MT 1A:

Introduction to Medical Technology with Science, Technology and Society

Report on Clinical Laboratory Section
Hematology Section

Clinical Laboratory Section

Hematology Section

1EMT - Group #4
Aquitania, Mary Christelle
Donato, Anna Katrina
Galope, Jerrica Charlene
Leachon, Sofia Marie
Manalastas, Keen
Mendoza, Jose Paulo
Nabong, Krizel Ann Therese
Samorano, Kathryn Chemaine
Whaley, Kristen Therese

Prof. Ron Christian G. Sison, RMT, AMT, MPH

University of Santo Tomas
Faculty of Pharmacy
Department of Medical Technology

September 2008
Table of Contents
I. Introduction .......................................................................................................................................... 3
II. Definition of Terms ............................................................................................................................... 4
III. Function of the Section ......................................................................................................................... 6
Laboratory Floor Plan of Hematology Section .......................................................................................... 7
IV. Lists of Tests .......................................................................................................................................... 8
1. Routine Tests..................................................................................................................................... 8
 COMPLETE BLOOD COUNT (CBC) .................................................................................................. 8
 About MANUAL DIFFERENTIAL COUNT ...................................................................................... 19
2. Special Tests .................................................................................................................................... 20
 Prothombin Time (PT) ................................................................................................................. 20
 Partial Thromboplastin Time (PTT) ............................................................................................. 20
 Diascopy ...................................................................................................................................... 21
 D-dimer ....................................................................................................................................... 21
V. Flow of Specimen ................................................................................................................................ 22
VI. Quality Assurance & Quality Control .................................................................................................. 23
VII. Updates & Automation ....................................................................................................................... 25

References ................................................................................................................................................. 27

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 I. Introduction
Blood is the most important fluid in our body which is being pumped by the heart through a
network of arteries and veins. It transports nutrients and oxygen throughout our body, removes
waste materials such as carbon dioxide, urea and lactic acid, regulates pH and body temperature.
Furthermore, and provides immunological, messenger and hydraulic functions.

Hematology is a part of the clinical laboratory which studies the blood, blood-forming organs
and the diseases related to it. It is a unique subdivision of internal medicine. This department is both
completely different but at the same time actually overlapping with the subspecialty, medical
oncology. The study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases
are also included in this division.

The physicians assigned to this section of clinical laboratory are called hematologists. These
physicians are usually board-certified interns who have managed to complete additional years of
training in hematology. Their work basically includes caring and treating patients with hematological
diseases. They are the ones assigned to view blood films and bone marrow slides under the
microscope, and then interpret the various hematological test results.

There are also physicians that are referred to as hemapathologists. These are pathologists who
specialize in diagnosing diseases that are related to hematology. Almost similar to a hematologist,
they manage and work in the hematology laboratory. Both physicians work closely together in order
to draw out an accurate diagnosis and dispatch the most appropriate treatment or therapy required.

Figure 1 Complete Blood Count by a hematologist in East Avenue Hospital (From left to right)

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II. Definition of Terms

1. Acanthocytes – A crenated red cell which

has a distinctive spiky outline.
2. Accuracy – It is defined as the best
estimate of the result to the true value.
3. Analyte – A substance or chemical
constituent that is undergoing analysis
4. Anticoagulant – A substance that
prevents the clotting of blood.
5. Biopsy – The surgical removal of tissue
from a living body for examination and Figure 2 Acanthocytes
diagnosis. It is also a medical examination
of this tissue.
6. Blood – The fluid consisting of plasma, blood cells, and platelets that is circulated by the
heart through the vertebrate vascular system, carrying oxygen and nutrients to and
waste materials away from all body tissues.
7. Chemiluminescent – Emission of light as a result of a chemical reaction at
environmental temperatures.
8. Coagulation – Process of forming a blood clot to prevent blood loss from a ruptured
vessel. A damaged blood vessel stimulates activation of clotting factors, eventually
leading to the formation of long, sticky threads of fibrin.
9. Controls (Control Materials) – These are used to monitor the performance of a method
after calibration.
10. EDTA - Abbreviation for ethylenediaminetetraacetic acid, used for anticoagulation.
11. Erythrocytes – A type of Blood Cell that distributes oxygen throughout the body tissues.
Also known as red blood cells.
12. Erythropoietin – It is a medicine used to treat a low red blood cell count. (Also refers to
Epoetin alfa, a recombinant preparation of human erythropoietin used to treat some
forms of anemia.)
13. Extravasate – To force the flow of blood or lymph from a vessel out into surrounding
tissue
14. Exudate – A fluid with a high content of
protein and cellular debris which has escaped
from blood vessels and has been deposited in
tissues or on tissue surfaces, usually as a result
of inflammation
15. Hematocrit – The proportion of the blood
volume that is occupied by the red blood cells.
16. Hematopoiesis – The formation of blood or
blood cells in the body. Also refers to
erythropoiesis.
17. Hemostasis - The stoppage of bleeding or
hemorrhage; the stoppage of blood flow Figure 3 Erythrocytes and a Leukocyte
through a blood vessel or body part.
18. Ischemia – An insufficient supply of blood to an organ, usually due to a blocked artery.

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19. Leukocytes – A type of Blood Cell that
defend the body against both infectious
disease and foreign material. Also known as
white blood cells.
20. Magtration – A simple, patented separation
method in which magnetic particles on the
inner wall of the pipette tip are washed and
separated.
21. Mean – It is the arithmetic average of a Figure 4 Spherocytes
group of data points.
22. Median – It is the middle value of a dataset.
23. Mode – It is the value occurring most frequently.
24. Precision – This relates to reproducibility and repeatability of test samples using the
same methodology.
25. PRP - A special blood concentrate known as platelet-rich plasma (PRP) that can promote
healing in different aspects of medical and surgical situations.
26. Reticulocytes – Immature red blood cells. These are non-nucleated and that contain
remnant RNA material, reticulum.
27. Rouleaux – The stacking up of red blood cells, caused by extra or abnormal proteins in
the blood that decrease the normal distance red cells maintain between each other.
28. Smear - A blood sample or specimen spread on a slide for microscopic examination or
on the surface of a culture medium
29. Spherocytes – A spherical red blood cell.
30. Thrombocytes – A small cytoplasmic bodies derived from cells. They circulate in the
blood of mammals and are involved in homeostasis. Also known as platelets.
31. Transudate – A fluid substance that has passed through a membrane or has been
extruded from a tissue; it is characterized by high fluidity and a low content of protein,
cells or solid matter derived from cells.
32. Trephine Biopsy – Removal of a small core of bone marrow under local anesthetic. It is
used to assess bone marrow structure, the number and distribution of all the blood cell
types.

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III. Function of the Section

A clinical laboratory functions as an information center for each of

the departments and programs that provide services within the Health
Department. The staff performs a multitude of test, providing virtually
immediate results for requests as basic as a urinalysis to those as
complicated as HDL Cholesterol. The laboratory also oversees tests that
are outside of the parameters of the laboratory’s certifications, and are
performed at several in-state and out-of-state facilities. The results of
the tests are critical for the individual departments and programs to be
able to provide accurate information and advice to their clients as it
relates to each individual’s medical concerns.

The laboratory is staffed with Medical Laboratory Technicians who

are individually certified by the American Society of Clinical Pathologists
(ASCP). All of the technicians are trained to operate all of the testing Figure 5 Hematologist performing differential
equipment employed by the laboratory, and are evaluated for blood count.
proficiency on a regular basis. Each technician receives continuing education (as required by laboratory
policy) in order to maintain and improve current knowledge and to be able to continue to provide SCHD
programs with test results reflecting the most recent technical training.

The hematology section is a section of a clinical laboratory which applies molecular, cellular and
morphological techniques to the study of blood, blood-forming tissues, and blood diseases. This section
of the laboratory is particularly involved in areas such as hemostasis, thrombosis, metabolism, and
morphology, and concentrated on the study of blood coagulation, fibrinolysis and the use of hemostatic
tests as markers of diseases. It performs routine and special tests on blood such as complete blood
count (CBC), peripheral smear and malarial parasite examination, and tests for hemostasis and
coagulation studies. The section also performs cell counts and microscopic examination of cerebrospinal
fluid (CSF) and other body fluids. The Hematology section counts and differentiates the types of cells in
blood. Tests performed in this area are used to check for anemia, leukemia, mononucleosis and
indications of viral or bacterial infection. They also observe the cells in other body fluids, such as
synovial (joint) fluid or spinal fluid, examine bone marrow aspirations and perform semen analyses.

Figure 6 Hematology laboratory: Test result analyzing Figure 7 CBC test using hematology analyzer

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Laboratory Floor Plan of Hematology Section
Courtesy of East Avenue Medical Center

Image 1 Hematology Section - Laboratory Floor Plan

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 IV. Lists of Tests

1. Routine Tests

 COMPLETE BLOOD COUNT (CBC)

CBC is a series of tests used to evaluate the composition and

concentration of the cellular constituents of blood. The nine components of the
CBC are the white blood cell count (WBC), red blood cell count (RBC), Hgb,
hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular Hgb
(MCH), eancorpuscular Hgb content (MCHC), platelet count, and red cell
distribution width (RDW). It provides information about the size and shape,
hemoglobin content of RBCs, percentage and absolute number determination
of the types of WBCs and identifies cell abnormalities. This will determine the
presence of infections and chronic disorders for diagnosis, preoperative test
and monitoring treatments, and ascertain the effects of chemotherapy and
Figure 8 Human Red Blood
Cells radiation therapy on blood cell production. These tests are performed using an
automated hematology analyzer.

This test is also known as Full Blood Count (FBC) and hemogram.

Table 1 Nine Blood Components and other routine tests

Component Description Reference Ranges Relevance
Red Blood Cell The number of red blood Male:  Diagnose for anemia (low
Count cells in 1 mm3 of blood; a 4.3 – 5.9 x1012/L [1] hemoglobin)
useful diagnostic tool in the 4.3 – 6.2 x1012/L [2]
determination of several Female:
kinds of anemia. 3.5 – 5.5 x1012/L [1]
3.8 – 5.5 x1012/L [2]
Infant/Child:
3.8 – 5.5 x1012/L [2]

Figure 9 Erythrocytes (RBC)

White Blood Cell It determine the number of 4,300 - 10,800  Detection of
Count white blood cells and the cells/µL/cu mm bacterial/parasitic
(Refer to Table 3: Type of percentage of each type of infection in the blood
WBC) white blood cell in a  Diagnose for leukemia and
(See image next page) person's blood other bone marrow
related conditions

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 Figure 10 White Blood Cell
Hemoglobin (Hgb) Measures the constituent Male:  Diagnose for anemia (low
of iron-containing 13 – 18 gm/dL hemoglobin)
respiratory pigment in red 2.1 – 2.7 mmol/L[1]
blood cells of vertebrates, 132 – 162 g/L[2]
consisting of about 6 135 – 175 g/L[1]
percent heme and 94
percent globin. Female:
12 – 16 gm/dL
1.9 – 2.5 mmol/L[1]
120 – 160 g/L

Figure 11 Hemoglobin
Hematocrit (Hct) Measures how much space Male:  Very useful in diagnose for
in the blood is occupied by 0.41 – 0.53 [1] anemia
red blood cells. 0 – 15 mm/hr

Female:
0.36 – 0.46 [1]
0 – 20 mm/hr

Child:
0.31 – 43 [2]

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 Figure 12 Hematocrit of the Blood Sample
Mean Corpuscular The average volume of red Male:  Detection in deficiency in
Volume (MCV) cells in erythrocyte indices, 82 – 102 fL vitamin B12
calculated from the  Detecting
hematocrit and the red Female: hemochromatosis
blood cell count. 78 – 101 fL  Useful diagnostic
haematological parameter
Normal RBC Indices for detection of α-
Value: thalassaemia at birth
80 – 96 fL

Mean Corpuscular A measure of the weight of 27 - 32 pg/cell  Detection in deficiency in

Hgb (MCH) hemoglobin in a single red vitamin B12
blood cell. 0.39 – 0.54  Detecting
[1]
fmol/cell hemochromatosis

Eancorpuscular Hgb Mean cell hemoglobin 31 – 35 g/dL[2]  Increased hyperchromic

content (MCHC) concentration. The average cells Determination
hemoglobin concentration
in a given volume of packed
red blood cells.

Platelet count A diagnostic test that 150,000 - 350,000/mL  Determine stable

(See image next page) determines the number of hemostasis process
platelets in the patient's
blood

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 Figure 13 Platelets in 100x magnification (pointed by the arrow)
Red blood cell Measure of the variation of 11.5 – 14.5 %  Diagnose for anemia (low
Distribution Width red blood cell volume (coefficient of hemoglobin)
(RDW) variation)

Figure 14 Representative of Red Blood Cell, Morphology

Reticulocyte Count A blood test performed to Adult:  Diagnose and treatment
(See image next page) assess the body's 0.5 – 1.5 % of RBC [1] [2] for anemia
production of immature red  Reflection of bone
blood cells (reticulocytes). Newborn: marrow health or injury
Sometimes it is called retic 1.1 – 4.5 % of RBC [2]
count.
Infant:
0.5 – 3.1 % of RBC [2]

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 Figure 15 Reticulocyte in peripheral smear
Erythrocytes A nonspecific screening test Male: 1 - 13 mm/hr  Used to assess blood
Sedimentation Rate indicative of inflammation content through blood
(ESR) which is used as an initial Female: 1 - 20 mm/hr sedimentation
screening tool and follow-
up test to monitor therapy Hemoglobin in
and progression or plasma:
remission of disease. This 0.16 – 0.62 μmol/L
test is reported in 1 – 4 mg/dL
millimeters.

Figure 16 Actual Blood Sedimentation and Constituents

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 Figure 17 Rouleaux Formation of RBC

 Any condition that will increase rouleaux formation will usually increase the
settling of red cells.
Bone Marrow This test refers to (refer to the Normal Range  Used in the diagnosis a
Examination pathologic analysis of bone of the 9 Components of
number of conditions,
CBC)
(See image in Figure 19) marrow samples obtained including leukemia,
by trephine biopsy and anemia, multiple myeloma
bone marrow aspiration. It and pancytopenia
is sometimes necessary to
examine the source of
blood in the bone marrow
to obtain information about
hematopoiesis.

Figure 18 Normal Bone Marrow at medium magnification

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 Figure 19 Bone Marrow Examination

Table 2 Factors in Erythrocyte Sedimentation Rate, from Practice in Hematology by Ciesla, B., page 300-301
Factors Affecting ESR
 Red cell shape and size: Specimens containing sickle cells, acanthocytes, or spherocytes will
settle slowly and give a decreased ESR
 Plasma fibrinogen and globulin levels:
o Increased fibrinogen or globulin levels will cause increased settling and give an
increased ESR
 Mechanical and technical conditions: Surfaces that are not level will influence red cell
settling. Specimens that are not properly anticoagulated will also affect red cell settling. EDTA
is the recommended anticoagulant.

Blood Fluid Cell A CSF cell count is a test to
Count/Cerebrospinal measure the number of red
Fluid Cell Count and white blood cells that
(CSF) are in CSF. CSF is a clear
(See image in Figure 20) fluid that circulates in the
space surrounding the
spinal cord and brain.It is
used to evaluate body
fluids, differential diagnosis
of exudates and transudate.
Cell counts and cell
morphology (refer to Figure
14) are key elements in
identifying abnormalities
within each of these
systems.
Normal white blood  Increase of white blood cells
cells: indicates infection,
0 and 5. inflammation or bleeding into
the cerebrospinal fluid that
Normal red blood cell may cause, such Abscess,
count: 0 Acute infection, Encephalitis,
Hemorrhage, Meningitis,
Multiple sclerosis, Stroke and
Tumor.
 Red blood cells may indicate a
sign of bleeding

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 Figure 20 CSF (cerebrospinal fluid) is a clear fluid that circulates in the space surrounding the spinal cord and
brain.
Differential Count A test based on the 4.3-10.8 × 103/mm3  Differentiate the different
percentage of each variety types of leukocytes and
of leukocytes in the blood, infection involve due to
usually based on counting varied results
100 leukocytes. Also known  Diagnose viral and
as leukocyte count. parasitological infection in
blood
(Refer to Table 4: Peripheral
Smear Preparation)

Figure 21 White Blood Cell Differentiation: Granulocytes and Agranulocytes

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Table 3 Leukocyte Count Identification
WBC Components
Type Assessment Normal Range Image
Neutrophils  Can increase in response to Adults:
bacterial infection or 50% to 70%
inflammatory disease
 Severe elevations in
Infants:
neutrophils may be caused
by various bone marrow 37% to 67%
disorders, such as chronic
myelogenous leukemia
 Decreased neutrophil levels
may be the result of severe
infection or other conditions,
such as responses to various
medications, particularly
chemotherapy.

Eosinophil  Can increase in response to Adults:

allergic disorders, 0% to 4%
inflammation of the skin, and
parasitic infections.
 Can increase in response to Infants:
some infections or to various 1% to 4%
bone marrow disorders
 Decreased levels can occur
as a result of infection.

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Basophils  Can increase in cases of Adults:
leukemia, chronic 0% to 2%
inflammation, the presence
of a hypersensitivity reaction
to food, or radiation therapy Infants:
0% to 2%

Lymphocytes  Can increase in cases of viral Adults:

infection, leukemia, cancer of 20% to 44%
the bone marrow, or
radiation therapy
 Decreased lymphocyte levels Infants:
indicate diseases that affect 18% to 38%
the immune system, such as
lupus, and the later stages of
HIV infection.

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Monocyte  Can increase in response to Adults:
all kinds of infection as well 4% to 10%
as to inflammatory disorders
 Increases in certain
malignant disorders, Infants:
including leukemia. 1% to 12%
 Decreases monocyte levels
indicate bone marrow injury
or failure and some forms of
leukemia.

Band Cells (Stab  Indicates early response to Adults:

Cells) infections that forms 1% to 10%
immature neutrophils
 Earliest sign of WBC
response, even before the Infants:
WBC becomes elevated 4% to 14%


Note 1 Reference Range Based on Three Different Sources:

1. Last page of Deepak A. Rao; Le, Tao; Bhushan, Vikas (2007). First Aid for the USMLE Step 1 2008 (First Aid for the
Usmle Step 1). McGraw-Hill Medical. ISBN 0-07-149868-0.

2. Normal Reference Range Table from The University of Texas Southwestern Medical Center at Dallas. Used in
Interactive Case Study Companion to PATHOLOGIC BASIS of DISEASE.

3. "Hematology in Practice" by Betty Ciela

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  About MANUAL DIFFERENTIAL COUNT
When automated differentials do not meet specified criteria programmed into the automated
hematology instrument, the technologist/technician must perform a manual differential count from a
prepared smear. There are two types of blood smears: the wedge smear and the spun smear. Usually,
wedge smear is done because it is easy to prepare and more reliable in terms of cell counting. A good
counting area is an essential ingredient in a peripheral smear for evaluating the numbers of and types of
white cells present and evaluating red cell and platelet morphology.

Table 4 Preparation of a Blood Smear through Wedge Smear

How To Prepare a Peripheral Blood Smear

Step 1. Placing a Step 4. The
small drop (2 - 3 spreader slide is
mm drop further pulled
approximately 1/4" out, leaving a
from the frosted thin layer of
slide) of venous blood behind.
blood on a glass
microscope slide,
using a glass
capillary pipette. A
wooden applicator
stick can also be
used for this
purpose.
Step 2. A spreader Step 5. The blood
slide has been smear is nearly
positioned at an complete.
angle and slowly
drawn toward the
drop of blood.

Step 3. The Step 6. End

spreader slide has result. A glass
been brought in slide with a well-
contact with the formed blood
drop of blood and film. After drying
is being drawn for about 10
away. Note layer of minutes, the
blood at the edge slide can be
of the spreader stained manually
slide. or placed on an
automated slide
stainer.

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 2. Special Tests

 Prothombin Time (PT)

Prothrombin time (PT) is a blood test that measures how long it takes blood to
clot which aids in checking bleeding problems. Generally, it measures the
integrity of the extrinsic and common pathways of coagulation. About 12
blood clotting factors are needed for blood to clot (coagulation). Prothrombin,
or factor II, is one of the clotting factors made by the liver. Vitamin K is needed
to make prothrombin and other clotting factors. It is an important test
because it checks to see if five different blood clotting factors (factors I, II, V,
VII, and X) are present.
Figure 22 A Wright's stained bone
marrow aspirate smear of patient
The normal range in Prothrombin Time is between 25 to 24 seconds of with precursor B-cell acute
coagulation. lymphoblastic leukemia.

Table 5 Prothrombin Time extends time due to different factors listed below.

Delaying Factors in Prothrombin Time

 Blood-thinning medicine, such as heparin
 Low levels of blood clotting factors.
 A change in the activity of any of the clotting factors.
 The absence of any of the clotting factors.
 Other substances, called inhibitors that affect the clotting
factors.
 An increase in the use of the clotting factors.

Prothrombin time abnormality is often caused by liver disease or injury or by

treatment with blood thinners.

 Partial Thromboplastin Time (PTT)

The activated partial thromboplastin time (PTT) measures the clotting time from the activation of factor
XII, through the formation of fibrin clot. This measures the integrity of the intrinsic and common
pathways of coagulation. PTT prolongations are caused by either factor deficiencies (especially of factors
VIII, IX, XI, and/or XII), or inhibitors (most commonly, lupus anticoagulants, or therapeutic anticoagulants
such as heparin, hirudin, or argatroban).

Table 6 Obtain information from Practice in Hematology by Ciesla, B., page 315

Principle behind PT ant (a)PTT

Coagulation instruments, most of which are capable of analyzing samples through the use of clotting,
chromogenic or immunoassay methods, are currently fully automated to analyze larger volume of samples
with high degree of accuracy. Clot method of photodetection uses light transmission (optical detection
method) to determine prothrombin (PT) and activated partial thromboplastin time (aPTT) times.
Meanwhile, The optical detection method detects the change in absorbance as a light-emitting diode
recognized fibrin or clot formation. Then, a sensor picks up the light beam and converts into an electrical
signal. A microcomputer signals and calculates the electrical power to determine the coagulation time.
Presently, some automated coagulation testing are now able to identify variables such as lipemia and
hemolysis and yet still able to present accurate clotting times.present accurate clotting times.

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  Diascopy
Diascopy is a medical approach used to differentiate between certain types of hematologic lesions. This
is divided in two general types of hematologic lesions: Vascular and Non-vascular lesions. This test relies
on the principle, difference in which it entails through the use of a thin plate of transparent to depress a
hematologic lesion. If the lesion blanches and no longer appears with the same bloodlike color, the
lesion is deemed vascular, as the glass or plastic has effectively blocked the circulatory flow of or about
the lesion, causing a momentary ischemia or the lesion. If the lesion is non-vascular, pressing it with the
plate will merely press on the collection of blood, but the area will not blanch.

Table 7 General Types of Hematologic Lesions

Vascular Lesions Non-vascular Lesions

It exists as pathologic formations of blood This are the result extravasated blood
vessels, such as telangectasias and collected below the surface of the
hemangiolas. skin or trapped between layers of
tissue, such as a hematoma.

 D-dimer
D-dimer is a performed test to diagnose thrombosis. Its primary objective is to exclude thromboembolic
disease where the probability is low. This use when there is a suspicion of deep venous thrombosis
(DVT) or pulmonary embolism (PE). In its range reference, values exceeding 250-500 ng/ml and above
are considered positive.

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 V. Flow of Specimen
Blood samples undergo series of procedure that ensures the accuracy and precision of results. The
Hematology section follows standardization and quality assurance for a quality service. The figure below
shows a step-by-step method on how blood samples are process within the premises of the laboratory.

BLOOD SPECIMEN
taken from the
patient

Record
Label the test
information of
tube in Number
the patient

BLOOD

Reticulocyte
CSF Differential Count CBC
Count

Test is repeated
until it satisfies
the requirement

Test Result
Clarification

Chief MT checks
the results

Pathologist
supervise and
checks the results
for finalization

RELEASE OF
RESULT

Figure 23 Specimen Flow in Hematology Section

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VI. Quality Assurance & Quality
Control

Quality assurance is a comprehensive and

systematic process that strives to ensure valid and
reliable patient results. This process includes every
level of laboratory operation. Phlebotomy services,
competency testing, error analysis, standard protocols,
PPE, quality control, and turnaround time are each a
key factor in the quality assurance system. From the
time a sample arrives in the laboratory until the results
are reported, an accurate quality assurance system is
the key feature in ensuring quality results. Each part of
the quality assurance plan or process should be Figure 24 Evacuated tubes and micro-collection tubes. (From left to
analyzed, monitored, and reconfigured as necessary to right: EDTA, Na Citrate, SST, Plain, Na Citrate, Na Heparin, EDTA, Acid
emphasize excellence at every outcome. Although many Solution A, EDTA, and SST). The sample volumes of these tubes range
from 250 microliters to 10 milliliters
hospitals and research facilities have “quality”
professionals who provide oversight for quality
assurance plans for their facilities, an elemental understanding of terms related to the total quality
assurance plan is required of all staff technologists and students. Quality control plays a large part in
quality assurance program at most facilities.

In maintaining quality assurance, a medical technologist notes important information to be obtained

about the patient. Specimens of blood are labeled and each undergoes a certain procedures. The
determination of results is recorded in a logged book or in a data sheet. Several repetition of procedure
is necessary to achieve the normal value needed, or in other cases are the abnormalities of the patient’s
blood result. All information is documented; this is to be signed by the medical technologist in the
laboratory. Released output is under the supervision and administration of the pathologist, or head
medical technologist of the section.

Table 8 Quality Assurance Indicators, from Practice in Hematology by Ciesla, B., page 8
Short List of Quality Assurance Indicators
• Number of patient redraws
• Labeling errors
• Patient and specimens properly identified
• Critical values called
• Pass rate on competency testing
• Test cancellation
• Integrity of send-out samples
• Employee productivity
• Errors in data entry
• Testing turnaround times
• Delays due to equipment failures or maintenance
• Performance on proficiency testing

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 The analytical component (actual measurement of the analyte in body fluids) is monitored in the
laboratory by quality control, a component of the laboratory quality assurance plan. Control materials
are assayed concurrently with patient samples, and the analyte value for the controls is calculated from
the calibration data in the same manner as the unknown or patient’s results are calculated. Control
materials are commercially available as stable or liquid materials that are analyzed concurrently with the
unknown samples. The control material measured values are compared with their expected values or
target range.

A statistical quality control system is used to

establish the target range. The procedure involves
obtaining at least 20 control values for the analyte
to be measured. Ideally, the repeated control
results should be the same; however, there will
always be variability in the assay. The concept of
clustering of the data points about one value is
known as central tendency. The mean, mode, and
median are statistical parameters used to measure
the central tendency. If the mean, mode, and the
median are nearly the same for the control values,
the data have a normal distribution.

Figure 25 Evacuated tubes and micro-collection tubes.

Clarifying accuracy and precision is usually a

troublesome task as these terms are often used interchangeably. When a test result is accurate, it
means that it has come closest to the correct value if the reference or correct value is known.
Theoretically, patient results should be repeatable if analyzed a number of times using the same
method. If there is great variability of results around a target value, then the precision is compromised.
Table 9 Specimen Time Frame Requirment

Specimen Time Frame Requirement for Examination

All peripheral smears (and body fluid cytospin) Kept for only one month
ESR Within 4 hours of collection
CBC Within 24 hours of collection
Differential Within 8 hours of collection
PT/PTT Within 4 hours of collection
Fibrinogen Within 4 hours of collection
Urinalysis Within 2 hours of collection

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VII. Updates & Automation
Retacrit is a biosimilar erythropoietin
approved in Europe3 for subcutaneous
administration in the treatment of anemia
associated with chemotherapy. Efficacy,
safety and tolerability in this indication
were evaluated from an open-label Phase III
trial involving 216 patients with solid
tumors, malignant lymphoma or multiple
myeloma who were undergoing
chemotherapy. Analysis of the safety of the Figure 26 Hematology-Analyzer-URIT-3300 used in CBC and other blood
data showed that, in almost all cases, examinations
patients and investigators reported tolerability as good or excellent.

"This study confirms that treatment with Retacrit has real benefits for cancer patients with anemia, a
common side-effect of chemotherapy. The data showed a high hemoglobin response rate, which means
a reduced need for blood transfusions during treatment and an improvement in patients' quality of life",
commented principal study investigator Valentina Tzekova, University Hospital Queen Joanna, Sofia,
Bulgaria.

There is a study in the September/October 2005 issue of The Journal

of Craniofacial Surgery presents accurate approach to measure
platelet count in PRP preparation through using standard
hematology analyzer to automate the time-consuming manual
platelet count technique. This analyzer can measure platelets, in PRP
preparation, up to 2 million platelets per microliter-relatively high.
Results in automated count were highly accurate, even though it
was beyond the limits of typical hematology equipment. However,
studies of PRP have yielded varying results, which is seen in differing
platelet concentration. Figure 27 PRP Treatment.

‘Intelligent’ molecules are the new discovery of Professor A. Prasanna de Silva, a scientist from Queen’s
University. The discovery is based on previous pioneering research by Professor De Silva and his
colleagues at Queen's, which created 'Catch and tell' sensor molecules that send out light signals when
they catch chemicals in blood. This technology help create blood diagnostic cassettes, which are being
used in hospitals, ambulances, and veterinary offices nowadays to quickly monitor blood for levels of
common salt components such as sodium, potassium and calcium. The new research at Queen's also
shows as feasible 'ID tags' for very small objects the size of biological cells. It enables the on-the-spot
analysis of salt levels and blood type during accidents. Such ID tags can also help track infection and
highlight vulnerable people during disease outbreaks. An extension of the same design has also
developed molecules which can act as simple 'logic gates': more complex versions of which what drive
current computers.

Page 25
 The Cedars-Sinai Medical Center recently purchased a blood mobile,
which helps to keep a steady and sufficient supply of blood and
blood products on hand. The blood mobile functions to transport all
of the equipment necessary to hold an off-site blood drive involving
up to 120 donors. The blood mobile is about the size of a city bus,
equipped with donor beds, two private screening rooms, automated
red-cell collection capabilities and a comfortable refreshment area
where donors can relax after giving blood. Designed to handle
smaller blood drives or locations that lack set-up space, the blood
mobile can accommodate up to 50 donors in one day.

Figure 28 Example of Blood Mobile from Oklahoma

Blood Institute
The PATHFAST is an
immunoanalyzer used for measuring emergency parameters in 17
minutes from whole blood at the same quality as produced in a
central laboratory. Measuring W14.7" x D22.4" x H20.0", it is easily
contain in the laboratory. Its user friendly methods allow the
technician to simply add blood to the cartridges, place them on the
system then to press the start button is easily stored and fits on a
laboratory. It utilizes a chemiluminescent technology combined
with a unique magtration separation method that allows this
system to report highly accurate results that compare to large
platform instruments. The system occupies individual cartridge-
based technology utilizing a whole blood sample which can handle Figure 29 PATHFAST immunoassay analyzer
six samples in batch or random access mode and report these six
results in 17 minutes. This sensitive technology will allow the laboratory to report NTproBNP results
from 15-30,000 pg/mL.

Von Willebrand disease is a bleeding disorder caused by a defect or deficiency of a blood clotting protein
called von Willebrand factor. Von Willebrand factor is a protein necessary in the initial stages of blood
clotting. Through Alphanate(R), which is the first and only dual inactivated (solvent detergent and heat
treatment) and affinity chromatography purified antihemophilic factor/von Willebrand factor complex
VWD can be treated. This has been proven safe and effective for the treatment of hemophilia

Page 26
References:

Tzekova V, Mihaylov G, Koytchev R., Epoetin zeta: efficacy data from an open-label, Phase III
trial in patients with chemotherapy-induced anaemia. 33rd European Society of Medical
Oncology (ESMO) Congress; 12-16 September 2008; Stockholm, Sweden. Poster 906P.
Mihaylov G, Tzekova V, Koytchev R., Epoetin zeta: safety data from an open-label, Phase III trial
in patients with chemotherapy-induced anaemia. 33rd European Society of Medical
Oncology (ESMO) Congress; 12-16 September 2008; Stockholm, Sweden. Poster 907P.
European Medicines Agency (EMEA) European Public Assessment Report: Retacrit®. Available at
http://www.emea.europa.eu. Accessed September 2008.
Bohlius J, Wilson J, Seidenfeld J, et al. Recombinant human erythropoietins and cancer patients:
updated meta-analysis of 57 studies including 9353 patients. J Natl Cancer Inst 2006;
98:708-714.
Blood News & Hematology News from Medical News Today. Available at
http://www.medicalnewstoday.com/sections/blood/. Accessed September 2008.o

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