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Clinical Chemistry (CC 1) > (P) Lec 2: Specimen Collection + Specimen Handling (Part 2) > Flashcards

(P) Lec 2: Specimen Collection + Specimen Handling (Part 2) Flashcards

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1
Q

TOF: Fasting is required in hematology

A

False

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2
Q

CLSI states that you should never combine tubes, holders, and needles from different what?

A

Manufacturers

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3
Q

A sudden change in position during blood draw can cause what?

A

Hemoconcentration or Hemodilution

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4
Q

How high should you apply the tourniquet from the puncture site?

A

7.5 - 10cm or 3-4 inches above

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5
Q

What should the BP cuff pressure be as an alternative to a tourniquet?

A

60mmHg (pump 1-2 times)

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6
Q

What kind of tubes are strongly recommended for medication levels?

A

Glass Tubes

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7
Q

Plastic/glass serum tubes should never be used before what?

A

Coagulation Tubes

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8
Q

What disinfectant is used for routine blood tests?

A

Isopropyl

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9
Q

What disinfectant is used for routine bacteriological tests?

A

Iodine

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10
Q

What disinfectant is used for alcohol determination?

A

Benzalkonium chloride

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11
Q

Fist pumping during blood draw causes what?

A

Hemoconcentration

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12
Q

What should be the needle angle upon entry?

A

15-30 degrees

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13
Q

A small-bored needle has a greater chance of producing a sample that has undergone?

A

Hemolysis

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14
Q

When doing the ETS method, when do you remove the tourniquet?

A

When all tubes are filled

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15
Q

When doing the ETS method, you are to remove the tourniquet before what?

A

Withdrawing the needle

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16
Q

This SOP prevents additives from carrying over

A

Order of draw

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17
Q

How long should you apply pressure on the puncture site?

A

3-5 minutes; maximum of 15 minutes

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18
Q

What size of gauze pad is ideal to use when applying pressure?

A

2x2

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19
Q

After sanitizing, no traces of alcohol should remain as this can cause what? (2 answers)

A
  1. Hemolysis
  2. Contamination of glucose testing
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20
Q

New studies show that what kind of cleaning motion is now better than circular motion?

A

Back and forth

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21
Q

No. of inversions: Clot Activator

A

5

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22
Q

No. of inversions: Sodium Citrate

A

3-4

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23
Q

No. of inversions: Heparin

A

8

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24
Q

No. of inversions: EDTA

A

8

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25
Q

No. of inversions: Sodium Fluoride

A

8

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26
Q

How long should you bandage the puncture site for?

A

15 minutes to 1 hour

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27
Q

Patients should not bend the arm in this manner after blood draw

A

Upward

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28
Q

If bleeding lasts for more than how many minutes, inform the nurse or supervisor

A

1 minute

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29
Q

This phase refers to all steps taken before actual testing (specimen handling, processing, collection, patient identification, material preparation, etc.)

A

Pre-analytical phase

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30
Q

What are the alternative names for the 3 phases?
> Pre-analytical
> Analytical
> Post-analytical

A

> Pre-examination
Examination
Post-examination

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31
Q

This refers to the combination of the pre-analytical phase, analytical phase, and post-analytical phase

A

Quality Assurance

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32
Q

This makes sure that all procedures in the lab will be done properly from specimen collection up to the reporting and recording of results

A

Quality Assurance

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33
Q

Refers to factors that alter test results that are introduced into the specimen before testing (+ before and during collection, and during transport, processing, and storage)

A

Pre-analytical errors

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34
Q

This phase refers to actual testing/test performance (all procedures that belong to the method of measurement)

A

Analytical phase

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35
Q

This phase comes after the test performance (reporting, interpolation, recording, and relaying of results to the physician)

A

Post-analytical phase

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36
Q

This is an important pre-analytical error (example stated in the reclec)

A

Improper handling of specimen that could result in erroneous, misleading, delayed results, and incorrect care of the patient

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37
Q

What are the 3 controllable pre-analytical variables?

A
  1. Physiologic
  2. Lifestyle
  3. Drug administration
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38
Q

Pre-analytical variables

It means you can do something about this factor (a form of intervention)

A

Controllable variables

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39
Q

Pre-analytical variables

It means you cannot do anything about this factor

A

Non-controllable variables

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40
Q

What are the 4 non-controllable pre-analytical variables?

A
  1. Biological influences
  2. Environmental factors
  3. Long-term cyclical changes
  4. Underlying medical conditions
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41
Q

Non-controllable pre-analytical variables

Age, sex, and race

A

Biologic

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42
Q

Non-controllable pre-analytical variables

Altitude, ambient temperatures, and place of residence

A

Environmental factors

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43
Q

Non-controllable pre-analytical variables

People living in high-altitudes have this important body substance comparatively decreased compared to those in low-altitide areas

A

Oxygen level

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44
Q

Non-controllable pre-analytical variables

This variable expands plasma volume which causes a significant decrease in plasma protein when being measured

A

Heat

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45
Q

Non-controllable pre-analytical variables

Seasonal influences and menstrual cycles

A

Long-term cyclical changes

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46
Q

Non-controllable pre-analytical variables

Fever, shock, trauma, and blood transfusion

A

Underlying medical conditions

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47
Q

Non-controllable pre-analytical variables

This underlying medical condition provokes many hormone responses which could affect certain analytes in blood

A

Fever

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48
Q

Patient preparation

This factor affects skeletal muscle enzymes (these increase when this activity is done); prone to produce false positive results

A

Exercise

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49
Q

Patient preparation

A state wherein the blood is collected early in the morning before rising

A

Basal State

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50
Q

Patient preparation

The basal state requires what type of patient preparation method?

A

Fasting

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51
Q

Patient preparation

If your glucose is being requested for testing, how many hours do you need to fast?

A

6-8 hours

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52
Q

Patient preparation

If your lipid profile (TAG, HDL, and LDL) is being requested for testing, how many hours do you need to fast?

A

10-12 hours (max. of 14)

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53
Q

Patient preparation

If both your glucose and a lipid profile are being requested for testing, how many hours do you need to fast?

A

8-12 hours

54
Q

Patient preparation

Refers to when people eat high-protein foods, sugary foods, are vegetarian, drink coffee regularly, etc.

A

Diet

55
Q

Patient preparation

Bananas and tomatoes increase the production of what metabolyte of serotonin?

A

5HIAA (5-Hydroxyindoleacetic acid)

56
Q

Patient preparation

This kind of diet could result to an increase in urea and creatine in the blood

A

High-protein

57
Q

Patient preparation

A sudden position change or prolonged stagnation can result to 2 events, which are?

A
  1. Hemoconcentration
  2. Hemodilution
58
Q

Patient preparation

These 2 activities (lifestyle-related) need to not be done 24 hours before collection because it can affect the analytes in the serum

A

Tobacco smoking and Alcohol ingestion

59
Q

Your physiologic variation is aka?

A

Circadian Rhythm

60
Q

Identify if these analytes are highest in the morning or night

  1. Iron
  2. Potassium
  3. Renin
  4. Cortisol
  5. Insulin
  6. Aldosterone
A

Morning

61
Q

Identify if these analytes are highest in the morning or night

  1. Growth hormone
  2. Testosterone
  3. TSH
  4. Prolactin
A

Night

62
Q

How many gentle tube inversions are needed depending on the additive present, type of tube, and manufacturer?

A

3-10

63
Q

This process allows the even distribution of the additives present in your tubes

A

Tube inversion

64
Q

Inadequate mixing is not ideal as this can result in what?

A

Microclots

65
Q

If there is inadequate mixing when using a gel separator tube, what can happen to the sample?

A

Incomplete clotting

66
Q

TOF: Non-additive tubes still require mixing

A

False

67
Q

Tubes should be transported with the stopper facing where?

A

Upwards

68
Q

This practice reduces sample agitation, it aids in clot formation, and prevents contact of tube contents with the stopper

A

Transporting tubes with the stopper up

69
Q

What kind of specimen gets transported like this?

Put in a plastic bag with a biohazard logo, liquid-tight closure, and slip pocket for paperwork

A

Blood specimens

70
Q

What kind of specimen gets transported like this?

Use leak-proof containers

A

Non-blood specimens

71
Q

What kind of transport system is this?

To be protected from shock and sealed in a zipper type plastic bag to contain spills

A

Pneumatic tube system

72
Q

If blood samples are allowed to clot within 20-30 minutes, it should arrive in the lab how many minutes upon collection?

A

45 minutes

73
Q

Once a blood sample has arrived in the lab, you must separate the serum with the cell within how many hours upon collection?

A

1 hour (CLSI states the maximum to be 2 hours including the 45-minute allowance for transport and the 20-30 minute allowance to clot)

74
Q

There should be no delay in sample delivery to minimize the effects of what?

A

Metabolic processes (e.g. glycolysis and cellular metabolism)

75
Q

Temperatures related to specimen handling

36.4 to 37.6 degrees

A

Body Temperature

76
Q

Temperatures related to specimen handling

15 to 30 degrees

A

Room Temperature

77
Q

Temperatures related to specimen handling

2 to 10 degrees

A

Refrigerated Temperature

78
Q

Temperatures related to specimen handling

-20 or lower

A

Frozen Temperature

79
Q

These analytes require which procedure?

  1. Gastrin
  2. Ammonia
  3. Lactic Acid
  4. Catecholamines
  5. Pyruvate
  6. PTH
A

Chilling (can be freezer or refrigerator temperature)

80
Q

Special handling

This method can slow down the metabolic proccesses and protects the analyte even when there is delay

A

Chilling of specimen

81
Q

Special handling

What equipments can you use to transfer specimen via chilling (refrigerator temperature)?

A
  1. Ice
  2. Ice packs
  3. Crushed ice together with water
82
Q

Special handling

What equipments can you use to transfer specimen via chilling (freezing temperature)?

A
  1. Solid CO2
  2. Nitrogen gas
83
Q

Special handling

What equipments can you use to transfer specimen via room temperature (37ºC)?

A
  1. Heat blocks
  2. Heel warmers (40-42ºC)
84
Q

Special handling

If a sample is ordered to be transported anaerobically, what should be absent? (for ABG and ionized and non-ionized calcium)

A

Oxygen

85
Q

Special handling

These produce an inadequate cooling effect on the sample

A

Large ice cubes

86
Q

Special handling

What happens when there is direct contact between the sample and solid ice?

A

Hemolysis/analyte breakdown

87
Q

These analytes require which transport procedure?

  1. Cold agglutinins
  2. Cryofibrinogen
  3. Cryoglobulins
A

Transport at 37 degrees (should also be pre-warmed prior to transfer)

88
Q

These tests require what handling procedure?

  1. Bilirubin
  2. All Vitamin Levels
  3. Beta carotene
  4. Porphyrins
  5. Folate
A

Protection from light (sunlight and artificial)

89
Q

What methods can you employ to protect your sample from light?

A
  1. Wrap in aluminum foil
  2. Use amber-colored microcollection tubes
90
Q

One must not discard a specimen until who are notified?

A

Physician or nurse

91
Q

In chemistry, reject the sample if it is what? (2 answers)

A
  1. Hemolyzed
  2. Quantity is not sufficient
92
Q

How do you know if your specimen is hemolyzed?

A

After centrifugation (or standing), the color of the plasma is pink or red

93
Q

In hematology, reject the sample if it is what?

A

Clotted

94
Q

This is a machine that spins blood and other specimens at a high number of revolutions per minute

A

Centrifuge

95
Q

This causes the cells and plasma or serum in blood specimens to separate

A

RPM/RCF (relative centrifugal force)

96
Q

What gravitational force setting should be done for a centrifuge?

A

850-1,000 GF for 10-15 mins OR 1,000-3,000 RCF for 10 mins.

97
Q

If one removes the tube stopper, what analyte is lost and what is increased? (2 answers)

A
  1. CO2 is lost
  2. pH is increased
98
Q

This should remain on tubes to prevent contamination, evaporation, aerosol formation, and pH changes

A

Stoppers

99
Q

Specimen awaiting centrifugation can be contaminated by what 2 possible contaminants?

A
  1. Sweat
  2. Powder from gloves
100
Q

A specimen should never be centrifuged more than how many times?

A

Once

101
Q

This improper use of the centrifuge results in hemolysis and analayte deterioration, which alters test results

A

Repeated centrifugation

102
Q

A centrifuge generates what during operation?

A

Heat

103
Q

Specimens requiring chilling should be processed in what kind of centrifuge?

A

Temperature-controlled refrigerated centrifuge

104
Q

When can you open the lid of a centrifuge after centrifugation?

A

After the rotors have stopped

105
Q

Blood must be completely what before centrifugation?

A

Clotted

106
Q

Complete clotting happens within how many minutes at RT?

A

30-60 minutes

107
Q

SST and tubes with clot activators take how long to completely clot?

A

30 minutes

108
Q

Thrombin (activates clotting) tubes take how long to completely clot?

A

5 minutes

109
Q

If there is incomplete clotting, there is the formation of what?

A

Fibrin

110
Q

When one is on anticoagulant medication, does it take longer or shorter to clot?

A

Longer time

111
Q

The use of what applicator stick for rimming the sides of the tube is not recommended?

A

Wooden

112
Q

When using a thixotropic gel separator (gold top) tube for centrifugation, what layers are generated in the tube after centrifuging?

A
  1. Serum on top
  2. Buffy coat (sometimes absent)
  3. Gel in the middle
  4. Blood cells on the bottom
113
Q

What is the specific gravity of the thixotropic gel once it has been centrifuged and placed between the serum and blood cells?

A

1.04

114
Q

What tests commonly require a plasma specimen collected in a citrated tube?

A

Prothrombin Time (PT) and Activated Thromboplastin Time (aPTT)

115
Q

TOF: When it comes to PT and aPTT, you do not need to separate the plasma from the cells as this has no effect

A

True

116
Q

To prevent or minimize aerosol spray or blood spray, the stopper should be pulled in what manner?

A

Straight up and off; not “popped off” using a thumb roll technique

117
Q

Refers to the portion of specimen that is used for testing

A

Aliquot

118
Q

Refers to when multiple tests are ordered using a single specimen; using different specimen in different areas of the laboratory

A

Aliquot Preparation

119
Q

This is prepared by transferring a portion of the specimen into one or more tubes

A

Aliquot

120
Q

When transferring aliquots, what kind of pipettes are to be used?

A

Disposable transfer pipettes (Pasteur pipettes)

121
Q

TOF: You may pour serum or plasma

A

False (causes increased risk for aerosol formation and splashing)

122
Q

TOF: Centrifuge the sample 1 hour after collection

A

False (immediately after collection)

123
Q

Never put these 2 together when they use different anticoagulants in the same aliquot tube

A

Plasma and Serum

124
Q

Which organization stated this: “all procedures involving blood or potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, splattering, and generation of droplets of those substances“

A

OSHA

125
Q

When performing this venipuncture method, it is common to see slightly overfilled tubes

A

ETS (you cannot predict the vacuum)

126
Q

A hemolyzed sample shows up as red/pink which indicates the presence of what?

A

Hemoglobin

127
Q

If your hemolyzed plasma/serum is red, how much hemoglobin is present?

A

100mg/dL

128
Q

If your hemolyzed plasma/serum is pink, how much hemoglobin is present?

A

20mg/dL

129
Q

A milky appearance of serum can be due to high levels of what?

A

Triglycerides

130
Q

TOF: A patient’s plasma sample appears milky (which indicates excess triglycerides) even after they’ve fasted correctly, do you reject the sample or not?

A

No (it is an indicator that something is wrong interiorly and should be investigated)

131
Q

TOF: A patient’s plasma sample appears dark yellow (even though it should be clear to pale yellow), do you reject the sample or not?

A

No (it means that bilirubin is increased; icteric sample)

132
Q

What could be a reason for why there is increased lipid content in plasma that is turbid?

A

Whenever there is inadequate fasting due to chylomicrons

Clinical Chemistry (CC 1) (22 decks)

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