Departments

The Hematology Program at Smilow Cancer Hospital offers comprehensive diagnosis and treatment of blood cancers: lymphoma, leukemia, and myeloma. While the causes of these cancers remain unknown, great strides in treatment, some of which originated from Yale Cancer Center research, are improving survival rates. The overall aim of treatment is to bring about a complete remission. Treatment approaches for blood cancers may include chemotherapy, radiation oncology, stem cell or marrow transplantation, or immunotherapy. Each patient receives an individual treatment plan, which includes standard care and/or clinical trials, which offer novel treatment options. Yale hematopathologists employ the complete range of diagnostic tools available, including bone marrow examination, bone imaging, M protein analysis, cytogenetics, immunophenotyping, and FISH and PCR analysis, as well as genetic testing and the identification of markers that guide prognosis. Additionally, patients have access to caregivers who help them cope with the physical, emotional, and psychological issues related to these cancers. Advanced practice nurses and social workers assist with education, general information, and practical issues of travel and accommodation assistance. The blood cancers we are fighting: Lymphoma is the most common blood cancer, affecting 81,000 Americans each year. While its rates continue to rise, there have also been rapid advances in treatment, and the current 5-year survival rate for all people diagnosed with Hodgkin lymphoma is 87%. Leukemia is a malignant cancer of the bone marrow and blood, diagnosed in 60,000 Americans each year. It is the most common cancer in children and teens. The leukemia death rate for children ranging from birth to age 14 in the United States has declined 60% over the past three decades, due to treatment advances. Myeloma is a disease of the plasma cell, and affects approximately 34,000 new patients annually. Overall survival in patients with myeloma has shown improvement in recent years, with treatments recently approved by the Food and Drug Administration (FDA). Monoclonal gammopathy of undetermined significance (MGUS) is a precursor condition that could potentially lead to cancer and should be closely evaluated and monitored. Our myeloma specialists are dedicated to the care of these patients and see them as part of a MGUS Clinic. Stem Cell Transplant The Stem Cell Transplant Program at Smilow Cancer Hospital is a FACT accredited program that was started in 1994 and currently performs around 200 transplants yearly. We perform stem cell and bone marrow transplants for a variety of malignant and benign diseases in both pediatric and adult populations. There are two types of stem cell transplantation that we perform: Autologous transplant: involves using a patient’s own stem cells, whichare collected from their blood and frozen. Allogeneic transplant: involves receiving stem cells from another person, called a donor. A search

Our expert pathologists are key players in all health care provided by Yale Medicine. By studying bodily fluids and tissues, we help other physicians make diagnoses. We offer highly specialized diagnostic and consultation services in all major specialty and subspecialty areas of pathology. Our subspecialists attend all regular meetings in which a number of doctors from various specialties review and discuss a patient's medical condition and treatment options.They are on call around the clock, ensuring that doctors working in oncology, surgery, transplantation, and other service areas always have access to our expert knowledge. Our internationally recognized physicians offer specialized expertise in breast, cytopathology (cell), dermatologic, endocrine, gastrointestinal and liver, gynecological, head and neck, hematologic (blood), neurologic, ophthalmologic, pediatric, kidney, soft-tissue and bone, transplant, thoracic and urologic pathology, molecular and genomic pathology, and autopsy pathology. Specialized care is offered in the following areas: Accredited PD-LI testing Autopsy Cytopathology Intraoperative frozen section and tumor triaging service Molecular diagnostics and tumor genomics profiling Pediatric pathology Support laboratories: histology, immunohistochemistry, translational pathology, and electron microscopy and quantitative immunofluorescence analysis of multiplexed tumor markers Surgical pathology with subspecialty expertise in gastrointestinal tract and liver; prostate; bladder; kidney; gynecological tract; endocrine system; head, neck, and oropharynx; bone and soft tissue; hematologic and lymphoid system; brain, muscle and eye; pulmonary system; and transplantation

The dedicated pediatric hematologists and oncologists of the Yale Pediatric Hematology and Oncology Program provide comprehensive and compassionate care for children with all forms of cancer and blood diseases, including leukemia, malignant tumors and lymphomas, as well as sickle cell disease, hemophilia, coagulation abnormalities, and platelet disorders. Our program utilizes a team approach to care, and is active in research that seeks to advance the diagnosis and treatment of pediatric cancer and blood diseases. Cure rates continue to rise for children with cancer. At Yale, we are determined that more and more children will survive, and that they will thrive. We work to design treatments that cause less discomfort to patients in the short term and fewer serious complications in the long term. Smilow Cancer Hospital and Yale New Haven Children’s Hospital’s care team works with patients and their families to design individual treatment plans. In addition to an oncologist, our multidisciplinary team includes advanced practice providers, registered nurses, social workers, a psychologist, psychiatrist, neuropsychologist, nutritionist, and child life specialists, all who have expertise in the medical, social, emotional and educational needs of children and teens. Understanding that children with cancer and blood disorders need more than medical care, we work with patients and their families to help them meet their social, emotional, educational, and behavioral needs. Our support services include: Routine psychosocial evaluations for newly diagnosed patients and their families. Home visits for the most gravely ill or psychiatrically symptomatic children and their families. A school integration program that includes counseling for families and children about their rights to have special services. We work with school districts to make appropriate accommodations for students returning to school, including providing special education services, if necessary. Psychoeducation and neuropsychological testing for patients at risk for neurocognitive problems. Support groups for siblings and parents. End-of-life support team for children and families. HEROS Survivorship Program The HEROS (Health, Education, Research & Outcomes for Survivors of Childhood Cancer) Survivorship Program at Smilow promotes the lifelong health of pediatric cancer patients after their cancer treatment has ended.It was the first childhood cancer survivorship program in Connecticut to offer comprehensive care for adults and children who had survived pediatric cancer. In our specialty clinic, patients receive detailed cancer treatment summaries and an individualized schedule for future screening for chronic conditions related to their original cancer treatment. Our multidisciplinary team that includes a pediatric oncologist, nurse practitioner, psychologist, registered dietician, and nurse educator are committed to caring for each patient as a whole person and empowering survivors

Annually, approximately 32,000 new patients are diagnosed with multiple myeloma, a cancer of a type of white blood cell, or plasma cell. Overall survival in patients with myeloma has shown improvement in recent years, with new treatments approved by the Food and Drug Administration (FDA) as recently as this year. Yale Cancer Center and Smilow Cancer Hospital have several clinical trials available for patients with myeloma in need of new options, or looking to receive the latest treatment advances. The treatment of multiple myeloma is usually given in phases and depends on the overall health and age of a patient at diagnosis. Induction therapy is used to reduce the amount of disease, followed by consolidation therapy to maximize response to treatment and reduce any remaining cancer cells. Maintenance therapy is administered after the initial treatment to help keep the disease well controlled. Autologous stem cell transplant, where patients serve as their own donor, is another treatment commonly used to treat multiple myeloma. When receiving therapy for multiple myeloma, our patients will be cared for by an expert, multidisciplinary team that can include the patient’s hematologist, focused on the treatment of myeloma and related diseases; stem cell transplant specialists; pathologists; and radiation oncologists, among other providers. The CAR T-Cell Therapy Program at Smilow Cancer Hospital brings innovative immunotherapy treatment options to patients with certain blood cancers. For adults with relapsed or refractory multiple myeloma, an FDA approved therapy ABECMA is available, which uses a patient’s own T-cells to help fight myeloma. This is the first cell-based gene therapy approved by the FDA for the treatment of multiple myeloma and is currently available at Smilow Cancer Hospital. Ongoing research and clinical trials in the field continue to provide patients with new options for care.

As part of our Center of Excellence for Classical Hematology at Smilow Cancer Hospital, our hematologists provide a full spectrum of highly specialized care to patients with nonmalignant hematology disorders and participate in research to advance treatment options. The types of disorders cared for are varied and include thrombosis, anemia, bleeding and platelet disorders, and other hematological conditions and rare diseases. Our hematologists work closely with a specialized team of advanced practice providers (APPs) and nurses, in addition to our colleagues in Laboratory and Transfusion Medicine, in order to provide a multidisciplinary clinical focus. Community outreach and education are key components of the program in order to improve awareness and understanding of non-cancer blood disorders and train the next generation of physicians, APPs, and nurses. We offer treatment for: Thrombosis: blood clots blocking blood vessels Anemia: a lower-than-normal amount of healthy red blood cells Bleeding and platelet disorders: an abnormal decrease or increase in platelets or platelet dysfunction; abnormal bruising or bleeding; low or dysfunctional platelets Other hematological conditions: hemoglobin disorders, thalassemia, red cell enzyme or membrane disorders, low white blood cells Rare diseases: porphyria, PNH, mast cell disorders, eosinophil and histiocyte disorders, cold agglutinin disease

Our multidisciplinary group of physicians and health providers are committed to providing state-of-the-art therapy to our patients with hepatitis B and hepatitis C infections. We have a 50-year tradition of excellence in liver research and patient care, and continue to be international leaders on the study and treatment of liver disorders. As a partner of the Yale School of Medicine Liver Center, one of only four liver research centers in the country sponsored by the National Institutes of Health, ours is the premier program in Connecticut offering comprehensive patient care for individuals with viral hepatitis. The key to effective disease management of acute and chronic viral hepatitis is our coordinated care among specially trained physicians, as well as a specialized nurse who provides teaching and psychological support. We enjoy close relationships with specialists in adult and pediatric gastroenterology, transplant hepatology, medical and transplant nephrology, transplant surgery, gastrointestinal pathology, diagnostic and interventional radiology, gastrointestinal surgery, rheumatology, OB/GYN, medical and surgical oncology, infectious diseases, the AIDS Care Program, psychiatry, and addiction medicine. The Gastrointestinal Pathology program at Yale is the only subspecialty program of its kind in Connecticut, and provides expert consultative services for the most challenging liver pathology examinations in the region. We partner with Yale New Haven Hospital’s Nathan Smith Clinic in the management of patients with HBV/HIV and HCV/HIV co-infections, and with the Yale Liver Transplant Program in the pre- and post-transplant evaluation and management of patients with liver cirrhosis and end-stage liver disease. We have four areas aimed at improving treatment and outcomes for viral hepatitis: Education: Providing formal education classes and individualized instruction sessions for patients with chronic hepatitis C infection prior to the initiation of antiviral therapy Treatment: Maintaining high standards of practice in treatment protocols and close coordination of care with referring physicians to provide the most advanced and scientifically based approaches to the management of viral hepatitis Research: Ensuring the opportunity for patient access to novel approaches in the treatment of viral hepatitis and liver disorders through clinical trials Community outreach: Building relationships with the surrounding communities of Greater New Haven and Connecticut to raise awareness about viral hepatitis, and to promote screening and education Special services offered by the Yale Viral Hepatitis Program include: Weekly multidisciplinary patient care conferences and liver pathology conferences to draw upon the varied expertise of our Yale Medicine physicians Coordination with the liver and kidney transplant programs Comprehensive services for diagnostic and interventional GI endoscopy, percutaneous and trans-jugular liver biopsy, paracentesis and trans

Covering every aspect of health care for adults, Internal Medicine is the largest department in the Yale School of Medicine, and the largest clinical service at Yale New Haven Hospital. We provide comprehensive and specialized services in all areas in a variety of outpatient settings as well as the Veterans Affairs (VA) Connecticut Health Care System campus in West Haven. Our culture of collaboration and research gives patients access to expert opinions from nearly 1,000 doctors, as well as opportunities to get tomorrow’s health care today through more than 100 clinical trials. Most importantly, we attend to our diverse community of patients with compassionate, thorough care. Specialized care is offered in the following areas: Allergy & clinical immunology Cardiovascular medicine Digestive diseases Endocrinology General internal medicine Geriatrics Hematology Infectious diseases Medical oncology Occupational health & environmental medicine Nephrology Pulmonology, critical care & sleep medicine Rheumatology International reputation for work in understanding function, independence, and quality of life in older persons Key research breakthroughs of the past decade that include the development of a protective Lyme bacillus disease vaccine, exploration of the underlying causes of allergic disease, and the discovery of novel inherited immunological diseases Largest interventional cardiology program in Connecticut Major referral center for patients with type 1 and type 2 diabetes, as well as other metabolic conditions Nationally ranked program in kidney diseases and the largest kidney transplant program in New England, with multidisciplinary care clinics One of the largest peripheral vascular programs in the country, with leadership and participation in multiple new percutaneous device trials Once of only a few motility centers in Connecticut to provide all motility procedures and services Unique medical forensic exams for individuals with claims of torture who are seeking asylum in the U.S.

We are a federally designated hemophilia treatment center—one of eight such centers in New England—with over 28 years of experience. Our team provides hemophilia care and treatment for bleeding. Although we are a part of the Department of Pediatrics, we treat both children and adults. In addition, we are a major referral center in southwestern Connecticut for hemostasis patient evaluations to urgently stop bleeding. Disorders we treat include: Thrombophilia von Willebrand disease Coagulation disorders Platelet disorders Disorders of hemostasis

Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder that causes some blood vessels to develop improperly. Yale radiologists are developing guidelines for the evaluation of blood vessel malformations in the lungs (pulmonary arteriovenous malformations) in children with HHT. This innovative approach will replace CT scans, avoiding the successive and often unnecessary radiation exposure for children who have no symptoms. We are also developing guidelines for the diagnosis and treatment of malformed blood vessels in the brain (cerebral arteriovenous malformations), and aim to have these guidelines become part of the standard of care. Our physicians are also examining potential liver transplant guidelines for patients with HHT in heart failure. We are continuously analyzing existing data and conducting evidence-based research to develop new treatment methods that can impact the lives of patients in our care.

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

Leukemia and lymphoma are two of the three primary blood cancers. Leukemia, a cancer of white blood cells, prevents the cells from fighting infections in the body. Lymphoma is cancer of the lymphatic system, and affects a type of white blood cell called lymphocytes. While the causes of these cancers remain unknown, great strides in treatment, some of which originated from Yale Hematology research, are improving survival rates. Yale uses a multidisciplinary approach to treating leukemia and lymphoma. We offer comprehensive diagnosis and treatment with the overall goal of bringing about a complete remission. Treatment approaches for blood cancers may include chemotherapy, radiation oncology, stem cell or marrow transplantation, or immunotherapy. Each patient receives an individual treatment plan, which includes standard care and/or clinical trials, which offer novel treatment options. Leukemia After initial blood work to identify the level of white blood cells relative to red blood cells and platelets, further testing, such as diagnostic blood tests, flow cytometry, a bone marrow biopsy, and/or molecular/genetic testing, will determine the type of leukemia and severity of disease. There are multiple types of leukemia including: Acute lymphocytic leukemia Acute myeloid leukemia Chronic lymphocytic leukemia Chronic myeloid leukemia Yale Medicine scientists can determine the particular mutation of the cell and target the mutation. Treatment may include chemotherapy, immunotherapy, targeted therapy, corticosteroids, and/or stem cell transplant. Lymphoma Lymphoma is classified into two broad categories: Hodgkin’s lymphoma and non-Hodgkin's lymphoma. Doctors confirm a lymphoma diagnosis through a lymph node biopsy. Further testing may be performed to determine the disease progression. The most common treatment for Hodgkin’s lymphoma is chemotherapy. Novel immunotherapy may also be used. Treatment for non-Hodgkin’s lymphoma may include active surveillance, chemotherapy, targeted therapy, immunotherapy, radiation therapy, or stem cell transplantation. Yale Hematology researchers are conducting numerous clinical trials to test new innovative treatment options in both leukemia and lymphoma.

Timely treatment is essential to maximizing quality of life after a stroke. At the Yale Stroke Center, our highly skilled physicians take pride in delivering safe, patient-centered, and efficient care. We provide emergency treatments for conditions such as acute stroke and brain bleeds, where immediate interventions are required, but also elective treatments for aneurysms and other vascular lesions that are discovered incidentally. A dedicated neurovascular surgeon is on call and ready to mobilize a team at a moment’s notice—24 hours a day, 7 days a week. We streamline access to emergency neurovascular care for referring physicians, guaranteeing that patients will receive the timeliest and best care anywhere. Our collaborative team includes neurologists, neurosurgeons, and neuroradiologists, as well as physical medicine and rehabilitation specialists, working together to deliver cutting-edge interventional treatment and imaging. In the emergency department, radiologists are always available to provide readings of imaging scans so that patients can proceed as quickly as possible to treatment. We have an array of 3-D imaging workstations to ensure doctors can pinpoint where they need to concentrate care. We work closely with Yale New Haven Hospital’s emergency medical service and emergency department teams to rapidly diagnose and treat acute stroke and other cerebrovascular disorders 24 hours a day. Our Y Access Line allows for the quick and easy transfer of patients to Yale New Haven Hospital. We also offer SkyHealth, an emergency patient transport helicopter, staffed by highly skilled medical professionals, including a critical care flight nurse and a trained paramedic. Life-saving interventions are delivered en route, for the best possible clinical outcomes. Our state-of-the-art, VISIUS Surgical Theater is equipped with a powerful MRI and an integrated, bi-plane X-ray angiography system that allows our experts to better visualize arteries and vessels. The ability to receive preoperative diagnostic imaging; open micro-surgery; percutaneous, catheter-based endovascular treatments; and postoperative checks all in the same room is unique in the tri-state area. Our services include: A dedicated neurointensive care unit A stroke consult service with a patient- and family-centered approach to the treatment and rehabilitation of patients with cerebrovascular disease Specialized stroke clinics for community physician referrals, stroke consults, and primary and secondary stroke prevention Telemedicine Program Through our Stroke Telemedicine Program, our neurologists use a video- and image-sharing telecommunications system to provide acute stroke care consultative services to outlying hospitals in the state. Yale New Haven Hospital is the only hospital in Connecticut to offer stroke telemedicine services. Within minutes of making an initial call to the Stroke Telemedicine Program, an on-call neurologist can examine a patient at the remote hospital to hel