Haematology Department information
Routine Haematology (CBC, FBC, Blood count)
Specimen required: EDTA anticoagulated whole blood (purple or lavender top tube). Specimen must be well mixed and free from clots.
Automated analysis will provide:
Haemoglobin
Haematocrit
MCV
MCH
Platelets
WBC and differential
These results will be made available in Clinical Portal as soon as they are available.
Results from automated analysis may appear as unauthorised in Clinical Portal and are subject to change. These results will update to authorised when reviewed and released by Scientist staff - this may not be until the next day. Amended results that have changed by a clinically significant amount will be communicated by phone. Community results for General Practice will be reported electronically (by HL7 Healthlink) when the results are authorised, this may not be until the next working day.
If results indicate, or if specifically requested, the blood film is examined and a comment made. Note this may not be until the next day, or longer on weekends and public holidays. If not available immediately, blood film review can be arranged by phone at any time. Please contact the laboratory to arrange this.
Paediatric
Capillary or venous blood collected into EDTA (purple or lavender top) Microtainers (0.5 ml) can be used. Successful analysis on volumes below 250ul cannot be guaranteed but analysis may be possible below this.
Reticulocyte count
Performed on request or at the discretion of Haematology staff based on the CBC/Blood Film results. Analysis is automated and performed on the same specimen as the CBC so no additional samples are required.
ESR
ESR requests are vetted and only performed for appropriate clinical indications. Clinical details must be provided. A minimum of 1.5ml whole blood is required for this assay, microtainer collects are therefore not appropriate.
Guideline on ESR acceptance criteria
The recommended marker for infection/inflammation is CRP. The lab will therefore only perform ESR testing for specific clinical indications where it has been shown to be of clinical value. ESR requests will only be processed if one of the following clinical details is provided and clearly marked on the request form:
Click here for ESR Indications for testing
Bone Marrow examination
Contact with Clinical Haematology (Palmerston North) is required before ordering Bone Marrow trephine and aspirate collection. Haematology staff must be present at the collection procedure to prepare the required samples, and this must be pre-arranged with the laboratory as availability of staff cannot always be guaranteed.
Analysis is not carried out on site but referred to Clinical Haematology (Palmerston North) and other reference labs for specialist testing as appropriate.
Coagulation Tests
Collection & Specimen required:
· Adults: 2.7 ml Sodium Citrate (Blue top tube)
· Paediatric: 1.8 ml Sodium Citrate (Blue top tube)
Samples must be thoroughly mixed by inversion and be filled to the marked fill level on the tube. Samples must be free from clots and must not be grossly haemolysed or lipaemic to be suitable for analysis. Please refer to chart below for guidance on fill volumes, tubes filled below the minimum fill indicator may not be acceptable for analysis. Under or overfilled tubes may be rejected and a repeat specimen requested.
Please supply sufficient clinical information to ensure the appropriate tests are performed, including any anticoagulants that the patient is receiving.
Coagulation screen
A routine coagulation screen will include an INR & APTT only. Fibrinogen and TCT will be performed if specifically requested or at the discretion of Haematology staff for further investigation as required.
D-Dimer, and Factor Assays require one full Blue top
Investigation of coagulation disorders
Unexplained abnormalities in coagulations screens will be investigated under the direction of the Head of Department. If a bleeding disorder is suspected, please phone the laboratory for advice on further testing.
Factor VIII
Routine Factor VIII assays are batched and performed weekly on Thursday. If this assay is requested urgently outside of 0800hrs to 2000hrs Monday to Friday, and on public holidays, a Haematology lab staff member will be called in to perform this assay. Laboratory staff may contact the requesting Doctor to confirm that the call back is required.
Thrombophilia screen
6 full 2.7ml blue tops and 5ml in a red top are required.
Tests included in a thrombophilia screen:
Coagulation screen (INR, APTT, Fibrinogen and TCT)
Protein C and S
Antithrombin III (ATIII)
Activated Protein C Resistance (APCR)
Lupus Anticoagulant screen (LA)
Anticardiolipin antibodies (ACA)
Requests for thrombophilia testing are vetted and will only be performed for appropriate clinical indications as per below.
Guideline on Thrombophilia Screen acceptance criteria
When screening is indicated:
· Early age of onset <45 years
· Familial history of venous thromboembolism (VTE) with more than two other symptomatic 1st degree family members
· Thrombosis after trivial provocation, age <45 years with symptomatic 1st degree family member
· Intrauterine death at >20 weeks gestation
· Stillbirth at >20 weeks
· Neonatal purpura fulminans (Protein C and S only)
· Warfarin-induced skin necrosis (Protein C and S only – patient cannot be on warfarin)
· Association of thrombosis and fetal losses (Lupus anticoagulant only)
· Arterial thrombosis (Lupus anticoagulant only)
When screening is not indicated:
· Commencement of oral contraceptive/hormone replacement therapy.
· General obstetrics – those clinically at risk should receive thromboprophylaxis regardless of thrombophilia screening
· Cancer patient screening
· Recurrent idiopathic thrombosis - by definition this is an indication for prolonged secondary prophylaxis
· Age of onset >45 years
Note: The existence of underlying conditions, drugs and treatment need to be considered as these may be the causative agents of clot formation.
Malaria
Please include clinical details on the form including recent travel locations, previous history of malaria and which type if positive.
Malaria screen is performed by PCR, and if positive followed up with immunochromatography (ICT) for malarial antigens and thick and thin film examination.
The required sample type is EDTA whole blood and can be performed from the same tube as the CBC.
Reference ranges
Age and sex adjusted reference ranges are issued as part of the standard report for all haematology testing. Click here for a detailed table.
Contact the Haematology Department for advice on interpretation of Neonatal and paediatric coagulation results (to 16 years).
Contacts
Haematology Laboratory
Phone 06 878 1308 Ext 2445
Grace Lim
Head of Department
(06) 878 1647 or internal ext 6249
Consultant Haematologist Clinical cover
Health New Zealand - Mid-Central Hospital provides a 24 hour specialist cover for clinicians and laboratory staff.
The following Haematologists can be contacted at (06) 350 8550 option 4
Dr Bart Baker
Dr Elayne Knottenbelt
Dr Allanah Kilfoyle
Dr Matt Stephens