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HAEMATOLOGY LABORATORY

Head of Unit : Dr Raudhawati Osman


Phone : +603-26155281
Email : raudhaosman@yahoo.com

1. INTRODUCTION

The Haematology Unit, Department of Pathology, HKL provides tertiary diagnostic and
consultative haematology services to all government hospitals and clinics in Malaysia. It also
serves as a training centre in laboratory haematology for undergraduates from local colleges
and universities. The unit is also a recognized training centre for doctors majoring in
haematology under the Masters in Pathology Program (MPATH) conducted by Universiti
Malaya, UniversitiKebangsaan Malaysia, UniversitiSains Malaysia and Universiti Putra
Malaysia.

2. LIST OF SERVICES AND LABORATORY TURN AROUNDTIME (LTAT)

Since the department reorganization in 2006, the Haematology Unit only provides
specialized haematology tests as listed below:

Section Test LTAT


( working days)
Morphology Full blood picture (FBP) Urgent: 3 days
Routine: 10 days
Bone marrow aspirate (BMA) 5 days
Trephine biopsy 20 days
Urine hemosiderin 3 days
CSF for blast 3 days
NAP score/ LAP score 3 days
H inclusion 3 days
Red Cell Haemoglobin analysis 20 days
Disorder Hb F quantitation 5 days
Heinz bodies 3 days
Kleihauer test 3 days
Sickling test 3 days
Osmotic fragility test (OFT) 3 days
Cryoglobulin 5 days
Leukaemia/lymphoma immunophenotyping (IPT) Verbal: 36 hours
Flow Formal: 10 days
cytometry CD4/CD8 enumeration 7 days
Paroxysmal nocturnal hemoglobinuria (PNH) 10 days
Immunophenotyping (IPT)
Molecular Alpha Thalasaemia 45 days
Molecular Molecular detection of mutations in acute leukaemia 14 days
haematology Molecular detection of BCR-ABLfor CML cases 14 days
Chimerism assay 30 days
CD34 enumeration 24 hours
Stem Cell Stem Cell Processing : Red cell depletion 6 hours
Transplant Stem Cell Processing : Plasma depletion 4 hours
Stem Cell Cryopreservation 24 hours
Stem Cell Donor lymphocyte cryopreservation 24 hours
Stem cell/ donor lymphocyte infusion (DLI) 30 minutes

3. REQUEST FORM

3.1. All specimens must be accompanied with PER-PAT 301 form.


3.2. Forms must be filled LEGIBLY and COMPLETELY with the following information:
 Patient’s details: Name, IC number, sex, age, ward / hospital name
 Patient’s clinical and test details: relevant clinical history, diagnosis, tests required,
type of sample, time and date of sampling,
 Requesting doctors details: name, stamp, signature
3.3. Incompletely filled forms may result in sample being rejected for testing.

4. SPECIMEN CONTAINERS

Specimen containers used in haematology laboratory are listed below:

Specimen containers Tests


EDTA tubes Generally most of the specialized haematology tests offered at our
laboratory use this tube unless stated otherwise
Lithium heparin OFT tests
Sodium citrate FBP in cases of platelet clumping TRO EDTA-induced platelet
clumping
Urine container Urine hemosiderin
Blood bag with ACD Stem cell collection from bone marrow, cord blood and peripheral
blood; Buffy Coat Preparation, Cryopreservation, Donor
Lymphocyte Cryopreservation, Plasma Depletion and Red Cell
Depletion.
Cryoshipper Stem cell/ donor lymphocyte infusion
Sterile bottle Body fluids

Specimen containers except blood bag with ACD and cryoshippercan be obtained from the
counter for “PembekalanTiubSetempat” located at the ground floor of Pathology Department
HKL.

5. SPECIMEN COLLECTION

5.1. General

5.1.1. Most of the tests use venous blood samples.


5.1.2. To ensure consistent and accurate result, follow strictly to the volume of blood
required for type of test specified on the label or fill the blood sample to the mark on
the label.
5.1.3. To prevent haemolysis:
 Avoid vigorous mixing
 Send the specimen to the laboratory as soon as possible
5.1.4. Avoid clot formation by:
 Ensuring a smooth venipuncture and steady flow of blood into the syringe.
 Introducing the blood in the anticoagulant bottle as soon as the blood has been
drawn.
 Immediately gently mix by inverting the tube at least 6-10 times.

5.2. Method for collection for special hematology test:

5.2.1. Bone Marrow Aspirate (BMA)

 Please call 6549 to arrange for an appointment


 On the appointment date, laboratory technologist will be at the procedure room to
prepare smears from bone marrow sample obtained by ward doctor. The ward
staff has to ensure that all necessary preparation is ready to avoid
unnecessary waiting of the laboratory technologist prior to commencement of
the procedure.
 Waiting time more than 15 minutes may result in the procedure been postponed.
 MLT in charge will provide the slides for BMA and universal container with 10%
formalin for trephine biopsy on the day of the procedure. Other containers for
other tests such as EDTA for immunophenotyping and molecular study,
lithium heparin for cytogenetic study and blood culture bottles for marrow
culture must be provided by ward staff if required.
 The slides will be taken back to the haematology laboratory by the laboratory
technologist for staining and reporting.
5.2.2. For other test :

Refer to Summary of Hematology Tests According To Alphabetical Order below.

SUMMARY OF HAEMATOLOGY TESTS ACCORDING TO ALPHABETICAL ORDER

SPECIMEN
BIL TEST CONTAINER REMARK
TYPE

Call ext. 6549 to set


1 BM Aspirate Smear Bone marrow
appointment.

Universal container (with Call ext. 6549 to set


2 BM Trephine Trephine biopsy
10% formalin) appoinment

Send immediately in room


temperature (20-24°C).
Avoid direct contact with
3 CD4/CD8 Enumeration EDTA tube Blood
ice. Specimens kept more
than 48 hours are not
suitable for analysis

Call ext 6697 to set


appointment. Avoid meal 4
2 EDTA tubes and 2 Plain
4 Cryoglobulin Blood hours before blood taking.
tubes
Sample collection in
Haematology Lab.

Send immediately. Please


i) Sterile container state time of collection.
CSF for
5 ii) EDTA tube if RBC CSF Sample need to be
Blast
contamination present processed within 2-4 hours
of sample collection

Send to the laboratory as


Full Blood Picture
6 EDTA tube Blood soon as possible (within 4
(routine)
hours of collection)
Send to the laboratory as
Full Blood Picture
7 EDTA tube Blood soon as possible (within 4
(urgent)
hours of collection)

Send to the laboratory as


8 H Inclusion EDTA tube Blood soon as possible (within 4
hours of collection)

SPECIMEN
BIL TEST CONTAINER REMARK
TYPE

Please write appropriate


9 Hb F quantitation EDTA tube Blood
indication on request form.

Detail history on index case


10 Haemoglobin Analysis EDTA tube Blood must be provided for family
screening.

Please call 6697 for


11 Heinz bodies EDTA tube Blood
appointment.

Please call 6697 for


12 Kleihaeur Test EDTA tube Blood
appointment.

Please call 6549 for


appointment. Send the
sample to the laboratory as
13 LAP/NAP Score EDTA tube Blood soon as possible. EDTA
sample need to be
processed within 30
minutes of blood collection.

Send immediately in room


temperature (20-24°C).
Blood/ Bone
Leukaemia/Lymphoma Avoid direct contact with
14 EDTA tube Marrow/Body
Immunophenotyping ice. Specimens kept more
Fluid
than 48 hours are not
suitable for analysis.

Please contact ext


5746/5748 for more
information. Must include
Hb Analysis report and
Molecular Alpha
15 EDTA tube Blood recent Full Blood Count
Thalassaemia
result. Detail history on
index case must be
provided for family
screening.
Sample need to be
Molecular detection of
processed within 24 hours
mutations in acute Blood/Bone
16 EDTA tube after sample blood
leukaemia and BCR- Marrow
collection
ABLfor CML cases

Molecular Detection of Please contact ext


Blood/Bone
17 Mutations in Acute EDTA tube 5746/5748 for more
Marrow
Leukaemia information.

SPECIMEN
BIL TEST CONTAINER REMARK
TYPE

Please clearly label donor


and recipient's identity.
PBSC/Bone Pre-sample must be sent
Molecular Chimerism
18 EDTA tube Marrow/Cord before chemotheraphy
Assay
Blood iniated. Please contact ext
5746/5748 for more
information.

Please call 6697 for


appointment. Send to the
laboratory before 9.00 am.
Test must be performed
Collect 5.0 ml of blood in
19 Osmotic Fragility Test Blood within 2 hours after blood
Lithium Heparin container.
collection if samples are
kept at room temperature;
or within 6 hours if samples
are kept at 20-60oC.

Send immediately in room


Paroxysmal Noctural temperature (20-24°C).
Haemoglobinuria Avoid direct contact with
20 EDTA tube Blood
(PNH) ice. Specimens kept more
Immunophenotyping than 48 hours are not
suitable for analysis.

Please call 6697 for


21 Sickling test EDTA tube Blood
appointment.

Please call ext 6697 for


Bone marrow,
appointment. Send
Peripheral
Stem Cell (CD34) immediately in room
22 EDTA tube Blood Stem Cell
Enumeration temperature (20-24 oC).
(PBSC), Cord
Avoid direct contact with
Blood
ice.
Please call ext 6697 for
appointment. Send
immediately in room
Stem Cell Processing : Bone Marrow temperature (20-24 oC).
23 Blood bag with ACD
Buffy Coat Preparation Harvest Avoid direct contact with
ice.

SPECIMEN
BIL TEST CONTAINER REMARK
TYPE

Please call ext 6697 for


Bone marrow,
appointment. Send
Peripheral
Stem Cell immediately in room
24 Blood bag with ACD Blood Stem Cell
Cryopreservation temperature (20-24 oC).
(PBSC), Cord
Avoid direct contact with
Blood
ice.

Please call ext 6697 for


appointment. Send
Stem Cell Processing : PBSC, Bone immediately in room
25 Blood bag with ACD
Plasma Depletion Marrow temperature (20-24 oC).
Avoid direct contact with
ice.

Please call ext 6697 for


appointment. Send
Stem Cell Processing : immediately in room
26 Blood bag with ACD Bone Marrow
Red Cell Depletion temperature (20-24 oC).
Avoid direct contact with
ice.

Please call ext 6697 for


appointment. Send
Stem Cell Donor
Donor immediately in room
27 Lymphocyte Blood bag with ACD
Lymphocyte temperature (20-24 oC).
Cryopreservation
Avoid direct contact with
ice.

Stem Cell / Donor Donor Please call ext 6697 for


28 Freezing bag
Lymphocyte Infusion Lymphocyte appointment.

Send sample immediately


29 Urine Hemosiderin Universal container Urine
after collection.
6. REJECTION CRITERIA

No Reasons for rejection


1 Incorrect specimen for test requested
2 Patient name and ID on specimen container does not match information in request form
3 Incorrect container / preservative used
4 Blood clotted
5 Insufficient sample
6 Blood markedly lysed
7 Specimen spilled / leaked
8 No sample
9 Empty container
10 Broken container
11 Expired sample container
12 Lipaemic sample
13 Unlabelled specimen
14 Unsuitable sample for analysis
15 Test is not offered in Haematology Laboratory, HKL
16 Incomplete request form : IC number- not stated/ incomplete
17 Incomplete request form : test request- not stated/ incomplete
18 Incomplete request form : no hospital/ ward/clinic stated
19 Incomplete request form: the name of requesting doctor is not stated.
20 Incomplete request form: no clinical history provided
21 Post-transfusion sample for hb analysis test
22 Redundant request: previous report is attached
23 Redundant request: earlier request is in progress
24 Unsuitable for CD4/CD8 testing i.e. specimen exceeding 48 hours after collection. Please
send another fresh sample.
25 No FBC results attached
26 No Hb analysis results attached
27 No FBC or Hb analysis results attached
SAMPLE RECEPTION

6.1. During office hour : Receiving Counter, Haematology Laboratory


6.2. After office hour : Receiving counter, Pre-Analytical Unit

At the reception counter, ward or clinic staff must ensure the date and the time of sample
arrival is recorded by using the electronic time clock/ recorder.

7. REPORTING OF RESULTS

7.1. The wards that have “Lab viewer system” can trace their result electronically.
7.2. Verbal report: will be issued for certain cases of IPT for leukaemia/ lymphoma and
urgent FBP (if requested by clinicians). Printed result will be dispatched once available.
7.3. Formal report will be printed and dispatched once available.

8. COLLECTION OF RESULTS

8.1. Formal reports for in-patients and cases from Klang Valley are dispatched to designated
pigeon holes located at the main counter of the department.
8.2. Formal reports for outside Klang Valley are mailed via Pos Malaysia to mailing centres
(state hospitals) or specific mailing address agreed between requester and our
laboratory6.
8.3. Urgent results will be informed to the wards by telephone or to be given by hand to the
waiting ward personnel.

9. ENQUIRIES

Enquiries regarding the haematology test, samples and result can be made via the following
numbers:

Section Extension

Morphology 6549

Red Cell Disorder 6697

Flow cytometry 6853


Stem Cell Transplant 6883

Molecular haematology 5748/ 5746

Medical Officer
 Urgent FBP/ MO Room 6374/ 7514
Pathologist Room
 Main laboratory 5598
 Diagnostic Room 7514

10. SERVICES AFTER OFFICE HOUR

The specialized haematology laboratory does not operate after office hours. However,
urgent requests for FBP and leukemia immunophenotyping can be arranged via the Medical
Officer or Pathologist on-call. Please refer to the monthly roster provided by the Department
of Pathology.

11. LIST OF PATHOLOGISTS AND CONTACT DETAILS

Pathologists Email Ext. number


Dr Raudhawati Osman raudhaosman@yahoo.com 5281
Dr Mimi Azura Aziz mimiazizmy@yahoo.com 7514/ 5598
Dr Siti Shahrum Muhamed Said drsitishahrum@yahoo.com 7514/ 5598
Dr Noraesah Mahmud noraesah@yahoo.com 7514/ 5598
Dr Suzana Zainol dr_suzana_zainol@yahoo.com 7514/ 5598
Dr Thatcheiany A/P Kumariah thatcheianykumariah@yahoo.com 7514/ 5598