MLT 232 - Adv. Hematology & Coagulation

1. Assess laboratory safety and quality control
   1. Identify safety and precaution labels and signs.
   2. Disinfect work area.
   3. Wear appropriate personal protective equipment.
   4. Practice correct hand-washing technique.
   5. Dispose of biohazardous waste.
   6. Protect self, student-patient, and clinical patients from transmission of infectious disease.
   7. Perform appropriate error correction and documentation.
2. Demonstrate professional conduct.
   1. Demonstrate interpersonal communication skills with patients, other health care professionals, and the public.
   2. Practice confidentiality.
   3. Follow written and verbal instructions.
   4. Demonstrate ethical time management.
   5. Choose workplace-appropriate clothing and jewelry.
   6. Recognize the responsibilities of other laboratory and health care personnel, interacting with them with respect to their jobs and patient care.
3. Perform Basic Hematology Skills
   1. Identify proper specimen collection and transport techniques/methods.
   2. List types of transport containers and medias and their rationales.
   3. Demonstrate correct use of the microscope.
   4. Demonstrate good dexterity in use of hematology lab equipment.
   5. Perform automated cell counts.
   6. Perform quality control and maintenance procedures.
   7. Perform HCT and SRT
   8. Identify sources of error in HCT and SRT.
4. Perform and assess manual cell counts
   1. Describe diluting fluid and dilution rations.
   2. Describe hemacytometer chambers used to perform counts.
   3. Calculate manual cell counts per uL and per L.
   4. Identify sources of error in the calculations of manual cell counts.
   5. Discuss cellular counts on body fluids and calculations
   6. Demonstrate Upper-left rule and good cell distribution on the hemacytometer.
5. Perform and assess peripheral blood differentials
   1. State the normal number of red blood cells, white blood cells and platelets in the body.
   2. State basic cell structure and functions of each.
   3. List the five (5) main types of leukocytes found in peripheral blood and list the normal range for each type.
   4. Describe factors affecting acceptability of a blood smear.
   5. Prepare and stain manual blood smears.
   6. Perform cell differential counts.
   7. Perform Platelet and WBC estimation and correlate with automated counts.
   8. Identify correct objectives in performing the differential and estimates.
6. Incorporate Hematopoietic theory with cell lines maturation
   1. Contrast the Monopoietic theory vs. the Pluripoietic theory of cell development.
   2. Describe the role of colony-stimulating factors (CSFs) on the production of specific cell types.
   3. Describe the development of cells from the stem cell level to the blast form of a cell.
   4. List the sites of hematopoiesis from the early embryonic stage of development until fully established in adults.
   5. Contrast medullary hematopoiesis vs. extramedullary hematopoiesis
   6. Explain stages of cell maturation.
   7. Identify stages of cell maturation.
   8. Compare the nuclear characteristics and cytoplasmic features in cell maturity.
7. Describe Erythrocytic Life Cycle
   1. Describe the production and function of erythropoietin.
   2. List the sites of erythropoiesis from the early embryonic stage of development until fully established in adults.
   3. Distinguish the various stages of erythrocyte maturation.
   4. State the normal number of red blood cells in the body and the lifespan of a red blood cell in days.
   5. Describe the function of Red Blood Cells.
8. Incorporate Hemoglobin Structure, Metabolism and Degradation into the erythrocytic life cycle
   1. Describe the structure of the hemoglobin molecule.
   2. Identify normal fetal and adult hemoglobin with respect to globin chains.
   3. State percentages of normal hemoglobin concentrations.
   4. State how iron is transported through the body and stored.
   5. Discuss the physiological functions of hemoglobin, the oxygen-hemoglobin dissociation curve and the Bohr Effect.
   6. Name the main organ in the body that breaks down red blood cells.
   7. Briefly explain extravascular and intravascular destruction of red blood cells; and, list common chemistry tests used to measure hemolysis.
   8. Recognize abnormal forms of hemoglobin.
9. Interpret Red Blood Cell Tests and Evaluate Indicies, Morphology and Inclusions
   1. State the normal hemoglobin and hematocrit values, reasons for and increases and decreases and sources of error.
   2. State the normal value for ESR, general cause of an increased erythrocyte sedimentation rate and sources of error.
   3. Calculate RBC indices and correlate size and hemoglobin content.
   4. Apply the ‘Rule of 3.
   5. Correlate red cells distribution with (RDW) with anisocytosis.
   6. Relate reticulocyte count to bone marrow activity.
   7. Explain a shift reticulocyte or stress reticulocyte.
   8. Perform a retic stain and count.
   9. Explain why reticulocyte stains are considered supravital staining.
   10. Calculate reticulocyte counts, corrected reticulocyte count and reticulocyte production index (RPI) and know normals.
   11. Perform and calculate corrected WBC count.
   12. Classify Red blood cell morphology and describe red blood cell inclusions.
10. Evaluate red cell anomalies
    1. Explain anemia and state morphologic classification of anemias.
    2. Correlate anemias with red cell indicies.
    3. List major characteristics of and laboratory identification of anemias and classify according to cause.
    4. Correlate red blood cell morphology with pathologic and non-pathologic conditions.
    5. Define anemia and discuss the physiologic changes occurring as result of anemia.
    6. Discuss symptoms of anemia in order of progressing severity.
11. Evaluate Hemoglobinopathies and Thalassemias
    1. Explain genetic inheritance of hemoglobinopathies and thalassemias.
    2. Describe hemoglobinopathies with respect to the globin chain variations, peripheral blood picture, clinical effects and treatment.
    3. Distinguish the definitive test for Sickle Cell Anemia and the sickle cell trait from the screening tests.
    4. Describe unstable hemoglobin disease and describe Hereditary Persistence of Fetal Hemoglobin (HPHF).
    5. Differentiate the ’ and ’ Thalassemias with respect to, peripheral blood picture, clinical symptoms and treatment.
    6. Briefly describe Hemoglobin H and Hemoglobin Barts.
    7. Integrate classifications, severity, and treatment of anemias.
    8. Given any patient with signs of anemia, recommend an initial battery of test to be performed.
    9. For any suspected type of anemia, recommend additional tests useful in confirmation.
    10. Briefly explain the use and methodology of hemoglobin electrophoresis.
12. Evaluate microcytic anemias
    1. List four (4) types of microcytic, hypochromic anemias.
    2. Compare and contrast microcytic anemias by cause and iron studies.
    3. Compare and contrast symptoms in microcytic anemias.
    4. Evaluate blood picture and view slides of microcytic anemia.
    5. Interpret lab tests and recommend treatment.
13. Evaluate macrocytic anemias
    1. List at least four (4) types of macrocytic, normochromic.
    2. Compare and contrast macrocytic anemias by cause and nutritional studies.
    3. Discuss Vitamin B12 Deficiency, Folate/Folic Acid Deficiency, Pernicious Anemia and Pure Red Blood Cell Aplasia.
    4. Compare and contrast symptoms in macrocytic anemias.
    5. Evaluate blood picture and view slides of macrocytic anemia.
    6. State common inclusions and WBC appearance.
    7. Interpret lab tests and recommend treatment.
14. Evaluate and categorize normocytic normochromic anemias
    1. List the stages of Myelodysplastic Syndromes (MDS) in order of progression.
    2. Classify hemolytic anemias due to intrinsic and extrinsic defects.
    3. Describe the Hereditary RBC membrane defects of normocytic anemias and Non-hereditary Paroxysmal Nocturnal Hemaglobinuria.
    4. Perform and discuss an osmotic fragility test.
    5. Discuss the RBC enzyme defects of Pyruvate Kinase Deficiency and Glucose-6-phosphate dehydrogenase Deficiency.
    6. Evaluate blood picture and view slides of normocytic normochromic anemias
    7. Compare and contrast normocytic anemias by cause and reticulocyte results.
    8. Interpret lab tests and recommend treatment.
    9. Discuss causes of microangiopathic hemolytic anemia and identify RBC morphology and lab.
    10. Discuss pathology of Aplastic Anemia and bone marrow expectations.
    11. Discuss Relative Polycythemia, Absolute Polycythemia (Secondary), and Polycythemia Vera Rubra.
    12. Explain why Polycythemia Vera is called a myeloproliferative disorder.
15. Evaluate Granulocytic maturation and abnormalities
    1. Describe the developmental changes that occur in granulocytic cells as the cells mature.
    2. List the stages of development from most immature to most mature cell in the granulocytic series.
    3. State the functions of neutrophils, eosinophils and basophils.
    4. Distinguish absolute from relative cells counts.
    5. Explain why an automated WBC count is corrected for nucleated RBCs.
    6. Calculate the WBC count when corrected for nucleated RBCs.
    7. Identify immature WBC’s and NRBC’s.
    8. State the causes of quantitative disorders of granulocytes.
    9. Explain ‘left shift’.
    10. State the causes of quantitative disorders of granulocytes.
16. Evaluate Monocytic maturation and abnormalities
    1. List the stages of development from most immature to most mature cell in the monocytic series.
    2. State the functions of monocytes.
    3. Calculate the absolute monocyte count and correlate with abnormality.
    4. State the causes of quantitative disorders of monocytes.
    5. State the causes, possible symptoms (if given) and lab evaluations of qualitative disorders of monocytes.
    6. List traits and cell morphology in infectious mononucleosis.
    7. Perform differential and identify immature monocytes.
17. Evaluate lymphoid maturation and abnormalities
    1. List the stages of development from most immature to most mature cell in the lymphoid series.
    2. Describe reactive lymphocytes, and when they might be found on a blood smear.
    3. State where T lymphs and B lymphs are produced.
    4. State the functions of T lymphs and B lymphs.
    5. State the causes and laboratory evaluation of quantitative disorders of lymphocytes.
    6. State the causes of qualitative disorders of lymphocytes.
    7. Name the cell that is considered to be the same cell as a plasma cell.
    8. State the causes and laboratory evaluation of an increase in plasma cells.
    9. State the causes and laboratory evaluation of qualitative disorders of plasma cells.
    10. Perform differential and identify immature lymphocytes or plasma cells.
18. Assess cytochemical stains (cytochemistry)
    1. Explain what types of specimens and fixatives are acceptable for cytochemical studies.
    2. State where the enzyme, terminal deoxynucleotidyl transferase (TdT), is commonly found, as well as when it is a useful lab test.
    3. Suggest additional stains in identifying cells.
19. Categorize and evaluate Leukemias
    1. Classify leukemias with respect to cell age and cell type.
    2. List characteristics of acute leukemias.
    3. List characteristics of chronic leukemias.
    4. State the frequency, symptoms and prognosis of ALL, AML, CLL, CML.
    5. List the FAB classification of ALL and AML.
    6. Define the M:E ratio; and, state the normal value.
    7. Define absolute leukocytosis.
    8. State the frequency, symptoms, prognosis, blood picture, bone marrow picture and special identifying characteristics of Hairy Cell Leukemia.
    9. Explain why CML is a myeloproliferative disorder.
    10. Differentiate CML from a leukemoid reaction.
    11. Perform differentials of leukemias and identify key characteristics of each category.
20. Categorize and evaluate the Myelodysplastic and Myeloproliferative Disorders
    1. List the general cause of myelodysplastic syndromes (MDS).
    2. Describe the five stages of the FAB classification of the MDS.
    3. List four myeloproliferative disorders (MPD).
    4. Describe the symptoms, lab results and treatment of the MPD’s.
21. Categorize and evaluate the lymphoproliferative Disorders
    1. Describe the incidence, symptoms, cause and lab results for Hodgkin’s Lymphoma.
    2. State the feature present on the peripheral blood smear used to diagnose Hodgkin’s Lymphoma.
    3. Briefly describe the four histologic (Rye) classifications of Hodgkin’s Lymphoma.
    4. Briefly describe the incidence, symptoms, cause and lab results for Non-Hodgkin’s Lymphoma.
    5. Differentiate the Internal Working Formulation classifications.
    6. Describe the incidence, symptoms, cause and lab results for Sézary Syndrome/Mycosis fungoides.
    7. Describe the incidence, symptoms, cause and lab results for the plasma cell dyscrasias.
    8. Perform differentials of lymphoproliferative Disorders and identify key characteristics of each category.
22. Perform automation and explain methodologies of automated differentials and cell counts
    1. Explain why an automated WBC count is corrected for nucleated RBCs.
    2. State the purpose of a histogram.
    3. Explain the term “shift to the left” as it relates to the WBC histogram.
    4. State the purpose of the red cell distribution width (RDW), the reference range, and when it may be increased.
    5. Explain the mean platelet volume (MPV), expected results, and when it may be increased on decreased.
    6. Recognize specified areas of cytograms or scattergrams covered in class, and interpret normal and abnormal results.
    7. Recognize a “flag” on a print-out of automated results.
    8. Perform daily quality control (QC) on the automated cell counter.
23. Discuss Hemostasis process
    1. List and briefly describe the four (4) systems involved in hemostasis.
    2. State and briefly describe the four (4) functions of platelets in hemostasis.
    3. State the roles of plasminogen and plasmin in hemostasis.
24. Assess Platelet Maturation, function and Disorders
    1. List the maturation sequence for platelets.
    2. State the length of time platelets circulate in the blood (in vivo).
    3. State the length of time platelets can survive outside of the body (in vitro).
    4. State the normal range for a platelet count.
    5. Discuss causes of qualitative and quantitative Platelet disorders.
    6. Differentiate immune thrombocytopenia from non-immune thrombocytopenia.
    7. Contrast acute ITP from chronic ITP.
    8. Distinguish between primary thrombocytosis, secondary thrombocytosis, and thrombocytosis as a myeloproliferative disorder.
    9. Differentiate between Bernard-Soulier Syndrome and Glanzmann’s Thrombasthernia.
    10. Name the coagulation screening test that tests platelet function.
25. Compare and contrast between the coagulation factors
    1. List the coagulation factors by name and number.
    2. List the coagulation factors in the intrinsic, extrinsic and common pathways.
    3. Demonstrate which factors are missing and present in fresh plasma, aged plasma, adsorbed plasma, serum and adsorbed serum.
    4. State which factors are lost in storage.
    5. State which factors are Vitamin K dependent.
    6. State which factors are used up in coagulation.
    7. Demonstrate coagulation mixing studies.
    8. Name two adsorbing salts.
    9. Name the coagulation screening test that evaluates function of the extrinsic, intrinsic and common pathways.
    10. Name the drug(s) the PT test monitors and the PTT test monitors.
    11. Perform Pt and PTT tests.
26. Evaluate Fibrinolysis system
    1. State the roles of plasminogen and plasmin in hemostasis.
    2. Briefly describe and diagram the fibrinolytic mechanism.
    3. Describe how and from what fibrinogen degradation products (FDPs) are formed.
    4. List common plasminogen activators and inhibitors and state their general role.
    5. Differentiate between hypofibrinolysis and hyperfibrinolysis, and state causes for each.
27. Categorize Hemostasis Laboratory Tests
    1. State the most common anticoagulant for blood specimens collected for coagulation tests and the ratio for blood to anticoagulant.
    2. Calculate to correct for the anticoagulant volume.
    3. State the principle, purpose, normal values and abnormal values for vasoconstriction.
    4. State the principle, purpose, normal values and abnormal values for tests of platelet Adhesion and Aggregation.
    5. State the principle, purpose, normal values and abnormal values for tests of coagulation factors.
    6. State the principle, purpose, normal values and abnormal values for tests of fibrinogen.
    7. State the principle, purpose, normal values and abnormal values for tests of D-dimers.
    8. State the principle, purpose, normal values and abnormal values for tests of Plasminogen.
    9. State the principle, purpose, normal values and abnormal values for tests of Circulating and Lupus Anticoagulants.
    10. Perform semi-automated and automated PT and PTTs.
    11. Calculate the International Normalized Ration(INR).
    12. Perform D-dimers.
28. Compare and contrast Hereditary Coagulation disorders
    1. State the mode of inheritance, alternate name (if any), cause, symptoms, lab results, special diagnostic lab tests performed and treatment for hereditary coagulation disorders.
    2. Differentiate Hemophilia A from von Willebrand’s disease.
    3. State the mode of inheritance, alternate name (if any), cause, symptoms, lab results, special diagnostic lab tests performed and treatment for factor deficiencies.
    4. Contrast Afibrinogenemia, Hypofibrinogenemia and Dysfibrinogenemia.
29. Evaluate Consumptive coagulation disorders
    1. List four (4) main reason for acquired factor deficiencies.
    2. Describe Disseminated Intravascular Coagulation (DIC) with Secondary Fibrinolysis, DIC only (Chronic DIC), and Primary Fibrinolysis.
    3. Explain why DIC with Secondary Fibrinolysis is life-threatening and difficult to manage.
    4. Describe common causes, consumption of factors and platelets, presence of fibrin, lab results blood picture and treatment for acute DIC (or DIC with Secondary Fibrinolysis).
    5. Differentiate Chronic DIC from DIC with Secondary Fibrinolysis (acute DIC).
    6. State the cause, physiology, lab results and treatment of Primary Fibrinolysis (Hyperfibrinolysis).
30. Evaluate Decreased Production, Circulating Anticoagulants and Massive Transfusions and appropriate treatments in coagulation disorders
    1. List three (3) reasons for a decreased production of factors leading to acquired factor deficiencies.
    2. Correlate PT, PTT, fibrinogen, TT and platelet count with liver diseases.
    3. State the lab results in renal diseases for the following tests: PT, APTT, fibrinogen, TT, platelet count, FDP.
    4. List at least three (3) causes of acquired Vitamin K deficiency.
    5. State when a circulating anticoagulant is suspected.
    6. Describe the lupus anticoagulant.
    7. Briefly explain why receiving massive blood or blood product transfusions can lead to factor deficiencies.
    8. State the four (4) goals of treating coagulation disorders.
    9. List “pro’s” and “con’s” of components used to treat coagulation disorders.
    10. Differentiate between factor deficiencies and circulating anticoagulants.
    11. Interpret data provided in case studies, including mixing studies.
31. Demonstrate judgment and decision making skills
    1. Analyze laboratory findings to recognize common procedural and technical problems.
    2. Evaluate laboratory findings to take corrective action according to predetermined criteria.