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Hematology 1 > Blood Specimen Collection and Handling > Flashcards

Blood Specimen Collection and Handling Flashcards

1
Q

blood collection methods

A
  • venipuncture
  • capillary puncture
  • arterial puncture
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2
Q

two methods of venipuncture

A
  • syringe method
  • evacuated tube system/vacutainer method
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3
Q

venipuncture method

uses syringe and is ideal for single withdrawal of blood sample

A

syringe method

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4
Q

it is the method of venipuncture most commonly used for CBC since venous blood is needed

A

syringe method

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5
Q

venipuncture method

it utilizes an evacuated collection system ideal for mutiple blood sampling

A

vacutainer or evacuated tube system method

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6
Q

patterns of vein

A

M and H

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7
Q

preferred site for a patient with H pattern

A

median cubital vein

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8
Q

preferred site for a patient with M pattern

A

median vein of the forearm

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9
Q

this site is not allowed as it has arteries adjacent to it

A

wrist area

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10
Q

if we cannot locate veins in the forearms and arms, we can resort to using the?

A

lower extremeties

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11
Q

considerations for collecting blood from the lower extremeties

A
  • compromised blood flow - elderlies
  • sickle cell anemia patient
  • diabetic patients
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12
Q

why do patients with sicke cell anemia have compromised blood flow?

A

the RBCs that become sickle in shape are trapped in the capillaries and blood vessels which forms clusters

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13
Q

if you cannot locate any vein, you can resort to collecting blood via?

A

capillary puncture

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14
Q

it is the first and most crucial step of blood collection

A

proper patient identification

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15
Q

T or F:

ask the patient’s name in a manner where he/she will state his/her full name and not just a question answerable by yes or no

A

true

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16
Q

are there fasting requirements for CBC

A

none

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17
Q

a test in clinical chemistry with fasting requirement

A

fasting blood sugar

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18
Q

this is a test for determining hemoglobin in blood that is affected by turbidity of a patient’s plasma

A

cyanmethemoglobin

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19
Q

why does the patient’s plasma become turbid after eating a meal

A

chyle formation makes plasma turbid

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20
Q

how many hours after meal should blood be collected for a patient who ate a hefty meal for cyanmethemoglobin

A

2 hours

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21
Q

what will be the result of cyanmethemoglobin if patient’s plasma is turbid

A

falsely elevated

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22
Q

special exams in hematology that requires fasting

A

platelet aggregation studies

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23
Q

how long is the fasting requirement for platelet aggregation studies

A

6-8 hours

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24
Q

factors that affects platelet function

A
  • taking aspirin or aspiring containing drugs
  • taking NSAIDs (non steroidal anti-inflammatory drugs)

these drugs have antiplatelet activity

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25
Q

how long should patient lay off from the antiplatelet activity drugs

A

should not be taking the drugs for about a week

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26
Q

drugs that affect WBC count

A
  • epinephrine
  • cortisol

falsely elevated

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27
Q

drugs that elevate neutrophil count

A
  • corticosteroids or cortisol
  • lithium containing drugs
  • digitalis
  • benazidine drugs
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28
Q

a drug that lowers the count of neutrophil

A

amidopyridine/amidopyridine drugs

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29
Q

patient should be collected blood in what position

A

sitting upright

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30
Q

should the position of the patient be included in the report

A

yes

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31
Q

what happens to the blood count of a patient when he/she is lying down

A

lower blood concentration - lower blood count (diluted)

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32
Q

blood count if patient is sitting upright

A

more concentrated

7-8% higher

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33
Q

most commonly used antiseptic

A
  • 70% alcohol
  • povidone iodine

but generally - 70% alcohol

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34
Q

it has 3 parameters and it is a mathematical computation which includes hemoglobin result

A

red cell indices

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35
Q

included in the red cell indices - MCH

A

mean cell hemoglobin

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36
Q

included in the red cell indices - MCHC

A

mean cell hemoglobin concentration

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37
Q

if patient’s plasma is turbid due to chyle formation, what happens to the MCH and MCHC

A

will also elevate

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38
Q

parameters affected if povidone iodine antiseptic is used

A
  • potassium level
  • phosphates
  • urates

iodine solution is not used in blood chem

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39
Q

but if bloodwork is for alcohol determination, then antiseptic should not be alcohol, but instead?

A

benzalkonium chloride

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40
Q

how long should a tourniquet be applied for?

A

not more than a minute

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41
Q

what happens if tourniquet is applied for too long?

A
  • bluish arm of patient
  • tissue fluid leaks due to excessive squeezing
  • tissue fluid causes hemodilution
  • clotting process of blood is activated
  • hemoconcentration
  • hemolysis
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42
Q

what is the result when tissue fluid leaks during prolonged tourniquet application

A

blood sample is contaminated and blood is diluted

hemodiluted blood - decreased blood count

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43
Q

this is a sensitive blood work that requires preservation of the integrity of clotting factors in the plasma

A

coagulation studies - PT/PTT

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44
Q

if tissue fluid contaminates the specimen for coagulation studies (PT/PTT) what happens to the results

A

abnormal results - shortened time in blood clotting

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45
Q

reference value of PT

A

7-14 seconds

46
Q

reference value of PTT

A

25-45 seconds

47
Q

this also occurs in the blood due to prolonged tourniquet application that affects results of CBC

A

activating the clotting process of the blood

causes blood cell counts to be decreased

48
Q

why are the blood cell counts decreased when clotting process is activated in the blood

A

the blood cells become trapped within fibrin clot when blood clots

49
Q

result of hemoconcentration

A

blood cell counts or analytes are increased

50
Q

result of trauma to red cells or hemolysis

A

decreased RBC count (hematocrit) because they are fragmented

51
Q

parameters in the red cell indices that may be affected when blood is hemolyzed

A
  • MCV -decreased
  • MCHC - increased
  • MCH - increased
  • platelet count - increased
  • WBC count - increased
52
Q

what format of time is used when labeling specimen

A

military time

53
Q

how long is pressured applied for after withdrawing the needle in blood collection

A

2-5 minutes, max of 15 mins

arm should be above the heart

54
Q
A
55
Q

what will you do if a patient has an IV line

A
  • choose the other arm
  • ask nurse to stop the IV line for about 2 mins before collecting
56
Q

what happens to blood when you collect it on an arm with an open IV line

A

blood will be diluted

decreased analytes

57
Q

test that requires blood to not be exposed to air

A

coagulation studies

58
Q

why is it required to prevent exposure to air in blood specimens for coagulation studies

A

platelet is sensitive to air - it becomes activated immediately making the specimen clot prior to testing

59
Q

what happens when blood is allowed to be in contact with air in coagulation studies

A

abnormal result - prolonged time

60
Q

tube used for fasting blood sugar

A

fluoride containing tube or gray top

61
Q

tube used for coagulation studies - PT/PTT

A

citrate or light blue top

62
Q

tube used for CBC

A

EDTA or lavender top

63
Q

tube used for BGA or blood gas analysis

A

heparin or green top

64
Q

always first in the order of draw

A

blood culture - SPS

65
Q

anticoagulants used

A
  • EDTA
  • sodium citrate
  • citrate oxalate
  • heparin
66
Q

an anticoagulant routinely used for hematology

A

EDTA

67
Q

concentration of EDTA used

A

1.5+-0.25 mg/mL (1.25-1.75)

68
Q

2 kinds of EDTA

A
  • K2 or dipotassium EDTA
  • K3 or tripotassium EDTA
69
Q

why do we have to consider the concentration used for EDTA?

A

a high concentration may affect RBC - it may shrink

hematocrit is decreased, MCV decreased, MCHC increased

70
Q
A
71
Q

kind of EDTA used for manual hematocrit

A

dipotassium

tripotassium - causes RBC to shrink

72
Q

advantage of EDTA over other anticoagulants

A

it can preserve the cells - it does not alter the appearance

73
Q

if EDTA is used for a specimen, it should be processed within how many hours?

A

processed immediately or within 2-3 hours (4 hrs at max)

74
Q

what do you call the specimen that exceeds 4 hours in EDTA

A

old EDTA specimens

75
Q

what happens if you use an EDTA specimen that exceeded 4 hours or 6 hours

A

blood cells affected
- platelets swell and burst - MPV increased
- WBC morphology - vacuolation, fragmentation, washing out of granules
- red cells also swell - MCV and hematocrit increased, MCHC decreased

causes platelet count to be decreased

76
Q

what should you do if EDTA specimens cannot be used immediately

A

preserve it in the refrigerator

the blood may then extend up to 12 hours and changes will be prevented

77
Q

if EDTA samples are left on a test tube rack, what happens to the cells and what should you do?

A

cells will settle at the bottom
- tube should be inverted for up to 60 times or simply place in a rotator for 2 minutes

this is for the cells to be distributed evenly again

78
Q

2 concentrations of sodium citrate

A
  • 3.2% - 0.109M
  • 3.8% - 0.129M
79
Q

sodium citrate specimens should be processed within how many hours

A

2 hours

80
Q

this is used for ESR analysis in the Wintrobe method

A

citrate oxalate

81
Q

ESR should be processed within how many hours

A

2 hours

especially if there is EDTA - if not, RBC swells - ESR decreased value

82
Q

it is an ESR analysis method that uses a combination of EDTA-citrate

A

Westergren method

83
Q

anticoagulant used for EOFT in hematology

osmotic fragility test

A

heparin

84
Q

tests that are not for heparin specimens

A
  • CBC
  • reticulocyte count
  • peripheral blood smear

affects WBC count, increased platelets, reticulocyte inclusions not seen

85
Q

blood collection techniques for coagulation studies

A
  • two syringe technique
  • two evacuated tube technique
86
Q

how is two syringe technique done to prevent tissue fluid contamination

A
  • first portion of blood is discarded
  • a new syringe is attached to the needle
  • then collect second portion that will be used
87
Q

how is two evacuated tube technique done

A

using two blue tops
- collect first tube and discard
- collect second tube that will be used for testing

88
Q

anticoagulant used for coagulation studies

A

sodium citrate

89
Q

ideal ratio of blood to anticoagulant

A

9:1

90
Q

what happens if there is too much blood and less anticoagulant

A

prolonged PT/PTT

91
Q

what happens if there is too much anticoagulant and less blood

A

prolonged PT/PTT

92
Q

complications encountered in venipuncture

A
  • ecchymosis
  • hematoma
  • syncope
  • petechiae
  • allergies
  • nerve damage
  • seizure
  • vomiting
93
Q

in obese patients, what should be used as tourniquet

A

blood pressure cuff

40mmHg

94
Q

venipuncture in special situation

A
  • edema
  • obesity
  • burned, damaged, scarred and occluded veins
  • intravenous therapy
  • mastectomy patients
95
Q

indications of capillary puncture

A
  • newborn - 0-11month old
  • difficult veins - chemotherapy, dialysis patient
96
Q

sites for capillary puncture

A
  • lateral side of heel
  • surface of 3rd and 4th digits

thumb is not allowed because there is a pulse

97
Q

this should be avoided in capillary puncture

A

milking process

98
Q

what happens to blood when milking process is done

A
  • hemolysis
  • hemoconcentrated
  • tissue fluid contamination
99
Q

order of draw for capillary puncture

A
  • tube for BGA
  • slides for PBS exam
  • EDTA microcollection tubes
  • other microcollection tubes
  • serum microcollection tubes
100
Q

what should be the distance of pressure from the site of finger tip puncture during microsampling

A

1 centimeter

101
Q

if warm cloth is applied during blood collection in capillary puncture, the temperature should not exceed?

A

42 degrees Celsius

102
Q

reasons for specimen rejection

A
  • tube labels do not match test request
  • hemolyzed sample
  • clotted sample
  • wrong tube is used
  • wrong time of collection - especially for fasting requirements
  • contaminated IV fluid
  • lipemic sample - affects hemoglobin
103
Q

common problems encountered in blood samples

A

hemolyze and clotted sample

104
Q

factors affecting hematology parameters

A
  • hemoconcentration
  • hemodilution
  • clot
  • hemolysis
  • old samples used
  • storage temperature
  • cold agglutinins
  • diurnal levels
105
Q

this is a factor that cannot be controlled

these are the antibodies that will clump our red cells

A

cold agglutinins

106
Q

affected in cold agglutinins

A
  • RBC count drops
  • MCV, MCH, MCHC increased

specimen must be prewared to 37 degrees Celsius - body temp

107
Q

affected in diurnal levels

A
  • eosinophil
  • ferritin values
  • WBCs
108
Q

toxic changes seen in old EDTA blood samples

A
  • karyorrhexis - nuclear degradation and vacuolation
109
Q

it is caused by EDTA in certain blood patient that causes platelet count to be decreased and WBC increased

A

platelet satellitism

110
Q

if a medtech observes platelet satellitism in PBS, what should he/she do?

A

use citrated blood sample instead of EDTA

but mutiply result to a factor of 1.1

111
Q

this system is intended for microbiological testing to make sure that blood sample is sterile

A

closed blood collection system

112
Q
A

Hematology 1 (3 decks)

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