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GK > Basic Blood Collection and Handling > Flashcards

Basic Blood Collection and Handling Flashcards

1
Q

what are common reasons for specimen rejection or test cancellation?

A

collected in wrong tube or kept at improper temperature

QNS for analysis

improperly labelled

inappropriate container

leaked in transit

incorrect or expired transport media

incomplete or incorrect test requisition

test requisition without a specimen or specimen without test request

no specimen type or source provided

inappropriate specimen type or difficulty obtaining sample (Hemolysis, Clotted)

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2
Q

how many identifiers are required by the Joint Commission ?

A

Two patient identifiers

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3
Q

What should proper specimen labeling include?

A

Patients first and last name

unique identifying number

date, time, name of person who drew spcimen

tests requested

recommended to include specimen type or source on sample

labelling should occur in PRESENCE OF PATIENT

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4
Q

Is it possible to use rejected sample for testing?

A

if re-collection is impossible or would compromise patient care, it may be possible to provide qualified result from original specimen

with understanding of ordering physician that validity may be questionable

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5
Q

What volume of blood does the average adult male have? How much is plasma vs cells?

A

5 quarts (4.75 liters)

3 quarts (2.85 liters) plasma and 2 quarts (1.9 liters) cells

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6
Q

What is hemolysis and how does it occur?

A

thin protective membrane encasing RBCs ruptures and allows hemoglobin to escape into plasma

caused by improper handling of blood specimen, dilution, exposure to contaminants, extremes in temperature, pathological conditions

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7
Q

How is serum obtained?

A

from clotted blood that has NOT been mixed with anticoagulant

clotted blood is centrifuged, yielding serum

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8
Q

What two types of proteins are contained in serum?

A

albumin and globulin

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9
Q

In what color tubes is serum collected?

A

marbled red/gray, red and or gold top

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10
Q

How is plasma obtained?

A

blood that has been mixed with anticoagulant in collection tube

mixed blood is centrifuged yielding plasma which contains albumin, globulin and fibrinogen

either plasma or serum may be separated from red blood cells by centrifugation

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11
Q

What are the components of blood?

A

plasma, cells

blood cells are suspended in plasma made up of water and dissolved materials including hormones, antibodies and enzymes

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12
Q

what is the difference between plasma and serum?

A

plasma retains fibrinogen (clotting component)

fibrinogen is removed from the serum

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13
Q

what may be required for plasma specimens?

A

various antiocoagulants and preservatives

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14
Q

how are the anticoagulants used in blood collection chosen?

A

based on test procedure ordered

must preserve features of sable necessary to work with test method

additives NOT interchangeable

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15
Q

What are the 4 main steps for quality specimen for testing ?

A

1) preparation of paient

2) collection of sample

3) processing

4) storing or transporting

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16
Q

What are pre-analytical errors?

A

occur during specimen collection, preparation, and submission

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17
Q

errors are most common in which phase of testing?

A

pre-analytical that occur during specimen collection, preparation and submission

more common than errors arise during analytical phase during actual testing or examination

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18
Q

What are the most common errors affecting all types of specimens during collection?

A

failure to label correctly and provide pertinent information on test request

insufficient quantity of specimen or QNS

failure to use correct container or tube for specimen preservation

failure to tighteen specimen lids

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19
Q

How is whole blood collected for testing?

A

drawn into tubes containing anticoagulant

tube inverted 8-10 times after filled to ensure adequate mixing and prevent clotting

submit entire tube for testing

NOT be frozen unless instruct4ed for specific test

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20
Q

What are some tubes used for whole blood?

A

Blue top: 3.2% sodium citrate

Purple/lavender: EDTA

Green top : heparin

Yellow Top: SPS (Microbiology)

Yellow Top: ACD Solution B (genetic/chromosome analysis, flow cytometry)

Navy Blue Top: EDTA

Gray top: potassium oxalate/ sodium fluoride

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21
Q

How is serum specimen prepared?

A

specimen drawn into tube containing no additives or anticoagulants

centrifuge sample afer allowed to clot

separate serum from RBC

ensure sample has completely clotted before centrifugation

failure to allow clotting may cause fibrin clots in sample

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22
Q

What causes fibrin clots in serum sample and what is the potential impact?

A

fibrin clots interfere

problems pipetting, erroneous results especially in automated systems

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23
Q

What can extended clotting time of serum samples cause?

A

increased enzyme levels, increase in potassium and decrease in glucose levels due to prolonged exposure to RBCs

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24
Q

How are plasma samples prepared?

A

collection tubes contain anticoagulant

plasma contains fibrinogen and other clotting factors when separated from RBCs

draw whole blood specimen then centrifuge to separate plasma

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25
Q

What are the most common errors affecting tests utilizing serum?

A

failure to mix tube and allow clotting before centrigue

failure to centrifuge at correct speed or time

hemolysis

loose container lids

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26
Q

What are the most common errors in preparing plasma samples?

A

collected using incorrect additive

improper mixing with additive immediately after collection

hemolysis

incomplete filling of tube - incorrect dilution factor QNS

failure to separate plasma from cells within 30-45 minutes of venipuncture

failure to label tubes as plasma

failure to indicate type of anticoagulant (EDTA/CITRATE ETC)

27
Q

What is hemolysis?

A

red blood cells rupture and release hemoglobin and other intracellular components into serum or plasma

hemolyzed serum or plasma is pinkish red rather than usual clear straw or pale yellow

grossly or moderately hemolyzed blood specimens may not be acceptable for testing

28
Q

what kinds of analytes are adversely affected by hemolysis?

A

glucose, potassium, lactate dehydrogenase (LDH), cholesterol, creatinine, iron, phosphorus, calcium, and most enzymes

29
Q

what are some tips for avoiding hemolysis?

A

20-22 gauge needle

replace vacuum tube if air leakage around needle or loss of vacuum

use clean dry sterile needles syringes and tubes

collect blood in room temperature containers

if difficulty accessign vein or tube fills slowly then collect fresh tube with good flow or select new puncture site

DO NOT remove needle from vein with vacuum tube engaged

be as gentle as possible drawing blood evenly

allow collection site to dry after cleaning - alcohol may cause contamination in a tube

DO NOT collect specimen in hematoma

allow specimen to clot completely before centrifuge

do not centrifuge prolonged period

30
Q

How much blood is required for coagulation tests?

A

full tube of blood

ratio of anticoagulant is specific for volume of specimen (1:9)

coagulation tests not performed on short draws

31
Q

What kind blood is needed for hematology and coagulation tests?

A

anti coagulated blood

clots will lead to errors for these tests

32
Q

What may cause cloudy plasma or serum?

A

chronic or transient high lipid levels

patients who consume high lipid foods within 12-16 hour period preceding collection may have temporarily elevated lipid levels -> cloudy or lipemic serum

33
Q

How soon after collection should hematology samples be analyzed?

A

within 24 hours

old samples will yield unreliable cell counts and distorted cell morphology

34
Q

What is the recommended order of blood collection to avoid cross-contamination of additives and maintain sterility?

A

1) blood culture
2) coagulation tube (blue)
3) serum tube with our without clot activator with or without gel (red)
4) heparin with or without gel (green)
5) EDTA with or without gel separator (lavender)
6) Glycolytic inhibitor (gray)

35
Q

Why should plastic or glass serum tubes containing a clot activator be drawn after coagulation testing tubes?

A

clot activator may cause interference with coagulation testing

36
Q

What is Lithium Heparin used for in collection tubes?

A

tubes typically contain spray-coated lithium heparin and a gel for PLASMA separation

used for PLASMA determinations in chemistry

eliminate need to wait for clot to form

ideal for STAT procedures

and patients receiving anticoagulant therapy

37
Q

What are K2 EDTA and K3 EDTA tubes used for?

A

whole blood hematology determinations and blood bank testing

require 8-10 inversions for through mixing of blood with ANTICOAGULANT

K2 EDTA is anticoagulant of choice in specimen collection and blood cell counting according to CLSI and ISCH

38
Q

What is the anticoagulant of choice in specimen collection and blood cell counting according to CLSI and ISCH? and why?

A

K2 EDTA
chosen over K3 EDTA because K3 EDTA results in greater RBC shrinkage

K3 EDTA produces more significant increase in cell volume

K3 EDTA is a liquid additive and dilutes specimen

39
Q

When is serum (silica) used in collection tubes?

A

serum determinations in chemistry, serology and blood bank

used for tests where gel-serum separator interferes with test methodology

40
Q

When is heparin used in collection tubes?

A

either lithium heparin or sodium heparin

PLASMA determinations in chemistry

41
Q

When is citrate used in collection tubes?

A

Routine coagulation studies

typically have 3.2% buffered sodium citrate solution

used for coagulation testing and must be filled to required volume to maintain appropriate concentration of citrate anticoagulant in plasma to be tested

42
Q

When is fluoride added to blood collection tube?

A

glycolytic inhibitor and used for glucose determinations on plasma where delay in processing is expected

serum or plasma separator tube may be used if centrifuging is available or glucose is analyzed soon after blood draw

also used for ETOH determination

43
Q

What is a red-stopper tube?

A

NO anticoagulant or preservative

Uses: serum or clotted whole blood

serum must be separated from cells within 45-60 minutes of venipuncture

44
Q

What is marbled red/gray or red-stopper, gold top, serum-separator tube (SST)?

A

Contains clot activator and gel for separating serum from cells

NO anticoagulant

Use: serum

must be separated from cells within 45 minutes

serum may remain in centrifuged tube with intact barrier between cells and serum or in plastic transport tube

DONT use for therapeutic drug monitoring unless manufacturer determines serum-separator is acceptable

45
Q

What is a lavender-stopper tube?

A

contains liquid k3 EDTA or spray coated K2 EDTA

use: EDTA whole blood or PLASMA

sample should be labelled Plasma, EDTA

46
Q

What is gray-stopper tube?

A

contains sodium fluoride (perservative) and potassium oxalate (anticoagulant)

use: sodium fluoride whole blood or plasma

sample should be labelled “Plasma, Sodium Fluoride”

47
Q

What is the blue-stopper tube?

A

sodium citrate (3.2%)

use: citrated whole blood or plasma

A protime (PT) test can be performed on a sample if kept unopened and uncentrifuged at room temp and delivered to lab within 24 hours

48
Q

What is green-stopper tube?

A

sodium heparin or lithium heparin

Use: heparinized whole blood or plasma

Should be labelled “plasma, Sodium heparin”

49
Q

What is yellow stopper tube ACD?

A

1 ml acid citrate dextrose (ACD) solution

ACD whole blood for genetic and chromosome analysis and flow cytometry

50
Q

What is yellow-stopper tube SPS?

A

SPS (Sodium polyanethol sulfonate)

use: blood culture microbiology

blood collected in tubes may remain 2-4 hours before transfer to blood culture bottle

51
Q

What is royal blue-stopper tube?

A

contains sodium EDTA for trace metal studies

use: EDTA whole blood or plasma

should read plasma EDTA

52
Q

When and why are plastic tubes used for blood collection?

A

safe method

reduce potential for tube breakage and spillage

may not be appropriate for all tests

with Hemogard (BD) closure to protect personnel from blood, which might splatter when tube is opened
-rubber stopper is recessed inside plastic shield preventing exposure to blood present on the stopper

53
Q

Where is the preferred venipuncture site?

A

antecubital fossa or back of hand

not underside of wrist

54
Q

what are examples of tests requiring specimen chilling? what is the effect?

A

gastrin

ammonia

lactic acid

catecholamines

pyruvate

parathyroid hormone (PTH)

SLOW METABOLIC PROCESSES

55
Q

What are tests requiring transportation at 37 C? What is the purpose?

A

cold agglutinin
cryofibrinogen
cryoglobulins

PREVENT PRECIPITATION OR AGGLUTINATION

56
Q

what are tests requiring protection from light? what is the purpose?

A

bilirubin
vitamin A
vitamin B6
beta carotene
porphyrins

AVOID ANALYTE BREAKDOWN

57
Q

what are examples of timed tests that must be collected at specific intervals?

A

glucose tolerance testing, cortisol, therapeutic drug monitoring

58
Q

Whta is CLSI?

A

Clinical Laboratory Standards Institute Formerly NCCLS

59
Q

What is CBC?

A

complete blood count

information about kinds and numbers of cells in the blood especially RBC, WBC and platelets

evaluate symptoms and diagnose conditions

60
Q

What is Icterus?

A

presence of increased bilirubin in the blood

61
Q

What is lipemia?

A

excess lipid in the blood

62
Q

what is Prothrombin time test?

A

measures how long it takes blood to clot

screen for bleeding abnormalities

also monitor treatment with medication that prevents formation of blood clots

63
Q

What is partial thromboplastin time PTT test?

A

measures time it takes blood to clot

used to screen for bleeding abormalities

64
Q
A

GK (15 decks)

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