Hematology in Emergency Lab: What I Need and What It Tells Me

The hematology emergency laboratory is essential for prescribing supportive therapies, diagnosis of hematologic emergencies and monitoring of patient outcome.

HEMATOLOGY IN EMERGENCY LAB: WHAT DO I NEED

Undoubtedly, emergency services need a in-house laboratory with an equipment that meets the following criteria:

• issuing rapid analytical results;
• easy to use and low maintenance;
• that provides precise and accurate analytical results on those parameters involving emergency treatment decisions;
• requiring small samples to avoid iatrogenic anemia.

Hematology basic equipment consists of: microhematocrit centrifuge, microscope with at least 3 plan achromatic objectives (10, 40 and 100 X) and a resolving power of 0.1-0.2 μ; clinical refractometer with automatic temperature compensation, lab consumables for cell counts, blood grouping and activated clotting time, as well as Romanowsky and supravital stains. A more advanced equipment, allowing at least one complete blood count, includes the basic equipment plus a hematology analyzer and hemostasis equipment at the patient's bedside. When purchasing a hematology analyzer, the answers to many questions have to be considered. The most important ones are:

1. What is the predominant species in the clinic? canine vs feline;
2. What differential count do you get? three vs five cell populations;
3. Does it offer cytograms or histograms of blood cell populations that aid the interpretation and validation of the results?
4. What does a CBC cost?

There are three types of hematology analyzers: those based on the quantitative analysis of the buffy coat (QBC), those using electrical impedance and those using flow cytometry. Generally, the parameters obtained in the impedance analyzers, except the differential WBC count, show a good correlation with the reference method, but there are certain limitations, particularly in the 1 platelet count, which is underestimated in canine blood by some analyzers . Cats have a physiological platelet anisocytosis that poses a problem for getting an accurate count in many impedance analyzers. Furthermore, platelet aggregates appear frequently in this species and can cause a pseudothrombocytopenia and/or a falsely increased leucocyte count […]