MEDT 25: VIRTUAL INTERNSHIP

HEMATOLOGY SECTION
ACTIVITY # 3: Processing of Sample

Name Date: October 24, 2022

:

Instruction: Analyze each case carefully and answer the given questions. Back-up your
answers by providing reliable references. Use APA 7th edition.
Case Answer
During the processing of sample in Beckman The quality control (QC) program is a part
Coulter HmX AL Analyzer, you noticed that the of the laboratory's overall quality
result of the machine has “***” to the WBC result. management system. A routine QC
You advice the medical technologist staff on duty program should also be developed to
about the problem. The staff said it is out of evaluate the analytical performance of the
control. As a medical technology intern, what is lab's measurement systems in order to
the importance of control and what will be the spot any errors that might arise during the
effect to the results if it is out of control range? analytical phase of testing and have a
Justify your answer. negative influence on patient care.

Unsatisfactory results are regarded as an

out-of-control event when a QC rule
evaluation for one or more QC measures
produces them. An out-of-control
occurrence typically means that the
measuring system is not performing
analytically within the range that is
expected of it. Out-of-control events need
to be found and investigated in order to
avoid publishing incorrect test results that
could endanger patients. The challenge
has expired if an uncontrollable event has
been identified. Once an uncontrollable
incident is discovered, it is the laboratory's
responsibility to determine its source, take
corrective action, protect patients from
danger, and put preventative measures in
place.

Reference(s):

Bachmann, L. M. & Vandepoele, N. (2021).

The 7 Best Practices to Recover from an Out-
of-Control Event Retrieved from
https://clpmag.com/lab-essentials/quality-
 systems/quality-control-programs/the-7-best-
practices-to-recover-from-an-out-of-control-
event/#:~:text=An%20out%2Dof%2Dcontrol
%20event%20typically%20means%20that
%20the%20measurement,that%20may
%20cause%20patient%20harm.

After checking the quality of blood sample, you The picture shows a case of platelet
run the specimen to the Beckman Coulter HmX satellitism. It is a phenomenon where the
AL Analyzer. After running, you notice a platelets adhere to the edge of the
spuriously low platelet count to the machine. The neutrophils giving it a “rosette”
staff said do manual checking of sample. Below is appearance.
the picture of the platelet

It is a rare occurrence in samples

processed with EDTA anticoagulation,
and it is thought to be a complicated
process involving alterations to proteins
and antibodies caused by EDTA. Platelet
clumping may cause falsely decreased
automated platelet count. The sample
may be taken again using sodium citrate
as the anticoagulant. The automated
technique can then be used to count
platelets.

. Reference(s):

Based on the picture above, explain the
phenomenon and how to resolve this problem.
Justify your answer.
During sample processing, you notice that the
result of the WBC is increase and the Hemoglobin
also increase. You inform your respective head
about the result and advice you to perform manual
checking. Below is the picture of a manual PBS
Identify all cells that cause of increase WBC and
Hemoglobin. Justify your answer.
After examining the sample received in the
hematology section, you notice a lipemic sample
American Society of Hematology. (n.d.).
Platelet clump. Retrieved from
https://imagebank.hematology.org/image/6
0929/platelet-clump?type=atlas
LabCE. (n.d.). Pseudo-thrombocytopenia:
Platelet Satellitism and Platelet Clumping.
Retrieved from
https://www.labce.com/spg280957_pseud
o_thrombocytopenia_platelet_satellitism_a
nd_p.aspx#:~:text=If%20either%20platelet
%20satellitism%20or,counted%20using
%20the%20automated%20method.
Hematology. (n.d.). Platelet satellitism.
Retrieved from
http://haematologyetc.co.uk/Platelet_satellitism
Based on the picture, there is no cells
that may cause elevated WBC and
hemoglobin. The cells that are present are
codocytes, spherocytes, sickle cells, and
hypochromic RBC. These cells are
present if a person has a hemolytic
anemia. Red blood cells are destroyed
more quickly than they can be produced in
hemolytic anemia. The destruction of red
blood cells is called hemolysis.
Reference(s):
Johns Hopkins Medicine. (n.d.). Hemolytic
Anemia. Retrieved from
https://www.hopkinsmedicine.org/health/c
onditions-and-diseases/hemolytic-anemia
Hematology tests are affected by lipemia
by the following process by light
to the EDTA tube. After examining, you run the
sample. After running you notice the result of
scattering. This has an impact on the
following outcomes: Hemoglobin and
indices related to hemoglobin: Leads to
erroneously elevated hemoglobin
absorbance values, resulting in an
erroneously high measurement.
When lipemia prevents the measurement
of hemoglobin, many methods are
frequently utilized to report the total blood
count. First, just the hematocrit, RBC,
MCV, WBC, and platelet count are
provided along with a note that an exact
Hb cannot be obtained due to lipemia and
a recommendation to repeat the tests after
the patient has fasted for at least two to
three hours. If the ordering physicians are
just concerned with the WBC or platelet
count, then this strategy is frequently
sufficient. The RBC and hematocrit
measurements are adequate to rule out
anemia.
The determination of a whole blood Hb
(Hemocue), which is unaffected by lipemia
since various wavelengths are employed,
is a second method. The whole blood Hb
can then be combined with the reliable
analyzer values, and the missing indices
can be calculated to report the entire CBC
battery. Although more thorough, this
method calls for more instrumentation.
A third strategy is to use a saline
replacement process, which entails
centrifuging the specimen, extracting the
plasma, replacing it with an equivalent
volume of saline, recombining the sample,
and then passing it through the analyzer.
Some claim that this procedure can have
an unknown impact, notably on the
platelet count since some platelets may be
eliminated with the plasma, because it
requires great care to remove the plasma
and replace it with saline.
A laboratory should decide on an
approach based on the clinical situation
and technological capabilities there.
hemoglobin is increase. What will be the course of Reference(s):
action for this situation? Justify your answer.
ECLINPATH. (n.d.). Interferences. Retrieved
from
https://eclinpath.com/test-basics/interferences/

Savage, R. A. (2004). Cap Today.

Retrieved from
http://www.captodayonline.com/Archives/
q_and_a/qa_07_04.html

After processing of blood sample, you noticed that
there is a decrease in RBC and Hematocrit. The
staff said that do manual checking. Below is the
picture
The plasma is slightly reddish in color. What will
be the course of action to this? Justify your
answer
Plasma or serum may appear pink or red
due to hemolysis, which is the process of
red blood cells breaking and hemoglobin
escaping as a result. Hemolysis can
happen if the phlebotomist attempted a
difficult blood draw with an inadequately
sized needle, drew the blood through an
existing hematoma, or withdrew the blood.
Too much force was used to drive blood
into a tube from a syringe, to vigorously
mix a tube, or to contaminate the
specimen with water or alcohol at the site
of venipuncture or in the tubes. In
addition, hemolytic anemias can cause
physiological hemolysis. Hemolyzed
samples can change test outcomes,
including potassium, lactate
dehydrogenase, and aspartate
aminotransferase levels, which can lead
to mistakes in patient care.

Reference(s):

Keohane, E. M., Smith, L. J., & Walenga, J. M.

(2016). Rodak's Hematology: Clinical
Principles and Applications. Elsevier
Saunders.

After running the specimen, you notice that the
result of RBC is decrease and the Platelet count
is increase. The staff ask you to do manual
checking. Below is the picture
Schistocytes (fragmented red blood cells)
are a hallmark of microangiopathic
hemolytic anemia and show red blood cell
injury from damaged endothelium on the
peripheral blood smear. On the other
hand, a portion of erythrocytes that show
up as target cells in stained blood smears
in sickle cell disease polymerize during
deoxygenation as a result of inheriting the
hemoglobin variation Hb S.
 Reference(s):

Wong, P. (2016). A hypothesis of target cell

formation in sickle cell disease. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/27372866/

Tefferi, A. & Elliott, M. A. (2004). Schistocytes

on the Peripheral Blood Smear. Retrieved from
https://www.mayoclinicproceedings.org/article/
S0025-6196(11)62635-9/fulltext

What is the reason of increase platelet and

decrease RBC? What is the best course of action
to this problem?
After running the specimen into the machine, you
notice that the RBC result is decrease and MCV
A grainy texture to the film could be a sign
of RBC agglutination, which is common in
disorders caused by cold hemagglutinins
and causes decreased RBC and
increased MCV and MCHC.

Some tests, like the cold agglutinin titer,

need the samples to be kept heated in
order to produce appropriate findings. The
serum's antibody will bind to the red blood
cells if the samples is chilled before the
serum is withdrawn, inflating the serum's
cold agglutinin titer. For tests including
those measuring glucose, potassium, and
lactate dehydrogenase, cells and serum
must be separated within 2 hours of
collection to guarantee appropriate
findings.

Reference(s):

Keohane, E. M., Smith, L. J., & Walenga, J. M.

(2016). Rodak's Hematology: Clinical
Principles and Applications. Elsevier
Saunders.
and MCHC are increase. The staff ask you to do a
smear and after that you notice a granny
appearance to the smear. What is the course of
action to this and what is the problem? Justify your
answer.
As a medical technology intern, you must know
also the history of the patient to better justify the
result of the laboratory. In a hematology section, a
blood is received and run to the machine. You
notice that there is a spurious decrease of WBC
and spurious increase of Platelets. You inform
your staff and ask that interview the patient. After
verifying the history, you know that the patient is
suffering from leukemia and currently undergoing
chemotherapy. What is the reason of its result in
the machine? Justify your answer.
Your blood count will probably reveal
greater than normal numbers of white
blood cells, which include leukemic cells,
if you have leukemia. Additionally, your
red blood cell and platelet cell levels may
be lower than usual.
Chemotherapy damages the bone
marrow cells, which reduces the amount
of white blood cells the body produces.
This lowers the white blood cell count.
The first line of defense against bacteria
and viruses that could make you ill is your
white blood cells. A typical adverse effect
of cancer and its treatment is a low
platelet count. If your body does not
produce enough platelets or if platelets
are lost or destroyed, you may experience
a low platelet count. A healthy person's
platelet count ranges from 150,000 to
450,000, while the usual range for
someone receiving chemotherapy or
radiation therapy is 20,000 to 50,000.

Reference(s):

Biggers, A. (2021). What Do Leukemia

Blood Counts Mean?. Retrieved from
https://www.healthline.com/health/leukem
ia/leukemia-blood-count

Cancer.Net. (2020). Low Platelet Count or

Thrombocytopenia. Retrieved from
https://www.cancer.net/coping-with-cancer/phy
sical-emotional-and-social-effects-cancer/
managing-physical-side-effects/low-platelet-
count-or-thrombocytopenia

Welsh, J. (2021). An Overview on How to

Increase White Blood Cells During
Chemotherapy. Retrieved from
https://www.verywellhealth.com/increase-
white-blood-cells-during-chemotherapy-
5203581