Hematology and Laboratory Sections Quiz

Introduction to Phlebotomy: The Clinical Laboratory

• Phlebotomy is the collection of blood samples for laboratory analysis to diagnose and monitor medical conditions.
• A phlebotomist is a trained individual who obtains blood samples primarily through venipuncture and microtechniques.

Clinical Laboratory Organizational Division

• The clinical laboratory is divided into two main areas: Anatomical and Clinical.

Anatomical Area

• Analyzes surgical specimens, frozen sections, biopsies, cytological specimens, and autopsies.
• Has sections for Cytology, Histology, and Cytogenetics.

Clinical Area

• Analyzes blood, bone marrow, microbiology samples, urine, and other body fluids.
• Includes the Laboratory Information System (LIS) which handles computer operations, record maintenance, and compliance with accrediting regulations.
• Further divided into specialized sections: Hematology, Coagulation, Chemistry, Blood bank (immunohematology), Serology (immunology), Microbiology, Urinalysis. Phlebotomy and sample processing are also included.

Hematology Section

• Studies the formed (cellular) elements of the blood such as red blood cells (RBCs), white blood cells (WBCs), and platelets (Plts).
• The most common fluid analyzed is whole blood (a mixture of cells and plasma) obtained using a collection tube with an anticoagulant (e.g., EDTA).
• Whole blood collection requires 8-10 times of immediate tube inversion to activate the anticoagulant.
• Blood is also analyzed as plasma (anticoagulated, contains fibrinogen) or serum (allowed to clot, does not contain fibrinogen).
• Common hematology tests include: Complete blood count (CBC), differential, white blood cell count (WBC), red blood cell count (RBC), hematocrit (Hct), hemoglobin (Hgb), indices (MCV, MCH, MCHC), platelet count, red cell distribution width (RDW), body fluid analysis, bone marrow, erythrocyte sedimentation rate (ESR), reticulocyte count, sickle cell, special stains.

Coagulation Section

• Evaluates the overall process of hemostasis.
• Important components evaluated include platelets, blood vessels, coagulation factors, fibrinolysis, inhibitors, and anticoagulant therapies (e.g., heparin and coumadin).
• Anticoagulant used: Sodium Citrate (3-4 times).
• Collection tubes for coagulation samples have a light blue stopper.
• Common coagulation tests include: Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), bleeding time (BT), and factor assays.

Chemistry Section

• The most automated area in the laboratory, studying blood components (enzymes, hormones, electrolytes, chemicals, poisons).
• Primarily tests serum collected in gel barriers, but may also use tubes with red, green, gray, or royal blue stoppers.
• Factors that may affect test results include hemolyzed (red due to hemoglobin release), icteric (yellow due to excess bilirubin), and lipemic (cloudy due to increased lipids) samples.
• Fasting samples (8-12 hours) are preferred.
• Common chemistry tests include: Tests for electrolytes (Na, K, Cl, CO2), lipid panel, total protein, enzyme immunoassays, fasting blood sugar, blood gas analysis, therapeutic drug monitoring, blood urea nitrogen, and creatinine.

Immunohematology/Blood Bank Section

• Collects, stores, prepares blood for transfusion.
• Blood is tested for bloodborne pathogens (e.g., Hepatitis and HIV).
• Blood components (packed cells, platelets, fresh frozen plasma, cryoprecipitate) may be separated.
• Collection tubes used: plain red (serum), lavender, or pink (plasma) stoppers.
• Serum separator tubes containing gel are not acceptable.
• Patient identification is critical.
• Common tests include: ABO and Rh typing, Type and crossmatch (ABO, Rh typing and compatibility testing), Antibody Screening, Direct Coombs Test, and Indirect Coombs Test

Serology (Immunology) Section

• Evaluates the body's immune response.
• Detects antibodies to bacteria, fungi, parasites, viruses, and antibodies produced against body substances (autoimmunity).
• Common tests include: Hepatitis B surface antigen, Hepatitis Panel, VDRL and RPR for syphilis, Anti-HIV, Western blot, HCG (pregnancy), and Antibody titer.

Microbiology Section

• Identifies pathogenic microorganisms.
• Improves antibiotic therapy, infection control in a hospital.
• Sections: Bacteriology, Mycology, Parasitology, Virology.
• Common tests include: Culture and Sensitivity, Gram stain, Blood culture, Acid-fast bacillus (AFB) culture, Fungal Culture, Occult blood, Ova and parasites (stool sample).

Urinalysis Section

• Detects disorders and infections of kidneys and metabolic disorders (e.g., diabetes, liver disease).
• Examines urine physically, chemically, microscopically.
• Urine samples should not sit at room temperature longer than 2 hours.
• Common chemical examinations: pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, specific gravity, nitrite, leukocyte esterase.
• Physical examinations include color, volume, and clarity.

Clinical Laboratory Personnel

• The staff includes the Laboratory Director (Pathologist), Laboratory Manager (Administrator), Technical Supervisor, Medical Laboratory Scientist, Medical Laboratory Technician, Laboratory Assistant, and Phlebotomist.

Phlebotomy and the Healthcare Field

• Duties for phlebotomists include: Correct patient identification and preparation, appropriate blood collection, proper sample containers, correct labeling, appropriate sample transportation, effective interaction with patients and hospital personnel, processing samples for labs, computer operations and record-keeping, following all safety regulations and quality control checks, and participation in continuing education.

Professional and Personal Characteristics

• Critical characteristics include dependability, cooperativeness, commitment, compassion, respectfulness, honesty, competence, organized, responsible, and flexible.
• Communication skills are important, including verbal, listening, body language, and telephone skills.
• Proper appearance, including clean/unwrinkled clothing, clean footwear, and proper hair/makeup, is also crucial.

Phlebotomy Education and Certification

• Certification requirements include adaptive testing, professional organization membership, continuing education, and maintaining certification.

Health-Care Delivery System

• Employment settings include hospitals, physician office laboratories (POLs), Health Maintenance Organizations (HMOs), reference laboratories, urgent care centers, nursing homes, home health-care agencies and blood donor centers.

Hospital Patient Care Areas

• Includes different areas based on patient types and conditions. Examples are Emergency Department (ED), Intensive Care Unit (ICU), Cardiac Care Unit, Pediatrics, Nursery, Neonatal Intensive Care, Labor and Delivery, Operating Room, Recovery Room, Psychiatric, Dialysis, Medical/Surgical units, Oncology, and Short-stay units.

Regulatory, Ethical, and Legal Issues

• Agencies overseeing clinical laboratories include CLIA (Clinical Laboratory Improvement Amendments of 1988), JC (Joint Commission), CLSI (Clinical and Laboratory Standards Institute), and CAP (College of American Pathologists).
• The Joint Commission has patient safety goals, such as accurate patient identification, improved communication, reduced infections, and patient involvement.
• Ethical and Legal issues include patient's rights regarding informed consent, refusal of treatment, confidentiality. Tort law issues (intentional and unintentional) are also mentioned.
• Sentinel events in a lab setting can result from errors like patient misidentification and sample mislabeling.

Test your knowledge on the Hematology section and other laboratory departments. This quiz covers key concepts such as blood collection methods, laboratory procedures, and test types in various sections. Perfect for students and professionals in the medical field.