[3] specimen collection, handling, and transportation Flashcards

Question

# Time Limit Exceptions Prothrombin time (PT) (1)

Answer 1

* stable for **24 hours**

Answer 2

* should be analyzed within **4 hours** from collection regardless of storage conditions * This test is concerned with the **viability of clotting factors**, which are **very sensitive to storage conditions** and are **ideally processed immediately.**

Answer 3

* **centrifuged immediately** without delay * no need to wait before spinning since clotting won’t occur due to the additive/anti-coag

Answer 4

* need to be **completely clotted (wait for 30-60 mins.)** prior to centrifugation; otherwise, only a small amount of serum will be obtained.

Answer 5

* Leave the stoppers on the tube before and during centrifugation ○ if stoppers are missing, use nesco films ○ no stoppers: ■ contamination ■ sample may evaporate ■ prevents aerosol formation or anything that introduces pressure and movement ■ prevents pH changes * Tubes should be balanced - should consider: ○ Placement ■ place the tubes on opposite sides ○ Size of tubes ○ Volume or content of tubes * **Heparin gel-barrier tubes (PSTs)** – centrifuged immediately without delay * **Non-additive and gel-barrier serum tubes (SSTs)** – need to be completely clotted prior to centrifugation

Answer 6

* Hematology Section * Used for examination of morphology * Timing of collection: Anytime of the day * Amount to be collected: 1 drop each, preferably thick and thin smears * Method of collection: Capillary puncture - smear can be made at bedside ○ Venipuncture - blood sample is delivered to the lab inside a lavender tube and then transferred to the glass slide using either a capillary tube (with a blue band), a pasteur pipette, or an automatic pipette with tips. ■ If none of the 3 apparatus are available, the glass slide can be placed on the mouth of the tube and then swiftly inverted to obtain a drop of blood on the slide as a last resort. ■ Advantage of PBS through venipuncture: making the smear can be repeated in case of mistakes. * Initial processing, handling, and storage: Make a smear on a glass slide and fix in methanol (fixative: preserves the morphology), store at RT * Transport/shipment conditions: Transport within 24 hours at RT * Typical disease/syndrome: Malaria; Microscopic examination of PBS in hematology ## Footnote Types of Smear: * Malaria smear - for identification of malaria, has thick and thin smears; thin smears are examined if no parasites are found in the thick smear. * Peripheral blood smear (for examination of blood cells) - only 1 ideally thin smear. Thick smears take up too much stain, making it hard to identify cells.

Answer 7

Performed especially if the patient is experiencing bacteremia (presence of bacteria in the blood, which is meant to be sterile in circulation). - can lead to appendicitis - can lead to Chronic Bacterial Infection (not cured by antibiotics) - results to sepsis or death * Microbiology Section * **Collection method: Venipuncture** * **Skin disinfection: 70% alcohol & 2% iodine for 1 minute prior to collection** ○ 3 changes of alcohol and 3 changes of iodine (1 change of alcohol, 1 change of iodine, wait for 1 minute, repeat) ■ to prevent contamination by normal flora ■ to let the asepsis take into effect * **Best drawing time: fever spike** ○ Preferably during chills (just before fever or when the patient is febrile) - The nurse has to check. ○ As body temperature rises, cell multiplication continues to occur. * **Frequency: 2 – 3 different sites within 24 hrs (roughly every 8 hours)** ○ 2-3 different sites (left-right-left) or hands if impossible *** Amount/Volume: --- Adults = 10 – 20 mL --- Infants/ small children = 1 – 5 ml** ○ volume of quantity collected -> possibility of isolating the bacteria * **Blood:broth dilution = 1:10** Broth - counterpart of anticoagulant in blood culture bottle; acts as a source of food for bacteria in order to isolate them * **Anticoagulant of Choice: SPS** * **Primary Inoculation Medium: Nutrient Broth or Brain-Heart Infusion Broth (BHIB)** * **ARD or resin bottles may be used** = if patient is on antibiotic treatment in order to kill antibiotic ## Footnote SPS * prevents phagocytosis * inactivates complement * neutralizes aminoglycoside antibiotics Disadvantages: May inhibit growth of: * Neisseria (N. gonorrhoeae and N. meningitidis) * Gardnerella vaginalis * Streptobacillus moniliformis * Peptostreptococcus anaerobius Not recommended ACs : EDTA, heparin, and citrate (they are not equipped with the same actions as SPS and they prevent blood from clotting.)

Answer 8

* Uncapping of blood culture bottles * Disinfection of rubber septa * Disinfection of collection site * Direct inoculation of blood culture bottles (BACTEC) * Direct inoculation of blood culture bottles (BacT/ALERT) **(closed system, ETS or butterfly technique)** * Indirect inoculation of blood culture bottles (BACTEC) **(open system and uses syringemethod)**

Answer 9

There is a direct relationship between the **volume of blood collected and rate of positive results**. As a general rule, about **4%** of a patient’s total blood volume can be taken safely for culture. The optimal ratio of blood to culture medium is about **1:5 to 1:10.** * If more blood is collected, it is more likely to isolate the causative agent; however, it is important to consider the age of the patient and, accordingly, the amount of blood to collect. ## Footnote age = amount < 10 years = 1mL of blood for each year of life > =10 = 20mL > = 10 (poor veins) = < 20mL

Answer 10

Because the frequency of bacteremic episodes varies, the timing and frequency of blood collection for culture may depend on the type of bacteremia suspected. A disadvantage of blood culture is that the growth of bacteria will take up several hours, and by then, the patient’s condition may have already changed/worsened. * **Transient Bacteremia** - No recommended timing; bacteremia may go undetected. (it is difficult/unsure that the causative agent can be isolated) * **Intermittent Bacteremia** - Blood culture specimens are recommended to be collected before an anticipated temperature rise (fever spike). * **Continuous Bacteremia** - No specific timing; the organisms are likely to be isolated whenever a specimen is taken (If not treated, there is a high chance that the patient may die.)

Answer 11

Blood culture media components: **Broth + anticoagulant** Anticoagulant: 0.025% - 0.050% sodium polyanethol sulfonate (SPS) **Functions of SPS:** * Anticoagulation * Neutralization of bactericidal activity (i.e. complement proteins & lysozyme) of human serum * Prevention of phagocytosis * Inactivation of certain antimicrobial agents (e.g. streptomycin, kanamycin, gentamicin, polymyxin B) * inhibition of certain bacteria ## Footnote SPS inhibits certain bacteria like: * Peptostreptococcus anaerobius * Streptobacillus moniliformis * Neisseria gonorrhoeae * Neisseria meningitidis * Gardnerella vaginalis If these are suspected, **1.2% gelatin** is added to neutralize the inhibitory effect of SPS.

Answer 12

* Substances produced by the body and can either be liquid or semi-liquid form. * Found within body organs such as the bladder and spaces of the joints ## Footnote * Urine * Amniotic fluid * CSF * Nasopharyngeal secretion * Semen * Serous Fluid * Sputum * Synovial fluid * Feces * Throat swabs

Answer 13

Most analyzed non-blood sample in the body (ultrafiltrate of blood) * Inexpensive to test * Purposes of urine examination: 1. Provides information of many metabolic processes in the body (can be seen in the urine dipstick) 2. Helps monitor wellness 3. Helps in diagnosis and treatment of UTI 4. Detects and monitors progress of treatment in metabolic diseases 5. Identify the effectiveness of an administered therapy a. The prescribed medicine can be monitored by the doctor through urine (eg. sugar levels), and they can decide to increase or change medicine. ## Footnote Preservatives: boric acid, toluene

Answer 14

**1. Collection method** - Can be categorized into two: Invasive and Non-Invasive. The midstream-clean catch is an example of non-invasive. For invasive, the examples are Suprapubic aspiration and catheterization. **2. Container used** - It should be translucent or clear in order to check turbidity and color. **3. Transportation and handling of specimens** - Preservatives may be added, or the specimen can be refrigerated. If it is stored at RT for a prolonged period of time, it will lead to the growth of more bacteria, which may lead to the patient being falsely suspected of UTI. **4. Timeliness of the testing** - This refers to appropriate time of the day in collecting the specimen.

Answer 15

1. Random 2. First morning/8-hour urine 3. Fasting 4. Timed ## Footnote Timed: a. Tolerance test (glucose) b. 2-hour postprandial c. 24-hour d. Double-voided

Answer 16

* Most commonly received specimen i. easy to collect, and ii. convenient for the patient. * May be collected anytime (actual time of voiding should be recorded on the container) -- it is important to take note of the time when the sample was collected (for the labelling of the container). * Useful for routine screening tests to detect obvious abnormalities

Answer 17

* Other names: first voided urine sample, overnight urine sample, or early morning specimen * Ideal screening specimen, especially if suspecting for pregnancy because it is a concentrated specimen; ideal to prevent false negatives in the pregnancy test * Collected immediately upon waking up from 8 hours of sleep and must be delivered within 2 hours or keep it refrigerated * Normally has a higher SG

Answer 18

* a second morning or second specimen voided after fasting (glucose monitoring) * typically used for glucose monitoring and helps assure that the specimen will not be affected by food consumed prior to fasting

Answer 19

collected at specific times or pooled throughout a specific time period

Answer 20

* Requires individual urine specimen collected serially at specific times corresponding with the timing of blood collection * Timing is important in the interpretation of samples of OGTT * Specimen should be collected as close to the requested time possible * Label of specimen should include: a. time of collection b. type of specimen | oral glucose tolerance test (OGTT)

Answer 21

* Collected two hour after a meal and tested for glucose * Used to monitor insulin therapy of patient with DM (Diabetes mellitus) * Results are often compared with Glucose results on Fasting urine and Fasting Blood Specimens ## Footnote * Patient Instruction: a. Void shortly before consuming a normal meal b. Collect the specimen 2 hours later

Answer 22

* Collected to allow **quantitative analysis** of a urine analyte * collection of specimen requires large, clean, (preferably wide-mouth) container capable of holding several liters. -- It is expected that the container must be big enough to hold urine specimens, as the patient will be urinating several times in a span of 24 hours. * Best time to begin collection: When patient wakes up in the morning (between 6-8 AM) * May require the addition of a preservative prior to collection ## Footnote Label of specimen also includes: a. a statement that the specimen is a 24-hour urine specimen, b. the type of preservative added and any precautions associated with it (some preservatives may burn the skin of patient or MT transporting the sample)

Answer 23

* One that requires emptying the bladder and then waiting a specified amount of time (30 mins) before collecting the specimen * Most commonly used to test urine for **glucose** and **ketones**

Answer 24

1. Regular voided 2. Catheterized 3. Midstream 4. Midstream clean-catch 5. Suprapubic aspiration 6. Pediatric collection

Answer 25

* common method used for collecting random specimens * patient voids or urinates into a clean container (sample cup)

Answer 26

* collected under sterile conditions by passing a hollow tube (catheter) through the urethra into the bladder; most commonly requested test is a **bacterial culture** -- done by inserting a sterile hollow tube into urethra of the patient until it reaches the urinary bladder * usually done for individuals that have difficulty rinating normally, are fresh from an operation, or have difficulty going to the restroom to void

Answer 27

* The patient voids or urinates into the toilet first, interrupts the urination for a while, and then restarts into the container with the last urine flow voided in the toilet. This is because the sample will be **free of genital secretion, pubic hair, and bacteria**. surrounding the urinary opening * purpose: to **avoid contamination of urine specimen** * not required to clean the genital area

Answer 28

* a **safer, less traumatic method** for obtaining urine for **bacterial culture** and **routine urinalysis** * Requires **special cleaning** (with wet wipes or soap and water) on the genital area of the patient prior to voiding. -- to avoid/reduce contamination by epithelial cells and bacteria -- This **specimen is a more representative sample** of the actual urine than the routinely voided specimen or midstream-collected specimen

Answer 29

* Like catheterization, this method is also **invasive**. * collection of urine through an **external introduction of a needle** which passes through the abdomen and into the urinary bladder * provides a sample for **bacterial culture** and **cytologic examination** * requires the use of local anesthesia (since invasive/painful), performed by physician * If the patient has a catheter, the specimen can be collected from the catheter by a **nurse** using a sterile needle and syringe. * sample: **sterile urine sample**

Answer 30

When the patient is a child who is not pottytrained, urine is collected in a plastic bag (that is attached to the genital of the child) and checked every 15 minutes until the required volume is collected

Answer 31

* Specimens must be collected in clean, dry, leak – proof containers. Disposable containers are recommended. * Containers for routine urinalysis should have a wide mouth to facilitate collections from female patients. -- It should be clear and transparent in order for the MTs to be able to perform macroscopic examination (the first step in routine urinalysis, which observes the color and turbidity of the urine sample). * Recommended capacity of container is 50 mL * For routine urinalysis, 12 mL is recommended volume for analysis. -- however, it is better for the sample collected to be more than 12 mL to ensure there is enough sample for the lab in case a repeat analysis is required or if there are discrepancies in the testing.

Answer 32

* All specimens must be labeled properly with the -- patient’s complete name and identification number, -- the date and time of collection , -- age, -- sex and -- physician’s name. * Labels must be **attached to the body of the container**, not to the lid and should not become detached if the container is refrigerated or frozen. -- If the label is attached to the lid, it would greatly lead to misidentification of the patient’s specimen.

Answer 33

* Routine Urinalysis * Urine Culture and Sensitivity * Urine Cytology Studies * Urine Drug Testing * Urine Pregnancy Testing * Urine Glucose and Ketone Testing

Answer 34

* **Frequently ordered urine test** * Analysis covers 3 major parameters: ○ **Physical (Macroscopic) analysis** (color, clarity, and odor) ○ **Chemical analysis** (pH, SG, glucose, protein, etc.) ○ **Microscopic analysis** (urine components such as cells, crystals, and microorganisms) * Ideal and recommended specimen: **Midstream clean catch specimen** * Specimen container characteristics: ○ Dry ○ clear ○ with tight-fitting lids to avoid spilling, especially during transport * After collection, the specimen should be transported to the lab immediately, but it could be held at RT for **exactly 2 hours**; otherwise, it could be refrigerated if transport will take longer than expected. ○ If storage at RT exceeds 2 hours, the specimen will be compromised, leading to the proliferation of bacteria and a decrease in the formed elements in the sample. * Specimens must also be protected from light, especially if analyzing for bilirubin.

Answer 35

* tested in the Microbiology section of the laboratory * Requested by the doctor if the patient has symptoms of UTI * Specimen should be collected using midstream clean-catch method and placed in a sterile container * A measured portion of the sample is cultured on a special nutrient medium, and the plate is incubated for 18-24 hours to allow for the growth of bacteria. ## Footnote If the bacteria are present and identified through biochemical testing, a **sensitivity or antimicrobial susceptibility test (AST)** is performed ■ MT will determine the possible antibiotics that can be given to the patient by the physician ■ An AST utilizes an antibiotic disk and is performed to determine whether or not an antibiotic is effective against an isolated microorganism. ■ The clear ring surrounding the microorganism is called the **zone of inhibition.** (tests which antibiotics to use or smth)

Answer 36

* Performed in the Histopathology section. * Performed to detect cancer, cytomegalovirus, and other viral and inflammatory diseases of the urinary system * Specimen: **Fresh clean-catch specimen** * A smear from the cells of the lining of the urinary tract is stained with PAP method (Papanicolaou smear) and examined under the microscope microscope to check for the presence of malignant urothelial cells. ○ When malignant urothelial cells are seen, it may be a sign for bladder cancer. ○ These cells take up more stain compared to normal urothelial cells. * If delays can’t be avoided, specimen must be preserved with **50% ethanol in a 1:1 ratio.**

Answer 37

* Many drugs can be detected in the urine than in blood samples. -- Urine is ideal for drug testing because it is non-invasive compared to blood collection. * This test is done to detect illicit use of recreational drugs, use of anabolic steroids to enhance performance in sports, and unwarranted use of prescription drugs * This test is also used to monitor therapeutic drug use and confirm drug overdose. * Required sample: **Random sample placed in a chemically clean container with lid**

Answer 38

* Performed to confirm pregnancy which can be detected **8-10 days after conception** * Required specimen: **First morning urine** - has the highest concentration of human chorionic gonadotropin (HCG) * utilizes pregnancy test kits

Answer 39

* **Urine Glucose Testing** - performed to screen diabetes and to determine the glucose level of patients who are already diabetic * **Urine Ketone** - used to determine if the patient is suffering from diabetic ketoacidosis | ○ Ketone - measured at exactly 15 secs ○ Glucose - " " 30 secs ## Footnote How are ketones created inside the body? * When the body does not metabolize glucose properly * The body breaks down fat for energy when the diet is deficient in carbohydrates.

Answer 40

A clear, colorless to pale-yellow liquid contained in the amniotic sac that surrounds the fetus during pregnancy * Method of collection: Transabdominal amniocentesis preferably 15 weeks after gestation * Collection is guided by an ultrasound machine (to ensure the safety of the fetus during collection) * This procedure is usually done by a physician * Volume collected: 10 mL (in a sterile container protected from light and transported immediately to the laboratory for testing ## Footnote Purpose: * Detection of genetic disorder (such as Down Syndrome) * check any problem in fetal development * verify gestational age test * identify hemolytic disease resulting from an incompatibility between the mother and fetus * check for fetal lung maturity

Answer 41

Clear and colorless liquid that surrounds the brain and spinal cord * Method of collection: Lumbar tap or spinal tap (which is done by a doctor/physician) collected in **three sterile tubes** * Tubes must be kept at room temperature and sent immediately to the lab for immediate testing, and each tube will be sent to 3 different laboratory sections: -- 1st tube: **Chemistry and immunology** -- 2nd tube: **Microbiology studies** -- 3rd tube: **Cell counts (hematology section)** * Testing is done to diagnose meningitis and other disorders that involve the brain and the spinal cord such as brain abscess, CNS cancer, and multiple sclerosis ## Footnote Routine test: * Cell counts * chloride * glucose * total protein

Answer 42

* used for gastric analysis * Purposes: -- To check the contents of the stomach for **abnormal substances** -- Evaluate the production of acid by evaluating the **gastric acid concentration** * A tube is passed through the mouth and throat (oropharynx), or nose and throat (nasopharynx) into the stomach of the patient after fasting for a specified period of time | to help label specimens, draw blood for **serum gastrin determinations** ## Footnote Method of collection: * A gastric stimulant (usually histamine or pentagastrin) is administered intravenously. * A tube is then passed through the mouth and throat (oropharynx), or nose and throat (nasopharynx) into the stomach of the patient after fasting for a specified period of time. * The specimen is collected at timed intervals and contained in sterile containers. Serum gastrin - a hormone that stimulates gastric acid secretion in the stomach

Answer 43

* Timing of collection: As soon as suspicion arises and before antibiotic therapy * To detect for the presence of microorganisms * Method of collection: Use cotton swab with calcium alginate for bacteriology ○ The swab is rotated and gently removed, then it is placed in a properly-labeled sterile container which contains a transport medium for immediate transport to the clinical laboratory. * Initial processing, handling, storage: Store in ref temp (2°C-8°C) * Transport/shipment conditions: Transport with iced packs ## Footnote The collected and cultured specimen determines the presence of bacteria that can cause the following conditions: ■ Diphtheria ■ Meningitis ■ Pertussis (whooping cough) ■ Pneumonia

Answer 44

* most common sample for the detection of viruses * Timing of collection: Within **7 days from onset** of illness * Amount to be collected: **One nasopharyngeal and one oropharyngeal swab combined** into one VTM * Method of collection: Swabbing with the use of **Dacron/Rayon tipped swab** (most ideal for collection of viruses) * Initial processing, handling, storage: Store in ref temp (2°C - 8°C) * Transport/shipment conditions: Transport with iced packs

Answer 45

A thick yellowish-white fluid that contains sperm released during male ejaculation * Examined in the Clinical Microscopy section. * Purpose for testing: -- evaluate the fertility -- assess the effectiveness of sterilization after vasectomy procedure -- For forensic or legal reasons such as criminal investigations involving sexual assault * Collected specimen is placed in a sterile container, kept warm (maintained at 37°C), and protected from light

Answer 46

* The majority of sperm are contained in the **first portion of the ejaculate**, making complete collection essential **for accurate testing of both fertility and post vasectomy procedures**. * Specimens are collected following a period of sexual abstinence of **2 – 3 days to not longer than 5 days.** * When performing fertility testing, 2 or 3 samples are usually tested at 2 weeks interval with **two abnormal samples considered significant.** * **Warm sterile glass or plastic containers** are provided by the laboratory. * Must be delivered to the laboratory **within 1 hour of collection**. (time of collection must be noted) * Specimens waiting for analysis: kept at **37 °C** * For artificial insemination, samples are frozen and stored in seminal banks for **one year at -85 °C**, respectively (seminal banks) to maintain the viability of the sperm cells

Answer 47

* **Self production or masturbation** – best method since it is not prone to contamination. (however, it will still depend on how it is collected.) * **Emission after interrupted coitus (coitus interruptus)** – also known as Withdrawal method * **Common condom collection** – not recommended since ordinary condoms have spermicidal properties ○ The sperm cells will die after coming in contact with the condom; the MT will be unable to assess the motility of dead sperm cells. * **Silastic condom collection** – – opposite of common condom collection; non-spermicidal, non-lubricated, ensures survival of sperm cells – containing rubber or polyurethane condoms * **Aspiration of seminal fluid from the vaginal vault after coitus**

Answer 48

* Pale-yellow and watery fluid between the membrane that encloses the pleural, pericardial, and peritoneal cavities. -- allows the membranes to glide through each other with minimal friction. * Aspiration procedures: -- Pleural fluid – thoracentesis -- Pericardial fluid – pericardiocentesis -- Peritoneal fluid – paracentesis * Sample collected in EDTA – used for cell counts and differential counts (hematology section) * Sterile heparinized evacuated tubes – used for microbiology and cytology * Plain tubes or heparinized tubes– used for chemistry tests ## Footnote * **pleural fluid** - lubricates surfaces of pleura (thin tissue lining the chest cavity and lungs) * **pericardial fluid** - secreted by the serous layer of pericardium into the pericardial cavity, reduces friction between the pericardial membranes of the heart, helping them to glide over each other during each heartbeat * **peritoneal fluid** - found in peritoneal cavity (space between the wall of the abdomen and organs inside) -- The accumulation of excess serous fluid in the peritoneal is called **ascites**. -- The fluid is called **ascitic fluid**. * The fluid is normally present in small amounts; the volume increases in the presence of inflammation or infection or when serum protein levels. * **Effusion** - refers to the increase in volume of serous fluids

Answer 49

* Used to diagnose/monitor lower respiratory tract infections like TB * Specimen: first morning specimen ○ secretions tend to accumulate in the lungs overnight * Collection: at least 1 hour before meal to avoid gagging or vomiting ○ MT won’t collect the sputum sample, rather, they only instruct the patient how to collect their own sample * When supervising the patient collecting sputum, the MT should not stand in front of the patient; it is better to stand in the sides or at the back to avoid inhaling the microorganisms of the tubercle bacilli (if there are any in the patient’s sample). * Specimens are transported at RT and require immediate processing upon arrival or receipt at the laboratory. ## Footnote Steps in collecting: 1) Patient should gargle with water and remove dentures (if any) 2) Take 3-4 deep breaths 3) Inhale and exhale 4) Cough forcefully on the last breath 5) Expectorate and expel sputum into a sterile container * Repeat the steps until the patient has collected an adequate amount/volume (3-5 mL).

Answer 50

* 50 mL capacity * Translucent or clear material * Single-use combustible material ■ If the patient has TB, it is necessary to burn the specimen and its container to kill the causative agent. * Screw-capped with a water-tight seal * Easily-labeled walls with the patient’s details

Answer 51

* Used to **analyze chloride content** of patient **under the age of 20** for symptoms of cystic fibrosis ○ **cystic fibrosis** - a genetic disorder which primarily affects the exocrine glands, causing them to produce abnormally thick and sticky mucus which builds up in the body; this can cause damage to the lungs, pancreas, and other organs. * Electrical stimulation in the forearm or thigh is used to transport **pilocarpine** (a sweat-stimulating drug) into the skin ○ The forearm is a more common site for the introduction of electrical stimulation. * Sweat is collected, weight is recorded, and chloride content is analyzed * Sweat specimen can also be used to determine illegal use of drugs ## Footnote 1) The skin is washed with water and patted dry; 2) The pad soaked in pilocarpine is placed on the skin, and an electrode creates a mild current that moves the pilocarpine through the skin into the area where the sweat glands are; 3) The electrode and pad are removed, and the area will start to sweat; 4) A piece of filter paper (that is previously weighed) is placed over the area; 5) The area is being covered with plastic and is tightly bandaged. sweat will be collected for the next 30 minutes 6) The filter paper is filled with sweat and will then be removed and weighed to determine how much sweat was obtained. It will then be placed into a buffer in order to determine the concentration of chloride.

Answer 52

A viscous fluid that lubricates movable joints * Tested to determine conditions such as arthritis, gout, and other inflammatory conditions * Method of collection: **Arthrocentesis** ## Footnote The fluid is collected in the following tubes: * **Sterile tube** – for Gram stain and culture (Microbiology section) * **Heparin/EDTA** – for cell counts, ID of crystals, and smear preparation (Hematology section) * **Plain tube** – macroscopic appearance, chemistry, immunology tests, and observing clot formation * **Sodium fluoride tube** – for glucose analysis

Answer 53

* Used to obtain loose cells inside the cheek for the purpose of DNA analysis * Less invasive and painless alternative to blood collection

Answer 54

* Examined to **identify blood diseases** such as some types of anemia, infections, leukemia, and other blood cancers and disorders * **Bone marrow aspiration** - a procedure that involves extracting a small portion of the bone marrow fluid * A large-gauge needle is inserted into the **sternum or iliac crest** ○ The syringe attached to the needle removes a sample of the liquid bone marrow, and the sample is sent to the laboratory for examination. ○ An **anesthetic is administered** in order to numb the skin and bone as the procedure is painful. * Volume of sample collected: **1-1.5mL** * **Smears are prepared** using the collected sample

Answer 55

Tested for the detection of microorganisms that can cause harm in the gastrointestinal tract (GIT) 1. C-urea breath test (C-UBT) 2. Hydrogen breath test

Answer 56

* Checks for the presence of **Helicobacter pylori**, a type of bacteria that damages the stomach lining (resulting in **stomach ulcers**.) * The patient is asked to drink a special substance that has **synthetic urea**, and then he/she is asked to breathe into a **mylar balloon at specified intervals.** * The breath specimens are analyzed for **carbon-13** (a unique substance produced by H. pylori), which confirms the presence of H. pylori

Answer 57

* Helps in the detection of **carbohydrate digestion** problems such as **lactose** and **fructose** * Also done to **detect bacterial overgrowth** in the **small intestine** * Baseline breath sample is taken before giving the special drink * Additional breath samples are taken **every 30 minutes for three hours** ## Footnote Preparation of patient: * The patient** must not take antibiotics 2 weeks prior** to scheduled test and * must also **avoid eating certain foods 24 hours before testing**. * **Fasting on the day** of the test must be observed.

Answer 58

Most commonly collected specimens next to urine. Collected to: * Determine GI disorder disorder (e.g. diarrhea: caused by the presence of intestinal ova and parasites) * Analyze presence of intestinal ova and parasites * Determine presence of pathogenic bacteria and virus through culture * Check fat and urobilinogen content * Test for the presence of occult blood blood (e.g. GI cancer or colon cancer)

Answer 59

Container characteristics: * Clean/Sterile * Wide mouthed ■ to facilitate ease of collection/transfer of sample to the container * With tight fitting lid ■ prevent sample from spilling especially if it is diarrhetic or watery * Made of leak-proof material: plastic, glass, or cardboard lined with wax * Containers containing stool may be sealed in a clean plastic bag for transport * Care should be taken to avoid contamination with urine or water ○ since it can kill trophozoites, if there are any in the sample ## Footnote * 5–7 grams for formed stool samples, approximately “thumb sized”. * 10 mL for liquid stool samples. ■ required volume for examination * If feasible, the whole sample may be collected. ■ Collecting the whole sample is not recommended because routine fecalysis only utilizes a small portion of the stool sample.

Answer 60

* If testing for the presence of ova and intestinal parasites (O & P), a **total of 3 samples** may be requested * Frequency: **On alternate days or no more than a 10-day interval**. Intestinal parasites are not consistently shed in the feces, therefore **more than 1 sample is recommended to rule out a negative result**. -- It is important to cover the 10-day interval. * Submission of remaining samples to the clinical laboratory will no longer be necessary if an ova or parasite has already been recovered in the previous specimens. Follow laboratory protocol. * The sample **must be processed within 2 hours.**

Answer 61

* Samples which cannot be examined within the 2-hr. limit must be preserved to maintain the morphology of the parasites present and to prevent overgrowth of microbiota. * Stool samples must be adequately mixed with the selected preservative in a proportion of **1 part stool to 3 parts preservative** * Most common preservative: 10% Formalin ○ Considered an all-purpose fixative, has a long shelf-life and extends the shelf life of the samples it preserves. ## Footnote **Formalin** * Considered an all-purpose fixative. * Fixative has a long shelf-life and preserved samples have a long shelf-life as well

Answer 62

* Fluid secreted by the glands glands (parotid glands, submandibular glands, and sublingual glands — collectively known as the major salivary glands) inside the mouth * Used to **check the hormone levels** and to **determine alcohol and drug or substance abuse** * Collection is easy and non-invasive (and the sample is available all the time) * Specimens need to be frozen to ensure **viability** prior to delivery to the clinical lab

Answer 63

* Can be used to analyze for traces of heavy metals or fungal infections * Preferred sample for detection of chronic drug abuse due to ease of collection and not easily altered or tampered

Answer 64

A yellow-green fluid produced by the liver that helps digests fats and eliminates waste -- functions: digestion of fats & elimination of wastes ○ eating fatty foods signal the release of bile * Method of collection: **Direct aspiration of the gall bladder by duodenal intubation** or by **T-tube drainage** * Tests performed: **bile acid analysis, bilirubin testing, and bile culture** * Storage and transport conditions: immediate transport to the lab with minimum delay; refrigerate samples if transport is delayed

Answer 65

* All collected specimens must be **properly LABELED**. ○ Name of patient, date of birth, age, sex, date and time of collection * All laboratory request must contain the **pertinent data of the patient** ○ The requisition form of the patient should be present alongside the specimen at all times. The absence of either of these two must be a ground for rejection. ○ The requisition form contains the ordered tests by the physician * Specimens for culture **should be sent early in the day** ○ This is done first thing in the morning for the processing to start early, allowing the microorganisms to grow during the incubation period (18-24 hours). * When the specimen column indicate that the specimen may be submitted in a syringe, the **rules for Universal Precautions must be followed**, i.e. syringe must be capped with a sterile closure (syringe with needles in place are UNACCEPTABLE) ○ Needles should be removed after collection and prior to sending the sample to the laboratory. * **Universal Precautions** must be observed at all times. (All specimens in the clinical laboratory are considered to be potentially infectious.)

Answer 66

**N = Never** refrigerate spinal fluids, anaerobic or gonococcal specimens ○ cold temperatures could affect quality of sample or kill the microorganism of interest **S = Set** up within 2 hours collection ○ e.g. CBC (lavender topped tube) - prepare smears one hour after collection of sample **A = Appropriate** collection devices ○ especially blood samples; follow appropriate procedures; consider volume **M = Material** from infection area ○ e.g. wound swabs to be examined in the Microbiology section must be directly collected from the affected area, where there’s presence of pus, in order to effectively isolate the microorganism. Samples should not be collected in the peripheral area. **O = optimum** time ○ e.g. S. typhi ■ 1st week: culture blood ■ 2nd & 3rd week: stool (best collection time due to the presence of bacteria) ■ S. typhi manifestations includes diarrhea **C = Collect** prior to antibiotic therapy ○ esp. if testing for bacteremia/presence of bacteria; however if collecting samples while the patient is on antibiotic therapy, blood culture bottles are already incorporated with ARD or antibiotic removing device ○ if certain organisms are being suspected, such as those inhibited by SPS in blood culture, you just have to add 1.2% gelatin **S = Sufficient** quantity ○ qns or short drawn samples are bound for specimen rejection

Answer 67

* **P = preservative** used ○ have to consider appropriateness of preservatives used as it extends the sample’s shelf life, depending on sample collected ○ consider preservatives for urine samples if ever delays occur ○ inappropriate preservative will affect the quality of the sample during processing ○ e.g. stool: formalin ○ urine: boric acid, toluene * **I = insufficient** quantity ○ QNS ○ if blood collection -short drawn ○ major grounds for rejection * **L = leaky** containers – contaminated specimen as well as biohazard ○ e.g. sputum & stool ○ QNS occurs by the time it reaches the laboratory; Messy during transportation ○ Needs to stay there until analyzed by MT * **D = dry** swab (e.g. wound swab, throat swab, oropharyngeal swab, nasopharyngeal, etc.) ○ microorganisms won’t be viable for culture or analysis ○ swab must be transported using the appropriate transport medium