Clinical functions of the Division of Hematology within the Department of Medicine include:
- To provide hematologic consultation on inpatients and outpatients of all departments of the three USC hospitals serving adult patients.
- To provide continuing care for all adult outpatients with serious hematologic problems through the operation of the adult Hematology Clinics at LAC+USC Medical Center.
- To operate an in-patient hematology ward and a day hospital for patients with hematologic disorders at the LAC+USC Medical Center.
- To operate a clinical service coagulation laboratory for the work-up of inpatients and outpatients with suspected hemorrhagic or thrombatic disorders.
- To provide consultation and/or continuing care for patients with hematologic malignancies referred from community physicians to the USC Norris Cancer Hospital and Research Institute.
- To provide consultation and/or continuing care for patients with hematology problems referred from community physicians to the Keck Hospital of USC.
LAC+USC Medical Center
Founded in 1878, the LAC+USC Medical Center is the primary teaching facility of the Keck School of Medicine of the University of Southern California. The Medical Center ranks as one of the largest acute care facilities in the United States and provides world-class medical care to the indigent population of Los Angeles County, ensuring the most comprehensive training for our Fellows. The LAC + USC Medical Center was recently moved to a new state-of-the-art, one billion dollar, 600-bed hospital and outpatient center on an 85-acre site.
The Division is responsible for an 18-bed inpatient ward (7B), which houses patients with hematologic malignancies. The ward is essentially filled at all times, with patients who have complex hematologic malignancies, and bone marrow failure. Attending physicians are assigned to this unit on a monthly basis, and make formal rounds five days per week, and informal rounds two days per week. In addition, the ward is managed by a Hematology fellow and four general medicine interns.
Hematology is also responsible for two consultation services. The consultation services are responsible for seeing all patients with general hematology problems, as well as those with hematologic malignancy and AIDS-related malignancies, or AIDS-related hematologic disorders. A Hematology faculty member is assigned to each consultation service, with formal rounds made four days per week on each service, and informal rounds made on the remaining days. Each consultation service is also managed by a Hematology fellow, by two general medicine residents, and by one or two medical students, taking electives in Hematology during that month.
Hematology is responsible for four clinics per week at the LAC+USC Medical Center. On Thursday mornings, the Division is responsible for a general hematology clinic (4P21), which cares for patients with problems of anemia, neutropenia, and/or platelet abnormalities. Patients with coagulation problems are also seen in these clinics. On Monday and Thursday afternoons, the Division is responsible for two half-day clinics in the Rand Schrader HIV/AIDS Clinic (5P21). Patients with AIDS/lymphoma and general hematologic problems associated with HIV are seen on Monday afternoons, while patients with AIDS related Kaposi’s sarcoma are seen on Thursday afternoons. Each of these clinics is staffed by two full time members of the Hematology faculty, who provide direct hands-on care. On Tuesday afternoons, the Division is responsible for a large clinic which cares for patients with hematologic malignancy. Six full time attendings are present in this clinic, which is also staffed by all Hematology fellows, as well as the interns who are currently rotating on the hematologic malignancy service. Chemotherapy is administered on an outpatient basis during this clinic, and complex medical problems are also handled.
Aside from the formal clinics discussed above, the Division is also responsible for staffing a daily Infusion Center/Day Hospital at LAC+USC. Patients are seen in this clinic for receipt of blood products and chemotherapy, and for performance of various required procedures such as bone marrow biopsies. Patients who become ill between clinic visits are also seen on a walkin basis in this Day Hospital area. The Day Hospital is staffed by Hematology fellows, with back-up from the Hematology faculty.
USC Norris Comprehensive Cancer Center
The Hematology Division is responsible for seeing private patients with various types of hematologic malignancy at the USC/Norris Cancer Hospital. Our Divisional members see patients on a daily basis in the clinic and Day Hospital, where they supervise the administration of chemotherapy, stem cell collection, and other procedures. Patients are admitted to the hospital as needed, and the inpatient Norris service is the responsibility of one Hematology faculty member, on a rotating monthly basis. One Hematology fellow is also responsible for the inpatient service, as well as two general medicine residents. Patients are also seen in the Day Hospital, for blood product support, infusions of chemotherapy, and other required procedures. The Hematology faculty is also responsible for providing consultations as required by other services on patients who have been hospitalized at the USC/Norris Cancer Hospital.
Averaged over the past few years, approximately 250 admissions and approximately 2,600 inpatient days were supervised by members of the Division (with a 10.8 day average length of stay). Close to 4,000 outpatient visits were conducted and approximately 3,500 Day Hospital visits were conducted.
Stem Cell Transplantation Program
Hematology is responsible for an active Stem Cell Transplantation (BMT) program, which is managed through USC Norris Comprehensive Cancer Center. Candidates for autologous stem cell transplantation are screened at the Norris Cancer Hospital. Our program has been able to sustain an increase in our autologous stem cell transplant activity over the past years. The Hematology Division is also responsible for peripheral blood stem cell collections and our program was awarded membership in the Federation for Accreditation of Hematopoietic Cell Transplantation (FAHCT).
The bone marrow transplantation unit at Norris has five isolation rooms with six beds, all of which have HEPA filters and positive pressure environments. Because of the increase in volume of transplant patients and since more patients with acute leukemia are referred to our Center, the five isolation rooms did not meet our needs. Therefore, three rooms on the 3rd floor of Norris, adjacent to the BMT unit, were modified to become additional isolation rooms with HEPA filters and positive pressure, allowing us to provide the same level of care as in the formal BMT unit. However, the increase in number of beds is still not sufficient, as we now have a waiting list for BMT, as well as a need to place the patients with severe neutropenia outside of an isolation bed. Our long term plan is to expand the BMT unit further. In the meantime, we will continue to efficiently manage patient admissions and discharges so as to maximally utilize the nine isolation beds that are currently available to us.
The clinical outcome of our BMT patients continues to be excellent. Out of 210 bone marrow and stem cell transplants performed since 1992, there have been 5 transplant related deaths (2%). Our autologous SCT survival rate, 100 days post-transplant for 2003-2004, was 96%. Median survival for all autologous transplant patients is 51 months. These survival rates are comparable to those established by the finest institutions in the United States.
Keck Hospital of USC
The Division of Hematology is responsible for seeing patients with various hematologic problems on a consultative basis.