinical issues such as alloantibody reporting and transfusion reaction evaluation, have more recently been engaged as experts and consultants in hemostasis and coagulation. Given the growing complexity in laboratory coagulation testing and its interpretation, the shortage of specialists in this arena, and the increasing costs associated with patient management, we believe that there are vital clinical roles in hemostasis that can be readily fulfilled by transfusion medicine practitioners. The aim of this article is to briefly outline three possible models by which transfusion medicine practitioners can begin to integrate coagulation consultation into their regular clinical practice. Moreover, we discuss a novel curriculum that we are developing at our institution to more fully train transfusion medicine fellows in the fields of hemostasis and thrombosis.

How do we manage cardiopulmonary bypass coagulopathy?

“…The CBH service provides an example of the important role that the pathologist can serve as clinical consultant. Clinical pathologists, especially those trained in transfusion medicine, have extensive knowledge of coagulation testing and interpretation, hemostasis, and the selection of blood products . Clinical pathologists have long been involved in consultations involving interpretation of coagulation tests and clinical issues related to alloantibodies and transfusion reaction evaluations.…”

“…Blood bank monitoring of blood components and intervention when suboptimal transfusion practice was identified resulted in improved survival and decreased transfusion need in the postoperative period of massively transfused patients . Tormey and Smith review potential models by which clinical pathologists can integrate consultation on coagulation into daily practice.…”

“…The CBH pathologist participating in patient rounds and writing consultation and progress notes educates clinicians about appropriate test ordering and interpretation and transfusion practices. Such interactions increase the availability of clinical pathologists and increases the impact they can have on patient care . Of note, the role of the CBH service is considered critical by the advanced heart failure clinicians at our institution.…”

“…In summary, we have successfully introduced a novel pathology consultation service that provides laboratory and transfusion support to patients with a high risk of bleeding and associated morbidity. There is a demand for such services, and clinical pathologists with their knowledge of coagulation testing, interpretation, and optimal transfusion practices can help fill this need . However, limitations of such services include the large amount of time required of attending pathologists who are also expected to cover other pathology services.…”

“…Clinical pathologists, especially those trained in transfusion medicine, have extensive knowledge of coagulation testing and interpretation, hemostasis, and the selection of blood products. 29 Clinical pathologists have long been involved in consultations involving interpretation of coagulation tests and clinical issues related to alloantibodies and transfusion reaction evaluations. Nevertheless, there is potential for clinical pathologists to further expand their role to direct management of coagulopathy in acute bleeding situations.…”