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Laboratory Management > Chapter 5: Pre-analysis > Flashcards

Chapter 5: Pre-analysis Flashcards

1
Q
  • It is defined as all the complex steps required before sample analysis.
  • The first and most crucial phase in the laboratory.
  • It is the major source of residual error.
A

Pre-analytic phase

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2
Q
  • Patient-related variables
  • Specimen collection and labeling techniques
  • Specimen preservatives and anticoagulants
  • Specimen transport
  • Specimen processing and storage
A

Pre-analytic factor

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3
Q

What are the most frequent pre-analytic errors?

A
  • Improper filling of the sample tube
  • Placing specimens in the wrong container or preservatives
  • Selecting the incorrect test
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4
Q

What phase of the collection?

  • Incorrect test ordered
  • Inadequate patient preparation
  • Misidentification of patient
A

Before collection

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4
Q

What phase of the collection?

  • Wrong container & additive
  • Short draw, wrong anticoagulant, and blood ratio
  • Hemoconcentration from prolonged tourniquet time
  • Hemolysis due to incorrect technique
A

During collection

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5
Q

What phase of the collection?

  • Inadequate mixing or clots
  • Mislabeling of specimen
  • Improper transport to lab; exposure to light, extreme temperature, or delayed delivery
  • Processing error; incomplete centrifugation, incorrect log-in, improper storage or aliquoting prior to analysis
A

After collection

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6
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Peaks 4-6 AM; lowest 8 PM–12 AM; 50% lower at 8 PM than at 8 AM; increased with stress

A

Cortisol

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7
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Lower at night; increased with stress

A

Adrenocorticotropic hormone (ACTH)

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8
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Lower at night; higher standing than supine

A

Plasma renin activity (PRA)

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9
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Lower at night

A

Aldosterone & Insulin

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10
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Higher in afternoon and evening

A

Growth hormone & Acid phosphatase

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11
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Increases with exercise

A

Thyroxine

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12
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Higher with stress; higher levels at 4 and 8 AM and at 8 and 10 PM

A

Prolactin

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13
Q

Tests Affected by Diurnal Variation, Posture, and Stress

Peaks early to late morning; decreases up to 30% during the day

A

Iron

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14
Q

Tests Affected by Diurnal Variation, Posture, and Stress

4% decrease supine

A

Calcium

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15
Q

What physiologic factors exercise are given?

  1. Free fatty acid - Initial decrease then increase
  2. Lactase - It will increase 300%
  3. CK, AST, LD - It will increase
  4. Activates coagulation, fibrinolysis, and platelets
A

Transient effect

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16
Q

What physiologic factors exercise are given?

  1. CK, aldolase, AST, LD - It will increase
  2. Prolactin - elevated
  3. Serum gonadotrophin - decrease
A

Long-term effect

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17
Q
  • It can greatly affect laboratory test results.
  • The effect is transient and is easily controlled.
A

Diet

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18
Q

Physiological factor: Diet

  • When determining blood constituents such as glucose, triglycerides, cholesterol, and electrolytes, collection should be done in the ___
A

Basal state

19
Q

Physiological factor: Diet

  • After how many hours of fasting when serum bilirubin increased?
A

48 hours

20
Q

Physiological factor: Diet

  • After how many hours of fasting when plasma glucose is decreased while plasma triglycerides, glycerol, and free fatty acids are increased.
A

72 hours

21
Q

What would be the effect of mental and physical stress?

A

Increased ACTH, cortisol, and catecholamines

22
Q

What would be the effect of mild stress?

A

Increased cholesterol and decreased HDL

23
Q

What would be the effect of hyperventilation?

A

Acid-base balance is affected, elevated leukocyte count, serum lactate, and free fatty acid

24
Q

Elements affected by postural changes;

A
  • Albumin
  • Calcium
  • Total protein
  • Enzymes
  • Bilirubin
  • Cholesterol
  • Triglycerides
25
Q

Upright position;

A
  • Increased hydrostatic pressure
  • Reduces plasma volume
  • Increased proteins
26
Q

Supine position;

A
  • Elevated albumin
  • Calcium
27
Q

Physiologic factor; age

  • Men in 20s
A
  • Uric acid at its peak
28
Q

Physiologic factor; age

  • Post-menopausal women
A
  • Increased in cholesterol while decreased estrogen level
29
Q

Physiologic factor; age

  • Elderly men
A
  • Decreased testosterone concentration
30
Q

Physiologic factor; age

  • Elderly woman
A
  • Increase FSH
31
Q

Physiologic factor; age

  • Alkaline phosphatase
  • Aminotransferase
  • Aldolase
  • Creatinine Kinase
A

For male

32
Q

Physiologic factor; age

  • Magnesium
  • Calcium
  • Albumin
  • Hemoglobin
  • Serum iron
A

For female

33
Q

Prolonged tourniquet application result?

A

It may increase serum enzymes, proteins, cholesterol, calcium, and triglycerides.

34
Q

Using a tourniquet for lactate concentration may result in?

A

Falsely increased value

35
Q
  • Policy on patient refusal
  • Policy on the difficult of blood drawing for some patients
  • Policy on how to deal combative patient
  • Emergency measures for patient
  • The Philippine Data Privacy Act of 2012 | Republic Act 10173
A

Test order

36
Q

Blood Collection Tubes

  • Anticoagulant of choice for hematol morphology
  • Maybe spray-dried or liquid form
A

EDTA (Ethylene-diamine-tetraacetic-acid)

37
Q

Blood Collection Tubes

  • Used for glucose measurements
  • Prevent glycolysis
A

Sodium fluoride | Potassium oxalate

38
Q

Blood Collection Tubes

  • Preserves labile coagulation factors
  • Used for coagulation studies
  • Tube must be adequately filled
A

Sodium citrate

39
Q

Blood Collection Tubes

  • Used for arterial blood gases
  • Accelerates the action of antithrombin III, neutralizing thrombin, and prevents the formation of fibrin
A

Sodium heparin | Lithium heparin

40
Q

Blood Collection Tubes

  • Contain separator gel
  • Used for routine chemistry test
A

Serum separator tube

41
Q

Order of Draw

A
  1. Color Varies - Blood cultures
  2. Light Blue - Sodium citrate
  3. Red - Clot activator
  4. Gold - SST
  5. Light Green - Lithium heparin
  6. Dark Green - Sodium heparin
  7. Violet - EDTA
  8. Gray - Sodium fluoride
42
Q

What are the preferred in order for arterial puncture?

A
  1. Radial
  2. Brachial
  3. Femoral
43
Q

Common interference

  • Tobacco smoking
  • Increased cortisol, lactate, and insulin
  • Increased hemoglobin
  • Decreased sperm counts and motility
A

In Vivo

44
Q

Common interference

  • Collection associated variables
  • Hemolysis
  • Light exposure
  • Prolonged tourniquet application
A

In Vitro

Laboratory Management (6 decks)

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