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

2. 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

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

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

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

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

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

8. 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

9. High power magnification: What do you see?

10. 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?
attempts to maintain quality, efficiency and effectiveness
Developing policies and procedures

11. Hematologic Diagnosis & Treatment fill in the blanks
Maintaining Wellness
RBC abnormalities _____________
WBC abnormalities _______________
Platelet abnormalities______________
Invasive organisms _______________
RBC- anemias, hemoglobinopathies
WBC - infections,leukemias, myelomas
Plt- thrombocytosis, thrombocytopenia, bernard soulier, etc.
Invasive: parasites, bacteria, virus

12. 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.

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

14. 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

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

16. Quality Assurance program
What are the Basic components?
Give examples of items found under the three components
What is proficiency testing?
What is competency testing?
Involves the detection, evaluation and resolution of problems directly related to patient outcomes
Assures positive patient outcome and quality laboratory product resulting in cost-effective, timely and appropriate patient care.
Necessary elements:
commitment
facilities and resources
technical competence
quality assurance procedures
problem-solving mechanisms
Proficiency testing determines the performance of individual laboratories for specific tests or measurements and is used to monitor laboratories’ continuing performance.
Competency assessment is one method by which we can verify that our employees are competent to perform laboratory testing and report accurate and timely results

17. 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 office’s preventive stand, problem identification and preventive actions.
Savings in time and money- tests are not repeated

18. 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
Delta check is the difference between the current value of one person and the previous one.
Delta check = Current value – Previous value
Delta check% = (Current value – Previous value) 100/Current value

19. Factors Contributing to Imprecise or Inaccurate Results
Give examples related to:
Testing environment
Pre-analytic factors
Analytic system
Post-analytic factors
Patient preparation
Specimen collection, identification, preservation, transportation
Result calculation
Result recording
Patient identification

20. Specimen Collection

21. 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

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

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

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

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

26. 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

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

28. 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

29. 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

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

31. 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

32. Problem Patient Reactions
Fainting
Nausea
Vomiting
Excessive bleeding
Convulsions

33. 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!!