Hematology

HEMATOLOGY

Telephone Numbers:

Laboratory:   

(617) 636-5475, 5476

Director:          

Igor Rozenvald, MD
(617) 636-5664

Monika Pilichowska, MD, PhD (Assistant Director)
(617) 636-5474

Supervisor:

Rouette Hunter
(617) 636-5477

Hours:

24 hours

Services:

The Hematology Laboratory performs routine hematology procedures, fluid cell counts, routine coagulation and urinalysis testing, special hematology testing, special stains, and Immunophenotyping.  The laboratory is open 24 hours, 7 days/week.  All results are available via the computer immediately after verification by the laboratory technologist.  Manual differentials are only performed when ordered and only if abnormal flags occur during testing on the cell counter.  Upon special request, a blood smear will be prepared and stained for House Staff review.  Indicate request on patient requisition.

Flow Cytometry analysis is available on blood, tissue or bone marrow for Leukemia/Lymphoma Phenotyping and T cell subsets.

CRITICAL VALUES

Telephoned to patient care provider.

HEMATOLOGY CRITICAL VALUES

TEST

RESULT LESS THAN

RESULT GREATER THAN

WBC

0.5 x 10⁹ / L

50 x 10⁹ / L

HCT

20%

60%

HGB

7 g/dL

20 g/dL

Platelet Count

30 x 10⁹ / L

1000 x 10⁹ / L

INR

5

APTT

130 seconds

Malaria or blood parasites – first incidence

Blasts in peripheral blood or csf – first incidence

Bacteria or yeast in peripheral blood or body fluid – first incidence

               ROUTINE HEME

TEST

SPECIMEN REQUIREMENTS

REFERENCE VALUES

AVAILABILITY

T.A.T.

Acid elution
(Kleihauer-Betke test)

(85460)

EDTA, purple top tube, minimum 0.5 mL.  Deliver to laboratory immediately after obtaining specimen.

adult=4 non-eluted cells/1000 RBC or less

Specimens received in the laboratory before 7 AM will be resulted by 11 AM.

4 hours

General use:

Determines the number of fetal (hemoglobin F) red blood cells in the maternal circulation.

(Activated) Partial
Thromboplastin Time (APTT)
(85730)

Blue top tube-Must be filled for appropriate blood: anticoagulant ratio.

23-34 seconds Therapeutic Range: 55-100 seconds

24 hours

1 hour

General use:

Detection of coagulation factor deficiency, presence of inhibitor, and monitor unfractionated heparin therapy.

Body fluids, cell count

(89051)

CSF in sterile tube.  Other fluids in EDTA, purple top tube. Deliver CSF to lab immediately.

See report.  Normal values are fluid type dependent.

24 hours

CSF-1 hr. All other fluids-4 hrs.

General use:

Evaluation of number of RBC and WBC, with description of fluid color and turbidity.

Body fluids, differential

(89051)

CSF in sterile tube. Other fluids in EDTA, purple top tube.

See report.  Normal values are fluid type dependent.

24 hours

CSF-1 hr.  All other fluids-4 hrs.

General use:

Evaluation of cell types present in fluid.

Body fluid-Specific Gravity

(84315)

CSF in sterile tube. Other fluids in EDTA, purple top tube.

Fluid type-dependent

24 hours

4 hours

CBC (Blood count, does not include a differential)

(85027)

EDTA, purple top tube, 1 mL minimum

24 hours

1 hour

General use:

WBC, RBC, HgB, hct, MCV, MCHC, RDW, PLT, MPV

D-Dimer, Sensitive

(85380)

Sodium citrate, blue top tube

<0.6 µg FEU/ml
For patients having a low to moderate pre-test probability for thromboembolism, the clinical cut- off is 0.5 µg FEU/ml.

24 hours

2 hours

General use:

Detects fibrin degradation products, useful in the diagnosis of disseminated intravascular coagulation, DVT, and PE.

Differential, WBC

(85023)

EDTA, purple top tube, 1mL minimum

24 hours

1 hour: STAT 4 hours

General use:

Determination of WBC cell types, red blood cell morphology, platelet estimate.

Eosinophil count

(85048)

EDTA, purple top tube, 1mL minimum

Newborn: 0-600/uL
1 yr. old: 0-300/uL
Adult:     0-500/uL

24 hours

4 hours

General use:

Assess allergic status. 

Erythrocyte Sedimentation Rate
(ESR)

(85652)

Special block top tube

Male    0-51 yrs. 0-15 mm
Male     >51 yrs. 0-20 mm
Female 0-51 yrs. 0-20 mm
Female  >51 yrs. 0-30 mm

24 hours

4 hours

General use:

Non-specific indicator of disease or inflammation. 

Fat Stain

(89125)

Body fluid in a clean, fat free container.

Negative

Mon - Fri
7:00 AM-5:00 PM

4 hours

General use:

Detect a fatty pulmonary embolism.

Fibrinogen (Clauss)

(85384)

Sodium citrate, blue top tube.

221 - 421 mg/dL

24 hours

2 hours
1 hour: STAT

General use:

Quantitative fibrinogen level.  May be increased during inflammation as an acute phase reactant. 

Hemosiderin

(83070)

Random urine specimen, 12-15 mL

Negative

Monday-Friday
9:00 AM-3:00 PM

4 hours

General use:

Evaluation of hemolytic disorders.

INR (Prothrombin Time)

Blue top tube-Must be filled for appropriate blood: Anticoagulant ratio.

Normal: 0.9 -1.1
therapeutic range: Varies with clinical indication

24 hours

1 hour

General use:

Monitor coumadin anticoagulant therapy.

Mixing study 

PT (85611)

PTT (85732)

Blue top tube-Must be filled for appropriate blood: anticoagulant ratio.

Negative

Contact Pathologist On- Call 24 hours

2 hours

General use:

Detection of factor deficiency or circulating acquired anticoagulant 
(or inhibitor).

MonoSpot

(86308)

Gold top tube

Negative

24 hours STAT from the ER

4 hours

General use:

Diagnosis of Mononucleosis.

Nasal smear

(89190)

1-2 slide preparations of nasal secretions

Negative

Weekdays
7:00 AM-5:00 PM

4 hours

General use:

Determination of eosinophil % in nasal secretions.

Platelet count
(included with CBC)

EDTA, purple top tube, minimum 1 mL

>12 yrs:
150-400 x 10³/uL

24 hours

2 hours

General use:

Quantitation of blood platelets.

Prothrombin time

(85610)

Blue top tube-Must be filled for appropriate blood: anticoagulant ratio.

10.7-13.2 seconds

24 hours

1 hour

General use:

Monitor

Reticulocyte count

(85045)

EDTA, purple top tube, minimum 1 mL

0.5-2.2%

24 hours

4 hours

General use:

Assessment of anemia and bone marrow response to blood loss or hemolysis.

Sickle cell test

(85660)

EDTA, purple top tube, minimum 1 mL

Negative

24 hours

4 hours

General use:

Screening test for sickling hemoglobins (e.g. hgb S).  When test results are positive, a Hemoglobinopathy Screen is automatically ordered.

Synovial Fluid Crystal

(89060)

Heparin, green top tube

Negative

Monday-Friday
9-5 pm

24 hours

General use:

Detection of gout or pseudo gout crystals in joint fluids. 

Thrombin time

(85670)

Blue top tube-Must be filled for appropriate blood: anticoagulant ratio.

See report

Send out.

1 week

General use:

Determination of hypofibrinogenemia.  Monitor streptokinase therapy.

Urinalysis, routine

(81003)

Random urine, minimum 12 ml. Sediment automatically examined if this test deemed abnormal.

24 hours

1 hour

Urinalysis, sediment

(81015)

Random urine, minimum 12 ml.

24 hours

1 hour

General use:

Assessment of various disease states of the kidneys/urinary tract.

Urine-Eosinophil Count

(89190)

Random urine, minimum 10 mL

Undefined

Monday-Friday
7:00 AM-5:00 PM 

4 hours

General use:

Helps to distinguish between allergic nephritis and acute nephritis.

Urine-Protein (Qualitative)

Random urine, minimum 2 mL

Negative

24 hours

1 hour

General use:

Screening test for pre-eclampsia in obstetrics patients. .

Urine-Reducing Substances (Qualitative)

(81002)

Random Urine minimum 2 mL

Negative

24 hours.  Ordered by pediatrics

4 hours

General Use: 

Assessment of inherited disorders of Carbohydrate Metabolism (ex. galactosemia) in pediatric patients.

Urine-Urobilinogen
(Qualitative)
(included with routine urinalysis)

Random urine collected in a dark container and protected from light.  Deliver to lab immediately. Minimum 2 mL.

0.1 - 1.0 Ehrlich U/dL

24 hours

4 hours

FLOW CYTOMETRY

TEST

SPECIMEN REQUIREMENTS

REFERENCE VALUES

AVAILABILITY

T.A.T.

Leukemia/Lymphoma
Phenotyping

·     AB1 (88184)
·     AB all other   (88185)

Blood Marrow, blood, or tissue-green top tube (sodium heparin).

Blood-6 mL minimum

Bone Marrow - 1 mL minimum

Interpreted by Hematology staff

Monday-Friday

24 hours

General use:

Diagnosis of leukemia and lymphoma.

PNH Panel

(88180)

Blood.  Green top tube (sodium heparin) and purple top (EDTA)

Interpreted by Hematology staff

Monday - Friday

4-6 hours

General Use:

Diagnosis of PNH.

T-Cell Subsets
·     CD 19
·     CD 16/56 (NK)
·     CD 3/4 and 3/8

EDTA, purple top tube, 1 mL minimum

See Report

Monday-Friday

48 hours

General use:

T Helper and Suppressor cells enumeration in HIV positive patients.

TCR

(88180)

EDTA, Purple top tube

Interpreted by Hematology staff.

Monday-Friday

4-6 hours

General Use:

To determine clomality in T-cells. 

CD34 

(86367)

EDTA, Purple top tube

Monday-Friday

9am-5pm

General Use:

Quantitate HPC (human progenitor cells) for harvest or infusion.  

SPECIAL HEMATOLOGY

TEST

SPECIMEN REQUIREMENTS

REFERENCE VALUES

AVAILABILITY

T.A.T.

Acid phosphatase stain

(83319)

Bone marrow or blood smears, EDTA purple top tube.

Send out

1 week

General use:

Differential diagnosis of hairy cell leukemia.

Blood parasite test (Concentration techniques, with smears)

(87207)

EDTA, purple top tube, minimum 1 mL.  Deliver to lab as soon as possible.  (Helpful is specimen is drawn immediately before a fever spike is anticipated.)

No blood parasites seen.

Screen available 24 hours.
ID available M-F 9-5 pm

1-2 days

General use:

Detection and speciation of blood parasites.  Note: one negative result does not rule out the possibility of a parasitic infection.

Bone marrow aspirate and biopsy
(Wright's Stain)

Prepared slides

Interpreted by Hematology Pathologist.

Weekdays
9:00 AM-3:00 PM

1-2 days

General use:

Bone marrow interpretation.

Fetal hemoglobin (Hgb F)

(83030)

EDTA, purple top tube, 1 mL minimum

0-2 yrs.  2-100%
Adult: <2%

Mon, Wed, Fri
9 AM - 3 PM

3 days

General use:

Used in the evaluation of hemoglobinopathies.  Performed as part of the Hemoglobinopathy screen.

G-6-PD (Quantitation)

(82955)

EDTA, purple top tube, 1 mL minimum

4.6-13.5 U/gHgb

Performed 1 times per week.

5-7 days

General use:

Quantitation of G-6-PD to rule out enzyme deficiency.

Heat precipitation test

(83065)

EDTA, purple top tube, minimum 3 mL

5% hemoglobin precipitation

Monday - Friday
9 AM - 1 PM

24 hours

General use:

Detection of unstable hemoglobin.  Investigation of hemolysis.

Hemoglobin A2

(83021)

EDTA, purple top tube, 1 mL minimum

1.5 - 3.5%

Mon, Wed, Fri

3 days

General Use:

Performed as part of the Hemoglobinopathy screen, to evaluate for Beta Thalassemia.

Hemoglobin S quantitation

(83021)

EDTA, purple top tube, 0.5 mL minimum

0%

Monday - Friday
9 AM - 3 PM

1 day

General use:

Determination of the % of hemoglobin S in the red blood cells of a sickle cell patient.

Hemoglobinopathy Screen

(82664)

EDTa, purple top tube, 1 mL minimum

See individual tests.

Mon, Wed, Fri

1 week

General use:

Hemoglobin identification by HPLC: A, A₂, F, rbc morphology examination followed by Neutral pH electrophoresis (82664), citrate agar electrophoresis (82664), hemoglobin H, Unstable hemoglobin (83065, 83068), and ZPP, as needed for the diagnostic interpretation.

Iron Stain

(85535)

Bone marrow, 2-3 slides

Interpreted by Hematology Pathologist.

Monday-Friday
9 AM - 3 PM

3 days

General use:

Evaluation of iron stores in bone marrow.

Isopropanol precipitation Test

(83068)

EDTA, purple top tube.  Deliver to laboratory within 30 minutes of collection. Minimum 1 mL.

Negative

Monday - Friday
9 AM - 1 PM

1 day

General Use: 

For unstable Hemoglobins.

Leukocyte alkaline phosphatase stain (LAP)

(85540)

Green top tube (Heparin, anticoagulant), minimum 1 mL.  Deliver specimen to laboratory as soon as possible.

16 - 175

Monday - Friday
9 AM - 1 PM

2 days

General use:

Differential diagnosis of CML vs. leukemoid reaction.

Myeloperoxidase stain

(88319)

Bone marrow or blood smears, 2 - 3 slides. Protect from light

Interpreted by Hematology Pathologist.

Weekdays,
9 AM - 3 PM

3 days

General use:

Differential diagnosis of myeloid leukemia.

Non-specific esterase stain

(88319)

Bone marrow or blood smears, 2 - 3 slides

Interpreted by Hematology Pathologist.

Monday-Friday
9 AM-3 PM

3 days

General use:

Differential diagnosis of monocytic leukemia.

Occult Blood

(82272)

Stool sample on Hemoccult card

Negative

24 hours

1 hour

General use:

Detect GI bleed

Osmotic fragility with incubation

(85557)

Sodium Heparin, green top tube, minimum 2 mL. Deliver to laboratory immediately

Refer to graph report

Monday-Thursday
9 AM - 3 PM

3 days

General use:

Evaluation of hemolytic anemia.

Periodic Acid Schiff stain (PAS)

(88319)

Bone marrow or blood smears, 2 - 3 slides

Interpreted by Hematology Pathologist.

Monday-Friday
9 AM - 3 PM

3 days

General use:

Differential diagnosis of myeloid leukemia.

Serum Viscosity

(85810)

Red top tube or tiger top tube.  Minimum volume of 2.5 mL of serum is necessary for testing.

1.4 - 1.8

Mon - Fri
9 AM - 3 PM

4 hours

General use:

Increased viscosity seen with multiple myeloma, macroglobulinemia.

Sudan Black B stain

(88319)

Bone marrow or blood smears, 2 - 3 slides

Interpreted by Hematology Pathologist.

Monday-Friday
9 AM - 3 PM

3 days

General use:

Differential diagnosis of leukemia.

Sugar water screening test

(86940)

Sodium citrate (blue top tube). Specimen must be <2 hours old.

5% or less hemolysis

Monday-Friday
9 AM-1 PM

24 Hours

General use:

Screening test for paroxysmal nocturnal hemoglobinuria.

Zinc Protoporphyrin (ZPP)

(84202)

EDTA or heparin (purple or green top tube), minimum of 1 mL)

30-80
µmolZPP/molHeme

Monday-Friday
9 AM-3 PM

3 days

General use:

Screening test for iron deficiency and lead poisoning.

SPECIAL COAG

TEST

SPECIMEN REQUIREMENTS

REFERENCE VALUES

AVAILABILITY

T.A.T.

Activated Protein C
Resistance 

(85307)

2.7 ml blue top tube.

>=2.2

Monday-Friday
9 AM-4 PM

run once a week

General use:

Test for hypercoagulability (venous thrombosis).  Screen for F.V. Leiden.

Anticardiolipin Antibodies Screen (86147)

ACA IgG-IgM Classification (86147)

5 ml gold top tube

Negative

0-15 IgG units
0-15 IgM units

Monday-Friday
9 AM-4 PM


Monday-Friday
9 AM-4 PM

run twice per week


run twice per week

General use:

A Lupus anticoagulant test specific for anticardiolipin antibodies associated with venous and arterial thrombosis.