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Phlebotomy > Blood Bottles > Flashcards

Blood Bottles Flashcards

1
Q

Full Blood Count

A

Purple

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2
Q

Erythrocyte Sedimentation Rate (ESR)

A

Purple

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3
Q

Blood film for abnormal paracites and malaria

A

Purple

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4
Q

Reticulocytes

A

Purple

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5
Q

Red cell folate (folic acid)

A

Purple

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6
Q

Monospot for EBV

A

Purple

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7
Q

HbA1C

(Glycosolated Haemoglobin)

A

Purple

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8
Q

Parathyroid Hormone

(Should be done with calcium levels)

A

Purple 3ml
Red Top 6ml

Gold Top 3.5ml

2mls needed.

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9
Q

Cyclosporin/Tacrolimus

A

Purple

Post organ transplant

Severe psoriasis/ulcerative colitis

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10
Q

G6PD

A

Purple

G6PD deficiency is an inherited condition. It is when the body doesn’t have enough of an enzyme called G6PD (glucose-6-phosphate dehydrogenase). This enzyme helps red blood cells work correctly. A lack of this enzyme can cause hemolytic anemia. This is when the red blood cells break down faster than they are made.

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11
Q

ACTH

A

Purple

Adrenocorticotropic hormone

Adrenocorticotropic hormone (ACTH) is produced by the pituitary gland. Its key function is to stimulate the production and release of cortisol from the cortex (outer part) of the adrenal gland.

An ACTH test is often done along with a cortisol test to diagnose disorders of the pituitary or adrenal glands. These include: Cushing’s syndrome, a disorder in which the adrenal gland makes too much cortisol. It may be caused by a tumor in the pituitary gland or the use of steroid medicines

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12
Q

Porphyria Screen

A

Purple

Porphyrias are a group of rare inherited blood disorders. People with these disorders have problems making a substance called heme in their bodies. Heme is made of body chemicals called porphyrin, which are bound to iron. Heme is a component of hemoglobin, a protein in red blood cells that carries oxygen.

Porphyria is a group of liver disorders in which substances called porphyrins build up in the body, negatively affecting the skin or nervous system. The types that affect the nervous system are also known as acute porphyria, as symptoms are rapid in onset and short in duration.

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13
Q

Plasma Metanephrines

A

Purple

This test measures the substances metanephrine and normetanephrine in your blood. It helps find out if you have a tumor of the adrenal glands called pheochromocytoma.

The adrenal glands sit on top of your kidneys. They make the hormone adrenaline and other adrenaline-like chemicals called cate­cholamines. Adrenaline controls your blood pressure and helps you cope with stress. Metanephrine and normetanephrine are catecholamines that result when adrenaline breaks down.

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14
Q

Fasting Gut Hormone

A

Purple

For diagnosis of endocrine tumors of the GI tract.

Must fast for 10 hours. Stop proton pump inhibitors for 2 weeks, ranitidine for 72 hours. Pack test on ice.

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15
Q

What is the additive in a purple tube?

A

EDTA

EDTA functions by binding calcium in the blood and keeping the blood from clotting.

invert at least 8 times to mix blood.

1 ml for FBC
Full tube for ESR

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16
Q

What additive is in the pink bottle

A

EDTA (like purple…is an anticoagulant)

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17
Q

Group and Save?

A

Pink Bottle

Group and save (G&S): this simply means the patient’s blood is typed and tested for antibodies, then saved in the lab in case it is required. It DOES NOT get you blood products for transfusion. If you need blood products you have to request a crossmatch.

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18
Q

Crossmatch

A

Pink.

Crossmatch (XM): this means that the patient’s blood is typed and tested as above, then matched to specific units of blood, platelets or other products for transfusion. You need to specify on the form how many units you need, why you need them and when they are required. A full crossmatch takes about 45-60 minutes in the lab – if you have an unstable bleeding patient and think you’ll need blood products sooner than this, you still need to send a crossmatch sample, but you can ask the lab for units of type-specific blood (which take 10-20 minutes), or in a genuine emergency you can use their stocks of O negative blood from the fridge.

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19
Q

Direct Coombs Test?

A

Pink

The Direct Coombs Test is used to test for autoimmune hemolytic anemia—that is, a condition where the immune system breaks down red blood cells, leading to anemia. The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells.

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20
Q

What tube do you use if you run out of purple tubes for FBC?

A

Pink Tube

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21
Q

How many times do you invert Pink Tube

A

8 times

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22
Q

What is the minimum amount of blood needed for pink tubes (labs prefer more)?

A

1 ml

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23
Q

What is special about the labelling of a pink tube?

A

Special label to prevent catastrophic mismatched blood transfusion.

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24
Q

What is the blue bottle used for?

A

Haematology involving the clotting system

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25
Q

What is the additive in a blue bottle?

A

Sodium citrate, which acts as a reversible anticoagulant by binding to calcium ions in the blood and subsequently disrupting the clotting cascade. Sodium citrate is also added to blood products for transfusion and acts as a preservative by stopping them from clotting in the bag.

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26
Q

Prothrombin time?

A

Blue Bottle

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27
Q

APTT?

A

Blue Bottle

Activated Partial Thromboplastin Time (APTT)

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28
Q

Thrombin time?

A

Blue Bottle

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29
Q

D-Dimer?

A

Blue Bottle

D-dimer to assist with ruling out thrombosis (e.g. deep vein thrombosis).

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30
Q

INR

A

Blue Bottle

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31
Q

APTR

A

Blue Bottle

Activated partial thromboplastin ratio (APTR) for monitoring patients on intravenous heparin infusions (this is calculated from the APTT).

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32
Q

Anti-Xa Assay

A

Blue Bottle

Anti-Xa assay for monitoring patients on high-dose low molecular weight heparins like tinzaparin.

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33
Q

Order of Draw.

What comes after Blood Cultures?

A

Blue (Sodium Citrate)

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34
Q

Order of Draw?

What 2 colours comes after Blue (Sodium Citrate)?

A

Red,

Yellow

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35
Q

Order of Draw.

What comes after Yellow?

A

Green

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36
Q

What comes after Green?

A

Purple

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37
Q

What comes after Purple

A

Pink

38
Q

What comes after Pink?

A

Grey

39
Q

Less common tests: (which bottle?)

Specific clotting factors (e.g. factor VIII, factor IX, von Willebrand factor)

Thrombophilia screen

Lupus anticoagulant

A

Blue

40
Q

How many times should you invert a blue bottle?

A

3 - 4 times

41
Q

How full must a blue bottle be?

A

The sodium citrate liquid in the bottle dilutes the blood sample, and the machines in the lab are specifically calibrated to interpret results based on a set ratio of blood to anticoagulant. It is, therefore, essential that the bottle is filled to the line marked around its edge to ensure the tests are interpreted accurately – otherwise, the samples may be over-anticoagulated.

42
Q

What is C-reactive Protein used for and which bottle?

A

The level of C-reactive protein (CRP), which can be measured in your blood, increases when there’s inflammation in your body. Your doctor might check your C-reactive protein level for infections or for other medical conditions.

A high-sensitivity C-reactive protein (hs-CRP) test, which is more sensitive than a standard test, also can be used to evaluate your risk of developing coronary artery disease, a condition in which the arteries of your heart are narrowed. Coronary artery disease can lead to a heart attack.

Yellow bottle

43
Q

Why should you avoid a butterfly needle when filling a blue bottle?

A

If your first bottle is light blue and you are using a butterfly needle you will likely need to use two of these blood bottles to obtain a full sample. This is because when you attach the first bottle it will draw in air from the tubing, resulting in a sample that is unable to fill with enough blood to reach the required level. To avoid this, you can initially attach a light blue blood bottle to remove the air (i.e. fill the tubing with blood), then detach this and fill a second blue blood bottle to the required level.

44
Q

When should you do an INR?

A

In the morning.

45
Q

When should you take an Anti-Xa?

A

Anti-Xa assays must be taken 3-4 hours after tinzaparin is given.

46
Q

What is the Yellow (Gold) bottle broadly used for?

A

biochemistry, endocrinology, oncology, toxicology, microbiology and immunology.

All of which require separated serum for analysis.

47
Q

What are included in LFT and which bottle?

A

Liver function tests(LFTs):

Bilirubin,
ALP,
AST/ALT,
GGT,
total protein and albumin.

Yellow Bottle

48
Q

What is the additive in a yellow bottle?

A

SST (serum separating tube). It contains two agents; silica particles and a serum separating gel. The silica particles work to activate clotting and cause the blood cells to clump together. The serum separator consists of an inert polymer gel which floats as a layer between the blood cells and plasma to form a physical barrier between them. This means that the sample can be centrifuged (spun) in the lab and the separated serum easily removed.

49
Q

What is included in U&Es and which bottle?

A

Creatinine

Urea

Sodium
Potassium

Yellow bottle

50
Q

C-reactive Protein?

A

Yellow Bottle

51
Q

What is ALT and which bottle?

A

ALT
alanine aminotransferase

ALT is an enzyme made by cells in your liver.

It plays a crucial role in metabolism, the process that turns food into energy.

ALT is normally found inside liver cells. However, when your liver is damaged or inflamed, ALT can be released into your bloodstream. This causes serum ALT levels to rise.

An ALT test is also known as a serum glutamic-pyruvic transaminase (SGPT) test or an alanine transaminase test.

52
Q

What is AST and which bottle?

A

aspartate aminotransferase

An enzyme, AST is found in the highest concentrations in your liver, muscles, heart, kidney, brain and red blood cells. A small amount of AST is typically in your bloodstream. Higher-than-normal amounts of this enzyme in your blood may be a sign of a health problem. Abnormal levels can be associated with liver injury.

and a check for hepatitis. Used in a ratio with ALT

Concentration of AST is elevated after bruising, trauma, necrosis, infection, or neoplasia of liver or muscle

Yellow bottle

53
Q

What is GGT and which bottle?

A

A gamma-glutamyl transferase (GGT) test measures the amount of GGT in the blood. GGT is an enzyme found throughout the body, but it is mostly found in the liver. When the liver is damaged, GGT may leak into the bloodstream. High levels of GGT in the blood may be a sign of liver disease or damage to the bile ducts. Bile ducts are tubes that carry bile in and out of the liver. Bile is a fluid made by the liver. It is important for digestion.

A GGT test can’t diagnose the specific cause of liver disease. So it is usually done along with or after other liver function tests, most often an alkaline phosphatase (ALP) test. ALP is another type of liver enzyme. It’s often used to help diagnose bone disorders as well as liver disease.

Yellow bottle

54
Q

What is ALP and which bottle?

A

Alkaline phosphatase (ALP) test measures the amount of ALP in your blood. ALP is an enzyme found throughout the body, but it is mostly found in the liver, bones, kidneys, and digestive system. When the liver is damaged, ALP may leak into the bloodstream.

Yellow bottle

55
Q

Amylase Assay

A

Yellow Bottle

Amylase (/ˈæmɪleɪz/) is an enzyme that catalyses the hydrolysis of starch (Latin amylum) into sugars.

If your results show an abnormal level of amylase in your blood or urine, it may mean you have a disorder of the pancreas or other medical condition. High levels of amylase may indicate: Acute pancreatitis, a sudden and severe inflammation of the pancreas.

56
Q

What does bone profile include and which bottle?

A

calcium,

phosphate,
ALP
albumin

Yellow Bottle

57
Q

Magnesium assay?

A

Yellow Bottle

58
Q

What do iron studies include and which bottle?

A

Iron studies: this includes
serum iron,
ferritin,
transferrin saturation
total iron-binding capacity.

Yellow Bottle

59
Q

What does Lipid Profile include and which bottle?

A

Lipid profile:

cholesterol,
LDL,
HDL
triglycerides.

Yellow Bottle

60
Q

How long to fast for cholesterol test and HDL test?

A

12 hours.

Whilst HDL blood tests can be performed accurately on non-fasting specimens, the test is usually performed as part of a complete lipid profile. In these circumstances, fasting for about 12 hours is required, with only water permitted.

Yellow bottle

61
Q

What are included in TFTs and which bottle?

A

Yellow Bottle

TSH, free T4 and sometimes free T3

62
Q

Vitamin B12 and D

A

Yellow Bottle

63
Q

Troponins

A

Yellow Bottle

Troponin is a protein that’s released into the bloodstream during a heart attack.

64
Q

Creatine kinase (CK)

A

Yellow Bottle

What is this test used for?

A CK (Creatine Kinase) test is most often used to diagnose and monitor muscular injuries and diseases. These diseases include:

Muscular dystrophy, a rare inherited disease that causes weakness, breakdown, and loss of function of skeletal muscles. It mostly occurs in males.

Rhabdomyolis, a rapid breakdown of muscle tissue. It can be caused by a serious injury, muscle disease, or other disorder.

The test can be used to help diagnose a heart attack, though not very often. CK testing used to be a common test for heart attacks. But another test, called troponin, has been found to be better at detecting heart damage.

65
Q

Urate/Uric Acid?

A

Yellow Bottle

This test is used to detect high levels of uric acid, which could be a sign of the condition gout, or to monitor uric acid levels when undergoing chemotherapy or radiotherapy; to detect high levels of uric acid in the urine in order to diagnose the cause of kidney stones and to monitor those with gout who are at risk of developing such stones. Uric Acid is also measured as part of the assessment of pre-eclampsia.

66
Q

Serum Osmolarity?

A

Yellow bottle

Serum osmolality: this requires a urine sample to be taken at the same time.

A serum osmolality test measures the amount of chemicals dissolved in the liquid part (serum) of the blood. Chemicals that affect serum osmolality include sodium, chloride, bicarbonate, proteins, and sugar (glucose). This test is done on a blood sample taken from a vein.

67
Q

Beta-hCG

A

Yellow Bottle

The human chorionic gonadotropin (hCG) blood test measures the level of hCG hormone present in a sample of your blood.

hCG is produced during pregnancy. Your doctor may refer to the hCG blood test by another name, such as the:

beta-hCG blood test

quantitative blood pregnancy test

quantitative hCG blood test

quantitative serial beta-hCG test

repeat quantitative beta-hCG test

Why is the hCG blood test performed?

The hCG blood test is performed to:

confirm pregnancy

determine the approximate age of the fetus

diagnose an abnormal pregnancy, such as an ectopic pregnancy

diagnose a potential miscarriage

screen for Down syndrome

The hCG blood test is sometimes used to screen for pregnancy before you undergo certain medical treatments that could potentially harm a developing baby. Examples of these treatments include X-rays.

Beta hCG is also considered a tumor marker which means it’s a substance that’s excreted by some kinds of tumors. That’s why, in some cases, the hCG blood test may also be used to evaluate and manage certain types of cancer.

Cancers that can cause higher-than-normal hCG levels include:

cancer of the uterus, or choriocarcinoma

lung cancer

breast cancer

ovarian cancer

Noncancerous conditions, such as cirrhosis, ulcers, and inflammatory bowel disease (IBD), can also result in hCG levels being elevated.

Your doctor may order this test as part of a series of lab tests to identify the cause of certain symptoms.

In men

Although hCG is closely associated with pregnant women, the hormone can also be present in men. An hCG blood test can indicate that a man has testicular cancer.

If a man detects a lump in one of his testicles, or if a doctor suspects that he’s at risk for testicular cancer, the test can be used to see if hCG is present.

If hCG is present in a man’s blood, further testing will be needed to determine the cause.

68
Q

Calcitonin

A

Yellow Bottle

Why Get Tested?

To help diagnose and monitor C-cell hyperplasia and medullary thyroid cancer (MTC); to screen those at risk for MTC because of multiple endocrine neoplasia type 2 (MEN 2) or other mutations in the RET oncogene

69
Q

Cortisol

A

Yellow Bottle

A cortisol test measures the level of cortisol in your blood, urine, or saliva. Blood tests are the most common way of measuring cortisol. If your cortisol levels are too high or too low, it may mean you have a disorder of your adrenal glands. These disorders can be serious if not treated.

70
Q

EPO

A

Yellow Bottle

Erythropoietin

Why Get Tested?

Either to help tell the difference between polycythaemia vera and secondary polycythaemia or to help tell the difference between different types of anaemia. It also shows whether the amount of erythropoietin being produced is appropriate for the level of anaemia present

71
Q

Other endocrinology tests, eg:

Sex hormones

Growth hormone

IGF-1

A

Yellow Bottle

72
Q

PSA

A

Yellow Bottle
Prostate Specific Antigen

73
Q

CEA

A

Yellow Bottle

A carcinoembryonic antigen (CEA) test is a blood test used to help diagnose and manage certain types of cancers. The CEA test is used especially for cancers of the large intestine and rectum. Your doctor can also use the test results to help determine if a cancer treatment is working.

74
Q

CA-125

A

Yellow Bottle

A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in your blood. A CA 125 test may be used to monitor certain cancers during and after treatment. In some cases, a CA 125 test may be used to look for early signs of ovarian cancer in people with a very high risk of the disease.

75
Q

CA19-9

A

Yellow Bottle

This test measures the amount of a protein called CA 19-9 (cancer antigen 19-9) in the blood. CA 19-9 is a type of tumor marker. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in the body.

76
Q

AFP

A

Yellow Bottle

An alpha-fetoprotein (AFP) test is a blood test that measures the amount of AFP present in blood. It’s usually part of what’s called a triple screen or quad screen in the second trimester of pregnancy. However, it can also be useful for adults who aren’t pregnant.

77
Q

Lactate dehydrogenase (LDH)

A

Yellow Bottle

A lactate dehydrogenase (LDH) test measures the amount of LDH in the blood.

Lactate dehydrogenase is an enzyme that the body uses during the process of turning sugar into energy for your cells to use.

LDH is found in many of the body’s tissues and organs, including the muscles, liver, heart, pancreas, kidneys, brain and blood cells.

The LDH test is mainly used to help identify the location and severity of tissue damage in the body.

It’s also sometimes used to monitor how far certain conditions have progressed.

These include:

kidney disease

liver disease

some types of cancer

In the past, LDH levels were also used to help diagnose and monitor heart attacks. But other tests are now usually used to do this.

78
Q

Ethanol

Cannabis

Opiates

Benzodiazepines

Other drugs (e.g. cocaine, amphetamines)

A

Yellow Tube (toxicology)

79
Q

Paracetamol

Salicylates (aspirin)

Digoxin

Lithium

Gentamicin

Carbamazepine

A

Yellow Bottle

Drug Level Tests

80
Q

Microbiology/virology tests

A

Yellow Bottle

The yellow blood bottle can be used to test for a wide variety of bacterial, viral, fungal and parasitic infections including HIV and viral hepatitis.

81
Q

How many times do you invert Yellow Bottle?

How much blood is needed for each test?

Separate tubes for biochemistry and microbiology.

A

The yellow bottle needs to be inverted about 5 times to mix the sample with the silica and separator. Don’t panic if the blood starts to clot or separate in the bottle, it’s supposed to!

The amount of blood required will depend on how many tests you’re doing, but at least 1ml is ideal. You can usually get about 12 tests from one full yellow bottle.

Remember that different labs may be located in different areas and technicians don’t like sharing – this means you’ll need to put your biochemistry and microbiology samples in separate yellow bottles to go to their respective laboratories.

82
Q

Immunology Tests:

Immunoglobulin levels

Complement levels

Autoantibody screen

Rheumatoid factor

Thyroid antibodies

α1AT

ACE

A

Yellow Bottle

83
Q

What are the two main additives in the grey bottle?

A

Sodium fluoride acts as an antiglycolytic agent to ensure that no further glucose breakdown occurs within the sample after it is taken. Potassium oxalate acts as an anticoagulant. Some variants of the grey bottle use EDTA as the anticoagulant instead.

84
Q

Glucose (fasting and non-fasting)

A

Grey Bottle

85
Q

Lactate

A

Grey Bottle

86
Q

How many times should you invert the grey bottle?

A

The grey bottle needs to be inverted about 8 times to mix the sample with the fluoride and oxalate.

87
Q

How much blood is needed for glucose and lactose?

A

Only a tiny amount of blood is required for a glucose test, but to assess lactate levels the bottle should ideally contain at least 1ml of blood.

Venous glucose results are generally more accurate than finger-prick capillary blood glucose tests, especially in hyperglycaemic patients, but can take a while to come back from the lab. If you require a blood glucose test urgently then kindly ask one of the nurses to perform a capillary blood glucose for you on the ward.

Samples for venous lactate need to be sent to the lab immediately. Again, the results tend to take a while to come back, so if you’re desperate to quickly assess a patient’s lactate level see if you can get access to an ABG machine that does arterial lactates – these are often available in A&E or ITU and take about 2 minutes to process.

88
Q

What is the red bottle used for?

A

The red bottle is less common – it is used for biochemistry tests requiring serum which might be adversely affected by the separator gel used in the yellow bottle.

89
Q

What is the additive in the red bottle?

A

The additive in red blood bottles contains silica particles which act as clot activators.

The red bottle needs inverting 5 times to mix the sample with the clot activator.

There is also another version of the red bottle made out of glass, which contains no additives whatsoever.

90
Q

What is the red bottle used for?

A

Common tests

The use of this bottle varies greatly, some hospitals use it for many sensitive tests, including hormones, toxicology, drug levels, bacterial and viral serology and antibodies, whereas others seem to only use it for a few very specific purposes and use the yellow bottle for most things.

Often for ionised calcium, but not much else.

Less common tests performed using the red bottle include:

Fluoride

Cryoglobulins

Cold agglutinins

91
Q
A
92
Q
A

Phlebotomy (1 decks)

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