Departments

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

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

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

Treating complicated pregnancies is our priority. We provide care for the entire spectrum of conditions related to high-risk pregnancy, and for women whose pregnancies require special testing, monitoring, treatment, and care . We offer state-of-the-art approaches to caring for women with high-risk pregnancies related to diabetes, hypertension, heart disease, and genetic disorders, among other medical conditions that can complicate a pregnancy. Maternal-Fetal Medicine (MFM) at Yale pioneered the development of chorionic villus sampling (CVS) and fetal blood sampling (FBS), and has the most experienced team for these procedures in New England. In addition, our skilled specialists, who are internally recognized for their expertise, conduct fetal echocardiography to diagnose congenital heart disorders of the fetus. We offer a variety of services for our patients across the following specialty programs: High-Risk Pregnancy Program, which supports ongoing care and management for women with a history of pregnancy risks or current medical complications. Prenatal Genetic Diagnostic Program, which provides expert genetic screening and testing for MFM patients. Available tests include first-trimester screening, CVS, amniocentesis, and FBS. After diagnosis, we provide counseling and connect patients when necessary to appropriate support networks to help parents adjust to and prepare for their child's special needs. Recurrent Pregnancy Loss Program, offered in conjunction with Yale’s Reproductive Endocrinology and Infertility Section. Our multidisciplinary team of pathologists, geneticists, and perinatologists uses a whole-patient approach to help couples with recurrent miscarriages and/or pregnancy losses. Other services offered in our MFM section include: First-trimester risk assessment for Down Syndrome Targeted ultrasound Fetal therapy, including percutaneous umbilical blood sampling (PUBS) and intrauterine transfusion Antenatal testing Diabetes management MFM physicians can also co-manage patients with high-risk pregnancies with referring practitioners. We can develop care plans with community obstetricians for cases that require intensive oversight by the team, or consultative guidance alone.

The Cardiovascular Disease and Pregnancy Program at Yale offers comprehensive and individualized support before, during, and after pregnancy for people with heart conditions. Our mission is to improve outcomes in pregnancy for patients with either pre-existing or newly diagnosed heart disease and ensure that pregnant patients receive appropriate and specialized risk assessment, treatment, and support. Cardiovascular disease is the number one cause of maternal mortality in the United States. While most people with pre-existing cardiovascular conditions can safely and successfully become pregnant, carry a baby to term, and breastfeed, patients with cardiovascular conditions are at higher risk of complications during pregnancy and after delivery. Pregnancy can also reveal or cause previously undiagnosed heart problems, and certain pregnancy complications can put patients at a higher risk for future cardiovascular disease. Yale’s Cardiovascular Disease and Pregnancy Program brings together cardiologists, maternal-fetal medicine specialists , nutritionists, pharmacists, lactation consultants , social workers, and family planning specialists who utilize their unique expertise to provide comprehensive patient care. Our multidisciplinary team meets regularly to create individualized care plans for each pregnant patient with heart disease. We provide care to: People with known heart disease, including congenital heart disease and acquired heart diseases, such as abnormal heart rhythms (arrhythmias), heart failure, and ischemic heart disease (coronary artery disease) People who develop cardiovascular disease or are newly diagnosed with heart disease during pregnancy (for example, peripartum cardiomyopathy) People who develop pregnancy-specific complications (including preeclampsia and related hypertensive disorders or gestational diabetes) that put them at higher risk for future cardiovascular disease Before pregnancy Contraception counseling: We provide individualized contraception counseling to patients with cardiovascular conditions to help determine the best and most reliable form of contraception for them based on a variety of factors, including specific heart conditions, interaction with other medications, and personal preferences. Comprehensive risk assessment: We provide a comprehensive risk assessment for patients with heart conditions who wish to become pregnant. We coordinate care to ensure they receive updated imaging and diagnostic studies and are on pregnancy-safe medications before they conceive. We also work closely with patients to provide nutrition and exercise guidance. Preconception counseling: We provide consultations to explore and discuss a potential pregnancy and family building. During this visit, we will answer all patient questions and develop care recommendations to support patients prior to, during, and after pregnancy. We also introduce members of the care team. During pregnancy Prenatal care management: We work wi

The Sickle Cell Program at Smilow Cancer Hospital consists of a team of experts focused on the care of patients with sickle cell disease. The comprehensive team consists of hematologists, hospitalists, nurses, a pharmacist, a psychiatrist, social workers, and chaplains. Using a patient-centered approach, the team provides care and education for patients and families as well as health care professionals. They partner with the community to care for people with sickle cell disease and conduct research to improve the care of people living with this rare inherited blood disorder. The team strives to care for patients with sickle cell disease and advance care options by building on the program’s strong foundation and using the resources of Yale, as well as the knowledge of the community. A dedicated 13-bed unit is also available to patients in need of inpatient care. This enables the team to provide continuity of care to patients. We offer the following services: Prescriptions and counseling for pain management Disease modifying therapy, including Hydroxyurea, Voxelotor, and L-glutamine, used to treat the underlying cause of sickle cell disease Blood transfusions, as needed, to reduce the risk of complications and reduce symptoms Attention to kidney problems, iron overload, and infectious diseases Referral for regular specialized eye care Partnerships with pediatric colleagues to offer curative therapies, including bone marrow transplant and gene therapy

For patients in our care during labor and delivery, we work in close collaboration with Yale’s Obstetrics, Gynecology, and Reproductive Sciences team. We also offer consultative services and management for high-risk obstetric patients. We provide different types of regional (local) anesthesia for vaginal and cesarean deliveries, tubal ligations, fetal surgeries, and EXIT procedures (for babies who have airway compression). We also have expertise in regional blockade for postoperative pain relief, and the use of ultrasound for regional analgesia and epidural placements. Along with our colleagues in maternal-fetal medicine, we provide anesthesia consultation for patients with complex medical issues such as congenital and acquired heart disease, neurological conditions, and clotting disorders. As a tertiary care center, Yale New Haven Hospital is equipped with facilities to care for patients with significant risk of peripartum hemorrhage, such as those with placenta accreta, which occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall.

We provide ongoing care and management for women with a history of pregnancy risks, or current medical complications. Our providers follow patients closely from the point of referral to delivery and beyond. Patients receive individualized attention, and continuity of care is guaranteed throughout the pregnancy. We are often able to co-manage problems with our patients’ primary obstetrician. However, our High-Risk Pregnancy Program provides the full spectrum of prenatal, delivery, and postpartum care for women with high-risk pregnancies. We offer the following specialty programs: Diabetes in Pregnancy Program. This provides comprehensive services for women with diabetes before, during, and after pregnancy. Our expert team of physicians, diabetic educators, and advanced practice nurses helps initiate and manage oral hypoglycemic and insulin therapies to ensure optimal glycemic control in pregnant patients with diabetes. Our team approach has resulted in significant decreases in our patients' A1C levels, rates of fetal macrosomia (high birth weight), and incidence of pregnancy complications. Hemostasis and Thrombosis Services. Our specialists provide pregnancy management for women who suffer from thrombosis, including regular consultations and treatment with blood thinners. In addition, we provide screening and primary care, as well as treatment for other blood conditions such as hemophilia. Recurrent Pregnancy Loss Program. This is offered in conjunction with Yale’s Reproductive Endocrinology and Infertility Section. Our multidisciplinary team of pathologists, geneticists, and perinatologists uses a whole-patient approach to help couples with recurrent miscarriages and/or pregnancy losses. Women & Children’s Blood Disorders Program. This program strives to improve the quality of women and children's health by addressing disorders of blood coagulation and thrombosis during the reproductive, menopausal, fetal, neonatal, and geriatric periods of life. The program also provides patient care and management for pregnant women with preeclampsia (high blood pressure, swelling, protein in the urine).

Patients often hesitate to discuss miscarriages, or spontaneous pregnancy losses. While one miscarriage might prompt a doctor's visit, experiencing two or more losses warrants a thorough examination for underlying reproductive issues. Yale Medicine’s Recurrent Pregnancy Loss Program assembles experts from various fields to provide comprehensive and compassionate care to patients facing this condition. We utilize cutting-edge technologies for diagnosis and tailor individualized treatments to address the root cause. Recurrent pregnancy loss is defined as two or more failed pregnancies, including those confirmed via pregnancy blood test or ultrasound. Miscarriage is relatively common, affecting 15% to 20% of known pregnancies within the first 20 weeks. However, experiencing two or more consecutive losses, which affects 1%-3% of pregnancies, may indicate underlying genetic, physiological, or anatomical issues. Anatomic abnormalities in the uterus, such as fibroids , polyps, adhesions, or the presence of a septum dividing the uterine cavity, can lead to pregnancy complications. Hormonal disorders, like uncontrolled diabetes or thyroid issues , can also contribute to recurrent pregnancy loss. Additionally, chromosomal abnormalities in embryos, autoimmune conditions, infections, and lifestyle factors, such as smoking, drug use, caffeine and alcohol consumption, toxin exposure, and obesity, may play a role. Our multidisciplinary team works closely with patients to identify potential contributing factors while offering emotional support during this challenging time. Initial assessments include a thorough review of medical history, physical examinations, specialized ultrasounds, and consultations with specialists, such as reproductive endocrinologists, maternal-fetal medicine specialists, reproductive immunologists, geneticists, and pathologists. We employ advanced diagnostic techniques, including genetic testing and analysis of fetal tissue, to pinpoint underlying causes. Our team includes psychological counselors, dietitians, and experienced nurses who provide comprehensive support throughout diagnosis and treatment. At Yale Medicine, our Recurrent Pregnancy Loss Program combines compassionate care with state-of-the-art genetic analysis. Following a definitive diagnosis, we offer customized treatment options, which may include surgical interventions to address anatomical abnormalities, in vitro fertilization (IVF) , or a genetic screening of embryos. Even in cases where a specific cause cannot be identified, the outlook remains positive, with the majority of subsequent pregnancies proceeding normally. Throughout the process, we remain dedicated to understanding the root cause of difficulties and providing empathy and reassurance to patients facing recurrent pregnancy loss.

For our youngest patients, we provide expert care in the neonatal intensive care units (NICUs) at Yale New Haven Children’s Hospital, Bridgeport Hospital, Waterbury Hospital, and Lawrence and Memorial Hospital in New London. We offer advanced treatments, including ECMO (Extracorporeal Membrane Oxygenation), a machine that acts as an artificial heart and lungs for a patient, which is crucial for an infant’s life-threatening heart and/or lung problems. Yale is home to the world’s first NICU. Every year, approximately 6,000 babies are born at Yale New Haven Children’s Hospital, and more than 850 newborns are admitted to the NICU. The NICU has a capacity of 55 patients, making it the largest clinical unit in the Children's Hospital, and the largest NICU in the state. Through participation in the National Institutes of Health’s neonatal research network and other national multicenter trials, we offer patients access to the latest treatments available. Our board-certified specialists care for newborns with a variety of problems including: Respiratory disorders Complex cardiac issues Genetic and metabolic diseases Congenital malformations, including lung malformations requiring ECMO Hypoxic ischemic encephalopathy Retinopathy of prematurity Problems of nutrition and growth Necrotizing enterocolitis Neonatal infections Anemia, jaundice, and other blood disorders Neurologic problems

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

The Prenatal Genetic Diagnostic Program provides expert genetic screening, testing, and counseling for parents. Our tests and services includefirst-trimester screening, chorionic villus sampling (CVS), amniocentesis, fetal blood sampling (FBS), and many others. After diagnosis, we provide counseling and connect patients to appropriate support networks to help parents adjust to and prepare for their child's special needs. In addition to pioneering the development of CVS and FBS, Yale has the most experienced team for these procedures in New England. Between 11 and 12 weeks after a woman's last menstrual period, she can instantly learn the baby's risk for Down syndrome and other abnormalities with our safe, noninvasive first-trimester risk assessment. Our team of specially-certified physicians, sonographers, and genetic counselors will provide patients with accurate information as quickly as technology allows. The procedure is simple: Patients provide a blood sample at least one week before their scheduled appointment, then visit us between weeks 11 and 14 of their pregnancy. Our comprehensive prenatal testing and genetic counseling services include: First and second trimester screenings Targeted ultrasound (formerly known as Level II ultrasound). We are equipped to perform targeted vaginal ultrasounds at an early gestational age, and provide diagnostic information early in a woman's pregnancy. Antenatal testing services. These services include nonstress testing, biophysical profiles, fetal versions, and PG gel insertions to help ensure fetal well-being throughout pregnancy. Fetal echocardiography. The Yale Fetal Cardiovascular Center is the most experienced diagnostic and treatment program of its kind in New England and provides the full range of prenatal surgical care. Prenatal ultrasound testing is typically performed during the second trimester to diagnose cardiac conditions in an unborn baby. Chorionic villus sampling (CVS). This is usually performed between the 10th and 12th weeks of pregnancy and involves the removal of a small sample of the placenta from the uterus. Amniocentesis. This is usually performed during the 15thweek of pregnancy or later, the procedure removes a sample of amniotic fluid from the uterus for evaluation. Fetal blood sampling. Fetal bloodis collected directly from the umbilical cord orfetus to test for signs of anemia and otherblooddisorders. Fetal tissue biopsy. This is typically performed between the 17thand 20thweeks of pregnancy, for patients who carry an abnormal gene for a severe skin disease to find out whether or not their fetus is similarly affected. Fetal karyotyping. This involving the collection of chorionic villi, amniotic fluid, or fetalblood to obtain and analyze chromosomes for abnormalities. Biochemical testing Fluorescence in situ hybridization (FISH) analysis. This involves laboratory testing to detect chromosomal abnormalities and other genetic mutations in a patient