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PMLS 2 > (M) Lesson 5: Specimen Handling and Processing of Blood Specimen > Flashcards

(M) Lesson 5: Specimen Handling and Processing of Blood Specimen Flashcards

1
Q

What are the three analytical phases inside the laboratory?

A

Preanalytical, Analytical, Postanalytical

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2
Q

T or F; The quality of laboratory results does not depend on the proper handling

A

False

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3
Q

What percentage of error occur prior to analysis?

A

46 - 68%

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4
Q

Most serious and potentially most dangerous pre-analytical error

A

Improper patient identification

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5
Q

Fasting hours for GGT

A

8 - 10 hours

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6
Q

T or F; you can use alcohol in blood alcohol testing as an antiseptic

A

False

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7
Q

Correct degrees for venipuncture needle position

A

15 - 30 deg

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8
Q

Standard bore size for kids

A

23 (blue)

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9
Q

Additive for (light) blue-coded vacutainer and for what test

A

Sodium citrate, coagulation studies

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10
Q

Additive for lavender-coded vacutainer and for what test

A

EDTA, Hematology

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11
Q

Additive for green-coded vacutainer and for what test

A

Heparin, Chemistry

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12
Q

Additive for gold and/or orange-coded vacutainer and for what test

A

Clot activator, Chemistry

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13
Q

Additive for red-coded vacutainer (plastic) and for what test

A

Clot activator, Chemistry

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14
Q

Additive for gray-coded vacutainer and for what test

A

Sodium fluoride, Chemistry

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15
Q

Additive for red-coded vacutainer (glass) and for what test

A

None, Chemistry

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16
Q

Recite the correct order of draw

A
  1. Sterile blood culture tubes – Yellow stopper
  2. Coagulation tubes – Light blue stopper
  3. Serum tube / Plain tube – Red stopper
  4. Heparin tube – Green stopper
  5. EDTA tube – Lavender / Purple stopper
  6. Anti-glycolytic tube / Fluoride – Gray stopper

“Stop, Light is Red. Green Light, Go. “
“Stop, Light is Red, Stay Put. Green Light, Go.”

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17
Q

What is the result of filling the vacutainer with less blood?

A

Dilution effect

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18
Q

What is the result of filling the vacutainer with too much blood?

A

Blood clots

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19
Q

What is the blood to anticoagulant ratio?

A

9:1

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20
Q

T or F; it is fine to combine 2 partially filled tubes

A

False

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21
Q

T or F; It is fine to send the partially-filled tube to the lab if the patient is no longer available

A

True

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22
Q

It is when the liquid enters the tissue

A

Hemoconcentration

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23
Q

It is when fluid goes outside the tissue

A

Hemodilution

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24
Q

T or F; Longer tourniquet application causes decreased pH, increased potassium, and decreased calcium and magnesium

A

False (lowered pH, increased potassium, INCREASED calcium and magnesium)

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25
Q

T or F; You can mix non-additive tubes

A

False (causes hemolysis)

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26
Q

What forms when there is an inadequate mixing of tubes with additives?

A

Micro-clot formation

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27
Q

What forms when there is an inadequate mixing of tubes with gel separation?

A

Clotting may be incomplete

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28
Q

How many inversions for EDTA?

A

8 - 10x

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29
Q

How many inversions for citrate tube?

A

3 - 4x

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30
Q

How many inversions for SST?

A

4 - 5x

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31
Q

How many inversions for heparin?

A

8 - 10x

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32
Q

How many inversions for flouride?

A

8 - 10x

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33
Q

What would rough handling and agitation cause?

A
  1. Hemolysis
  2. Activation of platelets that could affect coagulation tests
  3. Break glass types
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34
Q

These are tubes wrapped in absorbent package material and placed in a self-sealing bag with biohazard emblem

A

Primary container

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35
Q

These are bag or box for placement of samples

A

Secondary container

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36
Q

Compartments of primary container

A
  1. Sample
  2. Requisition form
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37
Q

T or F; Samples from different patients can be placed in the same bag

A

False

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38
Q

System that propels cylindrical containers through networks of tubes by compressed air or by partial vacuum

A

Pneumatic Tube System or Pneumatic tube transport (PTT)

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39
Q

T or F; PTT is more traumatic and can cause agitation

A

True

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40
Q

T or F; Too hot or freezing temperature can cause rupture of RBCs

A

True

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41
Q

T or F; Serum/plasma does not need to be separated from cells before transport

A

Theoretically, False

You can also separate it in the lab

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42
Q

Documentation of proper sample identification from the time of collection to the receipt of laboratory results

A

Chain of custody

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43
Q

Ensures that any results reported relate beyond all reasonable doubt to a particular individual

A

Chain of Custody

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44
Q

Special care is needed when handling blood specimens to protect its condition and quality in terms of

A
  1. Body temperature
  2. Chilled specimen
  3. Light-sensitive specimen
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45
Q

Body temperature range in Celcius

A

36.4 °C-37.6 °C (37 average)

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46
Q

Room temperature range in Celcius

A

22 - 25 deg Celcius

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47
Q

Type of robot that delivers the sample to the laboratory

A

Robot Courier Autonomous Mobile Robot

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48
Q

T or F; some samples are transferred in body temperature because they precipitate in cold

A

True

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49
Q

What are the tests/samples maintained at 37 deg C?

A

Cold agglutinins
Cryoglobulin
Cryofibrinogen

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50
Q

What does cryo mean?

A

Cold

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51
Q

T or F; Chilling does not do anything with the metabolic process of the sample

A

False (it slows it down)

52
Q

What is the classification of the ff samples/tests?

▪ Adrenocorticotropic hormone (ACTH)
▪ Acetone
▪ Ammonia
▪ Acid Phosphatase
▪ Catecholamines
▪ Lactic acid
▪ Parathyroid hormone
▪ pH/blood gases

A

Tests that require chilling

53
Q

Temperature for chilling samples

A

4 °C (preferred temp.) or 2-8 °C

54
Q

Ways/equipment to warm the samples

A
  1. Activated heel warmer
  2. Heat block
  3. Aluminum Double Head Heat Block
55
Q

Chilling of uncentrifuged blood will elevate which electrolyte?

56
Q

Ways/equipment to chill the sample

A
  1. Blood specimen transporter
  2. Submerged in crushed ice and water slurry
57
Q

In what direction is the microtainer and vacutainer label placed?

A

Left to right

58
Q

What are the light-sensitive specimens?

A
  1. Bilirubin
  2. Folic acid
  3. Carotene
  4. Vitamins B2, B6, B12, and C
  5. Urine porphyrins
  6. Urine porphobilinogen
  7. Red Cell folate
  8. Serum folate
59
Q

Up to what percent does bilirubin decrease after 1 hour of light exposure?

60
Q

Ways to protect bilirubin from the sun

A
  1. Wrap in aluminum foil
  2. Use light-blocking amber tubes

amber ate ni sofia i was just a girl in the village doing alright

61
Q

Where are collected specimens transported to?

A

Central processing triage or the sample reception area

62
Q

T or F; unsuitable specimens are rejected then the phlebotomist cries

A

False (the phlebotomist obtains new specimen instead of crying)

63
Q

Most frequent reason for rejection
(Chemistry Department)

A

▪ Hemolysis
▪ Insufficient amount of specimen QNS

64
Q

Most frequent reason for rejection
(Hematology specimens)

A

▪ Clotting
▪ Underfilled tubes (for coagulation
studies)

65
Q

Routine blood specimens should arrive at the
laboratory within ____ minutes of collection.

66
Q

Specimens that require separation of the serum or plasma from the cells should be centrifuged within _____ minutes of arrival in the lab.

A

60 minutes / 1 hour

67
Q

What is the maximum time limit for separating serum and plasma from the cells

A

2 hours from time of collection

68
Q

Enumerate what would increase if serum tubes have not been spun within 2 hours or refrigeration of serum tubes before centrifugation

A

potassium, creatinine,
phosphorus, LDH, lactic acid, lipids and
total protein

69
Q

Enumerate what would decrease if serum tubes have not been spun within 2 hours or refrigeration of serum tubes before centrifugation

A

glucose, ionized calcium,
chloride and carbon dioxide

70
Q

Blood smears (EDTA) is prepared within how long?

71
Q

CBC (EDTA): recommended to be analyzed
within how many hours? In the room tempt, how many hours is it stable?

A

6 hours, 24 hours

72
Q

CBC in micro-containers is analyzed w/in how many hours?

73
Q

Reticulocyte counts (EDTA) is stable up to ___
hours at RT; up to ___ hours if refrigerated

A

6 in room temperature; 72 if refrigerated

74
Q

Glucose test (sodium fluoride tubes) is stable
up to ___ hours at RT; ___ hours if refrigerated
(2-8 C)

A

24 in room temperature; 48 if refrigerated

75
Q

Prothrombin time (PT): unrefrigerated and uncentrifuged specimens up to ___ hours after
collection

76
Q

Partial thromboplastin time (PTT): test specimens within __ hours of collection

77
Q

Blood ammonia is separated within how many minutes?

78
Q

Molecular test specimens with plasma, at 4 C, is stored for how many hours?

79
Q

Three phases of specimen processing

A

Precentriguation
Centrifugation
Postcentrifugation

80
Q

Refers to the specimen processing after specimen collection and before centrifugation

A

Precentrifugation

81
Q

Refers to the specimen processing when the specimen is in the centrifuge

A

Centrifugation

82
Q

Refers to the specimen processing after centrifugation and before removal of serum or
plasma

A

Postcentrifugation

83
Q

Allow blood in nonadditive, clot activator, and gel-containing tubes used for serum tests (e.g., SSTs) to clot for the serum to separate from the cells

A

Precentrifugation

84
Q

T or F; When clotting is not complete, latent fibrin formation may form a clot in the serum before centrifugation

A

False (after centrifugation)

85
Q

Standard clotting time at room temperature

A

30 to 60 mins

86
Q

Which specimens take longer to clot? Enumerate

A

◦ patients on anticoagulant medications, heparin or warfarin (e.g., Coumadin)
◦ from patients with high WBC counts
◦ chilled specimens
◦ from patients with bleeding disorders

87
Q

What does “coagulopathies” mean?

A

Bleeding disorder

88
Q

Tubes with clot activators clot within how many minutes?

89
Q

Tubes with thrombin clot in how many minutes?

90
Q

Complete clotting can be determined in what way/action?

A

Tilting and inverting the tube

91
Q

T or F; rimming the tube with an applicator stick to release the clot from the walls of the tube is not a potential source of hemolysis and contamination

A

False (it is)

92
Q

It is a process in which centrifugal force is used to separate solid matter from a liquid suspension

A

Centrfugation

93
Q

machine that spins blood and other specimens at a high number of revolutions per minute (rpm) or centrifugal force

A

Centrifuge

94
Q

Enumerate the three types of centrifuge

A
  1. Refrigerated
  2. Floor-top model
  3. Tabletop (benchtop) model
95
Q

Unit for speed of rotation

A

revolution per minute (rpm)

96
Q

Relative centrifugal force is expressed as?

A

gravity (g) or RCF

97
Q

RCF depends on these two factors

A

speed of rotation (revolution per minute) and the radius of the rotor head

98
Q

Most specimens centrifuged for 15 minutes are centrifuged at ______

A

750 g to 1000 g

99
Q

Most specimens centrifuged for 10 minutes are centrifuged at ______

100
Q

T or F; removing the stopper of vacutainers during centrifugation will result in decreased pH

A

False (increased pH, less acidic because CO2 causes more alkalinity)

101
Q

T or F; removing the stopper of vacutainers during centrifugation will result in dilution of analytes

A

False (concentration of analytes because solvent will evaporate if not sealed)

102
Q

T or F; removing the stopper of vacutainers during centrifugation will result in aerosol formation

103
Q

T or F; drop of sweat interferes with electrolyte results

104
Q

What electrolytes in sweat may interfere with the electrolyte results during centrifugation?

A

Sodium and chloride

105
Q

What should be the placement of specimen of equal-sized tubes in a balanced centrifugation?

106
Q

Centrifuging more than once may result in?

A
  1. Hemolysis
  2. Analyte detoriation

Which can alter results

107
Q

T or F; Specimens that require chilling are processed in a normal centrifuge

A

False (in tempt-controlled refrigerated centrifuge)

108
Q

T or F; It is important to schedule regular maintenance of centrifuge machine

109
Q

What should be checked in routine maintenance of a centrifuge machine?

A

Balance
Braking mechanism
Centrifuge speed
Timer

110
Q

What instrument is used to measure rpm?

A

Tachometer

111
Q

STAT chem tests uses what color of tubes?

A

Green (Heparin reduces turn-around time)

112
Q

Which color-coded tubes maintain specimen stability after centrifugation?

A

PSTs or other heparin-containing gel tubes

113
Q

In postcentrifugation, what happens when the specimen is disturbed in tubes without separator gel?

A

Resuspension

114
Q

What prevents glycolysis in postcentrifugation?

A

Physical barrier

115
Q

T or F; Specimens in gel barrier tubes do not normally require manual separation

116
Q

T or F; Serum or plasma is not required to separated from the cells as soon as possible

117
Q

T or F; Stoppers are pulled l straight up to prevent release of aerosol: not “popped” off using a thumb roll technique

118
Q

Serum on gel barriers can be stored up to ___ hours at ___°C

A

48 hours at 4 deg C

119
Q

It is when the serum/plasma of the specimen is dark yellow instead of pale yellow

120
Q

It is when the serum/plasma of the specimen is cloudy, turbid

121
Q

It is when the serum/plasma of the specimen is pink or red

122
Q

In hemolyzed specimen, which solutes are increased?

A

Potassium, ammonia, phosphate, and enzymes

123
Q

a portion of a specimen used for testing

124
Q

method of dividing or separating specimens into separate containers

A

Aliquoting

125
Q

prepared when multiple tests are ordered on a single specimen

A

Aliquoting

126
Q

What is used to aliquot and transfer specimen into tubes?

A

A disposable transfer pipet

127
Q

Required Protective Equipment Worn when Processing Specimen is according to which law?

A

OSHA Act RA 11058

PMLS 2 (16 decks)

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