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| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
1.4a - Hematology and Coagulation General Information
MessageTechnical Director of Hematology
BACL Hematology Laboratory Supervisors
Laboratory Telephones
Tests Offered By Hematology and Coagulation:
B. COAGULATION:
C. DIFFERENTIALS:
Differentials (Automated or Manual) are only available when specifically requested.
Manual differentials are only performed on an abnormally flagged automated differential. Only one manual differential will be performed per patient in a 72hour period. Manual differentials will not be performed on patients who have had manual differential done in a previous 72 hour period unless their condition warrants a manual differential every 24 hours. Manual differentials are not performed STAT but priority will be given to emergency-STAT requests before routine orders. Smears will be stored for a minimum of 30 days and will be made available if a clinician wishes to review the slide.
For outpatients with conditions that produce markedly abnormal WBC or RBC morphology (e.g. CLL), which are known to the laboratory, and which have had stable findings for at least 3 months, a manual diff is not required (though one may be performed) even when triggered by the Differential, Blood test criteria unless the patient's WBC or automated differential parameters change markedly. A new manual diff should be performed in these patients if one has not been done in the last 6 months.
Reflex testing:
Hematology lab will reflex pathology smear review, manual differential and RBC morphology on patient samples showing abnormal or suspicious findings. Criteria for reflex testing include but not limited to the following:
D. CSF SPECIMENS:
It is absolutely necessary that cell counts be done as soon after the spinal tap as possible since most cells present will start to degenerate within a short period of time (approximately 1 hour). All spinal taps should be brought to Hematology first. All tubes must be labeled and accompanied by a requisition slip or computer generated lab order number. Ideally, Hematology should be given the 1st and last tube drawn (usually #1 and #4). If only one tube is to be given to Hematology it should be the LAST tube drawn from the tap.
Note: CSF specimens for patients with the clinical differential diagnosis of Creutzfeldt-Jakob Disease (CJD) must be clearly labelled “CJD” and the Lab must be notified prior to submission of the CSF specimen for testing.
E. ALL OTHER BODY FLUIDS:
All other body fluids for cell counts and differential must be submitted in a lavender top EDTA tube. SYRINGES ARE NOT ACCEPTABLE.
ALL TUBES MUST BE MIXED WELL TO PREVENT CLOTTING.
Clotted specimens are not acceptable for testing. If a clotted specimen must be tested it will be reported with a disclaimer that cell counts from clotted or clumped samples are inaccurate and therefore not valid. A smear will be reviewed for abnormal cellular morphology.
Specimens should be brought immediately to the lab to ensure accurate results.
| Shyam Prajapati, MD | 857-203-5429 |
BACL Hematology Laboratory Supervisors
| West Roxbury | Nolan Raymond | 857-203-5890 |
| Jamaica Plain | Joseph Manzone | 857-364-5092 |
| Brockton | Diane Robert | 774-826-2294 |
| Bedford | Bhumikaben Patel | 781-687-2976 |
Laboratory Telephones
| West Roxbury | 857-203-5328 |
| Jamaica Plain | 857-364-5115 |
| Brockton | 774-826-2293 |
| Bedford | 781-687-2603 |
Tests Offered By Hematology and Coagulation:
A. HEMATOLOGY
- CBC (includes WBC, RBC, Hgb, Hct, Indices, MPV, RDW, Platelet Counts, IPF)
- Differentials: Automated(6-part diff with absolute counts) with reflex to manual differential
- Sedimentation Rate
- Cell counts/Differentials on body fluids ((peritoneal, pleural, pericardial) performed at WX only
- Cell counts on CSF (performed at WX only)
- Differentials on CSF (performed at WX only)
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Cell counts/Differentials on CSF – Differential will only be performed if total nucleated cell count is >5 cells/uL (performed at WX only)
- Reticulocyte Counts
- Differential on BAL
B. COAGULATION:
Prothrombin time (PT)/INR is normally used to monitor coumadin therapy. The INR is only for use if the patient is on Oral anticoagulants. Activated Partial Thromboplastin Time (APTT) is utilized for all preoperative patients, and also to monitor heparin therapy. The time that the test is drawn in relationship to the patient's dose of heparin has a significant effect on the lab results. It is important for the lab and nursing personnel to monitor this relationship closely. Two Anti-Xa tests are available: LMWH and UFH.
For nursing heparin monitor protocol there are two tests available: Nurse Anti Xa and Nurse PTT. Nurse Anti Xa is specifically for Unfractionated Heparin.
Both a (PT) and (PTT) are monitored on patients being converted from heparin therapy to coumadin therapy.
NOTE: The following tests are performed upon request only, with clinical indications of coagulopathy, DIC or other clotting abnormalities such as unexplained prolongation of the Prothrombin time and or Activated Partial Thromboplastin Time.
- Fibrinogen
- Mixing studies to rule out inhibitors and/or factor deficiencies only with a Hematology/Oncology consult
- D-dimer Assay (performed in WX & BR only)
C. DIFFERENTIALS:
Differentials (Automated or Manual) are only available when specifically requested.
Manual differentials are only performed on an abnormally flagged automated differential. Only one manual differential will be performed per patient in a 72hour period. Manual differentials will not be performed on patients who have had manual differential done in a previous 72 hour period unless their condition warrants a manual differential every 24 hours. Manual differentials are not performed STAT but priority will be given to emergency-STAT requests before routine orders. Smears will be stored for a minimum of 30 days and will be made available if a clinician wishes to review the slide.
For outpatients with conditions that produce markedly abnormal WBC or RBC morphology (e.g. CLL), which are known to the laboratory, and which have had stable findings for at least 3 months, a manual diff is not required (though one may be performed) even when triggered by the Differential, Blood test criteria unless the patient's WBC or automated differential parameters change markedly. A new manual diff should be performed in these patients if one has not been done in the last 6 months.
Reflex testing:
Hematology lab will reflex pathology smear review, manual differential and RBC morphology on patient samples showing abnormal or suspicious findings. Criteria for reflex testing include but not limited to the following:
- Initial blasts seen on smear review
- Leukemic smears
- Abnormal lymphocytes
- Marked changes in red cell, white cell, or platelet morphology
D. CSF SPECIMENS:
It is absolutely necessary that cell counts be done as soon after the spinal tap as possible since most cells present will start to degenerate within a short period of time (approximately 1 hour). All spinal taps should be brought to Hematology first. All tubes must be labeled and accompanied by a requisition slip or computer generated lab order number. Ideally, Hematology should be given the 1st and last tube drawn (usually #1 and #4). If only one tube is to be given to Hematology it should be the LAST tube drawn from the tap.
Note: CSF specimens for patients with the clinical differential diagnosis of Creutzfeldt-Jakob Disease (CJD) must be clearly labelled “CJD” and the Lab must be notified prior to submission of the CSF specimen for testing.
E. ALL OTHER BODY FLUIDS:
All other body fluids for cell counts and differential must be submitted in a lavender top EDTA tube. SYRINGES ARE NOT ACCEPTABLE.
ALL TUBES MUST BE MIXED WELL TO PREVENT CLOTTING.
Clotted specimens are not acceptable for testing. If a clotted specimen must be tested it will be reported with a disclaimer that cell counts from clotted or clumped samples are inaccurate and therefore not valid. A smear will be reviewed for abnormal cellular morphology.
Specimens should be brought immediately to the lab to ensure accurate results.
Test Code
Hematology/Coagulation
Last Updated: May 19, 2025
