What I’ve Learned in Hematology Lab

We had our first proficiency (i.e. test) in hematology lab last Friday. As I was reviewing for the test, I realized I’ve really learned a lot in the six weeks we’ve had class. Up until this semester, most of what has been taught in my classes has been review for me. Sure I learned tidbits here and there, but as a whole, the material was not new to me. Most of what I’ve learned in hematology has been new. In all my clinic volunteering, I learned very little about making blood smears and running CBCs because the blood work was sent out to a lab (one clinic had an in-house blood work machine, but I didn’t do much with it). In previous semesters, I’ve walked out of class happy that class was out. When hem lab gets out, I’m happy class is over, but it’s because my brain is full and I have a headache (from the microscope work), not because I’ve been bored for the last two hours. It’s a good change.

Here’s a summary of what I’ve learned in the last six weeks:

  • How to make a good blood smear (which I could not do for the life of me when I took my test)
  • How to stain aforementioned smear (this was review from my biology classes in college)
  • How to test the PCV (packed cell volume, or percentage of red blood cells) and total protein
  • How to perform a WBC (white blood cell) estimate
  • What normal red blood cells should look, what the different abnormally shaped ones are called, and about other abnormalities (side note: my favorite is named the “Howell Jolly Body”. I found one in a blood smear two weeks ago! It looks like a little purple spot on the red blood cell.)
  • How to perform a WBC differential. This involves looking at 100 WBCs and determining which of the five types of WBC it is.
  • How to perform a platelet estimate. If you have a crummy microscope, the platelets can be really difficult to see.
  • How to perform an actual WBC count. This is cool. You follow some very precise steps that involve mixing a specific amount of blood with a lysing solution, let it sit awhile, carefully load it onto a precisely calibrated slide that has your $3 glass coverslip on it, and then count the little circles that are in the grid that’s printed on the slide. Pretty cool, eh? What I haven’t figured out is how WBC nuclei can be so oddly and differently shaped on the differential yet all look like perfect little circles on the actual count.
  • How to take all the numbers I get and multiply them with specific other numbers to get the appropriate platelet estimate, WBC estimate, actual WBC count, and absolute numbers.
  • Which microscope power and settings to use to be able to see all these cells.

That’s a lot of stuff to learn in two hours and forty minutes a week after only six weeks. We don’t just have to know the procedures and the math, we have to be able to perform them and perform them well. If our numbers (for our actual and estimated WBC counts, platelet estimates, differential, etc.) aren’t within a certain percentage of our instructor’s we lose points. I’m anxious to see how I did with my numbers. I’ll find out Friday (which is when I have my first pharmacology lab proficiency).

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