Hematology/Hemostasis Lab
Introduction
Faisal Klufah
M.S.H.S, MLS(ASCP)
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
Introduction to Hematology
 Class participation
 What is the meaning of Hematology & Hemostasis
terms?
 What is hematology and what do you expect to study?
Whether near or far…..
Med lab Students at
Malumghat, Bangladesh
Med lab Students at
Umm Al-Qura University
Basic Sciences of Hematology
 Biochemistry
 Immunology
 Cell biology
 Pathology
 Cytology
 Physiology
 Genetics
 Oncology
 Histology
Composition of Blood
 Liquid (plasma)
 Water, ions, proteins,
carbohydrates, fats,
hormones, vitamins,
enzymes
 Cellular elements
 Erythrocytes, leukocytes,
Thrombocytes
HEMATOLOGY TESTS
 CBC
 ESR
 Retic count
 Bone marrow Exam
 Hgb electrophoresis
 Sickle-cell screen
 Osmotic fragility
 Cytochemistry stains
 Molecular tests
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
High power magnification: What do you see?
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?
Hematologic Diagnosis & Treatment
fill in the blanks
1.
2.
3.
4.
5.
Maintaining Wellness
RBC abnormalities _____________
WBC abnormalities _______________
Platelet abnormalities______________
Invasive organisms _______________
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.
Oil immersion view of red and white blood cells
in the bone marrow
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
Clinical Microscopy
 Care of the microscope____________
 Component parts and functions_____
 Hematology uses _____________?
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?

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
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
Factors Contributing to Imprecise or
Inaccurate Results
 Give examples related to:
 Testing environment
 Pre-analytic factors
 Analytic system
 Post-analytic factors
Specimen Collection
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
* Serum
* Plasma
#
* Capillary blood #
* Heel blood #
Results are slightly higher than that of the venous samples
 Anticoagulants:
* Ethylene diamine tetra-acetic acid (EDTA)
* Trisodium citrate
* Heparin
Role of the Phlebotomist
 Represents laboratory to patients
 Assures quality of specimen
Types of Collection
 Venipuncture
 Routine
 Special
 Capillary Puncture
 Fingerstick
 Heelstick
 Arterial Blood Collection
Blood Vessels
 Veins
 Thinner walls, Less pressure, Valves
 Arteries
 Thicker walls, more pressure
 Capillaries
 Tiny vessels
Venipuncture Equipment
 tourniquet
 needle/syringe
 vacutainer holder
 vacutainer tubes
 winged infusion set
(Butterfly needle)
 alcohol
 gauze
 bandaid
 sharps container
 marker for tubes
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
Sequence of Tube Draw
 Sterile for blood culture
 Plain tubes, No additive
 Anticoagulant tubes
 blue (sodium citrate)
 green ( heparin)
 lavender (EDTA)
 gray (sodium fluoride)
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
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
Sources of Sampling Errors
 Wrong order of tube draw
 Prolonged tourniquet application
 Delay in processing
 Inadequate volume
 Hemolysis
 Unlabeled specimens
 Clotted anticoagulant specimen
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
Problem Patient Reactions
 Fainting
 Nausea
 Vomiting
 Excessive bleeding
 Convulsions
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!!