L3: SPECIMEN HANDLING AND PROCESSING (PART 2) Flashcards
1
Q
TOF: Proper handling of specimens from collection until test performance accurately re flects the status of the patient.
A
TRUE
2
Q
Systematic process of determining whether a product or service meets specified requirements
A
Quality Assurance
3
Q
What are the 3 Phases in Laboratory of QA?
A
Pre-analytical Phase
Analytical Phase
Post-analytical Phase
4
Q
known as the pre-examination
A
Pre-analytical Phase
5
Q
Determine the Phase in Lab:
Specimen Handling
A
Pre-Analytical Phase
6
Q
Determine the Phase in Lab:
Specimen Processing
A
Pre-Analytical Phase
7
Q
Determine the Phase in Lab:
Blood Collection
A
Pre-Analytical Phase
8
Q
Determine the Phase in Lab:
Patient Identification
A
Pre-Analytical Phase
9
Q
Determine the Phase in Lab:
Preparation of Materials
A
Pre-Analytical Phase
10
Q
Determine the Phase in Lab:
Specimen Testing
A
Analytical Phase
11
Q
Determine the Phase in Lab:
Test Performance
A
Analytical Phase
12
Q
Determine the Phase in Lab:
Reporting of Results
A
Post-Analytical Phase
13
Q
Determine the Phase in Lab:
Interpretation of Results
A
Post-Analytical Phase
14
Q
Determine the Phase in Lab:
Recording of Results
A
Post-Analytical Phase
15
Q
known as the Examination
A
Analytical Phase
16
Q
known as the Post-Examination
A
Post-Analytical Phase
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
17
Q
One of the important pre-analytical error.
A
Improper handling of specimen
18
Q
Pre-analytical error that could result in erroneous misleading, delayed results, and incorrect care of the patient.
A
Improper handling of specimen
19
Q
Labels on primary sample tubes that are vital in detecting errors and to minimizing clerical errors.
A
Barcode labels
20
Q
Give 3 controllable pre-analytical variables
A
- physiologic
- lifestyle
- drug administration
20
Q
A physiologic variable that risks the sample for hemoconcentration or hemodilution.
A
Posture
20
Q
What are the different types of barcode labels?
A
- 1D Linear Barcodes
- 2D QR Barcodes
- Radio Frequency ID
21
Q
A physiologic variable that is common with athletes.
A
Physical training
21
A physiologic variable that cause fluid retention - decreasing proteins and protein-bound constituents
Prolonged bed rest
22
TOF: Athletes have higher HDL, urea, and creatinine while having low levels of lipids and thyroxine.
FALSE - they only have low level of lipids
23
A physiologic variable that is influenced by growth hormone, cortisol, testosterone etc.
Circadian variation
24
Potassium, Renin, Aldosterone
High in morning or High at Night?
High in morning
25
Iron, Cortisol, Insulin
High in morning or High at Night?
High in morning
26
Growth hormone, testosterone, TSH, Prolactin
High in morning or High at Night?
High at night
27
A physiologic variable that decreases stimulation of hypothalamic pituitary axis.
Blindness
28
Two conditions caused by decreased stimulation of hypothalamic pituitary axis.
Hypopituitarism and Hypoadrenalism
29
A physiologic variable that is affected by several time zones and flights.
Travel
30
TOF: Traveling across several time zones affects the circadian rhythm.
TRUE
31
TOF: Traveling affects days to reestablish a new nocturnal pattern.
FALSE (diurnal)
32
TOF: Flights can cause increased glucose, triglycerides, glucocorticoids, fluid, and sodium retention
TRUE
33
A physiologic variable that is influenced by caffeine, serotonin, obesity, malnutrition, etc.
Diet
34
Diet sub-variable that increases 5 HIAA excretion.
Serotonin
35
Diet sub-variable that is affected by consumption of bananas, pineapples, tomatoes, and avocados.
Serotonin
36
Diet sub-variable that impedes gastrointestinal absorption of calcium, cholesterol, and triglycerides, when consumed habitually.
Bran (means the outer coating or shell on grain that is removed while processing white flour)
37
Diet sub-variable that increases glucose, iron, total lipids, ALP, urea, phosphates, and uric acid.
Food ingestion
38
Diet sub-variable that stimulates adrenal medulla.
Caffeine
39
Diet sub-variable that manifest increased catecholamines, glucose, cortisol, free fatty acids, lipids, and lipoproteins.
Caffeine
40
Diet sub-variable that increases urea, ammonia, and uric acid.
High meat diet
40
Diet sub-variable that decreases LDL, VLDL and phospholipids, total lipids, and vitamin B12.
Vegetarianism
41
Diet sub-variable that increase urine ketones and serum urea.
High protein, Low carbohydrate
42
Diet sub-variable that increases uric acid.
Purine-rich diet (e.g., organ meats, alcohol, seafood, sweetened beverages)
43
Diet sub-variable that has a positive correlation with cholesterol, triglycerides, LDL, uric acid, LDH and glucose.
Obesity
44
Diet sub-variable that has a negative correlation with serum phosphates and testosterone in males.
Obesity
45
What is the correlation of obesity with cholesterol, triglycerides, LDL, uric acid, LDH and glucose?
Positive
46
Diet sub-variable that impairs glucose tolerance.
Obesity
46
What is the correlation of obesity with serum phosphates and testosterone in males?
Negative
47
Diet sub-variable that decreases plasma proteins in general except the gamma globulins.
Malnutrition
48
Diet sub-variable that lowers blood glucose and insulin.
Fasting and starvation
49
Diet sub-variable that increases glucagon, lipolysis, triglycerides, and uric acid
Fasting and starvation
50
Diet sub-variable that increases serum bilirubin.
Fasting for 48 hours
51
A physiologic variable that is influenced by smoking, alcohol ingestion, and stress.
Lifestyle
51
Give 4 non-controllable pre-analytical variables
- biological influences
- environmental factors
- long term cyclical changes
- underlying medical conditions
52
Give the 3 biological influences under non-controllable variables.
age, sex, and race
52
Age sub-variable wherein they have higher Hgb and bilirubin.
Newborns
53
Age sub-variable that has increased ALP and creatinine.
Growth spurt
53
What is the predominant hemoglobin in newborns?
Hgb F / Hemoglobin F
54
What day after birth where bilirubin is at peak?
5th day
54
Age sub-variable that has increased cholesterol due to decreased estrogen.
Postmenopause
55
Sex sub-variable wherein these individuals have higher magnesium, calcium, albumin, hemoglobin, serum iron, and ferritin.
Males
55
Sex sub-variable wherein these individuals have lower ALP, aminotransferases, creatine kinase and aldolase.
Females
55
TOF: increased oxygen = increased hemoglobin 2 and 3
FALSE
56
Environmental factor sub-variable that have decreased oxygen causing increased hemoglobin, 2,3 DPG, and RBC Count.
Altitude
56
Age sub-variable that has decreased T3, PTH, aldosterone, and cortisol.
Elderly
57
It expands plasma volume and causes an increase in plasma protein when being measured.
Heat
57
Environmental factor sub-variable that have e ffects on the di fferent analytes presence in the body.
Ambient Temperatures
58
Give 3 environmental factors under non-controllable variable.
altitude, ambient temperatures, and place of residence
59
Non-controllable variable that is affected by seasonal influences and menstrual cycles.
Long Term Cyclical Changes
60
TOF: Hormonal changes during menstrual cycles affect certain analytes of males when being measured.
FALSE (female lang may menstrual cycle baliw)
61
Non-controllable variable that is affected by fever, shock, trauma, and blood transfusion.
Underlying medical conditions
62
What are the 9 factors affect the variation of results?
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
A factor affecting skeletal muscle enzymes.
Exercise
64
Give at least 2 skeletal muscle enzymes.
- creatine kinase (CK)
- transaminases aspartate aminotransaminase (AST)
- alanine aminotransaminase (ALT)
- lactate dehydrogenase (LDH)
- aldolase
65
TOF: Skeletal muscle enzymes increase after exercise. It will give false increase if the patient performed exercise before blood collection.
TRUE
66
What is the term wherein the blood is collected early in the morning before rising?
Basal State Collection
67
What is the term when a MT collects blood from the patient with the request/ test that needs fasting as one of the requirements.
Morning Peak
68
How many hours of fasting does glucose requires?
6 to 8 hours
69
How many hours of fasting does Lipid Profile requires?
10 to 12 hours (with 14 hours max.)
70
How many hours of fasting does glucose and Lipid profile requires when needed together?
8 to 12 hours
71
How many hours of no smoking and alcohol intake before blood collection?
24 hours (smoking and alcohol affect analytes in the serum)
72
Why do we need to invert tubes?
to distribute the additives with the blood sample
72
Vigorous mixing results to?
Hemolysis
72
Inadequate mixing results to?
microclot formation
incomplete clotting (in case of gel separation tube)
73
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.
Chain of Custody
73
How to transfer pneumatic tube system specimens?
- protected from shock
- sealed in a zipper-type plastic bag to contain spills
73
How to transfer blood specimens?
- plastic bag with a biohazard logo
- liquid tight closure
- slip pocket for paperwork
74
Why is it important to transport tubes with stopper up?
■ Reduce agitation
■ Aids in clot formation
■ Prevent contact of the tube contents with the tube stopper
74
What is the tube that does not have additive?
Red top (glass)
75
How to transfer non-blood specimens?
leak proof containers
76
Time for blood samples to clot
20 to 30 minutes
77
How many minutes/hours should a sample arrived within the laboratory?
45 minutes
78
What are the 2 metabolic processes that affect the sample when there is delay of delivery?
glycolysis and cellular metabolism
78
How many minutes/hours should a sample be separated to serum?
within 1-hour of collection
2 hours per CLSI recommendation
79
What is the maximum time for the clotting, delivery, and separation of cell serum?
2 hours
79
What is the term used when the result is needed immediately, thus performing the test immediately?
STAT (Shorten Turnaround Time)
80
How does temperature and light affects the analysts to be measured in a sample?
Negatively
80
Give the corresponding normal range of temperature relating to specimen handling:
- body temp:
- room temp:
- refrigerated temp:
- frozen temp:
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
It means refrigerating
chilling
80
It slows down metabolic process and protects the analyte.
Chilling/Refrigeration
81
Give the 6 Analytes that requires Chilling
gastrin
ammonia
lactic acid
cathecholamines
pyruvate
parathyroid hormone (PTH)
82
TOF: Transfer specimen using large ice tube with water to prevent metabolic process.
FALSE
83
TOF: Using ice packs, applying directly on the sample, will result in hemolysis or analyte breakdown.
FALSE
84
What is the recommended substance needed to achieve freezing temperature?
solid CO2 or nitrogen gas
85
Give the 3 analytes that require transport at body temperature?
- Cold agglutinins
- Cryo brinogen
- Cryoglobulins
86
What specimen is used for anaerobic transportation For ABG, ionized and nonionized calcium?
Acid phosphatase (ACP)
87
TOF: Using heat blocks may be used if the specimen requires more than 37 degree Celsius.
TRUE
88
Give the 5 analytes that requires protection from light.
- Bilirubin
- All Vitamin levels
- Beta carotene
- Porphyrins
- Folate
89
What is the meaning of OSHA?
Occupational Safety and Health Administration
90
Which of the following is a reason for specimen rejection?
a. hemolyis
b. QNS
c. clotting in Hematology
d. icteric sample
e. AOTA
e. AOTA
91
What is the indication of hemolyzed sample?
pink/red color of the plasma or serum
92
What analyte increased in a icteric sample?
bilirubin pigment
92
TOF: Clotted blood in gold top tube should be rejected for specimen suitability.
FALSE (clotted blood in EDTA)
93
What is the recommended RCF and time to separate the cells from the serum to the plasma?
at 850 - 1000 gravitational force
for 10 - 15 minutes
or 1000 - 3000 RCF for 10 minutes
94
TOF: Specimens for tests that require serum and plasma should be centrifuged first before distribution.
TRUE
94
A machine that spins blood and other specimens at a high number of revolutions per minute.
Centrifuge
95
Why should stoppers remain on tubes while waiting for centrifugation?
to prevent contamination, evaporation, aerosol formation, and pH changes.
96
Removal of stopper while waiting will result to 2 conditions of a sample:
1. Loss of CO2 and increases pH
2. Specimen may evaporate and be contaminated either sweat or powder from gloves
97
Centrifugation of sample more than once will result to?
hemolysis
98
On which apparatus should chilled specimens be processed for centrifugation?
temperature-controlled refrigerated centrifuge
99
Imbalance evacuated tubes in centrifuge will result in:
breakage of tube
aerosol contamination
100
What is the complete clotting time of a sample in room temperature?
30 to 60 minutes
101
What is the complete clotting time of a sample in SST and tubes with clot activators?
20 to 30 minutes
102
What is the complete clotting time of a sample in thrombin tubes?
5 minutes
103
Incomplete clotting of blood sample will result in _______
fibrin formation
104
TOF: The use of wooden applicator sticks for “rimming” the sides of the tube is RECOMMENDED!
FALSE (not recommended)
105
What is the specific gravity of thixotropic gel separator?
1.04
105
Give 5 reasons for rapid separation of blood after centrifugation
- to prevent hemolysis, glycolysis, lipolysis, and shift of electrolytes
- certain substances are very unstable
106
What are seen as the end product of a gold tube after centrifugation? (enumerate top to bottom)
- serum
- lymphocyte and monocyte band
- density gradient fluid
- gel barrier
- erythrocytes and neutrophils
107
It is defined as a portion of the specimen that is used for testing.
aliquot
107
What are the tests that required plasma collected in a citrated tube?
Prothrombin Time and Activated Plasma Thromboplastin Time
107
A disposable transferring device used in transferring a portion of the specimen into one or more tubes.
Pasteur pipettes
108
TOF: Pouring of plasma will decrease the possibility of aerosol formation.
FALSE (increase)
109
Give at least 5 reasons for specimen rejection
- 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
Which is more acceptable sample: overfilled or under-filled tube?
overfilled
111
What is the amount of Hgb found in red color plasma/serum?
100 mg/dL of hemoglobin
112
What is the amount of Hgb found in pink color plasma/serum?
20 mg/dL of hemoglobin
113
__________ is presence of a high concentration of lipids (or fats) in the blood
Lipemia
114
TOF: Specimen is unacceptable when it has milky appearance of serum due to inadequate fasting.
TRUE
(acceptable only if patient's fasting is correct)
115
Lactescent serum is present when there is inadequate fasting for lipid pro file caused by __________.
Chylomicrons
116
TOF: Dark yellow or orange plasma is a reason for rejection.
FALSE
117
Give the missing amount of Hgb in a hemolyzed sample:
(-) 0 mg/dl
(+) ___ mg/dl
(++) 150 mg/dl
(+++) ___ mg/dl
(++++) ___ mg/dl
50, 250, 525
118
Give the missing amount of Total bilirubin in a icteric sample:
(-) 0 mg/dl
(+) 1.7 mg/dl
(++) ___ mg/dl
(+++) ___ mg/dl
(++++) ___ mg/dl
6.6, 16, 30
119
Give the missing amount of intralipid in a lipemic (turbid) sample:
(-) 0 mg/dl
(+) ___ mg/dl
(++) ___ mg/dl
(+++) ___ mg/dl
(++++) 1000 mg/dl
125, 250, 500
120
TOF: Stoppers should be removed by using thumb roll technique.
FALSE (should be pulled straight up and o ff)
121
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.
FALSE (ideal to separate plasma in PT and PTT tests)
