Department of Laboratory Medicine and Pathology

Clinical Laboratory Scientist (CLS)/ Medical Technologist Program(MT)

Hematology Pre-Clinical Competencies

Introduction

The clinical hematology rotation at HCMC consists of a total of 5 weeks of practical laboratory experiences, individualized morphology studies, clinical case studies, and formal lecture instruction.

Throughout the course of rotation the student will be directly involved in the performance and evaluation of hematological specimens and procedures.  It is important that we graduate students who demonstrate both technical expertise and a broad cognitive base in hematology theory.

In order for the students to master these abilities it is necessary to have the basic pre-clinical competencies taught at the college level.  Our emphasis at HCMC will be on abnormal RBC/WBC morphology and disease states, hemoglobinopathies, clinical correlations, development of technical skills, instrumentation, and quality assurance programs.

NOTE:  Each student is required to write out answers for all of the objectives.  If the objective involves the performance of some activity, describe what you did in your college courses in order to meet that objective.  These answers must be turned in to the HCMC program director on the first day of orientation.  They will be evaluated for completeness by the HCMC education techs. Students will be required to review and know this material when they enter each of the rotations.

Lisa Hodson, MLS(ASCP)CM Updated 2-10

I. Basic Hematological Techniques

A.      The student should be able to accurately perform manual platelet and white blood cell counts using a hemocytometer.  Discuss counting/cell identification (platelets, red cells, white cells) and calculations.

B.      The student should be able to calculate the following red cell indices:  MCV, MCH, MCHC, state the normal values and discuss the significance of results as related to red cell morphology on a peripheral smear.

C.      The student  should be able to identify parts of the microscope and demonstrate correct usage and care.  Discuss the following:

1.       Vocabulary and microscope anatomy - include the meaning of  “parfocal”

2.       Correct procedure for examining stained blood films

3.       Care of microscope

4.       Troubleshooting

D.      The student should be able to perform normal differential counts from a peripheral blood smear demonstrating accuracy and precision within allowable limits

NOTE: It is imperative that the student demonstrate competency in the above stated "Basic Technique" category.  HCMC will provide self-instructional review units if necessary, but will not formally cover these areas again.

II. General Theory

A. Define and/or describe the following:

B.      Define hematopoiesis including the following:

1. Pluripotent stem cell development theory

2. Stem cell kinetics: Generative cell cycle

3. Hematopoietic inductive environment of regulatory growth factors and inhibitors

4. Apoptosis

           C.      Identify phases and the site of origin for cellular development of active hematopoietic                      tissue including:

1.  Embryo and fetus

a.  Mesoblastic phase

b.  Hepatic phase

c.  Medullary/myeloid phase

2.  Infant and young child

a.  Red marrow spaces (all cell lines)

b.  Thymus fully developed (T lymphs)

c.  Secondary lymphoid tissue (B-cell, T-cell and NK-cell)

3.  Adult

a.  Red marrow (axial skeleton and proximal ends of long bones)

b.  Primary and secondary lymphoid tissue (B-cell, T-cell and NK-cell)

D.      Describe the role of other organ systems during hematopoiesis including:

1. Mononuclear phagocyte system

2. Spleen

• Structure and blood flow
• Function

3. Liver

• Structure
• Function

4. Lymph nodes

• Structure
• Function

5. Thymus

• Structure
• Function

E.      Correlate physical description with the presence of hematologic disease including:

1. Splenomegaly

2. Hypersplenism

3. Hepatosplenomegaly

4. Lymphadenopathy

F.      Identify distinctive features during erythropoiesis used to characterize developing cells

including:

1. Overall cell size

2. Nucleus

a. Shape

b. Realative size

c. Staining reaction

d. Chromatin pattern

e. Nucleoli

3. Cytoplasm

a. Relative amount

b. Staining reaction

G.      Describe the following nutritional and regulatory factors during erythropoiesis

1. Erythropoietin (EPO)

2. Iron

3. Vitamin B12 and Folate

                     4.   Hormones

                              a.  Estrogen

                              b.  Androgens

                              c.  Thyroxine

                              d.  Growth hormone

H.      Describe the following components necessary for mature red cell survival and function:

1.  Membrane composition and function

                     a.  Lipids

                     b.  Integral proteins

                     c.  Peripheral proteins

                     d.  Function—structure, deformability, permeability, surface

antigens, cationic pumps

2.  Metabolic pathways for maintenance of cell function

                     a.  Embden-Myerhof

                     b.  Hexose monophosphate shunt

                     c.  Methomoglobin reductase

                     d.  Luebering-Rapoport

I.       White cell production and function

1.       State the origins of leukocytes.

2.       List the function of mature leukocytes.

                     3.       State the normal range for white cells in both adults and children.

4.       Compare and contrast relative and absolute white cell

counts.

References

1. Clinical Hematology and Fundamentals of Hemostasis.  D. Harmening.  5th Edition.  2009
2. Hematology: Clinical Principles and Applications.  B. Rodak.  3rd Edition.  2007
3. Clinical Laboratory Hematology.  McKenzie.  2004
4. Hematology:  Clinical Principles and Applications 2nd ed. Rodak.  2002
5. www1.umn.edu/hema/  (includes cell maturation chart and case studies)