For the next 3weeks starting from this week, i will be in the haematology lab. There are 2haematology labs which are the haematology routine lab and the haematology stat lab. The haematology stat lab will handle urgent and emergency samples such as blood samples from the accident and emergency department. The haematology routine lab will handle blood samples from the wards and samples which are not urgent. The haematology lab conducts many different types of tests which includes: Full Blood Count(FBC), Erythrocyte Sedimentation Rate(ESR), PT, PTT, APTT, 50%PT, reticulocytes count, differential count and bleeding time.
I was posted to the haematology stat lab for the first day. When a sample arrived from the emergency depratment, the medical technologists will check the blood tubes to make sure that the names and the identity on the sticky labels and the tubes are correct and they will check for the tests ordered e.g. FBC. After that blood film or smear will be made if the blood sample is in a baby tube (small tube) and automated FBC will be run. For blood sample which are in normal adult tubes, automated FBC will be run first. If the FBC results are abnormal or out of range, then blood smear will be made to see the differential count. The results will be printed out and for the haematology stat lab, 2reports will be printed out, one for the patient to bring it to the clinic for doctor's review and another for the lab to keep. For the routine lab, only one report will be printed out and attached to the request form. If the Hb level falls below 8g/dL, the medical technologist will call the doctor directly to report the results so if there is a need for blood transfusion for the patient, it can be done as soon as possible.
On the first day, i observed the automated FBC on the machine and i did ESR. i also observed the staining process on the automated stainer and practise on making blood smear or blood film. Till now i am still practising to produce a perfect blood smear:) it is quite difficult to make a perfect one without a "tail". Tails are not supposed to appear as it may lead to inaccurate results as the white blood cells may all "clump" at the tail end. On the first day, i also observed the Dengue Serology test which is to detect IgG and IgM and observed Bleeding Time done on a patient by an experienced medical technologist.
On the second day which is today, i was posted to the routine haematology lab which i helped to check and stick the labels on the patients tube and i run the automated full blood count (FBC) on the patients' samples. I also observed the bone marrow aspiration done by a doctor on a patient for immunophenotyping and cytogenetics studies. And i also practise on making a nice blood film during my free time.
hmm for your info, i am going to talk about bleeding time which may be unfamilar to many of you. Bleeding Time is a test whereby a small cut is made on the forearm of the patient and the time between the cut is made to the moment bleeding stop is measured. However, bleeding time is not able to diagnose plate disorder. It only shows there is a need for more testing. In the lab that i am working now, they used Surgicutt for bleeding test.
Bleeding Time
MATERIALS :
-Filter Paper
-Antiseptic Swab
-Stopwatch
-Plaster
-Sphygmomanometer (for measuring pressure, pressure should be about 40mmHg for junior to adult)
METHOD:
-The sphygmomanometer cuff was place on the upper arm and inflated to 40mmHg.
-The area which the cut is to be made, is being cleansed with antiseptic swab and allowed to dry.
-The Surgicutt was removed from the pack and safety clip was removed.
-The device was hold bewtween the thumb and middle finger.
-The device was rested on patient's forearm and the trigger was pushed gently and the stopwatch was started simultaneously.
-The device was removed immediately after the cut was made on the forearm.
-The blood was blotted from the filter paper close to the cut but not directly touching the cut every 30secs.
-The process was repeated for every 30secs until no blood stained the filter paper.
-The timer is stopped and the bleeding time was determined to the nearest 30secs.
-Sphygmomanometer was removed and the incision (cut) site was cleaned with antiseptic swab and a plaster was placed over the site.
so yup thats about it:)
Rachael
0606168C
Tg01
29 comments:
Hi, working in the haematology lab sounds interesting..
Just some questions: You mentioned you observed the doctor performing the bone marrow aspiration on the patient. Can briefly describe how is it done? Is the patient anaesthetized?
And since you said the bleeding test is not used to diagnose plate disorder (by the way what's that?), so what exactly is the bleeding test for?
Thanks.
Ka Hang
TG02
hihi...once you get your chance to go to the haematology lab u will know how busy the lab is...haha...
regarding the bone marrow aspiration, it was done by a doctor and when i entered the room, the doctor was doing the aspiration so i didnt really get to see the first part...however, i know that the patient is being locally anaesthetized which they called is LA...
the bleeding test is for patients with bleeding tendency and it is done basically to see if the patient will blee easily.
Rachael
Tg01
hihi
working in haematology lab really sounds busy, and i believe that you learnt a lot of new things=)
i have a question for you...
what is the different between PT and 50% PT ?
why there is a need to perform 50%PT when there is PT?
THANKS =}
TING JIE
TG02
hi...actually 50%PT is known as the 50%correction for PT...PT is a screening test while 50%correction for PT is an indicator to find out if a patient has a deficiency of coagulation and circulating factors:)
Rachael
Tg01
Heys Rach! Hope u're enjoying ur attachment =)
I have some questions for you. You mentioned that u were posted to the Dengue Serology lab then they were detecting IgG and IgM and observing bleeding time done on a patient.
1) Usually a person with Dengue will have decreased platelet count?
2) What is the purpose of testing the bleeding time? Is it used to test if the platlet count is significantly low to affect the bleeding time?
3) Why don't they do platlet count directly instead of bleeding time? Is it because the bleeding time will differs for each individual even if both person have same level of platelet count?
=P
Thanks
Jean
TG02
Hi! Hope things are going fine =)
I'm wondering if you can tell me more about the Sphygmomanometer? Does it has any other functions, other than measuring pressure?
Tq!
Tan Zhao Rong
Tg01
Hey rac.. i was just wondering, whats a plate disorder?
Andika Putra TG01
Hi rachael,
So have you tried the PT testings already? I've done it before, and my hospital do not have 50%PT. What is the difference between this and the normal ones?
Sorry, My post was the previous one, LESLIE (:
Hi Jean, oh i wasnt posted to the Dengue Serology Lab...its just that the haematology lab that i am in now has this type of test so bleeding time its not related to Dengue.
bleeding time is used on patients who has a history of prolonged bleeding after cuts or to find out the patient's bleeding response or tendency or has a history of bleeding probelms.
bleeding time does not diagnose platelet disorder it only shows the need for more testing e.g. platelet count.
Rachael
Tg01
Hi...hmm basically the Sphygmomanometer is just used to measure blood pressure and to restrict blood flow:)
Rachael
Tg01
Hi...a platelet disorder means that your platelets are abnormal...e.g cannot form clot thus you cannot stop bleeding...
Rachael
Tg01
Hi Leslie you asked the same qns as Ting Jie:) i have already replied her so you can scroll up and see:)thanks
Rachael
Tg01
Hi Rachael,
Hope you are enjoying yourself
Just 1 question:
Since a Sphygmomanometer is to restrict blood flow and to measure the blood pressure, then how does this plays a part in the bleeding test?
Thanks.
Xin Yi
TG02
ps: the comment previously deleted was accidentally done by me.
Hi jean to add on to your curiosity, i will share with you the principle of bleeding time...after a cut is being made, a haemostatic plug will be formed and this plus is dependent on whether there is adequate platelets to adhere to the subendothelium and to form aggregates...so if there is not enough platelets, the aggregates cannot be formed and thus the bleeing will not stop and the bleeding time will be prolonged:)
Rachael
Tg01
hi Xin Yi, haha i asked u one qns ok?how to delete comments?
oh the sphygmomanometer is inflated to 40mmHg so as to restrict the blood flow so that during the test the blood wont like "rushed out" at once...
Rachael
Tg01
hey rach,
you mentioned that the bone marrow aspiration is for immunophenotyping and cytogenetics studies. is it possible i you explain more about it because i am quite unsure what exactly is immunophenotyping and cytogenetics and how bone marrow aspiration can help in acquiring the results.
thanks!
Liyanah Zaffre
0607718D
TG02
Hey Racheal,
Bleeding time is done on patient with bleeding diorder. So how do you know the patient has an abnormal bleeding time?What is the reference range of a normal bleeding time?
Can bleeding time be use on any other situation instead of patient with bleeding disorder only?
Dyana
0605169B
Hi,
Haha. I think you can only delete your own comments.
Xin Yi
TG02
There is actually a trash bin kind of icon at the bottom left hand corner of your comment. I think you can only delete the comment if you have that icon.
Xinyi
what's plate disorder? and if bleeding test is not used to diagnose that then what is it really meant for? oh and any tips on how to do a good blood smear? like how to reduce the tails and such
what's plate disorder? and if bleeding test is not used to diagnose that then what is it really meant for? oh and any tips on how to do a good blood smear? like how to reduce the tails and such
yuxuan
Hi Liyanah, for haematology lab, we just collect the bone marrow for PBF making to be view under the microscope to detect any abnormal cells related to Leukemia for the immunophenotyping and cytogenetics stdies, it will be done by other labs which i have not been to:)
Rachael
Tg01
Hi Dyana, bleeding time test is done to detect any platelet disorder while PT, APTT test is to test for any factors disorder. Bleeding time test is done when the patient is suspected to have platelet disorder:)
Reference Interval:
Adult- 2to8 minutes
Junior(5mths to 15yrs)- 1.30to8.99minutes
Newborn(1 to 4mths)- 0.85to1.65minutes
Rachael
Tg01
Hi yuxuan, bleeding time test is used when the patient is suspected to have platelet disorder e.g in Von Willebrand's disease. alot of people confused bleeding time with PT,APTT test...PT and APTT test is used to diagnose any intrinsic and extrinsic factors deficiency while bleeding time is used for platelets disorder.
As for the making of PBF, dont use too much or too little blood e.g. use a capillary tube and dot about 4 dots on the slide:)hold the spreader firmly and just go through the slide without stopping:)actually practice makes perfect:)haha
Rachael
Tg01
hello!
hmm. who actually performs the test for bleeding time? is it the doctors or you guys, the med tech? do you go down to the ward to observe the process?
Thanks!
Chew Yu Mei
TG01
hihi yu mei,
its the med tech who will perform the bleeding time test and is done in the clinic where they take the blood also..not done by the doctors...i went to the wards to observe bone marrow aspiration done by doctors only:)
Rachael
Tg01
Hi Rachel
I read about your description about bleeding time. You should always start with the purpose of the test, followed by principle of the test, then brief description, reference range & then the interpretation. Prolonged bleeding time could be due to 1. thrombocytopenia, 2. Platelet function disorders 3. von Willebrand's disease 4. Vascular abnormalities 5. Occasional severe deficiency of Factor V or XI or afibrinogenaemia.
In your description you should mentioned how wide is the cut & how deep (in mm) & what are things to look out for when performing bleeding time eg. not cleaning off all the blood but only at the periphery & explain why this is so.
I hope to see better blogging in future.
Mr Poh
21 Aug 08
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