MLAB 1227 Coagulation

I. Introduction

Hematology is introduced with the study of the formed elements of blood and students perform laboratory procedures for enumeration and identification of blood components. Coagulation theory and procedures are studied. The laboratory exercises will endeavor to provide the student with the most comprehensive experiences possible, but will rely mainly on the commonly performed manual and semi-automated methods of hematology and coagulation.

II. Prerequisites

Enrollment in this course and the Medical Laboratory Technology Program requires department head approval and successful completion of the admissions process.

III. Course Goals

By the end of this course, the student should be able to:

1. Demonstrate an understanding of the components of human blood and characteristics, functions, and abnormalities and disease states of each.
2. Demonstrate proficiency in the skills necessary to perform blood cell counts, and evaluation of blood elements within stated limits of accuracy.
3. Demonstrate an understanding of all aspects of the coagulation mechanism including abnormalities and disease states.
4. Perform with proficiency the basic laboratory coagulation analyses.

IV. Methods of Presentation

1. Lecture
2. Demonstration
3. Laboratory practice
4. Audio-visual
5. Computer programs (available in the library)

V. Textbooks

A. Harmening, Clinical Hematology and Fundamentals of Hemostasis, 3rd edition, F.A. Davis
B. The Morphology of Human Blood Cells, Diggs, Sturm, Bell, Abbott

Recommended:

A. Medical Dictionary
B. Manual of Laboratory Diagnostic Testing

Textbooks are available at the RVS Bookstore.

VI. Course Requirements

A. Attendance Policy

Attendance is required at all times and roll will be taken at every class and laboratory meeting. All absences must be explained to the instructor on the day of the absence by telephone call or personal visit. The student is required to notify the instructor if any absence is anticipated. If absences exceed four (4), the student may be dropped from the course unless there are extremely extenuating circumstances. A student who is 15 minutes late is considered tardy. Three tardies constitute one absence. It is the student's responsibility to keep track of his/her attendance record and for all assignments, materials, examinations, etc., missed.

B. Dress Code

1. Students will be expected to attend class clean and neatly dressed.
2. A white laboratory coat, to be purchased by the student, must be worn buttoned during all laboratory sessions. Lab coats should be laundered frequently - preferably using a disinfectant like Lysol.
3. Footwear (non-skid, closed-toed) appropriate for a laboratory setting will be required.
4. Hair that is shoulder length or longer must be worn up or securely tied back.
5. Loose or dangling jewelry will not be permitted.
6. Strong smelling perfumes or after-shave lotion are inappropriate in a laboratory.
7. Latex gloves must be worn when handling blood or bloody fluids.
8. Safety glasses (available in RVS Bookstore) must be worn whenever there is danger of a splash with body fluids.

VII. Student Assistance Policy

It is the sincere desire of the program faculty to aid each student in developing his/her professional potential. Academic, clinical, and those personal problems that interfere with the student's development are of concern to the faculty. The program faculty has adopted the following policy:

A. Personal Problems - The MLT student should feel free to make an appointment to discuss problems of a personal nature with a faculty member of his/her choice. In addition, ACC counselors are available for student counseling.

B. Academic Problems - Problems encountered in the MLT lecture and/or laboratory sections should be brought to the attention of the course instructor. The instructor will work with the student to resolve the problem. If the student feels he/she cannot reach an agreement with the instructor, the student should present the situation to the Program Department Head.

VIII. Student Evaluation

A. Measurement - Written

Four major exams will be given over lecture material covering 6-8 lecture hours and the corresponding laboratory exercises and will comprehensively access student's knowledge of concepts, principles, techniques and procedures as related to the instructional material. There will be no retests given.

B. Measurement - Practical

Proficiency in clinical laboratory skills will be measured by performance of required skills within specific tolerance limits of each procedure. Points will be awarded for successful completion of laboratory exercises. A pre-test will be given at the beginning of each laboratory session. Study questions will reinforce theory and announced written and practical exams will be given. In addition, student performance in the laboratory is evaluated using the following criteria:

1. Attendance at the laboratory sessions is very important. It will not be possible to make up a missed laboratory assignment due to specimen, reagent, and/or instructor availability. (See Attendance Policy.)
2. Familiarity with procedure.
3. Setting up and performing procedure.
4. Appropriate specimens are obtained and utilized.
5. Proper use of equipment, glassware and pipets.
6. Proper use of equipment, glassware and pipets.
7. Organization and performance of individual tasks.
8. Completion of tests within a reasonable amount of time.
9. Clean up of work area.
10. Results of laboratory pre-tests.
11. Proper response to study questions which are due one week after the exercise is completed. Laboratory study questions must be turned in on time or will be given a grade of "0."
12. Results of laboratory quizzes.
13. Care and cleaning of microscopes, which are assigned by number to each student.

C. Determination of Final Grade - NOTE: Both lab and lecture must have a passing average in order for the student to pass the course and continue in the Program.

1. Lecture: 2/3 of final grade
   

   a. Four major exams = 75%
   b. Final exam = 25%

2. Laboratory: 1/3 of Final Grade

   The points awarded for each laboratory exercise are totaled and divided by the total points possible for a percentage grade. The total laboratory grade (1/3 of the final grade) is calculated according to the following:

   Laboratory Exercises = 30%
   Study Questions = 30%
   Pre-Tests = 10%
   Three Practical Exams = 30%

3. Grading System

   A = 90 - 100%
   B = 80 - 89%
   C = 75 - 79%
   D = 60 - 74%
   F = 59% or below

   I = Incomplete - To receive an "I," a student must have a passing average (75% or better) and have completed at least 80% of the course work.

   W = Withdrawal - Please meet with the MLT Department Head before making any decision on withdrawal. We will assist in any way we can with problem areas.

IX. Promotion, Failure and/or Dismissal from the Program

A minimum grade of "C" is required in all Medical Laboratory Technology and all other courses required for the A.A.S. degree. The student must make at least 75% in both the lab and lecture for each MLT course.

B. Any student may be withdrawn from the program for excessive absences (see Attendance Policy), consistently failing to meet class assignments, disruptive conduct, scholastic dishonesty, or for displaying conduct detrimental to the ethics of Medical Laboratory Technology.

C. The student may utilize the "Student Complaint Procedure of Austin Community College" as detailed in the ACC Student Handbook in the disposition of a grievance or complaint without fear of recrimination or retaliation.

D. The MLT faculty understand that learning in group situations can be beneficial. However, each student is expected to demonstrate his/her own competence by doing his/her own work. Any student caught cheating on examinations, plagiarizing, or sharing lab results will be subject to disciplinary action as outlined in the official ACC Student Handbook. This includes, but is not limited to, academic penalty and possible withdrawal from the Program.

X. Special Laboratory Requirements

1. It is the responsibility of the student to prepare for each lecture/laboratory session. Each student is responsible for his/her own work and for the cleaning up of their work station
2. Safety Regulations

   1. Proper Handwashing Procedure

   a. Wet hands and apply a small amount of an antiseptic soap (3-5 mL).
   b. Vigorously lather hands and rub together for at least 15 seconds.
   c. Wash well between fingers and up the wrists.
   d. Rinse well with a moderate stream of water in a downward motion.
   e. Dry with a paper towel and use the towel to turn off the faucet. Dry skin adequately to avoid dermatitis.

Alcohol hand rinse or foam products may also be used for decontaminating the hands whenever clean running water is not available. However, they should not be used as a substitution for hand washing.

Frequent hand washing can be very damaging to the skin's normal protective mechanisms by damaging or cracking skin, altering its pH, or changing its normal flora. Recent studies suggest that frequent application of hand lotion may reduce this damage; lab personnel, therefore, are now encouraged to use it. This may be difficult, however, as one should avoid applying hand lotion immediately after washing, right before giving direct patient care, or right before handling of sensitive instruments or equipment. Lotions might interfere with the residual action of the antimicrobial hand washing products.

2. Universal Precautions/Standard Precautions

The concept of universal precautions was first introduced in 1987 by the Centers for Disease Control (CDC) to decrease the occupational risks of blood-borne diseases such as AIDS and hepatitis B to healthcare workers. The application of universal precautions is continually evolving; all body fluids may soon be handled with the same precautions as blood. Blood, urine, and other biological specimens possibly containing pathogenic organisms will be used in this course; therefore, CDC guidelines will be followed as they apply. Precautions specific for clinical laboratories:

1. Use barrier protection routinely to prevent skin and mucous membrane contamination with blood or other body fluids.
2. Wear gloves:
   1) When cuts, scratches, or other breaks in skin are present.
   2) When performing any type of blood collection.
   3) Whenever blood and body fluid specimens are handled.
   4) Anytime it appears that contamination of the hands may occur.
3. Change gloves after each patient contact or when visibly contaminated with blood.
4. Wear a mask, eye glasses or goggles, or face shield during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of the mucous membranes of the mouth, nose, and eyes.
5. Wear a fluid-resistant gown, apron, or other covering when there is a potential for splashing or spraying of blood or body fluids onto the body.
6. Wash hands or other skin surfaces thoroughly and immediately if contaminated with blood or other body fluids.
7. Wash hands immediately after gloves have been removed even when no external contamination has occurred. Organisms on the hands multiply rapidly in the warm moist environment within the glove.
8. Handle laboratory instruments, especially needles and scalpel blades, with extreme caution.
9. Place used needles, disposable syringes, skin lancets, scalpel blades, and other sharp items into a puncture-resistant biohazard container for disposal. The container should be located as close as possible to the work area. Phlebotomists should carry puncture-resistant containers with them on their phlebotomy tray.
10. Needles must not be recapped, purposely bent, cut, broken, removed from disposable syringes, or otherwise manipulated by hand. If recapping is unavoidable (blood gas syringes, etc.), do it with one hand and use great caution.
11. Place large-bore reusable needles (bone marrow, biopsy needles, etc.) and other reusable sharp objects into a puncture-resistant container for transport to the reprocessing area.
12. Use mouth pieces, resuscitation bags, or other ventilation devices during emergency resuscitation procedures.
13. Exudative lesions or weeping dermatitis should be covered with an occlusive dressing to prevent contamination.
14. All specimens of blood and body fluids should be put in well-constructed containers with secure lids to prevent leaking during transport. Care should be taken when collecting each specimen to avoid contaminating the outside of the container and the laboratory form accompanying the specimen.
15. Use biological safety hoods (Class 1 or 2) for procedures that have a high potential for generating droplets (e.g., blending, sonicating, and vortexing).
16. Fill evacuation tubes, vials, and bottles by using their internal vacuum only. If a syringe is used, the fluid should be transferred to an evacuation tube by puncturing the diaphragm of the rubber stopper and allowing the correct amount of fluid to flow slowly into the tube along the wall. The tube should not be hand held when puncturing the top. Never force fluid into an evacuation tube by exerting pressure on the syringe plunger.
17. Use mechanical pipettes for manipulating all liquids (including body fluids, chemicals, or reagents) in the laboratory.
18. Decontaminate all laboratory work areas with an appropriate chemical germicide after a spill of blood or other body fluids and when work activities are completed. Laboratory counter tops should be disinfected at least once per shift.
19. Rinse off all body fluids from reusable contaminated equipment prior to reprocessing according to your institution policies.
20. Clean and decontaminate scientific equipment that has been contaminated with blood or other body fluids before being repaired in the laboratory or transported to the manufacturer. Always follow manufacture's recommendations.
21. Pregnant laboratory workers are not thought to be at greater risk of infection than others in the laboratory. However, if an infection does develop during pregnancy or the mother is a carrier prior to the pregnancy, the infant is at risk of infection by perinatal transmission. Therefore, pregnant laboratory workers should be especially aware of universal precautions.

3. All accidents are to be reported immediately to the laboratory supervisor/ instructor.

C. Required Materials

1. White laboratory coat
2. Felt-tip marking pen
3. Safety glasses or goggles
4. Optional but recommended - a digital watch with timer or a small digital kitchen timer
5. Optional but recommended - pocket calculator

D. General Comments

1. It may take more than one laboratory period to complete an exercise. It will be necessary, therefore, to bring each laboratory exercise to every laboratory period.
2. Each person will be responsible for his own work (no sharing results) and for cleaning up his work area.
3. Open laboratory hours to practice skill or complete work will be posted at a later date.
4. This course will endeavor to provide the student with the most comprehensive experiences possible, but will rely mainly on the commonly performed manual and semi-automated methods of hematology and coagulation.

XI. Materials of Instruction

A. References

1. Brown, Barbara, Hematology: Principles and Procedures, 6th edition. Lea & Febiger, 1993.
2. Rodak, Bernadette, Diagnostic Hematology, 1st edition. W.B. Saunders, 1995.
3. Lotspeich-Steininger, et al. Clinical Hematology, Principles, Procedures, Correlations, 1st edition. J.B. Lippincott, 1992.

B. Audio-Visual Program

1. "Hematology/Coagulation" (cat #QY 400 C652)
2. "Hematology Projection Series" (cat # WH 100 H487)
3. "Blood: Composition and Functions" (cat # WH 100 B655)
4. "Introduction to Blood Cell Morphology" (cat # WH 200 B995i)
5. "Blood Cell Morphology: Granulocyte Identification" (cat # WH 200 B995g)
6. "Blood Cell Morphology: Lymphocyte Identification" (cat # WH 200 B995L)
7. "Basic Laboratory Procedures" (cat # QY4B311)

C. Computer Software

1. Peripheral Blood Tutor