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Hematology/Hemostasis Lab Introduction

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

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Hematology/Hemostasis Lab Introduction

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  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 Med lab Students at • 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) • Water, ions, proteins, carbohydrates, fats, hormones, vitamins, enzymes • Cellular elements • Erythrocytes, leukocytes, Thrombocytes

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

  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?

  11. Hematologic Diagnosis & Treatmentfill in the blanks • Maintaining Wellness • RBC abnormalities _____________ • WBC abnormalities _______________ • Platelet abnormalities______________ • Invasive organisms _______________

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

  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

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

  20. Specimen Collection

  21. HAEMATOLOGY LABORATORYCOLLECTION & 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 • Routine • Special • Capillary Puncture • Fingerstick • Heelstick • Arterial Blood Collection

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

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

  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!!

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