Active Outline

General Information

Course ID (CB01A and CB01B)
HTEC D080.
Course Title (CB02)
Clinical Hematology Laboratory
Course Credit Status
Credit - Degree Applicable
Effective Term
Fall 2021
Course Description
This course introduces the various techniques and safety procedures used in the clinical hematology laboratory. Students will prepare and stain blood slides, perform microhematocrits, hemoglobin analysis, ESR, and Sickle Cell Screening. Students will perform manual WBC's and platelet counts using a hemacytometer. Students will evaluate printouts from the automated hematology analyzer. Students will determine the morphology and identification of common human blood cells. Special stains (Reticulocyte, giemasa, and Kleihaure-Betke) will be done. Correlating test results with disease states will be accomplished. Successful completion of this course and HTEC D080A, HTEC D081A, HTEC D081., HTEC D082A and HTEC D082. are required to enroll in Clinical Hematology/Urinalysis/Coagulation Practicum, HTEC D180. This course must be successfully completed in order to qualify for the clinical externship and take the exam.
Faculty Requirements
Course Family
Not Applicable

Course Justification

This course is CSU transferable and part of a CTE program. It was developed based on the National Accrediting Agency of Clinical Laboratory Sciences and California State Department of Public Health accreditation standards required for Medical Laboratory Technicians training programs. This course meets part of the requirement for the Certification of Achievement-Advanced Medical Laboratory Technician. This course introduces students to basic laboratory skills in the clinical hematology laboratory.

Foothill Equivalency

Does the course have a Foothill equivalent?
No
Foothill Course ID

Course Philosophy

Formerly Statement

Course Development Options

Basic Skill Status (CB08)
Course is not a basic skills course.
Grade Options
  • Letter Grade
  • Pass/No Pass
Repeat Limit
0

Transferability & Gen. Ed. Options

Transferability
Transferable to CSU only

Units and Hours

Summary

Minimum Credit Units
1.5
Maximum Credit Units
1.5

Weekly Student Hours

TypeIn ClassOut of Class
Lecture Hours0.00.0
Laboratory Hours4.50.0

Course Student Hours

Course Duration (Weeks)
12.0
Hours per unit divisor
36.0
Course In-Class (Contact) Hours
Lecture
0.0
Laboratory
54.0
Total
54.0
Course Out-of-Class Hours
Lecture
0.0
Laboratory
0.0
NA
0.0
Total
0.0

Prerequisite(s)

Corequisite(s)

HTEC D080A

Advisory(ies)

Limitation(s) on Enrollment

Entrance Skill(s)

General Course Statement(s)

Methods of Instruction

Discussion of assigned reading

Quiz and examination review performed in class

Collaborative learning and small group exercises

Laboratory experience which involve students in formal exercises of data collection and analysis

Laboratory discussion sessions and quizzes that evaluate the proceedings weekly laboratory exercises

Assignments

  1. Readings from required test, laboratory manual and supplemental sources.
  2. Perform laboratory procedures as outlined in laboratory manual.
  3. Completed laboratory worksheets that include observations, experimental results and critical analysis of data.

Methods of Evaluation

  1. Class activity - Discussions and oral question and answer sessions that test comprehension and require synthesis and application of course material. Graded according to a rubic.
  2. Lab Activity - Practice and demonstration of techniques used in the student laboratory designed to demonstrate critical thinking skills and to problem solve as required in the assignments and experimental investigations. Practical exams given, graded on a scale.
  3. Written Assignments - Laboratory worksheets designed to evaluate the student's performance understanding of the course material. Graded on points. Points are given based on a rubic for each assignment.
  4. Comprehensive Final Examination - Written test and hands on demonstration of proper laboratory techniques requiring the student to demonstrate their ability to summarize, integrate and critically analyze concepts examined throughout the course.
  5. Problem Solving - Case studies and analyzing unknown samples evaluate the student's ability to apply critical thinking skills to a clinical situation.
  6. Objective Test - Written test examination designed to demonstrate students understanding of the course material presented.
  7. Quizzes - Quizzes designed to cover each laboratory session will measure the student's understanding of the course material on a routine basis and help identify any areas that may need extra attention.
  8. Skill Demonstration - Laboratory practical exam demonstrating the student's ability to integrate the knowledge acquired in the course with the technical skills necessary for the MLT profession.

Essential Student Materials/Essential College Facilities

Essential Student Materials: 
  • None.
Essential College Facilities:
  • Laboratory classroom equipped with microscopes, automated hematology analyzer, chemistry and urinalysis analyzers, biological safety cabinet, and other clinical instrumentation and safety equipment; also includes reagents and other material needed for basic clinical tests
  • Books and other reading material is available for the students use to support and increase knowledge in the field of medical laboratory science

Examples of Primary Texts and References

AuthorTitlePublisherDate/EditionISBN
Keohane, Elaine."Rodak's Hematology: Clinical Principles and Applications", 6th Edition". Saunders. 2019

Examples of Supporting Texts and References

AuthorTitlePublisher
Carr, Jacquelin and Bernadette F. Rodak. "Clinical Hematology Atlas, 5th Edition". Saunders, 2017.

Learning Outcomes and Objectives

Course Objectives

  • Practice safety and the use of Standard Precautions as they apply in the clinical hematology laboratory according to Occupational Safety and Health Administration (OSHA) mandates.
  • Demonstrate safe use and disposal of biohazardous materials.
  • Demonstrate proper technique in applying differential stains to blood smears.
  • Critique and practice hematocrit testing using anticoagulated blood samples, compare and contrast normal ranges for adult males and females, and infants.
  • Calculate three RBC indices and interpret the significance of their changes in the various anemias.
  • Demonstrate the use of an automated hematology analyzer including start-up, routine operation and maintenance.
  • Perform, review and critique quality control tests on an automated hematology analyzer.
  • Set up and read test results from an Erythrocyte Sedimentation Rate (ESR) test, compare and contrast normal ranges for adult males and females.
  • Set up, read, interpret test results and discuss the prevalence of sickle cell disease and sickle cell trait among the African and Mediterranean cultures.
  • Demonstrate proper use of the microscope including routine maintenance.
  • Compare and contrast cell counts performed on a heamcytometer with those from an automated heamatology instrument. Compare and contrast normal ranges for adult males and females as well as infants and adolescence (referring to Red Blood Cell Count, RBC).
  • Prepare peripheral blood smears and perform differential cell counts on normal and abnormal specimens.
  • Dilute methylene blue stain and prepare slides for and perform reticulocyte counts, compare and contrast normal values for adult males and females.
  • Prepare and stain both a thick and thin Giemsa blood film slide.
  • Perform Kleihauer-Betke test by preparing 3 smears each for controls and unknown.

CSLOs

  • Practice proper application of OSHA standards as pertains to the clinical hematology laboratory.

  • Use proper technique and follow written laboratory procedures to perform Complete Blood Count (CBC) with differential and patelet estimate on a minimum of 2 normal blood samples.

  • Identify abnormal CBC results and correlate to possible causes.

Outline

  1. Practice safety and the use of Standard Precautions as they apply in the clinical hematology laboratory according to Occupational Safety and Health Administration (OSHA) mandates.
    1. Demonstrate the basic aspects of infection control policies, by:
      1. Using Standard Precautions when handling any laboratory specimen.
      2. Using proper handwashing technique.
      3. Choosing appropriate personal protective equipment for working in the clinical laboratory.
      4. Selecting proper glove size to be used during laboratory sessions and demonstrating proper removal and disposal of soiled gloves.
    2. Relate the importance of a safety program as defined in the Safety Manual (lab manual for this course) by supplying the correct answer to questions or by demonstration of appropriate actions related to prepared simulations.
    3. Explain the pre and post exposure prophylactic measures for handling potentially occupational transmission of certain pathogens.
    4. Select, prepare and use proper disinfectants to decontaminate the work area when a hazardous spill has occurred or when beginning or ending a laboratory session.
    5. Explain the basic steps to first-aid.
    6. Locate, describe and/or explain the following:
      1. Evacuation routes
      2. Biohazardous material
      3. Blood Borne Pathogens
      4. Standard Precautions
      5. Aerosols
      6. SDS (Safety Data Sheets)
  2. Demonstrate safe use and disposal of biohazardous materials.
    1. Describe how to properly segregate and dispose of various types of waste products generated in the clinical laboratory, including:
      1. Use of sharp containers for needles, lancets, glass and other sharps.
      2. Use of biohazard disposal bags for specimens and other contaminated material disposal.
    2. Demonstrate, via weekly performance, proper disposal of biological specimens, soiled gloves and sharps, as instructed by procedure or instructor.
  3. Demonstrate proper technique in applying differential stains to blood smears.
    1. Demonstrate proper technique for making peripheral blood smears by submitting 2 smears to the instructor.
    2. Demonstrate proper technique for staining peripheral blood smears by successfully staining the above 2 smears using Wright's stain.
    3. List the different types of stains used in the clinical hematology laboratory and explain their uses:
      1. Wright's stain
      2. Wright-Giemsa stain
      3. Methylene Blue stain
    4. Describe the staining characteristics of: (referring to the Wrights stain)
      1. Red blood cells
      2. White blood cells
      3. Platelets
    5. Identify the difference between staining characteristics of the formed elements in the blood. Then verify staining technique by reviewing slides for proper staining of cellular elements. (Referring to the Wrights stain),
      1. Lymphocyte nuclei & cytoplasm
      2. Monocyte nuclei & cytoplasm
      3. Neutrophil nuclei, cytoplasm & granules
      4. Eosinophil nuclei, cytoplasm & granules
      5. Basophil nuclei, cytoplasm & granules
    6. Describe the mechanism of action of the Wright's stain and the importance of pH in the staining process.
  4. Critique and practice hematocrit testing using anticoagulated blood samples, compare and contrast normal ranges for adult males and females, and infants.
    1. Perform two (2) hematocrits (spun) on anticoagulated blood samples and record results using proper procedure.
    2. Identify the different layers obtained on a spun hematocrit and describe their clinical relevance.
      1. Plasma
      2. Buffy coat
      3. Red Blood Cells
    3. Compare and contrast normal ranges for adult males and females, and infants.
      1. Adult males: 42-52%
      2. Adult females: 37-47%
      3. Newborn: 53-65%
      4. Infants: 31-43%
    4. Define and describe the quality control associated with spun hematocrits.
    5. Categorize common causes of error in manual hematocrit techniques and recommend corrective action.
      1. Improper sample collection
        1. Incorrect anticoagulant - collect blood sample in tube containing EDTA as an anticoagulant
        2. Clotted blood - redraw specimen assuring sample is well mixed after collection
        3. Hemolyzed specimen - redraw specimen avoiding unnecessary trauma to the RBC's
        4. Excess EDTA (inadequate blood for the fixed amount of EDTA in the blood collection tube - redraw specimen ensuring a proper "fill"
      2. Improper sample processing
        1. Insufficient centrifugation - follow manufacturer's instructions for the particular microhematocrit centrifuge being used.
        2. Insufficient seal - blood sample will be lost during centrifugation if the microhematocrit tube is not sealed completely
  5. Calculate three RBC indices and interpret the significance of their changes in the various anemias.
    1. Define the three RBC indices and given values, demonstrate ability to calculate these indices.
      1. Mean Corpuscular Volume (MCV) = [Hematocrit / RBC (in millions)] X 10
      2. Mean Corpuscular Hemoglobin (MCH) = [Hemoglobin (g) / RBC (in millions)] X 10
      3. Mean Corpuscular Hemoglobin Concentration (MCHC) = [Hemoglobin (g) / Hematocrit] X 10
    2. Discuss the clinical significance of RBC indices, interpret results of the calculations and relate these results to physiological conditions.
    3. Define anemia and aplastic anemia and correlate laboratory tests associated with anemia.
      1. Anemia - a condition in which there is reduced oxygen carrying capacity of the blood and therefore a reduced amount of oxygen reaching the tissues and organs.
      2. Aplastic anemia - failure of the bone marrow to produce blood cells
      3. Laboratory tests include: CBC, reticulocyte count, peripheral blood smear, and bone marrow examination.
  6. Demonstrate the use of an automated hematology analyzer including start-up, routine operation and maintenance.
    1. Perform daily start-up of the automated hematology analyzer.
    2. Perform and document daily maintenance on the automated hematology analyzer.
    3. Perform and document weekly, monthly and as needed maintenance on automated hematology analyzer.
    4. Analyze patient samples with 95% accuracy, on the automated hematology analyzer.
    5. Confirm instrument scattergram results by performing a manual differential using the microscope.
  7. Perform, review and critique quality control tests on an automated hematology analyzer.
    1. Analyze controls.
    2. Troubleshoot out of control results.
    3. Document/store results appropriately.
  8. Set up and read test results from an Erythrocyte Sedimentation Rate (ESR) test, compare and contrast normal ranges for adult males and females.
    1. Set up and record results for 2 ESR's.
    2. Categorize and describe the sample collection and technical factors that can affect the accuracy of the ESR and recommend corrective action..
      1. Improper sample collection
        1. Use EDTA anticoagulated blood collection tube and obtain a proper "fill"
        2. Hemolysis affects testing - obtain a blood sample without unnecessary trauma
        3. Fibrin affects testing - ensure that immediately after collection blood specimen has been properly mixed
      2. Technical Factors
        1. Tube must remain exactly vertical during the one-hour test time
        2. Test must be read at exactly 60 minutes
        3. The counter on which the rack is placed must be level and free of vibrations
        4. Test should be conducted at room temperature
        5. Tube should not be placed in a draft, and it should not be exposed to direct sunlight
    3. Describe the QC procedures necessary for ESR's.
    4. Identify the clinical factors that can increase or decrease an ESR.
      1. Increased ESR
        1. Bacterial infection
        2. Acute pelvic inflammatory disease
        3. Ruptured ectopic pregnancy
        4. Myocardial infarction
        5. Rheumatic fever and Rheumatoid arthritis
        6. Pyogenic arthritis
        7. Increased fibrinogen and immunoglobulin
        8. Rouleaux formation
        9. Heparin anticoagulant
        10. Menstruation and pregnancy
        11. Multiple myeloma
        12. Anemia
      2. Decreased ESR
        1. Extreme increases in plasma viscosity
        2. Sickle cell anemia
        3. Spherocytes
        4. Microcytes
        5. Polycythemia
    5. Compare and contrast the normal ranges of the ESR for adult males and females, includes infants and adolescences (referring to RBC count)
      1. Adult men = 0-15 mm/hr
      2. Adult women = 0-20 mm/hr
  9. Set up, read, interpret test results and discuss the prevalence of sickle cell disease and sickle cell trait among the African and Mediterranean cultures.
    1. Set up, incubate and interpret results of a sickle cell prep.
    2. Explain the genetic abnormalities that make up sickle cell disease and sickle cell trait
      1. HbSS vs. HbS
      2. Discuss the prevalence of sickle cell disease and sickle cell trait among the African and Mediterranean cultures.
    3. State limitations of the sickle cell prep test and recommend corrective action to correct or resolve.
      1. Severe anemia can cause false negatives - if total hemoglobin is <8g/dL, double the sample volume to 100uL.
      2. Patients with multiple myeloma, cryoglobulineamia and other dysglobulinemias may give false positive results. Wash patient red blood cells in physiologic saline to minimize these problems.
      3. Elevated levels of Hemoglobin F can cause false negative results - Do not test infants less than 6 months of age.
      4. Recent transfusion can cause false positive or false negative results - ensure patient has not been transfused recently.
      5. Some rare hemoglobin variants such as Hemoglobin C Harlem or C Georgetown may give a positive reaction.
      6. This test is a screening procedure only. All positive or questionable results should be further evaluated with hemoglobin electrophoresis.
  10. Demonstrate proper use of the microscope including routine maintenance.
    1. Identify and explain the various support systems of the microscope
      1. Frame
      2. Stage
      3. Light source
      4. Condenser
      5. Diaphragm
      6. Body tube
      7. Adjustment knobs
    2. Define and identify the optical system
      1. Eyepiece (monocular or binocular)
      2. Objective lens
      3. Low power and high power
      4. Oil immersion lens
    3. Focus on an object under low, high dry and oil immersion lens.
    4. Clean the microscope properly after each use.
    5. Rotate the objective properly to ensure it does not contaminate the "dry" lens.
    6. Increase and/or decrease the light intensity as needed.
    7. Identify points, which correlate with the proper care of a microscope.
  11. Compare and contrast cell counts performed on a heamcytometer with those from an automated heamatology instrument. Compare and contrast normal ranges for adult males and females as well as infants and adolescence (referring to Red Blood Cell Count, RBC).
    1. Fill an unopette from an EDTA tube or capillary puncture using correct technique per your laboratory procedure.
    2. Charge a hemacytometer.
    3. Focus on the grid of the microscope.
    4. List the Hemacytometer Counting "Rules"
      1. When counting cells on a grid, cells lying on the top and left borders ARE counted.
      2. Cells on the right and bottom borders are NOT counted.
    5. Locate the routine "red cell counting area", "white cell counting area" and "platelet counting area" of the grid.
    6. Complete with 95% accuracy, mathematical problems given the depth, area counted and dilution used in a manual count.
    7. Perform 3 counts from EACH cell type using parameters set for accuracy.
    8. List errors inherent in the performance of manual counts.
      1. Small sample size
      2. Nature of the sample - must be free of clots
      3. Faulty laboratory equipment
      4. Inherent error of cell distribution in the counting chamber
      5. Compare and contrast procedure of manual count to an automated platelet count
      6. Understand the differences between capillary and automated platelet counts
      7. Describe the clinical significance of decreased and increased cell counts.
      8. Compare platelet counts to different disorders associated with platelet dysfunction.
      9. Explain how to correct for "in vitro" platelet aggregation.
      10. Discuss accuracy vs. precision
    9. Compare and contrast your manual counts with those from the automated hematology analyzer.
    10. Compare and contrast normal ranges for adult males and females as well as infants and adolescence (referring to RBC count).
      1. Adult male: 4.7-6.1 X 10 /uL
      2. Adult female: 4.2-5.4 X 10 /uL
  12. Prepare peripheral blood smears and perform differential cell counts on normal and abnormal specimens.
    1. Perform 5 manual differentials including RBC morphology and platelet estimate.
      1. Identify each cell type within the granulocytic and agranulocytic cell line.
      2. List and detail the morphologic characteristics in each stage of normal granulocyte development, as seen on the peripheral smear.
      3. Name the types of inclusions seen in white blood cells and red blood cells, state their composition and staining characteristics.
      4. Identify cells that are "not normal" as seen on the peripheral smear.
      5. Estimate platelet counts and correlate them with automated counts.
      6. Compare and contrast the different cell line maturation schemes of normal cells seen on a peripheral smear.
      7. Identify plasma cells and atypical lymphocytes from slides and understand their significance in peripheral smears.
      8. Compare and contrast the variations seen in the differential depending upon where the differential is performed on the smear (what part of the smear)
        1. Neutophilia
        2. Eosinophilia
        3. Infections mononucleosis
        4. Leukemia
        5. Thrombocytosis
        6. Throbocytopenia
        7. Neutropenia
        8. Myelodysplastic syndromes
      9. Correlate RBC morphology with RBC indices.
    2. Identify key morphological factors, which aid in the cell identification and contrast the following factors to the specific identification of a specific cell.
      1. Nucleus to cytoplasm ration
      2. Chromatin pattern of nucleus
      3. Presence/absence of granules
      4. Shape and size of nucleus
      5. Presence/absence of vacuoles
      6. Density of color
  13. Dilute methylene blue stain and prepare slides for and perform reticulocyte counts, compare and contrast normal values for adult males and females.
    1. Describe the maturation of the reticulocyte.
    2. Describe how the reticulocyte count can be used in the diagnosis of anemias.
    3. Prepare 2 peripheral blood smears. Use Methylene blue stain; properly stain 2 slides for manual reticulocyte counts.
    4. Calculate absolute reticulocyte count and reticulocyte production index from reticulocyte results, hematocrit and RBC count.
    5. Compare and contrast manual reticulocyte count with that from an automated hematology analyzer.
    6. Compare and contrast normal ranges for adult males and females
      1. Adult males: 1.1-2.1%
      2. Adult females: 0.9-1.9%
  14. Prepare and stain both a thick and thin Giemsa blood film slide.
    1. Scan and examine for microfilariae and blood parasites.
    2. Scan and examine prepared Giemsa blood films from the laboratory library for microfilariae and blood parasites.
  15. Perform Kleihauer-Betke test by preparing 3 smears each for controls and unknown.
    1. Stain Kleihauer-Betke slides according to proper procedure.
    2. Count the appropriate number of fields and calculate % fetal cells with 80% accuracy.
Back to Top