Development of a Pediatric Transfusion Medicine Teaching Curriculum for Pediatric Anesthesiology Fellows to Improve Blood Product Utilization and Patient Safety: A Four-Year Experience

Abstract

Renal tubular dysgenesis is a rare disease of fetal kidney differentiation, which became a diagnostic entity with less than 30 years of history and with many etiologic-pathogenic variants. Most reported cases were autosomal recessive, but acquired cases, including drug-induced (ACE inhibitor, NSAID) and twin-twin transfusion-induced ones, were also present. Ischemia and reduced renal perfusion seem to be the common denominator in all cases. We report a new case and for the first time linked this entity to diabetic embryopathy. The patient was 5-hour-old premature girl born at 35 weeks of gestation via emergency cesarean section owing to an ultrasound finding of multiple fetal anomalies, oligohydramnios, and, later, fetal distress. The mother was a 22-year-old G1P1 with diet-controlled gestational diabetes but without other significant past or family medical history. External examination noted multiple dysmorphic features and abnormalities: large anterior fontanelle with open sutures; Potter face; prominent epicanthal folds; hypoplastic nasal bridge and small, low set ears; nuchal edema; bilateral clubfeet with overlapping toes; and sacral dimple. Dissection revealed bilateral renomegaly with mild hydronephrosis and features characteristic of renal tubular dysgenesis. The kidneys showed disorganized glomerulogenesis at various stages with no clear demarcation of the cortical vs medullary zones, and no cysts were identified. Most prominently were short and poorly developed proximal convoluted tubules. All tubules were monomorphic, lined by small darkly stained epithelial cells, positive for EMA, and lacking PAS-positive brush border in the apical surfaces. The other key findings included hepatomegaly, bilateral hypoplastic lungs, and hypoplastic left heart syndrome. The accompanying placenta showed placentomegaly, meconium staining, umbilical cord edema, and fetal thrombotic vasculopathy, reflecting gestational diabetes. Cytogenetic studies (FISH, karyotyping, and signature chip microarray) all showed a normal female 46,XX karyotype. We concluded that renal tubular dysgenesis can be part of a diabetic embryopathy spectrum.

Transfusion medicine curricular content for general pediatricians and pediatric subspecialists: A national multi‐specialty Delphi consensus study

“…First, the “core” curricular topics generated were similar to those identified in a study which identified curricular topics for adult residents, with RBC, platelet and plasma indications, blood bank testing and transfusion reactions and risks being rated most highly 10 . Alternatively, “extended” topics, many of which were discipline‐specific, were consistent with some of the curricular topics identified by subspecialty groups 7,9,29 . For example, management of fetal and neonatal autoimmune thrombocytopenia (FNAIT) was rated as important for clinical pathology residents, 7 while indications for use of irradiated or leukoreducted blood products was noted to be part of an anesthesia curriculum 9 .…”

“…10 Alternatively, "extended" topics, many of which were discipline-specific, were consistent with some of the curricular topics identified by subspecialty groups. 7,9,29 For example, management of fetal and neonatal autoimmune thrombocytopenia (FNAIT) was rated as important for clinical pathology residents, 7 while indications for use of irradiated or leukoreducted blood products was noted to be part of an anesthesia curriculum. 9 In addition, proposed TM topics were rated similarly by both the transfusion and non-transfusion groups of experts, highlighting their agreement on the curricular content reaching consensus.…”

“…Despite this, studies suggest that transfusion medicine (TM) knowledge is poor among both trainees and practicing physicians 3–6 . During medical training, TM teaching is limited and not standardized across programs 7–9 . There is recognition of a need to improve related education, with the goal of enhancing the safety of transfusion practice.…”

“…[3][4][5][6] During medical training, TM teaching is limited and not standardized across programs. [7][8][9] There is recognition of a need to improve related education, with the goal of enhancing the safety of transfusion practice. For residents trained in adult subspecialties, core transfusion-related competencies have been created.…”

Fundamentals of blood banking in anesthesiology: A problem-based learning simulation session as an addition to a novel curriculum of transfusion medicine education for anesthesiology residents

“…However, we were unable to find a curriculum that also included concrete teaching resources. 5 We sought to develop a curriculum that included novel materials specifically customized for anesthesiology trainees, that was brief enough to fit into a busy trainee education schedule, and that could be accessed free of charge. To these ends, we previously published an article with our “lecture-free” curriculum and complete learning materials.…”