There is always a hematology supervisor on duty in the lab. The path resident is encouraged to discuss any problems with the supervisor first.
If additional information or consultation is needed, the resident may call the Hematology Chief Tech, Sue Bell, or Dr. Kroft.
Please notify the day shift supervisor the following day if any tests are approved or authorized to be done by outside laboratories.
Hematology Lab: 214-590-8195, 214-590-8196
Sue Bell, Chief Tech: Home 817-265-8752
Dr. Robert McKenna: Home 214-357-6977
Dr. Hal Kaplan (Coagulation problems): Home 214-491-0309, Beeper
20052
Dr. Steve Kroft: Home 972-381-1317, Beeper 214-825-7826
See Microbiology section
Factor VIII assays are not done on an emergency basis at night, holidays, or on weekends without the approval of the path resident. This is because the assay is time consuming, and the hematology lab is not fully staffed during these hours. The path resident should discuss the situation with the clinician who requested the assay. It is the resident's responsibility to decide whether or not the request is a valid one. Other lab results such as protime and PTT may be helpful in evaluating the situation. Information from the clinician, such as past medical history (e.g., is the patient a known hemophiliac?, is emergency surgery required?, etc.) may also be important in reaching the appropriate decision. The path resident may wish to request a hematology/oncology consult.
The path resident may be asked to decide whether or not a bone marrow should be done on an emergency basis. Bone marrows are preferably done during the day on weekdays when the lab is fully staffed. The path resident should discuss the situation with the clinician making the request. The resident must investigate the circumstances (including history, physical findings, hematological parameters, personally review peripheral smear, previous diagnostic material, patient's clinical stability and any other pertinent information) then, evaluate and determine whether it is a medical situation needing an emergency marrow. It is appropriate to ask for a hematology/oncology consult. The stat bone marrow request should be approved only under the appropriate circumstances (e.g., the need to begin specific therapy without delay); it requires that Drs. Kroft or McKenna give final approval.
After hours and on weekends and holidays path resident on call will be required to review cases of new leukemias or fluids suspicious for malignant cells. Remember, the first step in evaluating these cases is to obtain pertinent history (i.e., previous marrow or fluid examination). If appropriate, the resident should submit sample to cytology lab (i.e., it would be appropriate if this sample is the original diagnostic material) and notify the clinician.
Residents may occasionally be called by the Hematology Lab to approve an after-hours bleeding time.
Patients should not have consumed large quantities of alcohol, nor be on any aspirin based medication, antihistamines or heparin for 10-14 days prior to bleeding time. Check the platelet count before you approve the test!
Any changes please notify Robyn Arndt (214-648-4014; e-mail: arndt.robyn@pathology.swmed.edu) as soon as possible so changes can be made.
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