Hematology 1 - PRELIM-TOPIC-1 PDF

Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT...

Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT INTRODUCTION HEMATOLOGY Greek word “______” meaning blood and “____” meaning study. the discipline that studies the development and diseases of blood, is an essential medical science. HISTORY _____________________ (1657) - described “worms” in the blood. ___________________(1674) – first viewed red blood cells, describing them as “small round globules.” _________________ (1800)-described platelets as “petites plaques.” _________________ (1902) –developed Wright stain and opened a new world of visual blood film examination through the microscope. BLOOD Total volume: _____ for male _____for female 3 layers of Buffy Coat Solid portion: 20g / 100 ml of blood -Upper most: ____________ ____ Formed elements -Middle layer: ____________ ____ Fluid portion -Lower layer: ______________ 90% water 10% proteins, carbohydrates, salts, hormones and other substances GENERAL CHARACTERISTICS OF BLOOD 1.In vivo, blood is in fluid form; in vitro, it coagulates 5-10 minutes 2. Thick and viscous; _______ times thicker than water 3. Approximately ___ grams solid per 100ml blood PLASMA SERUM 4. Blood pH: ____________(average of 7.40) Fluid portion of 5. Blood specific gravity anticoagulated blood Whole blood: __________ Slightly hazy Serum: __________ appearance Contains all Plasma: __________ coagulation factor 6.Color Normal Yellowish or Arterial (oxygenated) blood: __________ Straw colored Venous (deoxygenated) blood: ____________ 7. Osmolality- concentration of solutes dissolved in the blood Uses osmometer for measurement Reference range: _______milliosmoles/ kg 8. Makes up 75 to 85 ml blood per kilogram body weight or 7 to 8% of the total Body weight FUNCTIONS OF BLOOD 1.Respiratory – most important 2. Nutritional 3.Excretory "The expert in anything was once a beginner." 1  Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT 4. Buffering Action 5. Maintenance of constant body temperature 6.Transportation of hormones and other endocrine secretions that regulate cell function 7. Body defense mechanism LABORATORY SAFETY Standard precautions must be followed in the collection of blood, and all specimens must be treated as potentially infectious for bloodborne pathogens. Mode of Transmissions of blood borne pathogens accidental injury by a sharp object, such as a contaminated needle, a scalpel, broken glass, or any other object that can pierce the skin. Cuts, skin areas with dermatitis or abrasions, and mucous membranes of the mouth, eyes, and nose. Indirect transmission can occur when a person touches a contaminated surface or object and then touches the mouth, eyes, nose, or nonintact skin without washing the hands. HAND WASHING is the most important practice to prevent the spread of infectiousdiseases. The phlebotomist should wash his or her hands with soap and running waterbetween patients and every time gloves are removed. An alcohol-based hand rub may be used if hands are not visibly contaminated. Antimicrobial wipes or towelettes are less effective for hand sanitation. GLOVES essential personal protective equipment and must be worn during blood collectionprocedures. When gloves are removed, no blood from the soiled gloves should come in contact with the hands. RED OR RED-ORANGE BIOHAZARD SIGN designated puncture-resistant containers. Where contaminated sharps and infectious wastes are placed. COLLECTION AND HANDLING OF BLOOD SPECIMENS Major ways to collect blood sample for hematology: 1. Venipuncture (Syringe, ETS, and Winged Blood Collection Set /Butterfly) 2. Capillary or Skin puncture 3. Arterial Puncture VENIPUNCTURE VENIPUNCTURE SITES: A. Veins in the arms- superficial veins of the antecubital fossa are the most common sites for venipuncture. Three major veins in the arm (Ante-cubital fossa) Median Cubital vein Cephalic Vein Basilic vein B. Alternate vein sites including the ventral forearm, wrist area, back of the hand, ankle or foot. "The expert in anything was once a beginner." 2  Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT MUST KNOW IN VENIPUNCTURE NEEDLE  The larger the gauge the smaller the internal bore diameter (vice versa)  Needle Length: ____________ Color coded needle length Color Gauge White Pink Cream Yellow Green Black Blue Medium Purple Orange VENIPUNCTURE ANGLE  Standard=___degree angle (preferred)  Range =______-degree angle TOURNIQUET  Should not exceed______________ APPLICATION  3 to 4 inches (______________) above venipuncture site DISINFECTION  Standard disinfectant: __________________  most common form of skin disinfection for blood culture: ______________________________  Ethanol testing: __________________ BLOOD PRESSURE CUFF  Standard=___________ AS TOURNIQUET  Range=_____________ NUMBER OF ATTEMPTS  ________then call another Medtech POSITION OF THE  Lying down – ______________: ↓ Packed cell Volume by 8 %, ↓ WBC PATIENT  Standing/Up-______________: ↑ Packed Cell Volume 8%, ↑ WBC WASTE DISPOSAL Yellow bag (DOH) Orange bag Red bag Yellow with black band Green bag Non-infectious Wet waste or biodegradable waste Black bag Non-infectious Dry waste or non- biodegradable waste SPECIAL  Blood should never be drawn from a vein in an arm with a cannula CONSIDERATION (temporary dialysis access device) or fistula (a permanent surgical fusion of a vein and an artery).  Venipuncture should not be performed on the same side as the mastectomy.  Venipuncture should not be performed on areas with scars or burns "The expert in anything was once a beginner." 3  Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT  Venipuncture should not be performed in edematous areas because the extra fluid can make it difficult to palpate the veins, and the specimen may be contaminated with the fluid and produce erroneous test results. PATIENT WITH IV ARM  1st: Use the opposite arm  2nd: in case of both arm with IV line, ask the nurse to stop the IV for __ mins, discard __ ml  3rd: then collect sample below the IV line (1 to 2inches below) MASTECTOMY PATIENT  1st: draw blood from the opposite arm  2nd: In case of double mastectomy, draw blood from the back of the hand or perform skin puncture. do not use tourniquet EVACUATED TUBE SYSTEM ♥ Double pointed needle ♥ Most widely used for collecting venous blood sample ♥ Affected by environmental factors such as: ✓ Ambient temperature ✓ Altitude ✓ Humidity ✓ sunlight ♥ Storage temperature: should not exceed 25 Ç or 77’F ♥ Sterilization: through ___________ ♥ Shelf-life: _____________ ♥ Shelf life of an evacuated tube is defined by the stability of the additive and vacuum retention CAPILLARY / SKIN PUNCTURE Skin puncture is the technique of choice to obtain a blood specimen from newborns and pediatric patients. In adults skin puncture may be used in patients who are: Extreme obese Burned patient Vein with therapeutic Extremely fragile veins Blood obtained from skin puncture is a mixture of blood from venules, arterioles, capillaries, and interstitial and intracellular fluids. Depth of puncture: not deeper than _____ because of the risk of bone injury and osteomyelitis PUNCTURE SITES Infants under 1 year of age is the lateral (outside) or medial (inside) plantar (bottom) surface of the heel or big toe, distal portion of the third (middle/long) or fourth (ring) finger on the nondominant hand may be used ______ – less pain, fewer never endings, and less tissue juices. "The expert in anything was once a beginner." 4  Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT CONSIDERATIONS The phlebotomist should warm the site with a commercial heel warmer or a warm washcloth to a temperature no greater than _____ and for no longer than 3 to 5 minutes Wipe away the first drop of blood because it is not a true sample. The first drop of blood is mixed with lymphatic fluid and possibly alcohol Phlebotomist should carry red, puncture resistant containers in their collection trays. In finger puncture, puncture is made __________to the fingerprint lines False increase: _________________ False decrease: ________________ PHLEBOTOMY COMPLICATIONS Bleeding, hematoma, bruising, pseudo-aneurysm, thrombosis, reflex arteriospasm, and arteriovenous ,fistula formation Cellulitis (inflammation of tissue), phlebitis (inflammation of blood vessel), sepsis, septic arthritis, and osteomyelitis Orthostatic hypotension, syncope, shock, and cardiac arrest Iatrogenic, nosocomial, physician induced, anemia resulting from blood loss Diaphoresis, seizure, pain, and nerve damage Allergic reaction to iodine, necrosis, basal cell carcinoma, and scarring ANTICOAGULANT ETHYLENEDIAMINE TETRA ACETIC ACID (EDTA)  EDTA is used in concentrations of _____________ of whole blood.  The mode of action of this anticoagulant is that it removes ionized calcium (Ca2+) through an irreversible process referred to as_____________. This process forms an insoluble calcium salt that prevents blood coagulation.  EDTA is available into three forms: Dry form (___________________) & Liquid form (______)  It is the anticoagulant of choice in hematology  Disodium salt also known as _____________  Tri-potassium (K3 EDTA) salt also known as_______________. It is the liquid form.  _________ are recommended by the International Council for Standardization in Hematology (ICSH) and CLSI as the anticoagulant of choice for blood cell counting and sizing because they produce less shrinkage of RBCs and less of an increase in cell volume on standing. -Turgeon  For routine cell count and blood smear preparation  It is the preferred anticoagulant for platelet count and evaluation of blood cell morphology  Used for _____________________________________  If concentration of EDTA exceeds 2mg/ml of whole blood, platelets may swell and fragment that will lead to false increase platelet count  Not for coagulation tests  Labile factors such as Factor V is not stable in EDTA  It Inhibits fibrinogen –thrombin reaction "The expert in anything was once a beginner." 5  Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT  Effect of Increase/excess EDTA in ESR and Hematocrit results = _____________________________________________________ Platelet satellitosis  The phenomenon of “platelet satellitosis” may occur when using EDTA.  _______________________________________________, forming a ring of satellite effect.  Using _________________as an anticoagulant should correct this problem.  Because of the dilution in the citrate tubes, it is necessary to multiply the obtained platelet by ___(Rodak’s)  Associated with false decrease automated platelet count SODIUM CITRATE  Action is to binds calcium and form soluble complex  Anticoagulant of choice in __________________________  Ratio of blood to anticoagulant is _________  Should be buffered and used in concentration of ______ (0.105 M to 0.109 M)  It preserves factor V and VIII  Anticoagulant for ________________________(black top)  Ratio of blood to anticoagulant is _________  Use in Concentration of _____ (0.129 M)  Not recommended in coagulation studies because it can cause falsely prolonged coagulation results  The most preferred anticoagulant for ESR testing OXALATE  Used in concentration of 1 to 2 mg/ml  Binds calcium to form insoluble calcium oxalate  Different forms: ____________________________________________  Potassium oxalate is the most widely used  Double balanced oxalate (potassium oxalate + ammonium oxalate)  (2parts) Ammonium oxalate (Winthrobe’s) = can cause ____________  (3 parts) Potassium oxalate (Paul Heller’s) = can cause _________ HEPARIN ♥ also known as ____________________ ♥ Natural anticoagulant ♥ Action: an acid mucopolysaccharide that inhibits coagulation by inactivation of thrombin ♥ Heparin is used as an in vitro and in vivo anticoagulant ♥ _______________is the anticoagulant of choice on most chemistry test ♥ Optimum concentration: 15 to 20 U/ml of blood or 15 to 30 U/ml of blood (0.2mg/ml of blood) ♥ Anticoagulant for _____________________________________ ♥ Heparin anticoagulation is used during percutaneous transluminal coronary angioplasty (PTCA) and cardiopulmonary bypass (CPB) to prevent clot formation. ♥ Not for coagulation studies because Heparin inhibit all stages of coagulation cascade specially thrombin ♥ Not for blood film preparation o Heparin destroys WBC and platelets "The expert in anything was once a beginner." 6  Hematology 1 Clinical Instructors: DENNIS P. MONILLA, RMT PRELIM: LECTURE/ LABORATORY TOPIC 1 ROMILET D. DEL ROSARIO, RMT o Heparin can produce a _________________on Romanowsky stained smear SODIUM FLUORIDE ♥ Used for preserving __________ ♥ Inhibitor of glycolysis ♥ Can also be used in determination of ___________________________ "The expert in anything was once a beginner." 7