Hematology and Coagulation

• Complete Blood Count-No differential: Includes WBC, RBC, Hgb, HCT, MCV, MCH, MCHC, Plts and RDW.
• Complete Blood Count with Automated Differential: Includes all of the above plus a five-part differential. Cells identified are Granulocytes (includes Polys and Bands), Lymphocytes, Monocytes, Eosinophils, and Basophils.
• Manual Differential: Includes WBC differentiation, RBC morphology, and platelet estimation. This is not an orderable test. If the automated differential fails pre-set flagging criteria, a manual differential is then performed by the laboratory. It is charged at that time.
• Platelet Count: This test is a part of the blood count but may be ordered separately. On occasion, abnormalities of the sample may make it necessary to perform a manual, phase platelet count.
• Reticulocyte Count: Performed by flow cytometry method on the Coulter. If required STAT during off-hours, or when interferences exist in the sample, a manual count will be performed.
• Sedimentation Rate: Minimum volume for analysis is 1 mL EDTA blood.
• Body Fluid Analysis: Includes a manual red and white cell count and a differential based on a cytocentrifuge prepared smear. CSF specimens and all body fluids are performed STAT. Synovial fluid analysis may also includes Crystals.
  
  NOTE: When specific cellular or marked abnormalities are noted on any of the above tests, review by a Pathologist is initiated and, when appropriate, an interpretive report is sent to the chart.

• Urine Eosinophil Count: Then performed by manual staining methods.
• Blood Parasite Screen: Both thick and thin smears reviewed. Sent to Public Health for speciation.
• Rapid Malaria Testing: will reflex to Blood Parasite Screen if positive
• Kleihauer-Betke Stain: Screen for fetal bleed and numerate fetal cells if indicated.
• Hemoglobin Analysis (Electrophoresis): May include Electrophoresis by Isoelectric Focusing; Hemoglobin A2, Hemoglobin, Fetal, Quantitative, Fetal, Betke Kleihauer; Interpretation and blood count. Performed weekly, dayshift only.

• EDTA Anticoagulated tubes must be at least half full.
• Peripheral blood specimens containing clots will be rejected.
• CSF specimens to be sent in sterile CSF tube.
• Synovial fluids and body fluids should be sent in sterile containers.
• All body fluid samples must be received in the Hematology Laboratory no later than 4 hours after collection.

• EDTA blood tubes are retained 24 hours after testing.
• Stained peripheral blood and fluid smears are retained for 4 weeks after testing.

• (PT) Prothrombin Time resulted with INR
• (aPTT) Activated Partial Thromboplastin Time
• Fibrinogen
• D-Dimer
• Anti-Xa Unfractionated Heparin
• Anti-Xa Low Molecular Weight Heparin
• Fibrin Monomer
• FDP-Fibrin(ogen) Degradation Products
• Thrombin Time
• Antithrombin
• Inhibitor Screen (PT/PTT)
• Cryofibrinogen/Cryoglobulin

Performed weekly unless noted. Available dayshift Monday-Friday only.

• Factor Assays: Performed daily, Monday through Friday, dayshift only.  Available as STAT at other times with Pathologist's approval.
• Inhibitor Assay: Specify factor performed on Fridays
• Von Willebrand Activity: Performed on Wednesdays.
• Von Willebrand's Antigen: Performed on Wednesdays.
• Protein C Assay: Performed on Thursdays.
• Protein S Assay: Performed on Thursdays.
• Dilute Russel's Viper Venom Test (DRVVT): Performed Thursdays.
• Heparin Associated Antibody Test: Performed Monday through Friday day shift only
• Platelet Aggregation: Performed Tuesday by prearranged appointment only.
• ADAMTS13 testing; Performed on Wednesdays with Heme/Onc approval.  STAT testing may be available but must be approved by Heme/Onc and Pathology.

One 5 mL blue-top tube with liquid (3.2% buffered acid citrate) is adequate for all of the above mentioned tests except:

• Cryofibrinogen - 2.5 cc lavender (EDTA) top tube or red top maintained at 37 *C And sent to the lab ASAP following collection.
• Cryoglobulin - 7 cc red top maintained at 37 *C.
• Fibrin(ogen) Degradation Products - blue top tube with powder.
• Call SARC at extension 4-0500 if any of the above tubes are needed.

Use a "two-syringe" technique whenever drawing any specimen for hemostasis testing, i.e., the first 3 mL from a venipuncture should be drawn into a separate tube or syringe and set aside; then, blood from the second tube or syringe can be used for the hemostasis sample. The sample should be put on ice immediately. Drawing a hemostasis sample from a heparin lock is not advised due to the risk of heparin contamination. The ratio of blood:anticoagulant is very critical. Patients with hematocrits less than 20% or greater than 60% require a special tube available from the laboratory. Please call 4-0500 to request these tubes. All tubes drawn for coagulation work must be full.

Incompletely filled tubes and specimens received more than four (4) hours after collection will be rejected.