HEMATOLOGY LAB ● Post-processing storage

- Anticoag stored at room temp

ULS - BMLS 3A
- Serum stored at freezer temp
● Reporting the result (end of lab work -
Clinical Laboratory not ent of post-ana)
- complex operation that muse i. encoding (encode the result, e.g
smoothly integrate all the phases testing barcode)
process( pre-ana, ana, post-ana) ii. Validating - 1st hand checking
a. Pre-analytical - all act before testing iii. Verifying - 2nd hand checking
● Clinical need - px oriented, dx, 2 medtech/1 patho
prognosis, physician based procedures. 1 medtech/2 patho
● Clinical orders - all dx test that for ● Clinical actions done by your attending
follow up, checkup physicians/physicians(end of post-ana)
● Specimen transport 1. Accessing the result
● Specimen receiving 2. Interpret the result
● Sorting - in accordance of sec in lab. 3. Integrate w/ other dx results -
● Uncapping needle - aliquoting(for diff imaging(x-ray, CT scan, etc.)
sec)(microtome)
b. Analytical - lab act that produces Pre-analytical phase
result(process specimen)
- All complex depth that must take place
● Loading the sample in the analyzer
before the sample can be analyze
● Adding the sample or reagent
- 32-75% of all errors
● Mixing
- Major source of error
● Incubation
● Detection
● PRE COLLECTION VARIABLES
● Reduction of Data(Machine)
[Link] Factors - relates to body(how
● Result produced
the body works)
● Delta Check( checking for previous
a. Exercise- transient and long-term on
result, check if it is accurate & precise)
laboratory determination
- Review the result
b. Diet - transient and easily control
- Repeat the test
c. Stress - hormonal imbalance,
i. correct sample
hyperventilation
ii. correct label
d. Posture - (up right position - hypostatic)
iii. correct patient
- wrong tourniquet and fist
● Release result (machine → encoding)
exercise - erroneous result
c. Post- Analytical
● Recapping the tube
 - prolonged tourniquet - lead to - collection done 30 mins before drug
hemoconcentration administration and peak specimen
e. Age - effects on serum concentration - peak specimen - specimen w highest
serum concentration - (new born - high value
hemoglobin f(fetal) han hemoglobin - specimen collection immediately after
a(adult) drug administration
most serum constituent remain 3. Specimen acceptability and
constant until menopause for identification issues
women(50-60) and middle ages to - all specimens must be collected, transported,
man(50-60) labeled →processed in accordance to the SOP
f. Sex →because of the sample volume, handling needs
and container type →leads to rejection and is
MALE (bigger FEMALE(lower
muscle mass compared than costly and time consuming.
male) - Bacte - room temp, body temp
Joint Commission: 2015 lab national patient
-alkaline -magnesium
safety goals
phosphatase -calcium
1st goal: identify patient correctly
-creatinine kinase -albumin
(misidentification can delay the process of
amino transferase - -hemoglobin
transfusion which can be life threatening)
(alt-sgpt) (ast-sgot) -serum iron
4. Specimen Rejection
serum glutamine -ferritin
- hemolysis(destruction of RBC) or
oxalic transferase -menstrual cycle
lymphoma(presence of lipid in blood -
-aldolase (iron lvl is lower)
appearance of chylous
- clots are present in anticoagulated
specimen
2. Time of Collection - non fasting specimen when fasting is
a. ASAP - as possible required (underfast or overfast)
b. STAT - immediately (highest priority)
FBS 6-8 HRS
- highest priority and collected
immediately LIPIDS 12 HRS
- Emergency and intensive care
CHOLE, ALH,LDI NON FASTING
unit
12 -14 HRS
c. Timed collection/timed specimen - used TAG

for monitoring FBS R LP 10-12 HRS

- For therapeutic drug
- improper lab collection tube
- Through specimen - specimen
- short draw and wrong volume
w the lowest value
 - improper transport condition LIGHT BLUE TOP (0.105 M) - 3.2% 9:1
- discrepancy between requisition and
specimen label BLACK (0.129 M) 3.8% 4:1
- unlabelled or mislabeled specimen
- ESR westergren tube;
- contaminated specimen or leaking
Buffered Na Citrate
container
5. Phlebotomy and Venipuncture
- Insufficient blood = High Citrate (false
PLASMA SERUM
increased clotting time)
w/ anticoagulant, non w/out anticoagulant, - PCV = High HCT (plasma volume) =
clotted, (+) clotted packed RBC, falsely prolonged PT and PPT
fibrinogen (-) fibrinogen

TUBES
6. Anticoagulant and Additive

EDTA most referred

1. HEPARIN - effective anticoagulant in
anticoag in
small amount w/out side effect
hematology (cell
- Lithium Heparin - used in
count and cell
most chemistry
morphology)
● exception: lithium and
- K2 EDTA plastic tube, folate

spray-dried - Sodium Heparin - used in

toxicology, lead & trace
- K3 EDTA glass, liquid elements
form(diluted 1-2%) ● exception: sodium
- both of them does not affect lvl
EDTA PINK immunohematology
of ions
(BB) ABO, Rh, Ab
- should not be used in
screening
coagulation studies
EDTA WHITE EDTA gel molecular 2. GRAY TOP - glucose studies
testing of plasma. - Sodium Fluoride - prevents
glycolysis (for 3 days)
SODIUM CITRATE used for coag - Fluoride - prevents glycolysis by
testing(preserves forming ionic bonds w
your labile coag magnesium
factors) 3. RED TOP - non additive/non
coagulated top
 - glass - glass factor - coagulated-
Red - non- additive - Serum tubes
serum
gold/red SST
- Red top vs. Gold top(STT)
1. ease of use Green - heparin Heparin tubes
2. shorter processing time
Light - lavender, EDTA Tubes
3. higher serum yield
EDTA
4. minimal alliteration of
potentially hazardous Go - Gray= Glucose Glycolytic Inhibitor
aerosol tubes
5. only one centrifugation
6. use of a single tube Black ESR
7. ease of a single label
- advantage of SST - transported
w/o disturbing the separation
BLOOD COLLECTION

SPECIALIZED TUBE
1. Arterial(physician/physical therapy)
- more difficult than venous vein
1. SST - widely and most commonly used - highly pressurized= blood clot is difficult
tube in chemistry - prone in hematoma
- is not used on TDM(therapeutic - before collecting you should do
drug monitoring)- gel absorb modified Allen’s test
some drug= falsely negative/ - hierarchy(radial > brachial > femoral)
decreased drug - identified by pulsations
2. GOLD TOP - Finger/Heel stick(used in pediatrics)
3. RED-GRAY TOP - for routine testing for pedia, only
4. TIGER-STRIPED TOP needs small amount of blood
5. EDTA, Citrate, Oxalate - chelate CA²H - for newborn, heel prick is the
and decreased Ca²H collection of choice(massage,
heating, breastfeed)
ORDER OF DRAW 2. Phlebotomy / Venipuncture
- Trained person - phlebotomist
- Preferred site of choice- antecubital
Stop - yellow/ SPS Blood culture tubes
fossa

Light - light Coagulation - Vein of choice - median (it is well

blue/citrate anchored on tissue)

 - cephalic & basilic - easily to bruise & ● size of smear
roll a. thick smear - increased angle
3. Other alternative site of collection b. thin smear - decreased angle
1. Ventral forearm ● smear = non-stained - PBS
2. Wrist area ● film= stained - Blood film - h& e
3. Back of hand
4. Ankle & foot - always ask if diabetic the
physicians/nurses may cause amputated

● 15-30 ° (25 - Steininger)

BROWN STEININGER
● Tourniquet application(3-4 inches
rodak’s) 7.5-10 cm Head 3 1
- duration: > 1 min
Body 2 2
- wrong application of tourniquet
(cause hemolysis) End 1 3
- hemolysis - increased
potassium, LDH,Aldolase, AST, CHARACTERISTICS OF IDEAL SMEAR
Magnesium, POu
1. Gradual transition to thick area
2. The smear occupy ½ to ⅔ of slide
SMEAR(should be done 2-3 hrs only if EDTA) 3. No overlapping of cells
1. Ehrlic’s smear/ Coverglass smear/ 4. Should have a featherly end
Coverglass to cover glass
adv: even distribution of WBS - acc to rodak’s - thumb/ tongue shape
disad: a. time consuming - acc to turgeon - at least feathery edge
b. difficult to smear
c. cover glass are too small for 4. Spun Smear(automated smear)
automated stains, harder to label and 1. WBC evenly distributed
easily broken 2. RBC free of distortion
2. Beacom’s smear - glass slide to 3. Glass slide are easy to handle & label
coverglass
3. Wedge smear/spreader slide/ push
smear/two glass slide method -
glass slide to glass slide
- most fragile cell: lymphocyte