Flow Cytometry, Histocompatability and Immunology

Teaching of flow cytometry, histocompatibility, and immunology are combined into a one month rotation with the resident spending two weeks in flow cytometry, one week in the histocompatibility laboratory, and one week on diagnostic immunology. Although knowledge of some testing for immunologic diseases is acquired during this rotation (primarily cell-based testing), the serologic assays are covered during the chemistry rotation. Also in regards to immunology, an emphasis is placed on the understanding general immunology principles and the diagnosis and pathophysiology of primary and acquired immunodeficiencies during this rotation.

Goals and Objectives

By the end of the rotation, the resident will demonstrate the following skills: 

Patient Care 

• Understand techniques for cellular phenotyping by flow cytometry for the care of patients with hematologic malignancies and transplants.
• Understand the role of flow cytometry in the classification of hematologic malignancies for patient care.
• Understand the role of flow cytometry in the management of patients with immunologic diseases.
• Understand the quality management of the flow cytometry laboratory.
• Understand modern techniques for detecting histocompatibility antigens and antibodies to histocompatibility antigens for the care of patients with solid organ and hematologic transplants.
• To be able to provide advice to clinicians about appropriate specimens for different types of nucleic acid based diagnostic tests, and to communicate urgency of certain samples to the laboratory staff.
• Know the test of choice for the identification of specific viral diseases, including viral isolation, detection of viral antigens, detection of genomic nucleic acid, or viral serology.
• Know the fundamentals of testing for human immunodeficiency virus, and to be able to correlate the results with the stage of the patient's disease and treatment.
• Know current protocols and recommendations for testing cervical cytology specimens for human papilloma virus, including interpretation of tests.
• Learn current tests available for the detection of syphilis, including the ability to correlate test results with disease stage.

Medical Knowledge

• Understand basic principles of immunology and histocompatibity.
• Understand the use of phenotype in classifying hematologic neoplasms.
• Understand the utility of stem cell enumeration.
• Understand the significance of lymphoid cell quantification.
• Understand the technical basis for flow cytometry testing.
• Understand the quality issues involved in flow cytometry testing.
• Perform each of the tests offered by the histocompatibility laboratory.
• Understand the technical basis for histocompatibity testing.
• Know the advantage and disadvantage of antigen test and the sensitivity and specificity of each test.
• Understand the significant of each viral serology test.
• Understand and interpret the panel EBV test.
• Understand the different test methods and their usage.
• Know the biology of hepatitis viruses.
• Know the choice for hepatitis A virus and why.
• Know how to test for hepatitis Band how to interpret the results of the test panel.
• Know how to test for hepatitis C and the window period for different test.
• Know the biology of human papilloma virus.
• Know the properties of certain new emerging viruses and suspected viral diseases.
• Know the fundamentals of specimen collection, processing and preparation for virus isolation.
• Know the general principle of virus life cycle.

Practice-Based Learning and Improvement

• Interpret flow cytometry testing results.
• Understand potential technical errors and quality issues in the flow cytometry laboratory.
• Interpret histocompatibity testing result. 

Interpersonal and Communication Skills

• Provide important information about flow cytometry testing to clinicians.
• Demonstrate skills in interacting with the technical staff.
• Provide important information about histocompatibity testing to clinicians
• Read and present one paper from the current literature for laboratory staff.

Systems-Based Practice

• Understand the clinical utility of flow cytometry testing as applied to hematology/oncology practice.
• Understand the clinical utility of flow cytometry testing as applied to clinical immunology practice.
• Understand the clinical utility of histocompatibity testing as applied to organ and tissue transplantation.

Duration

Training in histocompatibility is one week and is combined with three weeks of flow cytometry in a one month rotation. 

Duties and Responsibilities of Residents by Year 

Because Resident training in this rotation is taught at one point in time, there is no incremental responsibility in different years of training. During the rotation each Resident is expected to perfom the following activities:

• Review and sign out all flow cytometry results with the Attending Pathologist.
• Review Cytospin and peripheral blood smears from specimens received from outside institutions with the attending pathologist to help in the interpretation of the flow cytometry findings.
• Review the CAP checklist questions and guidelines regarding flow cytometry.
• Review the phenotype of hematologic neoplasms.
• Review the immunologic findings in the primary immunodeficiencies.
• Review and sign out all immunodeficiency profiles with the Attending Pathologist.
• Observe, under the supervision of the technical staff, the processing and technical analysis of surgical, bone marrow, and blood specimens.
• Read one original paper in the field ofhistocompatibility testing and prepare a brief presentation of the paper for the histocompatibility laboratory staff.
• Review histocompatibility laboratory procedures.
• Review results of histocompatibility testing with the attending pathologist or laboratory manager.
• Perform a determination of the histocompatibility antigens present on a sample of the resident's own peripheral blood leukocytes.

In addition, whenever scheduling permits, residents will be expected to attend histocompatibility-related teleconferences (offered by the Georgetown University Histocompatibility Laboratory on a continuing basis) in which the laboratory staff participate.

Teaching Staff

Howard Meyerson, M.D.-Director of Flow Cytometry

Neil Greenspan, M.D., Ph.D. - Director of Histocompatibility

Christine Schmotzer, MD – Director of Diagnostic Immunology