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C O N T E N T S

Preface iv

PART ONE:

The Principles of Hematology

1 1 Safety and Quality in the Hematology

Laboratory . . . 1

An Overview of the Hematology Laboratory 1

The Study of Hematology 1

Functions of the Hematology Laboratory 1

Safety in the Hematology Laboratory 2

The Safety Offi cer 2

Occupational Safety and Health Administration Acts and Standards 2

Avoiding Transmission of Infectious Diseases 3 Immune Status: Screening and Vaccination 5

Safe Work Practices and Protective Techniques for Infection Control 6

Safety Manual, Policies, and Practices 6 Standard Precautions 6

Handwashing 6

Personal Protective Equipment 7

Decontamination of Work Surfaces, Equipment, and Spills 8 General Infection Control Safety Practices 9

OSHA Medical Waste Standards 11

Quality Assessment in the Hematology Laboratory 12

Regulations and Organizations Impacting Quality 12 Components of Quality Assessment 12

Nonanalytical Factors in Quality Assessment 12

Quality Control in the Hematology Laboratory 16

Terms Used in Clinical Quality Control 16 Functions of a Quality Control Program 17

Using Statistical Analysis of Results in Quality Assessment 18 Other Statistical Applications in the Hematology Laboratory 20

■ CHAPTER HIGHLIGHTS 20

■ REVIEW QUESTIONS 21

■ BIBLIOGRAPHY 23

2 Principles of Blood Collection . . . 25

Quality in Phlebotomy 25

Quality Assessment 25 Patient Care Partnership 25

The Phlebotomist as Laboratory Ambassador 26

Patients with Special Considerations 26

Pediatric Patients 26 Adolescent Patients 26 Geriatric Patients 26

Blood Collection Supplies and Equipment 26

Anticoagulants 26

Adverse Effects of Additives 27 Safe Blood Collection 27

Evacuated Blood Collection Tubes 29

Anticoagulants and Additives in Evacuated Blood Tubes 31 Capillary Blood 31

Specimen Handling Requirements 32

■ REFERENCE 48

■ BIBLIOGRAPHY 48

3 Molecular Genetics and Cellular Morphology . . . .50

Cellular Ultrastructure and Organization 50

Cellular Membranes 50 Cell Volume Homeostasis 52

Reactive and Neoplastic Growth Processes 53 Cytoplasmic Organelles and Metabolites 53 Cellular Inclusions and Metabolites 54 Nuclear Characteristics 54

Chromosomes 56 Activities of the Nucleus 58

The Foundations of Genetic Interactions 60 Genetic Alterations 61

Molecular Techniques in Hematology 63 Minimal Residual Disease 63

Hematopathology 67

Gene Rearrangement Studies 69

■ BIBLIOGRAPHY 72

4 Hematopoiesis . . . 73

Hematopoiesis Defi ned 73 Origin of Blood Cells 73

Types of Human Stem Cells 73 Early Development of Blood Cells 73

Bone Marrow Sites and Function 75 Cellular Elements of Bone Marrow 76

Progenitor Blood Cells 76 Erythropoiesis 79 Granulopoiesis 79 Lymphopoiesis 79 Megakaryopoiesis 79

Other Cells Found in Bone Marrow 79

Interleukins 79

Hematopoietic Growth Factors 82 Examination of Maturing Blood Cells 83

General Cellular Characteristics 83 Nuclear Characteristics 83 Cytoplasmic Characteristics 85

Mature Blood Cells in Peripheral Blood 86

■ BIBLIOGRAPHY 87

PART TWO:

Erythrocytes 89

5 Erythrocyte Maturation, Physiology,

and Lifecycle . . . 89

Erythropoiesis 90

Erythropoietin 90

General Characteristics of Maturation and Development 91 Developmental Stages 92

Reticulocytes 94

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Disorders Related to Erythrocyte Maturation and Production 97

Disorders of Erythropoietin 97 Red Cell Increases 98

Defective Nuclear Maturation 98

Characteristics and Biosynthesis of Hemoglobin 98

Genetic Inheritance of Hemoglobin 98

Chemical Composition and Confi guration of Hemoglobin 98 The Role of 2,3-Diphosphoglycerate 99

Oxygen Dissociation and Alterations 99 Carbon Dioxide Transport 100 Biosynthesis of Hemoglobin 101

Disorders Related to Hemoglobin Biosynthesis 104

Disorders of Heme (Porphyrin) Synthesis 104 Disorders of Iron Metabolism 105

Disorders of Globulin Synthesis 108 Ontogeny of Hemoglobin 108

Variant Forms of Normal Hemoglobin 109 Abnormal Hemoglobin Molecules 110 Analysis of Hemoglobin 110

Membrane Characteristics and Metabolic Activities of Erythrocytes 111 Membrane Characteristics 112 Cytoplasmic Characteristics 113 Metabolic Activities 113 Catabolism of Erythrocytes 114 Measurement of Erythrocytes 116

Mean Corpuscular Volume 116 Mean Corpuscular Hemoglobin 117

Mean Corpuscular Hemoglobin Concentration 117

■ CASE STUDIES 119

■ BIBLIOGRAPHY 124

6 Erythrocyte Morphology and Inclusions . . . 126

Erythrocytes: Normal and Abnormal 126 Types of Variations in Erythrocyte Size 126 Kinds of Variations in Erythrocyte Shape 127 Alterations in Erythrocyte Color 134 Varieties of Erythrocyte Inclusions 135 Alterations in Erythrocyte Distribution 137 Parasitic Inclusions in Erythrocytes 137

Malaria 137

Other Parasitic Inclusions 141

■ CASE STUDY 142

7 Classifi cation and Laboratory Assessment of

Anemias . . . 145

Causes of Anemia 145

Clinical Signs and Symptoms of Anemia 145 Classifi cation of Anemias 145

Laboratory Assessment of Anemias 146

Quantitative Measurements of Anemia 147

Semiquantitative Grading of Erythrocyte Morphology 147 Supplementary Assessment of Anemias 148

8 Acute and Chronic Blood Loss Anemias . . . 150

Acute Blood Loss Anemia 150

Etiology 150

Physiology 150 Laboratory Findings 150

Chronic Blood Loss Anemia 150

Etiology 150

9 Aplastic and Related Anemias . . . 154

Aplastic Anemia 154 Etiology 154 Pathophysiology 155 Clinical Features 158 Laboratory Findings 158 Treatment 158

Congenital Red Blood Cell–Related Disorders 159

Telomeres 159

Laboratory Findings in Bone Marrow Failure Syndromes 160 Pure Red Cell Aplasia 160

Diamond-Blackfan Anemia 160 Fanconi Anemia 161

Transient Erythroblastopenia of Childhood 162 Congenital Dyserythropoietic Anemia 163

10 Iron Defi ciency Anemia and Anemia of Chronic

Infl ammation . . . 166

Scope of the Problem 166 Iron Defi ciency Anemia 166

Early Diagnosis 166 Etiology 166 Epidemiology 167 Physiology 168 Pathophysiology 169

Clinical Signs and Symptoms 170 Laboratory Characteristics 170

Anemia of Infl ammation or Anemia of chronic Disorders 173

Etiology 173 Pathophysiology 173 Laboratory Characteristics 174 Treatment 175 ■ CHAPTER HIGHLIGHTS 175 ■ CASE STUDIES 176 ■ REVIEW QUESTIONS 179 ■ BIBLIOGRAPHY 180

11 Megaloblastic Anemias . . . 181

Megaloblastic Anemias 181 Etiology 181 Epidemiology 182 Physiology 182

Vitamin B₁₂ (Cobalamin) Transport 182

Vitamin B12 (Cobalamin) and Folic Acid Defi ciencies 183

Pathophysiology 184

Gastric Pathological Findings 184 Clinical Signs and Symptoms 186 Laboratory Findings 186

Treatment and Monitoring Therapy 188

■ CHAPTER HIGHLIGHTS 188 ■ CASE STUDY 190 ■ REVIEW QUESTIONS 191 ■ BIBLIOGRAPHY 191 Turgeon_FM.indd vii Turgeon_FM.indd vii 10/15/2010 10:48:11 AM10/15/2010 10:48:11 AM

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12 Hemolytic Anemias . . . 192

Hemolytic Anemias 192

Inherited Hemolytic Anemia 192 Acquired Hemolytic Anemia 197 Pathophysiology 200

Diagnostic Tests 201

Paroxysmal Nocturnal Hemoglobinuria 201

Etiology 201 Epidemiology 202 Pathophysiology 202

Clinical Signs and Symptoms 202 Laboratory Findings 203 Treatment 203

Paroxysmal Cold Hemoglobinuria 203

13 Hemoglobinopathies and Thalassemias . . . 210

Hemoglobin Defects 210

Demographics 210 Etiology 210

Sickle Cell Disease 211

Etiology 212 Epidemiology 212 Pathophysiology 212

Clinical Signs and Symptoms 213 General Signs and Symptoms 214 Laboratory Testing 214 Special Laboratory Testing 215 Management of Sickle Cell Disease 216

Sickle Cell Syndromes: Pathogenesis and New Approaches 218

Sickle b-Thalassemia 218 Sickle-C Disease 219 Sickle Cell Trait 219

Thalassemia 220 Demographics 220 Etiology 220 Pathophysiology 220 b-Thalassemia 220 α-Thalassemia 223 Other Hemoglobinopathies 224 Hemoglobin C Disease 224 Hemoglobin SC Disease 224 Hemoglobin D Disease 224 Hemoglobin E Disease 224 Hemoglobin H Disease 225 Methemoglobinemia 225 Unstable Hemoglobins 225

Hereditary Persistance of Fetal Hemoglobin 225

■ CHAPTER HIGHLIGHTS 226 ■ CASE STUDIES 227 ■ REVIEW QUESTIONS 232 ■ BIBLIOGRAPHY 233

PART THREE:

Leukocytes 235

14 Leukocytes: The Granulocytic and Monocytic

Series . . . 235

Introduction 235

The Granulocytic Series 235

Production of Neutrophils, Eosinophils, and Basophils 235 Sites of Development and Maturation 236

Development and Proliferation of Neutrophils, Eosinophils, and Basophils 236

Distribution of Neutrophils, Eosinophils, and Basophils 236 Normal Maturational Characteristics of Neutrophils, Eosinophils, and Basophils 237

Mature Forms 239

Granulation in Mature Forms 239

The Monocytic-Macrophage Series 240

Production and Development of Monocytes and Macrophages 240 Morphological Characteristics 241

Reference Ranges of Granulocytes and Monocytes 241 Functional Properties of Granulocytes and Monocytes 242

General Characteristics 243 The Role of Macrophages 243 Acute Infl ammatory Response 243 Sepsis 245

Steps in Phagocytosis 245

Specialized Functions of Granulocytes 247

Assessment Methods 248

Total Leukocyte Count 248

Differential Blood Smear Evaluation 248 Absolute Cell Counts 248

Erythrocyte Sedimentation Rate 248 Assessment of Eosinophils and Basophils 249 Leukocyte Alkaline Phosphatase Test 249 Neutrophilic Function 249

Neutrophilic Hypersegmentation Index 249

■ CASE STUDY 250

15 Nonmalignant Disorders of Granulocytes and

Monocytes . . . 254

Quantitative Disorders 254

Leukocytosis 254 Leukocytopenia 255

Morphological Abnormalities of Mature Granulocytes 256

Toxic Granulation 256 Döhle Bodies 256 Hypersegmentation 256 Pelger-Huët Anomaly 256 May-Hegglin Anomaly 257 Chédiak-Higashi Syndrome 257 Alder-Reilly Inclusions 258 Ehrlichia 258

Abnormalities of Mature Granulocytes in Body Fluids 258

Qualitative Disorders 258

Defective Locomotion and Chemotaxis 258 Defects in Microbicidal Activity 259

Other Functional Anomalies of Neutrophils 259

Monocyte-Macrophage Disorders 259 Gaucher Disease 259 Niemann-Pick Disease 260 ■ CHAPTER HIGHLIGHTS 260 ■ CASE STUDIES 260 ■ REVIEW QUESTIONS 264 ■ BIBLIOGRAPHY 265

16 Leukocytes: Lymphocytes and Plasma Cells . . . . 266

Anatomical Origin and Development of Lymphocytes 266

Sites of Lymphocytic Development 266 Lymphocyte Physiology 267

Normal Reference Values 267

Determining Absolute Lymphocyte Values 268

Morphological Characteristics of Normal Lymphocytes 268

Maturational Stages 269

Specifi c Lymphocyte Morphological Variations 272

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Characteristics of Lymphocytes 273

Major Lymphocyte Categories and Functions 273 Monoclonal Antibodies 274

Major Lymphocyte Membrane Characteristics and Development 274 Functional Testing of Lymphocytes 277

Plasma Cell Development and Maturation 277

Plasma Cell Development 277 Maturational Morphology 277 Plasmacytoid Lymphocytes 277 Plasma Cell Disorders 278

17 Leukocytes: Nonmalignant Lymphocytic

Disorders . . . 281

Characteristics of Lymphocytes 281 Lymphocytosis 281

Disorders Associated with Lymphocytosis 282

Infectious Mononucleosis 282 Cytomegalovirus Infection 286 Toxoplasmosis 287

Infectious Lymphocytosis 288

Bordetella pertussis (Haemophilus pertussis) Infection 289

Lymphocytopenia 289

Immune Disorders Associated with Lymphocytopenia 289

DiGeorge Syndrome 289

Acquired Immunodefi ciency Syndrome(HIV/AIDS) 289 Systemic Lupus Erythematosus 293

18 Characteristics of Leukemias, Lymphomas, and

Myelomas . . . 298

Comparison of Leukemias, Lymphomas, and Myelomas 298 Forms of Leukemia 298

Classifi cations of Leukemias 299

French-American-British Classifi cation 299 World Health Organization Classifi cation 299

Prognosis and Treatment 300

Factors Related to the Occurrence of Leukemia 300

Genetic and Immunological Factors 300 Occupational Exposure 302

Environmental Exposure 302 Chemical and Drug Exposure 302 Genetic Abnormalities and Associations 302 Viral Agents 303

Secondary Causes of Leukemias 303

Demographic Distribution of Leukemia and Lymphomas 304

Ethnic Origin and Race 304 Gender 305 ■ CHAPTER HIGHLIGHTS 305 ■ REVIEW QUESTIONS 306 ■ BIBLIOGRAPHY 306

19 Acute Leukemias . . . 307

Introduction 307

Epidemiology of Acute Leukemias 307 Prognosis of Acute Leukemias 308

French-American-British and World Health Organization Categories 308

French-American-British (FAB) Classifi cation 308 World Health Organization (WHO) Organization Classfi cation 308

General Characteristics of Acute Myeloid Leukemias 309

Genetic Differences 309 Micro-RNAs 310

Acute Myeloid Leukemia 310 FAB M0 311

Acute Myeloid Leukemia (FAB M1) 311 Acute Myeloid Leukemia (FAB M2) 312 Acute Promyelocytic Leukemia (FAB M3) 312 Acute Myelomonocytic Leukemia (FAB M4) 313 Acute Monocytic Leukemia (FAB M5) 314 Erythroleukemia (FAB M6) 315

Selected Examples of Unusual Forms 316 Acute megakaryoblastic leukemia FAB M7 316

Epidemiology of Acute Lymphoblastic Leukemia 316 Prognosis of Acute Lymphoblastic Leukemia 317 Classifi cations of Acute Lymphoblastic Leukemia 317 Characteristics of Acute Lymphoblastic

Leukemia 317

Clinical Signs and Symptoms 317 Laboratory Data 317

Special Identifi cation Techniques 318 Treatment 319

Mixed Lineage Leukemia 319 Cytogenetic Analysis 319

Cytogenetic Analysis in Acute Myeloid Leukemia 319 Cytogenetics in Acute Lymphoblastic Leukemia 320

Principles of Special Cytochemical Stains 320

Sudan Black B Stain 321 Myeloperoxidase Stain 326 Periodic Acid-Schiff Stain 322 Esterase Stains 323

Phosphatase Stains 324

Monoclonal Antibodies 325

Immunophenotyping 325 Lymphoid 325

Other Surface Membrane Markers 326

Life-Threatening Emergencies 326

Infection 326 Bleeding 326

Leukemic Infi ltration of Organs 326 Metabolic Abnormalities 326 Hyperleukocytosis 327 Treatment Options 327 Relapse 328

Stem Cell Transplant 328 Future Trends Vaccines 328

20 Lymphoid and Plasma Cell Neoplasms . . . 337

Mature B-Cell Neoplasms

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma 337

Epidemiology 337 Etiology 337 Cytogenetics 338 Molecular Genetics 339 Staging and Prognosis 339 Clinical Signs and Symptoms 340 Laboratory Data 341

Treatment Options 341 Minimal Residual Disease 342

Hairy Cell Leukemia 342

Hairy Cell Leukemia Variant 343

Prolymphocytic Leukemia 344

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Multiple Myeloma (Plasma Cell Myeloma) 344

Epidemiology 344 Etiology 344

Treatment 345

Waldenström Primary Macroglobulinemia (Lymphoplasmacytic lymphoma) 346

Epidemiology 346 Etiology 346

Treatment 347

Lymphomas 347

Relationship Between Lymphomas and Leukemias 347 Characteristics 347

Categories 347 Pathophysiology 349

Precursors of Hodgkin Disease and B-Cell Lymphomas 350 Hodgkin Disease 350

Non-Hodgkin Lymphoma 351 Characteristics of Other Forms 352 Sézary Syndrome 353

Mature T-Cell and NK-Cell Neoplasms 353

■ CHAPTER HIGHLIGHTS 353 ■ CASE STUDIES 354 ■ REVIEW QUESTIONS 358 ■ BIBLIOGRAPHY 358

PART FOUR:

Myeloproliferative Neoplasms

361 21 Myeloproliferative Neoplasms . . . 361

General Characteristics of Myeloproliferative Neoplasms 362

Relationship of the Myeloproliferative Neoplasms 362 Common Disorders of Hemostasis and Coagulation 362 Prognosis and Treatment 363

Chronic Myelogenous Leukemia 363

Epidemiology 363 Pathophysiology 363 Cytogenetics 364 Genetic Alterations 364 Laboratory Data 365 Cytogenetic Studies 367 Prognosis and Treatment 367 Minimal Residual Disease 368 Leukemia-Specifi c Targets 369

Allogeneic Bone Marrow Transplantation 370

Polycythemia Vera, Essential Thrombocytosis (Essential Thrombocythemia), and Primary Myelofi brois 370 Polycythemia Vera 370

Epidemiology 370 Etiology 370 Pathophysiology 370 Karyotype 371

Abnormalities of Hemostasis and Coagulation 372 Other Laboratory Assays 372

Treatment 373

Prognosis and Complications 374

Primary Myelofi brosis 374

Epidemiology 374 Pathophysiology 374 Karyotype 375

Clinical Signs and Symptoms 375 Cellular Alterations 375 Prognosis 376

Treatment 376

Essential Thrombocytosis/Essential Thrombocythemia 376

Diagnostic Characteristics 376 Epidemiology 377

Pathophysiology 377 Karyotype 377

Clinical Signs and Symptoms 377 Laboratory Findings 377

Relationship of Thrombocythemia and PV 377 Treatment 378

22 Myelodysplastic Syndromes and Myelodysplastic/

Myeloproliferative Neoplasms . . . 386

Classifi cation 386 Myelodysplastic Syndromes 386 Myelodysplastic/myeloproliferative neoplasms 386 Pathophysiology 387 Myelodysplastic Syndrome 387 Etiology 388 Epidemiology 389 Chromosomal Abnormalities 389 Clinical Signs and Symptoms 390 Laboratory Manifestations 390

Features of Selected Types of Myelodysplastic Syndromes 391

Myelodysplastic/Myeloproliferative Neoplasms 392

Chronic myelomonocytic leukemia 392 Other Classifi cations 393

Treatment Strategies 393

Relationship of Karyotype to Prognosis 394

PART FIVE:

Principles and Disorders of Hemostasis and

Thrombosis 399

23 Principles of Hemostasis and Thrombosis . . . 399

Overview of Hemostasis and Thrombosis 400 Blood Vasculature: Structure and function 400

Arteries and Veins 400 Arterioles and Venules 400 Capillaries 400

Vasculature Physiology 401

The Role of Vasoconstriction in Hemostasis 401 The Role of the Endothelium 401

Maintenance of Vascular Integrity 402

The Megakaryocytic Cell Series 403

General Characteristics of Megakaryocytic Development 403 Cellular Ultrastructure of a Mature Platelet 405

Platelet Kinetics, Life Span, and Normal Values 406

Platelet Function in Hemostasis 406

Overall Functions of Platelets 406 Platelet Adhesion 406

Platelet Aggregation 407

Platelet Plug Consolidation and Stabilization 408 Laboratory Assessment of Platelets 408

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Blood Coagulation Factors 410

Basic Concepts of Blood Coagulation 410

Common Characteristics of Coagulation Factors 410 Characteristics of Individual Factors 410

The Mechanism of Coagulation 413 Coagulation Pathways 413 Thrombin-Mediated Reactions 414 Fibrinolysis 414

Other Systems and Inhibitors 415

Laboratory Assessment of Blood Coagulation Factors 416 International Normalized Ratio 416

Specialized Assays for Coagulation Factors 417 Anticoagulants 417

New Thromboplastins 418 Assays for Fibrin Formation 419

Normal Protective Mechanisms Against Thrombosis 420

Normal Blood Flow 420

Removal of Activated Clotting Factors and Particulate Material 420

The Natural Anticoagulant Systems 420 Cellular Regulators 424

Modern View of Hemostasis 424

24 Disorders of Hemostasis and Thrombosis . . . 431

Vascular Disorders 431

Abnormal Platelet Morphology 432 Quantitative Platelet Disorders 432

Thrombocytopenia 432 Thrombocytosis 436

Qualitative Characteristics of Platelets: Thrombocytopathy 436

Types of Platelet Dysfunctions 437

Bleeding Disorders Related to Blood Clotting 439

Defective Production 440

Disorders of Destruction and Consumption 445 Disorders Related to Elevated Fibrin Split Products 449

The Hypercoagulable State 450

Primary States of Hypercoagulability 450 Secondary States of Hypercoagulability 450 Pregnancy-Associated Thrombosis 450 General Features 451

Impaired Fibrinolysis 454 Antithrombin III Defi ciency 456

Laboratory Assessment of Hypercoagulable States 457

PART SIX:

Fundamentals of Hematological Analysis

465 25 Body Fluid Analysis . . . 465

Introduction 466 Cerebrospinal Fluid 466

Anatomy and Physiology 466

Production of Cerebrospinal Fluid 466 Specimen Collection: Lumbar Puncture 466 Laboratory Analysis 467

Pleural, Peritoneal, and Pericardial Fluids 473

Effusions: Transudates and Exudates 473 Pleural Fluid 473

Peritoneal Fluid 478 Pericardial Fluid 482 Seminal Fluid 484 Synovial Fluid 486

Anatomy and Physiology of Joints 486 Purpose of Arthrocentesis 486 Aspiration 487

Laboratory Assays 487

Body Fluid Slide Preparation 490 Staining of Body Fluid Sediment 490 Amniotic Fluid 490

26 Manual Procedures in Hematology . . . 498

Procedural Format 498 Coagulation Procedures 516

Specimen Quality 516

Special Collection Techniques 516 Anticoagulants 517

Specimen Handling 517 Specimen Preparation 517 General Sources of Error 517 Quality Control 518 ■ REVIEW QUESTIONS 522

27 Instrumentation in Hematology . . . 526

Instrumental Principles 527

The Electrical Impedance Principle 527 The Optical Detection Principle 527 Characteristics of Light Scatter 527 Radio Frequency 528

Fundamentals of Laser Technology 528 Principles of Flow Cytometry 529 The Basis of Cellular Identifi cation 529

Whole Blood Cell Analysis 531

Types of Automated Cell Counting Instruments 532 General Histogram Characteristics 543

Analysis of Instrumental Data Output 543

The Erythrocyte Histogram 543

Quantitative Descriptors of Erythrocytes 543 The Leukocyte Histogram 544

Platelet Histograms 545 Derived Platelet Parameters 546

Laser Technology 547

Red Blood Cells/Platelets 547 Peroxidase 548

Basophil/Lobularity (Nuclear) Channel 549 Lymphocyte Subtyping 549

Applications of Flow Cytometry 549

General Properties of Flow Cytometry 550 Hematological Applications 550

Clinical Applications of Flow Cytometry 550 Other Cellular Applications 551

Digital Microscopy 554

Artifi cial Neural Networks 554 Digital Cell Morphology 554

Instruments in Coagulation Studies 555

Electromechanical Methods 555 Photo-Optical Methods 555 Viscosity-based Detection System 558 Platelet Agglutination 559

Platelet Aggregation 559 New Automation 559

Summary 559

Instrumental Principles 559

Analysis of Electrical Impedance Instrumental Data Output 559

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Laser Technology 560

Applications of Flow Cytometry 560 Instruments in Coagulation Studies 560

APPENDICES

A Answers to Review Questions . . . 573

B The Basics of Medical Terminology . . . 578

C SI Units . . . 580

D English-Spanish Medical Phrases for the

Phlebotomist . . . 581

E MSDS Sheet . . . 582

F Tube Guide . . . 588

G Frequently Used Abbreviations . . . 590

Glossary 591

Index 602

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