HEMATOLOGY UNIT

PRETEST
New Methylene Blue This is the most common supravital stain used for reticulocytes
count. This stain makes it possible to see the
reticulofilamentous pattern of ribosomes characteristically
precipitated in these live immature red blood cells by the
supravital stains.
ABX Difftrol/ABX Minitrol A tri-level multiparameter control intended for in vitro
diagnostic use and designed for use in monitoring the
accuracy and precision of HORIBA Medical hematology blood
cell counters.

Cuvette Roll/Wheel It is the roll/wheel that holds the cuvettes in Stago Compact
Max machine for PTPA/APTT/D-Dimer test. The cuvette
wheel is located on the right-hand side of the instrument.

Liatest D-D Plus ( Latex and Buffer) Is a well established, rapid, automated, quantitative immune-
turbidimetric assay that has been used for the quantitative
determination of D-dimer levels.

File Box is a box or container where smears are saved for 1 week. After
a week, smears are discarded.

ABX Diluent Buffered isotonic solution for sheating and diluting leucocytes,
and for the determination and differentiation of blood cells, and
the measurement of hematocrit on HORIBA Medical blood cell
counters/ABX Pentra XL machine.

Wintrobe Tube This is a tube of 110 mm long and with an internal bore
diameter of 3mm. The tube is closed at one end. This tube is
graduated on both sides from 0-10 in ascending and
descending order. The tube holds approximately 1 ml of blood.
One of its uses is for the determination of Erythrocyte
sedimentation rate (ESR).
ABX Pentra XL 80 High performance hematology analysis with integrated
validation 80 test per hour. Utilizes flow cytometry using
principles of impedance, cytochemistry and measurement of
light absorbance, Multi Distribution Sampling System (MDSS)
microsampling.

STAGO Compact Max a fully automated clinical analyzer designed to perform tests
on human plasmas, the results of which aid in the diagnosis of
coagulation abnormalities or in monitoring anticoagulant
therapy.

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 INTRODUCTION
Cells in the blood is being tested in the hematology Unit. There are different cells present in the blood.
It is the responsibility of a registered medical technologist to classify the cells present in our body. The rests of
these tests are important in identifying various diseases.

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 LABORATORY QUICK TOUR

Receiving area Post analytical section

(4 computers)

Department of Pathology Hematology Unit Services

Offered:
• Complete Blood Count (CBC)
• Red Cell Distribution Width (RDW)
• Platelet Count
• Activated Partial Thromboplastin Time (APTT)
Smear area and Hematocrit
• Hemoglobin Staining area
• D-Dimer Assay
• Red Blood Cell Count
• Bleeding Time (Duke's Method)
• Reticulocyte Count
• Clotting Time (Slide Method)
•Red Cell Indices
• Erythrocyte Sedimentation Rate (ESR)
Viewing area
• Mean Cell Volume (MCV)
• Absolute Eosinophil CountStandard Operating
• Mean Cell Hemoglobin Procedure
(MCH)
• Malarial Smear
• Mean Cell Hemoglobin Concentration (MCHC)
• Thin Smear
• Red Blood Cell Morphology
• Thick Smear
• Peripheral Blood Smear
• Malarial Parasite Count
LECTURE
ZENAIDA B. BALLAD INTERN'S MONITOR
MARIA NENETH DIONEDA, RMT UNIT SUPERVISOR
ALMA S. OPIDA, RMT ASSISTANT SUPERVISOR
TEST DONE IN HEMATOLOGY UNIT
ROUTINE TEST Complete Blood Count and Platelet Count
COAGULATION TESTS Prothrombin Time Test
Activated Partial Thromboplastin Time Test
SPECIAL TEST D-Dimer Test
OTHER TESTS Reticulocyte Count
RCM/PBS (Red Cell Morphology/Peripheral Blood Smear)
CT/BT (Clotting time/Bleeding Time)
ESR (erythrocyte Sedimentation Rate)
HEMATOLOGY UNIT

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HEMATOLOGY ANALYZER Main Unit On The Right Side
ABX Pentra x180 Back-Up Unit On The Left

Only 5 reagents ABX Alphalyse or ABX Lysebio (cyanide free)

ABX Basolyse II TM
ABX Eosinofix
ABX Cleaner
ABX Diluent

PRINCIPLE OF HEMATOLOGY ANALYZER ELECTRICAL IMPEDANCE

The traditional method for counting cells is electrical

impedance, also known as the Coulter Principle. It is used in
almost every hematology analyzer.

Whole blood is passed between two electrodes through an

aperture so narrow that only one cell can pass through at a
time. The impedance changes as a cell passes through. The
change in impedance is proportional to cell volume, resulting in
a cell count and measure of volume.

Impedance analysis returns CBCS and three-part WBC

differentials (granulocytes, lymphocytes, and monocytes) but
cannot distinguish between the similarly sized granular
leukocytes: eosinophils, basophils, and neutrophils.

Counting rates of up to 10,000 cells per second can be

achieved and a typical impedance analysis can be carried out
in less than a minute.
COAGULATION UNIT
PRINCIPLE OF STAGO COMPACT MAX MECHANICAL END-POINT DETECTION

Electromechanical clot detection systems measure a change

in conductivity between two metal electrodes in plasma. The
BBL Fibrometer was the first semiautomated instrument to be
used routinely in the coagulation laboratory. The probe of this
instrument has one stationary and one moving electrode.
During clotting, the moving electrode enters and leaves the
plasma at regular intervals. The current between the
electrodes is broken as the moving electrode leaves the
plasma. When a clot forms, the fibrin strand conducts current
between the electrodes even when the moving electrode exits
the solution. The current completes a circuit and stops the
timer.

Another mechanical clot detection method employs a magnetic

sensor that monitors the movement of a steel ball within the
test plasma. Two principles are used for the mechanical clot
detection in the routinely used coagulation instruments. In one
system, an electromagnetic field detects the oscillation of a
steel ball within the plasma-reagent solution. As fibrin strands
form, the viscosity starts to increase, slowing the movement

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 (Figure 44-1). When the oscillation decreases to a predefined
rate, the timer stops. indicating the clotting time of the plasma.
This methodology is found on all Diagnostica Stago. analyzers

COMPILATION OF PROCEDURES
CBC PROCEDURE (PRE-ANALYTICAL)
1. Receive the request 2. Check the quality
from with your dater and integrity of the
spx

3. Validate the 4. Record it on your

barcode master list

CBC PROCEDURE (ANALYTICAL)

1. Back-up machine will 2. Scan the barcode
be used with the barcode reader

3. Mix the specimen up 4. Process the spx

to 10 times

CBC PROCEDURE (POST-ANALYTICAL)

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1. After processing, will 2. Notice the flags
diplay the result in the present - Large immature
monitor cells (needs smearing)

3. Notice the 4. The machine will also

Scattergram (LMNE) print out the result. The
result will be transmitted
in the Laboratory
Information System

After this, procede to smear preparation.

SMEAR PROCEDURE
1. Mix the blood well 2. Make an ideal smear

3. Label your slide 4. Allow to air-dry

STAINING PROCEDURE
1. Prepare 4 2. Solution 1
solutions for (3-5 dips)
hema quick stain

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3. Solution 2 4. Solution 3
(5-10 dips) (40 – 60 dips)

5. Solution 4 6. Wash in a tap

(5 dips) water
(5 flow forward)

7. Allow it to dry. When Recap for Dips:

completely dried, it is now
ready for viewing in the
microscope
Solution 1 (3-5 dips)
Solution 2 (5-10 dips)
Solution 3 (40 – 60 dips)
Solution 4 (5 dips)
Wash in a tap water (5 flow forward)

RETICS COUNT PROCEDURE

1. Mix the tube spx 2. In a clean and dry test
tube, put two drops of blood

3. Add two drops of 4. Mix well

methylene blue

5. Stand for 10 minutes 6. After 10 minutes,

make a smear

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7. Label the slide 8. Allow air-dry.

The result from the LIS will be edited by the staff to include the platelet count and differential count based
on the laboratory’s manual reading. The result from the LIS will be transmitted in the HIS.
CBC PROCEDURE (FINAL POST-ANALYTICAL)
1. Copy the manual 2. Manage examinations in
results to the the HIS
machine results

3. Laboratory Information 4. Enter the names

System Press F8 so that (patient, pathologist and
the result may be medtech). Release the
transmitted to the HIS results on all wards.

5. Print the results. The

medtech will now sign the
results.

COAGULATION TEST (PT and APTT)

1. The citrated specimen must 2. Open the cap
be numbered with the last and position the
name of the patient. tube in the plates.

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3. Choose the test (PT or 4. After that, the result will be copied from the
APTT or D-dimer) machine and it will be released in the HIS

ACTIVITY 1
An amputated foot was brought to the laboratory Reject the specimen because of absence of proper
for disposal, problem is there is an absence of request form
request form. What will you do?
a) Accept the specimen then just make a Reject the amputated foot because lacks proper request form
request by yourself
b) Reject the specimen because of absence
of proper request form
c) Burn the amputated foot before it
decomposes
d) Dispose the amputated foot because it
will stink
Sputum specimen for cytology was brought to the Cut the segment of the ETA tube then spin in the
lab in endotracheal aspirate tube how would you centrifuge and prepare for 2 direct smear slides and cell
process it? block
a) Aspirate using syringes
b) Cut the segment of the ETA tube then It’s advisable to centrifuge ETA tubes when preparing slides
spin in the centrifuge and prepare for 2 and cell block
direct smear slides and cell block
c) Request for a new sputum specimen in a
specimen bottle
d) Blow the ETA tube using rubber aspirator
An outpatient was trying to get a copy of his/her Follow up on the pathologist about the matter and relay to
biopsy result on the date you indicated on the the patient what the pathologist said
claim stub but upon checking in the logbook there
was no result yet, what will you do? Post analytical for anatomical pathology are under the
a) Give your number to the patient and tell Pathologists
them to contact you for the result
b) Give the patient other tissue biopsy result
that is already available
c) Follow up on the pathologist about the
matter and relay to the patient what the
pathologist said
d) Tell the patient to come back tomorrow
A urine cytology together with urine culture and The specimen should be processed first by the
sensitivity was submitted to the laboratory how bacteriology unit; after that it must be forwarded to
would you process it? histopathology unit for two tube method way of
a) Get a separate sample from the specimen processing
brought
b) Demand a separate specimen from the Bacteriology unit needs sterile specimen so they should go
ward first.
c) The specimen should be processed first

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 by the bacteriology unit; after that it must
be forwarded to histopathology unit for
two tube method way of processing
d) Reject the specimen because its only one
A rush frozen section tissue was brought to the Enter the main organ with the same specimen number you
laboratory at 9:00 am after it was diagnosed as gave on the frozen tissue specimen
malignant by the pathologist you entered it in the
logbook for routine tissue biopsy, after three hours Receiving tissue specimens on the same day use only the
the main organ was brought in the laboratory. same accession number
What will you do?
a) Enter the main organ with the same
specimen number you gave on the frozen
tissue specimen
b) Discard the second specimen because
the pathologist already diagnosed it as
malignant
c) Enter the main organ with a new
specimen number
d) Reject the specimen because you had
already received one

ACTIVITY 1
Stage of granulocytic maturation where specific granules are Myelocyte
synthesized?
a) Myeloblast
b) Myelocyte
c) Metamyelocyte
d) Promyelocyte
Fastest migrating Hgb? Hgb H
a) Hgb I
b) Hgb H
c) Hgb A1
d) Hgb F
The following result may lead to prolong reptilase time and I, II, III, IV
thrombin time
I. Dysfibrogenimia
II. Hypofibrinogenimia
III. Afibrogenimia
IV. Fibrin Degrading Products
a) II, III, IV
b) I, II, III, IV
c) I, II, III
d) None of the above
Manner of making blood smear? Smooth and rapid
a) Rough and slow
b) Smooth and rapid
c) Smooth and slow
d) Rough and rapid
Rubricyte’s nucleus describe as checker board and its cytoplasm Both are true
is muddy; while lymphocyte’s nucleus is describe as crushed
velvet and cytoplasm is robin egg blue.
a) Both are true
b) 1st statement true, 2nd statement false
c) Both are false
d) 1st statement false, 2nd statement true

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Predominant WBC precursor in the bone marrow? Metamyelocyte
a) Band
b) Myelocyte
c) Neutrophil
d) Metamyelocyte
Patient platelet count is 655x 109/ L what will be the effect of the
platelet count in the patients hemoglobin result?
a) Nothing
b) Normalize
c) Falsely elevated
d) Falsely decrease
All of the following factors are associated with variation in white II only
blood cell count except?
I. Age
II. Sex
III. Stress
IV. Parasitic infection
a) I, II
b) II, III
c) I, II, III
d) II only
Largest molecule in the human plasma?
a) Calcium
b) Factor 8
c) Phospholipid
d) Von Williebrands
Extramedullary site of prenatal hematopoiesis? Liver
a) Spleen
b) Kidney
c) Liver
d) Brain
Special stain to differentiate Di Gugliemo leukemia from the Periodic Acid-Schiff
other types of leukemia?
a) Periodic Acid-Schiff
b) Sudan black B
c) Myeloperoxidase
d) Naphthol AS-D chloroacetate
The following leukocyte shows diurnal effect?
I. Neutrophil
II. Eosinophil
III. Basophil
IV. Lymphocyte
a) III, IV
b) I, III
c) I, II, III, IV
d) I, II
PBS: Normocytic; Normochromic
CBC:
WBC: normal
RBC: Low
Platelets: Normal
a) None of the above
b) Diamond black fan anemia
c) Fanconi anemia
d) Aplastic anemia
The following shows an unacceptable smear preparation?

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 I. Speed of the spreader is smooth and slightly rapid
II. Using heparin as substitute for EDTA
III. Feathery edge seen in 2/3 length
IV. CBC normal and angle done is 35o
a) I, II, IV
b) I, II, III, IV
c) II, IV
d) II, III
Interpret Lap score:
L1=32
L2=21
L3=30
L4=24
L5=32
(L= number of neutrophil)
a) Leukemoid reaction
b) Sideroblastic anemia
c) Chronic myelogenous leukemia
d) Polycythemia vera
Dawn of neutrophilia is seen in? Early myelocyte
a) Early myelocyte
b) Metamyelocyte
c) Late myelocyte
d) Band
Anticoagulated micro hematocrit tube ring color?
a) Green
b) Red
c) Blue
d) Cyan
Acute myelogenous leukemia seen in patients with M3
PT: prolong
PTT: prolong
Plt ct: 45x109/L
D-Dimer: positive
a) M5a
b) M5b
c) M4
d) M3
Associated with type II lymphocyte? I, III
I. Infectious mononucleosis
II. German measles
III. Flared skirt like
IV. Turk’s irritation cells
a) II, IV
b) I, II
c) III, IV
d) I, III
The four globin chain present in Hgb A1 are? 1 pair of alpha; 1 pair of beta
a) 2 pairs of beta
b) 1 pair of alpha
c) 1 pair of alpha; 1 pair of beta
d) 2 pairs of alpha; 2 pairs of beta
Immunologic markers associated with type I acute lymphocytic
leukemia?
I. CD10
II. CD19
III. CD20

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 IV. Tdt
a) None of the above
b) I, II, III
c) II, III
d) I, II, III, IV
Interpret the result: Disseminated Intravascular Coagulopathy
PT: prolong
PTT: prolong
Platelet count: 90x109/L
D-Dimer: positive
a) Ehler Danlos Symdrome
b) Disseminated Intravascular Coagulopathy
c) Dengue
d) Cirrhosis
The following may lead to shift to the left? I, II, III, IV
I. Hgb Kansas
II. Hgb F
III. Carboxyhemoglobin
IV. Hgb Chesapeak
a) I, II, III, IV
b) II only
c) I, II, III
d) I, II
Distance of the blood from the frosted edge of the smear?
a) inch
b) 0.95 inch
c) 0.25 inch
d) 2.0 inch
Platelet life span in our blood stream? 11 days
a) 11 days
b) 7 days
c) 10 hours
d) 121 days
Elongated RBC with a slit-like central pallor seen in RH null Stomatocyte
individual?
a) Stomatocyte
b) Acanthocyte
c) Dacrocyte
d) Mexican hat cell
The peripheral blood smear from a patient with acute M6
myelogenous leukemia shows Monocytic, Erythrocytic, and
sometimes megakaryocytic type, what is being describe?
a) M4
b) M5
c) M6
d) M7
Interpret the result: Microcytic: hypochromic
RBC count: 5.4x1012 / L
Hgb: 9.0g/dl
Hct: 32%
a) Microcytic: hyper chromic
b) Normocytic: normocytic
c) Microcytic: normochromic
d) Microcytic: hypochromic
Following factors causes false elevation of ESR? I, II, IV
I. Anemia

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 II. Tilted tube
III. Thalassemia
IV. Leukemia
a) I, II, III, IV
b) I, II, IV
c) I, III, IV
d) II, III, IV
Most specific cytokine for eosinophil lineage? IL 5
a) IL 5
b) IL 3
c) IL 4
d) IL 2
Presence of Philadelphia chromosome mean for the prognosis in The prognosis is worse originally, but there
case of CML? is a chance of cure with chemotherapy
a) The prognosis is worse originally, but there is a chance
of cure with chemotherapy
b) The prognosis is better than when the chromosome is
not present
c) The prognosis is worse than when the chromosome is
not present
d) Nothing; it is not predictive
The following description shows that RBC’s central pallor 2+
estimated: 2/3 diameter as normal RBC graded as?
a) 2+
b) 4+
c) 1+
d) 3+
The following test will lead to factor 9 deficiency PT: normal PTT: prolong TT: normal
a) PT: prolong PTT: normal TT: prolong
b) PT: prolong PTT: prolong TT: prolong
c) PT: normal PTT: prolong TT: normal
d) PT: prolong PTT: prolong TT: normal
The patients APTT failed to correct after the addition of fresh Circulating anticoagulant
plasma due to?
a) Afibrogenimia
b) Circulating anticoagulant
c) Hemophilia A
d) Proconvertin deficient
Macrocytic, Normochromic type of anemia may be associated D. Latum
with what anemia?
a) Von seigbold
b) H. nana
c) D. Latum
d) A. Duodenale
The 1st stage of hemoglobin synthesis occurs in? I, III, IV
I. Prorubricyte
II. Pronormoblast
III. Basophilic erythroblast
IV. Basophilic normoblast
a) None of the above
b) I, III, IV
c) II, III, IV
d) I, II, III, IV
Correct pairing about the blood color of each hemoglobin III only
variants?
I. Carboxyhemoglobin: Mauve Lavander

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 II. Sulfhemoglobin: Cherry red
III. Methemoglobin: chocolate brown
a) I, II
b) III only
c) I only
d) I, II, III
Mean plasma concentration of fibrinogen? 400mg/dl
a) 500mg/dl
b) 400mg/dl
c) 700mg/dl
d) 600mg/dl
Microcytic, Hypochromic anemia may be associated with what A. Duodenale
organism?
a) D. Latum
b) H. nana
c) Von seigbold
d) A. Duodenale
Considered to be the confirmatory test in patients with lupus
anticoagulant?
a) Activated clotting time
b) Platelet neutralization test
c) Prothrombin time
d) Partial thromboplastin time
Specimen for APTT should be process within? 4 hours
a) 8 hour
b) 16 hours
c) 24 hours
d) 4 hours
The nucleus is extruded at this stage and the cell imparts RNA Metarubrycyte
fragments?
a) Mature RBC
b) Metarubrycyte
c) Rubricyte
d) Riticulocytes
Interpret the result: Iron deficiency anemia
serum iron: low
TIBC: high
serum ferritin: low
FEP: high
a) Anemia of chronic disease
b) Lead poisoning
c) Iron deficiency anemia
d) Thalassemia
Acute lymphocytic leukemia known as Burkett’s lymphoma? L3
a) L4
b) L1
c) L3
d) L2
The following amino acid transfusion is true about Hgb S? Glu 6th to Val
a) Glu 26th to lys
b) Glu 121th to Lys
c) Glu 6th to Lys
d) Glu 6th to Val

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Correctly match clotting factors name I, II, III, IV
I. CF V: Thrombogen
II. CF II: Prothrombin
III. CF VII: Autoprothrombin I
IV. CF IX: Plasma thromboplastin component
a) I, II,III
b) I, II
c) I, II, III, IV
d) II only
True about congenital erythropoietic porphyria

I. URO III deficiency

II. Autosomal recessive
III. Photosensitive
IV. Hemolytic anemia
a) I, II, III, IV
b) I, II, III
c) I, III, IV
d) II, III, IV
The following can be stained by wright stain? I, II, III
I. Mature RBC
II. Reticulocyte
III. Howell-jolly bodies
a) I, III
b) I, II, III
c) I only
d) I, II
The following test will lead to factor 2 deficiency PT: prolong PTT: prolong TT: normal
a) PT: prolong PTT: prolong TT: normal
b) PT: prolong PTT: prolong TT: prolong
c) PT: prolong PTT: normal TT: normal
d) PT: normal PTT: prolong TT: prolong

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