BUREAU OF CLINICAL LOGBOOK REVIEW 2014

MOHD JAAMIA’ QAADIR BIN MOHD BADRIN

DR MOHD NAZIF DARAWI @ SAMAT

AHMAD NORASIDI BIN MOHD RAFFIE

ASMA BINTI HARUN

IZREEN BINTI SUPA’AT

EDITION 2-2018, MLS FHS UNISEL SHAH ALAM ALL

RIGHT RESERVED 2018 ©

Credit to: NUR AMIRAH NAZIFA BINTI LOKMAN

Faculty of Health Sciences Started: 2020

Universiti Selangor
Review: 2024
 FACULTY OF HEALTH SCIENCES
CLINICAL INTERNSHIP
LOGBOOK

NAME NUR AMIRAH NAZIFA BINTI LOKMAN

MATRIX NO. 4212003411

I/C NO. 960318085414

INTAKE APRIL2020

H/P NO. 01161771643

HOSPITAL HOSPITAL CANSELOR TUANKU MUHRIZ

 DECLARATION

I hereby declare that I understand all the requirements needed to be fulfilled during my clinical
practice placement. I also declare that this logbook has not previously or concurrently submitted by
any other undergraduate student in UNISEL or other institutions. This logbook is based on my
original work.

Date: …………………………… ….………………………………..

Name :
I/C Number :
UNISEL I/D :
 APPROVAL

This logbook was submitted by NUR AMIRAH NAZIFA BINTI LOKMAN partial fulfillment of the
requirement for the BACHELOR OF BIOMEDICAL SCIENCE (HONOURS), Faculty of Health Science,
University Selangor and was approved by

………………………………………………… …………………………………………………
( ) ( )

Head of Department Lecturer

I/C Num: Faculty of Health Sciences
Hospital: Universiti Selangor
DATE:

LABORATORY / DEPARTMENT: Haematology

TEST / DIAGNOSIS: Full Blood Count

SYNOPSIS:
TYPE OF SPECIMEN
Collection of blood specimens using a special K2EDTA anticoagulant blood tube with a
volume suggested by the supplier or at least 2.0 ml for adults and 500ul for children.
Specimens need to be processed at room temperature (18 - 25°C).

REFERENCE RANGE
Reference range for adult males and females.
PARAMETER NORMAL RANGE
(FBC) MALE FEMALE UNIT
White Blood Cell 4.0 – 10.0 X109/l
Count
Red Blood Cell 4.5 – 5.5 3.8 – 4.8 X1012/l
Count
Haemoglobin 13.0 – 17.0 12.0 – 15.0 g/dl
Concentration
Haematocrit 0.40 – 0.50 0.36 – 0.46 l/l
40 - 50 36 - 46 %
Mean Cell Volume 83 - 101 fl
Mean Cell Haemoglobin 27 - 32 pg
Mean Cell Haemoglobin 31.5 – 34.5 g/dl
Concentration
Red Cell Distribution 11.6 – 14.0 %
Width
Reticulocyte Count 50 – 100 X109/l
0.5 – 2.5 %
Neutrophils 2.0 – 7.0 X109/l
40 - 80 %
Lymphocytes 1.0 – 3.0 X109/l
20 - 40 %
Monocytes 0.2 – 1.0 X109/l
2 - 10 %
Eosinophils 0.02 – 0.5 X109/l
 1-6 %
Basophils 0.02 – 0.1 X109/l
<1-2 %
Platelets Count 150 - 410 X109/l

Reference range for babies and children.

PARAMETER NORMAL RANGE
(FBC) DAY 1 1 MONTH 1 YEAR 6-12 YEAR Unit

White Blood Cell

10 – 26 5 – 19 6 -16 5 - 13 X109/l
Count

Red Blood Cell 5–7 3 – 5.4 3.9 – 5.1 4.0 – 5.2 X1012
Count /l
Haemoglobin
140 – 220 115 – 165 115 -131 115 - 155 g/dl
Concentration

Haematocrit 0.45 – 0.75 0.33 – 0.53 0.30 – 0.38 0.35 – 0.45 l/l

Mean Cell Volume 100 – 120 92 – 116 72 - 84 73 -95 fl

Mean Cell
31 – 37 30 – 36 25 - 29 25 -33 pg
Haemoglobin
Mean Cell
Haemoglobi 300 – 360 290 -370 320 - 360 310 -370 g/dl
n
Concentration

Reticulocyte Count 120 – 400 20 – 60 30 - 100 30 - 100 X109/l

Neutrophils 4 – 14 3–9 1-7 2-8 X109/l

Lymphocytes 3–8 3 – 16 3.5 - 11 1-5 X109/l

Monocytes 0.5 – 2 0.3 – 1 0.2 – 1.0 0.2 – 1.0 X109/l

Eosinophils 0.1 – 1 0.2 – 1 0.1- 1 0.1 --1 X109/l

Platelets Count 100 – 450 200 – 500 200 - 550 170 -450 X109/l
EQUIPMENT / LAB AUTOMATION
This method uses Automated Hematology Analyzer instruments: Sysmex XN3000 and
XN1000. This technical procedure explains the measurement method of: -

I. Complete Blood Count (CBC)

II. WBC 5 Part Differential (Diff)
III. Reticulocyte

PRINCIPLES OF TESTING
Clinical aspects: The components of whole blood cells in peripheral blood to distinguish between
diseased blood and normal blood. The blood components are measured using the measurement
method using the Automated Hematology Analyzer instrument: Sysmex XN3000 as follows:
PRINCIPLES CHANNEL PARAMETER
Fluorescence flow cytometry WDF NEUT, LYMPH, MONO, EO, IG
with using semiconductor WNR WBC, NRBC, BASO
RET RETIC
Hydrodynamic focusing DC RBC/ PLT RBC, PLT, HCT
detection method
SLS- Hemoglobin Method. HGB HGB
Calculation from RBC, HGB & - MCV, MCH & MCHC
HCT

QUALITY CONTROL
Type of quality control material used: -
I. XN CHECK Level 1
II. XN CHECK Level 2
III. XN CHECK Level 3

STORAGE OF CONTROL MATERIALS

 Reagent storage 2o C - 8 o C
Reagent preparation Let the reagent in room temperature 18 o C -
25 o C for 15 min before use.
Stability Follow expired date

PROCEDURES FOR CARRYING OUT QUALITY CONTROL

Before quality control activities are performed, make sure daily check has been performed
on the instrument. Remove the QC material from storage and leave it at room temperature
(18 o C - 25 o C) for at least 15 minutes.

AUTOMATICALLY
I. Make sure the volume of QC material to be used is sufficient.
II. Combine the QC ingredients as shown in the diagram below.
III.

Arrange the QC material into the specimen rack.

IV. Place the specimen rack on the instrument.
V. After completion, store the QC material back into the designated refrigerator.

MANUALLY
I. Make sure the volume of QC material to be used is sufficient.
II. Combine the QC ingredients as shown in the diagram below.
III.

Click manual mode on the instrument to perform quality control activities.

IV. Scan/ auto scan bar code on tube of QC material.
 V. Put the QC material into the instrument as shown in the diagram below and then
click the blue button for process.
VI.

Wait until the following display is shown. Click on (Accept) if the result does not show
flagging.
VII. Repeat until all QC materials are implemented.
VIII. Close the manual mode and store the QC material back into the designated
refrigerator.

THE PROCEDURE FOR REVIEWING THE RESULTS OF QUALITY CONTROL.

I. Check the results on the QC File to know the status of the results
II. Click on QC File. Select and click on the relevant QC lot
III.

Refer to the upper limit and lower limit as shown in the diagram below. Make sure the
result does not exceed the set limit.
IV.

Ensure quality control activities PASS before conducting testing

MAINTENANCE AND TROUBLESHOOTING

AUTOMATIC RINSING
Automatic analyzer rinse can automatically perform rinsing of the analyzer and the post-
rinse background check. If a background check error occurs, a help dialog will appear on
the IPU screen.

CLEANING
If the error is not cleared after automatic rinsing is performed, perform cleaning. In addition,
when the required time for cleaning arrives, a help dialog will appear on the IPU screen. It
can clean the optical detector block and hydraulic circuit with CELLCLEAN AUTO.

REMOVE AN RBC DETECTOR CLOG

If the RBC detector is clogged or air bubbles have formed, a help dialog will appear on the
IPU screen

CLEANING RBC DETECTOR APERTURE

If the removing the clog from the RBC detector does not remove all the clog or clear the
error, rinse the RBC detector aperture.

DRAINING THE WASTE CHAMBER

If the waste tube from the waste chamber is clogged, a help dialog will appear on the IPU
screen.

RINSING THE WASTE CHAMBER

If the error is not cleared after waste fluid is drained from the waste chamber, rinse the
waste chamber. It can clean the waste chamber with CELLCLEAN AUTO.

REMOVING FLOWCELL AIR BUBBLES

If air bubbles have formed in the Flowcell, a help dialog will appear on the IPU screen.
Follow the procedure below to remove the air bubbles from the inside of the Flowcell.

RINSING FLOWCELL
If the Flowcell is clogged or dirty, a help dialog will appear on the IPU screen.
DRAINING REACTION CHAMBER
If the drain tubing in the RBC/HGB reaction chamber is clogged, the help dialog box
appears in the IPU screen.

DRAINING RBC ISOLATION CHAMBER

If the density of the reagent is inconsistent, [PLT sampling error] appears on a help dialog
of the IPU screen. If the error appears after clear it, drain the reagent from the RBC
isolation chamber.

ADJUSTING THE PRESSURE (0.25 MPA)

A 0.25 MPa pressure is applied to operate the master valves. If an error message for
pressure abnormality is displayed, first check the tubes to see if there is any air leakage. If
there is no abnormality in the tube, display the [Pressure Adjustment] window and adjust
the pressure by checking the numeric values.

ADJUSTING THE PRESSURE (0.16 MPA)

A 0.16 MPa pressure is applied to the optical detection block to supply the sheath fluid. If
an error message for pressure abnormality is displayed, first check the tubes to see if there
is any air leakage. If there is no abnormality in the tube, display the [Pressure Adjustment]
window and adjust the pressure by checking the numeric values.

ADJUSTING THE PRESSURE (0.07 MPA)

A 0.07 MPa pressure is applied to drain waste and mix the samples. If an error message for
pressure abnormality is displayed, first check the tubes to see if there is any air leakage. If
there is no abnormality in the tube, display the [Pressure Adjustment] window and adjust
the pressure by checking the numeric values.

DRAINING THE PNEUMATIC TRAP CHAMBER

If the pneumatic trap chamber becomes full of water, a help dialog will appear on the IPU
screen. Check if the trap chamber is full of water, and drain as needed.
DATE:
LABORATORY / DEPARTMENT: Haematology
TEST / DIAGNOSIS: Full Blood Picture
SYNOPSIS:

PRINCIPLE
Test principle using the SP-10 Automated Hematology Slide Preparation instrument
SP-10 is an instrument for the preparation of slides and the staining of whole blood cells
(whole blood sample) automatically. This procedure begins with the process of smearing
blood on the glass slide, the process of fixation, staining, mixing of buffer reagents, the
process of rinsing the slide until drying the slide. Microscopic examination of stained blood
smears can be used to help determine the patient's hematological status.

Principle of Supravital Stain (Wright Stain)

When staining is done on cells and cell components, a specific color will be produced due
to the reaction between the dye and the buffer. Azure B (a product that undergoes an
oxidation process from methylene blue) which is positively charged will combine with the
acid structure in the cell (nucleic acid and nucleoprotein) will produce a purple blue color.
Eosin, whether B or Y has a negative charge will stain the base components of the cell
(cytoplasmic content and hemoglobin) to orange and pink.

TYPE OF SPECIMEN
Collection of blood specimens using an EDTA anticoagulant blood tube with a volume
suggested by the supplier or at least 1.0ml. For pediatric collection tubes, the required
volume is at least 300µl.
NORMAL RANGE
COLOUR OF CELLS
RBC pink
RETICULOCYTE Cytoplasm: Grey-blue
PLATELET Granules : Purple
WBC
i NEUTROPHILS Nuclei : Purple
Granules :
Pink/orange
ii EOSINOPHILS Nuclei : Purple
Granules : Red-
orange
iii BASOPHILS Nuclei : Purple
Granules : Dark blue/ purple
iv MONOCYTES Cytoplasm : bluish-grey
v LYMPHOCYTES Cytoplasm : blue

EQUIPMENT
The testing of a complete image of whole blood cells (FBP) with the method of automatic
slide preparation and staining using the SP-10 Automated Hematology Slide Preparation
instrument (XN3000).

REAGENT
I. CELLPACK DCL
II. Wright’s stain
III. Phosphate buffer pH 6.8 (Prepare: 1 tablet + 1-liter distilled water)
IV. Distilled water

QUALITY CONTROL
Quality control activities
Quality control activities are carried out in batches (2 times a day, morning and afternoon
sessions). Record quality control activities into the FBP dyeing quality control record form.
Control in terms of slide management
I. Record the identification code (F) on each FBP test request form for blood film
preparation.
II. Record the date each reagent was first opened and used on the container for
staining purposes.
III. Do a check on the label on each blood film to avoid mistakes.
IV. Perform a review and comparison of the quality of staining provided on each blood
film produced through a microscope before being sent to the MO for test verification.
V. Make sure that every blood film that has completed the production of the test result
report is stored in the appropriate place according to the period of time that has been
set.
MAINTENANCE AND TROUBLESHOOT
Daily maintenance and Run [Shutdown 1] (clean the hydraulic line)
inspection Clean spreader glass
Checking the water level in the trap chamber and discarding
the water
Clean single cassettes
Replace the staining solutions in the stain chambers
Weekly maintenance Clean staining line
and inspection Run [Shutdown 2] (clean the hydraulic line and staining
chamber)
Monthly maintenance and Clean racks, right and left sampler rack pools, and
inspection measurement line.
As-needed maintenance Clean the smear and stain lines
and inspection Clean smearing line
Adjust air pressure
Replace the waste container (if installed)
Supply replacement Replace reagent
Replace hand gripper
Replace rubber plate No 39
Replace fuses
Replace spreader glass
Replace ink ribbon

ADDITIONAL INFORMATION
MOUNTING PROCESS
I. Before the mounting process is done, examine the slide under a microscope to see
the staining results. Do the mounting process on the slides that have been colored
either automatically or manually. Make sure the slide is completely dry before the
mounting process.
II. Make sure the smeared part is on the slide to be mounted. Drop DPX over the
section.
III. Place the cover slip on the slide. Make sure there are no air bubbles trapped
between the slide and the cover slip.
IV. (Note*: If there are many air bubbles or the mounting process is not perfect, remove
the cover slip immediately and repeat the mounting process using a new cover slip.
If the DPX has dried, immerse the slide in Xylene until the cover slip.

Head Film too thin

Filem terlalu tebal Ketebalan filem yang ideal ekor

Film too thick Ideal thickness Tail

SLIDE LABELING PROCEDURE

I. Print the barcode label using the provided barcode printer.
II. Stick the label on the left side of the slide.
III. If the barcode printer is damaged, use the label stickers provided.
IV. Write the patient's RN number, laboratory number and specimen date on the label.
V. Stick the label on the left side of the slide.

DATE:
LABORATORY / DEPARTMENT: Haematology
TEST / DIAGNOSIS: COAGULATION
SYNOPSIS:

TYPE OF SPECIMEN
Collection of patient blood specimens using sodium citrate type anticoagulant blood
collection tubes. This tube contains sodium citrate with a concentration of 0.109M (3.2% tri-
sodium citrate).

PRINCIPLE OF ANALYSIS
DIVC SCR TEST PRINCIPLE
The detection of testing screening covers 5 types of test parameters namely PT
(Prothrombin Time), APTT (Activated Partial Thromboplastin Time), FIB (Fibrinogen), TT
(Thrombin Time) and D-DI (D-Dimer) through in-vitro testing methods, aiming to diagnose
abnormalities of blood clotting and to see the development of anticoagulant therapy.

PRINCIPLE FOR EACH TEST PARAMETER IS AS FOLLOWS:

 PT Test Principles
PT is a screening test involving extrinsic pathways and common pathways of coagulation
such as Factor VII, X, V, II and fibrinogen. The principle of this test involves measuring the
clotting time in patient plasma (PT) that uses calcium thromboplastin material compared to
normal plasma control (NPT). The measured PT results will then be converted to INR
values through the following calculation formula:

 PT Mixing
PT Mixing is a screening test involving extrinsic pavement. When the PT is found to be
abnormal, further tests will be carried out to identify the cause. A PT Mixing test will be
performed to identify a deficiency of clotting factors. The PT Mixing test is conducted by
mixing the patient's plasma and normal plasma (NPP) with a ratio of 1:1. The assay was
performed immediately after incubation at 37°C.

Rosner Index:

Clotting time of 1:1 - clotting time of NPP

Index = X 100
Clotting time of patient

The following is the interpretation of the results (index) based on the Rosner Index count:
I. Index </= : Correction Suspicion – factor deficiency or specific factor deficiency
II. 12<index<15 : Doubtful; suggest to repeat
III. Index >/= : No correction