HEMA311 LAB WEEK 2 1

2. Chemical Hazard
SAFETY IN HEMATOLOGY LABORATORY
• Labelling of all chemicals properly
LABORATORY HAZARDS • Follow handling, storage requirements
๏ Biological Hazard • Use adequate ventilation
๏ Sharp Hazard • Spill response procedures should be included in the safety
๏ Chemical Hazard procedures
๏ Radiation Hazard • MSDS should be available and reviewed by laboratory personnel
๏ Electrical Hazard • MSDS (Material Safety Data Sheets)
๏ Fire Hazard
๏ Physical Hazard
๏ Other Hazard
BIOSAFETY LEVEL
• Bacillus Subtilise is the most common contaminant in the laboratory

SAFETY PRECAUTIONS
• Exposure to blood and body uids is the most common risk
associated in hematology laboratory
• Blood-borne pathogens are pathogenic microorganisms present in
blood causing infection or diseases 3. Electrical Hazard
OSHA STANDARDS • Use of adapters, gang plugs and extension cords are prohibited
• OSHA provides standards to maintain safe work environment • Stepping on cords, rolling heavy equipment over cords should be
• The following practices are enforced inside the laboratory: prohibited
1. Hand washing • Before repair or adjustment of electrical equipment, unplug rst the
2. Food, drink and medications not allowed equipment making sure that the hand is dry and no jewelry should
3. Applying cosmetics are prohibited be present
4. Fomites or any surfaces must be kept away from mouth and all 4. Needle Puncture
mucous membranes • Containers should be puncture proof
5. Contaminated sharps must be disposed properly • Improper disposal is the major cause of needle prick incident
6. Personal Protective Equipment must be worn at all times • Replaced once the container is ¾ full
following the proper donning PHYSICAL HAZARD
7. Equipment should be check and maintained • An agent, factor, or circumstance that can cause harm without contact.
HANDWASHING PROCEDURE • It includes:
• Wash your hands BEFORE: entering workplace, handling equipment, ✓ Ergonomic Hazard
before lling up napkin dispensers, eating ✓ Vibration Hazard
• Wash your hands AFTER: going to toilet, meal, smoking, cleaning, ✓ Noise Hazard
handling wastes, removing gloves, touching parts of the body, every LABORATORY WASTE MANAGEMENT
patient interaction, handling chemicals SEGREGATION
• HOW TO WASH YOUR HANDS? • BIODEGRADABLE
- Turn on tap, wet hands with warm water then apply liquid soap, • NON- BIODEGRADABLE
lather and rub at least for 20 seconds. Clean each nail, between • HAZARDOUS WASTE
each nger, front and back of the hands up to the wrist then rinse ✓ Special waste
o soap using water pointing downwards. Dry hands using ✓ Biological waste
disposable paper towel. Turn o the water tap using another ✓ Chemical waste
disposable paper towel. ✓ Radioactive Waste
OCCUPATIONAL HAZARD WASTE DISPOSAL STANDARD
1. Fire Hazard • Blood Containing Waste
• Enforcement of a non-smoking policy - Objects contaminated with blood should be autoclaved before
• Placement of re extinguishers every 75 feet, checked monthly and disposal
maintained annually - Blood should be treated before disposal; treatment involves the
• Placement of re detection system and manual re alarm near exit use of aldehyde, chlorine compounds, phenolic compounds or
doors which is less than 200 ft away and should be tested every thru autoclaving before pouring down the sink with running
three months water
• Written re prevention and response procedures and re drills • Standard Waste Protocol (PHIL)
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 HEMA311 LAB WEEK 2 2
DISPOSAL
• Flushing Down the Drain to the Sewer System
• Incineration
• Land ll Burial
• Recycling
OCCUPATIONAL SAFETY AND HEALTH ACT
Public Law RA 11058
• ”An Act Strengthening Compliance with Occupational Safety and Health
Standards and Providing Penalties for Violations Thereof”
• GOAL: Provide all employees (clinical laboratory personnel included) Order of Draw
with a safe work environment - EDTA
GOVERNMENT REGULATORY AGENCIES - BB
1. Department of Labor: 29 Code of Federal Regulations Parts - CC
1900-1910 Complications
• Hazard Communication Standard • collapse of veins if the tibial artery is lacerated from puncturing the
• Hazardous Waste Operations medial aspect of the heel
• Occupational Exposure to blood-borne pathogens Standards • osteomyelitis of the heel bone (calcaneus)
2. Department of the Interior, Environmental Protection Agency: • nerve damage if the ngers of neonates are punctured
40 Code of Federal Regulations Parts 200-399 • haematoma and loss of access to the venous branch used
• Clean Air Act and Clean Water Act • Scarring
• Toxic Substances Control Act • localized or generalized necrosis
• Comprehensive Environmental Response, Compensation and • skin breakdown from repeated use of adhesive strips
Liability Act (CERCLA) • Iatrogenic anemia - caused by excessive collection of blood
3. Voluntary Agencies/Accrediting Agencies Venipuncture
• The Joint Commission • manner of inserting a needle attached to a syringe to a palpable vein to
• College of American Pathologist collect blood for laboratory testing
• Centers for Disease Control and Prevention (CDC) • Specimen collected:
• Clinical and Laboratory Standards Institutes • Most widely used blood sample in all laboratory tests
Things to remember!
๏ Proper identi cation of patient
Blood Collection ๏ Tourniquet application
๏ Disinfection
Arterial Puncture ๏ Angle of needle insertion
• collected from an artery, primarily to determine arterial blood gases ๏ Bevel UP
• Performed by: Physician ๏ Needle length
• can be obtained either through a catheter placed in an artery, or by ๏ Position of the patient
using a needle and syringe to puncture an artery ๏ Label
• pre heparinized ๏ Disposal
• Puncture Sites Method of Collection
✴ Radial artery - where it is commonly puntured ๏ Single Collection
✴ Brachial artery ๏ Multiple Collection
✴ Femoral artery ๏ “Winged” Collection
Complications
• Arteriospasm
- involuntary contraction of the artery
• Hematoma
- Or excessive bleeding
• Nerve damage
- prevented by choosing an appropriate sampling site and
avoiding redirection of the needle
• Fainting
- prevented by ensuring that the patient is supine with feet
elevated before beginning the blood draw
Skin Puncture
• a mixture of capillary, venous, and arterial blood with interstitial (tissue)
uid and intracellular uid
• done when you only need small blood
• eg. test for blood type and new born screening
Sites of puncture
• Finger - hit in your dominant hand for less callous
• Earlobe
• <1yo: lateral portion of the plantar surface of the heel/toe
Sites to avoid
• in amed and pallor areas
• cold and cyanotic areas
• congested and edematous areas
• scarred and heavily calloused areas
Indications for Skin Puncture:
- when it is impossible or impractical to obtain a venous blood sample.
Advantages of Skin Puncture:
- requires less precision
- easy to obtain
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 HEMA311 LAB WEEK 2 3
Sites of Puncture ๏ Edema
๏ Newborns up to 18 months ๏ Allergies Petechiae
- External Jugular Vein Order of Draw
- Temporal vein - yellow/ micro (SPS)
- Antecubital fossa - blue
๏ Older children (18months to 3 yo) - Red/ non-additive
- Femoral vein - Green/ heparin
- Long saphenous vein - Lavander/ EDTA
- Popliteal vein - Gray/ Fluoride
- Ankle vein - Black/ Sodium Citrate
- Antecubital fossa

๏ 3yo to adult life Red Blood Cell Count

- Wrist vein
- Dorsal vein of hand RBC Count
- Dorsal vein of ankle • The number of RBCs in 1 liter or 1 microliter of blood
- Antecubital fossa • Manual RBC counts are rarely performed because of the inaccuracy of
the count and questionable necessity
Antecubital Fossa Materials Needed (Manual)
๏ Hemacytometer
๏ Thoma Pipet
๏ Suction device
๏ Thick coverslip
๏ Cell Counter
๏ Diluting uids
Hemacytometer
• “Heart of manual cell count”
• Di erent Types
✴ Improved Neubauer
✴ Neubauer
✴ Fuchs – Rosenthal
✴ Speirs – Levy
✴ Tuerk’s
✴ Bass - Jones
BLACK
- called primary square
GREY
- called secondary square
- has 9 in total
- also measures 1mm W&L
YELLOW with LIGHT BLUE bracket and square
- called WBC square
- the blue square is called tertiary square
- it has 16 square in total
- has 4 in total
DARK BLUE bracket with RED
- the red are the counted RBC square
- has total of 25 tertiary square
- and each tertiary has 16 box in it
RBC Diluting Fluids
๏ NSS
๏ 3.8% Na citrate
Sites to Avoid ๏ Dacies
๏ Sites with hematoma ๏ Hayem’s
๏ Occluded veins ๏ Toisson’s
๏ Edematous area ๏ Bethell’s
๏ Sites with burns, scar, tattoo ๏ Gower’s
๏ Sites with Fistula ***ISOTONIC
๏ IV uid sites Procedure
Adverse events

Complications
๏ Hematoma
๏ Pain
๏ Syncope and fainting
๏ Iatrogenic anemia
๏ Infections
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HEMA311 LAB WEEK 2 4
Post Laboratory Post Laboratory
Formula Formula

Example

Sources of Errors and Comments

• Dust and ngerprints may cause di culty in distinguishing the cells
• Diluting uid should be free of contaminants
• If the count is low, a greater area may be counted
• Chamber must be charged properly to ensure accurate count
• Allow cells to settle for 10mins before counting
• Use of other, more accurate manual RBC procedures, such as the
microhematocrit and hemoglobin concentration, is desirable when
automation is not available Sources of Errors and Comments
Normal Values: • Dust and ngerprints may cause di culty in distinguishing the cells
• Female: 3.6 – 5.6 x 1012/L • Diluting uid should be free of contaminants
• Male: 4.2 – 6.0 x 1012/L • If the count is low, a greater area may be counted
• At Birth: 5.0 – 6.5 x 1012/L • Chamber must be charged properly to ensure accurate count
RBC Count • Allow cells to settle for 10mins before counting
• Highest in the morning and at its lowest in the evening • N-RBC causes false elevation of WBC count
• Increased: myeloproliferative disorder such as polycythemia ✴ The accuracy of the manual WBC count can be assessed by
• Decreased: anemic cases, bleeding performing a WBC estimate on a Wright-stained peripheral blood lm
made from the same specimen
N-RBCs
- Falsely counted as WBC
White Blood Cell Count
- Not lysed by WBC diluting uids
WBC Count ✴ CORRECT THE WBC COUNT:
• The number of WBCs in 1 liter or 1 microliter of blood • if there are >5 nRBC/100 cells on di count
• Utilized to indicate infection Uncorrected WBC count x 100
• Important terms number of nRBC per 100WBC + 100
- Leukocytosis WBC count
- Leukopenia Normal Values:
Materials Needed (Manual) • 4.0 -11.0 x 109/L
๏ Hemacytometer • At birth: 10.0 – 30.0 x 109/L
๏ Thoma Pipet Leukocytosis
๏ Suction device ๏ Bacterial Infections
๏ Thick coverslip ๏ Appendicitis
๏ Cell Counter ๏ Leukemia
๏ Diluting uids ๏ Pregnancy
๏ Uremia
Diluting Fluids ๏ Ulcers
- 1-3 % acetic acid Leukopenia
- 1 % HCl
๏ Viral infection
- Turk’s diluting uid
๏ Brucellosis
๏ Typhoid fever
Procedure ๏ Rheumatoid arthritis
๏ cirrhosis
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