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Hematology

Safety Programs & Practices

The Hematology laboratory presents a unique intersection of biological and chemical hazards. The daily manipulation of fresh whole blood, the creation of glass slides, and the use of toxic staining reagents require a rigorous adherence to safety protocols. These programs are federally mandated by the Occupational Safety and Health Administration (OSHA) to ensure the protection of laboratory personnel

Prevention of Infection with Bloodborne Pathogens

The primary biological risk in Hematology is exposure to bloodborne pathogens, specifically Hepatitis B (HBV), Hepatitis C (HCV), and HIV. The foundation of infection control is the OSHA Bloodborne Pathogens Standard. This regulation mandates the use of Standard Precautions, which dictates that all human blood and body fluids must be treated as if they are known to be infectious, regardless of the patient’s diagnosis

  • Engineering Controls: These are physical devices that isolate the pathogen from the worker
    • Safety Needles: Phlebotomy equipment must have re-sheathing or retracting mechanisms
    • Sharps Containers: Rigid, puncture-resistant containers must be easily accessible. They must not be overfilled (replace at 3/4 full)
    • Biosafety Cabinets: Used when processing body fluids or bone marrow to contain aerosols
    • Self-Sealing Tubes: Hematology analyzers utilize cap-piercing technology to sample blood without removing the stopper
  • Hepatitis B Vaccination: Employers must offer the Hepatitis B vaccination series at no cost to potentially exposed employees within 10 days of initial assignment. Employees who decline must sign a mandatory declination form
  • Post-Exposure Protocol: In the event of a needlestick or splash, the site must be washed immediately, the incident reported, and the source patient tested (if possible). The employee receives baseline testing and follow-up monitoring for seroconversion

Use of Personal Protective Equipment (PPE)

PPE acts as the last line of defense when engineering controls cannot fully eliminate a hazard. PPE creates a barrier between the worker and the infectious material

  • Gloves
    • Must be worn during phlebotomy, instrument maintenance, and manual testing
    • Nitrile: is preferred over latex due to chemical resistance and allergy concerns
    • Gloves must be changed immediately if torn and between every patient contact
  • Laboratory Coats
    • Must be fluid-resistant: and fully buttoned
    • Knit cuffs: are essential in Hematology to prevent sleeves from dragging across slides or dipping into specimens
    • Coats must be removed before leaving the technical work area (e.g., going to the breakroom)
  • Face Protection
    • Face shields (or masks with goggles) are mandatory whenever there is a risk of splashing or aerosolization
    • Specific tasks requiring face protection include: making manual wedge smears, manually uncapping tubes, and processing body fluids outside of a biosafety cabinet

Safe Work Practices

Safe work practices are behavioral controls - specific procedures that alter the way a task is performed to reduce risk. Adherence to these practices prevents ingestion, inhalation, or percutaneous injury

  • Hand Hygiene: The single most effective infection control measure. Hands must be washed with soap and water immediately after removing gloves and before leaving the lab. Alcohol foam is acceptable only if hands are not visibly soiled (blood or stain requires soap and water)
  • Aerosol Prevention
    • Gauze Technique: When manually uncapping a tube, cover the stopper with gauze and twist gently away from the face to catch the aerosol “pop.”
    • Centrifugation: Never open a centrifuge immediately after a tube breakage. Allow 30 minutes for aerosols to settle. Always use capped tubes or sealed buckets
  • Sharps Handling
    • Needles must never: be recapped by hand (use a mechanical device or the one-handed scoop method if necessary)
    • Glass slides are considered sharps and must be disposed of in rigid containers, not soft biohazard bags
  • Prohibited Acts: Eating, drinking, applying cosmetics, or handling contact lenses in the technical area is strictly forbidden

Safety Data Sheets (SDS)

Chemical safety is governed by the OSHA Hazard Communication Standard (“Right to Know” / “Right to Understand”). The laboratory must maintain a Safety Data Sheet (formerly MSDS) for every chemical in the inventory. These documents follow a standardized 16-section GHS format

  • Key Sections
    • Section 1-6: Emergency information (Identification, Hazards, First Aid, Fire-fighting, Accidental Release)
    • Section 8: Exposure controls and required PPE
  • Secondary Labeling: If a reagent is transferred from its original bottle to a secondary container (e.g., a jar for staining), that container must be labeled with the chemical name and hazard warnings (pictograms/signal words)
  • Common Hematology Hazards
    • Wright-Giemsa Stain: Contains Methanol. Highly flammable and toxic/blindness if ingested. Requires ventilation
    • Lysing Agents/Diluents: Often contain Sodium Azide as a preservative. Azide can react with copper or lead plumbing to form explosive metal salts. Disposal requires flushing with copious amounts of water
    • Drabkin’s Reagent: Historically used for manual hemoglobin; contains Cyanide. Fatal if swallowed; creates toxic gas if mixed with acid