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DEPARTMENT OF HAEMATOLOGY AND BLOOD TRANSFUSION LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA (LASUTH) DEPARTMENT MANUAL AND LABORATORY USER FIRST EDITION (2015) HANDBOOK Department of Haematology and Blood Transfusion, LASUTH, Ikeja 2015 All Rights Reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publishers. Published and Printed by Bollyrose Nig.Company Tel:08087811554 Email: [email protected] Title Page 1 Contents 3 Forward 5 Scope and Purpose 6 Vision and Mission 7 List of Abbreviations 8 General Information 9 Contact Information of Head of Units 11 Opening Hours 12 Members of Staff Profile 13 Department Organogram 16 Haematology request form 17 Phlebotomy Procedure 18 Sample Collection 19 Haematology Tests, Sampling Requirements and Expected Turn Around Time 23 Consult to Haematologist on call 25 References Values and Result Interpretations 26 Panic Values 27 Reporting Test Results 27 Retention of Samples 28 Biosafety 29 LASUTH HIV PEP 30 LASUTH Blood Bank 32 Blood Donation 34 Consent to transfusion of blood and blood products 36 Bone marrow aspiration and biopsy information sheet and consent form 39 Consent for Anaesthesia or sedation 43 Consent for Chemotherapy 44 Standard Operating Procedures 47 Training and Research 61 List of recognized publications 61 Acknowledgements 66 References 67 Forward Blood they say is Life. Blood and blood products are essential therapeutic components for management of myriad of diseases. Their use also transcends boundaries of disciplines cutting across major clinical departments. Little wonder, the appearance of blood in an emergency room for a bleeding patient usually provides such a relief for physicians. Very much like other drugs, blood could be hazardous if improperly used either by error of preparation or application. An adequate knowledge of these essential products can therefore not be overemphasized. This departmental manual and hand-book in LASUTH represents the first to be produced which provides enough knowledge for all who have anything to do with blood. The high point of this handbook is the compilation of Standard Operating Procedures (SOP). I congratulate the leadership and entire staff of Haematology department for this avangard position worthy of emulation. I am sure the handbook will be cherished by all who read it. Dr Ayoade Adedokun MD,FMCGP. Director Clinical Services and Training/CMAC 5 Scope of Purpose This book is a compendium of Haematology and Blood Transfusion Department. It has been well researched and presented. Readers will benefit tremendously in improving their knowledge of the Department. Day-to-day interactions with the Department have been chronicled in this book. It is expected to bridge knowledge gaps existing between the Department and other Departments in the Hospital. The book brings to fore department’s members of staff profile, Haematology Tests, Sampling requirements and Expected Turn-Around Time, urgent services: consult to the Haematologist among other pieces of information highlighted. It is intended for all Laboratory users, Clinical, non-clinical Departments and the general community at large. It is a guide to understanding and utilizing services offered by the Department. Dr. Akinbami Akinsegun Abduljaleel Senior Lecturer/Consultant Haematologist Head of Department September 2015. 6 VISION AND MISSION VISION: To be a Centre of Excellence in Clinical Laboratory Services MISSION: To provide High quality Clinical Laboratory services in a friendly environment where patients’ satisfaction is the Ultimate 7 List of Abbreviations LASUTH- Lagos State University Teaching Hospital Hb - Haemoglobin ESR- Erythrocyte Sedimentation Rate PT- Prothrombin APTT - Activated Partial Thromboplatin Time INR - International Normalized Ratio FBC - Full Blood Count ICU - Intensive Care Unit CCU - Critical Care Unit HDC - Haematology Day Care HOD - Head of Department BMA - Bone Marrow Aspiration BMP - Bone Marrow Biopsy LE - Lupus Erythomatosus HIV- Human Immunodeficiency Virus HbsAg - Hepatitis Surface Antigen HCV - Hepatitis C Virus CNO - Chief Nursing Officer ACNO - Assistance Chief Nursing Officer CMLS - Chief Medical Laboratory Scientist ACMLS - Assistant Chief Medical Laboratory Scientist PMLS - Principal Medical Laboratory Scientist PMLT - Principal Medical Laboratory Technologist MLT - Medical Laboratory Technician ADML- Assistant Director ML SMLS- Senior MLS BDC - Blood Donor Clinic QMS - Quality Management System 8 General Information Introduction to Haematology Department The department runs a clinic which shares the same block with the hospital free pharmacy, and directly adjacent to the BT diagnostic complex. Clinic hours are from 8:00am to 4:00pm on Mondays, Tuesdays and Thursdays. Each clinic day is headed by a Consultant Haematologist supported by Resident Haemotologists and Medical officers. Also in the staff compliments are, Nurses, Record Officers, Laboratory Scientists, Pharmacists, Home based care coordinators, HIV/drug Adherence Counselors, Administrative and Secretarial staff. Seminars, case presentations, bone marrow aspiration/biopsy and laboratory work-up are done on Wednesdays and Fridays. Facilities available in the clinic include five well-furnished consulting rooms, resident lounge, the Head of Department’s office, a 30-seater meeting/conference room with a multimedia facility, nurses bay, Pharmacy, Records, Monitoring and Evaluation office, HIV/drug adherence counselor offices, a phlebotomy room and a well-equipped laboratory that generate results such as full blood count, CD4 count, HIV viral load, HIV and HBsAg serology, electrolyte, urea, and creatinine, lipid profile, and liver function test at a subsidized rate. The APIN-HIV laboratory was rated high (Green) in the last Quality Assurance evaluation by Centre for Disease Control, Atlanta Georgia, USA. The clinic operates a staggered appointment system; HIV-infected patients are seen from 8:00am to 12 noon and general Haematology patients’ i.e those with heamatological malignancies, sickle cell anemia and various forms of bleeding disorders are seen from 11:00am to 4:00pm. Consults are received from almost all departments in the hospital. 9 Patients’ attendance at the clinic is on the average of 240 new cases monthly and 6300 old cases monthly. This consist of about 15% of Haematology cases and 85% HIV-infected patients. Currently, about 5600 HIV-infected patients are enrolled into care in the clinic. The waiting time per patient is an average of 1 hour for old (follow-up) patients and about 3 hours for newly registered patients. The clinic has a three-bedded day care room, used for simple medical emergencies like rehydration of dehydrated patient’s blood transfusion of anaemic patients and minor surgical procedures like bone marrow aspiration/biopsy and urinary catheterization. The department also runs the blood donor clinic, the transmissible, transfusion infection (screening) unit attached to the blood bank and Haematology laboratory. The blood donor clinic is manned by an experienced laboratory scientist who coordinates blood donation amongst all prospective blood donors after going through preliminary screening of infectious diseases. The donated blood units are sent to the screening room for screening infectious diseases like HIV/AIDS, hepatitis B virus, Syphilis, and hepatitis C virus. The blood donor clinic opens from 8:00am to 4:00pm Monday to Friday. Units of blood free from these infectious diseases are sent to the blood bank for onward dispatch to the wards sending requests for blood after proper grouping and cross matching in the blood bank. The blood bank runs 24 hours’ services. Facility for blood component preparation is available for those who require platelet concentrates, (but temporarily out of order at press time) fresh frozen plasma, red cell concentrates and cryoprecipitate. The department is one of the three centers in Lagos where blood components are obtainable. The LASUTH Haematology laboratory attends to all Haematology laboratory requests and from the hospital clinics and the wards. Requests like full blood count. Coombs tests, blood film, ESR, Hb electrophoresis (genotype) and clotting profile are attended to at the laboratory. The Department is involved in training Resident Doctors, Medical students, Intern Medical Laboratory Scientists, Laboratory Technicians, and Students on Industrial attachment. Two of the trained Resident Doctors have qualified as Consultants at press time. It is also involved in research in all aspects of Haematology and Blood Transfusion as well as research collaborations with other departments in the Hospitals in order to publish World Class articles in high impact factor Journals. 10 Contact Information of Head of Units Title Head of Department Head of HIV/AIDS Unit Haematology Clinic Manager Laboratory Unit Head General Haematology Laboratory Head Blood Donor Clinic Head Blood Bank Head Chief Resident Doctor Safety Officer Head APIN Laboratory Head APIN Pharmacy Voluntary Donor Organizer Head of M&E and Records in the Clinic Haed Darlez Name Dr Akinbami Akinsegun Dr Dosunmu Adedoyin CNO Ekhaiyeme Taiwo Esther Adegbite Adetoun Ibikunle M.O Phone Number 08023064925,08183184621 e-mail address [email protected] 08023369785 [email protected] 08033370505 [email protected] 08036222047 [email protected] 08029528116 [email protected] Aile S.I.K 08135264464 [email protected] Adegbite Adetoun Dr Mustapha Olusegun 08036222047 [email protected] 08025535490 [email protected] Mrs Oyekoya Adeola Adelakun Olorunosebi Olayinka Animashahun Iredu Ifeyinwa. C 08088329224 Uzoma Ndulue 08053516251,08035997099 08053355031 [email protected] 08033011137 [email protected] 08033507164,08055643967 [email protected] Departmental email address: [email protected] 11 Opening Hours 1. Mondays to Fridays (Excluding Public Holidays) 8:00am to 4:00pm ---- Routine Services 4:00pm to 8:00am ---Emergency on-call Services only 2. Weekends and Public Holidays-hour Emergency On-Callservices 24-hour Emergency on-Call services. 3. Specimen Reception All Routine Samples should reach the Laboratory by 2pm. Any sample excluding those for FBC and grouping and cross matching that is sent after 2pm shall be treated with the next working day’s samples. 4. Haematology Day Care Mondays to Fridays 8amto4pm Used for patients requiring short hospital admission i.e patients requiring blood transfusions, chemotherapy and sickle cell patients in crises. Only Emergency will be seen after 2pm and these will be in Medical Emergency of the Hospital. 5. Clinical Services Clinical Consultations are provided 24 hours Clinical Haematology LASUTH Haematology/HIV/AIDS Clinics Days Consultants Clinic Clinics Mondays Dr. A. A. Akinbami Haematology/HIV Tuesdays Dr. T.M. Balogun Haematology/HIV Thursdays Dr. A. O. Dosunmu Haematology/HIV Ward Rounds Daily ward round with Residents are conducted. Haematology patients are admitted on male and female medical wards and Bola Tinubu medical ward. 12 Members of Staff Profile Doctors Name Designation Dr Akinbami A.A Consultant /HOD Consultant Consultant Snr Med Officer Snr Registrar Snr Registrar Snr Registrar Snr Registrar Snr Registrar Dr.Balogun T.M Dr Dosunmu A O Dr Mustapha OA Dr Adabale K.A Dr Adewolu A Dr Olayinka O.O Dr Badiru M A Dr Osikomaiya B I Dr Hassan AO Dr Adeyemi .O Dr Bamiro A R Dr Adelekan O. Med Officer Snr Med Officer Registrar Snr Registrar Telephone Number(s) 08023064925 e-mail address 08023039803 08023369785 08025535490 08033299761 08056068317 08036071793 08053552625 08086098717 [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 08034931826 07033449959 08023319018 [email protected] [email protected] [email protected] 08087759008 [email protected] [email protected] Blood Donor Clinic Name Designation Aile S.I.K Saliu F.F Kamson R.O Kareem O. Akinde A.O Basil Chinedu.B CMLS PMLS PMLS MLA MLT BMLS Telephone Number(s) 08135264464 08036476521 08023708438 08023592965 08027016169 08027187445 e-mail address [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] General Haematology Laboratory Name Designation Ibikunle M.O Oladipupo O.A Olupitan F.O Ihediwa J.C Aremu J.A Runsewe G.O Adetomiwa E.A CMLS ACMLS PMLS MLS PMLT MLT MLT Telephone Number(s) 08029528116 08033732411 08034118961 08060090676 08034707577 08029102088 08022556946 e-mail address [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 13 Blood Bank Name Designation Adegbite F.A Lawal B.F Ayandare K.M CMLS ACMLS PMLS Telephone Number(s) 08036222047 08039424441 08054641195 e mail address [email protected] [email protected] [email protected] Haematology Clinic Nurses Name Designation Telephone Number(s) 08033370505 e mail address Ekhaiyeme Taiwo Esther Osifeso Adeoti Adenrele Aleshiloye C.Tinuola Oluwole Bosede Kehinde Agboola Omolara Risikat Clinic manager/CNO CNO 08037227122 [email protected] CNO 08023011919 [email protected] CNO 08033768860 -------------- ACNO 08033893068 [email protected] [email protected] Haematology Administration Name Designation Banjoko. S.Akinyemi Taiwo Yusuf Assistant Chief Scientific Officer Higher Executive Officer Scientific Officer Animashahun Ganiyat.O Adekunle Ademola Clerical Officer Telephone Number(s) 08034615150 email address 08036074437 [email protected] 08050440114 [email protected] 08057031726 Nil [email protected] 14 Departmental O rganogram Chief Medical Director Director Clinical Service and Training Head of Department Laboratory H ead Unit Consultant CNO H aematologist (Clinic Manager) Medical Laboratory Senior Scientist Registrar CNO (O thers) Medical Laboratory Registrar Technician ACNO Medical Laboratory Assistance Medical Laboratory Attendants 16 Haematology Request Form Information required (to be entered by the requesting Doctor) 1. Surname 2. First Name 3. Hospital Number 4. Date Collected: 5. Ward/Clinic 6. Department 7. Age 8. Sex 9. Consultant 10. Date Reported 11. Nature of Specimen (Tick appropriate square) 12. Clinical Details 13. Examination Required 14. FBC Parameters 15. Retics 16. Hb Genotype 17. Retics Index 18. ESR 1. Blood stained requisition forms will be rejected 2. Forms must be filled completed 3. Samples should be transported into the Laboratory in a triple package. PHILEBOTOMY (Blood Sample Collection) Procedure Phlebotomy, the act of drawing blood from the vein with a needle, is a specialized skill. It is necessary for blood to be drawn for laboratory investigations in a variety of medical diagnosis. Typically, phlebotomists will use veins rather than arteries for phlebotomy. This guideline is provided to ensure the blood sample is properly collected, prepared, and preserved during and after collection. The integrity and quality of the result is dependent on these instructions being adhered to. 1. Assemble all items needed for procedure 2. Perform Hand hygiene 3. Identify and Prepare the patient 4. Select the venepuncture site 5. Apply the tourniquet 4-5 cm above the venepuncture site 6. Ask the patient to form a fist 7. Put on gloves 8. Disinfect the chosen site with 70% isopropyl alcohol and allow the site to dry completely. 9. Anchor the vein by placing a thumb below the venepuncture site 10. Enter the vein swiftly at 30 degree angle 11. Once sufficient blood has been collected release the tourniquet before withdrawing the needle 12. Withdraw the needle gently and apply gentle pressure to the site with a clean dry gauze or cotton wool. 13. Transfer the sample into the sample bottle, cap tightly and mix gently 14. Discard the needle and springs into a Sharp box 15. Immediately label the bottle after crosschecking the forms 16. Place the sample in a sample holder 17. Remove the gloves in a safe manner 18. Perform hand hygiene SAMPLE COLLECTION 1. Sample bottle must be appropriate for the test requested 2. Sample volume must be appropriate for the test(s) requested 3. Names, hospital number, date and request must correspond with those on the form 4. Is the sample clotted? Clotted samples are accepted only for Hb electrophoresis, and blood grouping and cross matching 5. Is the sample lysed? Please do NOT submit for Investigations, but may be acceptable for Hb Electrophoresis (genotype). 6. Is there any evidence of spillage? Please do NOT submit for Investigations, Spilled samples will generate wrong results particularly for FBC. Labeling the Sample Blood Specimens must be properly labeled. A properly labeled sample is essential so that the result of the test matches the patient. The key elements in labeling are: * Patient’s surname, first and middle * Patients’s hospital number. NOTE: Both of the above MUST match the same on the requisition form. * Date, time and initials of the phlebotomost. Consultant in Charge must be on the label of EACH tube or electronically entered. Automated systems may include labels with bar codes. The above MUST match with the request form Time Limit for Specimen Transfer to Laboratory All specimens collected on site must be transported into the laboratory within one hour of collection for processing. Samples from the ward or outside the hospital must be transported in cold using the triple package technique. Triple Packaging System - All Specimen shall be collected in a primary container that is should be correctly and securely closed. watertight and leak proof. The cap - The primary container shall be put into a secondary container that is watertight e.g Disposable, ziplock plastic bags. Several clinical specimens may be placed into one secondary container. - All secondary containers should be put into an outer container or packaging/box during transport. The outer container should be made of strong material that can be cleansed and distinfected. The outer container should have the Biohazard warning label. NOTE: For inter hospital/laboratory transport; there should be adequate cushioning materials inside the box so as to absorb shocks during transports, and adequate absorbing materials to absorb any spillage should it occur. Specimen Rejection Criteria A sample may be rejected if: 1. The sample bottle is not appropriate for requested test. 2. The type of specimen collection does not meet requirements of the assay to be performed i.e EDTA sample for grouping and cross matching will be rejected. 3. Documentation is incomplete or the information documented on the sample label and Requisition Forms do not match. 4. The sample or sample volume is inappropriate or insufficient for the test(s) required. 5. In addition, any of the following reasons may also be grounds for rejection of a sample for processing. a. The tube is not clearly labeled with necessary patient information. if there is any doubt as to whom the blood was drawn from. b. The sample is NOT clotted in the case of MOST blood bank requests c. If the integrity of the sample has been compromised or contaminated in any way. The following are several ways that this could occur: i. If the blood tube was not sterile prior to use ii. If blood samples from several patients could have been contaminated with other blood. iii. There wad a broken specimen container iv. There was a delay between collection of specimen and arrival in laboratory. Testing All tending procedures shall be performed within LASUTH blood bank. The turn around time (TAT) for each procedure is highlighted in table below. Specimens can consist of, but are not limited to, serum, plasma and whole blood. Back up Procedure Effective back up procedure is being put in place in case of eventuality, without compromise of standard or quality. In case of equipment breakdown, reagent stock out or prolonged power outage, BT diagnostic laboratory complex and other general hospitals are considered for selection as back up sites. Some of the criteria for selection include proximity and accessibility to the site, practicing of QMS, undergoing improvement projects for accreditation, availability of compatible equipment with appropriate back-ups and availability of qualified manpower. Getting Back Result All completed report forms after sample processing will be KEPT in the unit, until it is requested for by the physician through the attendants in Pediatrics, Family Medicine, Medical Outpatient Department and Medical Emergency. Family member from other Departments pick up results from the Laboratory. The laboratory will not release laboratory report to ANY patient or patient relative in line with the hospital policy Only physician directly involved in a patient’s care will be allowed access to such patient report in the laboratory Client Concern & Feedback The laboratory team will on regular basis conduct a ‘client satisfaction survey’ to assess lab user’s opinion on our services in order to identify areas for improvement. Any complaint, criticism or suggestion should please be directed to the lab management team, or concerned individual can make use of the suggestion box at the lab entrance. Haematology Tests, Sampling Requirements and Expected Turn-Around Times 1. The Department will expedite the processing of samples for patients to be reviewed with current results. Turn-around time is influenced by method of analysis among other things 2. Urgent request must be indicated on the form. This will be treated urgently only if indicated. 3. Full blood count service is available in the hospital laboratory request be sent to a private laboratory outside the hospital. 4. All samples from ICU, CCU, Peadiatric, Medical/Surgical emergencies and Neonatal units and some from HDC should be considered urgent. URGENT!!! Should be boldly written on the request forms. 5. Urgent request reports will be made available within minutes. 24 hours: on on account should TEST BOTTLE MINIMUM AMOUNT (mls) TURN-AROUND TIME FULL BLOOD EDTA (Green Cap) COUNT (FBC) 4-5 6 h ou r s PACKED CELL VOLUME ESR LE CELLS FBC, ESR, RETICS FBC, RETICS FBC, Hb ELECTROPHORESIS PT,INR,PTTK EDTA (Green Cap) 3 1 h ou r s EDTA (Green Cap) EDTA (Green Cap) EDTA (Green Cap) EDTA (Green Cap) EDTA (Green Cap) 3 10 4.5 4.5 4.5 6 h ou r s 24 h ou r s 8 h ou r s 6 h ou r s 36 h ou r s Sodium Citrate (Light Blue) THROMBINTIME Sodium Citrate (Light Blue) Sodium Citrate CORRECTION (Light Blue) STUDIES DIRECT EDTA (Green Cap) ANTIGLOBULIN 4.5 or 5 depending on the size of vacutainer 4.5 or 5 depending on the size of vacutainer 4.5 or 5 depending on the size of vacutainer 6 h ou r s 6 h ou r s 2 4 h ou r s Plain (White or Red Cap) 3 6 h ou r s Plain (White or Red Cap) 4 4 h ou r s ANTIBODT TITRATION (by a consult to the Haematologist Plain (White or Red Cap) 5 6 h ou r s HIV ELISA Plain (White or Red Cap) 4 6 h ou r s RAPID HIV SCREEN Plain (White or Red Cap) 4 6 h ou r s HBsAg (Rapid) Plain (White or Red Cap) 4 6 h ou r s HCV (Rapid) Plain (White or Red Cap) 4 36 h ou r s Cd4 Count (done at ART Lab) EDTA (Green Cap) 4 6 h ou r s HIVVIRAL LOAD BONE MARROW ASPIRATIONAND BIOPSY Blood Filmand FBC EDTA (Green Cap) Patient to buy disposable needle from the Store EDTA (Green Cap) 4 4 2 W eeks 24 hours (Biopsy sample sent for histology) 4.5 24 h ou r s TEST INDIRECT ANTIGLOBULIN TEST GROUPINGAND CROSSMATCHING 24 Consult to the Heamatologist on Call 1. The Department has three Consultants and hence three units. 2. Each Consultant is rostered on call to attend to consults from the hospital on weekly basis 3. Consults should be submitted to Haematology Clinic, handed over to any Doctor on ground and registered in the consult register in the clinic. 4. Any consult for Bone Marrow Aspiration and Biopsy must be accompanied by a recent FBC not older than 48 hours 5. Patients being evaluated for Lymphomas should have a Lymph node biopsy and NOT fine needle aspiration cytology done before referral to Haematology. 6. Unconfirmed cases of Sickle Cell Disease should have samples for at least Hb Electrophoresis taken before referring to the Department. 7. Patients with coagulopathies should have samples taken for FBC, PT, APTT before referral 8. INR request is not indicated for patient not on warfarin, INR is used to measure warfarin use. 9. The Department always welcomes enquiries regarding reference values and interpretations of laboratory results. Please always contact the Head of Department or any other Consultant Haematologist for query on any ambiguous result. 10. Bone marrow aspiration results are signed out by the Senior Registrar and Consultant on call when requests are made. 11. Reminder consult will be attended to by the unit on call when the first consult was written. Reference Values and Result Interpretations Some locally relevant reference values are as follows FBC mean values in HbAA and HbSS in Lagos......Akinbami et al. Haematological values in homozygous Sickle Cell Disease in Steady State and Haemaglobin Phenotype AA controls in Lagos, Nigeria BMC Research Notes 2012:5:396 Parameters Hgb g/dl HbAA HbSS Males Females Overall Males Females Overall 13.83±1.32 11.96±3.10 13.83±1.3 8.11±1.53 7.78±1.42 7.93±1.4 25.04±4.9 23.95±4.49 24.44±4.66 2 PCV % 43.07±3.95 36.59±3.30 43.07±3.9 5 WBC 5.75±1.63 5.63±1.59 5.67±1.59 10.82±4.95 9.83±2.86 10.27±3.94 239±62.25 222.15±58.03 222.82±57 408.40±13 416.21±15 412.7±155. 3.42 5.09 09 81.71±6.34 81.36±9.01 81.52±7.89 26.54±2.46 26.47±3.71 26.50±3.20 32.45±1.00 32.54±1.08 32.52±1.07 *109/L Platelets *109/L MCV Fl 86.90±4.69 84.63±8.82 86.90±4.6 9 MCH pg 28.25±1.34 27.20±1.92 28.50±1.3 4 MCHC g/dl 32.06±1.07 31.59±0.93 32.06±0.9 0 Abbreviations: Hgb----Haemoglobin Concentration, PCV---Packed Cell Volume MCV---Mean Cell Volume, MCH---Mean Cell Haemoglobin, MCHC-Mean Cell Haemoglobin Concentration, WBC-White Blood Cell Trimester-specific Mean Haematological Values Parameters Trimester Overall 1st 2nd 3rd HCT% 30.16±5.55 32.07±6.80 29.76±5.2 33.04±3.88 Hb g/dl 10.94±1.86 11.59±2.35 10.81±1.72 10.38±1.27 WBC count *109 7.81±2.34 7.37±2.38 7.88±2.32 8.31±2.15 Platelet count 228.29±6.56 231.50±79.10 227.57±63 200.82±94.4 MCV,fl 78.30±5.70 79.70±0.96 78.38±5.72 70.02±5.40 MCH,pg 28.57±2.48 28.23±2.40 28.63±2.50 28.18±1.92 MCHC g/dl 36.45±1.10 36.27±1.21 36.49±1.08 31.34±0.75 *109 Abbreviations:HCT---Haematocrit, Hgb---Haemoglobin Concentration, WBC-White Blood Cell, MCV---Mean Cell Volume, MCH--Mean Cell Haemoglobin, MCHC--Mean Cell Haemoglobin Concentration. Panic Values 1. PCV <_ 20% or >_ 60% 2. WBC <_ 2.0*109/ / or >_ 50*109/L 3. Platelets <_ 100*109/ / L or >_ 600*109/L The Department has developed a set of flag-signs for various investigations. All abnormal results must be reviewed by Resident Doctors and authorized by the Consultant Haematologists who will give full reports, clinical correlates and advice on further investigations and line(s) of management. This is possible only if the managing Physicians or Surgeon sends a consult regarding the result to the Haematologist on Call. Retention of Samples SPECIMEN STORAGE CONDITIONS RETENTION PERIOD FBC SAMPLES 4 to 8 degrees 1 week COAGULATION SAMPLES Minus 20 degrees 24 hours GROUPING AND 4 to 8 degrees 1 week Minus 20 degrees 1 year CROSSMATCHING SEROLOGY Biosafety 1. All samples should be treated as BIOHAZARDOUS hence universal safety precautions MUST be adhered to, by Staff in the Wards, Clinics and Laboratory. 2. Gloves must be worn before handling any samples, reagents or Laboratory equipment 3. Laboratory coats should be worn when collecting, handling or processing samples 4. Hand hygiene must be performed before wearing and after removing gloves 5. Do not transport samples to the Laboratory without a container like triple packaging 6. Do not use the request form to wrap the samples 7. Discard all sharps into appropriate containers 8. Do not recap syringes. In event of needle stick injuries or exposure of skin or mucous membranes to biological fluids, the following should be done 9. Do not squeeze the area, allow blood to flow freely 10. Exposed area should be washed with copious amount of water with soap. 11. Flush exposed mucous membranes with water/saline 12. Do not apply caustic agents, antiseptics or disinfectant 13. Inform your supervisor so that the Department will be contacted immediately LASUTH HIV PEP Guidelines 1. What is Post Exposure Prophylaxis (PEP)? Is the short term use of ante retroviral drugs to prevent or reduce the likelihood of HIV infection after potential exposure? 2. When Should PEP be commenced? PEP should be initiated as soon as possible, ideally within 2 hours of the exposure. A first dose of PEP should be offered to the exposed worker while the evaluation is under PEP should be used for 28 days 3. Evaluation of Victim: Assessment of HIV status of victim and source person should be commenced immediately by using rapid HIV test kit. 4. Exposure that may warrant post-exposure prophylaxis include or mucous membrane exposure may pose a risk of HIV infection: blood, blood-stained, saliva, breast-milk, genital secretions and cerebrospinal, amniotic, rectal, peritoneal, synovial, pericardial or pleural fluids 5. Exposure that does not require post-exposure prophylaxis include: when the exposed individual is already HIV positive: when the source is established to be HIV negative: and exposure to bodily fluids that does not pose a significant risk tears, non-blood-stained saliva, urine and sweat. 6. Number of ARV drugs prescribed for post-exposure prophylaxis: a regimen for post-exposure prophylaxis for HIV with two ARV drugs is effective but three drugs are preferred. 7. Post-exposure prophylaxis ARV regimens-adults and adolescents: TDF (Tenofovir)+3TC (Lamivudine) (or FTC) (Emtricitabine) is recommended as the preferred backbone regimen for HIV post-exposure prophylaxis for adults andadolescents. LPV/r (Lopinavir/ritonavir) or ATV/r (Atazanavir/ritonavir) is recommended as the preferred third drug for HIV post-exposure prophylaxis for adults and adolescents. EFV (Efavirenz) can be considered as alternative third drug options. 8. Post exposure Testing Immediately 6 weeks, 12 weeks, 6 months. Extended follow up 1 yr 9. Post-Exposure Counseling: Abstain from sex for at least 6 months or use condom or until third negative result is obtained. Do not donate blood, blood products or organs for 6 months. 10. Personal Protective Equipment: All LASUTH health workers when attending to patients should at all times be adorned with gloves, gowns, laboratory coats, face shields, eye protections, foot wear. LASUTH Blood Bank Location: Located on the ground floor opposite the entrance within the main Laboratory Opening Hours: 24 hours service Services available 1. Grouping and crossmatching of blood 2. Direct Antiglobulin Tests 3. Full blood Count (during call hours only) 4. Blood products availability Policies 1. Samples for grouping of blood are collected only in plain (white) bottles and not needles and syringes 2. Sample are collected from the ward and phlebotomy points, where samples are NOT collected in the blood bank as there is no facility for sample collection. 3. LASUTH blood bank DOES NOT sell blood nor arranges for donor on patient’s behalf 4. LASUTH blood bank DOES NOT refer patient to any other blood bank, only if the patient blood group is not available in the blood bank. 5. LASUTH blood bank DOES NOT issue clearance for purchase of blood from outside blood bank if the blood group in question is available in the hospital. 6. Patients on voluntary discharge must replace blood loaned to them before discharge. 7. LASUTH blood bank loans blood to patient on emergency WITH NO WITHOUT donation after payment of N4.500.00 per pint as long as the patient blood group is available in the blood unit. 8. Blood loan to patient on emergency MUST BE replaced by patient relatives before discharge. 9. LASUTH blood band DOES NOT accept blood from any unaccredited private laboratory or hospital BUT ONLY from general hospitals within Lagos State- National Blood Transfusion services or certified private laboratories in Lagos State. 10. LASUTH blood bank WILL ONLY be responsible for patients that are referred out on specified conditions mentioned above. 11. LASUTH blood bank WILL NEITHER receive nor store blood obtained from uncertified blood bank. 12. Patient MUST pay the sum of N4500 only, a NON-REFUNDABLE fee on each pint of blood collected from the blood bank despite having donated, being a cross matching and screening fee. 13. There is NO REFUND of money paid on any blood returned or unused 14. LASUTH blood banks re-groups and re-cross matches’ blood obtained from other general hospitals and certified private blood banks within Lagos at a fee of N1,000 only 15. LASUTH blood bank DOES NOT issues discharge clearance during call-duty hours, weekends and public holidays because there are no discharges 16. LASUTH blood bank SHALL use her discretion on other issues not mentioned above when necessary 17. Members of staff and patients should call the Head of Department or Head of Unit in the blood bank should there be any query. Their telephone numbers are displayed at the entrance of the blood bank. 18. LASUTH blood bank runs 24 hours’ services except where inevitable (like strike actions when skeletal services shall be arranged) LASUTH BLOOD SEEKS FOR EVERYONE’S CO-OPERATIONS AND UNDERSTANDING TO AVOID ANY DELAY, MISUNDERSTANDING OR EMBARRASSMENT Blood Donation The Department encourages Voluntary Non Remunerated Donors, however still relies on Family Replacement donors. The Department will be establishing an ative Voluntary Donor Unit very soon. The donor organizer, Animashahun Olayinka has been mandated by the management to commence vigorous voluntary donor drive in Lagos State and deliver voluntary donated blood to LASUTH on weekly basis in order to bring to a halt the policy of coercing family members of patients to donate blood. The management will also be establishing a stand/alone voluntary blood donation unit one Ayinke house come on/board. DONOR CLINIC: Location The Donor Clinic is located on the ground floor beside the main entrance to the laboratory services building of the hospital. Adjacent to it is the blood transfusion laboratory. Facility * Blood donation pre/counseling and testing * Donation of blood * Post/counseling Time of Operation/Blood Donation Eligibility 1. The LASUTH/ Blood Donation Centre-Donors Clinic (BDC-DC) operates Monday through Friday between 8:00am to 4:00pm except public holidays and weekends. 2. All intending Blood Donors for replacement and voluntary donation must be healthy and be physically and psychologically prepared to donate blood. 3. All intending family replacement blood donors must present themselves with their means of identification (I.D Cards) for screening process in order to deter touting. 4. Bleeding for pre-donation screening tests, packed cell volume (PCV), starts at 8:00am to 10:00am for the first batch of donors. It is free of charge. All such collected samples shall be subjected for PCV & Transfusion transmissible infections (TTIs) serological tests by rapid kit 5. The results of such tests shall determine whether an intending blood donor would be allowed to donate blood. 6. All eligible blood donors would be counseled, registered, their weights and heights obtained, fill the blood donor questionnaires and laid on the couch for donation. All non-eligible intending blood donors shall be counseled and thereafter deferred or referred as the case maybe. 7. Phlebotomy on the first batch of eligible donors commences from about 10:30am to 12:30pm. 8. Bleeding for pre-donation screening tests for the second batch starts almost immediately or any time from 1:00pm to 2:00pm, this is to allow for decongestion of the clinic of the first batch donors. Second batch donation starts at about 2:00pm 9. Voluntary Blood Donor shall be given PREFERENTIAL ATTENTION to facilitate their donation. 10. Touts shall not be allowed not donate blood. Blood touting IS HIGHLY PROHIBITED in LASUTH. 11. LASUTH/BDCS embarks on Voluntary DONOR DRIVES from time to time in order to boost supply of blood in the blood bank. 12. Therapeutic Phlebotomy for polycythaemias are expected to come with a referrals from the attending physicians. LASUTH STATE UNIVERSITY TEACHING HOSPITALIKEJA LAGOS Consent to Transfusion of Blood or Blood Products Patient Name _____________________Date _____ Time_______ 1. Blood Transfusion: it has been explained to me that I need or may transfusion and/or blood products for the following reasons: need a blood ____________________________________________________ 1. I understand in general what a transfusion is and the procedures that ill be used. 2. Risks: It was also explained to me that there are possible risks involved with this blood transfusion including, but not limited to, transfusion of infectious hepatitis, acquired immune deficiency syndrome (AIDS). Or certain other disease, unexpected blood reactions, such as immunization or allergic reaction. 3. Alternatives: Alternatives to blood transfusion and/or blood products, including the risks and consequence of not receiving this therapy, have been explained to me. 4. Patient consent: I accept all the risks explained and hereby authorized the administration of such transfusion or transfusions of blood or blood products to me in connection with my medical and surgical care as may be deemed advisable in the judgement of my attending physician or said physician’s associates or assistants. No Guarantee: While extensive testing is performed on all blood/products used for transfusions, no testing is 100 percent (100%) reliable. I acknowledge that no guarantees have been made to me about the outcome of the transfusion. If you have any questions as to the risks or hazards of blood transfusions, or any questions concerning the proposal procedure or treatment, ask your physician NOW, before signing this consent form. _______________ ______________ Witness Signature Patient Signature The patient is unable to consent because: ____________________________________________________ I, therefore, consent for this patient _____________________________ Relative/Guardian/Representative __________________________ Relationship to Patient By signing above, I have read or have had explained to me the contents of this consent and I agree to receive the transfusion as advised by my physician ______________________ Thumb Printing for illiterates As the physician ordering the transfusion/s, I have explained the risks, benefits and alternatives of blood or blood product transfusions to this patient. ____________________ Physician Name/Sign ___________________ Nurse Name/Sign LAGOS STATE UNIVERSITY TEACHING HOSPITAL, IKEJA -LAGOS. Refusal of Consent to Transfusion of Blood or Blood Products I,______________________________________ do refuse to consent to the transfusion of blood and/ or blood products described on this consent form. The risks attendant to my refusal have been fully explained to me, and I hereby release the YOUR HOSPITAL, its nurses and employees, together with all physicians in any way with me as a patient, from liability for respecting and following my express wishes and direction. _______________________ Witness _____________________ Patient or Responsible Person Date_____________ Time______Relationship to Patient_______ By signing above, I have read or have had explained to me the contents of this consent and I agree to receive the transfusion as advised by my physician______________________________ Thumb Printing for illiterates LAGOS STATE UNIVERSITY TEACHING HOSPITAL,IKEJA - LAGOS. DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Bone Marrow Aspiration and Biopsy Information Sheet General indications for the procedure: A bone marrow aspiration and biopsy is a procedure used to obtain a sample of the liquid part of the bone marrow and a small piece of the iliac bone to examine is a bone marrow abnormality. Description of the procedure: The aspiration and biopsy is performed in the haematology outpatient clinic procedure room, at the hospital bedside, or very rarely, in the operating room. The patient is positioned on his/her side. The procedure site is washed with the cleansing agents betadine and alcohol and anesthetized with lidocaine (similar to what a dentist uses) . The bone marrow aspiration needle is inserted through the skin into the bone marrow cavity to obtain a sample of the liquid part of the bone marrow. The bone marrow aspiration needle is then removed and another needle, the bone marrow biopsy needle, is inserted in the same way in order to obtain a small sample of bone biopsy. All steps of the procedure are thoroughly explained before any action is taken. If discomfort persists, extra local anesthesia (lidocaine) is given. Following the procedure, the patient lies on his/her back and is monitored for 5-10 minutes Procedure Alternative, if any: No biopsy, or having the biopsy done or having the biopsy done in the operating room with a surgical incision and the need for general anesthesia. Probable Consequences of Refusing Procedure: Not knowing the cause or the extent of the hematological problem to guide possible treatment of the blood problems. Risks of the procedure: The two most common complications that may occur from the procedure are bleeding and infection at the puncture site. The bleeding at the puncture site is usually controlled with external compression and gauze. Local infection at the punctual site is usually controlled with external compression and gauze. Local infection at the puncture site is rare, but can require oral antibiotics. The procedure is performed under sterile conditions to prevent infections. Person(s) Performing the Procedure: The key portion of the procedure is performed by a Physician, or who is a member of the Department of Haematology and Blood Transfusion at Lagos State University Teaching Hospital. Parts of the procedure which they perform will be based on their level of competency. LAGOS STATE UNIVERSITY TEACHING HOSPITAL, IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Bone Marrow Aspiration and Biopsy Consent Form 1. I authorize..................................................................... to perform the following procedure(s): Bone Marrow Aspiration and Biopsy 2. I understand my diagnosis/condition to be............................ I understand that I may need other urgent procedure that were unanticipated. I consent to the performance of any additional procedures determined during my original procedure to be in my interest and where delay might cause additional harm. I understand that other qualified practitioners including medical officers and residents (doctors who have finished medical school and getting more training), may be chosen to do or help with procedures. These practitioners may perform surgical tasks including: Opening and Closing incisions, harvesting grafts, dissecting tissues, removing tissues, implanting devices, and altering tissues. All qualified practitioners will only perform task that are within their scopes or practice and for which they have been granted clinical privileges. Residents will only perform all or parts of the procedures as deemed fit by my consultant. 3. I have been told about what results to expect,, which includes information about the chances for the expected results and about problems that might occur during recuperation. I know that results cannot be guaranteed. 4. I have been told about and understand the risks and benefits of the procedure(s) listed above. I understand that there are risks for all kinds of surgery. These risks, which can be serious, including bleeding, information, and damage to hereby tissues, vessels, nerves, or organs. They may result in paralysis, cardiac arrest, brain damage, and/or death. Other risks for this procedure may include: PAIN and SCARRING. 5. I understand the alternatives to the proposed procedure with associated risks: NO ALTERNATIVE OTHER THAN NOT TO UNDERGO THE PROCEDURE WITH ASSOCIATED RISKS, THE RISKS OF THIS ALTERNATIVE (I.E) NOT UNDERGOING THE ASPIRATION AND BIOPSY PROCEDURE) INCLUDE INABILITY TO DIAGNOSE AN UNDERLYING MEDICAL CONDITION WITH POTENTIAL PROGRESSIVE AND WORSENING OF THE MEDICAL CONDITION. 6. I understand that photograph and/or video or electronic recordings may occur during my procedure and may be used for internal performance improvement or educational purpose. 7. I understand that any tissues or parts removed during my procedure may be disposal of by the hospital or used for any lawful purpose including education and research. CONSENT FOR ANAESTHESIA OR SEDATION When local anaesthesia and/or sedation is used by the physician. I consent to the administration of such local anaesthetics as may be considered necessary by the physician in charge of my care. I understand that the risks of local anaesthesia include: local discomfort, swelling, bruising, allergic reactions to medications and seizures. I consent to the administration of sedative medications by or under the direction of the physician named; or the physician in charge of my sedation care. I acknowledge that I have been informed of the nature of the planned sedation and that I understand the risks of sedation to include: allergic reactions to medications, changes in breathing, charges in blood pressure and heart function, nausea, and vomiting, aspiration of stomach contents and/or excitement. I understand that recall of the procedure is possible. By signing below I state that I am 18 years of age or older, or otherwise authorised to consent. I have read or have had explained to me the contents of this form and I agree to receive the care, treatment or services listed on this content. I have had a chance to ask questions and all of my questions have been answered. _________________________________________ ________ _________ Name and Signature of Patient/Lagal Representative Date Time If signed by person other than the Adult patient please state relationship to patient ________________________________________________________________ Physician Statement/SIgnature and witness signature I have explained the procedure(s) stated in this form, including the possible risks, complications, alternative treatment (including non treatment) and anticipated results to the patient and/or his/her representative. The patient and/or their representative has communicated to me that they understand the contents of this form. _________________________ ____________________ Physician Name and Signature Nurse Name and Signature LAGOS STATE UNIVERSITY TEACHING HOSPITAL (LASUTH) IKEJA DEPARTMENT OF HEMATOLOGY AND BLOOD TRANSFUSION INFORMED CONSENT TO CHEMOTHERAPHY FORM I, ____________________________________________, understand that I have been diagnosed with_______________________________________________ I understand that the treatment suggested by my doctor, Dr._______________, will involve ________________________________________________________________ ________________________________________________________________ I understand that health professionals at the department of hematology, LASUTH will provide this treatment. I also understand that other health care providers may be needed for my care. I understand that there are benefits of this treatment if it is successful. I also understand that my doctors cannot be sure that the treatment will help me. I understand that the chemotherapy medications recommended by my doctor can have short-term and long-term side effects. My doctor talked to me about the following side effects that I might experience because of my chemotherapy. (check all that apply, additional space provided for physician comments) Nausea/Vomiting_________________________________________ Hair Loss________________________________________________ Low red blood cell count/Anemia______________________________ Fatique__________________________________________________ Risk of Infection___________________________________________ Risk of Bleeding___________________________________________ Constipation_____________________________________________ Diarrhea ________________________________________________ Sores of Mouth and Throat__________________________________ Skin Effects_____________________________________________ Muscle/Bone Effects______________________________________ Nerve Effects____________________________________________ Kidney/Bladder Effect_____________________________________ Sexual Effects____________________________________________ Heart Effects_____________________________________________ Lung Effects_____________________________________________ Reproductive/Fertility Effects________________________________ Other ___________________________________________________ I understand that I could have side effects from my chemotherapy that are not listed on this form. Each patient can respond differently to chemotherapy, and could have side effects that have not been reported by others. The reasonable alternatives to this chemotherapy treatment have been explained to me including: _______________________________________________________________ I also understand that I may stop this treatment at any time. I have the chance to ask questions about this treatment, and my questions have been answered to my satisfaction. I understand that I can contact my health care provider at anytime if I have questions. I understand that by signing this document I am consenting to received the chemotherapy medicines proposed by my health care provider: Patient Signature_______________________________ Date__________ For patients requiring translation or verbal reading of this document, the person Reading/translating should document and sign below: Reader/Translator Signature_______________________Date________ Physician Name & Signature_______________________ Date________ Nurse Name and Signature_______________________ Date________ LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP: BB 006 Revision NO:0 STANDARD OPERATING PROCEDURE FOR BABY’S CROSMATCHING Group both baby and mother sample 1. Check the SOP for grouping 2. Select donor based on the blood that will be compatible with the mother and baby serum 3. Then follow SOP for cross-matching 4. Label 2 tubes for room temperature and AHG at 37OC 5. Select blood for cross-matching based on the patient grouping 6. Take 1 drop of patient serum and add to 1 drop of 3% washed cells 7. Spin lightly for 1 minute 8. Check for agglutination. 9. Incubate the AHG labeled tubes at 37OC for 15 minutes, check for agglutinins 10 Washed the cells 11. Decant the supernatant 12. Add 1 drop of AHG 13. Check for agglutination or haemolysis LAGOS STATE UNIVERSITY TEACHING HOSPITAL, IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP: BB 008 Revision No: 0 STANDARD OPERATING PROCEDURE FOR HAEMOLYSIN TESTING FOR ALL GROUP O 1. Standard ABO cells(1 drop) is incubated with donor group ) serum 2. Check for haemolysis at tube labeled A or B cell 3. At A cell -hemolysin at B cell -hemolysin STANDARD OPERATING PROCEDURE OF AN INCOMPATIBLE TRANSFUSION REACTION 1. Regroup of pre-transfusion sample 2. Regroup of post transfusion sample 3. Sample from all units of blood taken either wholly or partly 4. Check post transfusion sample macroscopically and microscopically 1. Regroup and re-cross match 2. If found compatible then the clinical signs giving rise to the suspicion that the blood was incompatible were either not indicative of a hemolytic reaction or they had no serological basis. LAGOS STATE UNIVERSITY TEACHING HOSPITAL, IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP: BB 005 Revision No: 0 STANDARD OPERATING PROCEDURE FOR GROUPING AND CROSS-MATCHING 1. Select donor units for cross-matching on the basis of ABO and Rh grouping 2. Label 12 x 75mm tubes or khan tubes for saline and AHG per donor 3. Dispense 2 drops of patient serum into appropriate tubes 4. Add 2 drops of 2-3% donor washed cells 5. Mix serum/cell suspension. 6. Incubate the saline tubes at room temperature for 15 minutes 7. Spin lightly and examine for agglutination 8. Incubate the AHG labeled tubes at 37OC for 1 hour 9. Spin lightly and examine for agglutination 10. Wash the AHG tubes in generous amount of normal saline x 4 11. Decant the supernatant 12. Add 1 drop of AHG, mix and spin lightly in centrifuge for 1 minute 13. Read test macroscopically preferably over a light source. 14. Add 1 drop of “check cells” to all negative tubes 15. Mix, spin lightly for 1 minute and re-examine to confirm true negative 16. Set-up appropriate controls of positive weak anti-D and O negative and weak anti-D positive cells LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION result and O Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB007 Revision No: 0 STANDARD OPERATING PROCEDURE FOR UNCROSSMATCHED BLOOD 1. Use group O Rhesus D negative especially for women of child bearing age. 2. Where O Rhesus D negative is unavailable, use O rhesus D positive packed cells only particularly for male or older female. LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB001 Revision No: 0 STANDARD OPERATING PROCEDURE FOR BLOOD GROUPING (RAPID TILE GROUPING) 1. Take 1 drop of patient or donor cell. 2. Add 1 drop of antisera A,B and D on a grease free tile 3. Add 1 drop of patient or donor cell 4. Rotate or mix for 10-60 seconds 5. Check for agglutination 6. Then grade the result based on agglutination LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB002 Revision No: 0 STANDARD OPERATING PROCEDURE FOR BLOOD GROUPING USING MICROTITRE PLATE (FORWARD AND REVERSE GROUPING) 1. Put 1 drop of antisera A, B, and D in a microtitre plate 2. Add 1 drop of 3% cell suspension to it. 3. Incubate for one and half hour at room temperature 4. Check for agglutination 5. Set ABO standard cells along with test REVERSE GROUPING 1. To a known standard ABO cells, put 1 drop into the microtitre plate 2. Add 1 drop of patient or donor serum to the standard ABO cells 3. Check agglutination and hemolysis 4. Set up autocontrol along with the test 5. Check for agglutination or hemolysis 6. Grade result as 4, 3,2,1, 0 based on agglutination LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB003 Revision No: 0 STANDARD OPERATING PROCEDURE FOR ANTIBODY SCREENING 1. Label two 12x7mm glass tubes to correspond with each of the screening cells. 2. Dispense 2 drop of serum to each of the two tubes 3. Add 2 drops of the screening cells to each of the two tubes 4. Mis the content of the tubes 5. Incubate for 1 hour at 37OC 6. Check tubes for presence or absence of agglutination 7. Wash in several changes of normal saline x 4 8. Decant the supernatant completely 9. Add 1 drop of AHB to each tube 10. Spin lightly in the cenrifuge for 1 minute 11. Read over a light source 12. Add 1 drop of check cells to all negative tube 13. Set up controls of weak anti D and O Positive and weak anti D and O negative. LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB003 Revision No: 0 STANDARD OPERATING PROCEDURE ON TILE GROUPING 1. Prepare a 20% suspension of A cells, B cells and O cells as controls 2. Place 1 drop of antisera on a tile 3. One volume of 20% suspension of the A cells, A B, O, O negative and O positive are added each to the corresponding tiles with antisera 4. Mix and stir 5. Read by checking for agglutination Anti A should react within 10 seconds Anti B should react within 30 seconds Anti D should react withing 60 seconds 6. Grade the result based on agglutination. LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB004 Revision No: 0 STANDARD OPERATING PROCEDURE FOR REAGENTS CONTROL Antisera A cells B cells O cells O+ cells O- cells Anti A Anti B Anti C 1. Prepare a 2-5% suspension of A2 cells, B cells and O cells as control 2. Arrange the 20 tubes as in the block 3. Place 1 drop of antisera in the corresponding 5 tubes as above in the rows. 4. One volume of 2% suspension of the cells A2,B,O, O-, and O+ are added each to the corresponding 4 tubes column with antisera 5. Mix by tapping. Leave undisturbed for 15 minutes at room temperature 6. Grade result as 4+,3+,2+,1+,0 based on agglutination LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB0094 Revision No: 0 STANDARD OPERATING PROCEDURE FOR DIRECT COOMB’S TEST 1. Put 2 drops of patient’s cell in a khan tube. 2. Wash 4 times in a large amount of normal saline, make a 2% suspension of red cells. 3. Add 1 drop of the 2% red cell suspension to 2 drops of AHG in a tube 4. Centrifuge at low speed for 30 seconds 5. Shake and observe macroscopically for haemolysis and microscopically for agglutination. 6. Check negative result with sensitized cells (1gG and compliment) LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Effective: 01/09/13 Procedure Document: SOP BB010 Revision No: 0 STANDARD OPERATING PROCEDURE ON BLOOD TRANSFUSION REACTION Specimens required are: - Pre and post transfusion reaction - All donor units transfused - 24hr urine of post transfusion - 3ml of post transfusion blood in EDTA bottle\ - Blood culture - Check for blood bank clerical errors: Patients’ name, hospital number or blood group of donor and recipient 1. Patient’s blood in EDTA bottle Do the full blood count of the patient and check the blood film for red cell. fragments, agglutinations and microspherocytes Do gram stain Plasma-Inpsect for obvious hemolysis 2. Post transfusion clotted sample Cells-repear ABO, direct coomb’s test Serum-crossmatch (repeat) and screen for a typical antibodies 3. Pre-transfusion clotted samples Cells-repeat ABO and DAT Serum-repeat crossmatch and screen fro typical antibodies 4. Urine-haemoglobin and hemoglobin breakdown products 5. Submit report LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION Section: Blood Bank Section Effective: 01/09/13 Procedure Document: SOP BB011 Revision No: 0 TITRATION OF ANTISERA 1. Prepare a 2-5% suspensions of A cells, B cells and O cells as controls 2. Make a dilution of antisera in normal saline as shown below 1.1 1.2 1.4 1.8 1.16 1.32 1.64 1.128 1.256 1.512 Antisera Normal Size 3. Place 1 drop of 5% cell suspension in corresponding tubes as above in the rows 4. Mix by tapping. Leave undisturbed fro 15 minutes at room temperature 5. Read Agglutination+agglutination only on microscope + small agglutination is visible ++ large clumps with small agglutinates +++ a large clump of agglutinate Result: Haemolysis as ++ and record Anti A: 128:a Anti B: 128 Anti D:64 LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA-LAGOS DEPARTMENT OF HAEMATOLOGY & BLOOD TRANSFUSION STANDARD OPERATING PROCEDURE FOR BLEEDING DONORS 1. Collect 2-3 mls of blood from prospective donor into EDTA bottle and run the PCV or HB estimation 2. Carry out blood group and send sample for TTI screening 3. Give talk to all potential blood donors on the importance of blood donation 4. Give all potential blood donors the consent form to fill 5. Refer or defer all intending blood donors that have PVC value<37% for females and <39% for males and/or TTI positive 6. Arranges the donors with their appropriate result in order of arrival 7. Do the demographic data for each donor i.e weight, height, and blood pressure 8. Register the donor into BDC register 9. Encourage donor to assume a comfortable position on the couch and loosen all tight clothing at the neck, groin while reassuring the donor. 10. Look for a good vein at the cubital fossa or either the right or left arm. 11. Check the blood bag and pilot bottles for labeling errors 12. Swab the cubital fossa over the selected vein with 70-95% alcohol with a circular motion from inside out 2-3 times 13. Position bag carefully below the level of the donor’s arm on the blood bag scale 14. Allow blood to flow freely under pressure into the bag and mix at intervals till bag is about 450mls full. 15. Clamp the blood bag with an artery forceps close to the needle and remove the needle 16. Apply pressure on the vein and hold with sterile gauze and plaster 17. Rock bag gently to mix blood and anticoagulant properly. 18. Cut in between the two clamps and check abg again for leakages 19. Collect blood sample into a pilot bottles 20. Remove tourniquet from the arm and Seal the blood bag or tie art 3-4 sites and store in the refrigerator 21. Advice donor to lie still on the bed at least for another 5 minutes 22. Donor is observed for about 10 minutes for symptoms like nausea, vomiting, dizziness and headache that may require attention of a doctor 23. The donor is appreciated and encouraged to come back after 3 months for another donation. Training and Research and TTL The Department has a robust Residency Training in Place, Resident Doctors participate in the examinations of both the National Postgraduate Medical College of Nigeria and the West African College of Physicians. Three of the residents trained are now Fellows of the National Postgraduate Medical College of Nigeria, while two are preparing for Part 2 of the West African College of Physicians. The Department has a partial accreditation of the West African College of Physician and full accreditation of the National Postgraduate Medical College. Resident Doctors are rostered on Blood bank calls first week of every month so as to acquire competencies in Blood Transfusion Medicine. They also participate in routine Haematology investigations. Coagulation and other Specialised Haematological Procedures in the resident room and present seminars and Journal reviews to Consultants. The Department also trains interns Medical Laboratory Scientists, Student Laboratory technicians and Students on industrial Training (IT) undergoing rotations in the Department. Consultants in the Department have published widely in high impact factor journals and have collaborated with researchers from within and outside the hospitals, Some of the recognized publications are listed below. List of Recognized Publications 1. Akinbami A.A. Oshinaike O. O. Adeyemo I. A. Adediran A. et al. Haematologicl abnormalties in treatment-naive HIV patients. Infectious Diseases: Research and Treatment: 2010:3:45-49 2. Adedoyin O. Dosunmu, Taiwo M. Balogun, OlufunkeAdeyeyee, AkinsegunAkinbami et al, Prevalence of Pulmonary Hypertension in Sickle Cell anaemia patients of a Tertiary hospital in Nigeria. Nigeria Medical Journal: 2014:55:(2):161-165 3. A. O. Dosunmu A. A. Akinbami. O. O. Oshinaike, A. Adediran. T. A. Adeyemo: Open Heart Surgery: Prelimary Report of Blood Transfusion Practice And Haematology Changes, Experience from a Nigerian Tertiary Teaching Hospital. The Nigerian Postgraduate Medical Journal, 2011: Vol 18, No 3; page 177-181 4. Dada M. O. Akinbami A.A. Dosunmu A. O. Rabiu K. A. Voluntary Blood Donor Deferrals: Two Year Review at Lagos State Blood Transfusion Service. Africa Sanguine 2010:13:1 5. Taiwo Modupe Balogun, Folake Olayinka, Akinbami A.A Knowledge, Standard Precaution Practices and Attitudes of Healthcare Providers to people Living with Human Immune Deficiency Virus: Nigeria Medical Practitioner:2012:62:2:46-51 6. Akinbami A.A Dada M. O. Dosunmu A.O. Balogun M. T., Adult Haematooncology cases: A six year review at Lagos State University Teaching Hospital, Ikeja The Internet Journal of Haematology, 2009, Vol. 6 number. 1. 7. Akinbami A.A. Durojaiye I. Oshikomaye B. I. Ismail K. A. Gastric Maltoma: A Case Report and Literate Review pak. J. Med. Sci. July-September 2010: Vol 26:No 3.726-728 8. Akinbami A.A. Akanmu A.S Adeyemo T. A. et al Cytomegalovirus antibodies amongst blood donors at Lagos University Teaching Hospital S.Afr.Med.J2009:99:528-530 9. Akinbami. A.A. Aknamu A. S. Adeyemo T.A et al Cytomegalovirus antibodies amongst Immunocompromised HIV Patients at Lagos University Teaching Hospital J. Medicine. 2010; 11:151-154 10. Akinbami A.A Rabiu K. A, Adeyemo T.A, et al. Seroprevalence of Toxoplasma Gondii Antibodies amongst Pregnant Women at the Lagos State University Teaching Hospital. The Nigerian Postgraduate Medical Journal 2010 Vol. 17.No2,164-166 11. Akinbami A.A Oshinaike O.O, Adeyemo T.A, Adediran A et al Seroprevalence of Hepatitis C infection in HIV patients using a rapid one-step test strip kit. Nig. Qt. J. Hosp. Med.2010.Vol.20:3;144-146 12. Akinbami A.A, Adegboyega A.O, Adebola P.A Enebulele C. Chest X-ray findings in HIV patients in relation to the Cd4 count, Nig.Qt.J.Hosp. Med.2011.Vol.21:4;306-311 13. A.A. Akinbami, K.A.Rabiu, A.Adewunmi, A.O. Dosunmu, TA Adeyemo, A. Adediran Seroprevalence of Cytomegalovirus Antibodies Amongst Normal Pregnant Women in Nigeria International Journal of Women Health: 2011:3:423-428 14. Akinbami A.A. Dosunmu A. Adediran A. Oshinaike O. Adebola P., Osunkalu V. Arogundade O. Adelekan O. Steady state hemoglobin concentration an packed cell volume in homozygous sickle cell disease patients in Lagos Nigeria Caspian.J.Intern.Med.2012.3(2).368-371 15. Akinsegun Akinbami, Olajumoke Oshinaike, Owolabi Dosunmu, Seroprevalence of hepatitis Be antigen (Hbe antigen) And B core antibodies (IgG anti HB core and IgM anti-HBcore) among hepatitis B surface antigen positive blood donors at a Tertiary centre in Nigeria. BMC Research Notes.2012.5.167 1. Akinbami A.A. BalogunB. Balogun M.T. Chest X-ray. Findings in HIV infected Highly Active Antiretroviral treatment (HAART)-Naive Patients, Pan African Medical 17. Akinbami A.A Dosunmu A. O., Haematological values in Homozygous sickle Cell Disease in Steady State and haemoglobin phenotypes AA Controls in Lagos Nigeria, BMC Research Notes.2012.5.396 18. Akinsegun Akinbami, Adeoyin Dosunmu, Adewunmi Adediran, Sarah Ajibola et al. CD4 count pattern and Demographic Distribution of Treatment Naive HIV patients in Lagos, Nigeria. AIDS research and Treatment. 2012, Article ID 35273.6 pages.Doi:10:1:11551/2012/35273 19. Akinsegun Akinbami, AbiodunPopoola, Adewunmi Adediran, Adedoyin Dosunmu et al, Full blood count pattern of pre-chemotherpy breast cancer patients in Lagos,Nigeria:Caspian.J.Intern.Med.2013;4(1):574-579 20. Akinsegun Akinbami, Sarah Ajibola, KabiruRabiu, AdeniyiAdewumi et al, Haematological profile of normal pregnant women in Lagos Nigeria, International Journal of Women’s Health.2013:5,227232 21. AkinsegunAkinbami, AdedoyinDosunmu, AdewunmiAdediran, OlajumokeOshinaike et al, Serum ferritin Levels amongst Adult HbSS patients in Lagos, Nigeria Journal of Blood Medicine 2013:4:59-63 22. AkinsegunAkinbani, Ibidun Bode-Shojabi, Sarah Ajibola, OlajumokeOshinake et al, Prevalence of Asymptomatic Bacteriuria in HIV Infected Patients in Tertiary Hospital in Lagos, Nigeria: World Journal of AIDS, 2013,3,105-110 23. A.A. Akinbami, S.Ajibola, I. Bode-Shojobi, O. Oshinaike et al. Prevalence of Significant bacteriuria among symptomatic and asymptomatic homozygous sickle cell disease patients in a tertiary hospital in Lagos Nigeria. Nigerian Journal of Clinical Practice 2014:!7(2):163-167 24. A.A.Akinbami, A.O. Dosunmu, A. Adewunmi et al Cluster of differentiation 4+cells count mean value, reference range, and its influencing factors in Human Immunodeficiency virus negative pregnant women in Lagos, Nigeria Medical Journal 2014:%%:(2):51-55 25. AkinsegunAkinbami, MojeedOdesanya, Sunday Soyemi, et al. Kikushi Fujimoto Disease in Nigeria: A case Report and Literature Review, Case report in Medicine, 2014, article number 171029,page 3, htpp/dx.doi.org/10.1155/2014/171029 26. AkinbamiAkinsegun. Dada AkinolaOlusola, John-Olabide Sarah, OshinaikeOlajumoke et al. Mean Platelet Volume and Platelet Counts in type 2 Diabetes Mellitus on treatment and nondiabetic mellitus controls in Lagos, Nigeria. The Pan African Medical Journam.2014:18:42;doi:10,11604/pamj.2014.18.42.3651. 27. Akinsegun.A. Akinbami, Bodunrin I. Osikomaiya, sarah O. John Olabode, Adewunmi A. A. Adediran et al. Mycosis Fungoides: Case Reports and Literature Review. Clinical Medicine Insights: Case reports.2014:7:95-98,doi;10.4137CCrep.S15724. 28. AkinsegunAkinabami, IdrisDurojaiye, AdedoyinDosunmu, et al. Seroprevalence of human. T. lymphotropic virus antibodies among patients with lymphoid malignancies at a tertiary centre in Lagos Nigeria Journal of Blood Medicine:2011;5;169-174 29. Akinsegun Akinbami, AbidoyeGbadegesin Sarah, Ajibola EbeleUche, Factors Influencing CD4 cell sount in HIV-Positive pregnant women in a secondary health center in Lagos, Nigeria:HIV/AIDSResearch & Palliative care: 2015;7:115-118 30. OlajumokeOshinaike, AkinsegunAkinbami, OlaitanOjelabi, et al, Quality of Sleep in an HIV Population on Anteretroviral Therapy at an Urban Tertiary Centre in Lagos, Nigeria. Neurology Research International, 2014 Article ID.6 pages 29870,http:/dx.doi.org/10.1155/2014/298703 31. Idris Durojaiye, AkinsegunAkinbami, Adedoyin Dosunmu et al. Seroprevalence of Human T. Lymphotropic Virus amonst healthy blood donors at a Tertiary Centre in Lago, Nigeria, The pan African Medical Journal, 2014: 17:301;doi:10.11604/pamj.2014.17.301.4075 32. Sarah Oluwatayo Ajibola, AkinsegunAkinbami, KabiruRabiu, Adewunmi Adeniyi et al. Gestational Thrombocytopeania among pregnant women in Lagos , Nigeira. Nigeria Medical Journal 2014;55:(2);56-60 33. Ajibola Sarah, AkinbamiAkinsegun, OdusanyaMajeed, Dada AkinolaOlusola, Knowledge, Attitude and Practice of Blood Conservation Strategies amongst Physician in Tertiary hospitals, International Blood Research and Reviews.20142(3):121-131 34. Sebanjo.O. Akinbami. A. Akinwumi I, et al. halicobacterPhylori infection among Population with Sickle Cell Disease. J. Natl Med Assoc. 2010:102:1095-1099 35. K.A. Rabiu, A.A Akinbami, A.A. Adewunmi, O. I. Akinola et al. The Need to incorporate Routine Cervical Cancer Counseling and Screening in the Management of HIV Positive Women in Nigeria, Asaian Pacific J. Cancer. prev.2011:12:1211-1214. Acknowledgements: a Paediatric I appreciate the useful contributions of Mrs. Adegbite F. A. and Mr. Basil Chinedu Bonaventure for their contribution towards making this book a success. The Department is grateful to the pioneer Head of Department Professor Aba Omotunde Sagoe for laying a good foundation in the Department upon which we have built on. We also appreciate the first Resident Haematologist Dr. Idris Durojaiye, who is now a Fellow of the Nigerian Postgraduate Medical College, the first Clinic Manager Retired CNO Sabiyi A.A and the first Laboratory Unit Head, Mrs. Adeboboye C. O. We remember late Dr. Dada Olufemi a pioneer Consultant Haematologist who also contributed significantly to a well established department. They have all contributed in no small way to building a virile, strong and envy of all of a Department. Reference 1. Akinbami A. A. Dosunmu A. O. Haematological values in Homozygous Sickle Cell Disease in Steady State and haemoglobin Phenotypes AA Controls in Lagos, Nigeria BMC Research Notes.2012,5:396. 2. Akinsegun Akinbami, Sarah Ajibola Kabiru Rabiu, Adeniyi Adewumi et al, Haematological profile of normal pregnant women in Lagos, Nigeria, International Journal of Women’s Health.2013:5,227-232 3. WHO Guideline on drawing blood: best practices in phlebotomy, WHO Document Production Services, geneva Switzerland 2008 available at whqlibdoc.who.int/seminars and Journal reviews.
