Phlebotomy Flashcards by Trisha Anne

Haima is the greek word for

Blood

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3 types of blood vessels

veins
arteries
capillaries

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The longest blood vessel is

Vein (D: 5mm)

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The smallest and most numerous blood vessel

Capillaries (D: 8um)

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Diameter of arteries

4mm

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Blood is composed of (3) portions

Solid portion
Liquid portion
Gaseous portion

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Liquid portion of unclotted blood

Plasma

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Liquid portion of clotted blood

Serum

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Cellular elements are otherwise known as

Hemocytes

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The solid portion of the blood contains

RBC
WBC
PLT

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Other names for RBC

Erythrocyte
Akaryocyte
Erythroplastids

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Other names for WBC

Leukoplastids
Leukocytes

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Granular WBCs

Basophil
Eosinophil
Neutrophil

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Agranular WBCs

LYMPH
MONO

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Other names for PLTS

Thrombocytes
Thromboplastids

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pH of blood

7.35-7.45

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Average specific gravity of blood

1.055

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SG of water

1.000

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Blood is thicker than water

3.5-4.5x

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mL of blood per kg of body weight

75-85 mL

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grams of solid per 100 mL of blood

20 g

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Patient must be identified by asking for his/her

Name
Age/Sex
Birthdate

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The most critical step in blood collection is

Patient identification

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The mortal sin of phlebotomy

Mislabeling

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Physiologic factors that can affect test results

Posture Diurnal Rhythm Stress Exercise Diet Smoking

Shift in posture from supine to standing/sitting can increase the levels of

Protein Cholesterol Iron

In the morning the following are increased:

Cortisol TSH Iron

EO count is ____ in the morning

decreased

Fe, Chole, and Protein concentrations are increased when there is a shift in posture due to

them being too large and are not readily filtered into the the tissues from the blood vessels to the interstitial spaces

Stress increases

WBCs Fibrinogen group

Fibrinogen group are thrombin-sensitive group because

they are all activated by thrombin

Factors activated by thrombin

1 5 8 13

Exercise can increase (9)

Crea, CK, TP, Myoglobin, AST, HDL-Chole, LDH, WBC count, PLT count

After a fatty meal, ___ is falsely increased; also ___-ALP

Hemoglobin Intestinal ALP

Smoking increases

WBC count and cortisol

Skin puncture may be used for (5)

newborn, pedia severely burned px px veins reserved for tx purposes extremely obese px elderly px w/ fragile veins

For infants <1yo, the site for skin puncture is

medial or lateral side of the heel portion of the plantar surface of infant's foot

For >1 yo and adults, the site for skin puncture is on the

Palmar surface of the non-dominant 3rd or 4th distal finger

Recommended depth for skin puncture for infants and small children

<2.0 mm

Depth of puncture for adults

2-2.5 mm

Too much pressure or milking/squeezing the site can cause

hemolysis introduce excess interstitial fluid

Most common skin antiseptic

70% isopropyl alcohol

The first drop of blood must be discarded in skin puncture to

Discard excess tissue fluid/interstitial fluid Discard dead epidermal cells Facilitate free flow of blood

Devices used for skin puncture

Capillary tubes Microtainer tubes

Order of draw for skin puncture

Tube for Blood Gas Analysis Slides EDTA Other microtainer with anticoag Serum microcollection tubes

First tube that is filled in skin puncture

Tube for blood gas analysis

First tube that is filled before other microcollection tubes

EDTA

This can increase the blood flow by 7x

Warming of the puncture site

How to warm the puncture site

Warm washcloth (40-42C) for 3-5 mins max

Most common site for venipuncture

Superficial veins of the antecubital fossa

Two anatomical patterns of the veins

H M

H: veins used in order of preference

median cubital cephalic basilic

M: veins used according to preference

median vein accessory cephalic basilic

Important Considerations in Venipuncture: Angle between skin and needle must be

<30

Important Considerations in Venipuncture: Recommended length of time for tourniquet application

< 1 min/60 sec

Important Considerations in Venipuncture: Effects of prolonged tourniquet application includes

Hemoconcentration Hemolysis Shortened coagulation time

When there is stasis caused by prolonged tourniquet application, these factors accumulate leading to falsely shortened clot-based coagulation test results

Factor VIII and VWF

Important Considerations in Venipuncture: The tourniquet must be located _____ above the venipuncture site

3-4 inches/ 7.5-10 cm

Important Considerations in Venipuncture: Most common needle size for adult

21 G Length: 1 inch

The higher the gauge,

the smaller the bore size

Important Considerations in Venipuncture: A phlebotomist must never puncture a patient more than

twice

Important Considerations in Venipuncture: Pumping of fist during blood collection will result to an increase in

Potassium

Important Considerations in Venipuncture: Sites to avoid

Veins of the inner wrist, veins in the feet fistula arteries inflamed sites edematous sites

Important Considerations in Venipuncture: Causes of hemolysis

Prolonged tourniquet application Moisture/contamination in blood CT Needles with too small bores Excessive agitation Frothing of the blood sample

Important Considerations in Venipuncture: Standard Precautions was originally called

Universal Precautions

Practices to control diseases in which all blood, body fluids, and unfixed tissues are handled as if they were potentially infectious; including unfixed slides and microhematocrit clay

Standard Precautions

The most important practice to prevent the spread of infectious diseases

Hand washing

During hand washing, rub hands vigorously for at least

15 seconds

Important Considerations in Venipuncture: Replace sharps container when they are

3/4 full

The most common cause of needle puncture or puncture from other sharp objects is

improper disposal

Bruise is aka

Ecchymosis

The most common complication encountered in venipuncture

Ecchymosis/Bruise

How is ecchymosis different from hematoma

Ecchymosis: leakage of SMALL amounts of blood, FLAT purplish discoloration Hematoma: leakage of LARGE amounts of blood, SWOLLEN/BULGING purplish discoloration

To avoid hemoconcentration after prolonged tourniquet application, wait for ____ before reapplying tourniquet

2 mins

Increased concentration of cells, larger molecules, and analytes in the blood because of a shift in water balance

Hemoconcentration

If there is no alternative site for BC, ask nurse to stop IV for _____, Draw _____ catheter site The _____ is discarded

2 mins below first 5 mL of blood

In obese px, blood pressure cuff can be used to locate veins. However, BP cuff must not be

inflated >40 mmHg left on arm >1 min

Iatrogenic anemia is aka

Physician-induced anemia Nosocomial anemia

This is caused by continuous collection of blood for diagnostic purposes

Iatrogenic anemia

Fainting is aka

Syncope

Short lapse of consciousness

Syncope/Fainting

Formerly used to treat syncope; no longer used because it can trigger asthma attack

Ammonia inhalants

4 types of Additives

Anti-glycolytic agents Clot activators Separator gel Anticoagulants

These inhibit the use of glucose by blood cells

Anti-glycolytic agents

Quickens the clotting of the blood specimen

Clot activators

Inert material that undergoes temporary change in viscosity during the centrifugation process

Separator Gel

Separator gel aka

Thixotropic gel

inhibits the blood from clotting

Anticoagulants

Anti-glycolytic agents

Sodium fluoride Lithium iodoacetate

Similarities of sodium fluoride and lithium iodoacetate

gray top tube inverted 8x used for blood glucose and blood alcohol determination

anticoagulant in sodium fluoride tubes

potassium oxalate

anticoagulant in lithium iodoacetate tube

lithium heparin

Sodium fluoride can preserve glucose for

3 days/72 hours

Lithium iodoacetate can preserve glucose for

24 hours/1 day

Stat comes from the Latin word statim which means

immediately

Clot activators

Glass or silica particles Thrombin

Glass or silica particles activate

Factor XII

Thrombin activates

Factor I, V, VIII, XIII

Glass or silica particles are found in

red top tubes

T/F Plastic red top tubes has additives.

True

Red top tubes with glass or silica particles are inverted

Thrombin is found on

orange top tubes

Orange top tubes with thrombin are inverted

Clot activators (glass or silica particles and thrombin) are used for

stat serum determinations

Separator gels or Thixotropic gels are found on

gold top tubes

Gold top tubes with separator gels or thixotropic gels are inverted

Gold top tubes with separator gels or thixotropic gels are used for

serum determination

EDTA stands for

ethylenediaminetetraacetic acid

Most commonly used blood collection tube in the hematology section

Lavender/Purple top tubes

EDTA is found in

Lavender/Purple top tubes

EDTA tubes are inverted

EDTA is used for

routine hematologic determinations

Optimal EDTA concentration is

1.5 mg per mL of blood

MOA of EDTA

chelation of calcium

EDTA: CBC can be performed on blood stored at room temperature for up to

4 hours

What parameters in CBC is valid even after 24 hours of blood collection, given that the blood is collected in EDTA and refrigerated at 4C?

WBC count, Hematocrit, PLT count

WBC count, HCT, and PLT counts can be determined up to _____ after blood is collected in EDTA if it is refrigerated at 4C

24 hours

WBC count, HCT, and PLT counts can be determined up to 24 hours after blood is collected in EDTA if it is refrigerated at ______

ESR should be set up within _____ of collection, if the EDTA blood was stored at room temperature or within 6 hours, if the specimen was refrigerated.

2 hours

ESR should be set up within 2 hours of collection, if the EDTA blood was stored at room temperature or within ______, if the specimen was refrigerated.

6 hours

ESR should be set up within 2 hours of collection, if the EDTA blood was stored at _____ or within 6 hours, if the specimen was refrigerated.

room temperature

ESR should be set up within 2 hours of collection, if the EDTA blood was stored at room temperature or within 6 hours, if the specimen was ______.

refrigerated

Blood smears can be made from EDTA tube as long as they are made within _____ of blood collection

2 hours

Why is EDTA the recommended anticoagulant for platelet counts?

EDTA prevents platelet aggregation

EDTA affects MPV by causing the cells to swell, thereby

there is a 20% increase in MPV during the first hour after blood collection

MPV should be based on EDTA spx that are between

1-4 hours old

Overfilled lavender top tubes can cause

clot formation

Insufficient EDTA leads to the

presence of clots

Excessive EDTA is caused by

underfilled tubes

Excessive EDTA will result to (3)

falsely decreased Hct and ESR falsely increased MCHC and PLT degenerative changes in WBC

Possible causes of clotted specimens (4)

difficult phlebotomy blood sample not correctly inverted expired BCT overfilled tube

CBC is also known as

Full Blood Count Hemogram

A process in which a current test result is compared with the result of the same test from the previous specimen from the same patient

Delta check

Formation of a ring-shaped molecular complex in which a metal ion is covalent bound

chelation

A test being ordered automatically based on the results of prior tests or present parameters

Reflex test

Heparin is found in

green top tubes

Green top tubes are inverted

Green top tube is used for (4)

Flow cytometry Plasma cytometry determination Osmotic Fragility Test Blood Gas studies

Hematologic tests for green top tubes

osmotic fragility test flow cytometry blood gas studies

optimal heparin concentration is

15-20 units per mL of blood

MOA of heparin

binds antithrombin

Responsible for inhibiting thrombin and Factor Xa

Antithrombin

Factor Xa and Thrombin promote the

clotting process

The anticoagulant of choice for OFT and blood gas analysis

Heparin

3 Heparin formulations

Ammonium heparin Sodium heparin Lithium heparin

The heparin formulation that causes the least interference in chemistry testing

Lithium heparin

The most and widely used anticoagulant for plasma and whole blood chemistry tests

Lithium heparin

Must not be used for lithium level determination

Lithium heparin

must not be used for sodium level determination or for electrolyte panel

sodium heparin

must not be used for ammonia level determination

ammonium heparin

Heparin is not used for CBC because it causes

cellular clumping, especially of plts

Cellular clumping of platelets induced by heparin can cause

pseudoleukocytosis pseudothrombocytopenia

Heparin is also not used for blood smears since it causes

morphologic distortion of platelets and wbcs cause blue coloration of the background of smears

Heparin causes blue coloration of the background of blood smears stained with a Romanowsky stain because of its

Heparin causes blue coloration of the background of blood smears stained with a _____ stain because of its pH

Romanowsky

Heparin causes _____ coloration of the background of blood smears stained with a Romanowsky stain because of its

blue

Heparin must not be used in coagulation studies since it

inhibits thrombin

3.2% Sodium Citrate is found on

light blue top tubes

Light blue top tubes are inverted

3-4x

Light blue top tubes with 3.2% Sodium citrate is used for

coagulation studies

critical ratio between anticoagulant and blood

1:9

MOA of 3.2% sodium citrate

chelation of calcium

In light blue top tubes, forceful mixing or an excessive number of inversions can

activate platelets and shorten clotting time

Why must the order of draw be followed during blood collection?

To avoid cross-contamination of additives that may cause test errors

Information that must be present on the blood collection tube (4)

Px full name PID Date/Time OC (Military time) Phleb initials/code number

Number of inversions of a red top (glass) tube

Yellow top tube may contain either

Sodium Polyanethol Sulfonate Acid Citrate Dextrose

Anticoagulant for blood culture

SPS

MOA of SPS (4)

prevent phagocytosis prevent complement activation neutralize some antibiotics anticoagulant

Acid Citrate Dextrose is used for

Blood Bank tests HLA tests DNA tests Paternity testing

Color of tube for paternity testing

Yellow

Tan top tube has --- of lead

<0.01 ug/mL

Since tan top tube has <0.01 ug/mL of lead, it is recommended for

lead determination

Royal blue top tube contains

low levels of trace elements

Since the royal blue top tube contains low levels of trace elements, it is recommended for

toxicology nutritional chemistry determination trace elements determination

White top tube is used for

molecular diagnostic tests

Black top tube anticoagulant

3.8% sodium citrate

AC:B ratio in black top tube

1:4

Black top tube which contains 3.8% Sodium citrate is used for

Westergren ESR

_____ has a special crossmatch label or px information approved by AABB

Pink top tube

Pink top tubes can be used for

blood bank tests whole blood hema tests

Anticoagulant of white top tube

K2 EDTA with gel

Color of tubes with K2 EDTA

tan royal blue pink

light blue top tubes may contain either

3.2% sodium citrate CTAD

CTAD stands for

citrate theophylline adenosine dipyridamole

light blue top tubes with 3.2% sodium citrate are used for

coagulation tests e.g. PT and APTT

light blue top tubes with CTAD are used for

coagulation tests also for platelet function assays e.g. PF-4 and b-thromboglobulin assays