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IU (Chemical Pathology)
IU (Hematology)
IU (Immunology)
IU (Outsource)
Genetics
Histo & Cyto
Microbiology
Transfusion Med
Molecular Diagnostics

WELCOME TO INTEGRATED UNIT (HEMATOLOGY)

  • Introduction

    Haematology Unit offers diagnostic investigations in haematology.

    • Muhammad Amali Bin Kamarudin
    • Srly Binti Saman
    • Aizat Hafifi Hafriz Ahmad Sabri
    • Nur Atifah Rosidi
    • Siti Hazirah Hassan
    • Vithiya Rasasooria

  • Sampel Collection and Transportations

    1. Sample collection
      1. A correct amount of blood volume as stated on the tube is collected into the appropriate anticoagulant for the test requested.
      2. To ensure the volume of blood collected is correct, fill the tube to the indicator line.
      3. The blood should be mixed gently and thoroughly (Please refer to the colour of type of containers, colour, name, anticoagulants used and the test of use in the laboratory)
      4. All specimens should be sent to the laboratory immediately after collection.
      5. Delayed transportation of sample may affect the result.
      6. Sample for urgent cases need to be informed by contacting 04-562 2693.
      7. Every specimen should be accompanied by details of clinical history and diagnosis in the electronic request or a completely filled request form.
      8. All samples to be sent to Integrated Unit (Haematology) should use specific containers according to test requested.
    TESTCONTAINER TYPE

    Full Blood Count (FBC)

    Blood in EDTA tube

    Full Blood Picture (FBP)

    Blood in EDTA tube

    Routine Coagulation Test (PT / APTT / INR)

    Blood in Sodium Citrate tube

    D-Dimer

    Blood in Sodium Citrate tube

    ESR

    Blood in EDTA tube

    Notes:

    1. All specimen collection with EDTA, Tri-sodium Citrate and Lithium Heparin tube should be mixed gently and thoroughly for 1 minute by a rotary wrist movement.

  • Coagulation Test

    1. Guidelines for specimen collection
      1. Good specimen collection e.g. clean venepuncture with minimal stasis, not from indwelling catheters or arterial lines, mix well by inverting 5-6 times gently.
      2. Recommended to use a 21-gauge needle or butterfly. 19 gauge may be used in adults with good veins: 23 gauge may be required for infants.
      3. Do not use heparin-contaminated venous lines. If unavoidable, flush the lines with crystalloid and discard first few millilitres of blood.
      4. Correct ratio 1 part of sodium citrate to 9 parts of blood is essential.
      5. Collect blood to the indicator line on the tube to ensure correct amount of blood collected.
      6. Send blood to the laboratory immediately.
      7. The sample ideally tested within 1 hour of blood collection.
      8. Note down exact time blood is collected.
      9. Please be noted to sent sample without ice.
      10. If haematocrit is >0.55, contact laboratory for a tube with adjusted volume of anticoagulant.

    2. Coagulation screening test
      1. Where a patient is suspected of having a bleeding disorder, Full Blood Count (FBC) and Coagulation Profile should be performed as a preliminary screen.
      2. If results are abnormal, or in any case of doubt, the attending clinician should consult Haematologist.

    Guidelines for coagulation test

    INDICATIONSTEST

    Warfarin therapy control

    PT (Prothrombin Time)

    Heparin therapy control

    APTT (Activated Partial Thrombin time)

    DIC screening

    PT, APTT, Fibrinogen level, D-Dimer and platelet count

    Liver biopsy

    PT (Prothrombin Time), APTT

    Pre-operative cases

    PT, APTT

  • Acceptance Criteria for Verbal Requests

    1. Request should be made less than 4 hours after sample is received.
    2. Request can only be accepted if the sample is sufficient.
    3. Requested test is suitable to sample.
    4. Request should be made by requesting doctor.

  • Outsource Test

    List of referral laboratories are as below:

    1. Jabatan Hematologi, Pusat Pengajian Sains Perubatan, Kampus Kesihatan, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan.
    2. Unit Patologi dan Transfusi Darah, Hospital Kepala Batas, Jalan Bertam 2, 13200 Kepala Batas, Pulau Pinang.
    3. Makmal Hematologi, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158
    4. Innoquest Pathology Sdn. Bhd.
    5. Lablink Medical Laboratory Sdn. Bhd.

  • Turn Around Time (TAT)

    CASETURN AROUND TIME
    CASE:

    FBC & FBC-DC

    Urgent
    Non-urgent
    TURN AROUND TIME:

    Within 40 minutes from the time sample is received
    Within 160 minutes from the time sample is received
    CASE:

    FBP

    Urgent
    Non-urgent
    TURN AROUND TIME:

    Within 2 working days from the time sample is received
    Within 5 working days from the time sample is received
    CASE:

    Routine Coagulation Test (PT / APTT / INR)

    Urgent
    Non-urgent
    TURN AROUND TIME:

    Within 1 hour from the time sample is received
    Within 2 hours from the time sample is received
    CASE:

    D-Dimer

    Urgent
    Non-urgent
    TURN AROUND TIME:

    Within 1 hour from the time sample is received
    Within 2 hours from the time sample is received
    CASE:

    ESR

    Urgent
    Non-urgent
    TURN AROUND TIME:

    Within 1 hour from the time sample is received
    Within 2 hours from the time sample is received

  • Reference Ranges

    • Note: < 60 = Below 60 years old, ≥ 60 = 60 years old and over; Reference: Ambayya A et al., (2014) Haematological Reference Intervals in a Multiethnic Population. PLoS ONE
    • Reference: Dacie and Lewis Practical Haematology, S.M.Lewis, B J Bain and I Bates 12th Edition 2016

    Coagulation Tests

    VARIABLESANALYZER REAGENTRANGESUNIT

    PT
    INR
    APTT
    Fibrinogen level
    D-dimer

    STA-Neoplastine Cl Plus 5
    STA-Neoplastine Cl Plus 5
    STA-PTT Automate 5
    STA-Liquid Fib
    STAGO D-Dimer Test

    12.2 - 14.2
    0.97 - 1.18
    31.7 - 44.0
    2.32 - 4.44
    <0.5 / (-)

    Sec
    -
    Sec
    g/L
    ug/mL

  • Critical Values

    Panic value is defined as any result outside the normal ranges to a degree that may pose immediate health risk to patients or require immediate action on behalf of the treating doctors. Laboratory is responsible to immediately NOTIFY doctors of the panic values.

    CRITICAL VALUETESTLOWER CRITICAL LIMITUPPER CRITICAL LIMITUNIT
    Haematology Tests (For Adults)

    Hb
    Hct
    Platelet
    WBC

    6
    20
    20
    1

    19
    60
    1000
    50

    g/dl (adult)
    % (adult)
    X 109 /L
    X 109 /L
    Haematology Tests (For Paediatrics)

    Hb
    Hct
    Platelet
    WBC

    7
    20
    50
    2

    20
    40
    1000
    50

    g/dl (adult)
    % (adult)
    X 109 /L
    X 109 /L
    Haematology Tests (For Neonate)

    Hb
    Hct
    Platelet
    WBC

    8
    25
    50
    2

    22
    70
    1000
    50

    g/dl (adult)
    % (adult)
    X 109 /L
    X 109 /L
    VARIABLESCRITICAL VALUES
    Coagulation Tests

    PT
    APTT
    INR

    >40 Sec
    >100 Sec
    >5

    References:

    1. Stanford University Medical Center, Hospital and Clinic school of medicine critical values
    2. www.medicine.uiowa.edu/path_handbook/Appendix/Common/UN_CRIT_LAB_VAL.html critical value for hematology depts.washington.edu/labweb/PatientCare/Clinical/Critical.htm critical value for hematology
    3. DLMP Critical Values / Critical Results List [CL 041647.004]
    4. Quick Guide for Notification of Critical Laboratory Results in MOH Hospitals, Institute for Health Systems Research, 2010
    5. Macking, et al. Guideline on the laboratory aspects of assays used in haemostasis and thrombosis, International Journal of Laboratory Hematology, August 2012