CATALOGUE #MLT 250
CIP #51.1004
DATE: February 1, 2008
Moberly Area Community College
COMMON SYLLABUS
MLT 250 Hematology
Current Term
Instructor:
Office Number:
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Catalogue description:
MLT 250 Hematology (w/clinicals)
(3–8–5)
The course studies blood cells, normal and abnormal cell development, alterations
present in diseases, and coagulation factors. The student will learn and perform tests
employed in the hematology and coagulation laboratory.
Prerequisite: BOE 171 Medical Terminology, BIO 205 Human Anatomy, BIO 209
Physiology and MLT 150 Laboratory Methods and Management.
Text: Ciesla, B. (2012). Hematology in Practice. Baltimore, Maryland: F.A. Davis,
ISBN: 978-0-8036-2561-7.
Other Required Materials: Handouts, videos, training aids and transparencies as
provided by the instructor
Purpose of the course: This course provides students with basic scientific concepts,
procedural theory and clinical applications in the study of blood or hematology. In this
essential medical science, students also study the fundamentals of hemostasis or
thrombosis. Information derived from hematological studies guides physicians in
differential diagnosis.
Cognitive Course Objectives
It is the responsibility of the student to learn the following course material presented in
Hematology lectures, handouts, textbooks, audiovisuals, and computer-assisted learning:
1. Describe essential safety practices to use in the hematology laboratory.
2. Discuss quality control practices used in the hematology, such as “rules of three”
for CBC’s or delta checks, and results that suggest patient work may be
compromised.
3. Describe the organs involved in hematopoiesis throughout life.
4. Define and explain each of the erythrocyte indices, state the normal values, and
how RDW, RCMI, and MPV are calculated.
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5. Calculate red blood indices.
6. Recognize normal and critical values in an automated CBC.
7. Describe red blood cell structure, function, development, maturation, metabolic
activities and morphological characteristics.
8. Compare normal and abnormal erythrocyte morphology and inclusions.
9. Explain the characteristics, properties, and synthesis of hemoglobin in RBC’s and
abnormalities involving it.
10. Discuss the laboratory assessment of anemias including classification, causes,
clinical signs and symptoms, and laboratory diagnosis.
11. Discuss the etiology, epidemiology, pathophysiology, clinical signs and
symptoms and laboratory diagnosis of hemoglobinopathies such as sickle cell
disease and thalassemia.
12. Describe the production, distribution, normal values and properties of the
granulocytic, lymphocytic, and monocytic white cells series.
13. Recognize features of cells in the granulocytic, monocytes, and normal and
atypical lymphocytes.
14. Describe the appearance of white cells when the following abnormalities are
present:
Toxic granulation
Dohle bodies
Hypersegmentation
Pelger-Huot anomaly
May-Hegglin anomaly
Chediak-Higashi syndrome
Alder-Reilly inclusions,
Ehrlichia
15. Discuss quantitative and qualitative disorders of granulocytes and monocytes
16. Compare the morphological characteristics, functions and membrane
characteristics of lymphocytes and plasma cells.
17. Compare the patient symptoms and laboratory data involved in laboratory
diagnosis of acute myeloid and lymphoblastic leukemia.
18. Describe the types of chronic myeloproliferative disorders and laboratory data
involved in diagnosing.them.
19. Differentiate the myelodysplastic syndromes and state the prominent features of
each in laboratory diagnosis.
20. Characterize the function of platelets and blood coagulation factors in hemostasis.
21. Describe the general principles, specimen collection and handling, procedure,
quality control, and reference ranges for the following coagulation procedures:
Activated Partial Thromboplastin Time
Prothromin Time
Antithrombin III
Bleeding Time
D-Dimer Assay
Fibrinogen Assay
FDP
Xa
Factor Assays
22. Discuss bleeding disorders related to platelet dysfunctions and blood clotting
factors.
23. Describe the basic theory of electrical impedance, optical detection and laser
technology principles of cell counting and sizing.
24. Describe the principles of flow-cell cytometry.
25. Compare the appearance of erythrocytes, leukocytes and platelets on histograms.
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26. State specimen collection, handling, storage, preparation, physiologic theory, and
principles of the method for the following hematological studies:
Automated and manual counts of RBC, WBC, platelets and morphology.
Manual differential
Westergren sedimentation rate
Dithionate tube test
Factor V Leiden
Mixing studies
Alkali denaturation for Hgb F
Osmotic Fragility
Sugar Water test
Vitamin B12 and folate
Carboxyhemoglobin
Plasma hemoglobin
Haptoglobin
Hemoglobin Electrophoresis Hemoglobin
Bone marrow
27. State the essential components, principles of operation, and preventative
maintenance of the following instruments and, in addition, be able to
recognize unexpected test results, take corrective action or refer the
problem:
Automated stainers
Microhematocrit centrifuge
Automated cell counters
Automated WBC differential
Photo-optical detection of fibrin clot
Cytocentrifuge
Fibrometer
Psychomotor Course Objectives
After completion of the course with instruction and practice in the student lab and at the
affiliate site, students are responsible for performing the following to minimal
competency standards:
1. Perform the following hematologic studies and be able to recognize or resolve
basic technical, instrument, or physiologic causes of problems or unexpected test
results.
Automated counts for RBC, WBC and morphology, and platelets
Manual counts for WBC, reticulocytes, and platelets
Manual differential with morphology
Spun hematocrit
Hemoglobin
Westergren sedimentation rate
2. Recognize normal and abnormal RBC and WBC morphology, artifacts, and
inclusions.
3. Be able to differentiate or resolve basic technical, instrument, or physiologic
causes of problems or unexpected test results.
4. Correlate RBC indices with peripheral smear.
5. Perform a manual platelet count and estimate platelet count from a smear.
6. Estimate a WBC count from a blood smear.
7. Perform a manual reticulocyte count.
8. Perform manual cell counts on CSF and selected other body fluids.
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9. Perform QC and routine maintenance on an automated hematology instrument
and coagulation instrument.
10. Perform Factor V Leiden.
11. Perform the following hemostasis analyses
APTT
PT
d-Dimer
FDP
Bleeding time
Thrombin Clotting Time
Fibrinogen
Xa
12. Describe correct specimen collection for specified hematological determinations
and correctly process specimens for testing.
13. Follow laboratory policies for record keeping and reporting.
14. Evaluate specimen quality and describe corrective action to solve problems with
it.
15. Safely handle and dispose of infectious materials.
16. Perform daily maintenance routines.
17. Troubleshoot procedures and take appropriate action as needed
Affective Course Objectives
At the end of the course, the student should be able to demonstrate the following
behaviors and attitudes:
1. Perform hematological testing with good technique, paying attention to detail and
quality.
2. Maintain and operate instrumentation reliably and generate quality results.
3. Strictly adhere to written procedures and accept verbal technical direction.
4. Use proper quality control measures.
5. Treat laboratory results and issues confidentially.
6. Maintain technical competency and emotional stability in times of stress or
tension.
7. Initiate learning new techniques and persistence in developing skill.
8. Communicate legibly on paper.
9. Practice safety at all times.
10. Communicate confidently with other professionals, students and patients.
11. Organize for priority and efficiency.
12. Recognize unusual or abnormal results and consult an experienced technologist.
Course Outline
I.
II.
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Overview of the Hematology Laboratory
Safety in the Hematology Laboratory
A. Protective measures
1. Gloves/facial barrier/lab coat
2. Handwashing
3. Work surface decontamination
4. Needle precautions
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III.
IV.
V.
VI.
VII.
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5. Infectious waste
Basic Concepts of Quality Assurance in Hematology
A. Nonanalytical
B. Analysis of quantitative data
1. Standards or calibrators and controls
2. Normal or Reference Intervals
3. Delta checks
4. “Rules of three”
5. Statistical Concepts
6. Reflex testing
7. Preanalytic and postanalytic variables
Hematopoiesis
A. Spleen
B. Bone marrow
1. Stem cells and cytokines
2. Erythropoietin
3. Collection
C. CBC
D. Classification of Anemias
E. Calculating Red Cell Indices
1. RBC normal values
2. MCV, MCH, MCHC
F. RDW
G. Reticulocyte
RBC
A. Red Cell Production
B. RBC Maturation
C. RBC membrane development, function, metabolism
1. RBC
D. Normal and abnormal morphology
E. RBC inclusions
Hemoglobin Function and Principles of Hemolysis
A. Hemoglobin Structure and Synthesis
1. Types
2. Function
3. Abnormal Hemoglobin
Red Cell Disorders
A. Microcytic Anemias
1. Iron Intake, Absorption, Storage,Recycled
2. Iron Deficiency Anemia
3. Anemia of Chronic Disease and Inflammation
4. Sideroblastic Anemias
5. Thalassemia Syndromes
B. Macrocytic Anemias
1. Macrocytic vs Megaloblastic
2. Megaloblastic Anemia
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VIII.
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C. Normochromic Anemias
1. Hereditary Spherocytosis
2. Hereditary Elliptocytosis
3. Hereditary Stomatocytosis and Xerocytosis
4. G-6-P-D Deficiency
5. Pyruvate Kinase Deficiency
6. Miscellaneous RBC Disorders
D. Normochromic Anemias Caused by Hemoglobinopathies
1. Sickle Cell Anemia
2. Hemoglobin C Disease and Trait
3. Hemoglobin SC
4. Variant Hemoglobins
A. Other hemoglobinopathies
WBC Disorders
A. Leukopoiesis and Leukopoietic Function
B. Lymphocyte Origin and Function
C. Leukocyte Count from the CBC to the Differential
D. Abnormalities of WBC
1. Quantitative Changes in WBC’s
2. Stages of WBC Phagocytosis
3. Qualitative Defect of WBC’s
4. Hereditary WBC Disorders
5. Reactive Lymphocytosis in Common Disease States
6. The Effect of HIV on Hematology Parameters
7. Lipid Storage
8. Bacteria
E. Acute Leukemias
1. Acute and Chronic
2. Acute Myeloid Leukemia
3. Acute Lymphoblastic Leukemia
F. Chronic Myeloproliferative Disorders
1. Chronic Myelogeneous Leukemia
2. Chronic Neutrophilic Leukemia
3. Chronic Eosinophilic Leukemia
4. Polycythemia Vera
5. Myelofibrosis with Myeloid Metaplasia
6. Essential Thrombocythemia
G. Lymphoproliferative Disorders and Related Plasma Cell Disorders
1. Lymphoid Malignancies
2. Plasma Cell Disorders
H. Myelodysplastic Syndromes
1. Pathophysiology
2. Chromosomal Abnormalities
3. Common Features and Clinical Symptoms
4. Classification
5. Prognosis
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IX.
X.
Hemostasis and thrombosis
A. Vasculature: Structure, function, physiology
B. Primary Hemostasis: Platelets
C. Secondary Hemostasis
1. Coagulation Factors
2. Extrinsic Pathway
3. Intrinsic Pathway: APTT
4. Common Pathway
5. Thrombin
6. Feedback
7. Fibrinolysis
8. Inhibitors
9. Kinin
10. Complement
D. Quantitative and Qualitative Platelet Disorders
1. Quantitative
2. Inherited Qualitative
3. Acquired Defects of Platelet Function
4. Vascular Disorders Leading to Platelet Dysfunction
E. Defects of Plasma Clotting Factors
1. Evaluation of a Bleeding Disorder and Types of Bleeding
2. Classic Hemophilias
F. Fibrinogen, Thrombin, and the Fibrinolytic System
1. The Role of Fibrinogen in Hemostasis
2. Disorders of Fibrinogen
3. Thrombin in Hemostasis
4. Disseminated Intravascular Coagulation
G. Thrombosis and Anticoagulant Therapy
1. Physiological and Pathological Thrombosis
2. Pathogenesis of Thrombosis
3. Thrombotic Disorders
4. Lab Diagnosis
Hematology instrumentation
A. Cell counting principles
B. Types of automated cell counting instruments
C. Analysis of data: Histograms
D. Flow cytometry
General Notes: Library assignments, periodicals, computerized modules, and guest
speakers may be used as appropriate.
Assessment of Student Learning:
In both the didactic and the laboratory portions of the course, the student must achieve
78% or greater. Failure to achieve this minimum score will result in dismissal from the
program. In the laboratory portion of the course, the final grade will be recorded as
“Pass” or “Fail” and registered with the didactic portion.
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The following grading scale applies to all programs within the Allied Health Division:
100 – 92% = A
83 – 91% = B
78 – 82% = C
66 – 77% = D
65% and below = F
In the lecture portion of the clinical course, the final grade is derived from student
performance on examination(s) and/or assignments.
Grading/Student Assessment of lecture (didactic) portion of the course:
Final grade will be composed of:
1. Quizzes, study questions, assigned activities, class participation, etc. = 10%
averaged
2. Unit exams = 60% averaged
3. Final exam = 30%
TOTAL 100%
Grading/Student Assessment of laboratory (student laboratory and
clinicals) portion of the course:
1. Skills Checklist: Passing is 78% of the total points available
2. Professional Behaviors Evaluation: Passing is 78% of the total points
used
Final Pass/Fail clinical grade is the average of the Skills Checklist and the
Professional Behaviors Evaluation
Statement to Connect Course with General Education Outcomes or Technical
Program Outcome Statement: In compliance with MACC’S General Education
outcomes, the student who successfully completes this course will be able to:
a.
Demonstrate effective written and oral communication skills.
b.
Demonstrate an understanding of scientific principles and computational skills
and how to use them to solve problems and make informed decisions.
Program Outcomes and Assessments:
The Allied Health Department continually strives to meet the needs of the Medical
Laboratory Technician student through program improvements. This is a cooperative
effort that includes input from the faculty, student, Medical Laboratory Technician
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Advisory Board, and other appropriate agencies or entities. Students are assessed on
mastery of the course concepts and essential skills throughout the courses of the Medical
Laboratory Technician Program.
Other program assessments include clinical
performance criteria, essential skills mastery, the clinical process evaluation, ASCP
examination scores, placement rates, and follow-up surveys.
Instructor Policies/Expectations:
Instructors of this program expect the following from students:
1. Come to class prepared to discuss or apply important concepts by having read the
assigned material or reviewed materials for instrument operation.
2. Participate in class by listening, taking notes, and making contributions to
discussions.
3. Consult with faculty for clarification of difficult material or additional resources
to consult.
4. Respect the learning environment by averting distractions and disturbances such
as ringing cell phones and extraneous conversation in class.
5. Treat instructors and fellow students with consideration, concern, and fairness.
Academic Dishonesty: MACC board policy is as follows: “Academic dishonesty by
students damages institutional credibility and unfairly jeopardizes honest students;
therefore, it will not be tolerated in any form.” Forms of academic dishonesty include but
are not limited to the following: violations of copyright law, plagiarism, fabrication,
cheating, collusion, and other academic misconduct. Incidents of dishonesty regarding
assignments, examinations, classroom/laboratory activities, and/or the submission of
misleading or false information to the College will be treated seriously. The procedure
for handling academic dishonesty is outlined in the Student Handbook (Policy Handbook
M.010). In cases of alleged academic dishonesty, the burden of proof is on the student,
not on the instructor.
Attendance:
Students are expected to prepare for and attend all classes and clinical practice. Regular
attendance improves probability for success in the program. Habitual tardiness and
frequent absences are disruptive to the classroom and cause an unsafe environment in the
student laboratory. Instructors carefully plan learning experiences, so it is important as a
matter of courtesy and fairness to the class that all individuals be present. Students
absent for reasons beyond their control, such as verified personal illness or family illness
and/or death, can make up class work. If a student misses so many classes due to
extenuating circumstances that the instructor feels the student cannot catch up, the MLT
Program Coordinator will send a written report to the Director of Allied Health.
Students who miss two consecutive weeks of class during a regular sixteen-week
semester or the equivalent ratio of class time during a shorter session will be dropped
from that class unless acceptable justification is supplied to the instructor and the Dean of
Student Services. Additionally, students who miss more than one-fourth of the class
meetings during any scheduled session may be dropped from that class by the instructor
if, in the opinion of the instructor, the student does not have a reasonable opportunity to
succeed in the class.
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Tardiness, make-up, and late work: Tardiness to class and clinicals is disruptive and
inconsiderate of others. Being on time is mandatory.
Make-up and late work: See the MLT Student Handbook for guidelines. Remember that
communication, accountability and responsibility are very important professional
behaviors.
Refer to the MLT handbook for the following policies:
Drop policy
Drug/alcohol policy
Grade appeal procedure
Student code of conduct
Student due process and grievance procedure
Student rights and privacy act
Use of computing resources
ADA Statement
Students who have disabilities that qualify under the Americans with
Disabilities Act may register for assistance through the Office of Access
and ADA Services. Students are invited to contact the Access Office to
confidentially discuss disability information, academic accommodations,
appropriate documentation and procedures. For more information, please
call either the Moberly office at (660) 263-4100 x 11240 or the Columbia
office at (573) 234-1067 x 12120, or visit our web page at
http://www.macc.edu/index.php/services/access-office.
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