Hematology Investigation

[Dionisio Sechser]

TheStimulating Hematology Investigation: New Endeavors (SHINE) program is intended to promote innovative, high-quality nonmalignant hematology research relevant to the missions of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Aging (NIA), and the National Heart, Lung, and Blood Institute (NHLBI). Investigator-initiated research project grant applications (R01s) in specific areas of basic and early translational hematology research are invited to this program that supports growth in the nonmalignant hematology research domain. Specific emerging topics that are at the leading edge of the field will change over time and will be updated annually through the NIH Guide to Grants and Contracts and hyperlinked to this FOA.

Hematology is the study of blood and blood disorders. Hematologists and hematopathologists are highly trained healthcare providers. They specialize in diseases of the blood and blood components. These include blood and bone marrow cells. Hematological tests can help diagnose anemia, infection, and hemophilia. They also include blood-clotting disorders, and leukemia.

Hematologist. This is often a medical doctor who is a board-certified internist or pediatrician who has completed additional years of training in hematology. A hematologist usually focuses on direct care of people. They diagnose and manage hematologic disease. This includes cancers of the blood and bone marrow.

Hematopathologist. This is often a medical doctor who is board-certified in both anatomical and clinical pathology. They also have additional years of training in hematopathology. Hematopathology is the study of disease of the blood and bone marrow. It is also the study of the organs and tissues that use blood cells to do their physiologic functions. These include the lymph nodes, the spleen, and thymus. They also include other lymphoid tissue. The hematopathologist focuses on diagnosing conditions of the hematopoietic and lymphocyte-rich tissues. This is often done by direct exam of tissue and blood in the lab.

Full blood count or FBC testing is a routine test that evaluates three major components found in blood: white blood cells, red blood cells and platelets. There are many reasons for a full blood count test, but common reasons include infection, anemia and suspected haemato-oncological diseases.

The number of red blood cells in the body can increase through dehydration, stress and anxiety, or failure of the bone marrow, to name a few conditions. Decreased blood cells can be the result of receiving chemotherapy treatments, chronic inflammatory diseases, blood loss and some types of cancer.

Without hemoglobin, oxygen would not be able to travel around the body. This oxygen-rich protein is essential to life, but it can increase or decrease due to a number of conditions. Dehydration, congestive heart failure and chronic obstructive pulmonary disease can all cause an increase in hemoglobin levels, while blood loss, anemia, liver disease and lymphoma can result in a decrease.

Hematocrit, or HCT as it is commonly known in medical circles, is the ratio of plasma to red blood cells. Plasma accounts for the fluid component in blood. HCT testing is usually carried out when hydration levels and anemia are suspected of causing problems. HCT levels can be affected in the same way as hemoglobin levels.

Platelets are responsible for causing the blood to clot. Without them blood would continue to flow from a wound and would need immediate medical attention in order to stem the flow. Increased platelet levels can be the result of inflammatory conditions such as trauma, acute infection and a number of malignant cancers. Decreases in platelet levels can occur from anemia, coagulation disorders such as sickle cell anemia, alcohol toxicity and infection.

Infectious mononucleosis, also known as mono, is caused by the Epstein Barr virus. It can be a serious condition and is highly contagious. Mononucleosis testing involves looking for the antibodies the immune system makes as it works to fight the infection.

A lack of vitamin B12 can make the patient feel tired, run down and without energy. A simple blood test can detect whether vitamin B12 levels have decreased. This vitamin is essential for healthy blood cells, healthy nerves and stable DNA. If a deficiency is detected, this condition is easy to manage with supplements, changes to the diet and vitamin shots.

The kidneys are responsible for a lot of waste management and cleansing in the body. Renal profiling can provide a unique and valuable snapshot of how the kidneys are functioning. The blood test will include testing the levels of creatinine and blood urea nitrogen, both responsible for healthy kidney function.

Blood glucose testing is used to show how well the patient has been able to control his or her diabetes over the past few months. It is a non-fasting test that shows the level of glucose values in the blood. It is also known as A1c, Glycohemoglobin or HbA1c testing. While it is a very accurate test, it should never be used in place of routine daily glucose testing.

If you need to arrange a routine or urgent blood test with a hematology specialist in San Antonio, give our team a call or get in touch through our website to arrange an appointment. We specialize in many types of blood testing and a wide range of blood disorders and conditions. We would be delighted to arrange a convenient appointment for you.

In general, hematology testing is performed on EDTA- (purple top tube) anticoagulated blood. This is the only type of anticoagulant that can be assayed with our hematology analyzer, therefore all hematology tests performed with this analyzer (routine hemograms, red and white cell counts, etc) will only be done from EDTA tubes. Heparin (green top tube) is not recommended as an anticoagulant for cell counts, because the cells clump in heparin, invalidating counts. Citrate (blue top tube) is not recommended due to the dilution of the blood by the liquid citrate. These guidelines should be followed for collecting blood for hematology tests:

When there is going to be a delay between sample collection and submission, e.g. samples shipped to the laboratory or collected after hours, always make 2-3 peripheral blood smears. We have provided tips and an illustration for making a good blood smear below.

A: Use clean slides with a frosted end. Place a drop of blood on this slide as follows (we recommend the use of a microhematocrit or capillary tube rather than the pipette shown in the image). Fill a capillary tube at least 3/4 full with well-mixed blood; then hold your finger over one end to prevent it flowing out. Holding the tube horizontally over the slide, release the pressure of your finger from the end, and tilt the tube slightly toward the vertical to allow a controlled amount of blood to flow out of the tube and onto the slide. Place a drop of blood approximately 4 mm in diameter on the slide, approximately 0.5 cm from the frosted area.

C and D: Once the blood spreads along the edge of the spreader slide (this occurs quickly), push the blood forward along the length of the lower slide. It is very important to relax your wrist and maintain a constant smooth motion and the same angle for the spreader slide when spreading the drop of blood as well as consistently even contact (with very slight downward pressure) between the two slides.

Draw spreader slide completely back through the drop before pushing forward. If one side of the drop was left behind, the edge of the spreader slide was not in contact with the stationary slide - relax the wrist holding the spreader slide.

If blood has clotted in the EDTA tube, the sample will not be analyzed. Clotting affects our automated hematology analyzer adversely and also invalidates cell counts in an unpredictable fashion. For CUHA, we make every effort to notify the clinician/technician/student that a sample has clotted so that a new sample can be drawn from that patient. Furthermore, as soon as we know the sample is clotted, the test is cancelled in the computer. For samples submitted through the Samples for Hematology, we cancel hemograms or tests involving counts if the sample is clotted. However, if a blood smear is provided with the sample, we will add on a blood smear examination, which can provide valuable information.

Only small amounts of blood can be collected from these species, necessitating the use of Microtainer tubes. Similar to mammals, EDTA is the preferred anticoagulant for non-mammalian hematology. However, there are certain species of birds, e.g. cranes, and reptiles, e.g. turtles, whose blood hemolyzes on contact with EDTA. This hemolysis invalidates the PCV and affects assessment of red blood cell morphology during blood smear examination. For these species, blood can be collected directly from the needle into citrate anticoagulant. However, the correct citrate to blood ratio must be maintained, i.e. 1 part citrate to 9 parts blood. Ideally, the citrate should be placed into the syringe and the appropriate volume of blood withdrawn directly into anticoagulant. For example, to collect 1 ml blood, 0.1 ml citrate is placed into a syringe and 0.9 ml of blood is taken from the patient (collect blood up to the 1 ml mark). If less blood is collected, you will have to resample, hence make sure you can obtain the correct amount of blood. We require at least 500 L of blood for performing a hemogram, hence you can collect only this amount of blood, which is achievable in most non-mammalian patients. The correct amount of citrate to blood must be maintained because citrate dilutes the blood; this dilution must be corrected for when evaluating the hemogram (i.e. each value should be multiplied by 1.1 for a 1:9 citrate:blood ratio). We do not make this correction in our reports. Heparin is not recommended as an anticoagulant because leukocytes and thrombocytes clump, invalidating WBC counts and differential cell counts.

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