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Hematology 2 (Lecture) > Sample Preparation for Hemostasis Testing (F) > Flashcards

Sample Preparation for Hemostasis Testing (F) Flashcards

1
Q

What are the required blood collection tubes to be used for sample preparation for hemostasis testing?

A

1) Lavender top (EDTA)
2) Blue top (Sodium citrate)
3) Blue top (CTAD)

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2
Q

What is the anticoagulant present in lavender top?

A

Ethylenediaminetetraacetic acid

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3
Q

What are the purposes of lavender top?

A

It is used for:

1) PLT ct
2) Evaluation of PLT morpholoogy
3) Molecular testing to detect mutations

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4
Q

Elevated Hcts does not require the what (in terms of lavender top)?

A

It does not require the adjustment of anticoagulant

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5
Q

What is the anticoagulant present in blue top (sodium citrate)?

A

3.2% sodium citrate

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6
Q

What are the purposes of blue top?

A

It is used for majority of tests and assays in hemostasis testing

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7
Q

What must be strictly followed (when it comes to blue top)?

A

The blood:anticoagulant ratio

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8
Q

What is the blood:anticoagulant ratio in blue top?

A

9:1

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9
Q

What is the volume of blood and anticoagulant if regular tubes are used (in terms of blue top)?

A

Regular tubes require 2.7 mL of collected blood to be mixed w/ 0.3 mL of sodium citrate

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10
Q

What is the volume of blood and anticoagulant for other tubes (in terms of blue top)?

A

Some use 1.8 mL of blood + 0.2 mL sodium citrate

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11
Q

What should be done if the Hcts are 55% and above (in terms of blue top)?

A

If the Hcts are of 55% and above, it require the adjustment of anticoagulant

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12
Q

What is the formula used (for blue top)?

A 
C = (1.85 X 10^-3) (100 - Hct) V
D = 0.3 - C
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13
Q

What are the components of the formula (for blue top) and what does these components stand for?

A 
V = total volume of mixture in tube in mL
Hct = hematocrit of blood in percent
C = adjusted anticoagulant in mL
D = discarded anticoagulant in mL
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14
Q

Provide an ex of computation (executing the formula; for blue top)

A

E.g. A pt for hemostasis testing has a Hct of 65%

C = (1.85 X 10^-3) (100 - Hct) V
C = (1.85 X 10^-3) (100 - 65) 3 mL 
C = 0.19 mL sodium citrate must remain in the tube 
D = 0.3 mL - 0.19 mL
D = 0.11 mL sodium citrate must be discarded
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15
Q

What is the anticoagulant present in blue top (CTAD)?

A

Citrate theophylline adenosine dipyridamole

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16
Q

What is the purpose of blue top (CTAD)?

A

It is used for special assays in determining PLT activation or coagulation activation

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17
Q

What is the frequency of usage of blue top (CTAD)?

A

It is rarely used

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18
Q

What should be done in EDTA-mixed whole blood (as a part of the steps after blood collection)?

A

It should be mixed in an automated roller mixer to maintain the distribution of blood elements within the sx

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19
Q

What is the alternative that can be used for EDTA-mixed whole blood whereas automated roller mixer is used to it (as a part of the steps after blood collection)?

A

Alternative: should be in a rack and must be mixed well before processing

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20
Q

What should be done (or what are the parameters that should be done or observed) to citrated-whole blood (as part of the steps after blood collection)?

A

1) It should be maintained in an upright position
2) It should be intactly sealed
3) It should be only placed at ambient temperatures (15 - 25 DC)

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21
Q

What are the purposes of whole blood + sodium citrate?

A

It is used for:

1) Lumiaggregometry
2) Electrical impedance conventional aggregometry
3) Thromboelastography (TEG)
4) Thromboelastometry (ROTEM)

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22
Q

What should be done to whole blood + sodium citrate prior to testing?

A

Gently invert the tube prior testing

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23
Q

What is the time duration of testing the citrated whole blood?

A

It should be tested within 4 hrs at 15 - 25 DC

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24
Q

What should be done (in terms of storage) to EDTA whole blood if the sx will be used for automated or manual CBC?

A

1) It can be stored up to 6 hrs if it is at room temp

2) It can be stored up to 24 hrs if it is at 4 DC

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25
Q

If the sx (EDTA whole blood) will be used for PLT morphology in blood film, what should be done to the sx (in terms of preparation)?

A

The sx should be prepared within 3 hrs at room temp

26
Q

What is PLT-rich plasma?

A

It is described as a plasma w/ 200,000 - 300,000/uL of PLTs

27
Q

What are the uses of PLT-rich plasma?

A

It is used for:

1) Light transmittance conventional aggregometry
2) Lumiaggregometry

28
Q

What is the process (or steps) to acquire PLT-rich plasma(?)?

A

1) Centrifuge tube at 50 x g for 30 mins
2) Transfer supernatant using a plastic pipette to a plastic tube
3) Stand undisturbed for 30 mins to regain responsiveness

29
Q

What are the components of the mixture (inside the test tube) for acquiring PLT-rich plasma?

A

1) PLT-Poor Plasma
2) PLT-Rich Plasma
3) RBCs

30
Q

What is the time duration for testing of PLT-rich plasma?

A

It should be tested within 4 hrs at 15 - 25 DC

31
Q

What is PLT-poor plasma?

A

It is described as plasma w/ < 10,000/uL of PLTs

32
Q

What is the use of PLT-poor plasma?

A

It is used for clot-based coagulation tests

33
Q

What is the process (or steps) to acquire PLT-poor plasma?

A

1) Centrifuge tube at 1,500 x g for 15 mins

* if HemoCue StatSpin centrifuge is used, spin at 4,400 x g for 3 mins

34
Q

What should be done if the pt is not taking unfractionated heparin (centrifuged or uncentrifuged; for PLT-poor plasma) in correlation to tests?

A

PT: tested within 24 hrs at 15 - 25 DC
PTT: tested within 4 hrs at 15 - 25 DC
Factor assays: tested within 4 hrs at 15 - 25 DC

35
Q

What should be done if the pt is taking unfractionated heparin (centrifuged within 1 hr; for PLT-poor plasma) in correlation to tests?

A

PT: tested within 4 hrs at 15 - 25 DC
PTT: tested within 4 hrs at 15 - 25 DC

36
Q

What should be done if the sx will not be processed within the day (centrifuged within 1 hr; for PLT-poor plasma) in correlation to tests?

A

1) It can be stored until 2 wks if it is at -20 DC
2) It can be stored until 6 mos or beyond if it is at -70 DC
3) THAWING: thaw plastic tube at 37 DC, mix, should be tested within 1 hr

37
Q

What is double spin PLT-poor plasma?

A

It is described as a plasma w/ < 5,000/uL of PLTs

38
Q

What is the characteristic of double spin PLT-poor plasma?

A

It is preferred for lupus anticoagulant testing

39
Q

What is the process (or steps) to acquire double spin PLT-poor plasma?

A

1) Centrifuge tube at 1,500 x g for 15 mins
2) Transfer supernatant using a plastic pipette to a plastic tube
3) Centrifuge a plastic tube at 1,500 x g for 15 mins

40
Q

What is the preparation done to citrated whole blood?

A

Gentle inversion before testing

41
Q

What is the stability of citrated whole blood for electrical impedance conventional aggregometry and lumiaggregometry?

A

Electrical impedance conventional aggregometry: tested within 4 hrs at 15 - 25 DC
Lumiaggregometry: tested within 4 hrs at 15 - 25 DC

42
Q

What is the preparation done to EDTA-mixed whole blood?

A

Gentle inversion before testing

43
Q

What is the stability of EDTA-mixed whole blood for CBC and PLT morphology in blood film?

A

CBC: can be stored up to 6 hrs if it is at room temp
CBC: can be stored up to 24 hrs if it is at 4 DC
PLT morphology in blood film: should be prepared within 3 hrs at room temp

44
Q

What is the preparation done to PLT-rich plasma?

A

Centrifuge tube at 50 x g for 30 mins

45
Q

What is the stability of PLT-rich plasma for light transmittance conventional aggregometry and lumiaggregometry?

A

Light transmittance conventional aggregometry: tested within 4 hrs at 15 - 25 DC
Lumiaggregometry: tested within 4 hrs at 15 - 25 DC

46
Q

What is the preparation done to PLT-poor plasma?

A

Centrifuge tube at 1,500 x g for 15 mins

47
Q

What is the stability of PLT-poor plasma if pt is not taking unfractionated heparin (centrifuged or uncentrifuged)?

A

PT: tested within 24 hrs at 15 - 25 DC
PTT: tested within 4 hrs at 15 - 25 DC
Factor assays: tested within 4 hrs at 15 - 25 DC

48
Q

What is the stability of PLT-poor plasma if the pt is taking unfractionated heparin (centrifuged within 1 hr)?

A

PT: tested within 4 hrs at 15 - 25 DC
PTT: tested within 4 hrs at 15 - 25 DC

49
Q

What is the stability of PLT-poor plasma if sx will not be processed within the day (centrifuged)?

A

1) It can be stored until 2 wks if it is at -20 DC

2) It can be stored until 6 mos or beyond if it is at -70 DC

50
Q

What are the diff sx collection errors for hemostasis testing?

A

1) Underfilled citrate tubes
2) Overfilled citrate tubes
3) Elevated Hct
4) Clotted sx
5) Visible hemolysis
6) Lipemia (cloudy or milky) or icterus (yellow)
7) Tourniquet > 1 min

51
Q

What is the result for underfilled citrate tubes?

A

Prolonged clot-based time tests

52
Q

What is the result for overfilled citrate tubes?

A

Shortened clot-based time tests

53
Q

What is the result for elevated Hct?

A

Prolonged clot-based time tests

54
Q

What is the result for clotted sx?

A

Prolonged clot-based time tests

55
Q

What is the result for visible hemolysis?

A

Results are not detected by optical instruments for clot-based time tests; in vitro activation of primary and secondary hemostasis

56
Q

What is the result for lipemia (cloudy or milky) or icterus (yellow)?

A

Results are not detected by optical instruments for clot-based time tests; results are also not detected by chromogenic assays

57
Q

What is the result for tourniquet > 1 min?

A

Shortened clot-based time tests

58
Q

What are the sx storage errors encountered in hemostasis testing?

A

1) Storage at 1 - 6 DC
2) Storage > 25 DC
3) Removed blood collection seal

59
Q

What is the result for storage at 1 - 6 DC?

A

Prolonged clot-based time tests due to in vitro activation of PLTs and factor VII and precipitation of VWFs

60
Q

What is the result for storage > 25 DC?

A

Prolonged clot-based time tests due to deterioration of factors V and VIII

61
Q

What is the result for removed blood collection seal?

A

Prolonged clot-based time tests due to increased pH

Hematology 2 (Lecture) (11 decks)

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