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Clinical Chemistry 1 > A - CHAPTER III: PHLEBOTOMY > Flashcards

A - CHAPTER III: PHLEBOTOMY Flashcards

1
Q

– collection of minute sample of blood through capillary puncture

A

MICROSAMPLING

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2
Q

INFANTS up to 1 year of age

A
  • Plantar surface of the big toe
  • Median or lateral side of the heel
  • Depth of puncture: up to 2.4 mm
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3
Q

ADULTS:

A
  • Middle or ring finger
  • Puncture must be slightly off-center, perpendicular to the fingerprint
  • Margin of the earlobe
  • Depth of puncture: up to 3.1 mm
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4
Q

– collection of a greater volume of blood from the veins or arteries

A

MACROSAMPLING

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5
Q

ARTERIAL PUNCTURE:

A
  • Collection of arterial blood for blood gas analysis or blood pH determination
  • Common sites: radial artery, brachial artery, femoral artery
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6
Q
  • Collection of venous blood
A

VENIPUNCTURE

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7
Q

Infants up to 18 months:

A

External jugular vein
Superior longitudinal sinus
Temporal vein

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8
Q

18 months to 3 years:

A

Popliteal vein
Femoral vein
Long saphenous vein
Ankle vein

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9
Q

3 years to adulthood:

A

Veins on the antecubital fossa
Wrist vein
Veins on the dorsal of hands & feet

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10
Q

3 years to adulthood:

A

Veins on the antecubital fossa
Wrist vein
Veins on the dorsal of hands & feet

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11
Q

METHODS OF PERFORMING VENIPUNCTURE:

A

I. OPEN SYSTEM
II. CLOSED SYSTEM

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12
Q

– use of syringes

A

OPEN SYSTEM

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13
Q
  • The hub of the needle is color-coded, corresponding to its gauge
A

OPEN SYSTEM

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14
Q
  • The lower the gauge, the bigger the bore of the needle
A

OPEN SYSTEM

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15
Q

– use of an evacuated system (evacuated tube, two-way needle and adapter)

A

CLOSED SYSTEM

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16
Q
  • Evacuated tubes are equipped with a hemogard (color-coded in accordance to the additive present)
A

CLOSED SYSTEM

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17
Q
  • Multiple sampling can be carried out
A

CLOSED SYSTEM

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18
Q

– liquid portion of clotted blood

A

SERUM

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19
Q

– liquid portion of anti-coagulated blood

A

PLASMA

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20
Q

: preparation involves the removal of proteins from any biological specimen to prevent direct colorimetric interference by the formation of zwitterions at isoelectric pH where proteins exhibit maximum precipitation and minimum solubility

A

PROTEIN-FREE FILTRATE (PFF)

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21
Q

METHODS of PFF PREPARATION:

A

A. Physical Methods:
1. Heat
2. Ultracentrifugation

B. Chemical Methods
(ACID Method)
1. Folin-Wu
2. Hayden’s method
3. Van Slyke
4. TCA (5%)
(BASE Method)
1. Nelson-Somogyi

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22
Q

▪ Specimen: whole blood; plasma/serum
▪ 2/3 N Sulfuric acid
▪ 10% sodium tungstate

A

Folin-Wu

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23
Q

▪ Specimen: serum
▪ N/12 Sulfuric acid
▪ 10% sodium tungstate

A

Hayden’s method

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24
Q
  • makes use of a pre-mixed acid
A

Van Slyke

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25
Q

CONTAMINATION of SPECIMEN

A

❖ residual detergent in tubes
❖ Plasticizers in IV tubing and tube stoppers
❖ Cork stoppers & glass tubes
❖ Lead analysis: use lead-free, acid-washed containers

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26
Q

Serum or plasma should be separated from cells [?] (unless collected in a gel separator tube).

A

within 2 hours of collection

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27
Q

Rate of glycolysis:
At ref temperature –
At room temperature –

A

2 mg/dL
7 mg/dL

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28
Q

Allow red top tubes to clot sufficiently (?) before centrifugation to avoid fibrin strands.

A

20-30 minutes

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29
Q

Centrifuge [?] at [?] × g.

A

10 ± 5 minutes
1000-1200

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30
Q

Keep tubes [?] during centrifugation

A

capped

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31
Q

can be ultracentrifuged

A

Lipemic specimens

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32
Q

SPECIMEN HANDLING REQUIREMENTS

A
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33
Q

• Patients should not eat or drink anything (NPO) except water

A

FASTING

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34
Q

• Glucose determination:

A

6 – 8 hours fasting

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35
Q

• Lipid Profile:

A

10 – 12 hours fasting

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36
Q

• Specimen to be collected at a specified time

A

TIMED

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37
Q

• Label the tube with the time the specimen was drawn

38
Q

• Tests for Cardiac profile

39
Q

• Specimen collected when the highest serum concentration of a drug is anticipated

A

PEAK / Post-dose

40
Q

• Drawn 30 minutes to 1 hour after administration of the drug

A

PEAK / Post-dose

41
Q

• Therapeutic Drug Monitoring

A

PEAK / Post-dose

42
Q

• Specimen collected when the lowest serum concentration of a drug is expected, usually before the next dose is administered

A

TROUGH / Pre-dose

43
Q

• Chilling the specimen to slow down the metabolic process that will continue after blood is drawn

44
Q

• Placed in crushed ice & water for even cooling

45
Q

• Blood ammonia determination, blood gas analysis & Coagulation studies

46
Q

• Keep specimen at body temperature or close to 37°C (incubator)

47
Q

• For cold agglutinins

48
Q

• Specimen should be wrapped in aluminum foil or a light-inhibiting container should be used

A

PROTECT FROM LIGHT

49
Q

• Bilirubin, Vit. B12, Carotene

A

PROTECT FROM LIGHT

50
Q

• For legal or forensic proceedings, sample may be used as piece of evidence

A

CHAIN OF CUSTODY

51
Q

• Documentation of specimen handling begins with patient identification and continues until testing is complete

A

CHAIN OF CUSTODY

52
Q

o It must include date, time and identification of handler, all to be done in the presence of a witness

A

CHAIN OF CUSTODY

53
Q

• DNA Analysis, Drug testing, Alcohol levels

A

CHAIN OF CUSTODY

54
Q

REASONS FOR SPECIMENT REJECTION

A

✓ Hemolysis
✓ Lipemic / Lactescent serum
✓ Clots in an anti-coagulated specimen
✓ Partially-filled tubes
✓ Improper transport conditions
✓ Discrepancies b/w requisition & specimen label
✓ Unlabeled or mislabeled specimen
✓ Contaminated specimen/Leaking container

55
Q

SPECIMEN INTERFERENCES

A
  1. HEMOLYSIS
  2. ANTICOAGULANTS and PRESERVATIVES
  3. ICTERIC SERUM / JAUNDICED SERUM
  4. LACTESCENT SERUM / MILKY SERUM / TURBID SERUM
  5. PARTIALLY-FILLED TUBES
  6. SPECIMEN CONTAMINATION
56
Q

o Destruction of RBCs result in a plasma or serum appearing pink to red

57
Q

o Hemoglobin concentration: exceeds 200 mg/L

58
Q

o In-vivo hemolysis
o In-vitro hemolysis

59
Q

HEMOLYSIS Interferes with:

A

▪ Enzyme and electrolyte assays (K+, Zinc and Mg+2)
▪ Serum albumin (↑): Bromcresol Green method
▪ Serum protein (↑): Biuret method
▪ Serum bilirubin (↓): Diazo method

60
Q

▪ Serum albumin (↑):
▪ Serum protein (↑):
▪ Serum bilirubin (↓):

A

Bromcresol Green method
Biuret method
Diazo method

61
Q

o – dilution of plasma owing to water transport from the cells

A

Potassium oxalate

62
Q

o will inhibit various plasma enzyme activities

A

Anticoagulants that chelate calcium

63
Q

o inhibit amylase activity

A

Oxalates or citrates

64
Q

o inhibit Lactate dehydrogenase and Acid phosphatase

65
Q

will cause a decrease in calcium concentration

A

o EDTA, oxalates and citrates

66
Q

Bilirubin interferes with the ff:
▪ Albumin assay:
▪ Cholesterol assay:
▪ Glucose determination:
▪ Total Protein determination:

A

HABA method
Ferric chloride reagents
ortho-toluidine method
Biuret method

67
Q

LACTESCENT SERUM / MILKY SERUM / TURBID SERUM
o Interferes with the ff:
▪ Albumin assay:
▪ Calcium :
▪ Inorganic phosphates:
▪ CK, bilirubin and total protein levels decrease
▪ Inhibits the activity of

A

Bromcresol Green method
Cresolphthalein method
Ammonium molybdate
amylase, uricase and urease

68
Q

For proper ratio of blood to anti-coagulant to be achieved, all tubes should be filled until

A

the vacuum is exhausted

69
Q

Most important for Coagulation studies

A

PARTIALLY-FILLED TUBES

70
Q

o Improper application of antiseptic on the site prior to venipuncture, or traces of Povidone iodine on the site of puncture

A

SPECIMEN CONTAMINATION

71
Q

o Aseptic technique is very important for blood cultures.

A

SPECIMEN CONTAMINATION

72
Q

o increases K+ and Uric acid

73
Q

SOURCES OF VARIATIONS IN SPECIMEN COLLECTION & PROCESSING

A
  1. EXERCISE
  2. PROLONGED FASTING
  3. DIET
  4. TOBACCO SMOKING6. POSTURE
  5. POSTURE
  6. OTHER FACTORS
74
Q

immediate fall and then subsequent increase in the concentration of free fatty acids

A

Transient Effects

75
Q

Increase in activities of muscle enzymes such as Creatine kinase, aldolase, AST, and Lactate dehydrogenase

A

Longer-lasting Effects

76
Q
  • Changes the levels of sex hormones
  • During a six-month training, there is an increase in the mean plasma testosterone concentration by 21%, the androstenedione concentration by 25%
A

Long-term physical training

77
Q

An 8 – 12 hour fasting is a must (GNFH or General Normal Fasting Hours) to ensure that laboratory measurements are compatible with reference values.

A

PROLONGED FASTING

78
Q
  • Increase in the plasma concentration of potassium and triglycerides
79
Q
  • Increase in plasma concentration of lactate, urate and the metabolites of ethanol namely acetaldehyde and acetate
A

ETHANOL INGESTION

80
Q
  • Up to 80% increase in carboxyhemoglobin
A

TOBACCO SMOKING

81
Q
  • Obtain specimen in a supine or upright sitting position
82
Q
  • Incorrect application of tourniquet, fist exercise cause an increase in the concentration of lactate, enzymes, proteins, protein-bound substances
A

OTHER FACTORS

83
Q

DIURNAL VARIATION:
➢ Lower at night:
➢ Higher in the afternoon & evening:

A

• ACTH, Renin, Aldosterone, Insulin
• GH, ACP

84
Q

peaks early to late morning & decreases during the day

85
Q

SHOCK and TRAUMA:
➢ Increased:

A

cortisol, aldosterone, catecholamine, glucagon and insulin

86
Q

affects adrenal hormone secretion.

87
Q

will lead to disturbances in acid-base balance, an increase in the serum lactate concentration, and non-esterified fatty acids.

A

Anxiety resulting in hyperventilation

88
Q

an increase in the serum lactate concentration

A

acid-base balance

89
Q

SKIN COLOR:
➢ Blacks have increased

A

CK, aldolase, and LDH

90
Q

MENSTRUAL CYCLE:
➢ Increased

A

cholesterol, protein, albumin, fibrinogen, Mg, Cl-, Na+, and PO4

Clinical Chemistry 1 (10 decks)

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