Hematology: Intro to Clinical Hematology

the study of blood and the blood-forming organs

hematology

What are the 4 humors? What are they?

blood (oxygenated RBCs)

phlegm (WBCs and PLTs, buffy coat)

black bile (jelly-like, dark-red clot)

yellow bile (yellowish serum)

What is the difference between in vivo and in vitro?

in vivo: in the body

in vitro: in a tube

Who invented the microscope and discovered cellular components within the blood?

Antoine van Leeuwenhoek

What are the 3 blood components?

erythrocytes, leukocytes, thrombocytes (PLTs)

person who specializes in the study of blood and its components; studies the alterations in the blood components as a result of the disease, not the primary cause

hematologist

What are the 3 levels of testing and what to they entail?

1. pre-analytical: phlebotomy, specimen processing

2. analytical: testing via manual/automated methods

3. post-analytical: interpret results and send to chart

What is the order of draw?

blue, red, green, purple

What two tubes are mainly used in the hematology department? What are their additives and the purpose of those additives?

purple: EDTA binds to calcium to prevent clotting

blue: sodium citrate binds to calcium to prevent clotting

What is the difference between plasma and serum?

plasma contains clotting factors (because additive prevented clotting)

serum does not contain clotting factors (because clotting has occurred)

How long should a tube be allowed to clot before it is centrifuged?

15 minutes

A green, lithium heparin tube prevents blood from clotting by inhibiting what?

lithium heparin inhibits thrombin

What are the four fluids that can be tested in hematology?

synovial, CSF, pleural, peritoneal

What type of tubes are fluids collected in (synovial, CSF, pleural, peritoneal)?

sterile tubes (no additives)

T or F: it is ok to collect clots in tubes

false (cannot run tests, redraw, do not remove clot)

What are the 6 pre-analytical errors that occur with testing?

1. Clotting

2. Contamination

3. Short samples/microtainer tubes

4. Over-filling and under-filling

5. Mislabeling

6. Wrong temperature

What are 3 pre-analytical errors that could cause clotting?

1. taking too long to draw, sewing machine

2. not mixing enough

3. blood in syringe is mixed or aggressively handled

How can clots affect testing with respect to WBC counts and platelets?

clots falsely *elevate WBC* ct. and falsely *decrease PLT* ct.

How do clots affect testing on instrumentation?

clots can get stuck in the instrument probes that are used to aspirate the samples to perform the test

Why is contamination bad for testing?

it has the potential to give inaccurate results that lead to misdiagnoses and inappropriate results

What happens when a tube with clot activator is drawn before a tube with sodium citrate?

clotting will happen quicker and give a falsely shortened result

What happens if you collect blood in a tube containing lithium heparin before drawing a sodium citrate tube?

the heparin will prevent clotting and give a falsely increased result

What effect does EDTA have on whole blood that concerns calcium?

EDTA binds calcium to prevent clotting

If you poured blood from a EDTA tube into a lithium heparin tube (used for chem testing), how would this affect the result?

calcium decreases which increases potassium, giving a falsely increased K

The following is true about short samples except:

a) They are preferred samples for testing patients who are easy to draw

b) additional/repeat testing cannot be performed

c) acceptable for testing patients that are hard sticks

d) need to be mixed appropriately to avoid clots

a

List 3 things that over-filling can affect EDTA tubes

1. falsely decrease hemoglobin concentrations

2. forms clots (too much blood, not enough EDTA)

3. some analyzers will flag if the space between the cap and top of the specimen isn't there

What does QNS stand for? What pre-analytical error is it commonly associated with?

quantity not sufficient

associated with under-filling

type of QC that can detect sudden changes in a patient's physiology; useful in identifying instrument error and misidentified patient samples

delta check

What is the appropriate ratio of blood to anticoagulant in the sodium citrate tube?

9:1

Explain why coagulation results can be falsely shortened when over-filling the sodium citrate tube?

excess blood and too little coagulant = clots

Explain falsely elevated results when the sodium citrate tube is under-filled.

too little blood and excess coagulant

What are the 3 different temperature types that specimens can be stored/shipped in?

RT, fridge, frozen

What effect does cooler temperatures have on a specimen, either whole blood or serum/plasma?

slows down/inhibits chemical reactions and preserves analytes that need to be tested

What effect does hotter temperatures have on a specimen, either whole blood or serum/plasma?

hemolysis

Define hemolysis. What color is observed in the serum/plasma?

lysis of RBCs; cherry red

Which step of the specimen processing phase would you be able to ID hemolysis?

after centrifugation (does not cause hemolysis, can just see hemolysis present after centrifugation)

What type of testing is affected by hemolysis?

photometric testing methods

What is the resolution when you have a hemolytic problem?

redraw

the abnormal green color of the plasma/serum post centrifugation caused by elevated concentrations of bilirubin levels in the blood

icterus

What conditions do we generally see excessive levels of bilirubin when the sample is icteric? (3)

1. babies with immature livers that cannot process out and breakdown bilirubin in the blood

2. liver disease

3. hemolytic anemia

excessive amount of fats/lipids in the plasma/serum portion of the blood; looks milky white

lipemia

List the medications that could cause lipemia in the patient specimen.

beta-blockers, antivirals, corticosteroids, growth hormones, anticonvulsants, thiazide diruetics, birth control

What testing parameter indicates the possibility of lipemia?

MCHC and hemoglobin are high

What is the resolution for lipemia?

saline replacement

Strawberry milk looking serum/plasma is due to a combination of what two things?

lipemia and hemolysis

Extreme crying in an infant can elevate a WBC count by _____%

140%

Taking as little as ______ can cause a newborn to require a transfusion

10 mls

Maximum blood draw volumes in newborns, infants, and children should not exceed ____% of their total blood volume.

5%

Drawing a patient's blood work for a legal blood alcohol requires using which antiseptic?

betadine

Using betadine has the potential to elevate what 4 analytes?

bilirubin, uric acid, potassium, phosphorous

failure to act or perform duties according to standards of practice

negligence

verifying inaccurate results, contaminating specimens, not following procedures are examples of what?

negligence

the action or crime of injuring a person's reputation by something printed or written

libel

false statements regarding the integrity of the lab or other healthcare department, also known as slander is an example of what?

libel

being legally responsible for actions that do not meet the standards of care, causing harm to the patient (HIPAA violations)

liable

complaining about a patient at lunch with another coworker in a public area is an example of what?

liable

the unlawful beating of another or the carrying out of threatened physical harm

battery

beating of one person to another, harming a patient to get them to sit still during a blood draw are examples of what?

battery

an unjustifiable attempt to touch another person or the threat to do so in such circumstances as to cause the other person to believe that it will be carried out

assault

telling an argumentative patient that you are the one with the needle so they better behave or it won't feel good is an example of what?

assault

improper or unskilled care of a patient by a member of the healthcare team

malpractice

using wrong or faulty equipment to run patient samples, mixing up patient samples, mislableling specimens are examples of what?

malpractice