Davao Doctors College

Bachelors of Science
in Medical Laboratory Science

Neil Adryan D. Dacudao,RMT

A

A Manual of Laboratory Techniques

in Clinical Hematology 1

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 TABLE OF CONTENTS

TABLE OF CONTENTS

ACTIVITY NO. 6- PROPER STAINING OF BLOOD SMEAR -3

ACTIVITY NO. 7- MANUAL DIFFERENTIAL COUNTING - 4-5

WITH PLATELET ESTIMATE

ACTIVITY NO. 8- RBC INDICES - 6-7

ACTIVITY NO. 9- OSMOTIC FRAGILITY TEST - 8-

ACTIVITY NO. 10- ERYTHROCYTE SEDIMENTATION RATE -9

LEARNING REFLECTION ON:

a. MIDTERM DISCUSSION - 10-11

b. FINAL DISCUSSION - 12-13

c. OVER-ALL REFLECTION - 14-15

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 Department of Medical Laboratory Science
Davao Doctor’s College
HEMATOLOGY 1

Name: Ba-ay, Jaycel Mae R. Date Performed:

Course/Yr. /Sec.: BMLS 3C Date Submitted:

ACTIVITY NO. 6
PROPER STAINING OF BLOOD SMEAR

GUIDE QUESTIONS:

1. What are the features of a good stained smear?

 It is neither thin or thick (rainbow appearance)
 It should not touch the side of the slide
 It should form a tail

2. List down factors affecting staining quality.

 Poor sample fixation
 Under-staining of the specimen
 Poor staining due to weakened/exhausted stain or fixative
 Contamination
 Stain precipitation

1. List down common problems encountered in staining blood smears

and the possible causes.
o Drop of blood too large or too small.
o Spreader slide pushed across the slide in a jerky manner.
o Failure to keep the entire edge of the spreader slide against the slide while
making the smear.
o Failure to keep the spreader slide at a 30° angle with the slide.

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 Department of Medical Laboratory Science
Davao Doctor’s College
HEMATOLOGY 1

Name: Ba-ay, Jaycel Mae R Date Performed:

Course/Yr. /Sec.: BMLS 3C Date Submitted:

ACTIVITY NO. 7
MANUAL DIFFERENTIAL COUNTING WITH PLATELET ESTIMATE

GUIDE QUESTIONS:

1. What are the common causes of eosinophilia?

 Parasitic and fungal diseases
 Allergic reactions
 Adrenal conditions
 Skin disorders
 Toxins
 Autoimmune disorder
 Endocrine disorders.
 Tumors

2. Differentiate the shift to the left and the shift to the right in differential
white blood cell counting.
- Shift to the Left” means that there is a shift in the WBC towards more
immature cells (more bands and blasts). This is observed in most
bacterial infections and in some cancers. “Shift to the Right” means
that there has been a shift back to the normal diff.

3. Differentiate Schilling’s hemogram from Arneth’s classification of

neutrophilia.
- Schilling’s hemogram is a differential count of the leukocytes, in
which the polymorphonuclear neutrophil cells are divided into four
categories according to number and arrangement of the nuclei in the
cells, while the Arneth’s is a classification of polymorphonuclear
neutrophils based on the number of lobes (one to five) in the
nucleus, termed stages one to five, respectively.

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4. Compute for the corrected WBC Count if the uncorrected WBC count is
25,000/mm³ and 13 nucleated red blood cells are counted after performing
the differential count. Write the formula, substitution, and the answer
expressed in both conventional unit (CU) and International System of Units
(SI).

5. Enumerate the reasons why platelets are hard to count and cite some
conditions that can cause thrombocytopenia.
- A low platelet count, called thrombocytopenia, is a common
consequence of drug treatment and may be life-threatening. Be-
cause the platelet is responsible for normal blood vessel mainte-
nance and repair, thrombocytopenia is usually accompanied by easy
bruising and uncontrolled hemorrhage. Thrombocytopenia accounts
for many hemorrhage-related emer-gency department visits.
Accurate platelet counting contributes to patient safety because it
provides for the diagnosis of throm-bocytopenia in many disorders
or therapeutic regimens.

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 Department of Medical Laboratory Science
Davao Doctor’s College
HEMATOLOGY 1

Name: Ba-ay, Jaycel Mae R Date Performed:

Course/Yr. /Sec.: BMLS 3C Date Submitted:

ACTIVITY NO. 8
RED BLOOD CELL INDICES

GUIDE QUESTIONS:

1. Sample problem: Calculate the MCV, MCH & MCHC for a subject with a red
blood cell count of 4x106 per cubic mm, a hematocrit of 23% and a
hemoglobin concentration of 12 g/dl. Describe the subject's red cells: are
they normocytic? normochromic? Give examples of anemia that has this
type of morphology.

Given: RBC 4x106 per cubic mm

Hct 23%
Hgb 12g/Dl

For MCV = Morphology: Microcytic

For MCH = Morphology: Normochromic

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 For MCHC = Hyperchromic

• Morphology: Microcytic, Hyperchromic

• Type of Anemia: Congenital Spherocytic Anemia

2. How can Erythrocyte Indices results help in the diagnosis if Anemia?

- Hemoglobin transports oxygen. RBCs carry hemoglobin and oxygen to
our body's cells. The Erythrocytes indices test measures how well the
RBCs do this. The results are used to diagnose different types of
anemia. The RBC indices measure the size, shape, and physical
characteristics of the RBCs. Your doctor can use RBC indices to help
diagnose the cause of anemia. Anemia is a common blood disorder in
which you have too few, misshapen, or poorly functional RBCs.

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 Department of Medical Laboratory Science
Davao Doctor’s College
HEMATOLOGY 1

Name: Ba-ay, Jaycel Mae R Date Performed:

Course/Yr. /Sec.: BMLS 3C Date Submitted:

ACTIVITY NO. 9
OSMOTIC FRAGILITY TEST (OFT)

GUIDE QUESTIONS:
1. What is the best method for OFT?
- The OFT is usually performed on freshly drawn blood within 2 hours
from the collection but 24-hour incubation at 37 °C of the blood
sample, has been found to improve the sensitivity of the test since this
stress condition results in an increase of osmotic lysis.

2. List some conditions in which the fragility of the red cells is

increased/decreased.
Increased:
 hereditary spherocytosis
 hypernatremia

Decreased:
 Thalassemias
 Iron deficiency anemia
 Sickle cell anemia

3. How is OFT used in anemia diagnosis?

- The osmotic fragility test (OFT) is used to measure erythrocyte
resistance to hemolysis while being exposed to varying levels of
dilution of a saline solution. When erythrocytes are exposed to a
hypotonic environment, water enters the cell and causes swelling and
eventual lysis.

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 Department of Medical Laboratory Science
Davao Doctor’s College
HEMATOLOGY 1

Name: Ba-ay, Jaycel Mae R Date Performed:

Course/Yr. /Sec.: BMLS 3C Date Submitted:

ACTIVITY NO. 10
ERYTHROCYTE SEDIMENTATION RATE (ESR)

GUIDE QUESTIONS:
1. List the effects of the size and number of RBCs on ESR.
 Number
 Increased in red cell mass –decrease ESR
 Decreased Red cell mass – Increase ESR
 Size:
 Microcyte –sediment slowly.
 Macrocyte-sediment rapidly from normocytes

2. Which of the plasma protein hastens ESR?

- ESR reflects mainly changes in the plasma proteins that accompany
acute and chronic infections, some tumors and degenerative diseases.

3. What are the common sources of error in ESR determination?

- technical factors: short ESR tubes, low room temperature, delay in
test performance (>2 hours), clotted blood sample, excess
anticoagulant, bubbles in tube.

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LEARNING REFLECTION

Reflection: Midterm Discussion

The long period of our midterm class urge me to review a huge of load of different information. As
time pass by there are information that hard for me to recall. In this term, we learn what hematology about
and how it can be related to our course which is the Bachelor of Medical and Laboratory Sciences, we
discuss about the study of the formation and function of blood and those related diseases. We also discuss
about different characteristics of both white blood cells and red blood cells, those different disorders that
correlated and the ways of how the proper interpreting complete blood cells counts. All of those different
measurements will surely help the physicians for them to give diagnosis properly. In this field in our subject,
we discuss a lot of things that will help us in our future chosen field.

We discuss about the vocabularies in hematology, which I found it really fun to learn, for I love
connecting words and knowing those meanings of it gives me satisfaction. We discuss what blood really is,
the functions of the blood, components of the blood, blood volume, order of draw, specimen collection and
types of collecting blood. Well, for me still it is helpful for us to talk back or having a discussion that we
already discuss in 2nd year for us to retain the information that we’ve gain before until now. Although I’ve
been forgetting some of information, but by way of discussing it back, I can remember again those things
and those lessons we’ve discuss before. Honestly, I forgot more on about needle gauges and its color and
their uses, but by reviewing, it helps me a lot to remember it again. We discuss about erythpoeiesis, rbc
structure and its physiology, membrane structure and structure, rbc enzyme systems, energy metabolism,
erythrocyte destruction, hemoglobin synthesis, hemoglobin molecule, and oxygen dissociation curve, those
are the topics that we tackle in part 1 midterm. In the Part 2 of our discussion, we discuss more on
erythropoiesis which is process of erythroid precursor cells differentiate become mature rbc. The primary
regulator of this process is erythropoietin. It normally takes 3-5 days for the production of reticulocytes
from pronormoblasts. That is the erythpoiesis all about. In this part of the midterm discussion, we are
already starting to discuss different types of diseases. We discuss about hemoglobin structure synthesis,
abnormal hemoglobin, rbc anomalies, different hemoglobin contents, criteria for rbc evaluation, different
samples criteria for erythrocyte morphology evaluation, rbc inclusions and the miscellaneous that being
categorize in Autogglutination which is the clumping rbc and the Rouleaux which where the rbc in stack of
coin arrangement. Those are the different topics that we’ve been tackle in part 2 of our midterm discussion.
In the part 3 of our midterm discussion, we discuss more on wbc anomalies that includes, Toxic granules,
Dohle Inclusion Bodies, May-Hegglin Anomaly, Alder-Reilly Anomaly, Auer rods, Pelger-Huet Anomaly,
Pseudo-Pelger-Huet Anomaly, Hypersegmentation, Chediak-Hegashi Syndrome, Lazy Leukocytes, Job’s
syndrome, Chronic granulomatous disease, Congenital C3 deficiency, Gaucher’s disease, Nienmann- Pick
Disease, Tay-Sachs disease, Sea-blue histocytosis, Downey Type 1 or Turk’s cell or irritation leukocyte or
known as Plasmatocytoid Lymphocyte, Downey Type 2 od Stress Lymphocytes, Downey Type 3 or Non-
Leukemic Lymphoblast, Leukomoid reaction and the last one, the Leukoerythroblastosis. Those are the
topics that we’ve discuss and each of those disease was explained clearly to us. We are also given a project
that we will make an infographic about the topic or disease that were assigned to us, and those topics and
discussion might help us to understand well on what are those and how important it is to know those things.

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This midterm journey was somehow interesting specially when our teacher starting with her discussion, she
never let anyone to be left behind while she’s sharing her knowledge to us, she never hesitates to ask us if
we understand it clearly or we are still struggling in understanding those.

I really appreciate how approachable she is in terms of when someone raising their questions
regarding on the topic that she’s been discussing, she’s really willing to help us to understand those things.
I also appreciate our teacher specially when she’s always finding her ways to make us understand those
topics that we cannot discuss properly for we’re also running out of time, she sends us videos of her
discussing and making it easier to us to catch up the topic, particularly in solving. Honestly speaking, I was
being having problem when solving a problem but with the help of our teacher and the video she sends to
us, I now understand on how to solve problem solving in a right way. In our laboratory exam, her
explanations from her videos makes me understand more about the solving portion, that’s also the reason
on how and why I answer the solving and the supporting question very well although I’m very nervous that
time. That was the very first time I feel very confident when I’m solving while we are all in an open camera
and being unmuted in the zoom that she makes for us to have our practical exam. I really feel that if I’ve
got a question that has a solving problem, I can answer it and I really pray that time to get that question that
has solving problem for I really feel that I can answer it very well.

Regardless of having online class instead of face to face due to pandemic, our teacher still finds
effective ways for us to understand and correlate her discussion which is related to our chosen course which
is the Bachelor of Medical and Laboratory Sciences. To sum it up, during with this midterm discussions,
I’ve learn a lot of new information that might help me along in my journey. That information will remain
in me that she taught us. I also love the fact that our teacher is sharing her knowledge that might help us in
our board exam and also when we are in our chosen field in the future. All I can say that we are blessed and
thankful for having our teacher in hematology, because she never let anyone of us to understand her
discussions. Thankyou Ma’am.

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LEARNING REFLECTION

Reflection: Finals Discussion

The discussions went well although we are assigned to do reporting with our chosen topic. In this
period, we’ve all agreed to have asynchronous which we are going to record our report and post it in our
private page in facebook instead of using zoom to have a live reporting. Each of us puts effort in making
and comprehending each of our topic. Here’s the topic that our teacher assigned for each of us to make a
report, handouts for my classmates and a 15 items quizzes, our report was all about different disorders of
Iron Kinetics and Hemoglobin Metabolism that includes; a. Iron Deficiency Anemia. Anemia of Chronic
Inflammation, c. Sideroblastic Anemia, d. Iron overload, II. Anemia Caused by Defects in DNA
Metabolism; a. Folate and B12 Deficiency, III. Bone Marrow Failure; a. Aplastic Anemia I. Inherited Forms
of Aplastic Anemia: 1. Fanconi Anemia, 2. Dyskeratosis Congenita, 3. Shwachman-Bodian, Diamond
Syndrome; ii. Other forms: 1. Pure Red Cell Aplasia, 2. Congenital Dyserythropoietic Anemia, 3.
Myelophthisic Anemia, 4. Anemia of Chronic Kidney Disorder, IV. Increased Destruction of Erythrocytes;
a. Extravascular and Intravascular Hemolysis, b. RBC Membrane Structure and Function, i. Hereditary
Spherocytosis, ii. Hereditary Elliptocytosis, iii. Hereditary Ovalocytosis, iv. Overhydrated Hereditary
Stomacytosis, v. Hereditary Xerocytosis, vi. Paroxysmal Nocturnal Hemoglobinuria, c. RBC
Enzymopathies; i. Glucose-6-Phosphate Dehydrogenase Deficiency, ii. Pyruvate Kinase Deficiency, iii.
Pyrimidine 5’nucleotidase Tyoe 1 Deficiency, d. Microangiopathic Hemolytic Anemia: i. Thrombotic
Thrombocytopenic Purpura, ii. Hemolytic Uremic Syndrome, iii. HELLP Syndrome, iv. Disseminated
Intravascular Coagulation, e. Macroangiopathic Anemia: i. Traumatic Cardiac Hemolytic Anemia, ii.
Exercise-Induced Hemoglobinuria, f. Hemolytic Anemia Caused by Infectious Agents: i. Malaria, ii.
Babesiosis, iii. Bartonellosis, g. Hemolytic Anemia – Immune Causes: i. Autoimmune Hemolytic Anemia.
These are the topic and yes, each of us was assigned to understand it and make a recorded report for our
classmates and to our teacher to grade our output.

After learning from our teacher about some diseases, because our teacher does a synthesis for us to
understand it easier and to add information for us. We learn how to differentiate among hemoglobinopathies
and thalassemia, anemias, immature white blood cells, and characteristics of mature ones that suggest
infection or disease. This differentiation is important because many blood disorders can present similar
CBC results, but they look very different morphologically under a microscope using a demo like a picture
and to the day we tackled about our reporting just like me reporting a Folate and B12 Deficiency, therefore,
I will explain on my report, what are those all about, however, there are still information that I can't able to
add for I am running out of time, because I repeat my powerpoint presentation from the start for I am not
able to save my previous powerpoint presentation which I was done. It was also too late for me to read
some information from different resources that I could add on my recorded report. But still, I never lose
hope that I can still have and do m a new powerpoint presentation although the first one was better for I put
lot of efforts on it and a lot of information that I could explain while recording using it but sad to say I have

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to make a new one and I’m still glad to receive a comment from our beautiful teacher about my report after
I have post it on our private facebook page for our class only.

For the laboratory, we discuss about solving and analyzing different kind of problems that might
anyone of us in the future will encounter those kind of problems. This time, our teacher discusses it to us
through using zoom application which we can communicate, her discussions lasted for almost an hour,
we’ve also know that it is a long kind of discussion, for there are lot of things that we should understand
and we must listen to it carefully for our teacher loves adding new information that will serve as big help
for us, especially in our board exam and in our future chosen field. We are blessed of having a teacher like
her for she really gives her best when she’s teaching. Thankyou Ma’am.

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LEARNING REFLECTION

Over-all Learning

First and foremost, I would like to take this opportunity to express my greatest privilege of being
one of the student of our teacher who is handling Hematology 1. Covid 19 was never been a hindrance to
student who really want to learn and continue to study although we have online classes due to Covid 19.

For the over-all learning in this semester, I’ve learn a lot of things specially with this subject, I’m
always active when our teacher is discussing online for I really love the idea that she shares lot of new
information that might help us in our future fields. She shares new information that can be a big help to us
in our board exam. She never hesitates to repeat her discussions when one of my classmates don’t get the
information very well, she’s very dedicated when she’s teaching. She’s always finding ways to explain
every details of information that she’s teaching us. She always makes sure to have more patience to
understand with each other. She is our Teacher. I know how hard to handle 47 students in a class but she
handles us very well.

In the clinical field, hematology incorporates the therapy of blood issues and malignancies,
including sorts of hemophilia, leukemia, lymphoma and sickle-cell paleness. Hematology is a part of inward
medication that manages the physiology, pathology, etiology, analysis, treatment, guess and anticipation of
blood-related problems. Hematologists center to a great extent around lymphatic organs and bone marrow
and may analyze blood tally anomalies or platelet abnormalities. Hematologists treat organs that are taken
care of by platelets, including the lymph hubs, spleen, thymus and lymphoid tissue. Blood is comprised of
a few sections, including red platelets, white platelets, platelets and plasma. Red platelets, which make up
about 45% of entire blood, convey oxygen from the lungs to the body's tissue. They additionally convey
carbon dioxide back to the lungs to be breathed out. They are plate formed, and created in the bone marrow.
White platelets, which are additionally made in the marrow, help battle disease. Along with platelets, they
make up under 1% of entire blood. Platelets are little, dull pieces that remain together and collaborate with
thickening proteins to stop or forestall dying. They are additionally delivered in bone marrow. Plasma is
the liquid piece of the blood. Made out of 92% water, it additionally contains crucial proteins, mineral salts,
sugars, fats, hormones and nutrients.

Hematology as what I have learned from our teacher’s discussion, it is the study of blood, blood-
shaping organs and blood illnesses. In our discussion, we are finding out about the properties of red and
white platelets, their connected sicknesses, and the comprehension of the infection's full platelet tallies
(CBCs). A CBC is a rundown of proportions of platelets that typically happen when the blood is gathered,
and it demonstrates the number of red and white cells you have, their shapes, extents, relative plenitudes,
and the measure of hemoglobin present. Beside these things I have additionally found out about the various
sorts of blood issues and their treatment, Including kinds of leukemia and iron deficiency. It is significant
in our degree to truly go through or take this subject since hematology includes the conclusion and therapy

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of patients who have problems of the blood and bone marrow and it is the employment of a clinical
technologist to analyze this body liquid infinitesimally to give doctors legitimate finding and with the goal
for them to understand what treatment is appropriate for the patient’s condition. From this subject I have
likewise figured out how to know about our own body's wellbeing to have the option to be a solid individual
and a long way from getting these illnesses. Observing our body's blood microscopically or checking our
blood with the distinctive test performed by the clinical technologist causes us to know about certain body
illnesses or blood infections that may emerge over the long run as we get more seasoned. I truly trust that
all the hypotheses we have learned we could try and take a gander at tests through the magnifying lens on
the grounds that applying the hypothesis to practice will assist us with getting that or will show as that real
examples appear to shift from the standard, which is incredible preparing for our future professions. I am
hoping that what we’ve learn from our discussion would be a great help for us, especially in our board
exams and we could apply those learnings into our chosen work, someday.

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