Portland Community College | Portland, Oregon

Review hemoglobin, hematocrit, red blood cells counts and indices with emphasis on methodologies, instrumentation, sources of error, limitations and disease correlation. Normal and abnormal red and white blood cell morphology will be reviewed.  Classification, laboratory findings and clinical correlation of anemias, myeloproliferative and lymphoproliferative disorders, leukemias, myelodysplastic disorders, lymphomas and various other white cell anomalies will be presented.  Principles of automated instrumentation and flow cytometry will be presented with emphasis on interpretation of automated results, histograms and scattergrams.

Upon successful completion students should be able to:

1. Use an understanding of appropriate collection, identification, and processing of specimens; preparation of reagents; accurate performance
of routine hematology procedures; and correct interpretation of test results to make appropriate and effective on-the-job professional decisions.
2. Recognize normal and abnormal test results and correlate these data with appropriate pathologic conditions to accurately advise health care providers.
3. Adapt laboratory techniques and procedures in a corrective manner when errors and discrepancies in results are obtained to affect resolution in a professional and timely manner.

The material in this course will be presented in a traditional classroom (Campus program), or distance-learning format (Distance learning program). Both traditional and distance learning sections include required laboratory activities. Traditional classroom instruction consists of lecture, discussion, web-based instructional media (tutorials, animations, videos, etc.) and other educationally sound practices. Distance learning sections include similar educational practices and are primarily presented in a web-based format. Both campus and distance learning sections require periodic campus based laboratory exercises. In addition, the distance learning section may have hospital-based laboratory exercises. A laboratory manual will be provided. The laboratory exercises provide an opportunity for students to employ the testing principles and methodologies discussed and allow for discussion, application and correlation of the concepts presented. The student is expected to perform all laboratory procedures according to the criteria established by the department.

The instructor will outline the methods used to evaluate student progress and the criteria for assigning a grade at the beginning of the course. Assessment methods may include written and practical examinations and laboratory write-ups. Evaluation of problem solving skills, teamwork, attendance, laboratory performance and communication skills may also be included.

• Course Themes
  • Theme 1: Phlebotomy
    • Performing phlebotomy and capillary blood collection techniques according to the industry standards and recalling the types of blood samples, anticoagulants used, sources of error and the causes and effects of hemolysis and hemoconcentration
  • Theme 2: Common hematological tests
    • Methodologies and sources of error for blood cell counts, hematocrit and hemoglobin determinations, and the correlation between the three parameters
    • Hemoglobin, hematocrit and red blood cell count findings in anemias and polycythemias and the various abnormal hemoglobin pigments
    • Performing accurately hemoglobin, hematocrit and cell count determinations
    • Formulas for calculating indices (MCV, MCH and MCHC), their clinical applications, limitations and sources of error
  • Theme 3: Cell morphology
    • Maturation sequence of the erythrocyte series and each leukocyte series
    • Differentiating and identifying the various white blood cells to include series, step in the sequence and if the cell is normal or abnormal
    • Identify and describing normal and abnormal red blood cell morphology using acceptable terminology
  • Theme 4: Anemias
    • Classifying the various types of anemias morphologically and etiologically
    • General clinical findings of an anemia and the laboratory findings with each anemia discussed
    • Defining and classifying the various Hemoglobinopathies and Thalassemias, and the general clinical findings and laboratory results used in the diagnosis of each
  • Theme 5: Leukocyte Disorders
    • Discussing the different types of leukemia and differentiating between chronic and acute forms
    • WHO classification of acute leukemias and the general morphologic characteristics of each, hematologic and other laboratory findings in each type of leukemia
    • Myeloproliferative neoplasms disorders and myelodysplastic syndromes
    • Differentiating between Hodgkins and non-Hodgkins lymphoma
    • Listing the general causes of a leukocytosis and leucopenia and correlating the usual quantitative and qualitative white blood cell changes that occur with various disease states and physiologic conditions
    • White blood cell anomalies and the usual clinical and hematologic findings of each
  • Theme 5: Hematology Instrumentation
    • Principles utilized in automated instruments to count and differentiate blood cells
    • Interpreting automated results including histograms, scattergrams and instrument flags
    • Principles utilized in flow cytometry and its application to hematology

• Laboratory Skills
  • Proper collection of peripheral blood samples, including
    • Performing phlebotomy and capillary blood collection techniques according to the industry standards
  • Use a bright field light microscope to view and interpret slides, including
    • Correctly setting up and focusing the microscope
    • Proper handling, cleaning, and storage of the microscope
    • Correct use of all lenses
    • Recording microscopic observations
  • Properly perform differential counts, including
    • Preparing blood film smears
    • Staining blood smears
    • Differentiating white blood cells
    • Evaluating red blood cell morphology
    • Performing platelet and leukocyte estimations
    • Recording and interpreting results
  • Proper performance of hematological test, including
    • Performing blood cell counts utilizing hemacytometer
    • Performing analytical procedures for hemoglobin determination
    • Performing analytical procedure for hematocrit determination
    • Calculating RBC Indices
    • Performing special stains for hematological abnormality confirmations
    • Performing reticulocyte counts
    • Troubleshooting and problem solving
    • Recording and interpreting results
  • Troubleshooting and problem solving
    • Recognizing errors or discrepancies in results during lab procedures
    • Selecting corrective actions for problem solving

• Cognitive Skills
  • Cognitive processes, including
    • Formulating a clear, answerable question
    • Predicting expected results
    • Following written protocols and verbal instructions
  • Analysis skills, including
    • Collecting and organizing data in a systematic fashion
    • Presenting data in an appropriate form
    • Assessing the validity of the data (including integrity and significance)
    • Recognizing errors and developing a corrective course of action
    • Drawing appropriate conclusions based on the results
  • Communication skills, including
    • Discussing and presenting lab results or findings in the laboratory
  • Interpersonal and citizenry skills, including
    • Working effectively in teams or groups so that the task, results, and analysis may be shared
    • Effectively managing time and tasks allowing concurrent and/or overlapping tasks to be done simultaneously, by individuals and/or within a group
    • Integrating knowledge and making informed judgments about chemistry test results in the clinical setting

• Laboratory Safety
  • Laboratory procedures, including
    • Reporting all spills and broken glassware to the instructor and receiving instructions for clean up
    • Minimizing or containing the production of aerosols and describing the hazards associated with aerosols
    • Washing hands prior to and following laboratories and at any time contamination is suspected
    • Using universal precautions with blood and other body fluids and following the requirements of the OSHA Bloodborne Pathogen Standard
    • Disinfecting lab benches and equipment prior to and at the conclusion of each lab session, using an appropriate disinfectant and allowing a suitable contact time
    • Identification and proper disposal of different types of waste
    • Good lab practice, including returning materials to proper locations, proper care and handling of equipment, and keeping the bench top clear of extraneous materials
  • Protective procedures, including
    • Tying long hair back, wearing personal protective equipment (eye protection, coats, gloves, closed shoes), and using such equipment in appropriate situations
    • Always using appropriate pipetting devices and understanding that mouth pipetting is forbidden
    • Never eating or drinking in the laboratory
    • Never applying cosmetics, handling contact lenses, or placing objects (fingers, pencils, etc.) in the mouth or touching the face
  • Emergency procedures, including
    • Locating and properly using emergency equipment (eye wash stations, first aid kits, fire extinguishers, chemical safety showers)
    • Reporting all injuries immediately to the instructor
    • Following proper steps in the event of an emergency