hema - veni and anticoagulant Flashcards by Sharmaine Madjid

first step in skin preparation

cleanse the skin with alcohol swab

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what should be maintained in skin preparation?

asepsis

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2 sources of microbial contamination

hand of the phlebotomists
skin of the patient

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what are the blood collection method in skin puncture

capillary blood/peripheral blood

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site of the capillary blood

finger, earlobe and medial/lateral portion of the plantar surface of the foot

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skin puncture order of draw

lavender-plasma additive-serum tubes

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puncture site for infants under 12 mos

lateral/medial plantar heel surface

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puncture site for infants below 12 mos, children and adult

palmar surface of last digit of 2nd, 3rd, 4th finger

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two methods of venipuncture

syringe and evacuated tube method

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needle length range

1 inch for routine venipuncture and 1.5 inches for patients with deep veins

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angle of the syringe

15 degrees

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suitable needle gauge for adults

19-21 g

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suitable needle gauge for childreen

23g

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needle used when blood is to be collected from a very small vein

butterfly needles (21, 23, 25 g)

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site for venipuncture?

antecubital fossa

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veins in the antecubital fossa

median cubital, median cephalic, and basilic

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alternate sites

ventral forearm, wrist area, back of the hand and ankle/foot

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order of draw

yellow - blue - red - green - lavender - gray

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specimen rejections

clotted specimen, severely hemolyzed specimen, improperly labeled specimen, specimen too old, failure to meet volume criteria, improperly dilluted capillary specimen, leaking tube, delay in transport and collection of specimens in wrong tube.

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immediate local complications

haemoconcentration, collapse of the vein, failure of blood to enter the syringe.

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immediate general complications

syncope

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late local complications

thrombosis of the vein, thrombophlebitis, hematoma

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errors in s.c

misidentification of patient, mislabeling of specimen, short draws, mixing problem, wrong anticoagulant, hemolysis/lipemia, hemoconcentration of prolonged torniquet, extreme temperature, delayed delivery, processing errors

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peaks at 4-6 am, lowet at 8 pm to 12 am

cortisol

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lower at night, increased with stress

adrenocorticotropic hormone

lower at night, increased with supine>standing

plasma renin activity

lower at night

insulin, aldosterone

higher in the afternoon and evening

growth hormone, acid phosphate

increase with exercise

thyroxine

higher with stress and 4-8 am and 8-10 pm

prolactin

peaks early in the morning, decreases up to 30%

iron

4% decrease supine

calcium

commonly used anticoagulants

edta, double oxxalate, sodium citrate, sodium flouride, heparin, acd, cpd and cpda.

chelates ca (calcium)

EDTA

uses of edta

cell count, blood smear, platelet count and for routine hematology

EDTA salts

sodium, potassium and lithium

____ more soluble than _____

dipotassium, disodium

equally effective, sample of blood can be used for chemical investigations

dilithium

liquid form edta salt

tripottassium

disadvantage of tripotassium edta salt

dilution, shrinkage of rbc, decrease in 2-3% PCV in 4 hours and gradual increase in MCV

EDTA salt that is not recommended because of high pH

trisodium edta

coding of vial of EDTA

lavender cap

recommended EDTA concentration

1.5-2.0 mg/ml

binds ca in soluble complex

Na citrate

used for coagulation studies

na citrate

vial coding of na citrate

blue

acts as chelating calcium in blood used as 3.2% and 3.8%

trisodium citrate

gets rid of the calcium but not strongly as edta

na citrate

binds ca to form insoluble Ca oxalate

oxalate

disdvantages of oxalate

1. Calcium in the blood combines with oxalate to form insoluble calcium oxalate which precipitates. 2. They are phagocyted by neutrophils-distort WBC morphology-good for smears 3. Never used In blood to be transfused- as it is toxic and calcium oxalate precipitate may harm.

prevents glycolysis

flouride

double action of sodium flouride

1. prevents clotting by chelating calcium 2. prevents all phosphatase action 3. prevents glycolysis for 3 days

flouride is used for ___

determination of sugar

in bacterial septicemia, fluoride inhibition of glycolysis is neither

adequate nor effective

common disadvantages with calcium chelators

1. Amylase activity inhibited by oxalate and citrate 2. LDH and Acid Phosphatase inhibited by oxalate. 3. Fluoride, heparin OR EDTA interfere with accurate determination of electrolytes.

concentration of lithium or sodium salt

10-20 ml

recommended add in heparin

lithium

heparin is produced by

basophils and mast cells

heparin accelerates

antithrombin III

heparin neutralizes ____ and prevents formation of ____

thrombin ; fibrin

heparin prevents formation of

clots and extension of existing clots

heparin don't ___

break down clots already formed

blood storage for heparin

5-10 ml

sample collection for heparin

0.5-2.0ml

uses of heparin

ammonia, carboxyhemoglobin, blood gases, electrolytes, esr, methamoglobin, osmotic fragility and hla typing

disadvantages of heparin

costly, Not suitable for blood counts as it often induces platelet and leucocyte clumping, Should not be used in study of PCR with restriction enzymes because it inhibits enzyme activity.

used for routine hematology

edta (lavender)

used for coagulation studies

sodium citrate (blue)

fused for glucose determination

k-oxalate/sodium fluoride (grey)

used for collection of serum

no additive, red

used for preservation of RBC for blood banking and HLA typing

ACD (yellow)

used for inhibition of thrombin activation

Heparin (green)

required volume for preservation of blood

15mL of ACD and 14mL of CPD and CPDA-1 is required for preservation of blood

initial pH of acd, cpd and cpda

Initial pH of ACD 5.0 and of CPD & CPDA-1 is 5.6

storage time at 2-6 degree celcius for ACD, CPD AND CPDA-1

storage time at 2-6 degree celsius for ACD and CPD is 21 days and for CPDA-1 is 35 days.

causes chelation of calcium

citrate

prevents fall in pH

sodium diphosphate

addition of glucose prolongs survival of stored RBC as it is required for metabolism. Glucose passes from plasma to RBC and is utilized for energy production.

dextrose

2 pathways for energy production

90% embedem mayeroff and 10% pentose phosphate

there is breakdown of glucose into lactate though anaerobic glycolysis.

90% embedem mayeroff pathway

added in modified CPD as it improves viability of RBC because of enhanced ATP production.

adenine

pathway through aerobic glycolysis

10% pentode phosphate

fairly weak tribasic hydroxy acid.

citric acid

storage environment of RBC is altered by adding certain nutrients after removal of plasma.

additive system

adjust osmotic pressure

sodium chloride

maintains high level of ATP in RBC

adenine

prevents disintegration of RBC

mannitol