Sop Hematology

1 DAVAO MEDICAL SCHOOL FOUNDATION, INC.
2 DR. A. GAHOL AVENUE, BAJADA, BRGY. 19 – B, DAVAO CITY

3 DMSF HOSPITAL
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5 UNIT
6 D EPARTMENT P ROCEDURES M ANUAL
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Prepared by: Approval Date:
ERIKA MINA P. CELESTE ________________________________

Hematology Section Head
Reviewed by:
Effective Date:
AGATHA LAARNI C. LACUNA, RN ________________________________

ANCILLARY DIRECTOR
Manual No. ANC- ____ -M01

RANDY IAN J. ESPINOSA
QUALITY MANAGEMENT REPRESENTATIVE Version No. 1.0
Recommended by:
OSCAR P. GRAGEDA, MD,

Chief Pathologist
VICTOR D. ESPINO, MD, FPUA, FPCS

CHIEF OPERATIONS OFFICER
OLIVER G. VICTORIANO, DBA

CHIEF OPERATIONS OFFICER
Approved by:
ATTY. ALBERTO RAFAEL L. APORTADERA

PRESIDENT
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12 This Procedures Manual is contributed by the following Laboratory Personnel:

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14 ERIKA MINA P. CELESTE

15 Hematology Section Head
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1 ANCILLARY – LABORATORY – SECTION
2 DEPARTMENT PROCEDURES MANUAL
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20 TABLE OF CONTENTS
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Chapter Page
1 UNIT OVERVIEW 1
 Unit Vision and Mission 2
 Description of Key Personnel 2
 Unit Organizational Structure 11
2 GENERAL POLICIES FOR SECTION 21
3 GENERAL STANDARD OPERATING PROCEDURES 40

 General Policy 41
 Communication 45
 Telephone Courtesy 45
 Endorsement 47
 Routine Activities During Shifts 49
 Duties and Roles of MedTech 52
 Duties and Roles of Laboratory Aide 55
5 LABORATORY PROCEDURES 77
 Releasing of Laboratory Results 78
Table of Contents| i
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Table of Contents| ii
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23 CHAPTER 1
24 HEMATOLOGY SECTION OVERVIEW
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26  Hematology Vision and Mission

27  Description of Key Personnel
28  Hematology Section Organizational Structure
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Supersedes: Previous Procedures Manual of the Hematology Section
Approval Date:
Effective Date:
Version No.: 1.0
Authored by: Recommended by:
ERIKA MINA P. CELESTE OLIVER G. VICTORIANO, DBA

Section Head Chief Operations Officer
Authored by: Approved by:
Reviewed by: Approved by:
AGATHA LAARNI C. LACUNA, RN ATTY. ALBERTO RAFAEL APORTADERA

Ancillary Directors President
RANDY IAN J. ESPINOSA, PTRP

Quality Management Representative
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37 Hematology Unit Overview
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40 Hematology encompasses the study of blood cells and coagulation. Included in its concerns are
41 analyses of the concentration, structure, and function of cells in blood; their precursors in the bone
42 marrow; chemical constituents of plasma or serum intimately linked with blood cell structure and
43 function; and function of platelet and proteins involved in blood coagulation. Increasingly,
44 molecular biological techniques enable the detection of genetic mutations underlying the altered
45 structure and function of cells and proteins that result in hematologic disease.
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48 VISION:
49 Trusted laboratory partner-empowering health, impacting lives, living our core values, faith in God,
50 Integrity, respect, and excellence.
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52 MISSION:
53 Provide innovative, timely and quality clinical hematology services to our patients and the
54 community we serve.
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56 LOCATION:
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58 The Hematology Section unit is located inside the laboratory department at hospital ground floor.
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60 I. Definition of Terms:
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62 1. Blood constitutes 6 to 8% of the total body weight and consists of blood cells suspended
63 in fluid called plasma. The three main types of blood cells are the red blood cells
64 (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). The fluid
65 plasma forms 45 to 60% of the total blood volume; the red blood cells occupy most of the
66 remaining volume. White blood cells and platelets, although functionally essential,
67 occupy a relatively small proportion of the total blood mass. The proportion of cells and
68 plasma is regulated and is kept relatively constant.
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70 2. Coagulation is a chemical process whereby plasma proteins interact to convert the
71 large, soluble plasma protein molecule fibrinogen into the stable, insoluble gel called
72 fibrin. The active compound is the enzyme thrombin, which preferentially converts
73 fibrinogen into fibrin. There is a delicate balance between coagulation and maintaining
74 blood in a liquid state. Imbalance in one direction can lead to excessive bleeding,
75 whereas in the other it may lead to thrombosis.
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77 3. Automation is a procedure in which a machine or instrument is used to determine
78 complete blood count, differential count, coagulation tests, hemoglobin and hematocrit
79 determination test and platelet count.
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Chapter 1: Section Overview| 2

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84 4. Manual Procedure is done when determining complete blood count, differential count,
85 coagulation tests, hemoglobin and hematocrit determination and platelet count using
86 pipettes both RBC and WBC pipettes, smear for differential count, counting chamber and
87 photoelectric colorimetry in hemoglobin.
88
89 DESCRIPTION OF KEY PERSONNEL
91 I. SECTION HEAD
92 BASIC FUNCTION
93 Under the direct supervision of the Chief Medical Technologist, performs various laboratory
94 tests using microscopic techniques, computer-controlled analyzers, specialized automated
95 instruments and equipment following detailed instructions to provide data or information
96 for use in diagnosis, treatment, and monitoring of diseases.
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98
99 2. PRINCIPAL FUNCTIONS AND RESPONSIBILITIES:
100 1. Verifies or records identity of patients.
101 2. Receives samples from healthcare personnel and laboratory customers in a manner that
102 ensures the samples are kept in a clear “chain of custody” to ensure reliability of test results.
103 3. Verifies the integrity of sample and sees to it that proper transport and preservation
104 specimen is followed.
105 4. Performs Complete Blood Count, Blood Typing, Differential Cell Count, Erythrocyte
106 Sedimentation Rate, Prothrombin Time, Activated Partial Thromboplastin Time, and
107 Reticulocyte Count.
108 5. Performs venipuncture and finger sticks on out-patients and in-patients of varied ages in
109 approved sites.
110 6. Prepares machines to be used in running tests for hematology and maintains proper
111 functioning of equipment.
112 7. Process specimens including receiving, sorting and accessioning.
113 8. Follows SOP when processing specimens for analyses in the section.
114 9. Prepares standard solutions and reagents needed for testing following standardized formula.
115 10. Prepares peripheral blood smears, bone marrow aspirates and malarial smears.
116 11. Ensures that quality control testing and verification is completed within the section.
117 12. Checks hematology storage refrigerators for level of reagents.
118 13. Acts as rotating medical technologist and performs procedures such as phlebotomy, as
119 required or needed.
120 14. Ensures that results are accurate and timely.
121 15. Monitors and records average census of blood processed each month in hematology
122 department.
123 16. Responsible in hematology section orientation and training of new staff.
124 17. Provides reports at monthly unit meeting regarding the hematology section.
125 18. Documents all results of laboratory tests in hematology and accounts them in logbooks for
126 daily, monthly, and quarterly reports and submits copies to other hospital departments as
127 required.
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130 19. Maintaining laboratory quality assurance and safety standards by attending and
131 participating in National Quality Assessments.
132 20. Observes safe laboratory practice.
133 21. Checks inventory of supplies and reagents, and ensures that adequate supplies are always on
134 hand in the assigned section/s.
135 22. Discard all expired reagents or unusable supplies in the section.
136 23. Checks expiry dates and quality of reagents.
137 24. Documents incidents and problems and take appropriate actions and follow-up with staff.
138 25. Relays laboratory results to physicians as the need arises.
139 26. Collaborate in the practice of new policies and procedures.
140 27. Solves section service problems in an innovative manner and/or reports the said problems
141 to corresponding agencies concerned. Trouble shoots problems for malfunctioning
142 machines and refers to supervisor/ engineer for major repairs.
143 28. Prepares and facilitates sending out of specimens to the reference laboratory.
144 29. Attend and participate in conventions and seminars for updates and improvements in the
145 assigned area.
146 30. Courteously responds to telephone calls.
147 31. Observes cleanliness and orderliness to ensure the accuracy of laboratory results and help
148 protect workers from possible contamination or infection of disease inside the laboratory.
149 32. Secures all information from results gathered be kept confidential.
150 33. Shares in the vision of the institution, demonstrates its value and workplace ethics, support
151 and is sensitive to its mission.
152 34. Does other duties as may be assigned from time to time.
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154
155 3. PROBLEM-SOLVING
156 Solves section service problems in an innovative manner and/or reports the said problems
157 to corresponding agencies concerned. Troubleshoots problems for malfunctioning
158 machines and refers to supervisor/engineer for major repairs/problems.
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160 4. KEY ORGANIZATIONAL RELATIONSHIPS
161 Reports to: - Chief Medical Technologist, Assistant Chief Medical Technologists
162 Supervises: - Section Heads, Rotating Medical Technologists
163 Coordinates: - Attending Physician, Nursing on duty.
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172 5. QUALIFICATION GUIDE
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174 Education: A graduate and licensed Medical Technologist by the Professional
175 Regulation Commission
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177 Experience: At least 2 years or more experience in an approved hospital based
178 laboratory.
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180 Skills: With formal laboratory training for a certain period and granted a certificate
181 likewise in charge of major section and perform responsibility.
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184 6. WORKING CONDITION
185 - Always work indoors in laboratories or offices.
186 - Always wear protective gloves, masks, or glasses when handling chemicals.
187 - Are often exposed to contaminants or hazardous conditions while conducting
188 chemicals. There is some possibility of moderate injury. However, risk is
189 reduced by following safety procedures.
190 - Work within several feet of others in the laboratory.
191 - Work near others. They often share the same workspace with other Medical
192 Technologists.
193
194 II. MEDICAL TECHNOLOGY STAFF
195 1. BASIC FUNCTION
196 Under the direct supervision of the Chief Medical Technologist, performs various laboratory
197 tests using microscopic techniques, computer-controlled analyzers, specialized automated
198 instruments and equipment following detailed instructions to provide data or information
199 for use in diagnosis, treatment, and monitoring of diseases. Performs other related
200 functions.
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212 2. PRINCIPAL FUNCTIONS AND RESPONSIBILITIES:
213 1. Verifies or records identity of patients.
214 2. Receives samples from healthcare personnel and laboratory customers in a
215 manner that ensures the samples are kept in a clear “chain of custody” to ensure
216 reliability of test results.
217 3. Verifies the integrity of sample and sees to it that proper transport and
218 preservation specimen is followed.
219 4. Performs Complete Blood Count, Blood Typing, Differential Cell Count, Erythrocyte
220 Sedimentation Rate, Prothrombin Time, Activated Partial Thromboplastin Time and
221 Reticulocyte Count.
222 5. Performs venipuncture and finger sticks on out-patients and in-patients of varied
223 ages in approved sites.
224 6. Prepares machines to be used in running tests for hematology and maintains
225 proper
226 7. Process specimens including receiving, sorting, and accessioning.
227
228 . 8. Follows SOP when processing specimens for analyses in the section.
229 9. Prepares standard solutions and reagents needed for testing following
230 formula.
231 10. Prepares peripheral blood smears, bone marrow aspirates and malarial
232 smears.
233 11. Ensures that quality control testing and verification is completed within the section.
234 12. Checks hematology storage refrigerators for level of reagents.
235 13. Acts as rotating medical technologist and performs procedures such as
236 phlebotomy, chemistry, bacteriology, clinical microscopy as required or needed.
237 14. Ensures that results are accurate and timely.
238 15. Monitors and records average census of blood processed each month in
239 hematology department.
240 16. Responsible in hematology section orientation and training of new staff.
241 17. Provides reports at monthly unit meeting regarding the hematology section.
242 18. Documents all results of laboratory tests in hematology and accounts them in
243 logbooks for daily, monthly, and quarterly reports and submits copies to
244 other hospital departments as required.
245 19. Maintaining laboratory quality assurance and safety standards by attending and
246 participating in National Quality Assessments.
247 21. Checks inventory of supplies and reagents and ensures that adequate supplies
248 are always on hand in the assigned section/s.
249 22. Discard all expired reagents or unusable supplies in the section.
250 23. Checks expiry dates and quality of reagents.
251 24. Documents incidents and problems and take appropriate actions and follow-up
252 with staff.
253 25. Relays laboratory results to physicians as the need arises.
254 26. Collaborate in the practice of new policies and procedures.
255 27. Solves section service problems in an innovative manner and/or reports the said
256 problems to corresponding agencies concerned. Trouble shoots problems
257 for malfunctioning machines and refers to supervisor/ engineer for major
258 repairs.

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259 28. Prepares and facilitates sending out of specimens to the reference laboratory.
260
261 29. Attend and participate in conventions and seminars for updates and improvements
262 in the assigned area.
263 30. Courteously responds to telephone calls.
264 31. Observes cleanliness and orderliness to ensure the accuracy of laboratory
265 results and help protect workers from possible contamination or infection of
266 disease inside the laboratory.
267 32. Secures all information from results gathered be kept confidential.
268 33. Shares in the vision of the institution, demonstrates its value and workplace
269 ethics, support and is sensitive to its mission.
270 34. Does other duties as may be assigned from time to time.
271
272
274 Reports to: - Chief Medical Technologist, Assistant Chief Medical Technologists
275 Supervises: - Section Heads, Rotating Medical Technologists
276 Coordinates: - Attending Physician, Nursing on duty.
277
279 Education: A graduate and licensed Medical Technologist by the Professional
280 Regulation Commission
281
282 Experience: At least 2 years or more experience in an approved hospital based
283 laboratory.
284
285 Skills: With formal laboratory training for a certain period and granted a certificate
286 likewise in charge of major section and perform responsibility.
287
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290 - Always work indoors in laboratories or offices.
291 - Always wear protective gloves, masks, or glasses when handling chemicals.
292 - Are often exposed to contaminants or hazardous conditions while conducting
295 - Work within several feet of others in the laboratory.
296 - Work near others. They often share the same workspace with other Medical
297 Technologists.
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301 III. LABORATORY AIDE

302
303 1. PRINCIPAL FUNCTIONS AND RESPONSIBILITIES
304 1.1 Receive and check approved laboratory specimen from patient or nurse on duty.
305 1.2 Record all laboratory request forms received in a designated logbook.
306 1.3 Assists in the release of results to the patient or Wards promptly.
307 1.4 Clean and disinfect the laboratory area and wash all used glassware.
308 1.5 Help the Chief Medical Technologist in the procurement of reagents and supplies
309 from stockroom.
310 1.6 In charge of stock room arrangement and hygiene
311 1.7 Moderate supervision under Standard Operating Procedure
312 1.8 No supervision responsibility required.
313 1.9 Share in DMSF vision, mission and goals demonstrated, its values and
314 workplace ethics.
315
316 1.10 Adhere to and follow the DMSF policies, procedures, and compliance program.
317 1.11 Authorized specimen collector and encoder for Drug Testing.
318 1.12 Assists in the preparation and helps facilitate in sending out of specimens to the
319 reference laboratory.
320 1.13 Maintains a friendly, respectful and professional environment for all patients.
321 1.14 Maintains confidentiality of its customers and secures all information from results
322 gathered be kept confidential.
323 1.15 Shares in the vision of the institution, demonstrates its value and workplace
324 ethics, supports and be sensitive to its mission.
325 1.16 Does other duties as may be assigned from time to time.
326
328 Reports to: Chief Medical Technologist
329 Asst. Chief Medical Technologist
330 Rotating Medical technologist
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332 Supervises: None
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334 Coordinates: Chief Medical Technologist
335 Asst. Chief Medical technologist
336 Rotating Medical Technologist
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346 3.1 High school or college graduate or its equivalent
347 3.2 With health care service background and experience
348 3.3 Knowledge on basic laboratory principles and ability to follow laboratory
349 procedures and policies.
350 3.4 Have knowledge of basic laboratory principles and ability to operate autoclave and
351 other laboratory machines and equipment, likewise ability to work with other
352 people.
353
355 4.1. Always work indoors in laboratories or offices.
356 4.2 Always wear protective gloves, masks, or glasses when handling chemicals.
357 4.3 Are often exposed to contaminants or hazardous conditions while conducting
360 4.4 Work within several feet of others in the laboratory.
361 4.5 Work near others. They often share the same workspace with other Medical
362 Technologists.
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382 CHAPTER 2
383 GENERAL POLICIES FOR HEMATOLOGY SECTION
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Approval
Date:
Effective
Date:
Version No.: 1.0
Hazel Anne G. Dacayo, RMT, MLS(ASCPi) OLIVER G. VICTORIANO, DBA

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AGATHA LAARNI C. LACUNA,RN FR. MANUEL B. PEREZ, SJ MD

Ancillary Director President

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393 QUALITY MANAGEMENT
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395 Quality Assurance (QA)

396 Quality Assurance is encountered in the pre-analytic, analytic and post – analytic phase
397 of laboratory testing. It monitors quality performance starting from the ordering of a
398 laboratory determination to its reporting, interpretation of result and the application to
399 patient care. It also involves in total quality control which requires constant attention of
400 all involved with the processed system.
401
402 Quality Control (QC)
403 It is concerned with the analytical phase of QA. It monitors the overall reliability of
404 laboratory results in terms of accuracy and precision.
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406 External QC – monitors primarily the accuracy of laboratory tests.
407 Internal QC – primarily monitors the day-to-day performance of laboratory tests
408 namely precision, result of control specimen and result of patient
409 specimen.
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411 Objectives of Quality Control:
412  To provide a continuous record of precision and indications of technologist’s
413 analytical skills.
414  To give easy warning, trends and shift in control results so that remedial action
415 may be taken before serious loss of precision occur.
416  To permit valid judgment on the accuracy of results by monitoring precision and
417 permitting continuous comparison of assay values on “known” sera with stated
418 levels.
419  To facilitate comparison between different techniques for the assay of a
420 constituent and to derive a justifiable choice between method.
421  To monitor the performance of equipment especially automated one.
422  To accumulate a body of information about laboratory performance with which the
423 challenges of external monitoring organization can be met.
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429 CONSIDERATION OF CHOOSING A CONTROL SOLUTION

430
431 Quality control specimens are used in the laboratory to ensure that patient testing is
432 performed within acceptable limits of variation. In Hematology, both commercially prepared
433 and within laboratory prepared specimens may be used. In large busy laboratory, a Q.C.
434 specimen may be run every hour, whereas in a smaller operation, quality control testing may
435 be performed once each 8-hour shift. However, any time a change can occur in a procedure
436 that may affect test results (e.g., new reagents or change of instrument tubing or lamp), a Q.C.
437 specimen should be run.
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440 Selection of Quality Specimen
441 1. Should behave like the real specimen.
442 2. Should be available in sufficient quantity to last a minimum of one year.
443 3. Should be stable over a period of one year.
444 4. Should be available in convenient vial volume.
445 5. Should be minimally in concentration and composition from vial to vial.
446 6. Should include clinically normal, high, and low abnormal ranges.
447 7. Should be preferably lyophilized and require reconstitution before use
448
449 Proper Preparation of Quality Control Specimen
450 1. Lyophilized sample should be reconstituted and handle with good quantitative
451 technique.
452
453 2. Allow the lyophilized Q.C. sample to dissolve completely before use.
454
455 3. Aliquot it by 300-500ul to avoid deterioration and contamination then labeled with
456 number and date of reconstitution and freeze in -25 to -15C (only one freezing
457 session)
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470 Precision
471 1. Standard Deviation
472 It is the measurement of dispersion of the values around the mean in a
473 normal or Gaussian distribution.
474 2. Precision monitoring technique
475 Levey – Jennings Q.C. chart
476
477 a. The control result are plotted on the ordinate (y-axis) versus time on
478 the abscissa (x-axis)
479 b. The mean value of the control is indicated by solid line while the
480 control limit usually ±2SD around the mean are indicated by
481 interrupted or dotted lines.
482 c. Random error shows a wider range of scatter of the points on the
483 control chart, while systemic error can be seen when the points drift
484 or shift on one side of the central solid line.
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486 QC chart must be updated monthly.
487
488 3. Stains
489  Commercially prepared slide for hematology or slide of normal
490 patient must be available.
491  Change stains every Monday morning or if needed to have a reliable
492 blood smear.
493
494 4. Hematology Control must be run every day then record the result in
495 designated logbook for documentation.
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497 5. Coagulation control must be run every day or if needed.
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499 6. Slides storage of hematology slides in one box labeled per month.
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510 TRANSPORT OF SPECIMEN

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512 1. Use appropriate anticoagulant upon blood extraction.
513 2. Prevent biochemical exposure and contamination of specimen and decomposition
514 of its constituents.
515 3. Specimen must be received by other laboratory ASAP
516 4. Specimen proper storage must be followed.
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519 REAGENTS AND EQUIPMENTS
520
521 Proper handling and manipulation of machine is strictly observed and calibration of
522 instruments must be scheduled at least once or twice a year likewise preventive
523 maintenance must be done regularly by company engineer. For operation of
524 automated machines please refer to manual given by the Sales Representative of each
525 corresponding machine.
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527
528 REAGENTS PROTOCOL

529 A. Reagent kits must always be accompanied with their respective reagent
530 standard.
531 B. All reagents must be BFAD approved and passed the quality assurance test.
532 C. Always take note of the opening of each reagent kit.
533 D. Always run control specimen daily.
534 E. Normal range of control and normal value of patients must be posted for
535 guidance.
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549 CHAPTER 3
550 GENERAL STANDARD OPERATING PROCEDURES
551
552  General Policy

553  Communication
554  Telephone Courtesy
555  Endorsement
556  Routine Activities During Shifts
557  Duties and Roles of Medical Technologist
558  Duties and Roles of Laboratory Aide
559
Approval Date:
Effective Date:
Version No.: 1.0

AGATHA LAARNI C. LACUNA,RN ATTY. ALBERTO RAFAEL L. APORTADERA


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563 GENERAL POLICY

564 The healthcare Professional/ Provider assigned in any clinical area station must practice the
565 following:
566 1.Must be courteous at all times especially to the hospital staff, personnel, doctors, heads,
567 patients and watchers
568 2.Must respect their superiors and co-staff.
569 3.Must be polite in answering phone calls
570 4.Must follow and observe the policies imposed by the hospital and stations/departments
571 5.Must attend meetings set by the station head and or any hospital meetings or gatherings
572 scheduled
573 6.Must follow and observe the memorandum released by the hospital and other departments
574 7.Ladies hair should be tied up and no hair color or highlighted hair. Must wear light make-up
575 to look nice and beautiful.
576 8.Gentlemen should be following the standard of haircut for health care provider. Must look
577 tidy and neat at all times. No piercing is allowed
578 9.Wearing proper, prescribed uniform during duty hours as follows:
579 9.1 Medical Technologist
580 9.1.1 Prescribed uniform
581 9.1.2 Prescribed uniform with white undershirt without prints (for male nurses)
582 9.1.3 White socks
583 9.1.4 ------ shoes
584 9.1.5 Employee ID
585 9.2 Laboratory Aides
586 9.2.1 Prescribed uniform (scrub suit)
587 9.2.2 White socks
588 9.2.3 White shoes
589 9.2.4 Employee ID
590 10. Must come at least 30 minutes before the endorsement time. PUNCTUALITY is strictly
591 implemented in every station. Medical Technologist must report on time to receive
592 endorsement.
593 I.1 Proper endorsement must be made before going off duty. All special
594 endorsements must be read first before endorsement proper starts.

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595 I.2 Everybody must pay attention to the endorsement process.

596 I.3 In crashing out laboratory and other procedures, the staff concerned must never
597 forget to indicate the date it was taken, served or done.
598 I.4 The outgoing staff must leave the department in good order. ALL necessary
599 endorsements are well received and clarified by the incoming shift.
600
601 COMMUNICATION
602
603 1.Silence must be maintained at all times in all areas.

604 2.Communication must be made in low voices and not be heard within the hearing distance of
605 the patient.
606 3.Extra silence must be maintained and observed during night shift at all times.
607 4.Medical Technologist must not argue in front of the patient.
608 5.Complaints from the patient and or the public must be referred to the immediate superior
609 as soon as possible. This is to promote early resolution to the issue raised in the area.
610 Thus, improving and maintaining the quality of care to be rendered to the patient.
611 6.Laboratory personnel must always remember their responsibility and must maintain
612 confidentiality of all patient information and any privilege communication. This refer
613 not only to the information found in the laboratory result but also to whatever is
614 learned or seen by them while attending and taking good care of the patient.
615 7.While on duty and within hospital premises, employees are prohibited from gossiping or
616 engaging in rumor mongering.
617
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619 TELEPHONE COURTESY

620 1.Answer the phone in a low and accommodating tone of voice.
621 2.Answer call promptly after the first ring, if possible.
622 3.Identify yourself, if you are the caller; give your name and that of your department or unit. If
623 you are answering the phone, give your name and department/unit.
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625 4.Try placing and receiving your own calls.

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626 5.If you ask someone to place a call for you, make sure that you are ready for the information
627 that you wanted to relay on the line.
628 6.Plan what you are going to say and how to say it before dialing any number.
629 7.List down frequently called numbers; when in doubt refer to your telephone directory
630 8.Keep pad and pencil handy. Jot down necessary details of the message received accurately.
631 9.When the person called is not available, give the caller a definite time when to call again or
632 offer to take the message and relay promptly.
633 10. Leave message or information when leaving your office or desk. Have someone nearby
634 answer your phone during your absence.
635 11. Offer help to the caller if the call is not intended for you or your department; if your
636 phone is connected to another department try to connect the caller to the department
637 where he/she intends to call.
638 12. If you must leave the line during a conversation, explain to the caller that you are going
639 to get facts on the information the caller wanted to secure. Explain this to the caller
640 thoroughly and explicitly. Advise the caller to call you back or offer to call him back.
641 13. When screening calls or asking identifying calls, avoid using terms that might create a
642 negative impression on the one who receives the call. Be polite and courteous in
643 answering a phone call.
644 14. During a lengthy explanation by the caller, indicate your presence on the line by using
645 verbal expression such as “certainly”, “of course”, “yes, I understand”.
646 15. Be polite in receiving a wrong number call, you can answer back by telling the other line
647 such as “I’m sorry you dialed the wrong number”, “You are calling DMSF Hospital?” In
648 that way, you even advertised your hospital to the caller.
649 16. Finally, end the conversation politely. Don’t forget uttering the word “thank you” and
650 “goodbye”. Place the receiver gently.
651
652 ENDORSEMENT
653 Endorsement is an oral report given by the outgoing shift of Medical Technologist to incoming shift
654 of Medical Technologist on the significant evaluation of each patient’s laboratory procedure. It also
655 involves the transfer of responsibilities from one shift to another for the purpose of achieving
656 continuity of patient care.
657
658 LABORATORY ROUNDS

63 _______Version 1.0
659 1.The following should be observed/done by the staff during rounds:

660 1.1 Introduce self who will render test or procedure to the patient.
661 1.2 Address patient by name and observe courtesy.
662 1.3 Informs patient of any test, procedures and checks/validates if preparations have
663 been followed.
664 1.4 Accepts expression of complaint and assures patient that the complaint will be
665 attended to and will return to address any change necessary, if possible
666
667 ROUTINE ACTIVITIES DURING SHIFTS

668 1. Morning shift (7AM-3PM)
669  Endorsement will be done from the evening shift, patient details as well as the
670 physical upkeep of the machine and the working area
671  Routine analysis both manual and automated will start, after maintenance and
672 Internal Quality Control.
673 2. Afternoon Shift (3PM-11PM)
674  Endorsement will be done from the evening shift, patient details as well the
675 physical upkeep of the machine and the working area
676  Routine analysis will start.
677 3. Evening Shift (11PM-7AM)
678  Endorsement will be done from afternoon shift, patient details as well as physical
679 upkeep of the machine and the working area.
680
681  Daily Maintenance of the machine is performed once a day (at 12 midnight). This
682 includes shut down of the machine, Background checking, and running of Quality
683 Controls.
684  Once the results are displayed, record the result in the designated quality control
685 logbook. If there are flaggings (highlighted in red), press “Reanalyze” and re run the
686 control material. If the problem persists, contact a senior or a service engineer.
687  Record the results of the QC in the designated logbook.
688  Routine analysis will start.
689
690
691
692
693

66 _______Version 1.0
694
695 CHAPTER 4
696 LABORATORY PROCEDURES
697 699
698 700
701
Approval Date:
Effective Date:
Version No.: 1.0

AGATHA LAARNI C. LACUNA,RN ATTY. ALBERTO RAFAEL L. APORTADERA


702
703
704
705
706
707
708

69 _______Version 1.0
709
710
711 COLLECTION AND DISPOSAL OF SPECIMEN POLICIES

712
713 I. Blood Collection

714
715 1.1 Obtaining blood from a finger
716
717 Preparing the finger
718
719  The finger is cleansed with a gauze pad which has been moistened with 70%
720 alcohol or some similar antiseptic.
721  It is then dried so that the blood will form a round drop.
722
723 Puncturing the finger
724
725  The tip of the finger is punctured with a sterile lancet.
726  The puncture is made by grasping the finger firmly and making a quick
727 deliberate stab.
728  Since a deep puncture is not anymore painful than a superficial puncture, it is
729 best to go deep enough the first time and avoid puncturing the patient a
730 second time.
731 Eliminating the first drop
732
733  The first drop of blood may contain tissue juices.
734  Also the first drop may be contaminated with extraneous materials which
735 have been clinging to the surface of the skin.
736  When blood contains tissue juices and foreign particles, it is not a true
737 representative sample of the patient’s blood.
738  Therefore, the first drop of blood is always wiped away.
739
740 Withdrawing the blood
741
742  Gentle pressure is applied, if necessary, and drops of blood are taken for the
743 desired examination.
744  Heavy pressure should be avoided because it may cause the flow of tissue
745
746
747
748
749
750
751 Preventing further bleeding

72 _______Version 1.0
752
753  When the desired amount of blood has been obtained, an antiseptic pad is
754 placed on a puncture.
755  The patient is then instructed to apply pressure to the wound until bleeding
756 has ceased.
757
758 1.2 Obtaining the blood from vein
759  Preparing the needle and syringe
760  Applying the tourniquet
761 a. It is desirable to enlarge the veins of the forearm so that they may
762 become more prominent. This is accomplished by allowing blood to
763 enter the arm by way of the arteries and blocking its return via the
764 veins.
765 b. A tourniquet placed above the bend in the elbow serves the purpose.
766 c. The patient is instructed to clench his fist as this aid in building up
767 the pressure.
768  Selecting the vein
769 a. The most prominent vein is usually chosen.
770 b. If the veins are not visible, opening and closing the fist may help to
771 bring them out.
772 c. Quite often, the veins cannot be seen, but may be felt.
773 d. They will then reveal themselves as elastic tubes beneath the surface
774 of the skin.
775  Applying antiseptic
776 a. At the proposed site of the injection, an antiseptic solution is applied
777 with a piece of cotton or gauze pad.
778  Inserting the needle
779 a. Many veins have the tendency to roll over when stuck with a needle,
780 therefore must be held in position.
781 b. The needle is then held in line with the vein and inserted at
782 approximately a 25-degree angle.
783 c. The bevel of the needle should be up to facilitate easier passage of
784 the needle.
785 d. Precaution should be taken against pumping air into the vein. A few
786 cubic centimeters of air pumped into the vein could cause death.
787  Withdrawing the blood
788 a. When the needle enters the vein, the plunger is pulled slowly back
789 and the desired amount of blood is drawn into the syringe.
790 b. Should the blood start to enter into the syringe and cease, the needle
791 may have slipped out of the vein, or gone through it.
792 c. If it has gone through, it should be slowly withdrawn until it is once
793 again in the blood stream.
794  Releasing the tourniquet
795 a. Before the needle is withdrawn, the pressure must be released,
796 otherwise, the blood will continue to flow from the hole made by the
797 needle.
798 b. The pressure is removed by first instructing the patient to open his
799 clenched fist and then releasing the tourniquet.
800  Withdrawing the needle

75 _______Version 1.0
801 a. After the tourniquet is released, the needle is withdrawn.

802 b. As the needle is withdrawn, the antiseptic pad is applied to the
803 puncture.
804
805
806  Preventing the bleeding
807 a. In order to prevent bleeding, the patient is instructed to apply
808 pressure to the antiseptic pad covering the wound.
809
810 1.3 Obtaining blood from an infant
811
812  If only a few drops are needed for examination, the blood may be obtained by
813 puncturing the heel or big toe.
814  If several cubic centimeters are required, the blood may be obtained by making a
815 venipuncture on the scalp or neck
816 (Should be performed by a physician or an expert technician).
817
818
819 1.4 Procedure for obtaining blood from the external jugular vein:
820  Wrap the infant in a small sheet to prevent movement of arms and legs.
821  Place the infant on the edge of a table or bed so that the head just hang over the
822 edge.
823  Pin the sheet holding the baby to the table or bed.
824  Turn the baby’s head to one side and locate the external jugular vein. If the baby
825 cries or can be induced to cry, the external jugular vein becomes quite prominent.
826  Sterilize the area.
827  Attach the sterile needle to a syringe.
828  Hold the skin taut, insert the needle and withdraw the blood.
829  Withdraw a needle and place a piece of cotton moistened with alcohol on the site of
830 puncture. Apply gentle pressure until the bleeding has ceased.
831
832 note: In obtaining blood from an infant, it is always a good policy to double check
833 the wound and make certain that bleeding has ceased before leaving the
834 ward or room.
835
836 II. HANDLING AND STORAGE OF SPECIMEN
837 1. Transfer drawn blood to appropriate tube with each corresponding anticoagulant
838 taking precaution to avoid hemolysis of blood sample.
839 2. Label the tube with complete name of patient and date of extraction.
840 3. In cases of delay in examination, blood sample must be refrigerated.
841 4. After processing the test save the remaining sample for at least 7days.
842 5. In cases of abnormal cells microscopy save slide with each corresponding name.
843
844
845 III. PROCEDURES:
846
847

78 _______Version 1.0
848 1. Complete Blood Count (CBC) the importance of CBC cannot be underestimated. It
849 is a screening procedure that is helpful in the diagnosis of many diseases, it is one indicator of
850 the body’s ability to fight disease, it is used to monitor the effects of drug and radiation
851 therapy, and it may be employed as an indicator of the patient’s progress in certain diseased
852 states such as infection or anemia.
853
854
855 The CBC comprises of the following:
856 White blood cell count - Having a higher or lower number of WBCs than normal may indicate an
857 underlying condition. A WBC count can detect hidden infections within your body and alert doctors
858 to undiagnosed medical conditions, such as autoimmune diseases, immune deficiencies, and blood
859 disorders.
860 Hemoglobin determination- measures the amount of hemoglobin in your blood. Hemoglobin is a
861 protein in your red blood cells that carries oxygen to your body's organs and tissues and transports
862 carbon dioxide from your organs and tissues back to your lungs. If a hemoglobin test reveals that
863 your hemoglobin level is lower than normal, it means you have a low red blood cell count (anemia).
864 Anemia can have many different causes, including vitamin deficiencies, bleeding and chronic
865 diseases. If a hemoglobin test shows a higher than normal level, there are several potential causes
866 — the blood disorder polycythemia vera, living at a high altitude, smoking and dehydration.
867 Differential count - A differential blood count gives the relative percentage of each type of white
868 blood cell mainly Neutrophils, Lymphocytes, Eosinophils and Basophils. It also helps to reveal
869 abnormal white blood cell populations (eg, blasts, immature granulocytes, and circulating
870 lymphoma cells in the peripheral blood).
871
872 Hematocrit - test measures the proportion of red blood cells in your blood. Red blood cells carry
873 oxygen throughout your body. Having too few or too many red blood cells can be a sign of certain
874 diseases.
875
876 Red blood cell count - also called erythrocytes, are cells that circulate in the blood and carry
877 oxygen throughout the body. The RBC count totals the number of red blood cells that are present in
878 your sample of blood. It is one test among several that is included in a complete blood count
879 (CBC) and is often used in the general evaluation of a person's health.
880
881 Red blood cell indices (MCV,MCH,MCHC) - Mean corpuscular volume (MCV), mean corpuscular
882 hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were first introduced
883 by Wintrobe in 1929 to define the size (MCV) and hemoglobin content (MCH, MCHC) of red blood
884 cells. Termed red cell indices, these values are useful in elucidating the etiology of anemias. Red cell
885 indices can be calculated if the values of hemoglobin, hematocrit (packed cell volume), and red
886 blood cell count are known.
887

81 _______Version 1.0
888
889
890
891
892
893 III. EQUIPMENTS
894
895 A. SYSMEX CA-500
896
897 Reagents: Sysmex Thromborel
898 Sysmex Pathromtin
899 Sysmex Calcium Clean
900 Sysmex Calcium Chloride
901 Sysmex Citrol
902 Buffered Water
903
904 B. SYSMEX XS-1000i
905
906 Reagents: Sysmex Cellpack
907 Stromatolyser 4DL
908 Stromatolyser 4DS
909 Sulfolyser
910 Sysmex E-check
911
912
913
914 ABX PENTRA XL 80
915
916 Pentra XL 80 system is a fully automated hematology analyzer used for in vitro diagnostic
917 testing of whole blood specimens.
918
919
920 Measurement and Computations:
921
922 - Impedance for WBC, platelets,RBC, basophils.
923 - Photometry for hemoglobin
924 - Impedance and light scattering for lymphocytes, monocytes,
925 neutrophils, and eosinophils.
926 - Computation from stored data that was directly measured for hematocrit, MCV, MCH,
927 MCHC, RDW, MPV,PCT, and PDW.
928
929 Procedures:
930
931 For autoloader:
932
933 1. Press worklist.
934 2. Enter rack number.
935 3. Enter patient’s name.
936 4. Click the icon.

84 _______Version 1.0
937 5. Put the rack with corresponding blood sample on the left side of the machine.
938 6. Wait for the results.
939
940
941
942 For STAT mode:
943
944 1. Press STAT mode icon.
945 2. Press Details icon.
946 3. Enter patient’s name.
947 4. Click the icon.
948 5. Put the sample on the tube holder.
949 6. Wait for the instructions to appear.
950 7. Push the tube holder.
951 8. Wait for the results.
952
953
954
955 SYSMEX XN-550 – is an automated hematology analyzers for in vitro Diagnostic use in
956 screening patient population found in clinical laboratories. Perform analysis of WBC and
957 differential with an optical detector block based on flow cytometry method, using a
958 semiconductor laser. The RBC’s and platelets areanalyzed by the RBC detector using the
959 Hydrodynamic focusing method. Hemoglobin is analyzed by HGB detector based on the SLS
960 hemoglobin detection method.
961
962
963 Procedures:
964
965 For Sampler Mode :
966
967 1. Click on the sampler button on the toolbar
968 2. Double click the Sampler Sample no. Icon on the MenuScreen.
969 3. Enter the necessary parameters as prompted by the dialog box:
970 - Sample Number
971 -Rack Number
972 -Analysis start position
973 -Discrete
974 4. Click OK- The main unit READY LED changes to green, and
975 system changes to Manual Aspiration Ready Status.
976 5. Open the Sample cover
977 6.. Set the samples in the Sampler rack, then place the racks to the
978 sampler as shown in the diagram, starting from the interior.
979 7. Close the Sampler Cover then Press start switch in the Sampler.
980
981 For Manual Mode:
982
983 1. Select the Manual Sample No. Icon on the Controller Menu, then double click or press the
984 Enter Key to start the Manual Sample No. Screen.
985 2. Data input

87 _______Version 1.0
986 3. Click OK - The main unit READY LED changes to green, andsystem changes to Manual
987 Aspiration Ready Status.
988 4. Press the Open/Close switch to open the sample position.
989 5. Sample tube adapter selection and attachment
990 6. Gently invert sample 10 times, remove the cap, then fit the tube into the sample position.
991 7. When the start switch is pressed, the sample position goes back inside the instrument and
992 the READY LED flashes green, indicating the sample is being aspirated.
993 8. When sample aspiration is complete, the buzzer beeps and the READY LED goes out.
994
995
996 Bleeding Time is a screening test for detecting disorders of platelet function and von Willebrand’s
997 disease, and is directly affected by the platelet count and the ability of platelets to form a plug. The
998 thickness and vascularity of the skin and the ability of the blood vessels to constrict and retract may
999 also affect test results. The coagulation mechanism, however, does not influence the bleeding time
1000 unless there is a severe deficiency present.
1001
1002 Procedure:
1003
1004 1. Make a finger puncture (deeply enough to ensure a free flow of blood).
1005 2. Record the time.
1006 3. At 30 second interval, remove the drops of blood with a filter paper.
1007 4. When blood ceases to flow, record the time.
1008
1009 Normal Value: 1 – 3 minutes
1010
1011 Clotting Time is the time elapsed between the placing of the drops of blood on the slide
1012 and the observance of fibrin thread. And it is the time when the clot is formed firmly on the
1013 slide.
1014
1015 A. Slide Method
1016
1017 Procedure:
1018
1019 1. Make a finger puncture (deeply enough to ensure a free flow of blood).
1020 2. Wipe away the first two drops of blood.
1021 3. Place several drops of blood on the slide, start to note the time.
1022 4. At 15 second interval, draw the lancet through a drop of blood.
1023 5. When the lancet picks up fibrin threads and drags them along record
1024 time.
1025
1026 Normal Value: 2 – 6 minutes
1027
1028
1029 Prothrombin Time (PT) is a useful screening procedure for the extrinsic coagulation
1030 mechanism including the common pathway. The PT will also be prolonged when
1031 the fibrinogen concentration is less than 80 mg/dl and in cases of
1032 dysfibrinogenemia.ThePT is frequently used to follow the course of oral
1033 anticoagulant therapy.
1034

90 _______Version 1.0
1035 note: Centrifuge citrated tube with patient’s blood for 15 minutes.
1036
1037
1038 Activated Partial Thromboplastin Time (APTT) is a most useful procedure for
1039 routine screening of coagulation disorders in the intrinsic system, for detecting the
1040 presence of circulating anticoagulants, and for monitoring heparin therapy.
1041
1042 note: Centrifuge citrated tube with patient’s blood for 15 minutes.
1043
1044
1045
1046 SYSMEX CA-500 Series
1047
1048 The Sysmex Automated Blood Coagulation Analyzer CA-500 series is a
1049 compact fully automated instrument capable of 5-parameter random analysis
1050 for in-vitro diagnostic use. This instrument incorporates latest technologies as
1051 represented by microcomputers, thus enabling analysis of multiple
1052 parameters with increased flexibility of PT, APTT, Fbg, Thrombin Time
1053 (Coagulation Method).
1054
1055 In addition, it has a number of functions including preferential processing of
1056 STAT samples and a built-in quality control function. Moreover, it allows
1057 analyzed data to be displayed and printed out together with reaction curves,
1058 thus making it possible to obtain a highly reliable analysis result.
1059
1060 Procedure for running of sample of PT and APTT:
1061
1062 With completion of analysis preparation and registration of tests (PT and
1063 APTT), the instrument is now ready to start analysis:
1064
1065 1. Check the system status display of the instrument. Make sure that the Root
1066 Menu screen displays “Ready”.
1067 2. Press (Start) key.
1068 The screen confirming the first tube’s initial position will appear.
1069 3. Press CONTINUE key or FIRST TUBE key.
1070 CONTINUE key: Starts with the reaction tube that follows the last used tube in
1071 the previous analysis.
1072 FIRST TUBE key: Start with the upper extreme-right tube in the right-hand
1073 reaction tube rack.
1074 4. When all analyses are over, the alarm sounds.
1075
1076 APTT MIXING with One Hour Incubation
1077
1078 Procedure:
1079
1080 1. Mix 50ul patient’s sample and 50ul control
1081 2. Get 10ul from mixed sample and control.
1082 3. Mix and incubate for 1 hour (or as doctor’s preference) at dry incubate
1083 (blood bank Inc.)

93 _______Version 1.0
1084 4. Run as APTT

1085 5. Wait for the result.
1086
1087
1088
1089 PT MIXING
1090
1091 1. Mix 100ul patient’s sample and 100ul control
1092 2. Get 100ul from mixed sample and control.
1093 3. Add 200ul neoplastine Reagent.
1094 4. Wait for the result.
1095
1096
1097 Erythrocyte Sedimentation Rate (ESR) is a nonspecific measurement used to detect
1098 and monitor an inflammatory response to tissue injury in which there is a change
1099 in the plasma concentration of several proteins. This procedure, very simply,
1100 consists of allowing a specific amount of blood to sit in a vertical position for a
1101 period of time. The distance, in millimeters, that the red cells fall during this time
1102 period is the erythrocyte sedimentation rate and is reported in mm/hr.
1103
1104 Procedure:
1105 1. Get materials for a venipuncture. Make a venipuncture and collect 2ml of
1106 blood.
1107
1108 2. Mix by inverting the tube 3-4 times.
1109
1110 3. Insert the pipette through the pierceable stopper. The blood will
1111 automatically rise to zero.
1112
1113 4. It is absolutely essential that the pipette makes firm contact with the bottom
1114 of the tube.
1115
1116 5. Place the tube with pipette in the rack provided. Let it stand for 1 hour.
1117
1118 6. In exactly 1 hour, record the number of mm the cells have fallen.
1119
1120
1121 Normal Value: 0 – 20 mm/hr
1122
1123
1124
1125 Reticulocytes Count is an important diagnostic tool. It reflects the amount of effective
1126 red blood cell production taking place in the bone marrow. A decreased
1127 reticulocyte count is found in aplastic anemia and in conditions in which the bone
1128 marrow is not producing red blood cells. Increased reticulocyte counts are found
1129 in hemolytic anemia, individuals with iron deficiency anemia receiving iron
1130 therapy, thalassemia, sideroblastic anemia, and in acute and chronic blood loss.
1131
1132

96 _______Version 1.0
1133
1134
1135
1136 A. Test Tube Method ( Kobe)
1137
1138 Procedure:
1139 1. The test tube is pre-dosed with 50 ul staining solution. 50 ul whole
1140 blood, or 50 ul capillary blood from EDTA tube is added to this staining
1141 solution.
1142 2. Then the tube is closed with the attached stopper and mixed gently.
1143 3. Approximately 20-30 minutes after test insertion it is mixed again and
1144 then the smear can be made.
1145 4. It has to dry and to be counted within 1 hour.
1146
1147
1148 Normal Value: 0.5 – 1.5%
1149
1150
1151 Computation:
1152
1153
1154 # of reticulocytes seen x 100 = %
1155 1,000 erythrocytes
1156
1157
1158 Normal Values: Adults - 1% to 2%
1159
1160 Infants - 4% to 8%
1161
1162
1163
1164 Blood Smear for Malaria Parasite (BSMP)
1165
1166
1167
1168 A. Preparation for blood smears for malaria
1169
1170
1171 Procedure:
1172
1173 1. Before extracting blood, ask first the patient’s for details( Name,
1174 Age ,History of travel and Address )
1175
1176 2. Clean the 3rd and 4th finger from the thumb with alcohol swab, using
1177 firm strokes to remove the dirt and grease from the finger. Air-dry the
1178 finger. Use sterile lancet, puncture the ball of the patient’s finger. Apply
1179 gentle pressure to the finger to express the first drop of blood and
1180 wipe it with dry cotton.
1181

99 _______Version 1.0
1182 3. Apply gentle pressure to the finger then collect 3 small drops of
1183 blood on one side of a clean slide and 1 small drop next to the 3 drops,
1184 leaving some space between the thick and thin smears to be made.
1185 Handle clean slides only by edges. Wipe the remaining blood away
1186 from the patient’s finger with dry, clean cotton.
1187
1188 4. Make a thin smear first. Place slide on flat surface, firm surface.
1189 Bring down a second slide(spreader) on the 1 small drop at an angle of
1190 45 degrees, allow the blood to run along its edge.
1191
1192 5. Firmly push the angled slide away from the blood towards the end
1193 of the slide.
1194
1195 6. After spreading the thin smear, make a thick smear. With the corner
1196 of the second slide, quickly join the drops of blood, and spread them in
1197 a circular motion until it is about the size of a centavo coin. The
1198 thickness should be such that it is just possible to see newsprint
1199 through it.
1200
1201 7. Using a lead pencil, label the smear with name or number of the
1202 patient and date on the thick portion of the thin film. Air dry slide on a
1203 flat, level position, protected from insects, dust and extreme heat.
1204
1205 8. Fix the thin smear with methanol by using dropper or by dipping it
1206 in the solution for a few seconds. Airs dry the smear. Do not fix the
1207 thick smear.
1208
1209 9. Stain thick and thick smears with Giemsa or Wright’s stain for 10-15
1210 minutes then wash under running tap water.
1211
1212 (10% Giemsa stain preparation: 1 part + 9 parts distilled water)
1213
1214 10. Air dry smears in a vertical position then examine under oil
1215 immersion.
1216
1217 Computation in THICK FILM:
1218
1219 a) If > 100 parasite: count upto 200 WBC
1220
1221 number of parasites counted x 8000
1222 200 WBC
1223
1224 b) If < 100 parasite: count upto 500 WBC
1225
1226 number of parasites counted x 8000
1227 500 WBC
1228
1229
1230
1231

102 _______Version 1.0
1232
1233
1234
1235 Computation in THIN FILM:
1236
1237 Number of parasites x 5,000,000
1238 20 fields x 250 RBCs
1239
1240 Reporting:
1241
1242 NMPS - NO MALARIAL PARASITE SEEN
1243
1244
1245 P. falciparum
1246 -Trophozoites only F
1247 -Trophozoites and gametocytes F+g
1248 -gametocytes only Fg
1249
1250
1251 P. vivax
1252 -any/ all stages seen V
1253
1254 P. malariae
1255 -any/all stages seen M
1256
1257 Mixed infection VFg, FM, VMFg
1258
1259
1260
1261 PERIPHERAL BLOOD SMEARS and SAVE SMEARS:
1262
1263 Procedure:
1264
1265 1. Collection of specimens through prick method.
1266 2. Proper smearing and labelling of smears. Make atleast 3 to 4 smears.
1267 3. Ask the patient or Nurse if the reader of the smear is Pathologist or Hematologist.
1268 4. Stain the slides in Wright’s stain properly.
1269 5. Air dry the slides.
1270 6. Make a slide pouch and include the following details: (Name, Age, Sex, Room and
1271 Accommodation, prepared by, verified by, Recorded by and Reader of the smear.)
1272 7. The slides should be verified by another Medtech
1273 8. Record the details in PBS logbook located in Histopathology area.
1274 9. Place the slides in unread area if the reader is pathologist.
1275 10. Contact the designated Hematologist if they are the preferred reader then place the smears on
1276 slide storage in Hematology Section.
1277
1278
1279
1280

105 _______Version 1.0
1281
1282
1283
1284 Blood Typing (ABO and Rh)
1285
1286
1287 A. Tube Method
1288
1289 Procedure:
1290 1. Fresh drawn sample from the patient into EDTA anticoagulant tube.
1291 2. Label each tube with letters A, B, D for forward typing and KAC, KBC
1292 for reverse typing.
1293 3. Prepare for 5% red cell suspension (NSS + red cell until cherry
1294 red is attained)
1295
1296 Cell/Forward typing:
1297 a. Place 1 drop of 5% patient’s red cell suspension in tubes labeled
1298 A, B, D.
1299 b. Add 1 drop of anti-A sera in tube A
1300 c. Add 1 drop of anti-B sera in tube B
1301 d. Add 1 drop of anti-D in tube D.
1302
1303 Backward /Reverse typing:
1304 a. Place 2 drops each to tubes labeled KAC, KBC of patient’s
1305 serum/plasma
1306 b. Add 1 drop of Known A Cell to tube KAC
1307
1308 c. Add 1 drop of Known B Cell to tube KBC
1309
1310 4. Mix and centrifuge for 45 seconds.
1311 5. Read results and confirm it with another Med Tech on duty to validate
1312 blood typing result.
1313
1314 6. Record results in blood typing worksheet according to grades of
1315 agglutination.
1316
1317 7. The performing Med Tech will sign in the blood typing worksheet
1318 countersigned by the med tech that validated the blood typing result.
1319
1320
1321
1322
1323
1324
1325
1326

108 _______Version 1.0
1327
1328
1329
1330 Interpretation and Manner of Reporting:
1331
1332 Presence of agglutination: + (positive) - (negative)
1333
1334
1335
Forward Typing Reverse
Typing
Anti-A Anti-B Known A Cell Known B Cell
Blood Type
A + - - +
B - + + -
O - - + +
AB + + - -
1336
1337
1338
1339
1340 PROPER IDENTIFICATION OF PATIENTS
1341
1342 Proper identification of patients must be followed. This can be ensured with proper labeling
1343 of specimen. These labels must contain the following information:
1344 Patient Name
1345 Age
1346 Sex
1347 Room Number
1348 Date and Time of Collection.
1349
1350 Information on the label and information on the request form should coincide. The type of
1351 specimen (urine, stool, semen and other body fluids) must also be written on the label. The
1352 test to be done must be indicated on the request form.
1353
1354 To ensure proper identification of patients the following must be strictly followed by the
1355 phlebotomist:
1356
1357 1. Check if patient identification tag matches with the electronic request
1358 encoded by the nurse on duty.
1359 2. Ask and let the conscious patient say his/her full name before blood
1360 extraction.
1361 3. Check the identity of unconscious patients from NOD or watcher prior to
1362 extraction.
1363 4. If identity is unknown assign a temporary identification.
1364 5.. In situations where it is not feasible for a patient to have an identification
1365 bracelet on their person, for example burn patients, the phlebotomist will

111 _______Version 1.0
1366 obtain the identification of the patient from the attending nurse or
1367 physician prior to blood collection.
1368 6. Pediatric patients must be identified by their parent/guardian.
1369
1370
1371 EXTRACTION
1372 BLOOD COLLECTION GUIDELINES

1373 1. The phlebotomist (blood collector) will collect blood samples ordered by the
1374 physician provided the sample can be collected in an evacuated tube, microtainer
1375 or syringe.
1376 - A family member or authorized person is allowed to accompany the patient/client
1377 during extraction of blood, if and when requested.
1378
1379 2. All requests for blood examinations must be paid or approved by billing section/
1380 cashier/ pharmacy before any examination will be carried out.
1381 3. The phlebotomist is limited to drawing from approved blood collection sites (see Site
1382 Selection for Blood Collection).
1383 4. Clean the venipuncture site with 70% alcohol or 1% iodine.
1384 5. Apply tourniquet several inches above the puncture site.
1385 6. Never leave the tourniquet longer than one minute.
1386 7. The needle as it enters the skin should be positioned at approximately 15 degrees to
1387 the site with the bevel up.
1388 8. After withdrawing the needle, a ball of cotton secured with a plaster is placed over
1389 the wound to stop the bleeding.
1390 9. Check the condition of the patient before he/she leaves the extraction area.
1391 10. Syringes and needles must be used only once. Dispose the used syringe and
1392 needle in a thick plastic container with hypochlorite and disinfectant.
1393
1394 11. Transfer drawn blood to appropriate tubes taking precaution to avoid hemolysis of
1395 blood sample.
1396 12. Label the tube with complete name of patient, date of extraction, initial or other
1397 identifier of the phlebotomist.
1398
1399 RELEASING OF RESULTS

1400 TURN AROUND TIME OF RELEASING OF RESULTS
1401
1402 STAT PROCEDURE:
1403
1404 30 MINUTES: CBC
1405 BLOOD TYPING
1406 CLOTTING TIME AND BLEEDING TIME
1407
1408 1 HOUR: PROTIME
1409 APTT

114 _______Version 1.0
1410 ESR
1411
1412
1413 TAT PROCEDURE: 1 HOUR- 2 HOURS: ALL TESTS
1414
1415
1416
1417 SPECIMEN AND RECORDS RETENTION

1418
MATERIAL/RECORD PERIOD OF RETENTION
Quality Control Records 2 years
Daily Maintenance Charts 1 year
Raw data and Requistions 2 years
Worksheet/Reports 2 years
SPECIMENS
Coagulation Plasma 48 hours
EDTA blood 48 hours
Peripheral Blood Smears (Normal) 7 days
Peripheral Blood Smears (Abnormal) 1 year
Slides Indefinitely
1419
1420
1421 CRITICAL VALUES
1422
NAME OF TEST LOW HIGH
Platelet Count <100x109/L >500x 109/L
Hemoglobin Count < 80 g/dL
WBC < 2.0 x 109/L
Prothrombin Time > 14 seconds
INR >6.0
1423
1424

117 _______Version 1.0
1425
1426
1427
1428
1429
1430 Legend: NPO (no food and water intake), NPP(no patient preparation),WB (whole blood)
Laboratory Procedure Specimen,Container Schedule Releasing of Other
and of official result Information
Running of
Patient Preparation the tests
Hematology
CBC
CBC/Platelet Whole Blood (WB), Within 2 hour
Platelet Count 2 ml, lavender top Daily
Platelet/Hematocrit tube,NPP
Hemoglobin(Hgb)
1.STAT Request and
Hgb/Hct
result will be
RBC prioritized.
WBC
Differential Count
WBC&Differential Ct.
Whole Blood<2 ml NPP Daily After 2 hour
ESR
WB 3-5 drops, direct
BSMP smear,NPP Daily Within 2 Day 2. Hemolyzed
WB, 2ml lavender top specimen may
Reticulocyte Ct. tube ,NPP Daily interfere with the
Clotting&BleedingTime(CT/BT) WB 2-3 drops, direct result.
smear,NPP Daily
Protime WB 1.8ml blue top tube
APTT Daily Within 2 hour
Whole Blood (WB),
2 ml, lavender top
Blood Typing tube,NPP Daily
Plasma, Sodium Citrate
D-dimer Tube, NPP Daily Within 2 hours
1431
1432
1433
1434
1435
1436
1437
1438
1439

120 _______Version 1.0
1440
1441
1442
1443
1444 WORKFLOW IN HEMATOLOGY SECTION

1445
PRE ANALYTICAL
Receiving of Test Request

Identifying the patient and extraction of blood
Pass the sample to the section for testing
ANALYTICAL
Identifying the patient and patient’s

sample
Processing the sample by request
(CBC, BLOOD TYPING, PT, APTT ETC)
Double checking of results
Verification of results by other Medtechs
POST ANALYTICAL
Releasing of results of it’s designated

turn around time.
1446
1447
1448
1449
1450
1451

123 _______Version 1.0
1452
1453
1454
1455
1456
1457
1458
1459 SAFETY MEASURE IN HEMATOLOGY SECTION
1460
1461 I. SAFETY IN THE LABORATORY
1462
1463 Personnel working in the laboratory maybe exposed to risks from various chemicals, infectious
1464 materials, fire hazard, gas leak, etc. The environment is also at risk of being contaminated by
1465 hazardous materials used and wastes generated in the laboratory.
1466
1467
1468
1469 II. PSYCHOLOGICAL SAFETY
1470
1471 Safety begins with the recognition of hazards and it is achieved through the
1472 application of common sense, a safety focused attitude, good personal behavior,
1473 good housekeeping in all laboratory works and storage area and the continual
1474 practice of laboratory techniques.
1475 The following are preventive measures and practices of personnel in the
1476 laboratory to lessen the unnecessary exposure to health and safety risks.
1477
1478 1. Annual safety review
1479 2.. Safety drill
1480 3.. General Consciousness
1481 4.. Appropriate orientation to safety rules
1482 5.Safe work environment
1483
1484 III. SAFETY AWARENESS FOR LABORATORY PERSONNEL
1485
1486 1. Label all storage areas, refrigerators, etc., appropriately, and keep all
1487 chemicals in properly labeled containers.
1488 2. Date all bottles/ reagents when received and when opened.
1489 3. Note special storage conditions.
1490 4. Post warning signs for unusual hazards such as flammable materials,
1491 biohazards or other special problems.
1492
1493 Blood and body fluids are considered potentially infected with blood borne pathogens.
1494 Safety awareness is meant to minimize exposures to laboratory personnel skin, eyes, mucous
1495 membrane or parental contact with blood or other potentially infectious materials.
1496
1497
1498

126 _______Version 1.0
1499
1500
1501
1502
1503
1504 IV. Precautions include:
1505 Appropriate barriers such as gloves, gown, masks and goggles must be worn by the Medical
1506 Technologist to prevent skin, eye exposure when contact with blood or other body fluids of
1507 patients. Laboratory personnel must have hepatitis B vaccination upon hiring.
1508
1509 Universal precautions to be followed by laboratory personnel:
1510 1. Wearing of gloves, when performing phlebotomy especially whenthe
1511 medical technologist has open wounds.
1512 2. Hand washing after removal of gloves or after any contact with, blood or
1513 body fluid in between patients is a must. Hand washing area must be
1514 accessible for collection and processing of specimen.
1515 3. Washing and reusing of gloves between patients is discouraged because
1516 microorganisms that adhere to gloves are difficult to remove
1517 4. Laboratory gown must be removed before leaving the laboratory area.
1518 Eating, drinking, smoking, applying heavy cosmetics or touching contact
1519 lenses is strictly prohibited in the laboratory work area.
1520
1521
1522
1523 V. Personal Safety
1524
1525 1. Safety goggles should be worn in the laboratory when
1526 handling blood and other body fluids to protect the eyes
1527 from chemical and other body fluids splash.
1528 3. Laboratory coat should be worn in the laboratory.
1529 4. The lab coat is designed to protect the clothing and skin from
1530 chemicals and other body fluids that may be spilled or
1531 splashed.
1532 5. Appropriate closed-toed shoes should be worn in the
1533 laboratory.
1534 6. Never pipette anything by mouth in the laboratory.
1535 7. Never store food in a refrigerator where hazardous and
1536 infectious materials are stored.
1537 8. Wash hands as soon as possible after removing protective
1538 gloves.
1539 . 9. Wash hands before leaving the laboratory.
1540
1541
1542
1543
1544

129 _______Version 1.0
1545
1546
1547
1548
1549
1550
1551
1552
1553
1554 VI. Disinfectants used by laboratory
1555
1556 17.6.1 Heat sterilization – 2500 °C for 15 minutes
1557 17.6.2 10% Lysol
1558 17.6.3. 10% hypochlorite
1559
1560
1561
1562
1563
1564 VII. Safety Equipment
1565
1566 1. The laboratory must have safety shower, wash station and fire
1567 extinguisher which must be periodically tested and inspected for
1568 proper operation.
1569
1570 2. If possible, first aid supplies must be available for the laboratory
1571 personnel.
1572
1573 3. Mechanical pipetting devices must be used for manipulating all types
1574 of liquid. Mouth pipetting is strictly prohibited.
1575
1576 4 Fume hoods should be provided for bacteriology department.
1577
1578 VIII. Biological safety
1579 1. All samples and other body fluids should be collected, transported,
1580 handled and processed using strict precautions.
1581 2. Gloves, gowns, goggles and face protection must be used if splash or
1582 splattering is likely to occur.
1583 3. Specimen should remain capped and centrifuge machine should be
1584 closed during the process, because biologic specimen could
1585 produce finely dispersed aerosol that are a risk source of infection.
1586 4. Strict implementation of proper labeling of infectious specimen must
1587 be followed.
1588 5. Biological safety cabinet should be installed in a strategic place to
1589 facilitate manipulation of infection.
1590 6. Any blood, body fluid or other potentially infectious material spills must

132 _______Version 1.0
1591 be cleaned up and the area or equipment must be disinfected

1592 immediately.
1593
1594
1595
1596
1597
1598
1599 IX. Safety Measure in cleaning spill infectious materials:
1600 1. Wear appropriate protective materials when cleaning.
1601 2. Use mechanical devices to pick up broken glasses.
1602 3. Absorb the spill with paper towel, gauge pack or tissue.
1603 A. Disinfect the spill site using 10% Lysol or 10% hypochlorite
1604 for 30 minutes to 1 hour.
1605 B. Rinse the spill site with water.
1606 C. Dispose all materials used in appropriate biohazard
1607 container.
1608
1609 X. Safety against exposure to toxic chemicals
1610 A. Laboratory must have a chemical hygiene plan.
1611 B. Maintain and update inventory periodically of all hazardous
1612 substances used in the work place.
1613 C. Proper labeling of containers and posting of warning sign.
1614 Laboratory must be provided with fume hood when reagent
1615 preparation is done.
1616
1617 XI. Electrical Safety
1618 1. Lock out/ try out malfunction electrical or mechanical equipment
1619 and machine until serviced.
1620 2. Report to the Chief Medical Technologist / electrician any small
1621 shocks. Unplug and tag equipment until serviced.
1622 3. In case of severely shocked person who cannot let go off the
1623 instrument, unplug it without touching the person using non-
1624 conductive materials like wood.
1625
1626
1627 XII. Fire Safety
1628 1. Laboratory personnel should know the location and type of portable
1629 fire extinguisher near the work area and know how to use it.
1630 2. Purchase and store flammable reagents in the smallest quantities
1631 available.
1632 4. Do not store incompatible reagents together (e.g., acids with
1633 flammables)
1634 5. Be aware of the condition and location of the fire extinguishers.
1635
1636 XIII. Housekeeping
1637

135 _______Version 1.0
1638 A. Eliminate safety hazards by maintaining laboratory areas in good

1639 state of order.
1640 B. Maintain clear passages to laboratory exits.
1641 C. Wipe down bench tops and other laboratory surfaces after each
1642 use with an appropriate cleaning or disinfecting agent.
1643 D. Keep laboratory floor dry at all times. Immediately attend to spills
1644 of chemicals or water, and notify other lab workers of potential
1645 slipping hazards.
1646
1647
1648
1649 XIV. Disposal of infectious/ hazardous specimen or materials used.
1650
1651 A. Disposal Technique
1652 1. Landfill buried
1653 2. Recycling
1654 B. Chemical wastes are those expired reagents but these are rare
1655 cases in the laboratory.
1656 a. Strong acid or base should be neutralized first before disposal.
1657 b. Solid chemical waste must be buried in landfill.
1658 c. Other liquid waste must be collected in appropriate containers
1659 and segregated properly or return to the supplier.
1660 d. Blood, body fluids and pathological tissue including media agar
1661 from Bacteriology Department must be pretreated before
1662 disposal.
1663 e. Syringe, needle, and disposable plates used by Bacteriology
1664 Department must be pretreated before disposal.
1665 f. Color coded trash bins must be provided for proper disposal of
1666 waste.
1667  Black– general waste (dry noninfectious )
1668  Green– general waste ( wet noninfectious )
1669  Yellow– infectious and pathologic tissue specimen
1670  Red – sharps
1671
1672 C. Categories of waste
1673 a. General waste – domestic type of waste from packing materials
1674 wh ich is noninfectious.
1675 b. Pathologic and infectious waste – tissues, organ, blood and body
1676 fluid of human together with related swabs for culture, blood
1677 bags and infected gloves, mask and laboratory gown.
1678 c. Sharps – needle, syringe, scalpel and broken glasses.
1679 d.Chemical – solid and liquid chemical for laboratory use,
1680 cleaning, housekeeping and disinfection procedures.
1681
1682 XV. Emergency Procedures
1683
1684  Be familiar with the emergency evacuation plan.

138 _______Version 1.0
1685  Be evacuated plan must be posted in the laboratory.

1686  Be familiar with the location, use and limitations of the safety shower, eye wash
1687 station, and spill clean-up materials, first aid kit, fire alarm and fire extinguisher.
1688  Maintain a clear path to all safety equipment at all times.
1689
1690
1691
1692
1693 XVI. Waste Disposal
1694
1695 The chemical waste produced by the machine is disposed together with the other chemical
1696 wastes as per implemented by the Hospital Waste Management Committee.
1697 LABORATORY WASTE:
1698
1699 CHEMICAL WASTE
1700 a. HAZARDOUS (flammable, corrosive, carcinogenic toxic)
1701 b. ON-HAZARDOUS (Sugar, amino acids, organic and
1702 Inorganic salts)
1703
1704 METHOD OF DISPOSAL: Toxic chemical waste must undergo pre-treatment process prior
1705 To disposal such as incineration or autoclaving.
1706
1707 Non-hazardous chemical disposed directly to the sink or treated
1708 as ordinary domestic waste.
1709
1710
1711 COLOR –CODING SCHEME CONTAINERS
1712
COLOR OFF CONTAINER/BAG TYPE OF WASTE
Black Non-infectious dry waste
Green Non-infectious
Yellow Infectious ad Pathological waste
Yellow with Black band Chemical waste including those with heavy metal
Orange Radioactive waste
Red Sharps and pressured container
1713
1714
1715 PROCEDURES FOR LABORATORY CHEMICAL WASTE DISPOSAL
1716
1717 In an effort to create a more effective, cost efficient and environmentally friendly waste
1718 management system on campus, we are proposing the following procedures for the
1719 disposal of hazardous chemical laboratory waste.
1720
1721 Procedures for disposal of hazardous waste
1722

141 _______Version 1.0
1723 Segregate materials according to the categories listed on pages 3 and 4. If possible, also
1724 segregate within categories. Unless the materials are used together during the course
1725 of an experiment, segregate all waste. Do not mix chemicals together in one container
1726 for convenience sake. We cannot stress strongly enough that different chemicals have
1727 different disposal methods. If you are unsure of which category to use or if the
1728 materials can be safely mixed into one dump, call the safety office (737-4320). Do not
1729 guess and do not assume.
1730
1731 Label all containers with the group name from the chemical waste category and an itemized
1732 list of the contents. For example, do not label a container simply `Corrosive Liquids'.
1733 List each chemical in the container, including all solvents used. List by full name only.
1734 Abbreviations, initials or chemical formulas are not acceptable labels.
1735
1736 Liquid dumps are intended for liquids only. Do not place glass or plastic items, such as tubes
1737 or pipettes, into solution dumps. If these items require disposal, package them
1738 separately. (Keep plastic and glass waste separate.) Any waste containing PCB's must
1739 not be placed in waste dumps. Special procedures are in place for disposal of PCB's and
1740 it is important to keep the volumes small.
1741
1742
1743 Packaging and containers:
1744
1745 All waste must be appropriately packaged for the waste category. For example: corrosive
1746 waste should be stored in non-metallic containers.
1747
1748 All liquid waste must be stored in leakproof containers with a screw- top or other secure lid.
1749 Snap caps, mis-sized caps, parafilm and other loose-fitting lids are not acceptable. Solid
1750 debris must be placed in plastic bags. Do not place chemical or othernon-biohazardous
1751 material in a biohazard bag. Biohazard bags are for biohazardous material only. Any
1752 waste disposed of in these bags will be treated as such. For the disposal of vials
1753 containing liquid scintillation fluid, place plastic and glass scintillation vials in separate
1754 boxes. Plastic vials can be placed loose in a cardboard box lined with a garbage bag.
1755 Glass vials should be placed in trays, then placed in a box. Attach a completed "Waste
1756 Scintillation Fluid" label (include all requested information). Please do not "hide" items
1757 for disposal in the boxes; the boxes are opened for final disposal and unexpected items
1758 can create a safety hazard to personnel.
1759
1760 Sharps (needles) must be well packaged to avoid any possibility of puncturing
1761 personnel. Used needles should be disposed of in a commercial sharps container or
1762 other suitable heavy plastic container. With the lids secured, place the containers into a
1763 cardboard box and seal with tape. Label "Sharps for disposal".
1764
1765 Importance of segregating waste:

144 _______Version 1.0
1766
1767 It is very important that hazardous materials are segregated into the proper categories.
1768 Different hazardous waste has different disposal methods. These disposal methods are
1769 also reflective in the cost of disposal. For example, waste which has the potential for
1770 reuse or recycling, such as non-halogenated organic waste is less expensive to dispose
1771 of than waste which is destroyed in a chemical incinerator, such as halogenated organic
1772 waste. There is also a tremendous environmental advantage to reusing and recycling
1773 chemical waste. When categories are mixed, the disposal method is always for the
1774 "more hazardous" chemical. To use the above examples, when a few liters of
1775 ahalogenated solvent is mixed with a drum of non-halogenated solvent, the entire
1776 volume must be considered halogenated waste. The contents of the drum, including the
1777 recyclable waste, will be destroyed in an incinerator.
1778
1779
1780 Importance of proper labelling:
1781
1782 Waste that is picked up from a lab is not sent to the final waste disposal facility in the
1783 original container. For example, a 4L bottle of waste lead solution is bulked into a 205L
1784 drum with lead solution from other labs. This is either done on-site at our campus
1785 transfer station or, in the case of larger volumes, at a waste brokers transfer station.
1786 Little on site testing is done before bulking. We depend on the labels you place on the
1787 containers. If a container is mis-labelled or incompletely labelled, that is, all the
1788 contents are not listed, we may inadvertently place the waste in the wrong bulking
1789 drum. With the many hazardous combinations of chemical incompatibility possible,
1790 this could have serious implications. The result could be the release of noxious fumes,
1791 formation of more hazardous compounds, fire or even explosion.
1792
1793 It is also important when shipping hazardous waste to the disposal companies that the
1794 exact contents of the containers are known. Transportation of Dangerous Goods (TDG)
1795 regulations require that the transport of hazardous materials include detailed shipping
1796 documents. Also, although we do not test the container's contents, the waste disposal
1797 companies do extensive testing of all waste to determine the proper waste disposal
1798 method. Surprises in the containers will result in a surcharge levied onto the cost of
1799 disposal. Besides the unnecessary cost expenditure, this can also result in an
1800 embarrassing situation when it appears that we are hiding "more hazardous" waste in
1801 with other materials.
1802
1803 Chemical Waste Categories:
1804
1805 AVOID MIXING WITHIN, AS WELL AS, BETWEEN CATEGORIES. SEGREGATE WASTE
1806 WHEREVER POSSIBLE.
1807

147 _______Version 1.0
1808 CONSULT WITH SAFETY AND ENVIRONMENTAL SERVICES (4320) BEFORE MIXING
1809 WASTE.
1810
1811 Organic waste – Phenol
1812
1813 Examples: any waste generated which contains phenol or phenol mixtures, including
1814 phenol-acid mixtures and phenol-chloroform mixtures.
1815
1816 Organic waste – Halogenated
1817
1818 Examples: any halogenated organic waste or any mixtures containing halogenated
1819 organic waste, except those containing phenol. Including chlorinated oils such as
1820 cutting oil. Examples: chloroform, 1,1,1-trichloroethane, methylene chloride
1821
1822 Organic waste – Corrosive
1823
1824 Examples: non-halogenated solvent-acid mixtures, non-halogenated organic acids such
1825 as acetic acid, trichloroacetate, acetic anhydride.
1826
1827 Organic waste - Non-halogenated plus water
1828
1829 Examples: non-halogenated solvent-water mixtures or non-halogenated solvents with
1830 greater than 20% water such as 80% ethanol.
1831
1832 Organic waste - Non-halogenated
1833
1834 Examples: acetone, toluene, acetonitrile, ethyl acetate, heptane, hexane, alcohol with
1835 less than 20% water.
1836
1837 Corrosive waste – Acid
1838
1839 Examples: hydrochloric acid, sulphuric acid, nitric acid, chromic acid, hydrofluoric acid.
1840
1841 Corrosive waste - Inorganic/acid mixture
1842
1843 Examples: iron III chloride, aluminium trichloride, mercury compounds dissolved in
1844 acid, other inorganic compounds dissolved in acid.
1845
1846 Corrosive waste - Alkali
1847
1848 Examples: hydroxides, phosphates, ammonia.
1849
1850 Corrosive waste - Alkali mixture

150 _______Version 1.0
1851
1852 Examples: compounds dissolved in hydroxides, phosphates, ammonia.
1853
1854 Waste Oil
1855
1856 Examples: used pump oil, crankcase oil, hydraulic oil. Excluding halogenated oils such
1857 as cutting oils.
1858
1859 Reactive waste
1860
1861 Examples: air and water sensitive materials such as Grignard reagent, alkaline metals,
1862 reactive halides.
1863
1864 Waste oxidizers
1865
1866 Examples: all nitrates, potassium dichromate, metal peroxides such as chromium
1867 dioxide.
1868
1869 Inorganic waste
1870
1871 Examples: heavy metal compounds and solutions such as those of mercury, lead,
1872 copper and zinc (except those dissolved in acid), other inorganic compounds not
1873 covered by another category.
1874
1875 Hazardous waste –Other:
1876
1877 Examples: waste not covered by any other category. All waste in this category must be
1878 segregated. No mixtures. Does not include radioactive waste, biohazardous waste,
1879 highly hazardous waste, explosive waste or surplus chemicals.
1880
1881 Materials not covered under these procedures:
1882
1883 Radioactive waste
1884
1885 Follow procedures in place for the disposal of radioactive waste.
1886
1887 Biohazardous waste
1888
1889 Follow procedures in place for the disposal of biohazardous waste.
1890
1891 PCB waste
1892

153 _______Version 1.0
1893 Includes any waste containing or suspected of containing PCB's. Follow procedures in
1894 place for the disposal of PCB's.
1895
1896 Explosive or other highly hazardous materials
1897
1898 Examples: peroxide formers such as aged ether, di and tri -nitro compounds, old flares,
1899 azides. These materials require special disposal. Consult the safety office for
1900 arrangements.
1901
1902 Surplus chemicals
1903
1904 Examples: any chemical which is no longer used or needed but which is still in good,
1905 usable condition. Consult the safety office for an assessment.
1906
1907 NATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME
1908
1909 Procedure:
1910
1911 1. National Kidney Transplant Institute National Reference Laboratory usually send the invitation
1912 for the annual quality assurance program for Blood count during first quarter of the new year, the
1913 deadline for registration usually is April-May.
1914
1915 2. Hematology Section Head will send a letter to COO for the requisition of funds for the NEQAS of
1916 Hematology.
1917
1918 3. Once approve, fill up the registration form and encash the check to deposit in their bank account.
1919
1920 4. After depositing, send the registration form along with the original deposit slip and indicate the
1921 bank branch where the transaction was done.
1922
1923 5. NKTI usually send the NEQAS samples along with the receipt from September to November of
1924 that year.
1925
1926 6. Hematology head records the receiving of specimen and the NEQAS samples should be tested
1927 within 2 weeks after receiving.
1928
1929 7. The NEQAS sample results should be send immediately before the deadline.
1930
1931 1. The NEQAS certificate along with the results will be send to the hospital after a few months.
1932
1933
1934
1935
1936
1937
1938

156 _______Version 1.0
1939
1940
1941
1942
1943
1944
1945
1946 CHAPTER 5
1947 REFERENCES
1948
1949 Henry, John Bernard. Clinical Diagnosis and Management by LaboratoryMethods. W.B. Saunders
1950 Company, 17th ed.,1984
1951
1952 College of American Pathologist
1953 Clinical Diagnosis and Management by Laboratory Medicine
1954
1955 Sysmex Automated Hematology Analyzer XS Series
1956 XS-1000i/XS-800i, Instruction for use
1957
1958 ABX Diagnostic, ABX Pentra XL 80 User Manual
1959
1960
1961

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1 DAVAO MEDICAL SCHOOL FOUNDATION, INC.

2 DR. A. GAHOL AVENUE, BAJADA, BRGY. 19 – B, DAVAO CITY

Prepared by: Approval Date:

ERIKA MINA P. CELESTE ________________________________

AGATHA LAARNI C. LACUNA, RN ________________________________

Manual No. ANC- ____ -M01

OSCAR P. GRAGEDA, MD,

VICTOR D. ESPINO, MD, FPUA, FPCS

OLIVER G. VICTORIANO, DBA

ATTY. ALBERTO RAFAEL L. APORTADERA

12 This Procedures Manual is contributed by the following Laboratory Personnel:

14 ERIKA MINA P. CELESTE

2 GENERAL POLICIES FOR SECTION 21

3 GENERAL STANDARD OPERATING PROCEDURES 40

26  Hematology Vision and Mission

Supersedes: Previous Procedures Manual of the Hematology Section

Version No.: 1.0

Authored by: Recommended by:

ERIKA MINA P. CELESTE OLIVER G. VICTORIANO, DBA

AGATHA LAARNI C. LACUNA, RN ATTY. ALBERTO RAFAEL APORTADERA

RANDY IAN J. ESPINOSA, PTRP

Chapter 1: Section Overview| 2

89 DESCRIPTION OF KEY PERSONNEL

Chapter 1: Section Overview| 3

Chapter 1: Section Overview| 4

Chapter 1: Section Overview| 5

Chapter 1: Section Overview| 6

Chapter 1: Section Overview| 7

301 III. LABORATORY AIDE

Chapter 1: Section Overview| 8

345 3. QUALIFICATION GUIDE

Chapter 1: Section Overview| 9

Supersedes: Previous Procedures Manual of the Hematology Section

Version No.: 1.0

Authored by: Recommended by:

Hazel Anne G. Dacayo, RMT, MLS(ASCPi) OLIVER G. VICTORIANO, DBA

AGATHA LAARNI C. LACUNA,RN FR. MANUEL B. PEREZ, SJ MD

RANDY IAN J. ESPINOSA, PTRP

Chapter 1: Section Overview| 10

395 Quality Assurance (QA)

Chapter 1: Section Overview| 11

429 CONSIDERATION OF CHOOSING A CONTROL SOLUTION

Chapter 1: Section Overview| 12

Chapter 1: Section Overview| 13

528 REAGENTS PROTOCOL

Chapter 1: Section Overview| 14

552  General Policy

Supersedes: Previous Procedures Manual of the Hematology Section

Version No.: 1.0

Authored by: Recommended by:

ERIKA MINA P. CELESTE OLIVER G. VICTORIANO, DBA

AGATHA LAARNI C. LACUNA,RN ATTY. ALBERTO RAFAEL L. APORTADERA

RANDY IAN J. ESPINOSA, PTRP

Chapter 1: Section Overview| 15

563 GENERAL POLICY

Chapter 1: Section Overview| 16

595 I.2 Everybody must pay attention to the endorsement process.

603 1.Silence must be maintained at all times in all areas.

619 TELEPHONE COURTESY