The Consultation Hematology Team will see and manage all general hematology consultations requested on University Hospital or Audie L. Murphy Memorial Veterans Hospital patients. The Consultation Team serves both advisory and gatekeeper functions. Except for BMT patients and the obvious acute leukemias, there are no direct admissions from the ER to the Hematology Critical Care Service. Admissions to this service occur only after evaluation and approval by the Consultation Team. The Consultation Team will sometimes need to evaluate patients in the ER to determine their need for hospitalization on the Critical Care Service. In general, we expect that most nonacute or noncomplex patients with hematological illnesses who are hospitalized will remain on the Medicine Service but with close involvement and participation by the Hematology Consultation Team. These patients will include but not be limited to uncomplicated febrile neutropenia, ITP, sickle cell disease, lymphoma and myeloma workups, etc. Some faculty may wish to manage some of these patients as the attending physician of record. Such patients will become the full responsibility of the faculty member and fellow who will then write orders and take call for them. Consultations involve a mixture of hematologic malignancies, myelodysplasia, other leukocyte disorders, RBC disorders, platelet disorders and coagulopathies. This service will generally be following 10 to 20 inpatients at any given time. On this rotation Residents should expect to learn the appropriate workups for anemia, leukopenia, and thrombocytopenia, elevated blood counts, evaluation and management of coagulopathies and hypercoagulable states, as well as evaluation of normal and abnormal blood smears. Since examination of a properly prepared blood smear is a crucial part of the hematologic evaluation of each patient, this rotation will provide an excellent opportunity to develop skill in evaluating blood cell morphology. Bone marrow aspirations and biopsies are performed by the fellow or resident under the fellows supervision. The fellow and residents are responsible for reviewing bone marrow slides of each patient they consult on. All bone marrow preparations also are reviewed with the attending physician.  The Consultation Team will consist of an attending physician, a first year hematology/medical oncology fellow, two 2nd year Medicine residents, and 4th year medical students on elective rotations. On some months there may be, in addition, fellows from the Army or Air Force on rotation, or more rarely, senior residents on elective rotation. The fellow will be responsible for assigning consultation cases to housestaff and students, as well as dealing with acute situations and overseeing and coordinating ongoing management issues. Generally there will be two Medicine Residents assigned to the Consultation Team. Usually one resident will be in charge of consultations at either the UH or VA; but depending upon caseload, some crossover may be necessary. Residents will see new consultations on a daily basis. Presentation to the fellow and staff should occur within 24 hours of the consultation request so that definitive management recommendations will be communicated promptly to the inpatient teams. Clearly, urgent or emergent situations will require immediate attention as will all ER consultations. Presentations should be appropriately organized and include pertinent past history and current laboratory data. A peripheral blood smear and (when available) bone marrow specimen should be available for review at the time of presentation. Although these smears and bone morrows will be reviewed with the attending, it is expected that residents and fellows will have examined them independently before presentation. The resident will be responsible for communicating management recommendations to the inpatient team. It will be the responsibility of the residents to provide daily follow-up for every consultation initially seen. This is important to assist with ongoing inhouse management and to ensure appropriate disposition of the patient upon discharge. The resident will be responsible for arranging followup outpatient clinic appointments, for communicating with outpatient hematology physicians who will see patients subsequently, and for ensuring that the necessary records are sent to the outpatient clinics.  Residents will attend two half-day Hematology Clinics each week. These are: (1) the VA Hematology Clinic on Tuesday mornings, 9:00 a.m. - noon; (2) the downtown Hematology Clinic on Friday mornings from 9:00 a.m. - noon in the Medicine Clinic area at the University Health Center -Downtown.  Residents will be expected to attend Hematology teaching conferences. These include the following: (1) Hematopathology Conference with Dr. Fiona Craig held on alternate Mondays at 8:00 a.m. in the Pathology Conference Room 331.5B; (2) Hematology Clinical Conference, Thursdays at 8:00 a.m. in the Medicine Conference Room, 5.303T; (3) Bone Marrow Transplant Conference. Thursdays at noon in the Medicine Conference Room, 5.303T or at an off-campus site. Other conferences of potential interest during this rotation are the Combined Modality Conference, Monday at 4:00 p.m. in Room 331.5B, and the Hematology Research Conference, Tuesdays at 4:00 p.m. in the Medicine Conference Room, 5.303T.  Rounding schedules for the Consultation Hematology Team will vary by attending. However, it is likely that regular rounds will be held with the attending 6 days per week. Evening (5 to 9 p.m.) in-house and weekend coverage will be shared among the four Residents rotating on Hematology and Oncology Services and will be scheduled by the House Staff Office. Check off will be to the night call team. Days off should be scheduled with the team and should be planned to avoid days with heavy clinical or educational commitments i.e. clinic days or Thursdays.