Slides

3. SPECIMEN RECEPTION/PRE - ANALYTICS
Receive a range of samples/specimens via pod system:
 Haematology (EDTA)
 Chemistry
 Coagulation
 Blood bank
 Virology
 Immunology
 Microbiology
 COVID-19 samples
• Communicate to service users
• Treat every sample as category 3
• Answer phone calls from wards/GP’s/nurses - process of sample
• Book in all the samples and forms received from reception onto APEX (3 – 4 identifiers)
• Urgent/A&E samples are always prioritised and booked into APEX (turnaround time 30
mins - 1 hour)

4. HAEMATOLOGY
• EDTA samples are placed into the analyser to measure patients FBC/parameters (E.g. HGB, RBC,
WBC, MCH, PLTS) displayed through numerical data and scatterplots. Results are transmitted to
APEX & EPU which are then authorised by BMS.
• Once analysed, samples are archived into a tube sorter and placed into a walk in fridge (up to 5
days in case additional test is required by GP)
• Internal QC – run x3 a day on all analysers and displayed on a Levvy Jennings plot. - To ensure that
all analysers can produce appropriate results within the standard deviation. If out of standard
deviation, expiry date and LOT number would be checked, sample will be mixed thoroughly and
placed into the analyser for a repeat.

5. HAEMATOLOGY
Internal QC:
• Run a QC test on the interliner, hemocue and glandular fever kit – Results are written and
signed onto the ‘Daily Sheet and Maintenance Record’
• Perform a weekly cross city for both sites of the Sheffield Teaching Hospital – perform
tests on a patient sample (RBC/WBC/HGB count and ESR result) record results and
samples are then sent to RHH to see if they have similar results as the NGH for the same
patient.
• Perform weekly/monthly maintenance of the interliner wearing PPE & following standard
operating procedures – in accordance to IBMS
• Every Friday – weekly QC audit to observe trends
External QC – NEQAS:
To see if all participating laboratories that have analysers from the same manufacture are
producing the same results and are in conformance – UKAS accredited.
(Malaria rapid diagnostic test, following morphology)

7. HAEMATOLOGY
• Technique: Infectious mononucleosis – Full PPE, add reagents to patient plasma
and check for agglutinants/white latex beads – positive result
• Daily – Collect HbA1c samples required from RHH and send over – Haemolysis
department which investigate diabetic patients.
• If the department received a phone call from a patient wanting their results –
refer them to their GP (not in our position to give results due to limit of practice)
• Patient with low PLT count , check for a clot using wooden stick, wearing full PPE
(gloves) and dispose clot into the yellow clinical waste bin – Accordance to
COSHHH (Control of Substances Hazardous to Health)
• Change reagents – aware of date, LOT number and signs present (COSHH)
• Ensure clinical waste bins are not overflowing – limit

8. BLOOD BANK
• MHRA – professional body which regulates blood products to ensure safe blood
transfusions
• Techniques used, e.g. antibody screening – detects any irregular blood group
antibodies that can attack the patients red cells.
• If wrong blood transfused – patients immune system will destruct their own red cells =
fatal reaction/shock
• Due to A&E/trauma centre – Emergency will be spontaneous/working under pressure
My duties due to limit of practice:
• Visiting A&E wards and theatre rooms to check the temperature of blood bank fridge,
and giving emergency blood bags in A&E
• Case study – patient with low HGB post surgery. Completed variety of manual testing
(ab identification, Grifols gel card, cross match, phenotyping)

9. COAGULATION
• 2 analysers that both analyse for clotting screen – 1 specifically for D-dimer and the other
specifically for anti 10a. Once a week after cross city, D-dimer is swapped around between
analysers = to see if both analysers can produce the same results.
• Normal/abnormal QC ran at specified intervals
• Normal = (clotting screen) Thrombin, PT, APTT & Fibrinogen
• Abnormal = INR, D-dimer & Heparin
• Based around the clotting cascade
• Intrinsic pathway – focused on PT (measures how long it takes for blood to clot)
• Extrinsic pathway – focused on APTT (measures how well clotting factors are working)
• Techniques: Made FLS by centrifuging samples and pipetting plasma into alliquots for further
specialised testing
• Manual PT/APTT testing in water bath and timing the formation of a clot using SOP – to compare
our results with the analyser for accuracy and reliability
• Instrument failure: haemolysed sample or under filled sample (must be filled with 9:1 ratio – set on
analyser, otherwise, false results occur).
• pre-analytical variables e.g. date and time patient was bled

10. COAGULATION
• Communicate to health care professionals regarding haemolysed/under filled
sample to reject the sample.
• Professional manner: use patient confidentiality – ensure I am calling the correct
ward & ask if they have the patient, before giving out patient identifiers (NHS
number, hospital number, name, DOB.) – in accordance to HCPC standards.
Progress & personal responsibility:
 Improved communication skills & gained more confidence after calling many
wards.
 Discussed with senior from NGH about what to expect from RHH coagulation
department in order to be prepared for my roles/responsibilities there.

12. N G H
• Cardiac
• Renal
• A&E/Trauma
• Lupus/Thrombophilia
• Covid-19 patients
• Training notice board –
morphology area in haem
R H H
• Jessops wing
• Western park
• Neuropathology
• Haemolysis
• Cell markers
• Specialised areas in Coag
• Training notice board – Haem &
Coag
Haematology/coagulation/blood bank – same routine and
duties as NGH, HOWEVER, each hospital has different
wards/centres, therefore different patient types..

13. HAEMOLYSIS
• Mass spectrometry & Gel electrophoresis to identify haemoglobin variants
• HOPS– Haemoglobinopathies screen to detect sickle cell/thalassemia
• 2 analysers – one to monitor haemoglobinopathies (variants) and one for diabetes
• Haemoglobinopathies analyser – I observed E-gram to identify abnormal peaks
• Antenatal patients – test mother of the child to identify if their child will be affected from any
haemoglobinopathies
• Check patients haemoglobin pre-surgery
Manual testing (PPE)
• Sickle cell = further confirmed with morphology and if positive – blood transfusion required.
• Patient blood & sickle reagent: Cloudy = positive/ Clear = Negative
ZPP test performed if MCH below 27 (to detect iron deficiency)

14. CELL MARKERS
• Investigation of blood cancers and monitoring of HIV
• Use of flow cytometry, subsets, immuno-phenotyping and morphology
CD34 test
Performed to identify amount of stem cells in patients undergoing chemotherapy – amount of CD34
found is given to clinicians in order to preserve patients stem cells. After chemotherapy = no stem cells
left - their preserved stem cells can be added back into their body to produce more. If the patient does
not have enough stem cells (below 10) = healthy compatible donor can have their stem cells preserved
for patient.
• Attended a MDTM – consultants from cytogenetics, molecular genetics, histopathology and
haematology unifying & streamlining results to get a conclusive answer to best direct treatment for
patients.
• I carried out a blood film & morphology on patient suspected for chronic lymphatic leukaemia

15. COAGULATION
• BMS book in samples/external forms
• Limited time to accept samples as this is dependent on the type of test, e.g. D-
dimer = 24 hour limit, Clotting screen & INR = 6 hour limit
• Pre-analytical variables are important as it can affect sample & patient result,
leading to wrong treatment
Coag specialist areas – 1 day in each department
• Investigate patients clinical history
• Due to my limit of practice – no manual testing
• Gained interest in theory & knowledge – use for my final year at university

16. SPECIALIST AREAS - COAGULATION
Thrombophilia
Lupus
Assays
Platelets
Use chromogenic assays to measure levels of
thrombosis .
Platelet function test
Aim to detect lupus autoantibodies that
increases ability to clot.
Monitor factor deficiencies for bleeding
disorders, Von Willebrands disease.

17. WHAT I HAVE GAINED
• Confidence with communication e.g. phone calls A&E wards
• Increased knowledge in laboratory duties (multi-disciplinary teams)
• Teamwork (Inform one another with results, helping with manual tasks, discuss further
steps needing to take place)
• Improved manual skills (blood films and morphology)
• Working under pressure (multi-task during busy hours)
• Can adapt to changes and working environments (COVID-19)