MACC Catalog # MLT250
CIP # 51.1004
Updated July 2017
Moberly Area Community College
Common Syllabus
MLT 250 Hematology
Current Term
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Catalog description: MLT250 Hematology (w/clinicals) (3-8-5)
The course studies blood cells, normal and abnormal cell development, alterations present in diseases, and coagulation factors. The student will learn and perform tests employed in the hematology and coagulation laboratory.
Prerequisite:
HSC171 Medical Terminology, BIO205 Human Anatomy, BIO209 Physiology and MLT150 Laboratory Methods and Management
Text:
Ciesla, B. (2012). Hematology in Practice 2nd ed. Baltimore, Maryland: F.A. Davis.
Other Required Materials:
Handouts, videos, training aids and transparencies as provided by the instructor. Library assignments, periodicals, computerized modules, and guest speakers may be used as appropriate.
Purpose of the course:
This course provides students with basic scientific concepts, procedural theory, and clinical applications in the study of blood or hematology. In this essential medical science, students also study the fundamentals of hemostasis or thrombosis. Information derived from hematological studies guides physicians in differential diagnosis.
Cognitive Course Objectives:
Upon successful completion of this course, students will be able to:
· Describe essential safety practices to use in the hematology laboratory.
· Discuss quality control practices used in the hematology, such as “rules of three” for CBC’s or delta checks, and results that suggest patient work may be compromised.
· Describe the organs involved in hematopoiesis throughout life.
· Define and explain each of the erythrocyte indices, state the normal values, and how RDW, RCMI, and MPV are calculated.
· Calculate red blood indices.
· Recognize normal and critical values in an automated CBC.
· Describe red blood cell structure, function, development, maturation, metabolic activities and morphological characteristics.
· Compare normal and abnormal erythrocyte morphology and inclusions.
· Explain the characteristics, properties, and synthesis of hemoglobin in RBC’s and abnormalities involving it.
· Discuss the laboratory assessment of anemias including classification, causes, clinical signs and symptoms, and laboratory diagnosis.
· Discuss the etiology, epidemiology, pathophysiology, clinical signs and symptoms and laboratory diagnosis of hemoglobinopathies such as sickle cell disease and thalassemia.
· Describe the production, distribution, normal values and properties of the granulocytic, lymphocytic, and monocytic white cells series.
· Recognize features of cells in the granulocytic, monocytes, and normal and atypical lymphocytes.
· Describe the appearance of white cells when the following abnormalities are present:
Toxic granulation Dohle bodies
Hypersegmentation Pelger-Huot anomaly
May-Hegglin anomaly Chediak-Higashi syndrome
Alder-Reilly inclusions, Ehrlichia
· Discuss quantitative and qualitative disorders of granulocytes and monocytes
· Compare the morphological characteristics, functions and membrane characteristics of lymphocytes and plasma cells.
· Compare the patient symptoms and laboratory data involved in laboratory diagnosis of acute myeloid and lymphoblastic leukemia.
· Describe the types of chronic myeloproliferative disorders and laboratory data involved in diagnosing.them.
· Differentiate the myelodysplastic syndromes and state the prominent features of each in laboratory diagnosis.
· Characterize the function of platelets and blood coagulation factors in hemostasis.
· Describe the general principles, specimen collection and handling, procedure, quality control, and reference ranges for the following coagulation procedures:
Activated Partial Thromboplastin Time Prothromin Time
Antithrombin III Bleeding Time
D-Dimer Assay Fibrinogen Assay
FDP Xa
Factor Assays
· Discuss bleeding disorders related to platelet dysfunctions and blood clotting factors.
· Describe the basic theory of electrical impedance, optical detection and laser technology principles of cell counting and sizing.
· Describe the principles of flow-cell cytometry.
· Compare the appearance of erythrocytes, leukocytes and platelets on histograms.
· State specimen collection, handling, storage, preparation, physiologic theory, and principles of the method for the following hematological studies:
Automated and manual counts of RBC, WBC, platelets and morphology.
Manual differential Westergren sedimentation rate
Dithionate tube test Factor V Leiden
Mixing studies Alkali denaturation for Hgb F
Osmotic Fragility Sugar Water test
Vitamin B12 and folate Carboxyhemoglobin
Plasma hemoglobin Haptoglobin
Hemoglobin Electrophoresis Hemoglobin
Bone marrow
· State the essential components, principles of operation, and preventative maintenance of the following instruments and, in addition, be able to recognize unexpected test results, take corrective action or refer the problem:
Automated stainers Microhematocrit centrifuge
Automated cell counters Automated WBC differential
Photo-optical detection of fibrin clot
Cytocentrifuge Fibrometer
Psychomotor Course Objectives:
After completion of the course with instruction and practice in the student lab and at the affiliate site, students are responsible for performing the following to minimal competency standards:
· Perform the following hematologic studies and be able to recognize or resolve basic technical, instrument, or physiologic causes of problems or unexpected test results:
Automated counts for RBC, WBC and morphology, and platelets
Manual counts for WBC, reticulocytes, and platelets
Manual differential with morphology
Spun hematocrit
Hemoglobin
Westergren sedimentation rate
· Recognize normal and abnormal RBC and WBC morphology, artifacts, and inclusions.
· Be able to differentiate or resolve basic technical, instrument, or physiologic causes of problems or unexpected test results.
· Correlate RBC indices with peripheral smear.
· Perform a manual platelet count and estimate platelet count from a smear.
· Estimate a WBC count from a blood smear.
· Perform a manual reticulocyte count.
· Perform manual cell counts on CSF and selected other body fluids.
· Perform QC and routine maintenance on an automated hematology instrument and coagulation instrument.
· Perform Factor V Leiden.
· Perform the following hemostasis analyses:
APTT PT d-Dimer
FDP Bleeding time Thrombin Clotting Time
Fibrinogen Xa
· Describe correct specimen collection for specified hematological determinations
and correctly process specimens for testing.
· Follow laboratory policies for record keeping and reporting.
· Evaluate specimen quality and describe corrective action to solve problems with it.
· Safely handle and dispose of infectious materials.
· Perform daily maintenance routines.
· Troubleshoot procedures and take appropriate action as needed
Affective Course Objectives:
At the end of the course, the student should be able to demonstrate the following behaviors and attitudes:
· Perform hematological testing with good technique, paying attention to detail and quality.
· Maintain and operate instrumentation reliably and generate quality results.
· Strictly adhere to written procedures and accept verbal technical direction.
· Use proper quality control measures.
· Treat laboratory results and issues confidentially.
· Maintain technical competency and emotional stability in times of stress or tension.
· Initiate learning new techniques and persistence in developing skill.
· Communicate legibly on paper.
· Practice safety at all times.
· Communicate confidently with other professionals, students and patients.
· Organize for priority and efficiency.
· Recognize unusual or abnormal results and consult an experienced technologist.
Course Content:
I. Overview of the Hematology Laboratory
II. Safety in the Hematology Laboratory
A. Protective measures
1. Gloves/facial barrier/lab coat
2. Handwashing
3. Work surface decontamination
4. Needle precautions
5. Infectious waste
III. Basic Concepts of Quality Assurance in Hematology
A. Nonanalytical
B. Analysis of quantitative data
1. Standards or calibrators and controls
2. Normal or Reference Intervals
3. Delta checks
4. “Rules of three”
5. Statistical Concepts
6. Reflex testing
7. Preanalytic and postanalytic variables
IV. Hematopoiesis
A. Spleen
B. Bone marrow
1. Stem cells and cytokines
2. Erythropoietin
3. Collection
C. CBC
D. Classification of Anemias
E. Calculating Red Cell Indices
1. RBC normal values
2. MCV, MCH, MCHC
F. RDW
G. Reticulocyte
V. RBC
A. Red Cell Production
B. RBC Maturation
C. RBC membrane development, function, metabolism
1. RBC
D. Normal and abnormal morphology
E. RBC inclusions
VI. Hemoglobin Function and Principles of Hemolysis
A. Hemoglobin Structure and Synthesis
1. Types
2. Function
3. Abnormal Hemoglobin
VII. Red Cell Disorders
A. Microcytic Anemias
1. Iron Intake, Absorption, Storage, Recycled
2. Iron Deficiency Anemia
3. Anemia of Chronic Disease and Inflammation
4. Sideroblastic Anemias
5. Thalassemia Syndromes
B. Macrocytic Anemias
1. Macrocytic vs Megaloblastic
2. Megaloblastic Anemia
C. Normochromic Anemias
1. Hereditary Spherocytosis
2. Hereditary Elliptocytosis
3. Hereditary Stomatocytosis and Xerocytosis
4. G-6-P-D Deficiency
5. Pyruvate Kinase Deficiency
6. Miscellaneous RBC Disorders
D. Normochromic Anemias Caused by Hemoglobinopathies
1. Sickle Cell Anemia
2. Hemoglobin C Disease and Trait
3. Hemoglobin SC
4. Variant Hemoglobins
A. Other hemoglobinopathies
VIII. WBC Disorders
A. Leukopoiesis and Leukopoietic Function
B. Lymphocyte Origin and Function
C. Leukocyte Count from the CBC to the Differential
D. Abnormalities of WBC
1. Quantitative Changes in WBC’s
2. Stages of WBC Phagocytosis
3. Qualitative Defect of WBC’s
4. Hereditary WBC Disorders
5. Reactive Lymphocytosis in Common Disease States
6. The Effect of HIV on Hematology Parameters
7. Lipid Storage
8. Bacteria
E. Acute Leukemias
1. Acute and Chronic
2. Acute Myeloid Leukemia
3. Acute Lymphoblastic Leukemia
F. Chronic Myeloproliferative Disorders
1. Chronic Myelogeneous Leukemia
2. Chronic Neutrophilic Leukemia
3. Chronic Eosinophilic Leukemia
4. Polycythemia Vera
5. Myelofibrosis with Myeloid Metaplasia
6. Essential Thrombocythemia
G. Lymphoproliferative Disorders and Related Plasma Cell Disorders
1. Lymphoid Malignancies
2. Plasma Cell Disorders
H. Myelodysplastic Syndromes
1. Pathophysiology
2. Chromosomal Abnormalities
3. Common Features and Clinical Symptoms
4. Classification
5. Prognosis
IX. Hemostasis and thrombosis
A. Vasculature: Structure, function, physiology
B. Primary Hemostasis: Platelets
C. Secondary Hemostasis
1. Coagulation Factors
2. Extrinsic Pathway
3. Intrinsic Pathway: APTT
4. Common Pathway
5. Thrombin
6. Feedback
7. Fibrinolysis
8. Inhibitors
9. Kinin
10. Complement
D. Quantitative and Qualitative Platelet Disorders
1. Quantitative
2. Inherited Qualitative
3. Acquired Defects of Platelet Function
4. Vascular Disorders Leading to Platelet Dysfunction
E. Defects of Plasma Clotting Factors
1. Evaluation of a Bleeding Disorder and Types of Bleeding
2. Classic Hemophilias
F. Fibrinogen, Thrombin, and the Fibrinolytic System
1. The Role of Fibrinogen in Hemostasis
2. Disorders of Fibrinogen
3. Thrombin in Hemostasis
4. Disseminated Intravascular Coagulation
G. Thrombosis and Anticoagulant Therapy
1. Physiological and Pathological Thrombosis
2. Pathogenesis of Thrombosis
3. Thrombotic Disorders
4. Lab Diagnosis
X. Hematology instrumentation
A. Cell counting principles
B. Types of automated cell counting instruments
C. Analysis of data: Histograms
D. Flow cytometry
Connection with Career and Technical Education (CTE) Outcome Statement:
In compliance with MACC’s CTE outcomes, the student who successfully completes this course will be able to:
· Students will demonstrate effective written and oral communication.
° Organize for priority and efficiency.
° Strictly follow written procedures and verbal instructions
° Communicate in a professional way with instructors and other students
· Students will demonstrate an understanding of discipline-related math and scientific principles
° Define and explain each of the erythrocyte indices, state the normal values, and how RDW, RCMI, and MPV are calculated
· Students will think critically while systematically assessing problems, identifying issues and implementing solutions.
° Perform the following hematologic studies and be able to recognize or resolve basic technical, instrument, or physiologic causes of problems or unexpected test results: Automated counts for RBC, WBC and morphology, and platelets; manual counts for WBC, reticulocytes, and platelets; manual differential with morphology; spun hematocrit; hemoglobin; westergren sedimentation rate
· Students will apply principles of professionalism and safety standards when entering the workforce.
° Demonstrate proper hand washing technique.
° Safely handle and dispose of infectious materials.
° Follow laboratory policies for record keeping and reporting.
· Students will demonstrate skill mastery and will pursue lifelong learning in their filed while adapting to changing industry standards and following evidence-based practices.
° Strictly follow written procedures and verbal instructions
° Demonstrate initiative and resourcefulness; learn more than the minimum
° Exhibit a professional appearance and attitude
ASSESSMENT OF STUDENT LEARNING
Assessment:
In both the didactic and the laboratory portions of the course, the student must achieve 78% or greater. Failure to achieve this minimum score will result in dismissal from the program. In the laboratory portion of the course, the final grade will be recorded as “Pass” or “Fail” and registered with the didactic portion.
The following grading scale applies to all programs within the Allied Health Division:
100 – 92% = A
83 – 91% = B
78 – 82% = C
66 – 77% = D
65% and below = F
In the lecture portion of the clinical course, the final grade is derived from student performance on examination(s) and/or assignments.
Grading/student assessment of lecture (didactic) portion of the course:
Final grade will be composed of:
Unit tests averaged / 60%Quizzes, case studies, study questions, or other assignments, attendance and punctuality averaged / 10%
Final Exam / 30%
Total: / 100%
Grading/student assessment of laboratory (student laboratory) portion of the course:
Final PASS/FAIL grade will be composed of:
Laboratory Exercises averaged / 30%Professional Behaviors Evaluation / 70%
Total: / 100%
Program Outcomes and Assessments:
The Allied Health Department continually strives to meet the needs of the Medical Laboratory Technician student through program improvements. This is a cooperative effort that includes input from the faculty, student, Medical Laboratory Technician Advisory Board, and other appropriate agencies or entities. Students are assessed on mastery of the course concepts and essential skills throughout the courses of the Medical Laboratory Technician Program. Other program assessments include clinical performance criteria, essential skills mastery, the clinical process evaluation, ASCP examination scores, placement rates, and follow-up surveys.
INSTRUCTOR POLICIES
Tardiness and Attendance:
Students are expected to prepare for and attend all classes and clinical practice. Regular attendance improves probability for success in the program. Habitual tardiness and frequent absences are disruptive to the classroom and cause an unsafe environment in the student laboratory. Being on time is mandatory.