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Blood Banking/Transfusion Medicine

Image F: H&E stain, high magnification, brain

Image F: H&E stain, high magnification, brain

Blood banking/transfusion medicine is a fascinating subspecialty, replete with time-sensitive critical decisions that can affect a single patient or many. It’s unique in that it’s not only heavily regulated, but often involves direct contact with patients, donors, and physicians.

Being an efficient practitioner in this arena requires confidence, definitive knowledge about transfusion and its practices, and interdepartmental cooperation. Pathologists practicing in blood banking/transfusion medicine work not only in the laboratory, but also at the bedside, often actively managing patient care.

Because blood banking/transfusion medicine requires extremely specific skills for employment—such as blood donor centers, hospital laboratories, or cellular therapy laboratories—flexibility is helpful for those looking to practice exclusively. The good news is that there are more positions available now than in the recent past, a trend which is likely to continue as institutions increasingly emphasize the role of the blood banking/transfusion medicine physician in apheresis and cellular therapy practice.

Private practice could be composed of blood centers such as a Red Cross collection center, which focus solely on blood banking but will have a lower salary. If you want to focus solely blood banking/transfusion medicine, you might also potentially be limited to an academic center.

Medical school loan reimbursement programs are available in academic centers but not in private practice, which may help ease salary differences initially, and it’s important to figure out what geographic locations might be best tailored to your training.

Frequently Asked Questions

The standard fellowship is one year, although some programs offer additional research years or focus on cell therapy practice.

Yes, there is plenty of on-call time, with varying levels of responsibility depending on the program and position. Some on-call duties can be managed through phone calls, while others may require you to be there in person for urgent circumstances—regulatory, patient safety, etc—and apheresis services.

The on-call workload can be heavy and may require constant access to an electronic medical record system. In addition, a pathologist must be on call 24/7 for emergency blood issues, and an attending physician is always available as a supervisor.

Generally, in transfusion medicine, the case volume does not accurately reflect the testing volume and variety of work performed, as it can vary greatly depending on the institution and its program. Other factors—such as the presence of apheresis patients and the size and location of the laboratory—can also play a role in determining the number of ancillary tests run.

For instance, you can have a mixture of apheresis, transfusion consults, and prospective reviews of blood products. Or your program might run 20–30 apheresis procedures a day, compared to others that may only run a handful. Moreover, large academic centers have many routine and “zebra” cases, but smaller institutions may be limited due to volume.

Other duties such as administrative tasks, laboratory management, and subspecialty fields may also contribute to the workload. Size also determines specialty laboratories for blood banking/transfusion medicine such as immunohematology reference laboratory and HLA/tissue typing, cell therapy, and manufacturing.

It’s probably easier to list specialties that blood banking/transfusion medicine doesn’t interact with—like psychiatry and ophthalmology—because this subspecialty interacts with any service that utilizes or transfuses blood.

So in addition to its role in the apheresis clinic, blood banking/transfusion medicine extends into many other medical specialties, including internal medicine, hematology/oncology, neurology, emergency medicine, obstetrics/gynecology, pulmonology, nephrology, trauma, anesthesia, pediatrics/neonatal, critical care, intensivists, rheumatology, solid organ and bone marrow transplant, and transplant, orthopedic, and general surgery, among others.

The level of variety is what many prospective practitioners find inherently enjoyable about this subspecialty.

Yes. The Association for the Advancement of Blood and Biotherapies (AABB) is the main national organization, but there are other organizations such as the American Society for Apheresis (ASFA), the International Society for Cell & Gene Therapy (ISCT), and the American Society for Transplantation and Cellular Therapy (ASTCT).

There are also state associations—such as the California Blood Bank Society (CBBS)—that can provide a more local support network when needed. They are always open to any inquiries and encourage any interaction.

Ultimately, this is predicated upon ones’ personal, professional, and career goals. But most commonly, transfusion medicine practitioners also take care of the coagulation laboratory.

In terms of other fellowships, some pair it with hematopathology and work with both benign and malignant blood. Others have paired it with informatics to develop data-driven processes to improve practice. Still others have paired with a surgical pathology subspecialty to better position themselves for community/private practice.

The short answer is “Yes,” as either a consultative or direct provider. You may routinely see patients in a consultative manner for anything applicable. But you may also be called upon to be in person at the bedside for occurrences such as (and not limited to) apheresis, adverse events, challenging clinical consults, etc.

Association for the Advancement of Blood and Biotherapies | American Society of Apheresis