Clerical error is the most common cause of fatal hemolytic transfusion reactions. A major cause

of clerical error is the mislabeling of the patient's blood specimen. The phlebotomist will not

draw blood until an armband properly identifies the patient. When an unidentified patient is

admitted to the Emergency Room and laboratory work is ordered, packet containing

an armband with a medical record number should be used. If there are delays in this process

the phlebotomist may place a temporary green armband, (Typenex) with a unique number, on

the patient to facilitate swift identification. It is ESSENTIAL that this temporary armband remain

on, even after the regular band has been put on.

The individual who draws a specimen to be used for Transfusion Service

testing MUST label the tube with their initials, the patient's first and last name, the

medical record number, and the date and time drawn. Labeling must occur at the

patient's bedside.

Red blood cells are suspended in a small amount of plasma and anticoagulant

/preservative solution (AS-1, AS-3, AS-5) with an approximate total volume of

350 mL. Each RBC unit should raise the average adult's hemoglobin 1 gm/dL.

Prestorage leukoreduced red cells are used. This component provides red

cells to carry oxygen to the tissues. RBCs must be started within 30 minutes after

pickup. Infusion must be completed within four hours after issue. If needed,

divided units are available to transfuse over a longer period of time.

The CISH Tests in volves the following

HPV High Risk Group (Tissue)

HPV Low Risk Group (Tissue)

Immunoglobulin Light Chain Kappa (mRNA) (Tissue)

Immunoglobulin Light Chain Lambda (mRNA) (Tissue)

Both blood and urine samples for the following classes or families of drugs in  drug screening test

• amphetamine/methamphetamine - stimulants such as methamphetamine (crank, ice), amphetamine, and methylenedioxymethamphetamine (MDMA, Ecstasy)
• barbiturates - sedatives such as butalbital (Fiorinal), phenobarbital, and pentobarbital (sodium pentothal)
• benzodiazepines - tranquilizers such as diazepam (Valium) and alprazolam (Xanax)
• cannabinoids - active chemicals in marijuana
• cocaine metabolite - cocaine and its related metabolites
• opiates - narcotic analgesics derived from opium such as codeine, morphine, heroin, oxycodone, and hydrocodone
• phencyclidine - also know as PCP or angel dust

In confirmatory tests, a procedure specific to the class or family of drug for which the sample screened positive is employed to "wash" or separate the drug itself from the matrix, i.e. blood or urine, in which it resides. The procedure of separating the drug from the sample is called an extraction. The Toxicology Section has different procedures for each class of drug. The general scheme of an extraction is to adjust the pH of the sample, expose the sample to an organic solvent to wash out the drug, collect and concentrate the organic solvent, and derivatize the drug in the sample. Some extractions have a but a few steps in the scheme, while others have many steps. The extraction process is one of the most time-consuming aspects of drug testing.

Hodgkin's lymphoma is a malignancy (cancer) of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow.

The disease may be diagnosed after:

• A lymph node biopsy
• A bone marrow biopsy 
• A biopsy of suspected tissue
• Detection of Reed-Sternberg (Hodgkin's lymphoma) cells by biopsy