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Hematology 2 > (P) Lesson 4: Special Collection and Handling for Hemostasis Laboratory > Flashcards

(P) Lesson 4: Special Collection and Handling for Hemostasis Laboratory Flashcards

1
Q

What are the two (2) most commonly encountered tests in a hemostasis laboratory?

A
  1. Prothrombin Time (PT)
  2. Partial Thromboplastin Time (PTT)
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2
Q

What two (2) specific clotting factors were mentioned to be prone to deteriotation?

A
  1. Factor V
  2. Factor VIII
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3
Q

The deterioration of clotting factors may result in what?

A

Prolonged coagulation time

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4
Q

T or F: Special collection and handlng of blood samples for PT and PTT are crucial to ensure accurate and reliable results.

A

True

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5
Q

What are some of the factors to be considered in samples for PT and PTT tests?

There are three (3) mentioned answers here.

A
  1. Temperature
  2. Anticoagulant used
  3. Method of Collection
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6
Q

Ideal specimen for platelet function or clotting factor assessment?

A

Citrated blood collected using blue top

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7
Q

What two (2) reasons behind why citrated blood is used for platelet function and clotting factor assessment?

A
  1. Chelates calcium
  2. Preservation of all clotting factors
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8
Q

Ideal Specimen

  • Acts as a chelating agent, binding to calcium ions in the blood
A

Citrate

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9
Q

Ideal Specimen

  • Essential for the coagulation cascade
  • Citrate prevents the formation of blood clots by chelating ____
A

Calcium

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10
Q

Ideal Specimen

T or F: Citrate alters the activity of the clotting factors.

A

False

They do not alter the activity.

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11
Q

Ideal Specimen

There are two (2) clotting factors that are considered as labile factors since they are sensitive and deteriorate easily in certain anticoagulants (e.g. EDTA).

A

Factor V and Factor VIII

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12
Q

Ideal Specimen

Factors in the coagulation cascade that are sensitive to change in temperature, time, and handling during the blood collection and processing

A

Labile clotting factors

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13
Q

What is the principle behind using whole blood in coagulation tests?

A

No anticoagulant is used and the whole blood is allowed to clot.

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14
Q

What three (3) tests in the hemostasis laboratory uses whole blood?

A
  1. Clotting Time
  2. Clot Retraction Time
  3. Whole Blood Clot Lysis Time
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15
Q

Whole Blood Specimen

What are the three (3) different methods in measuring clotting time?

A
  1. Slide Method/Drop Method
  2. Lee and White Method
  3. Capillary Tube Method
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16
Q

Whole Blood Specimen

  • Measures the time it takes for blood to clot
  • Determines if there are problems under the common and intrinsic pathways?
A

Clotting Time

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17
Q

Whole Blood Specimen

  • One of the special tests used for evaluation of platelets

Sorry, yan lang talaga malalagay ko. 💔

A

Clot Retraction Time

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18
Q

What are the two (2) types of tests for clot retraction time?

A
  1. McFarlan Method
  2. Hirschboeck Method
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19
Q

Whole Blood Specimen

  • Measures the stability of the clot within 48 hours
A

Whole Blood Clot Lysis Time

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20
Q

Serum Specimen

Pop Quiz: What are the clotting factors under the fibrinogen group?

A
  1. Factor I
  2. Factor V
  3. Factor VIII
  4. Factor X
  5. Factor XIII

Balik ka muna sa secondary hemostasis if hindi mo ‘to nasagot. 😠

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21
Q

Serum Specimen

The clotting factors of the ____ group are completely absent in the serum since they are completely consumed/

A

Fibrinogen

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22
Q

Serum Specimen

How much of the residual prothrombin or Factor II is left in the serum?

A

About 20% or less

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23
Q

Serum Specimen

What are the two (2) tests that use serum as a sample?

A
  1. Serum Prothrombin Time (Serum PT)/Thrombin Consumption Test
  2. Mixing Studies
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24
Q

Serum Specimen

  • Involves mixing patient plasma with serum
  • Used to pinpoint what clotting factor is deficient in the patient’s sample
  • Mixes the plasma of the patient to the serum of another individual or the normal serum mix to plasma of the patient before proceeding and repeating PTT after mixing
A

Mixing Studies

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25
Q

Serum Specimen

What two (2) types of plasma are under the serum specimen?

A
  1. Platelet Rich Plasma (PRP)
  2. Platelet Poor Plasma (PPP)
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26
Q

Serum Specimen

  • Plasma that contains higher concentration of platelets
A

Platelet Rich Plasma (PRP)

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27
Q

Serum Specimen

Within what range should a platelet count fall within to be considered as platelet-rich plasma?

A

200,000 to 300,000 platelets/uL

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28
Q

Serum Specimen

What are the three (3) tests in the hemostasis laboratory that uses platelet-rich plasma?

A
  1. Platelet Aggregation Studies
  2. Plasma Recalcification Time
  3. Plasma Retention Test
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29
Q

Serum Specimen

  • The ideal specimen for PT/PTT tests as it doesn’t require platelets
A

Platelet-Poor Plasma

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30
Q

Serum Specimen

T or F: In PT/PTT tests, there should be no cellular elements or contaminants such as RBC, WBC, or platelets present in the plasma.

A

True

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31
Q

Serum Specimen

Why should there be no cellular elements or contaminants in the plasma?

A

They could interfere with the accuracy of the tests.

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32
Q

Serum Specimen

Within what range should a platelet count fall within to be considered as platelet-poor plasma?

A

Less than 10,000 platelets/uL or total absence of platelets

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33
Q

Serum Specimen

What are the three (3) tests in the hemostasis laboratory that uses platelet-poor plasma?

A
  1. Prothrombin Time (PT)
  2. Partial Thromboplastin Time (PTT)
  3. Reptilase Time
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34
Q

T or F: PT/PTT are part of the platelet function tests.

A

False

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35
Q

They are specifically designed to assess the functionality of platelets in the blood.

A

Platelet Function Tests

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36
Q

They primarily assess the clotting function of plasma, focusing on the clotting factors involved in the intrinsic and extrinsic clotting pathways.

A

PT/PTT

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37
Q

Any abnormal results from the platelet function test will be deemed as ____ or ____ by PT/PTT.

A

Normal or unaffected

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38
Q

Anticoagulant Used for Coagulation Tests

  • Ideal to use to preserve all clotting factors, especially labile clotting factors such as clotting Factor V and Factor VII
A

Sodium Citrate

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39
Q

Anticoagulant Used for Coagulation Tests

For PTT requests, the specimen should be processed immediately within ____

A

Within 2 hours

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40
Q

Anticoagulant Used for Coagulation Tests

If the test requested is for PT only, the plasma retrieved can still be used within ____

A

Within 24 hours

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41
Q

Anticoagulant Used for Coagulation Tests

Both specimens for PT and PTT are stored at what temperature?

A

Room temperature

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42
Q

What are two (2) types of sodium citrate concentration?

A
  1. 3.2% (0.109 M)
  2. 3.8% (0.129 M)
43
Q

The two types of sodium citrate concentration are ideal specifically among patients with increased ____, frequently seen in patients with ____

A

Increased hematocrit value as seen in polycythemia vera

44
Q

T or F: Relative polycythemia vera causes a false increase in the hematocrit value.

45
Q

T or F: Dehydration causes a false decrease in hematocrit value.

A

False (False increase)

46
Q

T or F: Absolute polycythemia vera causes a true increase in hematocrit.

47
Q

If the hematocrit value has reached ____, it will affect the PT/PTT results.

48
Q

If the hematocrit exceeds ____, there will be an excess of citrate in the specimen.

49
Q

Excess of citrate in the specimen causes ____ of coagulation time tests.

A

Prolonged coagulation

50
Q

Remedy Used for Increased Hematocrit Value

This formula is used to determine the amount of anticoagulant that we have to remove from that particular tube due to high hematocrit value.

A

C = (1.85 x 10^-3) x (100 - Hct) x Vol

51
Q

Remedy Used for Increased Hematocrit Value

T or F: Authors recommend to not open the blue top tube before testing or separating plasma from the specimen.

52
Q

Remedy Used for Increased Hematocrit Value

Use ____ citrate concentration if the patient has high hematocrit.

53
Q

Remedy Used for Increased Hematocrit Value

What ratio should be maintained in any test if you are mixing the blood to a particular anticoagulant?

54
Q

Anticoagulants that should not be used for coagulation tests

What are the three (3) anticoagulants that should not be used for coagulation tests?

A
  1. Heparin
  2. Ethylenediaminetetraacetic Acid (EDTA)
  3. Oxalate
55
Q

Anticoagulants that should not be used for coagulation tests

  • Has anti-thrombin property
  • Will inhibit clotting formation
56
Q

Anticoagulants that should not be used for coagulation tests

Most coagulation tests rely on the formation of ____ which comes from ____

A

Formation of thrombin from prothrombin

57
Q

Anticoagulants that should not be used for coagulation tests

  • Not ideal for coagulation tests since it makes Factor V unstable
58
Q

Anticoagulants that should not be used for coagulation tests

  • Not ideal when automated machines are used
  • Binds to calcium which will form a precipitate that affects the absorbance and transmittance of light
59
Q

Anticoagulants that should not be used for coagulation tests

Most automated machines use ____ for testing PT/PTT.

A

Light source

60
Q

What are the two (2) suggested techniques of collection for coagulation tests?

A
  1. Two-syringe technique
  2. Two evacuated tube technique
61
Q

What is the main objective of the two collection techniques?

A

To prevent tissue fluid contamination in our specimen

62
Q

Please review the procedure of the two-syringe method and two evacuated tube method.

A

Hehe, thanks pi.

63
Q

What are the five (5) factors affecting the specimen during blood collection?

A
  1. Tissue Fluid
  2. Drug Administration
  3. Acidity and Basicity
  4. Tourniquet Application
  5. Anticoagulant Used
64
Q

Factors affecting the specimen during blood collection

Generally, how do we ensure there is no tissue fluid contamination?

A

Using two blue tops - discarding the first one and utilizing the second one for coagulation tests

65
Q

Factors affecting the specimen during blood collection

If we conduct a PT test when there is thromboplastin from tissue fluid in our PT reagent, it will lead to what?

A

Shortened PT test time

Due to excess thromboplastin present

66
Q

Factors affecting the specimen during blood collection

These drugs inhibit platelet function by altering the cyclo-oxygenase metabollic pathway.

A

Aspirin and other anti-inflammatory drugs

67
Q

Factors affecting the specimen during blood collection

If a patient will undergo platelet function test, they must refrain from taking those drugs at least ____

A

1 week prior to testing

68
Q

Factors affecting the specimen during blood collection

Why should we not flick or tap the arm?

A

It can lead to the formation of lactic acid

69
Q

Factors affecting the specimen during blood collection

Besides tapping or flicking the arm, what is another way that we can have acidic plasma?

A

When plasma is left in contact with blood for too long after centrifugation

70
Q

Factors affecting the specimen during blood collection

When the resources or sugars are depleted, cells may enter what pathway due to the absence of oxygen and formation of lactic acid?

A

Glycolytic pathway

71
Q

Factors affecting the specimen during blood collection

The formation of lactic acid in the plasma due to absence of oxygen can result in what?

72
Q

Factors affecting the specimen during blood collection

T or F: Acidosis causes an increase in blood pH and affects clotting factors.

A

False (decrease)

73
Q

Factors affecting the specimen during blood collection

To avoid having acidic plasma, what three (3) things should we remember?

A
  1. Do not tap it
  2. Avoid prolonged tourniquet application
  3. Separate plasma immediately
74
Q

Factors affecting the specimen during blood collection

T or F: CO2 level in the plasma will decrease if not covered and will cause basicity in the plasma.

75
Q

Factors affecting the specimen during blood collection

T or F: Tourniquet application should not be too tight or prolonged to prevent arterial occlusion and stasis.

A

False (venous occlusion)

76
Q

Factors affecting the specimen during blood collection

What two (2) things may occur when the tourniquet is too tight?

A
  1. Fluid contamination
  2. Hemoconcentration of blood
77
Q

Factors affecting the specimen during blood collection

Hemoconcentration of blood causes a ____ result of coagulation tests?

A

False increase

78
Q

Factors affecting the specimen during blood collection

If we don’t use a certain amount of anticoagulant or do not use 3.2% sodium citrate, it causes what type of results for clot-based coagulation tests?

A

Falsely prolonged results

79
Q

Factors affecting the specimen during blood collection

If PT/PTT test is proceeded, what do we add to bring back the calcium for the blood to clot for polycythemic blood?

A

Calcium reagent

80
Q

Factors affecting the specimen during blood collection

The process of bringing back calcium for the blood to clot.

A

Recalcification

81
Q

Factors affecting the specimen during blood collection

T or F: Plasma cannot clot without red cells.

A

False (can)

82
Q

Setting the ____ of the centrifuge is vital in preparing PPP or PRP specimen.

A

Time and speed/gravitational force

83
Q

Factors affecting the specimen during blood collection

What are the four (4) tests that use PPP?

A
  1. PT
  2. PTT
  3. Thrombin Time
  4. Reptilase Time
84
Q

Match the purpose to the plasma specimen.

  1. Assess clotting factors
  2. Assess platelet function

A. PPP
B. PRP

85
Q

What are the three (3) tests that use PRP?

A
  1. Platelet Aggregation Studies
  2. Platelet Retention Test
  3. Plasma Recalcification Test
86
Q

PPP or PRP

  • Perform a heavy spin
  • Set gravitational force to 2000 to 3000 for 10 to 15 minutes
  • Contains approximately less than 10 x 10^9/L platelets
  • Can be stored at room temperature
  • Testing should be done within 2 hours
  • Stored at 4C if test cannot be done immediately for not more than 4 hours
  • If cannot be processed immediately, can be stored in a freezer (-15C to 20C) to extend validity for up to 2 hours
  • Used in PT/PTT
87
Q

PPP or PRP

  • Perform light spin
  • Set gravitational force to less than 200 for 10 to 15 minutes)
  • Contains approximatelt 250 x 10^9/L platelets
  • More turbid appearance
  • Commonly used for platelet aggregation studies
  • May be left at room temperature in capped plastic tubes for 2 hours before testing
  • Cannot be stored in a freezer or ref
  • Fasting for 6 to 8 hours is required to decrease turbidity
88
Q

What are two (2) other analytes in the plasma that can be analyzed using a blue top on a cold centrifuge?

A
  1. Beta-thromboglobulin
  2. Platelet Factor IV
89
Q

What are the six (6) factors that affect blood specimen for coagulation?

Feeling ko natanong ko na ‘to kanina pero paulit-ulit kasi, yawa.

A
  1. High PCV or HCT
  2. Contact with glass surface
  3. Hemolysis
  4. Premature clotting or presence of clot on blood samples prior to testing
  5. Storage temperature
  6. pH of blood samples
90
Q

Factors that affect blood specimen for coagulation

High hematocrit values will cause ____ citrate.

91
Q

Factors that affect blood specimen for coagulation

Glass surface provides a ____ charge, causing platelets to be activated.

92
Q

Factors that affect blood specimen for coagulation

What are the clotting factors that can be prematurely activated upon contact with glass surface?

A

Contact Group (Factor XI, Factor XII, HMWK, PK)

93
Q

Factors that affect blood specimen for coagulation

If the contact group of clotting factors was activated prematurely because of contact with the glass surface, the PTT result will be ____ because there is lower concentration of clotting factors.

94
Q

Factors that affect blood specimen for coagulation

T or F: Glass syringe may be used for PTT.

95
Q

Factors that affect blood specimen for coagulation

T or F: Always reject hemolysed specimen.

96
Q

Factors that affect blood specimen for coagulation

Why don’t we accept hemolysed sample for PT/ PTT and certain coagulation tests?

A

Once red cells are damaged, ADP and tissue thromboplastin-like component is released.

97
Q

Factors that affect blood specimen for coagulation

The release of ADP and the thromboplastin will cause a lowering of the concentration of clotting factors which will cause ____ of the result of PT/PTT.

A

Prolongation

98
Q

Factors that affect blood specimen for coagulation

Specimen collected ____ should be rejected.

A

More than 2 hours ago

99
Q

Factors that affect blood specimen for coagulation

Decreases the concentration of CF and causes clumping of platelets

A

Premature clotting

100
Q

Factors that affect blood specimen for coagulation

T or F: The plasma on a centrifuged blue top should immediately be transferred to another tube.

101
Q

PT measures what pathway/s?

A

Extrinsic and common pathway

102
Q

PTT measures what pathway/s?

A

Intrinsic and common pathway

103
Q

If the person is ____ deficient and tests for PT and PTT, the result would be normal.

A

Factor XIII

Because Factor XIII is part of the
common pathway.

Hematology 2 (10 decks)

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