PRELIM LEC: BASIC HEMATOLOGICAL METHODS Flashcards
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
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
Can be the biggest risks of the modern research lab
Biological Hazard
Melioidosis / Vietnamese time bomb
Burkholderia pseudomallei
Bioterrorism agent
Bacillus anthracis, Burkholderia
mallei (Glanders disease)
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)
Sodium hypochlorite: kills all except spore formers bacterias (1 minute)
5.25 - 6.15
1 part of Sodium hypochlorite; 9 parts of water
1:10
Treat all patients as a possible source of a blood-borne pathogen
UNIVERSAL PRECAUTION
```
Wear gloves when handling blood of body
fluids that are contaminated with blood
UNIVERSAL PRECAUTION
All body fluids are infectious
BODY SUBSTANCE ISOLATION
Recommended wearing of gloves
BODY SUBSTANCE ISOLATION
Does not recommend handwashing after gloves removal
BODY SUBSTANCE ISOLATION
Combines UP and BSI
STANDARD PRECAUTION
Recommend wearing of gloves
STANDARD PRECAUTION
Handwashing (every after encounter a sample)
STANDARD PRECAUTION
PHASES OF COLLECTION:
- Pre-collection
- Collection
- Post – collection
Pre-collection
Proper patient preparation:
* Stress
* Exercise
* Smoking
* Meal within 2 hours
* Crying
HORMONES INCREASE IN Stress
- catecholamines
- albumin
- cortisol
- glucose
- ACPH
- prolactin
- insulin
HORMONES INCREASE IN Exercise (SHORT TERM)
cortisol, adrenalin, noradrenalin, and dopamine
HORMONES INCREASE IN Smoking
CORTISOL
CARBON DIOXIDE TO CARBON HEMOGLOBIN
HORMONES INCREASE IN Meal within 2 hours
GASTRIN
INSULIN
DOPAMINE
GLUCOSE
HORMONES INCREASE IN Crying
WBC
OXYTOCIN
HORMONES INCREASE IN Exercise (LONG TERM)
- INSULIN
- TESTOSTERONE
- GH
- CK
- CORTISOL
- URIC ACID
- AST
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
- Cold and cyanotic areas
- Inflamed and pallor areas
- Congested and edematous area
- 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
