Phlebotomy Flashcards
Haima is the greek word for
Blood
3 types of blood vessels
veins
arteries
capillaries
The longest blood vessel is
Vein (D: 5mm)
The smallest and most numerous blood vessel
Capillaries (D: 8um)
Diameter of arteries
4mm
Blood is composed of (3) portions
Solid portion
Liquid portion
Gaseous portion
Liquid portion of unclotted blood
Plasma
Liquid portion of clotted blood
Serum
Cellular elements are otherwise known as
Hemocytes
The solid portion of the blood contains
RBC
WBC
PLT
Other names for RBC
Erythrocyte
Akaryocyte
Erythroplastids
Other names for WBC
Leukoplastids
Leukocytes
Granular WBCs
Basophil
Eosinophil
Neutrophil
Agranular WBCs
LYMPH
MONO
Other names for PLTS
Thrombocytes
Thromboplastids
pH of blood
7.35-7.45
Average specific gravity of blood
1.055
SG of water
1.000
Blood is thicker than water
3.5-4.5x
mL of blood per kg of body weight
75-85 mL
grams of solid per 100 mL of blood
20 g
Patient must be identified by asking for his/her
Name
Age/Sex
Birthdate
The most critical step in blood collection is
Patient identification
The mortal sin of phlebotomy
Mislabeling
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
5x
Thrombin is found on
orange top tubes
Orange top tubes with thrombin are inverted
8x
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
5x
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
8x
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 ______
4C
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
8x
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
pH
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
0
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
