Department of Haematology and Blood Transfusion

DEPARTMENT OF HAEMATOLOGY AND BLOOD TRANSFUSION

LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA (LASUTH)

DEPARTMENT MANUAL AND LABORATORY USER

FIRST EDITION (2015) HANDBOOK

Department of Haematology and Blood Transfusion, LASUTH, Ikeja 2015

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publishers.

Published and Printed by

BollyroseNig.Company

Tel:08087811554

Email:

Title Page1

Contents3

Forward5

Scope and Purpose6

Vision and Mission7

List of Abbreviations8

General Information9

Contact Information of Head of Units11

Opening Hours12

Members of Staff Profile13

Department Organogram16

Haematology request form17

Phlebotomy Procedure18

Sample Collection19

Haematology Tests, Sampling Requirements and Expected Turn Around Time23

Consult to Haematologist on call25

References Values and Result Interpretations26

Panic Values27

Reporting Test Results27

Retention of Samples28

Biosafety29

LASUTH HIV PEP30

LASUTH Blood Bank32

Blood Donation34

Consent to transfusion of blood and blood products36

Bone marrow aspiration and biopsy information sheet and consent form39

Consent for Anaesthesia or sedation43

Consent for Chemotherapy44

Standard Operating Procedures47

Training and Research61

List of recognized publications61

Acknowledgements66

References67

Forward

Blood they say is Life.Blood and blood products are essential therapeutic components for management of myriad of diseases. Their use also transcends boundaries of disciplines cutting across major clinical departments.

Little wonder, the appearance of blood in an emergency room for a bleeding patient usually provides such a relief for physicians. Very much like other drugs, blood could be hazardous if improperly used either by error of preparation or application. An adequate knowledge of these essential products can therefore not be overemphasized.

This departmental manual and hand-book in LASUTH represents the first to be produced which provides enough knowledge for all who have anything to do with blood. The high point of this handbook is the compilation of Standard Operating Procedures (SOP).

I congratulate the leadership and entire staff of Haematology department for this avangard position worthy of emulation. I am sure the handbook will be cherished by all who read it.

DrAyoadeAdedokun MD,FMCGP.

Director Clinical Services and Training/CMAC

Scope of Purpose

This book is a compendium of Haematology and Blood Transfusion Department. It has been well researched and presented. Readers will benefit tremendously in improving their knowledge of the Department. Day-to-day interactions with the Department have been chronicled in this book. It is expected to bridge knowledge gaps existing between the Department and other Departments in the Hospital.

The book brings to fore department’s members of staff profile, Haematology Tests, Sampling requirements and Expected Turn-Around Time, urgent services: consult to the Haematologist among other pieces of information highlighted. It is intended for all Laboratory users, Clinical, non-clinical Departments and the general community at large. It is a guide to understanding and utilizing services offered by the Department.

Dr. AkinbamiAkinsegunAbduljaleel

Senior Lecturer/Consultant Haematologist

Head of Department

September 2015.

VISION AND MISSION

VISION:

To be a Centre of Excellence in Clinical Laboratory Services

MISSION:

To provide High quality Clinical Laboratory services in a friendly environment where patients’ satisfaction is the Ultimate

List of Abbreviations

LASUTH- Lagos State University Teaching Hospital

Hb - Haemoglobin

ESR- Erythrocyte Sedimentation Rate

PT- Prothrombin

APTT - Activated Partial Thromboplatin Time

INR - International Normalized Ratio

FBC - Full Blood Count

ICU - Intensive Care Unit

CCU - Critical Care Unit

HDC - Haematology Day Care

HOD - Head of Department

BMA - Bone Marrow Aspiration

BMP - Bone Marrow Biopsy

LE - Lupus Erythomatosus

HIV- Human Immunodeficiency Virus

HbsAg - Hepatitis Surface Antigen

HCV - Hepatitis C Virus

CNO - Chief Nursing Officer

ACNO - Assistance Chief Nursing Officer

CMLS - Chief Medical Laboratory Scientist

ACMLS - Assistant Chief Medical Laboratory Scientist

PMLS - Principal Medical Laboratory Scientist

PMLT - Principal Medical Laboratory Technologist

MLT - Medical Laboratory Technician

ADML- Assistant Director ML

SMLS- Senior MLS

BDC - Blood Donor Clinic

QMS - Quality Management System 8

General Information

Introduction to Haematology Department

The department runs a clinic which shares the same block with the hospital free pharmacy, and directly adjacent to the BT diagnostic complex. Clinic hours are from 8:00am to 4:00pm on Mondays, Tuesdays and Thursdays. Each clinic day is headed by a Consultant Haematologist supported by Resident Haemotologists and Medical officers. Also in the staff compliments are, Nurses, Record Officers, Laboratory Scientists, Pharmacists, Home based care coordinators, HIV/drug Adherence Counselors, Administrative and Secretarial staff. Seminars, case presentations, bone marrow aspiration/biopsy and laboratory work-up are done on Wednesdays and Fridays.

Facilities available in the clinic include five well-furnished consulting rooms, resident lounge, the Head of Department’s office, a 30-seater meeting/conference room with a multimedia facility, nurses bay, Pharmacy, Records, Monitoring and Evaluation office, HIV/drug adherence counselor offices, a phlebotomy room and a well-equipped laboratory that generate results such as full blood count, CD4 count, HIV viral load, HIV and HBsAg serology, electrolyte, urea, and creatinine, lipid profile, and liver function test at a subsidized rate. The APIN-HIV laboratory was rated high (Green) in the last Quality Assurance evaluation by Centre for Disease Control, Atlanta Georgia, USA.

The clinic operates a staggered appointment system; HIV-infected patients are seen from 8:00am to 12 noon and general Haematologypatients’i.e those with heamatological malignancies, sickle cell anemia and various forms of bleeding disorders are seen from 11:00am to 4:00pm. Consults are received from almost all departments in the hospital.

Patients’ attendance at the clinic is on the average of 240 new cases monthly and 6300 old cases monthly. This consist of about 15% of Haematology cases and 85% HIV-infected patients. Currently, about 5600 HIV-infected patients are enrolled into care in the clinic. The waiting time per patient is an average of 1 hour for old (follow-up) patients and about 3 hours for newly registered patients.

The clinic has a three-bedded day care room, used for simple medical emergencies like rehydration of dehydrated patient’s blood transfusion of anaemic patients and minor surgical procedures like bone marrow aspiration/biopsy and urinary catheterization.

The department also runs the blood donor clinic, the transmissible, transfusion infection (screening) unit attached to the blood bank and Haematology laboratory. The blood donor clinic is manned by an experienced laboratory scientist who coordinates blood donation amongst all prospective blood donors after going through preliminary screening of infectious diseases. The donated blood units are sent to the screening room for screening infectious diseases like HIV/AIDS, hepatitis B virus, Syphilis, and hepatitis C virus. The blood donor clinic opens from 8:00am to 4:00pm Monday to Friday.

Units of blood free from these infectious diseases are sent to the blood bank for onward dispatch to the wards sending requests for blood after proper grouping and cross matching in the blood bank. The blood bank runs 24 hours’ services.

Facility for blood component preparation is available for those who require platelet concentrates, (but temporarily out of order at press time) fresh frozen plasma, red cell concentrates and cryoprecipitate. The department is one of the three centers in Lagos where blood components are obtainable.

The LASUTH Haematology laboratory attends to all Haematology laboratory requests and from the hospital clinics and the wards.

Requests like full blood count. Coombs tests, blood film, ESR, Hb electrophoresis (genotype) and clotting profile are attended to at the laboratory.

The Department is involved in training Resident Doctors, Medical students, Intern Medical Laboratory Scientists, Laboratory Technicians, and Students on Industrial attachment. Two of the trained Resident Doctors have qualified as Consultants at press time. It is also involved in research in all aspects of Haematology and Blood Transfusion as well as research collaborations with other departments in the Hospitals in order to publish World Class articles in high impact factor Journals.

Contact Information of Head of Units

Title / Name / Phone Number / e-mail address
Head of Department / DrAkinbamiAkinsegun / 08023064925,08183184621 /
Head of HIV/AIDS Unit / DrDosunmuAdedoyin / 08023369785 /
Haematology Clinic Manager / CNO Ekhaiyeme Taiwo Esther / 08033370505 /
Laboratory Unit Head / AdegbiteAdetoun / 08036222047 /
General Haematology Laboratory Head / Ibikunle M.O / 08029528116 /
Blood Donor Clinic Head / Aile S.I.K / 08135264464 /
Blood Bank Head / Adegbite Adetoun / 08036222047 /
Chief Resident Doctor / Dr Mustapha Olusegun / 08025535490 /
Safety Officer
Head APIN Laboratory / MrsOyekoyaAdeola / 08088329224
Head APIN Pharmacy / AdelakunOlorunosebi / 08053355031 /
Voluntary Donor Organizer / Olayinka Animashahun / 08033011137 /
Head of M&E and Records in the Clinic / Iredu Ifeyinwa. C / 08033507164,08055643967 /
HaedDarlez / UzomaNdulue / 08053516251,08035997099

Departmental email address:

Opening Hours

1.Mondays to Fridays (Excluding Public Holidays)

8:00am to 4:00pm ---- Routine Services

4:00pm to 8:00am ---Emergency on-call Services only

2.Weekends and Public Holidays-hour Emergency On-Callservices 24-hour Emergency on-Call
services.

3.Specimen Reception

All Routine Samples should reach the Laboratory by 2pm. Any sample excluding those for FBC
and grouping and cross matching that is sent after 2pm shall be treated with the next working
day’s samples.

4.Haematology Day Care

Mondays to Fridays 8amto4pm

Used for patients requiring short hospital admission i.epatients requiring blood transfusions,
chemotherapy and sickle cell patients in crises. Only Emergency will be seenafter 2pm and
these will be in Medical Emergency of the Hospital.

5.Clinical Services

Clinical Consultations are provided 24 hours

Clinical Haematology

LASUTH Haematology/HIV/AIDS Clinics

DaysConsultants ClinicClinics

MondaysDr. A. A. AkinbamiHaematology/HIV

TuesdaysDr. T.M. BalogunHaematology/HIV

ThursdaysDr. A. O. DosunmuHaematology/HIV

Ward Rounds

Daily ward round with Residents are conducted. Haematology patients are admitted on male and female medical wards and Bola Tinubu medical ward.

Members of Staff Profile

Doctors

Name / Designation / Telephone Number(s) / e-mail address
DrAkinbami A.A / Consultant /HOD / 08023064925 /
Dr.Balogun T.M / Consultant / 08023039803 /
DrDosunmu A O / Consultant / 08023369785 /
Dr Mustapha OA / Snr Med Officer / 08025535490 /
DrAdabale K.A / Snr Registrar / 08033299761 /
DrAdewolu A / Snr Registrar / 08056068317 /
DrOlayinka O.O / Snr Registrar / 08036071793 /
DrBadiru M A / Snr Registrar / 08053552625 /
DrOsikomaiya B I / Snr Registrar / 08086098717 /
Dr Hassan AO / Med Officer / 08034931826 /
Dr Adeyemi .O / Snr Med Officer / 07033449959 /
DrBamiro A R / Registrar / 08023319018 /
DrAdelekan O. / Snr Registrar / 08087759008 /

Blood Donor Clinic

Name / Designation / Telephone Number(s) / e-mail address
Aile S.I.K / CMLS / 08135264464 /
Saliu F.F / PMLS / 08036476521 /
Kamson R.O / PMLS / 08023708438 /
Kareem O. / MLA / 08023592965 /
Akinde A.O / MLT / 08027016169 /
Basil Chinedu.B / BMLS / 08027187445 /

General Haematology Laboratory

Name / Designation / Telephone Number(s) / e-mail address
Ibikunle M.O / CMLS / 08029528116 /
Oladipupo O.A / ACMLS / 08033732411 /
Olupitan F.O / PMLS / 08034118961 /
Ihediwa J.C / MLS / 08060090676 /
Aremu J.A / PMLT / 08034707577 /
Runsewe G.O / MLT / 08029102088 /
Adetomiwa E.A / MLT / 08022556946 /

Blood Bank

Name / Designation / Telephone Number(s) / e mail address
Adegbite F.A / CMLS / 08036222047 /
Lawal B.F / ACMLS / 08039424441 /
Ayandare K.M / PMLS / 08054641195 /

Haematology Clinic Nurses

Name / Designation / Telephone Number(s) / e mail address
EkhaiyemeTaiwo Esther / Clinic manager/CNO / 08033370505 /
OsifesoAdeotiAdenrele / CNO / 08037227122 /
AleshiloyeC.Tinuola / CNO / 08023011919 /
OluwoleBosedeKehinde / CNO / 08033768860 / ------
AgboolaOmolaraRisikat / ACNO / 08033893068 /

Haematology Administration

Name / Designation / Telephone Number(s) / email address
Banjoko. S.Akinyemi / Assistant Chief Scientific Officer / 08034615150 /
Taiwo Yusuf / Higher Executive Officer / 08036074437 /
AnimashahunGaniyat.O / Scientific Officer / 08050440114 /
AdekunleAdemola / Clerical Officer / 08057031726 / Nil

Haematology Request Form

Information required (to be entered by the requesting Doctor)

1. Surname

2. First Name

3. Hospital Number

4. Date Collected:

5. Ward/Clinic

6. Department

7. Age

8. Sex

9. Consultant

10. Date Reported

11. Nature of Specimen (Tick appropriate square)

12. Clinical Details

13. Examination Required

14. FBC Parameters

15. Retics

16. Hb Genotype

17. Retics Index

18. ESR

1. Blood stained requisition forms will be rejected

2. Forms must be filled completed

3. Samples should be transported into the Laboratory in a triplepackage.

PHILEBOTOMY (Blood Sample Collection) Procedure

Phlebotomy, the act of drawing blood from the vein with a needle, is a specialized skill. It is necessary for blood to be drawn for laboratory investigations in a variety of medical diagnosis. Typically, phlebotomists will use veins rather than arteries for phlebotomy. This guideline is provided to ensure the blood sample is properly collected, prepared, and preserved during and after collection. The integrity and quality of the result is dependent on these instructions being adhered to.

1.Assemble all items needed for procedure

2.Perform Hand hygiene

3.Identify and Prepare the patient

4.Select the venepuncture site

5.Apply the tourniquet 4-5 cm above the venepuncture site

6.Ask the patient to form a fist

7.Put on gloves

8.Disinfect the chosen site with 70% isopropyl alcohol and allow the site to dry completely.

9.Anchor the vein by placing a thumb below the venepuncture site

10.Enter the vein swiftly at 30 degree angle

11.Once sufficient blood has been collected release the tourniquet before withdrawing the needle

12.Withdraw the needle gently and apply gentle pressure to thesite with a clean dry gauze or cotton wool.

13.Transfer the sample into the sample bottle, cap tightly and mix gently

14.Discard the needle and springs into a Sharp box

15.Immediately label the bottle after crosschecking the forms

16.Place the sample in a sample holder

17.Remove the gloves in a safe manner

18.Perform hand hygiene

SAMPLE COLLECTION

1.Sample bottle must be appropriate for the test requested

2.Sample volume must be appropriate for the test(s) requested

3.Names, hospital number, date and request must correspond with those on the form

4.Is the sample clotted? Clotted samples are accepted only for Hb electrophoresis, and blood grouping and crossmatching

5.Is the sample lysed? Please do NOT submit for Investigations, but may be acceptable for Hb Electrophoresis (genotype).

6.Is there any evidence of spillage? Please do NOT submit for Investigations, Spilled samples will generate wrong results particularly for FBC.

Labeling the Sample

Blood Specimens must be properly labeled. A properly labeled sample is essential so that the result of the test matches the patient. The key elements in labeling are:

*Patient’s surname, first and middle

*Patients’s hospital number. NOTE: Both of the above MUST match the same on the requisition form.

*Date, time and initials of the phlebotomost. Consultant in Charge must be on the label of EACH tube or electronically entered. Automated systems may include labels with bar codes.

The above MUST match with the request form

Time Limit for Specimen Transfer to Laboratory

All specimens collected on site must be transported into the laboratory within one hour of collection for processing.

Samples from the ward or outside the hospital must be transported in cold using the triple package technique.

Triple Packaging System

- All Specimen shall be collected in a primary container that is watertight and leak proof. The cap should be correctly and securely closed.

- The primary container shall be put into a secondary container that is watertight e.g Disposable, zip-lock plastic bags. Several clinical specimens may be placed into one secondary container.

- All secondary containers should be put into an outer container or packaging/box during transport. The outer container should be made of strong material that can be cleansed and distinfected. The outer container should have the Biohazard warning label.

NOTE: For inter hospital/laboratory transport; there should be adequate cushioning materials inside the box so as to absorb shocks during transports, and adequate absorbing materials to absorb any spillage should it occur.

Specimen Rejection Criteria

A sample may be rejected if:

1.The sample bottle is not appropriate for requested test.

2.The type of specimen collection does not meet requirements of the assay to be performed i.e EDTA sample for grouping and cross matching will be rejected.

3.Documentation is incomplete or the information documented on the sample label and Requisition Forms do not match.

4.The sample or sample volume is inappropriate or insufficient for the test(s) required.

5.In addition, any of the following reasons may also be grounds for rejection of a sample for processing.

a.The tube is not clearly labeled with necessary patient information. if there is any doubt as to whom the blood was drawn from.

b.The sample is NOT clotted in the case of MOST blood bank requests

c.If the integrity of the sample has been compromised or contaminated in any way. The following are several ways that this could occur:

i. If the blood tube was not sterile prior to use

ii. If blood samples from several patients could have been contaminated with other blood.

iii. There wad a broken specimen container

iv. There was a delay between collection of specimen and arrival in laboratory.

Testing

All tending procedures shall be performed within LASUTH blood bank. The turn around time (TAT) for each procedure is highlighted in table below. Specimens can consist of, but are not limited to, serum, plasma and whole blood.

Back up Procedure

Effective back up procedure is being put in place in case of eventuality, without compromise of standard or quality.

In case of equipment breakdown, reagent stock out or prolonged power outage, BT diagnostic laboratory complex and other general hospitals are considered for selection as back up sites. Some of the criteria for selection include proximity and accessibility to the site, practicing of QMS, undergoing improvement projects for accreditation, availability of compatible equipment with appropriate back-ups and availability of qualified manpower.

Getting Back Result

All completed report forms after sample processing will be KEPT in the unit, until it is requested for by the physician through the attendants in Pediatrics, Family Medicine, Medical Outpatient Department and Medical Emergency. Family member from other Departments pick up results from the Laboratory.

The laboratory will not release laboratory report to ANY patient or patient relative in line with the hospital policy