Welcome

Welcome to the Hemoglobinopathies & Red Cell Disorders Fellowship at McMaster University. McMaster is a leader in the laboratory diagnosis and clinical care of patients with sickle cell disease, thalassemia and other inherited red blood cell disorders.

Fellows joining this program will have an opportunity to learn from internationally renowned clinicians who are deeply engaged in medical education, research, health policy and advocacy. The goal of the fellowship training program in Hemoglobinopathies & Red Cell Disorders is to develop the next generation of experts and leaders in this rapidly expanding area of Hematology.

By the end of training, the fellow will be able to:

1. Effectively diagnose and treat patients with Hemoglobinopathies and Red Cell Disorders, including complex, multisystem acute and chronic complications.
2. Provide patient-centred counseling and expert management of targeted disease modifying therapy, including hydroxyurea, transfusions, chelation therapy, and to provide patient education about novel and emerging therapies.
3. Take proactive measures in a structured, systematic way to prevent the development of chronic complications of red cell disorders.
4. Act as an expert resource and leader in diagnosis and clinical care of Hemoglobinopathies and Red Cell Disorders in their chosen practice setting.

Certification Outcome

The successful completion of the fellowship will grant a McMaster Fellowship Certification.

Entry Requirements

Trainees must be certified in Internal Medicine and Hematology, or be eligible to receive such certification during Fellowship training, to be accepted into the program.

Recent graduates are required to submit an application form and comply with McMaster University Postgraduate Medical

Application Deadline

The application deadline is November 1st for the training period beginning July 1st of the subsequent year.

Length of Training

This is a 1-year fellowship program.

The fellowship can be extended up to 2 years if combined with significant research and/or graduate degree.

Goals of Training

The Hemoglobinopathies & Red Cell Disorders (H&RCD) objectives include:

1. Medical Expert

As Medical Experts, physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician Role in the CanMEDS framework.

H&RCD Diagnosis

• Understand the core pathophysiologic principles responsible for hemoglobinopathies
  • Understand normal and disordered hematopoiesis including changes related to age
  • Understand normal and disordered red cell structure and function
• Understanding of the natural history of disease, across the spectrum of hemoglobinopathy diagnoses, both with and without medical intervention
• Develop a robust understanding of the clinical evaluation to establish an H&RCD diagnosis
• Expert understanding of the essential components of history and physical examinations requisite to establish a confident diagnosis
• Understand and apply current Sickle Cell and Thalassemia diagnostic guidelines
• Understand the role and utility of the investigations required to evaluate hemoglobinopathies
• Appropriately order, perform, and interpret the results from:
  • Laboratory evaluation
    • Molecular analysis including PCR, restriction endonuclease mapping,
    • Hemoglobin separation methods including electrophoresis, HPLC, IEF, capillary electrophoresis
    • Sickle solubility test
    • Hemoglobin H prep
    • Morphology and interpretation of peripheral blood smears
• Apply and integrate the findings of investigations and procedures in clinical decision making taking into account clinical presentation, natural history, comorbidities and prognostic assessment
• Understand the skills and personnel required to coordinate care for H&RCD in multi-disciplinary discussions
• Genetic counseling for patients and their family members

H&RCD Management

• Develop and coordinate comprehensive treatment strategy focusing on both pharmacologic and non-pharmacologic intervention
• Understand and apply current sickle cell and thalassemia treatment guidelines
• Demonstrate proficient and appropriate use of up-to-date therapeutic options in patients with hemoglobinopathies and other red cell disorders
  • Erythroid stimulating factors and maturation agents (eg luspatercept), hydroxyurea, voxeletor, crizanlizumab, pyruvate kinase activators, etc.
  • Develop a firm understanding of the indication, mechanism of action, expected treatment response, and associated adverse events associated with the therapies utilized in the management of hemoglobinopathies, including prophylactic therapies
  • Develop firm understanding of the presentation and management of acute exacerbations of sickle cell disease managed in both an outpatient and inpatient setting
  • Vasoocclusive crises, Acute chest crisis, Splenic or hepatic sequestration, Aplastic crisis, Stroke, Priapism
• Understand the physiologic changes and management of sickle cell disease and thalassemia in pregnancy and post-partum
• Appropriately recognize the indications for referral for Stem Cell Transplant evaluation
• Appropriately recognize the indications for referral for genetic therapy evaluation
• Understand the pathophysiology of iron metabolism and overload, chelation including monitoring therapy, side effects, and relevant patient counseling
• Develop firm understanding of the presentation and management of chronic complications of red cell disorders managed in both an outpatient and inpatient setting
  • Sickle Cell Disease: Retinopathy, pulmonary hypertension, functional asplenia, nephropathy, leg ulcers
  • Thalassemia: complications of chronic transfusion including chelators and their side effects, extamedullary hematopoiesis,
  • Membranopathies and hemolytic disorders: thromboembolic risk, pigmented gallstones
• Recognize the key comorbidities associated with hemoglobinopathies and develop a firm understanding their appropriate management and when to refer for subspecialist expertise
• Understand and apply the principles of transfusion medicine in thalassemia and sickle cell disease
  • Role of red blood cell phenotyping and phenotype-matched transfusion
  • Indications and monitoring for chronic simple transfusion in sickle cell disease
  • Role and management of red blood cell exchange transfusion in sickle cell disease
  • Mechanism and principles of management of hyperhemolysis
• Develop management plan for treatment in collaboration with patient and their family

Hemoglobinopathies and Red Cell Disorders Research objectives

• Refine critical and scholarly skills in the methodological aspects of applied clinical research
• Understand the core concepts of evidence-based medicine to critically appraise the hemoglobinopathy and red cell disorder literature
• Develop skills in the domains of:
  • Research synthesis and design
  • Hypothesis generation
  • Data gathering
  • Knowledge translation
  • Data-analysis and interpretation