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Quality Assurance

Quality assurance (QA) in the haematology laboratory is intended to ensure reliable diagnostic test results with the necessary degree of accuracy and precision. There are some key definitions in QA that are fundamental to an understanding of its practice ( Table 25-1 ). Table 25-1 Some key definitions used in quality assurance Specificity Measures only the analyte of interest Accuracy The closeness of agreement between the…

Laboratory Organisation, Management and Safety

Acknowledgement The authors wish to acknowledge the major contribution of Dr Mitchell Lewis, the author or co-author of this chapter in previous editions. The services provided by laboratories are an essential and fundamental component of health systems across the globe. The essential functions of a haematology laboratory are (1) to provide clinicians with timely, unambiguous and meaningful information to assist in the clinical diagnosis of disease…

Approach to the Diagnosis and Classification of Blood Cell Disorders

Common presentations of haematological diseases An abnormal blood count or blood cell morphology does not necessarily indicate a primary haematological problem because it may reflect an underlying nonhaematological condition or may be the result of therapeutic interventions. Anaemia occurs in many conditions, but a primary blood disease should be considered when a patient has splenomegaly, lymphadenopathy, a bleeding tendency or thrombosis and/or nonspecific symptoms characteristic of…

Laboratory Aspects of Blood Transfusion

Safe and effective blood transfusion requires the combined efforts of blood transfusion services, biomedical scientists and clinicians to ensure the highest standards are applied to all the systems in a complex process from ‘vein to vein’. This chapter provides a description of the laboratory framework required to provide the right blood components to the right patients at the right time. The increased awareness of what can…

Blood Cell Antigens and Antibodies: Erythrocytes, Platelets and Neutrophils

Erythrocytes Red cell antigens Since Landsteiner’s discovery in 1901, that human blood groups existed, a vast body of serological, genetic and biochemical data on red cell (blood group) antigens has been accumulated. More recently, the biological functions of some of these antigens have been appreciated. A total of 30 blood group systems have been described ( Table 21-1 ). Each system is a series of red…

Laboratory Control of Anticoagulant, Thrombolytic and Antiplatelet Therapy

Anticoagulant and antithrombotic therapy is given to prevent formation or propagation of thrombi. Anticoagulant drugs, unlike fibrinolytic agents, have little if any effect on an already-formed thrombus. There are five main classes of drugs that require consideration: 1. Coumarins and indanediones, which are orally active and act by interfering with the γ-carboxylation step in the synthesis of the vitamin K-dependent factors (see p. 371). 2. Heparin, heparinoids…

Investigation of a Thrombotic Tendency

Introduction to thrombophilia Investigations to identify an acquired or inherited thrombotic tendency are most frequently carried out in patients who develop venous or arterial thrombosis at a young age, in those who have a strong family history of such events or have thrombosis at an unusual site and in individuals of all ages with recurrent episodes of thromboembolism. In recent years the utility of these tests,…

Investigation of Haemostasis

Components of normal haemostasis The haemostatic mechanisms have several important functions: (1) to maintain blood in a fluid state while it remains circulating within the vascular system; (2) to arrest bleeding at the site of injury or blood loss by formation of a haemostatic plug; (3) to limit this process to the vicinity of the damage and (4) to ensure the eventual removal of the plug…

Diagnostic Radioisotopes in Haematology

Radioactive isotopes must be distinguished from nonradioactive isotopes of the same element. The radioactive forms are usually referred to as radionuclides or radioisotopes. These terms are interchangeable and in this chapter, the latter term is used. Methods using radioisotopes have an important place in haematological diagnosis. Tests that may be undertaken in haematology departments include total blood volume (TBV), red cell survival studies and, occasionally, ferrokinetic…

Immunophenotyping by Flow Cytometry

Acknowledgement The authors would like to acknowledge Kathryn Moss for her contribution to the HIV monitoring section. Principles of flow cytometric immunophenotyping The primary methods for immunophenotyping in the haematological setting are immunocytochemistry (described in previous editions of this book) and flow cytometry. In this chapter we shall focus on flow cytometry and its application to the diagnosis and treatment response of haematological neoplasms. Flow cytometry…

Erythrocyte and Leucocyte Cytochemistry

Acknowledgement The major contribution of the late Dr David Swirsky to this chapter in previous editions of the book is gratefully acknowledged. Erythrocyte cytochemistry Siderocytes and sideroblasts Siderocytes are red cells containing granules of non-haem iron. They were originally described by Grüneberg in small numbers in the blood of normal rat, mouse and human embryos and in large numbers in mice with a congenital anaemia. The…

Investigation of Variant Haemoglobins and Thalassaemias

The haemoglobin molecule Human haemoglobin is formed from two pairs of globin chains each with a haem group attached. Seven different globin chains are synthesised in normal subjects; two, ε and ζ, are characteristic of the embryo and contribute to four transient embryonic haemoglobins referred to as haemoglobins Gower 1, Gower 2, Portland 1 and Portland 2. Haemoglobin F is the predominant haemoglobin of fetal life…

Acquired Haemolytic Anaemias

Assessing the likelihood of acquired haemolytic anaemia Haemolytic anaemia may be suspected from either clinical or laboratory abnormalities. Suggestive clinical features include anaemia, jaundice and splenomegaly. Other relevant clinical features that should be sought are a history of autoimmune disease, recent blood transfusion, recent infection, exposure to drugs or toxins, the presence of a cardiac prosthesis and risk of malaria. Previous clinical history and laboratory results…

Coma

Coma Disorders of altered consciousness present a diagnostic dilemma to the clinician in the critical care setting. They represent a wide of range of pathology that can be systemic in nature or the result of structural or nonstructural intracranial pathology. Immediate evaluation and accurate diagnosis leading to lifesaving interventions are of paramount importance, as some causes of coma are irreversible. However, this can be a difficult…

Advanced bedside neuromonitoring

Introduction Little can be done to reverse the primary brain damage caused by an insult; however, one of the major factors influencing outcome in patients with acute brain injury is the additional brain damage that occurs from secondary brain injury processes. These secondary insult processes entail a combination of inflammatory, biochemical, and excitotoxic changes, , making it challenging for the clinician to detect which processes are…

Nutritional support

Critically ill patients typically have anorexia and are frequently unable to take oral diets. Therefore micronutrients and macronutrients should be prescribed as enteral or parenteral nutrition. The catabolic response of critical illness is characterized by inflammatory and endocrine stress responses that may induce variations in resting energy expenditure (REE) and urinary nitrogen excretion. Nutritional intake may be insufficient and lead to accumulated energy and protein deficits.…

Extracorporeal membrane oxygenation (venovenous and venoarterial ECMO)

Introduction Use of extracorporeal life support (ECLS) for respiratory and/or cardiac failure continues to increase, with almost 500 Extracorporeal Life Support Organization (ELSO) centers worldwide and almost 100,000 patients now added to the ELSO registry. In actuality, ECLS use is likely much higher, as many centers do not report data to ELSO or any other international registry. The survival rate for ECLS varies significantly by indication…

Target temperature management in critically ill patients

Definitions Hypothermia is defined as a core body temperature lower than 36°C, regardless of the cause. Within hypothermia we can still distinguish mild (i.e., between 35°C and 32°C), moderate (i.e., between 32°C and 28°C), severe (i.e., between 28°C and 24°C), and profound (i.e., <24°C) hypothermia. The concept of target temperature management (TTM) includes the use of induced hypothermia (i.e., cooling procedures initiated to provide brain and/or…

Basic principles of renal replacement therapy

Acute kidney injury (AKI) is a common complication in critically ill patients admitted to the intensive care unit (ICU). Epidemiologic data suggest that over 50% of ICU patients suffer from AKI, and up to 13.5% will be treated with renal replacement therapy (RRT). Change in patient characteristics, with admission of older patients with more comorbidities such as diabetes, cardiovascular disease, and hypertension, resulted over the last…

Basic principles of mechanical ventilation

Mechanical ventilatory support provides pressure and flow to the airways to help accomplish oxygen (O 2 ) and carbon dioxide (CO 2 ) transport between the environment and the pulmonary capillary bed. The overall clinical goal of mechanical ventilation is to maintain appropriate levels of O 2 and CO 2 content in the arterial blood while unloading the ventilatory muscles. An equally important goal is to…