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The
Clinical Hematology Laboratory at Yale-New Haven Hospital
The
hematology laboratory receives an average of 1000 specimens a day,
and does about 500,000 tests a year. The main parts of the lab are
- "Routine,"
encompassing complete blood counts, white cell differentials,
reticulocyte counting, erythrocyte sedimentation rate, and related
tests.
- "Coagulation,"
routine and special, the former being prothrombin time and partial
thromboplastin time, fibrinogen, and fibrin split products; and
in the latter category, clotting factor assays, and tests for
hypercoagulable states, APC resistance, natural anticoagulants,
lupus anticoagulant, and others.
- "Body
fluids and Urinalysis," meaning morphology and protein measurement
in cerebrospinal, pleural, peritoneal and joint fluids, and the
familiar chemical and morphologic tets of urine
- "Special
Hematology" including erythropoietin, hemoglobin electrophoresis
and related tests, osmotic fragility, special cytochemical stains
of blasts and other cells, and many other tests done occasionally
- "Platelet
Testing," comprising platelet aggregation, heparin-platelet antibody
and related platelet function tests.
Areas
of special interest and strength have been blood morphology, hemostasis
tests, anticoagulant monitoring including LMWHs, abnormal hemoglobin
identification, and cytochemical stains, meshing with flow cytometry
and other tests for the typing of acute leukemia.
While we have been struggling to restrict our test volume in some
areas, growth in hemostasis testing has continued and broadened.
New tests in the lab include:
- An
ELISA test for heparin-platelet antibody, which detects the antibody
by its affinity for the complex of platelet factor 4 and heparin;
the test is a backup and confirmation for platelet aggregation,
which can be done on the day needed.
- Thromboxane
B2, for confirmation of platelet cyclooygenase deficiency
- Serum
transferrin receptor, for confirmation of the diagnosis of iron
deficiency.
We have
a long term interest in making the workup of anemia, hemostatic and
hypercoagulable disorders more efficient, and an interest in providing
consultation with our results. Residents are encouraged to learn test
performance as well as interpretation and triaging, and to help us
evolve the use of new tests. |
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