The coagulation rotation combines laboratory aspects of coagulation with clinical experience managing both adult and pediatric patients with coagulopathies. Residents will begin the rotation discussing pre-analytical variables and specimen collection issues specific to the coagulation laboratory and then throughout the month, become familiar with the instrumentation and methodologies available in our coagulation laboratories, including the BCS® and Stago coagulation analyzers and PFA-100®. The resident will learn detailed information about available in-house tests, including the PT, PTT, fibrinogen, factor 8, antithrombin 3, factor Xa, D-dimer, and platelet function assays, mixing studies, platelet counts, and lupus anticoagulants through daily interaction with faculty and technologists. Experience with more specialty coagulation testing, including platelet aggregation studies, von Willebrand tests, factor and inhibitor assays, PF4 and ADAMTS13 assays will be provided by weekly participation in the combined BloodCenter of Wisconsin/Children’s Hospital of Wisconsin coagulation conference. Residents will have exposure to available molecular testing as it relates to hypercoagulable work-ups. The resident will apply their acquired knowledge of coagulation testing in concentrated studies on specific disease states, including platelet hypofunction states, von Willebrand disease, disseminated intravascular coagulation, hemophilia/coagulation factor deficiencies, and thrombocytopenic and hypercoagulable states.
At the end of the rotation, aspects of laboratory management and regulation specific to a coagulation laboratory will be emphasized, using the College of American Pathologists coagulation inspection checklist as a guide. Additionally, opportunities exist for resident involvement in several clinical settings during this rotation, including the Children’s Hospital of Wisconsin outpatient coagulation clinic, adult outpatient hematology clinic, inpatient benign hematology consultation service, and the transfusion medicine service.