Quantcast
Skip to main content
Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Hematology and Coagulation

Christie Falk (Supervisor)
Jennifer Jeffries (PM Supervisor)

Routing Hematology Testing

  1. Complete Blood Count-No differential: Includes WBC, RBC, Hgb, HCT, MCV, MCH, MCHC, Plts and RDW.
  2. Complete Blood Count with Automated Differential: Includes all of the above plus a five-part differential. Cells identified are Granulocytes (includes Polys and Bands), Lymphocytes, Monocytes, Eosinophils, and Basophils.
  3. Manual Differential: Includes WBC differentiation, RBC morphology, and platelet estimation. This is not an orderable test. If the automated differential fails pre-set flagging criteria, a manual differential is then performed by the laboratory. It is charged at that time.
  4. Platelet Count: This test is a part of the blood count but may be ordered separately. On occasion, abnormalities of the sample may make it necessary to perform a manual, phase platelet count.
  5. Reticulocyte Count: Performed by flow cytometry method on the Coulter. If required STAT during off-hours, or when interferences exist in the sample, a manual count will be performed.
  6. Sedimentation Rate: Minimum volume for analysis is 3 mL EDTA blood.
  7. Microhematocrit: Minimum requirement for analysis is 2 heparinized microcapillary tubes for microcentrifugation.
  8. Body Fluid Analysis: Includes a manual red and white cell count and a differential based on a cytocentrifuge prepared smear. CSF specimens are performed STAT. Synovial fluid analysis may also includes Crystals.

    NOTE: When specific cellular or marked abnormalities are noted on any of the above tests, review by a Pathologist is initiated and, when appropriate, an interpretive report is sent to the chart.

Special Hematology Testing

  1. Eosinophil Count: Performed by automated cell counter unless interferences are present. Then performed by manual methods.
  2. Malaria Smears: Both thick and thin smears reviewed. Sent to Public Health for speciation.
  3. Sugar Water Test: Screen for PNH
  4. Heinz Body Stain
  5. Betke-Kleihauer
  6. Leukocyte Alkaline Phosphatase Stain: Specimen consists of 6-8 peripheral blood smears from fingerstick. Test is not performed on weekends, evenings or holidays.
  7. Hemoglobin Analysis (Electrophoresis): May include Electrophoresis by Isoelectric Focusing; Hemoglobin A2, Hemoglobin, Fetal, Quantitative, Fetal, Betke Kleihauer; Interpretation and blood count. Performed weekly, dayshift only.

Acceptable Specimens for Routine Hematology Testing

 

  1. 1. EDTA Anticoagulated:
    1. 5.0 cc tube, minimum ? full
    2. 3.0 cc tube, minimum ? full
    3. 1 lavender top microvette filled to second line (500 mL) for newborns.
      Note: Sedimentation Rate: minimum requirement is a full 3 mL EDTA tube.
  2. CSF specimens may be sent in sterile CSF tube.
  3. Synovial fluids should be sent in 1 heparinized tube and 1 red top tube.
  4. All samples must be received in the Hematology Laboratory no later than 4 hours after collection.
  5. Specimens containing clots will be rejected for cell counts. Only a differential will be performed when a fluid is received containing clots.

      Specimen and smear retention:
    1. EDTA blood tubes are retained 24 hours after testing.
    2. Stained peripheral blood and fluid smears are retained for 4 weeks after testing.

Routine Coagulation Testing

  1. (PT) Prothrombin Time resulted as INR
  2. (aPTT) Activated Partial Thromboplastin Time
  3. Fibrinogen (Semiquantitative)
  4. Fibrin Monomer
  5. FDP-Fibrin(ogen) Degradation Products
  6. D-Dimer
  7. Thrombin Time
  8. Antithrombin
  9. Plasminogen
  10. Inhibitor Screen
  11. Cryofibrinogen/Cryoglobulin
  12. Heparin

Special Coagulation Testing

Unless otherwise noted. Available dayshift Monday-Friday only.

  1. Factor Assays: Performed daily, Monday through Friday, dayshift only. Available as STAT at other times with Pathologist's approval.
  2. Inhibitor Assay: Specify factor
  3. Ristocetin Co-Factor: Performed on Wednesdays.
  4. Von Willebrand's Antigen: Performed on Wednesdays.
  5. Factor XIII Screen
  6. Protein C Assay: Performed on Tuesdays.
  7. Protein S Assay: Performed on Tuesdays.
  8. Dilute Russel's Viper Venom Test (DRVVT): Performed Tuesdays.
  9. Anti-Cardiolipin Antibody Test: Performed on Thursdays.
  10. Anti-Phospholipid Antibody Test: Performed on Thursdays.
  11. Heparin Associated Antibody Test
  12. PFA
  13. Platelet Aggregation

Acceptable Specimens for Hemostasis Testing

One 5 mL blue-top tube with liquid (3.2% buffered acid citrate) is adequate for all of the above mentioned tests except:

  • Cryofibrinogen - 2.5 cc lavender (EDTA) top tube or red top maintained at 37?C And sent to the lab ASAP following collection.
  • Cryoglobulin - 7 cc red top maintained at 37?C.
  • Fibrin(ogen) Degradation Products - blue top tube with powder.
  • Call SARC at extension 4-0500 if any of the above tubes are needed.

Technique for Collection of Hemostasis Samples

Use a "two-syringe" technique whenever drawing any specimen for hemostasis testing, i.e., the first 3 mL from a venipuncture should be drawn into a separate tube or syringe and set aside; then, blood from the second tube or syringe can be used for the hemostasis sample. The sample should be put on ice immediately. Drawing a hemostasis sample from a heparin lock is not advised due to the risk of heparin contamination. The ratio of blood:anticoagulant is very critical. Patients with hematocrits less than 20% or greater than 60% require a special tube available from the laboratory. Please call 4-0500 to request these tubes. All tubes drawn for coagulation work must be full.

Incompletely filled tubes and specimens received more than four (4) hours after collection will be rejected.