USER MANUAL HAEMATOLOGY
Contents
1. for infants Do not use heparin contaminated venous lines Where this is unavoidable because of poor venous access flush the line with crystalloid and discard the first few millilitres of blood the first 5 ml Use 0 105 0 109 M tri sodium citrate 9 volumes blood to 1 volume anticoagulant Use plastic or siliconized glass collection tubes Ensure correct filling of tube Blood and anticoagulant should be mixed immediately by gentle inversion 5 6 times Do not shake or vigorously mix the sample as this could cause haemolysis and activation of the clotting factors lf the haematocrit is gt 0 55 will need to adjust volume of anticoagulant Transport blood samples rapidly ideally within 1 h at room temperature Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis 2012 Blackwell Publishing Ltd Int Jnl Lab Hem 3 1 2 Summary of Differential Effects of Testing Different Sample Types on Hemostasis test Table 2_ Summary of Differential Effects of Testing Different Sample Types on Select Hemostasis Tests Sample Type EDTA plasma Serum or fully Potential Consequences Potential Consequences On Routine Coagulation Tests On Factor Assays Other Hemostasis Tests Prolongs PT and APTT and occasionally TT False low levels especially False impression of inhibitors to FV and Might influence fibrinogen and FV and FVIII IlI and may show time dependence D dimer assays ie enhanced with incubation false2. of treatment Hb analysis is indicated if MCH is persistently low despite adequate iron e For family screening please include the index case particulars name I C diagnosis in the request form In cases which need DNA analysis for confirmation please send new sample to the laboratory along with Hb analysis report and latest FBC FBP alpha thalassemia will be sent to HKL and Beta thalassemia will be sent to IMR e Please fill the request form properly as those with no relevant history will be rejected 3 5 CD4 CD8 count e Specimen collection is on Mondays to Thursdays according to HIV Clinic days e If sample is taken on a day before public holiday blood sample must reach the lab before 1 pm as ideally it should be analysed within 48 hours of collection END A USER MANUAL HPP PAT USER MANUAL HM VER 4 1 DECEMBER 2014
3. status Specimen information and Referring Physician in the request form Incomplete request form may result in rejection of test Samples are received every day preferably sent in the morning Try to avoid sending sample on day follows by long public holidays USER MANUAL HPP PAT USER MANUAL HM VER 4 1 DECEMBER 2014 3 HAEMATOLOGY DEPARTMENT OF PATHOLOGY HOSPITAL PULAU PINANG COLLECTION TUBE AND TEST AT A GLANCE EDTA TUBE CITRATED TUBE FBC PT APTT PBF D dimer CD4 CD8 Fibrinogen Ham s test LA Kleihauer test Thrombophilia Hb Analysis screening Immunophenotyping Factor Assay DNA Analysis Mixing DNA Extraction Inhibitor Molecular Diagnostic Bethesday assay Molecular test Von Willerbrand test HEPARIN TUBE Universal Bottle OFT CSF for Blast Cells Chromosome study PD fluid for WBC differential Urine Eosinophils amp Hemosiderin ESR Tube ESR USER MANUAL HPP PAT USER MANUAL HM VER 4 1 DECEMBER 2014 4 Cytogenetic Transport Media Bone marrow cytogentic Renee HAEMATOLOGY DEPARTMENT OF PATHOLOGY HOSPITAL PULAU PINANG 3 0 Test Requirement 3 1 Coagulation Test 3 1 1 Summary of recommendations for blood collection amp handling for coagulation test Vi Vil Viil IX Perform clean venepuncture with minimal stasis Use a 21 gauge needle or butterfly 19 gauge may be used in adults with good veins 23 gauge may be required
4. LA feasible clotted No fibrinogen so no clot in PT APTT or TT False low levels especially Fil FV False impression of factor inhibitors or VWD coagulation sample False impression of afibrinogenemia and FVIII false high FVII false LA feasible D dimer assays can be affected especially if testing delayed Partially clotted Depending on relative extent of platelet False low factor levels or false Flow obstructions in PFA 100 testing coagulation sample activation hemolysis and loss of fibrinogen high factor VII might lead to false prolongation of PT APTT and TT or false shortening of APTT Underfilled primary citrate Will typically prolong PT APTT and TT May False low factor levels likely False low levels of most hemostasis tests anticoagulant tube underestimate fibrinogen and D dimer likely Vitamin K deficient plasma Prolongs PT and APTT PT raised gt APTT False low factors especially False low protein C potentially different patient on vitamin K antagonist raised Fil FVII FIX FX effect with clot based assays vs therapy liver disease sample chromogenic assays false low protein S false APCR false LA feasible Heparin contamination either Prolongs PT APTT and TT usually TT raised Reduced factors especially False low Antithrombin false LA feasible ex vivo or due to collection gt APTT raised gt PT raised false low FVIII AX FXI FXII tube error fibrinogen False impression of factor inhibitors Ta
5. ble has been adapted and updated from reference 4 Pre analytical Variables in Coagulation Testing Associated With Diagnostic Errors in Hemostasis February 2012 m Volume 43 Number 2 LABMEDICINE USER MANUAL HPP PAT USER MANUAL HM VER 4 1 DECEMBER 2014 5 HAEMATOLOGY DEPARTMENT OF PATHOLOGY HOSPITAL PULAU PINANG COAGULATION REQUIREMENT AT A GLANCE ADULT TUBE PAEDIATRIC TUBE Sample level indicator Blood volume required Sample will be rejected if falls above or below these lines Label should not cover the whole tube for visual inspection in lab lipaemic lysed or icteric sample Requirement for coagulation tests request 1 Sample volume adequate and well mixed gentle inversion five times Documentation of time sample taken 2 Detailed clinical history especially any bleeding family history should be sought from the patient and indicated in the request form as further test analysis might need to be carried out Please indicate if patient is on any anticoagulant 3 Documentation of haematocrit level only if hct gt 55 In this case the blood citrate ratio should be adjusted Please call the lab ext 5146 for a new tube with adjusted citrate volume USER MANUAL HPP PAT USER MANUAL HW VER 4 1 DECEMBER 2014 6 TS HAEMATOLOGY DEPARTMENT OF PATHOLOGY HOSPITAL PULAU PINANG QIN DIOS 1041 OOOS DOL LLUTLLOC 100 2DOVO_CELIOLLOAMLLLDG_LOlOCIO L 3 2 Bone marrow aspirate BMA e By appo
6. intment only Request form should be countersigned by the clinical specialists in charge of the patient e Bone marrow aspirate is usually obtained from posterior iliac crest It may be also obtained from a number of different sites such as sternum and tibia in children e Usually only the first 0 5 ml will contain marrow particle therefore take no more than 0 5 ml into the first syringe for smears Use a second syringe to aspirate if more samples are required for immunophenotyping IP and cytogenetic study However it is advisable to take an extra sample for IP in all cases in case the reporting pathologist decides to run the IP e Immunophenotyping is also carried out in new cases of leukemia and lymphoma with marrow involvement 3 3 Full Blood Picture e Diagnosis and relevant clinical history including drugs or transfusion history should be provided in the request form e Request forms with no clinical history will be rejected e In anemia cases suggestive of iron deficiency please do iron study first and treat accordingly before sending sample for FBP 3 4 Hb analysis HPLC and Hb electrophoresis e Thalasaemia screening is indicated in cases with first degree relatives of thalasaemia haemoglobinopathy and cases with low or normal Hb with low MCH e For those with low Hb and low MCH please provide iron study results when requesting for Hb analysis e Incase of iron deficiency please treat accordingly and repeat FBC after 1 month
7. n HAEMATOLOGY DEPARTMENT OF PATHOLOGY HOSPITAL PULAU PINANG a 1 0 INTRODUCTION Hematology Laboratory is divided into 3 sub units 5146 i ii Specialized Sam Spm _ _ 5157 ii Cytogenetic 8am 5pm _ 5652 2 0 TEST 2 1 Clinical Laboratory Request 2hours Erythrocyte Sediment Rate ESR 1 ESR Tube Per PAT 301 2 hours Factor Assays Factor VIII amp Factor XI 2 Citrated Per PAT 301 Tube Wa Full Complete Blood Count FBC 1 EDTA Tube Per PAT 301 Urgent 1hour Non urgent 2hours iv Full Blood Picture 1 EDTA Tube Per PAT 301 Urgent 3 days Semi urgent 7 days Non urgent 1 month vo v G6PD Screening Filter Paper Request Slip Lupus Anticoagulant 2 Citrated Per PAT 301 Tube vil Mixing Inhibitor screening amp 4 Citrated Per PAT 301 3 days Bethesda Assay Tube vil PT APTT Fibrinogen D Dimer 1 Citrated Per PAT 301 Urgent Tube 1 hour Non urgent 2hours vill Von Willebrand Antigen amp Activity Ricof 2 Citrated Per PAT 301 1 month Tube X Outsourced test PDN 1 Citrated PDN request 6 8 weeks i Other Factor assays Tube for each Form li Thrombophilia screening test send Anti Cardiolipin B2GPI AntiThrombin iii ProteinC Protein S Factor V Leiden USER MANUAL HPP PAT USER MANUAL HM VER 4 1 DECEMBER 2014 HAEMATOLOGY DEPARTMENT OF PATHOLOGY HOSPITAL PULAU PINANG 2 2 Specialized Laboratory Bone Marrow Aspirate j Per PAT 301 By ap
8. poinment A4 Size 1 EDTA Tube CD4 CD8 Per PAT 301 Test Performed in batch Sample received Monday Thursday only CSF for Blast Cells Sample should 3 days container arrived in lab latest by 3pm iv Ham s test 1 EDTA Tube Per PAT 301 By appoinment 1 week Hb Analysis 1 EDTA Tube Per PAT 301 Test Performed in 1 month batch 3 days 5 days vi Immunophenotyping 1 EDTA Tube Per PAT 301 By appoinment 3 days A4 Size Kleihauer test 1 EDTA Tube Per PAT 301 By appoinment 3 days viii LAP Score Blood taken Per PAT 301 By appointment 3 days in lab OFT 3 days differential container in lab xii Urine eosinophils amp Universal Per PAT 301 3 days hemosiderin container ee gt lt thalassemia months thalassemia months months weeks BCR ABL JAK 2 Ampang weeks vii Bone marrow cytogenetic Cytogenetic follow up for cases done Transport months in IMR Media viii Translocation leukemia 1 EDTA Tube months Q3 Q3 V k i l ek NO k ee Se Se CO Se O USER MANUAL HPP PAT USER MANUAL HMW VER 4 1 DECEMBER 2014 2 HAEMATOLOGY DEPARTMENT OF PATHOLOGY HOSPITAL PULAU PINANG 2 3 Cytogenetic laboratory Request TAT mol wwe te ae Bone Marrow Cytogenetic Cytogenetic Bone Urgent 14 Transport Media marrow days cytogenetic request Non urgent form 28 days Please complete the required Patient Information Clinical Diagnosis Disease
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