Department of Pathology
Hematology

Hematology is a section of the Division of Clinical Pathology in the Department of Pathology at the University Medical Center. This lab is inspected by the College of American Pathologists. Therefore, policies and procedures are written in compliance with those standards.

Location: Hematology is located on the first floor of the hospital across the hall from the acute services wing, room S102.

Telephone: Extension 42370

Any inquires concerning this section should be made by calling the following:

  • John Lam, M.D., Director .................................................................................. Ext. 56253
  • Janice Trussell, BS, MT(ASCP), Chief Technologist, Hematology ......... Ext. 42783
  • Sharma Stokes, BS, MT(ASCP), MT Supervisor, Hematology................. Ext. 42370
  • Felicia Tardy, BS, MT(ASCP), MT Supervisor, Hematology ...................... Ext. 42364

Hours of Operation: Hematology is staffed 24 hours a day, seven days a week.

Objective: The hematology section strives to provide quality laboratory services in hematology, body fuids, and flow cytometry. A comprehensive range of diagnostics tests are available by routine request or by consultation. These tests are listed in the following pages.

A comprehensive program of quality control and quality assurance is maintained to assure the precision and accuracy of each patient result. Do not hesitate to contact the hematology section concerning any problems or special hematologic needs, as we welcome the opportunity to be of service.

Consultations: Consultations for special procedures, diagnostic tests and the management of special clinical problems in hematology are available 24 hours a day, seven days a week. Phone contact is required, Monday through Friday, 7:30 am to 3 pm, extension 42370. After hours, weekends, and holidays, contact the resident or staff pathologist by contacting the lab or the hospital operator.

STAT Requests: All Stats that are received in hematology are processed as soon as possible, with priority being given to specimens from the emergency rooms. Stats should be limited to life threatening situations. If your area does not have stat printer broadcast, call back to the following laboratory extension for results. Hematology: Ext. 42371

Routine Requests: Routine requests are processed seven days a week, in the order in which they are received. The turn around time for the routine tests is four hours, but usually less. Some test procedures that are more extensive and require additional preparation are batched and routinely performed Monday through Friday, 7:30 am to 3:00 pm.

Collection of Specimens for Hematology: Test results are only as good as the quality of the specimens collected. Some exact techniques are required to avoid contamination of the specimen.

Venous Blood Collection:

A. General Steps

  1. All equipment used for venipuncture should be dry and sterile.
  2. If a tourniquet is used, it should be just tight enough to occlude the venous return of blood.
  3. The area must be cleaned with a Betadine Solution or alcohol swab using an expanded circular motion.

B. Vacuum Tube Technique (Single or Two Tube Technique)

    1. The tube is fixed to its adapter-held needle so that the innermost shaft of the needle holds the stoppered tube in place but does not completely penetrate the stopper and lose the vacuum.
    2. After the vein is entered, the adapter is held firmly and the vacuum tube is forced onto the needle shaft so that the rubber stopper is penetrated.
    3. When the vein has been properly entered the blood will gush into the tube.
    4. The tube must be allowed to fill to its capacity. This is Critical.
    5. If an improper amount of blood is mixed with the premeasured amount of anticoagulant, gross errors in the HCT and other results can occur.
    6. If more than one tube is required, use the multiple sample needle, pull the filled tube from
    7. the needle shall and quickly replace with another vacuum tube.
    8. If an anticoagulant is in the tube, slowly invert the tube several times immediately after it has been removed from the holder in order to mix thoroughly.

Reference Section:

Notice to all outreach facilities: The proper preservation of specimens is critical to accurate measurement. If your facility (by virtue of its location) will be sending specimens to UMC for arrival in excess of the time defined in the Laboratory Handbook for processing, you will need to prepare and store the specimen in a different manner and contact the specific lab for special instructions. For the Hematology section the following are the most common tests in the lab requiring special preparation and preservation when there is a delay arriving in the UMC main laboratory.

 

Hematology: The majority of Hematology samples (CBC, ESR, Retic, Sickle Screen and Hemoglobin electrophoresis) require whole blood with EDTA anticoagulant. If there is a delay in CBC, Retic Sickle Screen and Hemoglobin electrophoresis testing, samples stored capped at room temperature are stable for 24 hours after collection. Samples stored at 2-8°C are stable for 48 hours. Samples for ESR testing are stable for 2 hours at room temperature and 24 hours at 4°C.

Miscellaneous body fluids (synovial, pleural, peritoneal, etc.) require EDTA anticoagulant. Samples should be analyzed within one hour after collection.

CSF samples require no anticoagulant. Samples should be analyzed within one hour after collection.

Standard Operating Protocol Laboratory Processing of Cerebrospinal Fluid

Principle: This SOP has the single purpose of assuring that all the tests requested on a spinal fluid sample are performed in an immediate fashion provided sufficient sample is submitted for evaluation. To achieve this purpose, all persons who handle the specimen, write orders, and order in the computer must follow the SOP.

Procedure:

  • Labeling the specimen: Specimens are labeled 1, 2, 3, 4 or 5.
  • Completing the requisition card: For each numbered tube submit a requisition card with its own computer generated requisition number. Write the physician's beeper number on each requisition card .
    • The following tests should be performed for each tube.

    Tube 1: One mL volume

    • Protein Mnemonic:CFP SMS Location Cerebrospinal #1
    • Glucose Mnemonic:CFG SMS Location Cerebrospinal #2

    Tube 2: One mL volume

    • Cell count, Differential, Xanthochromia Mnemonic: FCSF1
    • SMS Location Cerebrospinal #7

    Tube 3: One mL volume

    • Culture for bacteria Mnemonics: CSFC SMS Location Microbiology #7
    • Culture for fungus Mnemonics: FCO SMS Location Microbiology #21
    • Culture for tuberculosis Mnemonics: TB SMS Location Microbiology #20
    • - Order on separate requisition number

    Tube 4: One mL volume

    • VDRL Mnemonic: VDRL SMS Location Cerebrospinal #6
    • Cryptococcal antigen Mnemonic: CRYP SMS Location Cerebrospinal #5

Tube 5: Three different options for this tube as follows;

Option 1 One mL volume

  • Cell count, Differential, Xanthochromia Mnemonic: FLCEL2
  • SMS Location Cerebrospinal #8

Option 2 Five mL volume

  • Multiple Sclerosis Panel Mnemonic: MSP SMS Location Cerebrospinal #11

Option 3 Ten mL volume

  • Cytology: submit on completed Special Cytology Form No. 01050

With pediatric samples, a CSF lactate or CSF amino acid may be required. Order this under Tube 1 and call the lab at extension 42882.

CAUTION:Do not add a test mnemonic to a previously ordered requisition number. Order with a new requisition number, and refer back to old requisition number.

WHY : The computer does not tell the laboratory an additional test is added to the previous requisition number, and therefore the request is never seen by the laboratory.

EXAMPLE: A cell count is ordered and the specimen submitted to the laboratory. Ten minutes later, a CSF protein and glucose are ordered on the same requisition number. The way our computer is organized the laboratory does not see that additional order.

You must order with a new requisition number for the specimen to be analyzed, and refer back to the old requisition number for the specimen.

After ordering on a new requisition number, call the lab at extension 42350 and tell us what has been done.

If you do not have an extra tube of CSF fluid, please call the lab before you make additional orders. The lab will check the sample already submitted to see if there is enough CSF to perform the new additional test.

  • It is the responsibility of the requesting physician to assure that all the tubes are labeled properly, and that the orders are correctly written for the computer request.
  • The Unit Secretary is responsible for entering the request into the computer.
  • When samples are received in the laboratory the medical technologist in Central Receiving/Hematology/Chemistry/Microbiology will inspect the samples and determine if they are entered properly. If there is a problem with the sample, the physician will be called by the beeper number on the request card for clarification.
  • Each laboratory section: chemistry, hematology, and microbiology that is involved in processing the specimen will coordinate their analyses to maximize the sample when possible.