PROCEDURES, LABORATORY AND DIAGNOSTICS TESTS

1. Complete Blood Count (CBC)

• It is the most common laboratory test done. Examines the component of blood: red
blood cells, white blood cells and platelets. It is a broad screening test for disorders such
as infections, anemias etc.

• It gives an analysis of the blood that provides much information. It shows a comparison
of a patient’s blood count result to the normal values.

• Purpose: It is done to examine and monitor any changes or progress in a patient’s

blood count. It also checks if the patient’s blood count is in the normal range. It helps in
determining a client’s over-all health status.

• Procedure: A CBC is done by extracting blood from the patient. It is usually done by a
medical technologist.

• A health professional will usually draw the blood from a vein. If the blood is being
drawn from a vein, the skin surface is cleaned with antiseptic, and an elastic band
(tourniquet) is placed around the upper arm to apply pressure and cause the veins
to swell with blood.

• A needle is inserted into a vein (usually in the arm inside of the elbow or on the back
of the hand) and blood is withdrawn and collected in a vial. A compound in the vial
keeps the blood from clotting before the sample is analyzed.

• After the procedure, the elastic band is removed. Once the blood has been
collected, the needle is removed and the area is covered with cotton or a bandage
to stop the bleeding.
• Normal Values for CBC and Patient’s result of CBC:

Blood
Normal Values June 29, 2009 July 1, 2009
Component

HgB 120-170g/L 144 12.0

RBC 4.0-6.0 x 1012/L 4.86

Hct 0.37-0.54% 0.41 37

MCV 87+ - 5 U3 84.80

MCH 29 + - 2 Pg 29.70

MCHC 34 + - 2 g /dL 35.00

RDW 11.6 – 14.6 13.60

MPV 7.4 – 10.4 fL 7.9

Platelet 150-450 x 109 L 379 400,000

WBC 4.5 – 10 x 109 L 17.20 10.10

Neutrophils 0.50 – 0.70 0.86 49

Band
0.50 – 0.70 0.86
Segmenters

Lymphocytes 0.20 – 0.40 0.13

Monocytes 0.00 – 0.07 0.02

Eosinophils 0.00 – 0.05 x 103 0.01 12

Basophils 0.00 – 0.01

2. Bone Marrow Aspiration (BMA)

• In a BMA, only a sample of cells are needed and examined. The bone marrow is
aspirated usually from the iliac crest and sometimes the sternum.

• Purpose: BMA is used to study cells involved in blood production. BMA assesses how
an individual’s blood cells are being formed. It helps to assess the quantity and quality of
each type of cell produced in the bone marrow.

• Procedure: A doctor punctures iliac crest (the preferred site), vertebrae body, sternum,
or tibia (for infants) to collect tissue from bone marrow.

• Information the patient that a feeling of brief sharp pain that may be felt during
aspiration. Deep breaths or using relaxation techniques may help.

• Skin is cleansed for any minor surgery, using aseptic technique. A small area is
anesthetized with a local anesthetic through the skin and subcutaneous tissue to the
periosteum of the bone.

• The bone marrow needle is introduced with a stylet in place. When the needle is felt
to go through the outer cortex of the bone and enter the marrow cavity, the stylet is
removed, a syringed it attached and a small amount (0.5ml) of blood and marrow is
aspirated.

3. Factor VIII test and Infusion

 • Factor VIII test/Factor VIII Assay: It evaluates the function of a protein which helps in
blood clotting.

• Purpose: Factor VIII test helps diagnose or monitor the treatment of hemophilia A. It
helps to identify the reason for an abnormal result on other clotting tests (such as PTT or
PT), or when a child has a family member with a bleeding disorder. It may be done as
part of an evaluation for a bleeding disorder called von Willebrand disease.

Factor VIII 250 iu

• Procedure:

• A health professional will usually draw the blood from a vein. If the blood is being drawn
from a vein, the skin surface is cleaned with antiseptic, and an elastic band (tourniquet) is
placed around the upper arm to apply pressure and cause the veins to swell with blood.
• A needle is inserted into a vein (usually in the arm inside of the elbow or on the back
of the hand) and blood is withdrawn and collected in a vial. A compound in the vial keeps
the blood from clotting before the sample is analyzed.

• After the procedure, the elastic band is removed. Once the blood has been collected, the
needle is removed and the area is covered with cotton or a bandage to stop the bleeding.

Factor VIII Infusion/Factor Replacement

Therapy

• Factor VIII concentrates are either purified from large pools of plasma collected from
paid or volunteer donors or synthesized in vitro by recombinant DNA techniques.

• It is a preventive care known as prophylaxis. Prophylaxis is the infusion of clotting factor

on a schedule to increase or maintain high levels of factor VIII. It prevents spontaneous
bleeding and decrease the number of bleeding episodes.
• The patient was given Factor VIII through vials 255 iu/ml q12 hr. On the 9th
hospitalization day the dose was increased to 300 iu.

• Purpose of Factor VIII infusion: To prevent bleeding that causes joint damage.

• Procedure: It is infused into veins via intravenous route.

4. Partial Thromboplastin Time (PTT)

• A test that measures how long it takes for a clot to form in a blood sample.

• The PTT test is used to evaluate the ability of a person's blood to clot. If it takes an
abnormally long time for the blood to clot, it can indicate a problem with one or more of
several different clotting factors, liver disease etc. Normal PTT is 60-70 seconds.

• Purpose: To find a cause of abnormal bleeding or bruising. It is useful in monitoring the

effects of the blood-thinning medication, Heparin. It is done to ensure that clotting ability
is normal before any patient undergoes a major procedure like surgery. PTT is done to
check if the dose of anti-clotting medicine is right.

• Procedure:

• A health professional will usually draw the blood from a vein. If the blood is being
drawn from a vein, the skin surface is cleaned with antiseptic, and an elastic band
(tourniquet) is placed around the upper arm to apply pressure and cause the veins to
swell with blood.

• A needle is inserted into a vein (usually in the arm inside of the elbow or on the back of
the hand) and blood is withdrawn and collected in a vial. A compound in the vial keeps
the blood from clotting before the sample is analyzed.

• After the procedure, the elastic band is removed. Once the blood has been collected,
the needle is removed and the area is covered with cotton or a bandage to stop the
bleeding.
5. Prothrombin Time (PT)

• Is a measure of how long it takes for blood to start clotting. Normal PT is 9-12 seconds.
PT is usually done with PTT.

• PT is also called an International Normalized Ratio (INR) which standardizes the time it
takes to clot on the basis of slightly different thromboplastins used in different
laboratories.

• Purpose: PT is done to find a cause for abnormal bleeding. To check low levels of blood
clotting factors. To check low levels of Vitamin K. (Vitamin K is needed for formation of
prothrombin). To check how the liver is working. It is done to check if the medicine to
prevent blood clots is working.

• Procedure: The same as the procedure for PTT

6. Blood Transfusion

• The transfer of blood or blood components from one individual to another.

• A Registered Nurse (RN) may administer blood transfusion to patients. A consent is

usually given and must be signed by the patient before transfusion.

• Purpose: Blood transfusion is done to keep blood in safe or normal level. Red blood
cells, white blood cells and platelets may be transfused. It replaces blood loss due to
injury, surgery, cancer and anemia.

• Procedure:

• Vital signs are taken (before, during and after)

• IV line is prepared through which blood will pass going to blood vessels. An IV line is
inserted with the use of a needle.

• The procedure usually takes 1-4 hours depending on the amount to be administered.