Condensed Case

A purple top tube was received from the emergency department on a 24-year-old man with a possible gastrointestinal bleed. A hemoglobin and hematocrit were ordered. Once the sample was run through the automated instrumentation, a clot was detected. A redrawn sample was ordered and again the same thing occurred—a clotted sample. Name three reasons for a clotted sample.

Answer

Clotted samples may occur if (A) the phlebotomy was difficult, (B) the sample was not inverted at least eight times, or (C) the tube was expired.

Summary Points

• Hematology is the study of blood in health and disease.

• Morphological and analytical skills are needed in the practice of hematology.

• Compound microscopes have a two-lens system to magnify the image.

• The objectives of the microscope are X10, X40, and X100; a X 50 oil immersion lens may be added.

• Proper care of the microscope is essential for maintaining microscopic quality.

• Standard precautions involve behaviors that prevent contact with bodily fluids, aerosol contamination, or contaminated surfaces.

• PPE includes gloves, eyewear, laboratory coats, face shields, and fluid-resistant gowns.

Handwashing is the most important element of standard precautions.

Quality assurance is a set of laboratory practices that ensure reliable outcomes for patient results. Quality control is part of the quality assurance plan and consists of standards, controls, normal distribution, and statistical parameters. Accuracy and precision are measured by the mean standard deviation around a set of data points. Patient identification is the essential first step in ensuring the quality of laboratory results. Preanalytic variables refer to events or circumstances that occur to the unknown sample before analysis. Postanalytic variables refer to laboratory practice after the sample has been analyzed. Critical results are those results that exceed or are markedly decreased from the reference interval.

A technologist in the hematology laboratory has been observed wearing blood-spattered gloves. Her colleagues in the laboratory are uncomfortable working with her, and they have confronted her on this issue. Her explanation for her behavior is that gloves are expensive and that frequent changing leads to excessive spending on gloves and other disposables. Her colleagues are concerned for their safety, and because they have been unsuccessful in changing her behavior, they consult the hematology supervisor for guidance. How should this employee be counseled?

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