1. Source 2. Mode of Transmission 3. Susceptible Host 4. Infectious Agents (Diagnosis/Treatment) 5. Portal of Exit (handwashing, control of aerosol & splatter) 6. Portal of Entry (First aid, personal hygiene, handwashing)

PRELIM LEC: BASIC HEMATOLOGICAL METHODS Flashcards by Chin Lys

Bacteria, viruses, blood, tissues, and/or bodily
fluids can all carry disease or hazardous
allergens which could put the lab team at risk

Biological Hazard

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Could prove to be a massive risk for not only
the lab professionals working with the
materials, but anyone they come into contact
with outside of work

Biological Hazard

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Can be the biggest risks of the modern research lab

Biological Hazard

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Melioidosis / Vietnamese time bomb

Burkholderia pseudomallei

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Bioterrorism agent

Bacillus anthracis, Burkholderia
mallei (Glanders disease)

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CHAIN OF INFECTION

Source
Mode of Transmission
Susceptible Host
Infectious Agents (Diagnosis/Treatment)
Portal of Exit (handwashing, control of aerosol & splatter)
Portal of Entry (First aid, personal hygiene,
handwashing)

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Sodium hypochlorite: kills all except spore formers bacterias (1 minute)

5.25 - 6.15

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1 part of Sodium hypochlorite; 9 parts of water

1:10

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Treat all patients as a possible source of a blood-borne pathogen

UNIVERSAL PRECAUTION

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Wear gloves when handling blood of body
fluids that are contaminated with blood

UNIVERSAL PRECAUTION

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All body fluids are infectious

BODY SUBSTANCE ISOLATION

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Recommended wearing of gloves

BODY SUBSTANCE ISOLATION

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Does not recommend handwashing after gloves removal

BODY SUBSTANCE ISOLATION

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Combines UP and BSI

STANDARD PRECAUTION

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Recommend wearing of gloves

STANDARD PRECAUTION

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Handwashing (every after encounter a sample)

STANDARD PRECAUTION

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PHASES OF COLLECTION:

Pre-collection
Collection
Post – collection

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Pre-collection

Proper patient preparation:
* Stress
* Exercise
* Smoking
* Meal within 2 hours
* Crying

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HORMONES INCREASE IN Stress

catecholamines
albumin
cortisol
glucose
ACPH
prolactin
insulin

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HORMONES INCREASE IN Exercise (SHORT TERM)

cortisol, adrenalin, noradrenalin, and dopamine

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HORMONES INCREASE IN Smoking

CORTISOL
CARBON DIOXIDE TO CARBON HEMOGLOBIN

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HORMONES INCREASE IN Meal within 2 hours

GASTRIN
INSULIN
DOPAMINE
GLUCOSE

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HORMONES INCREASE IN Crying

WBC
OXYTOCIN

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HORMONES INCREASE IN Exercise (LONG TERM)

INSULIN
TESTOSTERONE
GH
CK
CORTISOL
URIC ACID
AST

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INCREASE IN CLENCHING

POTASSIUM LACTATE PHOSPHATE

Collection

Proper patient identification Considerations: A. Methods to use B. Sample to use C. Pressure during collection D. Posture E. Diurnal Variance F. Hemoconcentration

ideal for non – ambulatory patient

Supine

ideal for ambulatory patients

Sitting upright

Diurnal Variance EXAMPLE

CORTISOL

CAN CAUSE Hemoconcentration

a. Prolonged tourniquet application b. False increase (K, RBC, Hematocrit) c. Probing

Post – collection

Considerations: A. Proper Patient Care B. Proper specimen transport and handling

Also known as Microcollection

Capillary Puncture

COLLECTION SITES OF CAPILLARY PUNCTURE:

o Last phalanx of the 3rd or 4th finger o Plantar Heel (Lateral) o Earlobe o Big toe of the foot

Capillary Puncture IS IDEAL FOR:

a. Newborn b. Pediatrics (<6 mos.) c. Patients with poor vein i. Extreme obesity ii. Severe burns iii. Geriatric patient

o Mixture of venous blood, arterial blood and tissue fluid o Generate slightly different results

Capillary Blood

Infant’s finger should not be punctured to as to avoid serious injury to the bones | CAPILLARY PUNCTURE

YES TRUE

Capillary beds in an infant’s heel are located between ____ the skin surface | CAPILLARY PUNCTURE

0.35-1.6mm below

Puncture depth CAPILLARY PUNCTURE: | CAPILLARY PUNCTURE

<2mm

Generally, distance of the skin surface to the bone/cartilage in the middle finger: | CAPILLARY PUNCTURE

1.5-2.4mm

CAPILLARY PUNCTURE ADVANTAGES:

* Easily accessible to the Med. Tech * Easy to manipulate * Less intimidating * Ideal for peripheral blood smear * More free flow of blood * Ideal when searching abnormal cells

CAPILLARY PUNCTURE DISADVANTAGES:

* Less amount of blood can be obtained * Blood hemolyzes easily * Additional and repeated tests cannot be done

Areas to avoid: | CAPILLARY PUNCTURE

1. Cold and cyanotic areas 2. Inflamed and pallor areas 3. Congested and edematous area 4. Scarred and heavily calloused area

Warm the area before puncturing | CAPILLARY PUNCTURE

(<42 degrees Celsius for 2-5 minutes)

Position of the puncture | CAPILLARY PUNCTURE

Perpendicular

Depth of incision | CAPILLARY PUNCTURE

a. Adult:<2mm quick and firm b. Children: not deeper than 1.6mm

NEVER DO: | CAPILLARY PUNCTURE

a. Lock and Key b. Double pricking with the same lancet

- A.k.a Phlebotomy - Process by which blood is obtained from the VEINS

Venipuncture

✓ 2nd most preferred vein; the easiest vein to palpate in obese patients | Vein Selection:

Cephalic Vein

✓ Most preferred vein ✓ Stable; well anchored ✓ Less painful ✓ Biggest vein | Vein Selection:

Median Vein

✓ Least preferred; not stationary; close to brachial artery and median cutaneous nerve branch | Vein Selection:

Basilic Vein

Alternative Sites: | Vein Selection:

✓ Dorsal vein of the hand ✓ Veins of wrist ✓ Veins of the foot (with consent of the physician

Blood Donation | Vein Selection:

✓ Median ✓ Basilic ✓ Cephali

For alcohol testing:

Benzalkonium Chloride (Zephiran)

Sites to Avoid:

✓ Hematomas ✓ Burns ✓ Scars/Edema ✓ Side of which mastectomy was performed ✓ Arm receiving in intravenous infusion

TYPES OF TOURNIQUET:

- Seraket - Rubber - Velcro

Local Immediate | Complications:

✓ Hemoconcentration ✓ Circulatory Failure ✓ Syncope/Faintin

Local Delayed | Complications:

✓ Hematoma ✓ Thrombosis/Clot formation ✓ Thrombophlebitis

Late General | Complications:

✓ Serum Hepatitis ✓ AID

✓ Process by which blood is obtained from the Artery

Arterial Puncture

Performed by a Physician/ respiratory therapist

Arterial Puncture

for Blood Gas analysis

Arterial Puncture

Preferred Sites: | Arterial Puncture

– Radial Artery – Brachial Artery – Femoral Artery – Scalp Artery – Umbilical Artery

this test assesses whether ulnar artery can provide enough blood supply to the radial artery during collection | Arterial Puncture

Allen’s Test

Transport in an | Specimen Handling

Upright position

. Separation from cellular components is within | Specimen Handling

30 minutes after collection

Delivery to lab within | Specimen Handling

45mins. to 1 hour after collection

Exposure to light: Decrease | Specimen Handling

* Bilirubin * Carotene * RBC folate * Porphyrins

Chilled Specimen: – Best for | Specimen Handling

* Arterial Blood Gas * Ammonia * Lactic Acid * Certain Coagulation test

Warm Specimen: – Best for | Specimen Handling

* Cold Agglutinin * Cryofibrinogen * Cryoglobulin

Procedure for blood collection of patients with IV line:

✓ Stop IV (nurse) ✓ Wait for 3-5 minutes ✓ Extract 5ml blood and discard ✓ Extract blood to be used for examination

Increased analytes in prolonged standing:

● Calcium ● Albumin ● Cholesterol ● AIP ● mnemonics: CACA tayo

Platelet count

Ethylenediaminetetraacetic Acid

Prevent platelet aggression

Ethylenediaminetetraacetic Acid

Most commonly used anticoagulant in hematology

Ethylenediaminetetraacetic Acid

Ethylenediaminetetraacetic Acid Optimal anticoagulant concentration:

1.5 mg/mL of blood

Platelet study

Citrate

blue top | Citrate

3.2% ○ 0.109 molar (plastic) ○ 0.105 molar (glass)

black top | Citrate

3.8%

Inhibits blood clotting by binding calcium in a soluble complex and is used for many coagulation studies | Citrate

3.8% - black top

Is an acid mucopolysaccharide that inhibits coagulation by the inactivation of thrombin

Heparin

Choice for the osmotic fragility test

Heparin

Optimal concentration: | Heparin

15-20 u/mL of blood