Student Internship Programme (SIP) HAEM

Howdy my coursemates!

I've been scheduled to the routine lab of the haematology department for the first 4 weeks (not first6weeks :D). It's not named the routine lab for nothing and surely there is always going to be a general routine flowchart to follow. So, here goes (a brief one)!

1) Starting up the automation at the start of operating hours (8am), daily maintenance check, run quality control (QC)
2) Run commercial controls a.k.a primary controls (low/medium/high) during startup and secondary controls (either one of low/medium/high) at specific intervals, say 10am, 12noon, 2pm
3) Collect patient samples and test request forms at the reception and run various tests
4) File unverify automatch results
5) Delta check prompt? (it means a significant difference in current and previous results spotted by the LIS in any tests done in the same individual patient)
6) Screen blood films (BF)
7) Full blood count (FBC) result tally with BF diagnosis?
8) Enter and verify results in LIS

In case you're wondering what sort of tests are done in the routine lab, there are full blood count, miscellaneous tests like

- Retics
- Haemoglobin (Hb)
- Malarial parasite (MP)
- Erythrocyte sedimentation rate (ESR)
- Platelet
- White blood cell (WBC)
- HbH test etc..

The test that I've chosen to elaborate will be the ESR.

Name of Test: Erythrocyte Sedimentation Rate (ESR)

Principle of Test: ESR test measures the settling of erythrocytes in human plasma over a specific time period, usually 60 minutes. The reported numerical value is derived from measuring the distance (millimeters) from the bottom of the surface meniscus to the top of the erythrocyte sediment in a column of anticoagulated blood that has remained perpendicular in a special-purpose pipette (solely for ESR usage) for 60 minutes.

A typical sigmoid curve resulting from the descent of the plasma-red interface plotted against time distinguishes three phases of ESR. The lag phase (initial portion of curve) reflects the period where individual erythrocytes form rouleaux. During the decantation phase (second portion), the plasma-red interface falls more rapidly. In the final phase, the cell aggregate pile up on the bottom of the tube but may not always be evident within the 60 minutes time frame. The final ESR test result, read at 60 minutes, will therefore include varying contributions from the three phases.

The erythrocyte sedimentation process can be affected by a number of factors such as
1) incorrect amount of blood for dilution, 2) air bubbles in ESR tube, 3) inadequate mixing of sample before and after dilution, 4) failure to ensure vertical alignment of tubes and 5) vibration.

Conditions such as variations in erythrocyte shape for eg, sickle-cell formation or acanthocytosis (mixed erythrocyte shapes) will inhibit the ability of erythrocytes forming rouleaux and hence, ESR results will be affected.

Test Results with reference range:
Male - 1-10 mm/hr
Female (up to age 50 years) - 3-15 mm/hr
Female (age 51 years and above) - 3-20 mm/hr

Clinical interpretation: ESR is a nonspecific test used to detect inflammatory, neoplastic, infectious and necrotic processes which are associated with a modification of the plasma protein (primarily fibrinogen, globulins and albumin). It is not diagnostic for any particular disease or injury. It is a fairly reliable indicator of the course of disease and therefore can be used to monitor disease therapy.

I hope I've put up a fair recollection of what's happening around me and share a thing or two with everyone.

Have mercy please. Don't kill me with all the questions! :/

- Alex Tg02 0503222B