Hematology

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• Hematology
• Laboratory
• Notes
• By
• Dr. Jay Shahed

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Bonemarrow

• Hemopoeises
• Production of blood cells
• Types of blood cells
• Erythrocytes ( RBC )
• Leukocytes ( WBC )
• Thrombocytes ( platelets )

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VENIPUNCTURE TUBE ORDER

• Sterile-no additive - liquid additive - powder
  additive.
• Yellow (sterile )
• plain red (no additive)
• Gray and red (tiger top) (no additive)
• Lavender ( purple) (liquid)
• Blue (liquid)
• Green (liquid or powder)
• Gray (powder)

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BLOOD TUBES ADDITIVES

• Yellow (none)
• Plain red (none)
• Gray red (silicon ) (separation wax)
• Lavender (EDTA)
• Blue (sodium citrate anti coag.)
• Green (heparin)
• Gray (potassium oxalate)

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COMMON BLOOD TESTS TUBES

• Yellow (blood cultures)
• Plain red (serum blood chemistries, blood
  typing, pregnancy, HIV viral studies,
  serology,immunology ).
• Gray red (blood chemistries, all profiles,
  clotted blood.)
• Lavender (hematology whole blood, CBC, ESR).
• Blue (blood coagulation, PT, PTT).
• Green (whole blood, plasma, blood gases)
• Gray (blood glucose, alcohol, act activated
  clotting time)

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• HEMATOLOGY normal values

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RBC

• MALE
• 4.5 - 6 mill/mm3
• FEMALE
• 4 - 5.5 mill/mm3
• ABNORMALITIES
• ANEMIA
• POLYCYTHEMIA

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Hb

• MALE
• 14 - 18g/dl
• FEMALE
• 12 - 16/dl
• ABNORMALITIES
• ANEMIA

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HCT

• MALE
• 40 - 54
• FEMALE
• 33 - 46
• ABNORMALITIES
• POLYCYTHEMIA
• ANEMIA

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WBC

• MALE
• 4500 - 11,000/mm3
• FEMALE
• SAME
• ABNORMALITIES
• INFECTIONS
• LEUKEMIA

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PLATELETS

• MALE
• 100,000 - 400,000
• FEMALE
• 100,000 - 400,000
• ABNORMALITIES
• Clotting disorders

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SEDIMENTATION RATE

• WINTROBE
• MALE 0 - 9 mm/hr
• FEMALE 0 - 20 mm/hr
• WESTERGREN
• MALE 0 - 20 mm/hr
• FEMALE 0 - 20 mm/hr
• ABNORMALITIES
• Inflammation
• Autoimmune disorders

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Clotting factors

• Bleeding time ( BT )
• 1 - 3 min
• Clotting time ( C.T )
• 6 - 10 min
• ABNORMALITIES
• Hemorrhage
• Aspirin
• Anticoagulants

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• Prothrombin time ( PT )
• Extrinsic factors
• 6 - 10 min
• Partial thromboplastin time ( PTT )
• Intrinsic factors
• 70 - 110
• ABNORMALITIES
• Hemophilia
• Von Wilibrand disorder

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WBC (LEUKOLYTES)

• GRANULOCYTES
• NEUTROPHILS 60 - 70
• EOSINOPHILS 1 - 4
• BASOPHILS 0.5 - 1
• AGRANULOCYTES
• MONOCYTES 2 - 6
• LYMPITOCYTES 20 - 40

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• CAPILLARY PUNCTURE

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MICROHEMATOCRITT

• PURPOSE
• TO OBTAIN A BLOOD SAMPLE USING A CAPILLARY
  PUNCTURE TO DETERMINE THE HEMATOCRITT PERCENTAGE
  .

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Procedure

• Assemble equipment.
• Ask patient if ever had this procedure before .
• Explain the procedure.
• Ask the patient to wash their hands with warm
  water for a minute.
• Checking the digits of both hands, select your
  site, choose depending on a digit that is free of
  any scars, erythema , lesions or bruises.

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• Don gloves.
• Ask the patient to shake their hand massage the
  middle digit away from the blood site to increase
  the circulation.
• Swab site.
• Remove the lancet shield (preferred an autolet),
  hold the digit with the non dominant hand and
  insert the needle.

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• Wipe off the first drop.
• Fill 2 capillary tubes at a 45 degrees angle by
  the principle of osmosis.
• Invert the tube swiftly and press the non bloody
  end into the clay tray.

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• Ask patient to apply pressure .
• Apply ban-aid .
• Discard disposable.
• Complete lab forms.
• Record results in patient chart.
• Example
• 8/19/97
• 10 am
• Result Hct 44
• JS

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VENIPUNCTURE

• PURPOSE
• THE CORRECT PROCEDURE IN USING A VACCONTAINER TO
  OBTAIN A BLOOD SAMPLE FROM A PATIENT.

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Procedure

• Assemble equipment.
• Ask patient if ever had this procedure before .
• Explain the procedure.
• Select site by checking both antecubital areas
  of both arms preferably the cephalic or basilic
  veins.
• Don gloves.

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• Apply tourniquet 3-4 inches above the elbow.
• Swab site.
• Remove the needle shield.
• Locate vein and fix with non dominant hand.
• Insert into vein with the dominant hand.

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• Push tube into the holder with the non dominant
  hand.
• Switch tubes if needed.
• Release tourniquet as the last tube is half
  filled.
• Apply gauze gently over the site.
• Remove the needle.
• Ask patient to apply pressure .

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• Apply ban-aid over gauze.
• Discard disposable.
• Complete lab forms.
• Record in patient chart.
• Example
• 10/20/97
• 1000 am
• 1 red top
• 1 lavender
• JS

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BUTTERFLY

• PURPOSE
• THE CORRECT PROCEDURE IN USING A BUTTERFLY TO
  OBTAIN A BLOOD SAMPLE FROM A PATIENT.

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Procedure

• Assemble equipment.
• Ask patient if ever had this procedure before .
• Explain the procedure.
• Select site by checking both dorsal of hands.
• Don gloves.
• Apply tourniquet to wrist.Swab site.

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• Remove the needle shield.Locate vein and fix
  with non dominant hand.
• Hold needle from wings bevel up and insert into
  vein.
• Push tube into the holder with the non dominant
  hand.
• Switch tubes if needed.

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• Release tourniquet as the last tube is completely
  filled.
• Apply gauze gently over the site.Remove the
  needle.
• Ask patient to apply pressure .apply ban-aid
  over gauze.
• Discard disposable.
• Complete lab forms.

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• Record in patient chart.
• Example
• 10/28/97
• 900 AM
• 2 red tops
• JS

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HEMOGLOBINOMETER

• PURPOSE
• TO MEASURE THE AMOUNT OF HEMOGLOBIN IN A PATIENT.

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Procedure

• Assemble equipment.
• Ask patient if ever had this procedure before .
• Explain the procedure.
• Ask the patient to wash their hands with warm
  water for a minute.
• Checking the digits of both hands, then select
  your site that is free of any scars, erythema ,
  lesions or bruises.

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• Don gloves.
• Ask the patient to shake their hand massage the
  middle finger if possible to increase the
  circulation.
• Swab site.
• Remove the lancet shield (preferred an autolet,
  hold the digit with the non dominant hand and
  insert the needle.

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• Apply a drop of blood to the slide glass then
  spread it in the rectangular area using a wood
  applicator.
• Ask patient to apply pressure .apply ban-aid .
• Discard disposable. Cover the slide with top
  glass cover, then insert into the clamp and into
  the chamber.

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• Read the hemoglobinometer by matching the two
  rectangular shaded areas facing the light.
  Complete lab forms.Record in patient chart.
• Example
• 10/9/97
• 830 PM
• 12mg/dl
• JS

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ERYTHROCYTE SEDIMENTATION RATE

• PURPOSE
• TO MEASURE THE TIME NEEDED FOR THE BLOOD CELLS TO
  PRECIPITATE IN THE BOTTOM OF THE TUBE.

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WINTROBE

• Procedure
• Assemble equipment.
• Draw a purple top tube from the patient.
• Draw a sample blood 3/4 of the way into a glass
  pipette.
• Fill the wintrobe glass tube with the sample
  blood starting from bottom upward till you reach
  the fill line at 0 or 10.

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• Let the sample sit on a rack for 1 hour.
• Read the results by measuring the distance that
  the blood settled down from the 0 mark.
• Document results into chart.
• Example
• 9/9/97
• 230 PM
• 4 mm/ hr.
• JS.

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WESTERGREN

• Procedure
• Assemble equipment.
• Draw a purple top tube.
• Draw 1/2 filled glass pipette.
• Remove the cap from the small plastic heparin cup
  and fill it to the marked fill line.
• Cover the cup with cap.
• Insert the long plastic tube into the cup and let
  the blood rise

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• In the tube up to the fill line at the 0 mark.
• Let the sample sit on a rack for 1 hour.
• Read the results by measuring the distance that
  the blood settled down from the 0 mark.
• Document results into chart.
• Example
• 9/9/97
• 230 PM
• 14 mm/ hr.
• JS.

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DIFFERENTIAL SMEARS

• PURPOSE
• TO PREPARE A SLIDE FOR MICROSCOPIC EXAMINATION.

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Procedure

• Assemble equipment.
• Draw a purple top tube.
• Fill a small amount into a glass pipette.
• Place a drop of blood on the slide 1/4 of the
  distance from the edge.
• Place another slide with its edge in the front
  of the blood drop of the other slide.

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• Using a sliding motion spread the blood gently
  across the slide smearing the blood with a
  complete slide width, no air bubbles and with
  feathers at the end.

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MICROSCOPIC WBC DIFFERENTIAL

• PURPOSE
• TO IDENTIFY THE DIFFERENT BLOOD CELLS USING THE
  MICROSCOPE.

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Procedure

• Immerse a smeared slide into WRIGHT stain
• Then immerse into sterile water.
• Allow to air dry .
• Place slide under the high power of 100x.
• Place a drop of immersion oil on the slide.

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• Observe the RBC and the different types of WBC
• Neutrophils, Basophils, Eosinophils, Monocytes
  and lymphocytes.
• Count the number of different cells you have seen
  using the zig zag motion then record the numbers

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• BLOOD CHEMISTRIES

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THE EKTACHEM MACHINE

• PURPOSE
• TO MEASURE DIFFERENT BLOOD CHEMISTRIES INCLUDING
  GLUCOSE, CHOLESTEROL, HDL, LDL, UREA, CREATININE,
  URIC ACID BUN.

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• Draw a red serum tube
• Centrifuge for 10 minutes.
• Pore the serum into a small cup.
• Place the electrical pipette into the serum
  sample in the cup and press the bottom on the top
  of the pipette, that will allow the blood to
  enter the pipette, this is confirmed by a beep
  sound.

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• Insert a chosen blood chemistry slide into the
  slider with grove of the slide facing to the
  inside.
• Insert the pipette containing the sample into the
  required opening.
• The screen will direct you to spot slide with
  fluid press the bottom on the top of the pipette,
  which will allow the serum sample to smear the
  slide , that is confirmed by a beep sound.

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• Remove the pipette and wait about 7-10 minutes
  for the results.
• Record the results on the MPR.
• Example
• Chol 180 mg / dl
• 10/10/98
• 1000 Am
• Dr. Jay

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GLUCOMETER

• PURPOSE
• TO MEASURE THE GLUCOSE LEVEL IN A PATIENT.

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Procedure

• Assemble equipment.
• Ask patient if ever had this procedure before .
• explain the procedure.
• Ask the patient to wash their hands with warm
  water for a minute.
• Checking the digits of both hands select your
  site depending on a digit that is free of any
  scars, erythema , lesions or bruises.

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• Don gloves.
• Ask the patient to shake their hand
• Massage the middle finger if possible away from
  the site to increase the circulation.
• Swab site.
• Remove the lancet shield (preferred an autolet),
  hold the digit with the non dominant hand and
  insert the needle.

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• Wipe off the first drop
• place a drop on to the strip.
• Insert the strip into the calibrated glucometer .
• Read the results after the required time.
• Record your results.
• Example
• 10/10/971000 am120mg/dlJS