Hematology
adequately before disinfection
Safety in the clinical hematology laboratory
- Classification of hazards
o Biologic
o Chemical
o Electrical
o Mechanical
o Thermal
BIOLOGIC
- Includes all body fluids which are
highly infectious and potentially lethal
- Materials are referred to as biohazards
- Extreme caution when processing
- Greatest concern of all hazards
- All biologic specimens, regardless
of source, should be considered
biohazardous
General rules that are strictly followed
in the laboratory
1. Gloves must be worn when handling
biologic specimens
2. Areas or equipment used by personnel
who are not gloved should not be
touched with contaminated gloves
3. Wash hands immediately if they
become contaminated, with or without
gloves on
4. Do not remove specimen tube
stoppers until necessary
5. Mouth pipetting is strictly prohibited
6. Replace clay slabs for microhematocrit
tube sealing frequently
7. Decontaminate sedimentation tube
racks regularly
8. Unfixed or unstained slides should be
considered infectious
9. Do not handle needles
10. Obtain immediate treatment for
accidental and inappropriate contact
with biohazards
11. Properly dispose of contaminated
laboratory supplies
12. Disinfect and clean biohazard spills
immediately
Note: 1:10 dilution (0.5% sodium
hypochlorite) if contaminated surface
is porous and cannot be cleaned
1:100 (0.05% sodium hypochlorite)is
for hard, smooth surfaces that can be
decontaminated adequately,
inactivates HBV for 5 mins and HIV
for 2 mins, 20 mins for large spills of
infectious agents
For metals: iodophores registered
as hard-surface disinfectants (not
antisceptic) or phenolic
disinfectants.
13. Protective clothing should always be
worn in the laboratory but never
outside the laboratory
CHEMICAL
- Solid, liquid or gaseous chemicals may
be hazardous if processed
inappropriately
- Toxic or corrosive chemicals should
only be used under a fume hood
- Flammable or explosive chemicals
should be stored in a safety cabinet
designed for such chemicals
- Always wear PPE when performing
special staining of cells because they
are carcinogenic
- Wear safety glasses when working
with acid or alkaline
- Mouth pipetting is strictly prohibited
- When carrying bottles or flasks, hold it
in the body rather than the neck
- Always add acid to water and never
vice versa, perform it in a deep sink to
be easily flooded with water
- Reagents should always be labeled
with its name and concentration, the
person who prepared it (initials only),
and the date on which the reagent was
prepared.
- Material safety data sheet (MSDS) –
information necessary for the safe
handling of the material
- Most noncarcinogenic, diluted may be
flushed down the sink, otherwise, an
environmental safety specialist do the
job.
ELECTRICAL
- Caused by inappropriate use or
maintenance of electrical instruments
or equipment that may cause electrical
shock, burns, or a fire or explosion
- Maintenance is mandatory for safe use
of equipment, include replacement of
frayed wires or electrical connections.
- All equipments should be grounded
by 3 pronged plug according to OSHA
- NEVER OPERATE WITH WET HANDS
MECHANICAL
- Improper use, storage, or disposal of
glassware, sharp instruments,
compressed gases or equipments.
- Avoid breakage
- Glass and sharp objects that are
contaminated should be disposed in a
puncture proof container
- Dispose needles left uncapped
FIRE
- Thermal hazards may be caused by
improper use or storage of either
cryogenic or combustible substances.
- Prevention is the easiest way to deal
with fire hazard
- Fire extinguisher should be accessible
in the laboratory (dry chemical is
popular because of its versatility), fire
blanket should also be available for
small fires
REMEMBER THE CARDINAL RULES
- Good personal habits
o Wear proper attire inside the
laboratory and not outside
o Tie back long hair
o Do not eat, drink, or smoke in
the work area
o Always wear gloves
o Never do mouth pipetting
o Do not put objects in the mouth
o Wash hands frequently
o Keep hands away from any
other mucous membranes
- Good housekeeping practices
o Keep work areas clean
o Store chemicals properly
o Label reagents and solution
o Post warning signs
- Good laboratory technique
o Careful in transferring
chemicals and always add acid
to water
o Do not operate new or
unfamiliar equipment until you
are trained and authorized
o Read all labels and instructions
carefully
o Use the personal safety
equipment that is provided
o Safe handling, use, and
disposal of chemicals
o Learn emergency procedures
and become familiar with the
place
Specimen collection
Specimen collection is vital, it is the
laboratory’s first step toward reporting
accurate and reliable results
PROFESSIONALISM AND INTERPERSONAL
SKILLS
- Phlebotomist is essential to the health
care team and provides the link
between the patient and laboratory
- Good interpersonal skills
- Professional attitude
- Neat appearance
- Patient consideration and concern
- Patient confidentiality
SPECIMEN COLLECTION BY VENIPUNCTURE
- It is the most common technique to
obtain a blood specimen
VENIPUNCTURE PROCEDURE
PATIENT INTERACTION
- Identify the patient
- Note patient isolation and
restrictions
- Note patient dietary restrictions
- Reassure patient
- Verify paperwork
- Position patient
ASSEMBLE SUPPLIES AND EQUIPMENT
VENIPUNCTURE
- Select general venipuncture location
- Apply the tourniquet
 - Select exact venipuncture site
- Cleanse area
- Inspect needle
- Perform venipuncture
- Release tourniquet
- Position gauze over puncture site
- Remove needle and apply pressure
SPECIMEN PREPARATION
- Fill the right tubes for the right test
Discard needle
- Label specimens
- Transport specimens promptly and
properly
- Discard needle
- Label specimens
- Transport specimens promptly and
properly
Initial steps
PATIENT IDENTIFICATION
- The first step
- The patient’s name, ID number, and
any additional information on the test
requisition should initially be
compared with, and found to be
identical to, the information posted
outside the patient’s room or on the
chart
- Greet the patient when entering the
room and identify himself/herself
- Explain why it is necessary to collect
blood (to aid in diagnosis and
treatment)
- Ask the patient to state his/her full
name (spell out any unusual name)
- Never ask a yes or no identity question
- Compare the requisition information to
the patient’s wristband
- If patient is unconscious, ask the
responsible nurse
- Age and sex are also identified
(differences in reference range)
NOTE ISOLATION RESTRICTIONS
- Note any color-coded isolation sign on
the patient’s room or door
- Patients are isolated either to prevent
spread of disease or to protect them
from employees and visitors
- PPE are placed outside the patient
room and worn when entering
(remove all accessories and wash
hands before PPE)
NOTE DIETARY RESTRICTIONS
- Make sure the patient has fasted for
the required period of time (usually
not required in hematology)
REASSURE PATIENT
- The phlebotomist should relieve the
patient from stress and anxiety
POSITION THE PATIENT
- Make sure the patient is comfortable
- Ask assistance if patient movement is
required
- Patient position is noted on the
requisition (variation in blood count
values e.g. PCV can decrease an
average of 8% when a patient is
lying down because of
hemodilution, when a patient gets
out of bed, hemoconcentration
occurs)
ASSEMBLE SUPPLIES
- Organize things and place it in an
accessible location before doing
venipuncture
- Equipments:
o Evacuated tubes (normally
blood clots after removal from
the body, therefore
anticoagulants are needed to
prevent clotting; anticoagulant
of choice for CBC: disodium
or tripotassium salt of EDTA,
specific tubes are indicated by
the color of the rubber
stopper; marked with an
expiration date, If expired it
may either have an ineffective
additive or lose their vacuum;
certain of amount of blood
must be drawn within a certain
amount of anticoagulant
[correct blood-to
anticoagulant-ratio], too
much anticoagulant =
changes in cell size and
 morphology, too little o Gloves
anticoagulant = clotting; 5 or VERIFY THE PAPERWORK
7ml tubes = adult specimen - Accession numbers on the
collection, 2-3ml = preprinted specimen labels and test
pediatrics; 1.5mg/ml is the requisition must be identical
required final concentration of SELECT GENERAL VENIPUNCTURE
EDTA for complete LOCATION
anticoagulation) - Veins in the arm are commonly used
Routinely used evacuated - 3 major veins
tubes o Median cubital (large, close
Stopper Additive to the skin surface, and well
color anchored by tissue so it will
Red None not roll or move away when
Red and Inert polymer punctured)
Gray barrier o Cephalic (tend to bruise and
material; no roll more easily)
anticoagulant o Basilic (tend to bruise and roll
Lavender EDTA (K3 or more easily)
Na2)
- Alternate sites
Blue Citrate
o Ventral forearm
Green Heparin
o Wrist area
Gray Sodium
fluoride o Back of the hand
o Ankle or foot(consult the nurse
o Tube rack or physician before collecting;
o Syringes cannot be used in circulatory
o Butterfly infusion sets problems in the lower
o Needles (gauge number refers extremity, diabetes in poor
control,
to the diameter or the bore of
the needle; the higher the hemoglobinopathies)
gauge, the smaller the - In selecting the site, avoid areas with
diameter, 19, 20 [most hematomas, burns, scars or
common], 21 [for small and edema(swelling), mastectomy on the
difficult veins, may cause same side, IV infusion side (if both
hemolysis]; most commonly arms are on IV, ask the nurse to stop IV
used needle length: 1-1.5in) infusion for 2 minutes then discard
o Tourniquet (most commonly small amount of blood before
used is a pliable piece of specimen collection, glucose and
phosphorus are not acceptable)
rubber tubing,
seraket[seatbelt like
apparatus, advantageous Blood collection methods
because the phlebotomist can
partially release venous 1. Evacuated tube system
o most commonly used
pressure, thus preventing
hemoconcentration], Velcro o components: vacutainer 2-
and blood pressure cuff can way needle, plastic tube
holder, evacuated glass tube
also be used
o Alcohol pads 2. Syringe method
o Gauze pads o Method of choice in some
o Adhesive bandages or gauze instances
bandage rolls
 o Components: barrel and
plunger to which needle is
attached
o Used for small, fragile or
damaged veins because they
may easily collapse under the
vacuum pressure of evacuated
tubes
3. Butterfly infusion set
o Components: stainless steel
beveled needle with attached
plastic wings (for the
phlebotomist to grasp during
the needle insertion), platic
tubing, adapter, syringe,
tube holder
o Commonly used for pediatric
venipuncture, difficult veins,
special collectons requiring
more than one syringe
o Costly

Final steps
APPLY THE TOURNIQUET
SELECT HE VENIPUNCTURE SIITE
CLEANSE THE SITE
INSPECT THE NEEDLE
PERFORM VENIPUNCTURE
EVACUATED
SYRINGE
RELEASE TOURNIQUET
REMOVE NEEDLE AND APPLY
PRESSURE
DISCARD NEEDLE
LABEL SPECIMENS
TRANSPORT SPECIMENS
PROMPTLY AND PROPERLY