Lesson 8: Special Collections and Point-Of-Care Testing Flashcards
determine the blood type and Rh factor
blood bank: blood type and screen
- checks compatibility between the donor’s and the recipient’s blood
- patient’s serum or plasma and donor’s RBCs
blood bank: Cross-match test
- determines the presence of infection
- identifies the type of organism involved
- measures extent of infection
- identifies best antibiotic that could be prescribed
- blood volume should be 20 to 30mL per culture
- minimum of 10mL per draw for patients weighing more than 80 pounds
- Infants, only 1% to 4% of the total blood volume.
blood culture
- evaluates the blood clotting function
- microclots are avoided by gently inverting anticoagulants tubes 3 or 4 times after collection.
Coagulation Test
- screens for diabetes and other metabolic disorders
- must be obtained 2 hours after meal
2-hour Postprandial Glucose
- diagnose problems in carbohydrate metabolism
- checks the ability to metabolize glucose through the tolerance level
- 1 hour for gestational diabetes
- 3 hours for other glucose metabolism evaluation
Glucose Tolerance Test (GTT) and Oral Glucose Test (OGTT)
-determines the lack of mucosal lactase which is responsible for conversion of lactose into glucose
- same procedure as 2-hour GTT but an equal amount of lactose is substituted for glucose
lactose tolerance test
- verifies the probability that the patient fathered a particular child
- follow the chain of custody protocol and specific identification procedures
Paternity/ Parentage Testing
- tests the drug levels at specific intervals to establish proper drug dosage and avoid toxicity
- collection timing should include the peak and trough levels
Therapeutic Drug Monitoring
- treats polycythemia and hemochromatosis
- done to restore the levels to normal range
- involves withdrawal of approximately 500mL as part of the treatment
Therapeutic Phlebotomy
- checks the presence of toxins in the blood, hair, urine, and other substances
- Toxins usually exist in very small amounts
Toxicology test
- checks the presence of aluminum, arsenic, copper, lead, iron, and zinc
- measured in small amounts
Trace elements
to determine which blood product can be safely used for blood transfusion
blood bank specimen
tube used for collecting blood bank specimen
- lavender-top or pink-top EDTA tube
- red-top non-additive glass as an alternative
What are the important information for strict specimen identification and labeling procedures in blood banks? [FHSDDI]
- Full name including middle initial
- Hospital ID Number
- Social Security Number for Outpatients
- Date of Birth
- Date and Time of Collection
- Initials of the phlebotomist
What is the procedure for conducting a cross-match test?
the plasma or serum from the patient is mixed with the RBC of the donor to check for compatibility
What are the qualifications for being a blood donor?
- 17 to 66 years of age
- minimum weight of 110 lbs.
- completed the physical exam
- declared their medical history
- patients donate blood for their own use especially for elective surgeries
- eliminates risk associated with blood transfusion
- upon the written permission of the physician, blood can be collected within a minimum of 72 hours from the surgery schedule
autologous blood donation
- blood of the patient is salvaged (during surgical procedure)
- washed, and re-infused after testing for residual free hemoglobin
- salvaged blood needs to be tested prior to reinfusion
- high free hemoglobin level means that too many red cells were destroyed during the salvage process and reinfusion is not recommended because it will result in renal dysfunction
cell salvaging
- checks the blood for pathogen for patients with fever of unknown origin
- determines the existence of bacteria in the blood that results in bacteremia
- determines the presence of microorganism and toxins in the blood that causes septicemia
blood culture
When does a physician orders a blood culture test?
only when there is a probability of bloodstream microorganism invasion
What are the special preparation for optimum results in blood culture test?
- collection should have 2 to 4 blood culture sets placed in a special bottle
- one aerobic (with air)
- one anaerobic (without air)
- drawn 30 to 60 minutes apart
prevents the contamination by microbial flora in the skin which can be introduced in the blood culture bottles and affect the results
skin antisepsis
What antiseptics can be used to sterilize the blood culture test specimen collection site? [BCPFB]
- betadine swab sticks
- chloroprep
- PVP ampule
- Frepp/ Sepp II
- Benzalkonium Chloride
What should be done to minimize the risk of contamination in blood culture test specimen collection site?
- friction rub of the collection sites for 30 to 60 seconds
- using tincture of iodine, chlorhexidine gluconate, and a povidine/70% ethyl alcohol combination
Why is blood culture collection takes first priority in the order of draw?
to prevent contamination
What are the three ways to inoculate the medium in the blood culture collection procedure?
- directly into the bottle (during collection)
- collected in a syringe (after collection)
- through an intermediate collection tube (in the laboratory)
What is the procedure in direct inoculation?
- butterfly and a specially designed holder are used
- holder is connected to the Luer connector of the butterfly collection set
- aerobic vial is filled first and each container is mixed after removal from the holder
- needle is removed after completing the collection
- safety device is activated as pressure is applied over the collection site
What is the procedure in inoculation using a syringe method?
- blood is transferred to the culture bottles after completing the draw using a safety transfer device
- safety transfer device is attached to the syringe
- bottle is pushed into the device until it reaches the stopper
- blood will be drawn from the syringe filling the vacuum in the container
- bottle should be placed in a solid surface or in a rack
What is the procedure in inoculation using the intermediate collection tube?
- performed in the laboratory rather at the patient’s bedside
- NOT recommended because the sodium polyanethole sulfonate (SPS) in collection tubes increases its concentration when added to the blood culture bottles
- transfer of the blood increases the risk of contamination and the exposure to the laboratory staff
- if it could not be avoided, the yellow SPS tube is acceptable for collection purposes
Why does physician requests a coagulation tests?
to assess the blood clotting functions especially if the patient has an unexplained bleeding
What are the coagulation tests? [PAT]
- prothrombin time (PT)
- activated partial thromboplastin time (aPTT)
- thrombin time (TT)
- done to check if the patient is suffering from diabetes
- also used to monitor insulin therapy
2-hour Postprandrial Glucose (2-hour PP)
What is the principles of 2-hour Postprandrial Glucose (2-hour PP) specimen collection?
- patients is on high-CHO diet 2 to 3 days prior to the test
- patient should fast for at least 10 hours before the test
- Fasting glucose specimen may be collected before the start of the procedure
- special breakfast containing an equivalent of 100g glucose or a glucose beverage is given on the day of the test
- blood glucose specimen is collected 2 hours after the meal
- evaluate the ability of the body to metabolize glucose by measuring the tolerance level to high glucose level.
- Insulin response to a measured dose of glucose is recorded by consistent specimen collection at a given intervals.
Glucose Tolerance Test
What is the special preparation of patients for Glucose Tolerance Test?
- patient must eat a balanced meal containing approx. 150g of CHO for 3 days
- must fast for 12 to 16 hours before the scheduled test
- drinking water is allowed to avoid dehydration
measures the ability of the body to process lactose and determines if the patient lacks mucosal lactase, an enzyme that converts lactose into glucose
Lactose Tolerance Test
What is the curve if the patient is lactose intolerant?
flat curve
What are the patients that will show false-positive result in lactose tolerance test? [SCC]
- slow gastric emptying
- crohn’s disease
- cystic fibrosis
performed to exclude the possibility of paternity of a particular child
Paternity/Parentage Testing
What are the testings involved in Paternity/Parentage Testing? [AB]
- ABO and Rh Typing
- Basic red cell antigen testing
In Paternity/Parentage Testing if the result does not exclude alleged parent, what are further tests that needs to be performed? [ERSWWH]
- extended red cell antigens
- red cell enzymes
- serum proteins testing
- white cell enzymes
- white cell antigen
- human leukocyte antigen
What are included in genetic proof to establish parentage in DNA paternity testing?
- genetic fingerprinting
- DNA profiling
What are the principles of DNA paternity testing?
- all involved parties need to submit a government issued photo identification along with the completed chain-of-custody form
- photos of all tested parties are also taken
- buccal samples are collected using swab rubbed inside the cheek
- sealed and tamper-evident package is used to hold the specimen during transport to the laboratory
- test results are ready after 48 hours and are usually sent via mail
measured drug levels at designated intervals so that the appropriate dosage can be established and maintained for the patient, avoiding toxicity
Therapeutic Drug Monitoring
performed by drawing a large volume of blood, 500 mL, from the patient as part of the treatment procedure for polycythemia and hemochromatosis
Therapeutic Phlebotomy
overproduction of RBC that is harmful to the patient
polycythemia
- excess iron deposits in the tissues which could be due to problems with iron metabolism
- caused by multiple blood transfusion or excessive iron intake
hemochromatosis
detection of toxins and treatment
clinical toxicology
forensic toxicology
legal consequences of toxin exposure
What are the common toxicology specimens?
Blood
Hair
Urine
track the specimen from time of collection until the time that the results are released using a special protocol
chain of custody
uses aqueous povidone-iodine and aqueous benzalkonium chloride
Blood Alcohol (Ethanol) Specimens
- specimen is urine
- companies, healthcare organizations, and sports associations subject their potential employees to _______ as part of their pre-employment requirement
Drug Screening
What are the presence of elements/mineral that trace element testing checks? [AACLIZ]
Aluminum
Arsenic
Copper
Lead
Iron
Zinc
any analytical test that is done outside the centralized laboratory and near the site where the patient receives treatment
Point-of-Care Testing
Bleeding Time
to evaluate the capillaries for platelet plug formation
measures the level of oxygen, carbon dioxide, and acid-base in the blood
Arterial Blood Gases
presence of hydrogen ions in a solution
pH
What does arterial pH test checks?
the balance of the acid-base level, which shows the metabolic and respiratory status of the patient
What is the normal pH range of blood?
7.35 to 7.45
What does a Partial pressure of Carbon Dioxide (PCO2) test indicates?
- how well air is exchanged between the blood and lungs
- test shows the measure of pressure exerted by dissolved CO2 in the blood plasma in proportion to the PO2 in the alveoli
- PCO2 level increases to an abnormal level
- higher concentration of CO2 and development of of more H ions and leads to acidosis
hypoventilation
- PCO2 level decreases
- reduces concentration of CO2 and leads to alkalosis
hyperventilation
What is Partial pressure of Oxygen (PO2)?
representative of the pressure exerted by the dissolved O2 and the ability of the lungs to diffuse oxygen through the alveoli
What is the use oxygen saturation (SO2) test?
- used to evaluate the oxygenation status of the patient
- measures the percentage of the binding sites of the hemoglobin that is occupied by oxygen in blood
- normal person exhibits 98% oxygen saturation
aid in moving nutrients in the body and remove wastes in the cells of the body
Electrolytes
- helps keep the normal balance of fluids in the body
- plays a role in transmitting nerve impluses
Sodium (Na+)
What is the term for elevated and reduced level of Sodium?
Hypernatremia
Hyponatremia
- helps in nerve conduction and muscle function
- regulates the acid-base balance and osmotic pressure
Potassium (K+)
What is the term for elevated and reduced level of blood Potassium?
Hyperkalemia
Hypokalemia
maintains the integrity of the cells by helping in balancing the osmotic pressure as well as the acid-base and water balance of the body
Chloride (Cl-)
helps transport carbon dioxide to the lungs and regulate blood pH
Bicarbonate ion (HCO3-)
helps in:
muscular function
cardiac function
blood clotting
nerve transmission
Ionized Calcium (iCa2+)
- could be detected as early as 10 days from conception
- by checking the presence of Beta-subunit of human chorionic gonadotropin (hCG) in the urine or serum
Pregnancy Testing
gauge the effectiveness of the thrombolytic therapy being administered to patients who have suffered from heart attacks
Cardiac Troponin T (TnT) and Troponin I (TnI)
the alanine transferase (ALT) of patients under lipid-lowering medication
Lipid Testing
chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF)
B-Type Natriuretic Peptide (BNP)
infection, tissue injury and other inflammation disorders
C-Reactive Protein (CRP)
glucose level of patients with Diabetes Mellitus
Glucose testing
a diagnostic tool for diabetes therapy monitoring
Glycosylated Hemoglobin
the volume of red blood cells
Hematocrit testing
the hemoglobin level to manage patients suffering from anemia
Hemoglobin testing
the severity of the lactic acid disorder and the stress response of the patient
Lactate testing
gastrointestinal (GIT) bleeding
Occult blood (guaiac)
the presence of human chorionic gonadotrophin (hCG)
Pregnancy Test
contact with allergens and determines if the body has developed antibodies
Skin test checks
the presence of group A streptococci
Strep testing
physical, chemical, and microscopic analyses of the urine specimen
urinalysis
