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HAEMATOLOGY LABORATORY
1. INTRODUCTION
The Haematology Unit, Department of Pathology, HKL provides tertiary diagnostic and
consultative haematology services to all government hospitals and clinics in Malaysia. It also
serves as a training centre in laboratory haematology for undergraduates from local colleges
and universities. The unit is also a recognized training centre for doctors majoring in
haematology under the Masters in Pathology Program (MPATH) conducted by Universiti
Malaya, Universiti Kebangsaan Malaysia, Universiti Sains Malaysia and Universiti Putra
Malaysia.
Head of Unit : Dr Raudhawati Osman Phone : +603-26155281 Email : [email protected]
2. LIST OF SERVICES AND LABORATORY TURN AROUNDTIME (LTAT)
Since the department reorganization in 2006, the Haematology Unit only provides
specialized haematology tests as listed below :
Section Test LTAT ( working days)
Morphology Full Blood Picture (FBP) Urgent: 3 days
Routine : 10 days
Bone Marrow Aspirate (BMA) 7 days
Trephine biopsy 20 days
Urine hemosiderin 3 days
CSF for blast 3 days
NAP score/ LAP score 3 days
H inclusion 3 days
Red Cell Disorder
Haemoglobin analysis 20 days
Hb F quantitation 5 days
Heinz bodies 3 days
Kleihauer test 3 days
Sickling test 3 days
Osmotic Fragility Test (OFT) 3 days
Cryoglobulin 5 days
Flow cytometry
Leukaemia/Lymphoma Immunophenotyping (IPT)
Verbal: 36 hours
Formal: 10 days
CD4/CD8 Enumeration 7 days
Paroxysmal Nocturnal Hemoglobinuria (PNH) Immunophenotyping
10 days
Molecular haematology
Molecular Alpha Thalasaemia 60 days
Molecular detection of mutations in acute leukaemia 14 days
Molecular detection of BCR-ABL for CML cases 14 days
Molecular Chimerism Assay 30 days
Stem Cell Transplant
Stem Cell : CD34 Enumeration 24 hours
Stem Cell Processing : Red Cell Depletion 6 hours
Stem Cell Processing : Plasma depletion 4 hours
Stem Cell Cryopreservation 24 hours
Stem Cell Donor Lymphocyte Cryopreservation 24 hours
Stem cell / Donor Lymphocyte Infusion (DLI) 30 minutes
3. REQUEST FORM
3.1. All specimens must be accompanied with PER-PAT 301 form.
3.2. Forms must be filled LEGIBLY and COMPLETELY with the following information :
Patient’s details: Name, IC number, sex, age and ward / hospital name.
Patient’s clinical and test details: relevant clinical history, diagnosis, tests required,
type of sample, time and date of sampling.
Requesting doctors details : name, stamp and signature.
3.3. For Molecular Alpha Thalassaemia testing, please fill in the DNA Analysis For
Thalassaemia Syndromes request form and consent form. Refer Appendix.
3.4. Incompletely filled forms may result in sample being rejected for testing.
4. SPECIMEN CONTAINERS
Specimen containers used in haematology laboratory are listed below :
Specimen containers Tests
EDTA tubes Generally most of the specialized haematology tests offered at our laboratory use this tube unless stated otherwise
Lithium heparin OFT tests
Sodium citrate FBP in cases of platelet clumping TRO EDTA-induced platelet clumping
Urine container Urine hemosiderin
Blood bag with ACD Stem cell collection from bone marrow, cord blood and peripheral blood, Cryopreservation, Donor Lymphocyte Cryopreservation, Plasma Depletion and Red Cell Depletion.
Cryoshipper Stem cell/ Donor Lymphocyte Infusion
Sterile bottle Body fluids
Specimen containers except blood bag with ACD and cryoshipper can be obtained from the counter for “Pembekalan Tiub Setempat” located at the ground floor of Pathology Department HKL.
5. SPECIMEN COLLECTION
5.1. General
5.1.1. Most of the tests use venous blood samples.
5.1.2. To ensure consistent and accurate result, follow strictly to the volume of blood
required for type of test specified on the label or fill the blood sample to the mark
on the label.
5.1.3. To prevent haemolysis :
Avoid vigorous mixing
Send the specimen to the laboratory as soon as possible
5.1.4. Avoid clot formation by :
Ensuring a smooth venipuncture and steady flow of blood into the syringe.
Introducing the blood in the anticoagulant bottle as soon as the blood has been
drawn.
Immediately gently mix by inverting the tube at least 6-10 times.
5.2. Method for collection for special haematology test :
5.2.1. Bone Marrow Aspirate (BMA)
Please call 6549 to arrange for an appointment.
On the appointment date, laboratory technologist will be at the procedure room to
prepare smears from bone marrow sample obtained by ward doctor. The ward
staff has to ensure that all necessary preparation is ready prior to
commencement of the procedure, to avoid unnecessary waiting of the laboratory
technologist.
Waiting time more than 15 minutes may result in the procedure been postponed.
MLT in charge will provide the slides for BMA and universal container with 10%
formalin for trephine biopsy on the day of the procedure. Other containers for
other tests such as EDTA for immunophenotyping and molecular study, lithium
heparin for cytogenetic study and blood culture bottles for marrow culture must
be provided by ward staff if required.
The slides will be taken back to the haematology laboratory by the laboratory
technologist for staining and reporting.
5.2.2. For other test :
Refer to Summary of Haematology Tests According To Alphabetical Order
below.
SUMMARY OF HAEMATOLOGY TESTS ACCORDING TO ALPHABETICAL ORDER
BIL TEST CONTAINER SPECIMEN
TYPE REMARK
1 BM Aspirate Smear Bone marrow Call ext. 6549 to set
appointment.
2 BM Trephine Biopsy Universal container (with
10% formalin) Trephine biopsy
Call ext. 6549 to set appoinment
3 CD4/CD8 Enumeration EDTA tube Blood
Send immediately in room temperature (20-24°C). Avoid direct contact with ice. Specimens kept more than 48 hours are not suitable for analysis
4 Cryoglobulin 2 EDTA tubes and 2 Plain
tubes Blood
Call ext 6697 to set appointment. Avoid meal 4 hours before blood taking. Sample collection in Haematology Lab.
5 CSF for Blast
i) Sterile container ii) EDTA tube if RBC
contamination present CSF
Send immediately. Please state time of collection. Sample need to be processed within 2-4 hours of sample collection
6 Full Blood Picture (routine)
EDTA tube Blood Send to the laboratory as soon as possible (within 4 hours of collection)
7 Full Blood Picture (urgent)
EDTA tube Blood Send to the laboratory as soon as possible (within 4 hours of collection)
8 H Inclusion EDTA tube Blood Send to the laboratory as soon as possible (within 4
hours of collection)
BIL TEST CONTAINER SPECIMEN
TYPE REMARK
9 Hb F quantitation EDTA tube Blood Please write appropriate
indication on request form.
10 Haemoglobin Analysis EDTA tube Blood Detail history on index case must be provided for family
screening.
11 Heinz bodies EDTA tube Blood Please call 6697 for
appointment.
12 Kleihaeur Test EDTA tube Blood Please call 6697 for
appointment.
13 LAP/NAP Score EDTA tube Blood
Please call 6549 for appointment. Send the sample to the laboratory as soon as possible. EDTA sample need to be processed within 30 minutes of blood collection.
14 Leukaemia/Lymphoma Immunophenotyping
EDTA tube Blood/ Bone Marrow/Body
Fluid
Send immediately in room temperature (20-24°C). Avoid direct contact with ice. Specimens kept more than 48 hours are not suitable for analysis.
15 Molecular Alpha Thalassaemia
EDTA tube Blood
Please contact ext 5746/5748 for more information. Must include Hb Analysis report and recent Full Blood Count result. Detail history on index case must be provided for family screening.
16 Molecular detection of mutations in BCR-ABL for CML cases
EDTA tube Blood/Bone
Marrow
Sample need to be processed within 24 hours after sample blood collection
17 Molecular Detection of Mutations in Acute Leukaemia
EDTA tube Blood/Bone
Marrow
Please contact ext 5746/5748 for more information.
BIL TEST CONTAINER SPECIMEN
TYPE REMARK
18 Molecular Chimerism Assay
EDTA tube PBSC/Bone Marrow/Cord
Blood
Please clearly label donor and recipient's identity. Pre-sample must be sent before chemotheraphy iniated. Please contact ext 5746/5748 for more information.
19 Osmotic Fragility Test Collect 5.0 ml of blood in
Lithium Heparin container. Blood
Please call 6697 for appointment. Send to the laboratory before 9.00 am. Test must be performed within 2 hours after blood collection if samples are kept at room temperature; or within 6 hours if samples are kept at 20-60oC.
20
Paroxysmal Noctural Haemoglobinuria (PNH) Immunophenotyping
EDTA tube Blood
Send immediately in room temperature (20-24°C). Avoid direct contact with ice. Specimens kept more than 48 hours are not suitable for analysis.
21 Sickling test EDTA tube Blood Please call 6697 for
appointment.
22 Stem Cell (CD34) Enumeration
EDTA tube
Bone marrow, Peripheral
Blood Stem Cell (PBSC), Cord
Blood
Please call ext 6697 for appointment. Send immediately in room temperature (20-24 oC). Avoid direct contact with ice.
23
Stem Cell Cryopreservation
Blood bag with ACD
Bone marrow, Peripheral
Blood Stem Cell (PBSC), Cord
Blood
Please call ext 6697 for appointment. Send immediately in room temperature (20-24 oC). Avoid direct contact with ice.
BIL TEST CONTAINER SPECIMEN
TYPE REMARK
24 Stem Cell Processing : Plasma Depletion
Blood bag with ACD PBSC, Bone
Marrow
Please call ext 6697 for appointment. Send immediately in room temperature (20-24 oC). Avoid direct contact with ice.
25 Stem Cell Processing : Red Cell Depletion
Blood bag with ACD Bone Marrow
Please call ext 6697 for appointment. Send immediately in room temperature (20-24 oC). Avoid direct contact with ice.
26 Stem Cell Donor Lymphocyte Cryopreservation
Blood bag with ACD Donor
Lymphocyte
Please call ext 6697 for appointment. Send immediately in room temperature (20-24 oC). Avoid direct contact with ice.
27 Stem Cell / Donor Lymphocyte Infusion (DLI)
Freezing bag Donor
Lymphocyte Please call ext 6697 for
appointment.
28 Urine Hemosiderin Universal container Urine Send sample immediately
after collection.
6. REJECTION CRITERIA
No Reasons for rejection
1 Incorrect specimen for test requested.
2 Patient name and ID on specimen container does not match information in request form.
3 Incorrect container / preservative used.
4 Blood clotted.
5 Insufficient sample.
6 Blood markedly lysed.
7 Specimen spilled / leaked.
8 No sample.
9 Empty container.
10 Broken container.
11 Expired sample container.
12 Lipaemic sample.
13 Unlabelled specimen.
14 Unsuitable sample for analysis.
15 Test is not offered in Haematology Laboratory, HKL.
16 Incomplete request form : IC number- not stated/ incomplete.
17 Incomplete request form : test request- not stated/ incomplete.
18 Incomplete request form : no hospital/ ward/clinic stated.
19 Incomplete request form: the name of requesting doctor is not stated.
20 Incomplete request form: no clinical history provided.
21 Post-transfusion sample.
22 Redundant request: previous report is not attached.
23 Redundant request: earlier request is in progress.
24 Unsuitable for CD4/CD8 testing i.e. specimen exceeding 48 hours after collection. Please
send another fresh sample.
25 No FBC results attached.
26 No Hb analysis results attached.
27 No FBC or Hb analysis results attached .
7. SAMPLE RECEPTION
7.1. During office hour : Receiving Counter, Haematology Laboratory
7.2. After office hour : Receiving counter, Pre-Analytical Unit
At the reception counter, ward or clinic staff must ensure the date and the time of sample
arrival is recorded by using the electronic time clock/ recorder.
8. REPORTING OF RESULTS
8.1. The wards that have “Lab Viewer System” can trace their result electronically.
8.2. Verbal report : will be issued for certain cases of IPT for leukaemia/ lymphoma and
urgent FBP (if requested by clinicians). Printed result will be dispatched once available.
8.3. Formal report will be printed and dispatched once available.
9. COLLECTION OF RESULTS
9.1. Formal reports for in-patients and cases from Klang Valley are dispatched to designated
pigeon holes located at the main counter of the department.
9.2. Formal reports for outside Klang Valley are mailed via Pos Malaysia to mailing centres
(state hospitals) or specific mailing address agreed between requester and our
laboratory.
9.3. Urgent results will be informed to the wards by telephone or to be given by hand to the
waiting ward personnel.
10. ENQUIRIES
Enquiries regarding the haematology test, samples and result can be made via the following
numbers :
Section Extension
Morphology 6549
Red Cell Disorder 6697
Flow cytometry 6853
Stem Cell Transplant 6883
Molecular Haematology 5748/ 5746
Medical Officer
Urgent FBP/ MO Room
6374/ 7514
Pathologist Room
Main laboratory
Diagnostic Room
5598 7514
11. SERVICES AFTER OFFICE HOUR
The specialized haematology laboratory does not operate after office hours. However,
urgent requests for FBP and leukemia immunophenotyping can be arranged via the Medical
Officer or Pathologist on-call. Please refer to the monthly roster provided by the Department
of Pathology.
12. LIST OF PATHOLOGISTS AND CONTACT DETAILS
Pathologists Email Ext. number
Dr Raudhawati Osman [email protected] 5281
Dr Mimi Azura Aziz [email protected] 7514/ 5598
Dr Siti Shahrum Muhamed Said [email protected] 7514/ 5598
Dr Noraesah Mahmud [email protected] 7514/ 5598
Dr Suzana Zainol [email protected] 7514/ 5598
Dr Thatcheiany A/P Kumariah [email protected] 7514/ 5598