Hematology in Practice

Betty Ciesla, ms, mt(ascp)sh

Faculty, Medical Technology Program Morgan State University Baltimore, Maryland Assistant Professor Villa Julie College Stevenson, Maryland

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Copyright © 2007 by F. A. Davis Company

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Library of Congress Cataloging-in-Publication Data

Ciesla, Betty. Hematology in practice / Betty Ciesla. p. ; cm.

Includes bibliographical references. ISBN-13: 978-0-8036-1526-7 ISBN-10: 0-8036-1526-4 1. Blood—Diseases. 2. Hematology. I. Title.

[DNLM: 1. Hematologic Diseases. 2. Case Reports. 3. Hematologic Tests—methods. WH 120 C569h 2007] RB145.C5444 2007

616.1'5—dc22 2006028917

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For my daughters, who changed my life For my husband, whom I cherish For my mother and sisters, who challenged my imagination

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In its most fundamental form, hematology is the study of blood in health and in disease. Blood is the window to the body; it is the predictor of vitality and long life. In ancient times, blood was worshipped. Men were bled to obtain a cure and blood was studied for its mystical powers. It was an elevated body fluid. The discipline of hematology was an outgrowth of this fascination with blood. As we practice it in the clinical laboratory today, this discipline encompasses skill, art, and instinct.

Hematology is about relationships; the relationships of the bone marrow to the systemic circulation, the relationship of the plasma environment to the red cell life span and the relationship of hemoglobin to the red cell. In this textbook, you, the student, are a vital part of this relationship. I have queried many students over my two decades of teaching and asked them what it is they want to see in a textbook. I have asked, What helps? What gets in the way? What makes you feel more comfortable? Students answered honestly and in great detail, and I even managed to have one of my students review each chapter, so that the student perspective would not be minimized.

Hematology is a difficult subject to master because it forces students to think in an unnatural way. Educators are always asking why, well before students can cross the intellectual bridge between the marrow and the peripheral smear. Many students begin a hematology course with little foundation in blood cell morphology, physiology, or medical terminology. With this is mind, I have built several helpful strategies within this text. Each chapter contains readable text that engages the students to learn, master, and then apply the critical concepts in hematology. Medical terminology is absorbed through a designated Word Key section, defining terms to which student may not have been exposed. End of chapter summaries and multiple levels of case studies illustrate the key principles of each chapter. Additionally, there are unique troubleshooting cases in each chapter which encourage each student to role play as a working professional to develop and refine problem solving skills in practice. An Instructor's Resource Disk is available to adopting educators. The CD includes a Brownstone electronic test generator, a PowerPoint presentation with lecture points, and a searchable Image Ancillary.

I hope that this text travels with you as you continue your career in the laboratory professions and I hope that the information motivates you and arouses your intellectual curiosity. Two year and four year students can benefit from the chosen topics within the text and perhaps it may even find a home on the shelves of working laboratories nationally and internationally. I welcome your comments ([email protected]) and encourage you to assist me in creating a memorable textbook.

Betty Ciesla, MS, MT (ASCP)SH

Betty Ciesla

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Barbara Caldwell, MS, MT(ASCP)SH

Manager, Clinical Laboratory Services Montgomery General Hospital Olney, Maryland

Donna D. Castellone, MS, MT(ASCP)SH

Technical Specialist, Department of Special Coagulation

New York Presbyterian/Weill Cornell Medical Center New York, New York

Betty Ciesla, MS, MT(ASCP)SH

Faculty, Medical Technology Program Morgan State University Baltimore, Maryland Assistant Professor, MLT Program Villa Julie College Stevenson, Maryland

Kathleen Finnegan, MS, MT(ASCP)SH

Clinical Assistant Professor

School of Health Technology and Management

Department of Clinical Laboratory Sciences

Stony Brook University

Stony Brook, New York

Lori Lentowski, BS MT(ASCP)

St. Joseph Medical Center Towson, Maryland

Mitra Taghizadeh, MS, MT(ASCP)

Assistant Professor

Department of Medical and Research Technology University of Maryland School of Medicine Baltimore, Maryland

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Hassan Aziz, PhD, CLS(NCA)

Department Head Medical Technology Armstrong Atlantic State University Savannah, Georgia

Linda Collins, MS, MT(ASCP)

Instructor Medical Laboratory Delaware Tech Georgetown, Delaware

Sharon T. Columbus, MEd, MT(ASCP)

Program Coordinator Medical Laboratory Technology Clinton Community College Plattsburgh, New York

Susan Conforti, MS, MT(ASCP)SBB

Chairperson, Program Director Medical Laboratory Technology Farmingdale State University Farmingdale, New York

Sandra Cook, MS, MT(ASCP)

Coordinator, Adjunct Instructor Clinical Laboratory Science Ferris State University Big Rapids, Michigan

Program Director, Associate Professor Medical Laboratory Technology Stark State College North Canton, Ohio

Veronica Dominguez, MEd, MT-NCA

Program Coordinator Medical Laboratory Technology El Paso Community College El Paso, Texas

Andrea G. Gordon, MEd, MT(ASCP)SH

Program Director

Clinical Laboratory Science

New Hampshire Community Technical College

Concord, New Hampshire

Cindy Handley, PhD, MT(ASCP)


Medical Laboratory Technology Seward County Community College Liberal, Kansas

Debbie Heinritz, MT(ASCP), CLS(NCA)


Clinical Laboratory Science Northeast Wisconsin Technical College Green Bay, Wisconsin

Sheryl Herring, MSA, BS, MT(ASCP)

Program Coordinator, Assistant Professor Clinical Laboratory Technology Louisiana State University Alexandria, Louisiana

Interim Dean Allied Health

Northern Virginia Community College Springfield, Virginia

Jeanne M. Isabel, MSEd, MT(ASCP), CLSpH(NCA)

Associate Professor Clinical Laboratory Sciences Northern Illinois University DeKalb, Illinois

Arthur Keehnle, MS, MT(ASC), CLS(NCA)

Program Director Medical Laboratory Technology Beaufort County Community College Washington, North Carolina

Susan J. LeClair, PhD, CLS(NCA)

Chancellor Professor Medical Laboratory Science University of Massachusetts Dartmouth, Massachusetts

Sandra Paynter, MT(ASCP)(AMT)

Coordinator Medical Laboratory Maria Parham Medical Center Henderson, North Carolina

Terry Piatz, MS, MT(ASCP)

Program Director, Assistant Professor Medical Laboratory Technology Presentation College Aberdeen, South Dakota

Kelly Ryan AAS, MLT(ASCP)


Villa Julie College Stevenson, Maryland

Yasmen Simonian, PhD, MT(ASCP), CLS(NCA)

Department Chair, Professor Clinical Laboratory Sciences Weber State University Ogden, Utah

Lauren Strader, MEd, MT(ASCP)

Program Director, Department Chair Medical Laboratory Technology North Georgia Technical College Clarkesville, Georgia

Kathleen Wagner, MT(ASCP)

Adjunct Faculty Clinical Laboratory Technology Elgin Community College Elgin, Illinois


Writing a textbook is a collaborative exercise, and it takes a collective group of supportive individuals to bring a project to completion. I consider myself extremely fortunate to have Christa Fratantoro of F. A. Davis and Keith Donnellan of Dovetail Content Solutions to guide me through this writing endeavor. Their patience, counsel, good humor, and psychology were invaluable. I am indebted to Dr. Diane Wilson of Morgan State University, who gave me the time and encouragement to pursue and complete this project. I am humbled by her gentle spirit and deeply grateful for her friendship. A special note of thanks goes to my talented contributors, whose manuscripts came in on time and in good form. Without them, this text would have been much less complete. With regard to the procedures chapter, Kathy Finnegan and Joyce Feinberg offered me much needed help within an extremely short time frame and I am so grateful. And many thanks to Candi Grayson and Dr. Robert Palermo from Greater Baltimore Medical Center for providing the expertise to shoot the digital selections. I appreciate the efforts of Lori Lentowski and St. Joseph Hospital in Baltimore, Maryland, in augmenting the case study and procedures sections. In addition, thanks to Kelly Ryan who was my student reviewer and author of the PowerPoint section.

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