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Faisal Klufah M.S.H.S, MLS(ASCP) Hematology/Hemostasis Lab Introduction

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Objectives Define Hematology & Hemostasis Describe the Composition of Blood Define Management of the Hematology department List Hematology tests & Reference Ranges Describe Safety Issues Identify Quality Assurance Describe Specimen Collection

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Introduction to Hematology Class participation What is the meaning of Hematology & Hemostasis terms? What is hematology and what do you expect to study?

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Whether near or far.. Med lab Students at Malumghat, Bangladesh Med lab Students at Umm Al-Qura University

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Basic Sciences of Hematology Biochemistry Cell biology Cytology Genetics Histology Immunology Pathology Physiology Oncology

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Composition of Blood Liquid (plasma) Water, ions, proteins, carbohydrates, fats, hormones, vitamins, enzymes Cellular elements Erythrocytes, leukocytes, Thrombocytes

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HEMATOLOGY TESTS CBC ESR Retic count Bone marrow Exam Hgb electrophoresis Sickle-cell screen Osmotic fragility Cytochemistry stains Molecular tests

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Reference Ranges Concentration of blood components varies with gender, age, race, geographic location and others Ranges for this class will be found in Tables A-K on the inside covers of the textbook

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High power magnification: What do you see?

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Management of the Hematology department What does the Health system want? Who handles personnel issues? What will this class help you with? Who is responsible for inventory control?

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Hematologic Diagnosis & Treatment fill in the blanks 1. Maintaining Wellness 2. RBC abnormalities _____________ 3. WBC abnormalities _______________ 4. Platelet abnormalities______________ 5. Invasive organisms _______________

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Examples of patients questions My hematocrit was 16 and I had to have an infusion, but I am still suffering with headaches. Is it normal to have headaches with a low hematocrit? My WBC is 3.2 and the range is 4.0 10.0. The doctor told me my lab tests were fine, but on my copy there is an H next to the MPV of 10.7.

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Oil immersion view of red and white blood cells in the bone marrow

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Safety Issues Handling of potentially harmful material (Universal Precautions) Safety Agreement Forms Sharps containers/ Yellow Bags Student Lab Surface Cleaning Safety Manual/ MSDS/ Incident Reports

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Clinical Microscopy Care of the microscope____________ Component parts and functions_____ Hematology uses _____________?

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Quality Assurance program n What are the Basic components? n Give examples of items found under the three components n What is proficiency testing? n What is competency testing?

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Critical features of a Quality Assurance Program Compliance with legislation and accreditation standards (CBAHI, JCI, & CAP) Minimize risk of producing unreliable results Accuracy: ability to determine true value Precision: ability to obtain nearly identical result with repetition Alert the operator when the analytic system begins to fail Document the offices preventive stand, problem identification and preventive actions. Savings in time and money- tests are not repeated

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Quality Control Three levels of control material are run on each instrument daily (each shift) Low Normal High Plot on Levey-Jennings chart to spot shift or trend Should be within 2 standard deviations Instrument delta checks

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Factors Contributing to Imprecise or Inaccurate Results Give examples related to: Testing environment Pre-analytic factors Analytic system Post-analytic factors

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Specimen Collection

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HAEMATOLOGY LABORATORY COLLECTION & HANDLING OF SAMPLES Precautions: * Gloves * Avoid injury * Sharp objects disposal * Samples must be sent in closed plastic bags * Proper & safe disposal of waste products Samples: * Venous blood * Capillary blood # * Serum * Heel blood # * Plasma # Results are slightly higher than that of the venous samples Anticoagulants: * Ethylene diamine tetra-acetic acid (EDTA) * Trisodium citrate * Heparin

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Role of the Phlebotomist Represents laboratory to patients Assures quality of specimen

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Types of Collection Venipuncture Routine Special Capillary Puncture Fingerstick Heelstick Arterial Blood Collection

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Blood Vessels Veins Thinner walls, Less pressure, Valves Arteries Thicker walls, more pressure Capillaries Tiny vessels

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Venipuncture Equipment tourniquet needle/syringe vacutainer holder vacutainer tubes winged infusion set (Butterfly needle) alcohol gauze bandaid sharps container marker for tubes

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Step by Step Procedure All supplies within easy reach, Assemble needle and holder Put on Gloves Apply tourniquet Select site and cleanse with alcohol Remove needle cover Pull down skin to anchor vein Penetrate skin with bevel of needle up Push on tubes, release tourniquet, apply gauze and pressure Apply bandaid, label tubes

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Sequence of Tube Draw Sterile for blood culture Plain tubes, No additive Anticoagulant tubes blue (sodium citrate) green ( heparin) lavender (EDTA) gray (sodium fluoride)

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Site selection of difficult patients Hematoma: avoid areas where bruising is present Edema: difficult to palpate, tissue fluid contamination IV lines: draw below or shut off for 3 min. Scarring, burns: painful, susceptible to infection Dialysis: never draw from a fistula

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Alternate Sites and Methods Applying warm towel to hand, arm, heel Dangle arm for a few minutes Dorsal surface of hands and wrists Ankle or foot - last resort

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Sources of Sampling Errors Wrong order of tube draw Prolonged tourniquet application Delay in processing Inadequate volume Hemolysis Unlabeled specimens Clotted anticoagulant specimen

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Special Venipuncture Collection Timed specimens post-prandial, fasting Therapeutic drug monitoring trough (immediately before dose) peak (1/2 to 1 hour after dose) Blood cultures specific cleansing techniques using betadine Pediatric and infant draws

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Problem Patient Reactions Fainting Nausea Vomiting Excessive bleeding Convulsions

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What you can do to learn the process Practice on the artificial arms Practice with a classmate under the supervision of lab technician or instructor. You Are READY!!