Third Rotation: Hematology Section
When I hear the word Hematology, what comes first in my mind is smearing. Well, basically it was my job during the rotation to smear the delivered blood specimens in the laboratory. You'll know later why do I have to do it. So, Hematology is my third rotation for this internship in a private hospital. It was not a exhausting job since we got the power of Sysmex in doing the complete blood count and even for the retics and protime. My only downfall during the duty is that I have to keep standing for the whole day and just a little bit of sitting down because the specimens were unlimited.
These are EDTA tubes or the Ethylenediaminetetraacetic acid tubes. The anticoagulant binds with calcium or also known as chelation to prevent from coagulation because calcium is one of the clotting factors or the Factor IV.
After receiving the specimes from OPD, STAT or from warding, I have to label the smeared slides which are from the microtainer and make a smear for those specimens which don't have a smear yet. Tips are always refilled once I come in for duty. If the request was peripheral smear, you have to make three good slides and stain in it properly because these will be submitted to a hematologist for reading.
This is Sysmex XE-1200 with a test principle of Flow Cytometry Method using Semiconducter Laser. Well, this is basically the same with the Sysmex we used in the Microscopy Section which is the Sysmex UF-1000i. But before running any microtainer samples, these are needed to be rimmed to check if there is any clot because if there is, it should be rejected and specimens are needed to be mixed properly in order to avoid false results.
Cytometry is used to analyze physiological and chemical characteristics of cells and other biological particles. Flow cytometry is used to analyze those cells and particles as they are passed through extremely small flows.
A blood sample is aspirated and measured, diluted to the specific ratio and stained. The sample then fed into the cell and this Hydro Dynamic Focusing mechanism improves cell count accuracy and reproducibility. And since the blood cell particles pass in a line through the center of the flow cell, the generation of abnormal pulses is prevented and flow cell contamination is reduced.
A semi conductor laser beam is emitted to the blood cells passing through the flow cell. The forward scattered is received by the photodiode, and the lateral scattered light and lateral fluorescent light are received by the photomultiplier tube. The light is converted into electrical pulses, thus making it possible to obtain blood cell information.
On the IPU, this is what is like in the scattergram. That's why smears are made to manually observe the blood under the microscope if there is any WBC flaggings because usually the IPU reports if there are any atypical lymphocytes or other types of erythrocytes.
This is the microscope, the stains and the counter that we usually use. I also use them to comply my quota which is three differential counts and two abnormal cells everyday. I mean whenever we have our Clinical Instructor. They only come three times a week.
I was able to complete my quota for the whole week and what you can see on the picture are just erythrocytes and a couple of lymphocytes.
Another thing I do in the section is the forward blood typing where a washed whole blood is mixed with antisera to determine what blood type your patient is.
With this method, what I only need to remember is "Blue Angel, Yellow Bird" which means if there is a clumping on the blue anti-sera or the anti-A, it is Type A and if it clumps in the yellow anti-sera or the Anti-B, it is Type B. However, there is a future explanation about this principle but it is soon to be discussed once I am done with my Blood Banking rotation, which is next week.