Introduction to Clinical Hematology 1 James Homer Wright

History -pathology laboratory at the Massachussets

17th Century General Hospital
-birth of science of studying blood -1902, modification of Romanowsky stain
-as a science, it has grown enormously in the last -megakaryocyte origin of platelets
70 years
Aristotle Common Prefixes used in Vocabulary of
-human body is made up of four elements: fire, Hematology
air, water, and earth A-/An- Lack, Without
William Harvey Absent,
-first completed the description of the circulatory Decreased
system Aniso- Unequal
Athanasius Kircher Dissimilar
-1646, using a microscope: plague victims Ante- Before
-1658, Scrutunium Pestis: “little worms” or Brady- Slow
“animalcules” in the blood Cyto- Cell
Jan Swammerdam Dia- Through
-1658, discovered that RBCs are different from Dys- Abnormal
mother cells, that they have no nucleus and have Difficult, Bad
a lifespan of 120 days Erythro- Red
Malphigi Ferr- Iron
-1666, pioneered the study of coagulation Hemo- Pertaining to
Antoine Van Leeuwenhoek blood
-1674, first described the human erythrocyte Hyper- Above, Beyond
Wharton Jones Extreme
-1846, first described the polymorphonuclear Hypo- Beneath, Under
cells from other cells Deficient,
Gabriel Andral Decreased
-1879, first described the complete classification
Iso- Equal, Alike
of leukocytes
Same
Paul Ehrlich
Leuko- White
-1891, found that certain mixtures of acidic and
Macro- Large, Long
basic dyes produced better staining
Karl Ludwig Mal- Bad, Abnormal
-1816-1895, established that hemoglobin carried Mega- Large, Giant
oxygen Meta- After, Next,
E.F. Pfluger Change
-1816-1895, showed that carbon dioxide was Mono- One
taken from tissues and released in the lungs Morph- Shape
Max Perutz Myel(o) From BM or SC
-discovered the structure and function of Pan- All, Overall, All-
hemoglobin inclusive
Giulio Bizzozero Phleb- Vein
-discovered Helicobacter pylori and function of Phago- Eat
platelets Ingest
Poikilo Varied, Irregular
Schis- Split

CPT1
 Scler- Hard Panmyelosis Pan + myel(o) +
Splen- Spleen osis
Thromb(o) Clot, Thrombus
Xanth- Yellow Blood
-nutritive fluid
Common Suffixes used in the Vocabulary of -participates in the physiologic and pathologic
Hematology activities of the body
-blast Primitive Arterial Blood
-cyte Cell -bright red
-ectomy Excision Venous Blood
Cut-out -dark red
-emia Blood Functions of Blood:
-itis Inflammation  Respiration
-lysis Destruction,  Nutrition
Dissolving  Excretion
-(o)logy Study of  Buffer
-oma Swelling, Tumor  Transports hormones and other
endocrine substances needed for
Opathy Disease
normal body functions
-osis State, Condition
 Maintenance of a constant body
Increase
temperature and slight alkalinity of
-penia Decrease
tissues
Lack of
 Protection
-phil(ic) Attracted to
Affinity for
Blood Components
-plasia Cell production or
repair
-poiesis Cell production
Formation,
Development
-poietin Stimulate
production
-stasis Same
Standing still
-trophy Nourishment
 Plasma (55%)
Examples of Hematologic Terms -90% water
Anisocytosis An + iso + cyt + -8% solutes
osis -proteins
Aplasia A + plasia  Albumin (60%)
Anemia An + emia  Alpha and Beta Globulins
 Gamma Globulins
Dysmyelopoiesis Dys + myelo +  Fibrinogens
poiesis -gas
-electrolytes
-organic nutrients

CPT2
  Carbohydrates -travels away from the heart to the different
 Amino Acids arteries of the body
 Lipids -appears bright red because oxygen cause
 Vitamins hemoglobin molecules turn from blue to red
-hormones
-metabolic Waste Deoxygenated Blood
 Carbon Dioxide -travels back to the heart to be resupplied with
 Urea oxygen
 Buffy Coat (<1%) -appears very dark red because so many of the
 Platelets hemoglobin molecules have turn blue again
Types of Blood Vessels:
 Leukocytes
 Arteries
 Formed Elements (45%)
-thick walled, strongest, branches out to
 Red blood cell (Erythrocytes)
smaller arterioles
 White blood cell (Leukocytes  Veins
 Platelets (Thrombocytes) -carry deoxygenated blood from
capillaries to heart; not as thick,
Blood Volume muscular, elastic as arteries have valves
Whole Blood: that allow blood flow in only one direction
 Normovolemia  Capillaries
-5-7L -smallest, thin-walled connect smallest
 Hypovolemia arterioles with smallest venules
-<5L
-decrease volume of blood
-small amounts of nutrients that will give
to other organs
-tachycardia
Causes:
 Loss of Whole Blood
 Loss of Body Fluid
 Loss of Plasma
 Hypervolemia
->7L
-increase volume of blood
-strain on heart because of the weight
-worse case is death (cardiac arrest)
Causes:
 Preganancy
 IV Fluid Ingestion
 Massive Blood Transfusion

Blood Vessels and Circulation

Blood Vessels
-have the mechanisms to increase or decrease
blood in the circulation
Oxygenated Blood

CPT3
Basic Hematological Methods of Examination Provisions for Healthcare Workers
Specimen Collection  Universal Precaution
Biohazard Symbol -treat all patients as a possible source of
a blood-borne pathogen
-wear gloves when handling blood or
body fluids that are contaminated with
blood
 Body Substance Isolation
-all body fluids are infectious
-recommended wearing of gloves
Chain of Infection -does not recommend handwashing after
 Source gloves removal
 Mode of Transmission  Standard Precaution
 Susceptible Host -combines UP and BSI
-recommend wearing of gloves
-handwashing (every after encounter a
sample)

Disposal of Waste
 Yellow
-infectious wet and dry
 Green
-non-infectious wet
 Black
-non-infectious dry
 Orange
-radioactive materials
 Red
-sharps

Phases of Collection
 Pre-collection
-proper patient preparation
 Stress
 Exercise
 Smoking
 Meal within 2 hours
 Crying
 Collection
-proper patient identification
 Methods to use
 Sample to use
 Pressure during collection
 Posture
Supine

CPT4
 -ideal for non-ambulatory in the middle finger: 1.5-
patients 2.4mm
Sitting Upright  Puncture depth: <2mm
-ideal for ambulatory patients Advantages:
 Diurnal Variance  Easily accessible to the
-cortisol MedTech
 Hemoconcentration  Easy to manipulate
-prolonged tourniquet application  Less intimidating
-false increase (K, RBC,  Ideal for peripheral blood
Hematocrit) smear
-probing  More free flow of blood
 Post-collection  Ideal when searching
 Proper Patient Care abnormal cells
 Proper Specimen Transport Disadvantages:
and Handling  Less amount of blood can
be obtained
Methods of Blood Collection  Blood hemolysis easily
 Capilliary Puncture  Additional and repeated
-also known as microcollection tests cannot be done
Ideal for: Areas to Avoid:
 Newborn  Cold and cyanotic areas
 Pediatrics (<6 mos)  Inflamed and pallour areas
 Patients with poor vein  Congested and edematous
o Extreme Obesity area
o Severe Burns  Scarred and heavily
o Geriatric Patients calloused area
Capillary Blood Methodology:
-mixture of venous blood, arterial blood,
 Equipment to use
and tissue fluid
o Puncturing Device
-generate slightly different results
-needle
Collection Sites:
-blade
 Last phalanx of the 3rd or 4th -lancet
finger o Capillary Tube
 Plantar Heel (Lateral) -caraway pipet
 Earlobe -sarstedt capillary
 Big toe of the foot pipette
Note: -length: 75mm or 7.5cm
 Infant’s finger should not be -should be filled up to:
punctured to as to avoid ¾ of the tube
serious injury to the bones -length: 4mm
 Capillary beds in an infant’s o Cotton Pads
heel is located between 0.35- o Disinfectant/Antiseptic
1.6mm below the skin surface -best disinfectant: 70%
 Generally, distance of the skin isopropyl alcohol
surface to the bone/cartilage o Microcollection Tubes

CPT5
  Evacuated Method
Puncture Technique: -contain vacuum inside
 Warm the area before -multi-sample needles/two way
puncturing needle
-<42 degrees celsius for 2-5 -needle holder/adaptor
minutes
 Depth of incision
-adult: <2mm quick and firm
-children: not deeper than
1.6mm
 Position of the puncture
-perpendicular
 Never do lock and key
 Venipuncture
-aka phlebotomy
-process by which blood is obtained from
the veins  Butterfly Method
Vein Selection: -needle has wings used for
 Median Vein anchoring
-most preferred vein -used in pediatrics
-stable; well-anchored Sites to Avoid:
-less painful  Hematoma
-biggest vein  Burns
 Cephalic Vein  Scars/Edema
-2nd most preferred vein  Side of which mastectomy
-the easiest vein to palpate in was performed
obese patients  Arm receiving intravenous
 Basilic Vein infusion
-least preferred; not stationary; Equipments:
close to brachial artery and  Tourniquet
median cutaneous nerve -locate for vein
branch Less than 1 minute
Blood Donation Vein Selection: -3 fingers/2-4 inches above
 Median Vein puncture site
 Basilic Vein -must be disposable
 Cephalic Vein -blood pressure cuff must be
Alternative Sites: inflated at no more than
 Dorsal Vein of the Hand 40mmHg
 Veins of Wrist Types:
 Veins of the foot (with consent o Seraket
of the physician) o Rubber
Methods of Collection: o Velcro
 Syringe Method  Evacuated Tube
-needle insertion -plastic/glass
-bevel up and 30 degrees angle -with variety of pre-measured
additives

CPT6
 -follow proper correct order of Specimen Handling
draw -proper inversion; no shaking
 Needles -transport in an upright position
-length: 1-1.5 inches -deliver to the lab within 45mins to 1 hour after
-two way needle (evacuated collection
system) -separation from cellular components is within 30
Gauges: mins. after collection
o 21 (Adult) Exposure to light: Decrease
o 23-25 (Children)  Bilirubin
 Disinfectant  Carotene
-commonly used: 70%  RBC Folate
isopropyl alcohol  Porphyrins
-alcohol testing: benzalkonium Chilled Specimen:
chloride (Zephiran)  Arterial Blood Gas
Complications:  Ammonia
 Local Immediate  Lactic Acid
-hemoconcentration  Certain Coagulation Test
-circulatory failure Warm Specimen:
-syncope/fainting  Cold Agglutinin
 Local Delayed  Cryoglobulin
-hematoma  Cryofibrinogen
-thrombosis/clot formation
-thrombophlebitis
 Late General
-serum hepatitis
-AIDS
 Arterial Puncture
-process by which blood is obtained from
the artery
-performed by physician/respiratory
therapist
-for blood gas analysis
Preferred Sites:
 Radial Artery
 Brachial Artery
 Femoral Artery
 Scalp Artery
 Umbilical Artery
Allen’s Test
-assesses whether ulnar artery can
provide enough blood supply to the
radial artery during collection

CPT7
Safety in Clinical Hematology Laboratory  Sharps safety and Needle
Occupational Safety and Health Stick Prevention
Administration (OSHA)  Hands, pens, fomites must be
-US Department of Labor kept away from workers
-safe working environment for all employees mouth and mucous
1996 membranes
-Standard Precaution is now used encompasses  Fire Hazards
UP and BSI -improper use or storage of cryogenic
1991 OSHA substances (thermal burn) or substances
-issued final rule for occupational exposure to capable of combustion (fire, explosion, or
blood borne pathogens asphyxiation)
Potentially Infectious Materials:
 Microhematocrit Clay
 Unfixed Slides
 Blood
 Urine
 Feces
 Spinal Fluids
 Semen
 All body fluids identified or
unidentified  Chemical Hazards
-“Occupational Exposure to Hazardous
Occupational Hazards Chemicals in Laboratories”
 Biologic Hazards July 1, 1998
-greatest risk: exposure to blood and -federal register
body fluids  Toxic
1991  Flammable
-“Occupational Exposure to Bloodborne  Carcinogenic
Pathogens” standard MSDS by Federal Law:
March 6, 1992  Labelling
-standard precautions protecting lab  Proper Storage
workers and other healthcare
 Ventilation
professionals
NFPA Diamond Hazard Symbol
Applicable Safety Practices Required by
OSHA Standard:
 Handwashing
 Personal Protective Clothing
and Equipment
 Decontamination of work
surfaces, equipment, and
spills
 Eating, drinking, smoking,
applying make-up must be Degree of Hazard:
prohibited in the lab  4: Extreme Hazard
 Pipetting Safeguards  3: Serious Hazard
 2: Moderate Hazard

CPT8
  1: Slight Hazard
 0: No or Minimal Hazard
 Electrical Hazards
-electrical shock, burns, fire, or explosion
-maintenance is important
 Grounded (Three-pronged
Plug)
 Avoid Use of Extension Cords
(CLSI)
 Operate with Dry Hands
 Mechanical Hazards
-improper use, storage or disposal of
glass wares, sharp instruments,
compressed gases, or equipment
 Use caution to prevent
unnecessary or accidental
breakage of glass wares
 Sharps, broken glasses must
be dispose in puncture-proof
containers
 Use common sense in storing
glass wares
 Centrifuges must be balanced
and lid must never be opened
until rotor has completely
stopped

CPT9
Quality Control and Quality Assurance in Diagnostic Specificity
Hematology -proportion of patient’s identified correctly by the
Quality Assurance test as not having the disease
-control and monitor
 Staff Competence Types of Analytical Errors
 Materials, Methods  Systematic Errors
 Reporting of Results -errors within test system or method
 Patient and Doctor Satisfaction  Random Errors
 Financial Cost -occur without prediction or regularity
Quality Control
Procedures: Sources of Analytical Errors
 Evaluate and Monitor  Preanalytical Errors
 Cxs of Testing System  Postanalytical Errors
Control
-same matrix as patient’s specimens Internal Quality Control
-predetermined assay value Control Sample
Primary Standard -specially prepared specimen treated as a patient
-calibrate instrument specimen
-fixed and known composition Calibrators and Standards
-essentially pure form -adjust instrumentation
-certified reference material -define a std curve from which patient results are
Secondary Standard read
-analyte concentration ascertained by reference
to a 1o std External Quality Control
Calibrator -provide proficiency surveys
-preserved human/surrogate cell suspension -monitor accuracy of individual laboratories
-determined hematologic parameters
Accuracy
-closeness to the true/actual value
Precision
-closeness of results obtained from repeated
analysis of same specimen
-reproducibility
Delta Checks
-assess change
-compare results from specimen analyses with
result of previous specimen: same analyte, same
patient
Reliability
-extent to which a mtd is able to maintain
accuracy and precision over time
Reference Interval
-reference range
-range of values of analyte in healthy individuals
Diagnostic Sensitivity
-proportion of patients with the disease with a
positive result
CPT10