PATIENT’S PREPARATION FOR HAEMATOLOGY TESTS

Patient’s preparation is one of the most important aspects of pre-analytical measures that laboratory personnel or whoever is responsible for sample collection and transportation must take to ensure quality. A good number of times, people carry out procedures without adequate patient’s preparation thus compromising quality. Where a professional failed to do adequate pre-test counselling, rather than engaging the patient in post-test counselling, he/ she will be handling crises counselling.

The following are some of the inevitable steps that must be followed to ensure quality of results through adequate patient preparation for haematology tests:

1. Discuss the procedure of sample collection. Right information must be given regarding the degree of the invasive procedure. If venipuncture, spinal tap for CSF sample, bone marrow aspirate or trephine biopsy is to be taken,, this must be explained sufficiently enough to the patient to enable him/her make informed consent.
2. Patient has the right to accept or refuse any procedure. Health care professionals must remember the Patient’s Bill of Rights.
3. Posture: The patient must be in the right posture for haematological procedures. For instance, patients on admission who is in a lying state must be in a sitting position to prevent haemodilution. Haematological parameters will be lower than expected should error of sample collection in a lying position takes place. For instance, PCV can drop by as high as 6-8% in a patient with debilitating condition. The patient must be duly informed of the need to assume the right posture for quality results.
   Sampling while standing results in haemoconcentration.
4. Fatty meal: Patients coming for complete blood count analysis or clottology assay must avoid this. Lipemic samples are rejected as there is the tendency of creating holes in the stained peripheral blood films of such patients. Same samples can interfere with clear-cut observation of fibrin clot as d end point of coagulation. This is the era of digital morphology and coagulometry. Digital morphology instruments have advanced haematology practice beyond routine. Peripheral blood films are made in a different compartment and following an algorithm integrated by AI, images of patients’ films are reviewed and compared with several hundreds to thousands of in-built slide images for optimal diagnosis. Advanced and appreciated as this is, failed simple steps of patient preparation can hamper proper diagnosis. Similar interference is seen with photo-optical coagulometers that depend on optical density for clot detection. Hence, Medical Laboratory Scientists, phlebotomists and physicians must be well informed.
5. Fasting: Patients must be well informed on the necessity of fasting for certain clottology procedures. For instance best results when diagnosing platelet function disorders. Though some authors presented a different viewpoint that it may be unnecessary to do so. Experiences of experts in haemostasis recommended the need for patients to do so. Certain antibiotics or foods do interfere with factor specific assays and a number of clottology assays too. MLS must be well informed to explain the fundamental sources of errors for whatever tests we are carrying out.

MLS professionals or researchers in need of more information on haemostasis can contact me through the website.

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