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CLINICAL CHEMISTRY > L3: SPECIMEN HANDLING AND PROCESSING (PART 2) > Flashcards

L3: SPECIMEN HANDLING AND PROCESSING (PART 2) Flashcards

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1
Q

TOF: Proper handling of specimens from collection until test performance accurately re flects the status of the patient.

A

TRUE

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2
Q

Systematic process of determining whether a product or service meets specified requirements

A

Quality Assurance

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3
Q

What are the 3 Phases in Laboratory of QA?

A

Pre-analytical Phase
Analytical Phase
Post-analytical Phase

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4
Q

known as the pre-examination

A

Pre-analytical Phase

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5
Q

Determine the Phase in Lab:
Specimen Handling

A

Pre-Analytical Phase

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6
Q

Determine the Phase in Lab:
Specimen Processing

A

Pre-Analytical Phase

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7
Q

Determine the Phase in Lab:
Blood Collection

A

Pre-Analytical Phase

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8
Q

Determine the Phase in Lab:
Patient Identification

A

Pre-Analytical Phase

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9
Q

Determine the Phase in Lab:
Preparation of Materials

A

Pre-Analytical Phase

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10
Q

Determine the Phase in Lab:
Specimen Testing

A

Analytical Phase

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11
Q

Determine the Phase in Lab:
Test Performance

A

Analytical Phase

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12
Q

Determine the Phase in Lab:
Reporting of Results

A

Post-Analytical Phase

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13
Q

Determine the Phase in Lab:
Interpretation of Results

A

Post-Analytical Phase

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14
Q

Determine the Phase in Lab:
Recording of Results

A

Post-Analytical Phase

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15
Q

known as the Examination

A

Analytical Phase

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16
Q

known as the Post-Examination

A

Post-Analytical Phase

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17
Q

Factors that alter test results that are introduced into the specimen before testing, including before and during collection, and during transport, processing, and storage.

A

Pre-Analytical Errors

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17
Q

One of the important pre-analytical error.

A

Improper handling of specimen

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18
Q

Pre-analytical error that could result in erroneous misleading, delayed results, and incorrect care of the patient.

A

Improper handling of specimen

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19
Q

Labels on primary sample tubes that are vital in detecting errors and to minimizing clerical errors.

A

Barcode labels

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20
Q

Give 3 controllable pre-analytical variables

A
  • physiologic
  • lifestyle
  • drug administration
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20
Q

A physiologic variable that risks the sample for hemoconcentration or hemodilution.

A

Posture

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20
Q

What are the different types of barcode labels?

A
  • 1D Linear Barcodes
  • 2D QR Barcodes
  • Radio Frequency ID
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21
Q

A physiologic variable that is common with athletes.

A

Physical training

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21
Q

A physiologic variable that cause fluid retention - decreasing proteins and protein-bound constituents

A

Prolonged bed rest

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22
Q

TOF: Athletes have higher HDL, urea, and creatinine while having low levels of lipids and thyroxine.

A

FALSE - they only have low level of lipids

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23
Q

A physiologic variable that is influenced by growth hormone, cortisol, testosterone etc.

A

Circadian variation

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24
Q

Potassium, Renin, Aldosterone

High in morning or High at Night?

A

High in morning

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25
Q

Iron, Cortisol, Insulin

High in morning or High at Night?

A

High in morning

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26
Q

Growth hormone, testosterone, TSH, Prolactin

High in morning or High at Night?

A

High at night

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27
Q

A physiologic variable that decreases stimulation of hypothalamic pituitary axis.

A

Blindness

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28
Q

Two conditions caused by decreased stimulation of hypothalamic pituitary axis.

A

Hypopituitarism and Hypoadrenalism

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29
Q

A physiologic variable that is affected by several time zones and flights.

A

Travel

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30
Q

TOF: Traveling across several time zones affects the circadian rhythm.

A

TRUE

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31
Q

TOF: Traveling affects days to reestablish a new nocturnal pattern.

A

FALSE (diurnal)

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32
Q

TOF: Flights can cause increased glucose, triglycerides, glucocorticoids, fluid, and sodium retention

A

TRUE

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33
Q

A physiologic variable that is influenced by caffeine, serotonin, obesity, malnutrition, etc.

A

Diet

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34
Q

Diet sub-variable that increases 5 HIAA excretion.

A

Serotonin

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35
Q

Diet sub-variable that is affected by consumption of bananas, pineapples, tomatoes, and avocados.

A

Serotonin

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36
Q

Diet sub-variable that impedes gastrointestinal absorption of calcium, cholesterol, and triglycerides, when consumed habitually.

A

Bran (means the outer coating or shell on grain that is removed while processing white flour)

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37
Q

Diet sub-variable that increases glucose, iron, total lipids, ALP, urea, phosphates, and uric acid.

A

Food ingestion

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38
Q

Diet sub-variable that stimulates adrenal medulla.

A

Caffeine

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39
Q

Diet sub-variable that manifest increased catecholamines, glucose, cortisol, free fatty acids, lipids, and lipoproteins.

A

Caffeine

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40
Q

Diet sub-variable that increases urea, ammonia, and uric acid.

A

High meat diet

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40
Q

Diet sub-variable that decreases LDL, VLDL and phospholipids, total lipids, and vitamin B12.

A

Vegetarianism

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41
Q

Diet sub-variable that increase urine ketones and serum urea.

A

High protein, Low carbohydrate

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42
Q

Diet sub-variable that increases uric acid.

A

Purine-rich diet (e.g., organ meats, alcohol, seafood, sweetened beverages)

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43
Q

Diet sub-variable that has a positive correlation with cholesterol, triglycerides, LDL, uric acid, LDH and glucose.

A

Obesity

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44
Q

Diet sub-variable that has a negative correlation with serum phosphates and testosterone in males.

A

Obesity

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45
Q

What is the correlation of obesity with cholesterol, triglycerides, LDL, uric acid, LDH and glucose?

A

Positive

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46
Q

Diet sub-variable that impairs glucose tolerance.

A

Obesity

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46
Q

What is the correlation of obesity with serum phosphates and testosterone in males?

A

Negative

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47
Q

Diet sub-variable that decreases plasma proteins in general except the gamma globulins.

A

Malnutrition

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48
Q

Diet sub-variable that lowers blood glucose and insulin.

A

Fasting and starvation

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49
Q

Diet sub-variable that increases glucagon, lipolysis, triglycerides, and uric acid

A

Fasting and starvation

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50
Q

Diet sub-variable that increases serum bilirubin.

A

Fasting for 48 hours

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51
Q

A physiologic variable that is influenced by smoking, alcohol ingestion, and stress.

A

Lifestyle

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51
Q

Give 4 non-controllable pre-analytical variables

A
  • biological influences
  • environmental factors
  • long term cyclical changes
  • underlying medical conditions
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52
Q

Give the 3 biological influences under non-controllable variables.

A

age, sex, and race

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52
Q

Age sub-variable wherein they have higher Hgb and bilirubin.

A

Newborns

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53
Q

Age sub-variable that has increased ALP and creatinine.

A

Growth spurt

53
Q

What is the predominant hemoglobin in newborns?

A

Hgb F / Hemoglobin F

54
Q

What day after birth where bilirubin is at peak?

A

5th day

54
Q

Age sub-variable that has increased cholesterol due to decreased estrogen.

A

Postmenopause

55
Q

Sex sub-variable wherein these individuals have higher magnesium, calcium, albumin, hemoglobin, serum iron, and ferritin.

A

Males

55
Q

Sex sub-variable wherein these individuals have lower ALP, aminotransferases, creatine kinase and aldolase.

A

Females

55
Q

TOF: increased oxygen = increased hemoglobin 2 and 3

A

FALSE

56
Q

Environmental factor sub-variable that have decreased oxygen causing increased hemoglobin, 2,3 DPG, and RBC Count.

A

Altitude

56
Q

Age sub-variable that has decreased T3, PTH, aldosterone, and cortisol.

A

Elderly

57
Q

It expands plasma volume and causes an increase in plasma protein when being measured.

A

Heat

57
Q

Environmental factor sub-variable that have e ffects on the di fferent analytes presence in the body.

A

Ambient Temperatures

58
Q

Give 3 environmental factors under non-controllable variable.

A

altitude, ambient temperatures, and place of residence

59
Q

Non-controllable variable that is affected by seasonal influences and menstrual cycles.

A

Long Term Cyclical Changes

60
Q

TOF: Hormonal changes during menstrual cycles affect certain analytes of males when being measured.

A

FALSE (female lang may menstrual cycle baliw)

61
Q

Non-controllable variable that is affected by fever, shock, trauma, and blood transfusion.

A

Underlying medical conditions

62
Q

What are the 9 factors affect the variation of results?

A
  1. exercise
  2. fasting
  3. diet
  4. posture/position
  5. tobacco smoking
  6. alcohol ingestion
  7. stress
  8. drugs
  9. circadian rhythm (physiologic variation)
63
Q

A factor affecting skeletal muscle enzymes.

A

Exercise

64
Q

Give at least 2 skeletal muscle enzymes.

A
  • creatine kinase (CK)
  • transaminases aspartate aminotransaminase (AST)
  • alanine aminotransaminase (ALT)
  • lactate dehydrogenase (LDH)
  • aldolase
65
Q

TOF: Skeletal muscle enzymes increase after exercise. It will give false increase if the patient performed exercise before blood collection.

A

TRUE

66
Q

What is the term wherein the blood is collected early in the morning before rising?

A

Basal State Collection

67
Q

What is the term when a MT collects blood from the patient with the request/ test that needs fasting as one of the requirements.

A

Morning Peak

68
Q

How many hours of fasting does glucose requires?

A

6 to 8 hours

69
Q

How many hours of fasting does Lipid Profile requires?

A

10 to 12 hours (with 14 hours max.)

70
Q

How many hours of fasting does glucose and Lipid profile requires when needed together?

A

8 to 12 hours

71
Q

How many hours of no smoking and alcohol intake before blood collection?

A

24 hours (smoking and alcohol affect analytes in the serum)

72
Q

Why do we need to invert tubes?

A

to distribute the additives with the blood sample

72
Q

Vigorous mixing results to?

A

Hemolysis

72
Q

Inadequate mixing results to?

A

microclot formation

incomplete clotting (in case of gel separation tube)

73
Q

Refers to a system of controls and procedures that document the progress of a sample from the point of collection through the laboratory to its disposal after the results have been accepted.

A

Chain of Custody

73
Q

How to transfer pneumatic tube system specimens?

A
  • protected from shock
  • sealed in a zipper-type plastic bag to contain spills
73
Q

How to transfer blood specimens?

A
  • plastic bag with a biohazard logo
  • liquid tight closure
  • slip pocket for paperwork
74
Q

Why is it important to transport tubes with stopper up?

A

■ Reduce agitation
■ Aids in clot formation
■ Prevent contact of the tube contents with the tube stopper

74
Q

What is the tube that does not have additive?

A

Red top (glass)

75
Q

How to transfer non-blood specimens?

A

leak proof containers

76
Q

Time for blood samples to clot

A

20 to 30 minutes

77
Q

How many minutes/hours should a sample arrived within the laboratory?

A

45 minutes

78
Q

What are the 2 metabolic processes that affect the sample when there is delay of delivery?

A

glycolysis and cellular metabolism

78
Q

How many minutes/hours should a sample be separated to serum?

A

within 1-hour of collection

2 hours per CLSI recommendation

79
Q

What is the maximum time for the clotting, delivery, and separation of cell serum?

A

2 hours

79
Q

What is the term used when the result is needed immediately, thus performing the test immediately?

A

STAT (Shorten Turnaround Time)

80
Q

How does temperature and light affects the analysts to be measured in a sample?

A

Negatively

80
Q

Give the corresponding normal range of temperature relating to specimen handling:

  • body temp:
  • room temp:
  • refrigerated temp:
  • frozen temp:
A

Body Temperature: 36.4 - 37.6
Room Temperature: 15 ̊C - 30 ̊C
Refrigerated Temperature: 2 ̊C - 10 ̊C
Frozen Temperature: -20 ̊C or lower

80
Q

It means refrigerating

A

chilling

80
Q

It slows down metabolic process and protects the analyte.

A

Chilling/Refrigeration

81
Q

Give the 6 Analytes that requires Chilling

A

gastrin
ammonia
lactic acid
cathecholamines
pyruvate
parathyroid hormone (PTH)

82
Q

TOF: Transfer specimen using large ice tube with water to prevent metabolic process.

A

FALSE

83
Q

TOF: Using ice packs, applying directly on the sample, will result in hemolysis or analyte breakdown.

A

FALSE

84
Q

What is the recommended substance needed to achieve freezing temperature?

A

solid CO2 or nitrogen gas

85
Q

Give the 3 analytes that require transport at body temperature?

A
  • Cold agglutinins
  • Cryo brinogen
  • Cryoglobulins
86
Q

What specimen is used for anaerobic transportation For ABG, ionized and nonionized calcium?

A

Acid phosphatase (ACP)

87
Q

TOF: Using heat blocks may be used if the specimen requires more than 37 degree Celsius.

A

TRUE

88
Q

Give the 5 analytes that requires protection from light.

A
  • Bilirubin
  • All Vitamin levels
  • Beta carotene
  • Porphyrins
  • Folate
89
Q

What is the meaning of OSHA?

A

Occupational Safety and Health Administration

90
Q

Which of the following is a reason for specimen rejection?
a. hemolyis
b. QNS
c. clotting in Hematology
d. icteric sample
e. AOTA

A

e. AOTA

91
Q

What is the indication of hemolyzed sample?

A

pink/red color of the plasma or serum

92
Q

What analyte increased in a icteric sample?

A

bilirubin pigment

92
Q

TOF: Clotted blood in gold top tube should be rejected for specimen suitability.

A

FALSE (clotted blood in EDTA)

93
Q

What is the recommended RCF and time to separate the cells from the serum to the plasma?

A

at 850 - 1000 gravitational force
for 10 - 15 minutes

or 1000 - 3000 RCF for 10 minutes

94
Q

TOF: Specimens for tests that require serum and plasma should be centrifuged first before distribution.

A

TRUE

94
Q

A machine that spins blood and other specimens at a high number of revolutions per minute.

A

Centrifuge

95
Q

Why should stoppers remain on tubes while waiting for centrifugation?

A

to prevent contamination, evaporation, aerosol formation, and pH changes.

96
Q

Removal of stopper while waiting will result to 2 conditions of a sample:

A
  1. Loss of CO2 and increases pH
  2. Specimen may evaporate and be contaminated either sweat or powder from gloves
97
Q

Centrifugation of sample more than once will result to?

A

hemolysis

98
Q

On which apparatus should chilled specimens be processed for centrifugation?

A

temperature-controlled refrigerated centrifuge

99
Q

Imbalance evacuated tubes in centrifuge will result in:

A

breakage of tube
aerosol contamination

100
Q

What is the complete clotting time of a sample in room temperature?

A

30 to 60 minutes

101
Q

What is the complete clotting time of a sample in SST and tubes with clot activators?

A

20 to 30 minutes

102
Q

What is the complete clotting time of a sample in thrombin tubes?

A

5 minutes

103
Q

Incomplete clotting of blood sample will result in _______

A

fibrin formation

104
Q

TOF: The use of wooden applicator sticks for “rimming” the sides of the tube is RECOMMENDED!

A

FALSE (not recommended)

105
Q

What is the specific gravity of thixotropic gel separator?

A

1.04

105
Q

Give 5 reasons for rapid separation of blood after centrifugation

A
  • to prevent hemolysis, glycolysis, lipolysis, and shift of electrolytes
  • certain substances are very unstable
106
Q

What are seen as the end product of a gold tube after centrifugation? (enumerate top to bottom)

A
  • serum
  • lymphocyte and monocyte band
  • density gradient fluid
  • gel barrier
  • erythrocytes and neutrophils
107
Q

It is defined as a portion of the specimen that is used for testing.

A

aliquot

107
Q

What are the tests that required plasma collected in a citrated tube?

A

Prothrombin Time and Activated Plasma Thromboplastin Time

107
Q

A disposable transferring device used in transferring a portion of the specimen into one or more tubes.

A

Pasteur pipettes

108
Q

TOF: Pouring of plasma will decrease the possibility of aerosol formation.

A

FALSE (increase)

109
Q

Give at least 5 reasons for specimen rejection

A
  • Inadequate, inaccurate, or missing specimen identification
  • Under filling of additive tubes
  • Hemolysis
  • Wrong Tube
  • Outdated/expired Tube
  • Improper handling of specimen
  • Contaminated Specimen
  • Quantity Not Sufficient (QNS)
  • Wrong Collection Time
  • Light Exposure
  • Delay in Testing
  • Delay or Error in Processing
110
Q

Which is more acceptable sample: overfilled or under-filled tube?

A

overfilled

111
Q

What is the amount of Hgb found in red color plasma/serum?

A

100 mg/dL of hemoglobin

112
Q

What is the amount of Hgb found in pink color plasma/serum?

A

20 mg/dL of hemoglobin

113
Q

__________ is presence of a high concentration of lipids (or fats) in the blood

A

Lipemia

114
Q

TOF: Specimen is unacceptable when it has milky appearance of serum due to inadequate fasting.

A

TRUE
(acceptable only if patient’s fasting is correct)

115
Q

Lactescent serum is present when there is inadequate fasting for lipid pro file caused by __________.

A

Chylomicrons

116
Q

TOF: Dark yellow or orange plasma is a reason for rejection.

A

FALSE

117
Q

Give the missing amount of Hgb in a hemolyzed sample:

(-) 0 mg/dl
(+) ___ mg/dl
(++) 150 mg/dl
(+++) ___ mg/dl
(++++) ___ mg/dl

A

50, 250, 525

118
Q

Give the missing amount of Total bilirubin in a icteric sample:

(-) 0 mg/dl
(+) 1.7 mg/dl
(++) ___ mg/dl
(+++) ___ mg/dl
(++++) ___ mg/dl

A

6.6, 16, 30

119
Q

Give the missing amount of intralipid in a lipemic (turbid) sample:

(-) 0 mg/dl
(+) ___ mg/dl
(++) ___ mg/dl
(+++) ___ mg/dl
(++++) 1000 mg/dl

A

125, 250, 500

120
Q

TOF: Stoppers should be removed by using thumb roll technique.

A

FALSE (should be pulled straight up and o ff)

121
Q

TOF: In real settings, the plasma is not separated with the blood in PT and PTT tests., since it is not ideal to separate them.

A

FALSE (ideal to separate plasma in PT and PTT tests)

CLINICAL CHEMISTRY (1 decks)

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