Specimen Handling and Processing of Blood Flashcards
1
Q
most serious, potentially most dangerous pre-analytical error
A
improper patient identification
2
Q
Pre-analytical Errors make up _____ % of all errors for laboratory samples
A
46-68
3
Q
2 types of handling
A
- routine handling (mixing, transport at RT)
- special handling (body temp., chilled, light-sensitive specimen)
4
Q
Centrifugation, aliquot preparation refer to what?
A
Processing
5
Q
8 possible sources of pre-analytical error?
A
- misidentified the patient
- antiseptic not dry
- expired tube
- wrong collection time
- incorrect needle position
- incorrect needle size
- mislabeled tube
- nonsterile site preparation
6
Q
Why is it important to let antiseptic dry before collecting sample from patient?
A
Could cause hemolysis
7
Q
Additive for (light) blue tubes?
A
sodium citrate
8
Q
tests done for blue tube?
A
coagulation studies (PT, APTT)
9
Q
Additive for lavender tube?
A
EDTA
10
Q
Tests done for lavender top?
A
hematology (CBC, platelet cf)
11
Q
Additive for green tube?
A
heparin
12
Q
test done for green tube
A
chemistry (BGA, electrolytes)
13
Q
additive for gold/orange tube?
A
clot activator
14
Q
test done for gold/orange tube?
A
chemistry?
15
Q
additive for red plastic tube?
A
clot activator (serum)
16
Q
test done for red plastic tube?
A
chemistry
17
Q
additive for gray tube?
A
sodium fluoride/potassium oxalate
18
Q
test done for gray tube?
A
chemistry (glucose)
19
Q
Additive for red glass tube
A
none
20
Q
test for red glass tube
A
chemistry, blood bank, serology/immunology
21
Q
Additive for pink tube
A
edta
22
Q
test for pink tube
A
blood bank
23
Q
Additive for orange/gray/yellow
A
thrombin
24
Q
test done for orange/gray/yellow
A
chemistry
25
Additive for royal blue
None/EDTA/Sodium heparin
26
test done for royal blue tube?
chemistry
27
Additive for tan tube?
EDTA
28
test done for tan tube
chemistry
29
Additive for yellow tube
sodium polyanethol sulfonate (SPS)
30
test done for yellow (SPS)
microbiology
31
Additive for yellow (not SPS)
acid citrate dextrose (ACD)
32
test done for yellow tube (ACD)
blood bank/immunohematology
33
Correct order of draw (based on additive)
1.Sterile blood culture tubes
2. Coagulation tubes
3. Serum tube/ Plain tube
4. Heparin tube
5. EDTA tube
6. Anti-glycolytic tube/ Fluoride
34
correct order of draw based on color
yellow
light blue
red
green
lavender/purple
gray
35
Pre-analytical error where in there is an incorrect volume of blood in the tube
underfilled tube
36
effect when there is less blood in a tube
dilutional effect
37
what happens if there is too much blood in a tube?
blood clots
38
most critical tube to have correct volume of blood?
citrate tube for coagulation studies
39
correct blood to anticoagulant ratio?
9:1
40
What to do with partially filled tube?
collect again
41
What to do if there are 2 partially filled tubes?
do not combine
42
What happens when patient changes from supine to standing position while collecting sample?
hemoconcentration
43
what happens when patient remains in supine position for a long time while collecting blood?
hemodilution
44
* Prolonged tourniquet application
◦Torniquet increases the ______
◦ small molecules are pushed from the _________ to the surrounding tissue
◦ ideal: not more than __ minute
◦ ____ inches above the site
◦ Prolonged tourniquet application: ______
* intravascular blood pressure
* blood vessels
* 1
* 3-4
* hemoconcentration
45
When should specimens be labelled?
* immediately after collection
* before dismissing an outpatient
* before leaving the room of an inpatient
46
2 things to do for the reverification of patient information before labeling:
◦ show the labeled tube to the patient, or
◦ have the patient initial or sign a document stating that they were shown the labeled tube and confirmed that the information was correct
47
* REGULAR VACUTAINER LABEL PLACEMENT
* patient's name must be read from _______
* label to cover the manufacturer's label leaving a gap from the ____ to the ______
* left to right
* top of the label to the colored cap
48
* MICROTAINER LABEL PLACEMENT
* patient's name from ____ to ____
* label directly underneath the ______
* no gap between the __ and _____
* left to right
* colored top
* colored top and the label
49
POSSIBLE SOURCES OF PREANALYTICAL ERROR: During specimen transport
* Agitation-induced ___
* Delay in ______
* Exposure to ___
* Failure to follow _____ requirements
* ______method (e.g., hand vs. pneumatic tube)
* hemolysis
* transporting
* light
* temperature
* Transport
50
POSSIBLE SOURCES OF PREANALYTICAL ERROR: During specimen processing
* ______ (e.g., dust or glove powder)
* Delay in _____ or _____
* Delay in ______ from cells
* ______
* Failure to ______ specimen according to test requirements
* Failure to ______ fluid from cells
* Incomplete _____
* Mislabeled ____
* Multiple _____
* _____of clots
* Contamination
* processing or testing
* fluid separation
* Evaporation
* centrifuge
* separate
* centrifugation
* aliquot
* centrifugations
* Rimming
51
◦ During specimen storage
* Exposure to _____
* Temperature change outside ______
* light
* defined limits
52
ROUTINE HANDLING
◦ Mixing of _____
◦ ______
◦ Adherence to ______ set for delivery of specimen to the laboratory
* tubes
* Transport
* time limits
53
Inversion range for additive tubes?
3 - 10 gentle inversions, depending on the type of tube and additive
54
This causes:
* even distribution of additive
* minimizes hemolysis
gentle inversions
55
Vigorous mixing can cause _______
hemolysis
56
What tests are not performed if the specimen are hemolyzed?
potassium, magnesium and most enzyme tests
57
Inadequate mixing of anticoagulated tubes results in:
◦ micro clot formation
◦ erroneous test results, hematology studies
58
Inadequate mixing of gel separation tubes results in:
clotting may be incomplete
59
Should you mix non-additive tubes?
no
60
Rough handling and agitation in transporting specimen can cause: (3)
◦ hemolyze specimens
◦ activate platelets and affect coagulation tests
◦ break glass tubes
61
Tubes should be transported stopper up to....?
◦ to reduce agitation
◦ aid clot formation in serum tubes
◦ prevent contact of the contents with the stopper
62
Primary container in transporting specimen:
◦ ________
◦ 2 compartments
◦ 1. ______
◦ 2. _______
◦ wrap in ________ material
* with _______
* self-sealing plastic bag
* sample
* requisition form
* absorbent package
* biohazard logo
63
Secondary container in transporting specimens
placed in a bag or box
64
In transporting specimens:
◦ Multiple samples from one patient = ________
◦ Samples from different patients should ______
◦ Large number of samples: place in a _____,
◦ Place the rack in _________ or __________
* one bag
* not be placed in the same plastic bag
* rack
* a bag or leak-proof box
65
System that propels cylindrical containers through networks of tubes by compressed air or by partial vacuum
* Pneumatic tube system
◦ pneumatic tube transport or PTT)
66
◦ pneumatic tube transport or PTT)
◦ System that ____ cylindrical containers through networks of tubes by compressed air or by partial vacuum
◦ More ______
◦ Faster ____
◦ Bagged sample in _____
◦ specimens should be protected from ______ and sealed in zipper type plastic bags to contain spills
* propels
* traumatic
* delivery
* padded container
* shock
67
Robot Automated Transportation system
RoboCourier® Autonomous Mobile Robot.
68
Avoid extreme temperatures:
* too hot or freezing temp causes what
rupture of RBCs
69
Avoid extreme temperatures:
* What should you do to the serum/plasma?
Separate serum/plasma from cells before transport
70
Avoid extreme temperatures:
* Samples in a car should be placed where?
in a cooler
71
documentation of proper sample identification from the time of collection to the receipt of laboratory results
Chain of custody
72
chronological documentation or paper trail? (6)
◦ Collection
◦Transfer
◦ Receipt
◦ Analysis
◦ Storage
◦ Disposal of the sample
73
This ensures that any results reported relate beyond all reasonable doubt to a particular individual
Chain of custody
74
Medico-legal Transport: Blood alcohol Testing (2)
◦ Special draw kit
◦ Chain of custody form
75
Medico-legal Transport: Paternity Testing (2)
◦ Documentation that samples were collected from the correct individuals
◦ Pictures of the child, alleged mother or father
76
________ is needed when handling blood specimens to protect its condition and quality
Special care
77
3 methods of special handling of specimen
1. Body temperature
2. Chilled specimen
3. Light-sensitive specimen
78
Temperature needed for specimens transported and stored at body temperature
37ºC
79
For handling specimens that precipitate at cold temperature, you should:
* Collect in a ______ (37ºC) tube
* Transport at _______
* Use heat/warming blocks during transport
* Wrap in an _______
* pre-warmed
* normal body temp 37ºC
* activated heel warmer
80
3 examples of specimens that precipitate at cold temperature (Keep at 37C)
◦ Cold agglutinins
◦ Cryoglobulin
◦ Cryofibrinogen
81
For chilling specimens, what is the temperature range?
4ºC, 2-8ºC
82
Chilling specimens ____________
slows metabolic process
83
In chilling specimens, they are submerged in _______ during transport, tested immediately or refrigerated
crushed ice and water slurry
84
8 specimens that require chilling
◦ Adrenocorticotropic hormone (ACTH)
◦ Acetone
◦ Ammonia
◦ Acid Phosphatase
◦ Catecholamines
◦ Lactic acid
◦ Parathyroid hormone
◦ pH/blood gases
85
What happens if you chill an uncentrifuged blood?
Elevate potassium
86
5 light-sensitive analytes
◦ Folic acid
◦ Carotene
◦ Vitamins B2, B6, B12, C
◦ Urine porphyrins
◦ Urine porphobilinogen
87
- decreases up to 50% after 1 hr of light exposure
- wrap in aluminum foil
- light-blocking, amber tubes
- amber containers for urine specimen
- light-blocking secondary transport containers
Bilirubin
88
Bilirubin decreases up to ______ after _____ of light exposure
50%, 1hr
89
What containers are used for urine specimen?
amber containers
90
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* cold agglutinin
keep at 37ºC
91
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* cryofibrinogen
Keep at 37ºC
92
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* cryoglobulins
Keep at 37ºC
93
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* adrenocorticotropic hormone (ACTH)
Chill
94
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* acetone
chill
95
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* angiotensin-converting enzyme (ACE)
chill
96
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* ammonia
chill
97
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* catecholamines
chill
98
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* free fatty acids
chill
99
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* gastrin
chill
100
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* glucagon
chill
101
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* homocysteine
chill
102
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* lactic acid
chill
103
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* parathyroid hormone (PTH)
chill
104
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* pH/blood gasses (if indicated)
chill
105
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* pyruvate
chill
106
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* renin
chill
107
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* bilirubin
protect from light
108
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* carotene
protect from light
109
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* red cell folate
protect from light
110
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* serum folate
protect from light
111
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* Vit b2
protect from light
112
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* vit b6
protect from light
113
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* vit b12
protect from light
114
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* vit c
protect from light
115
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* urine prophyrins
Protect from light
116
Keep at 37ºC, Chill in crushed Ice slurry, or protect from light?
* urine porphobilinogen
protect from light
117
Collected specimens are transported to the ______ for screening and prioritizing
central processing triage
118
In blood specimen processing, specimens are: (4)
1. identified
2. logged and accessioned
3. sorted by department and type of processing
4. evaluated for specimen sustainability
119
What to do to unsuitable specimens?
reject
120
Most frequent reason for specimen rejection in chemistry?
* hemolysis
* insufficient amount of specimen QNS
121
Most frequent reason for specimen rejection in hematology
clotting
122
11 criteria for specimen rejection:
◦ Specimen is not identified properly
◦ Inadequate volume/ Insufficient specimen (QNS)
◦ Hemolysis
◦ Wrong tube
◦Tube used is outdated
◦ Clots in anticoagulated tubes (improper mixing)
◦ Contaminated specimen
◦ Incorrect collection time
◦ Exposure to light (bilirubin)
◦ Testing time limits not followed
◦ Delay or error in processing
123
Blood should be transported to the laboratory without _______
delay
124
routine blood specimens should arrive at the laboratory within ___ minutes of collection
45
125
Specimens that require separation of the serum or plasma from the cells should be ______
centrifuged within 1 hour
126
Hematology test specimens drawn in EDTA tubes should ________
never be centrifuged
127
maximum time limit for separating serum and plasma from the cells is ___ hours from time of collection
2
128
What will happen to serum tubes that have not been spun within 2 hours or refrigerated
◦ Increase potassium, creatinine, phosphorus, LDH, lactic acid, Lipids, total protein
◦ Decrease glucose, ionized calcium, chloride, and CO2
129
What tubes are these: completely clotted before centrifugation
Non-additive and gel barrier serum tubes (SSTs)
130
What tube is this: can be centrifuged right away
Heparin gel-barrier tubes (PSTs)
131
Specimens in _______ do not require manual separation
gel-barrier tubes
132
This must be prepared within 1 hour from collection
blood smears from EDTA
133
this must be:
* Analyzed within 6 hours
* Stable for 24 hours (RT)
CBC (Edta)
134
this must be:
* Analyzed within 4 hours
CBC in micro-containers
135
This must be:
* Tested within 4 hours( RT)
* Within 12 hours (refrigerated)
ESR (erythrocyte sedimentation rate)
136
What test/additive is this:
* Stable up to 6 hours at RT
* 72 hours if refrigerated
Reticulocyte counts (EDTA)
137
What tube/test is this:
* Stable for 24 hrs( RT)
* 48 hrs(refrigerated)
Glucose test in sodium fluoride tubes
138
What test is this: stable for 24 hours
Prothrombin time (PT)
139
What test is this: stable for 4 hours
Partial thromboplastin time (PTT) test
140
What test/additive is this: Separated from cells within 15 mins
blood ammonia
141
What test/additive is this:
* must be performed ASAP
* plasma is stored at 4ºC for 48 hours
molecular test specimens
142
Refers to after specimen collection and before centrifugation
precentrifugation
143
Refers to when the specimen is centrifuge
Centrifugation
144
Refers to after centrifugation and before removal of serum or plasma
postcentrifugation
145
Allow blood in nonadditive, clot activator, and gel containing tubes used for serum tests (e.g., SSTs) to clot for the serum to separate from the cells
pre-centrifugation
146
A sample must be allowed to ____ completely before centrifugation
clot
147
This happens when _________: latent fibrin formation may form a clot in the serum after centrifugation
clotting is not complete
148
Complete clotting:
______ minutes at room temperature (__ to ___C)
* 30 to 60
* 22°to 25°
149
4 instances that specimens may take longer to clot
◦ patients on anticoagulant medications, heparin or warfarin (e.g., Coumadin)
◦ from patients with high WBC counts
◦ chilled specimens
◦ from patients with coagulopathies (bleeding disorders)
150
How long does it take for tubes with clot activator to clot completely?
Within 30 minutes
151
How long does it take for tubes with **thrombin** to clot completely?
5 mins
152
Complete clotting can be determined by ______ or ____
* tilting
* inverting the tube gently
153
_______ with an applicator stick to release the clot from the walls of the tube is a potential source of hemolysis and contamination
Rimming the tube
154
is a process in which centrifugal force is used to separate solid matter from a liquid suspension
centrifugation
155
* machine that spins blood and other specimens at a high number of revolutions per minute (rpm) or centrifugal force
* to separate serum or plasma from cells
Centrifuge
156
What does centrifuge separate in blood samples?
serum or plasma
157
Relative centrifugal force depends on the ______ ( revolution per minute) and the ________
* speed of rotation
* radius of the rotor head
158
Relative centrifugal force :
◦depends on the speed of rotation (revolution per minute) and the radius of the rotor head
◦ Expressed as gravity (g) or RCF
◦ Most specimens are centrifuged for:
◦ 15 minutes at ____ to ____
◦ 10 minutes at ______ Centrifugation
* 750 g to 1000g
* 1000 g
159
3 types of centrifuge
* refrigerated
* floor-top model
* table top (benchtop) model
160
4 things that will result from removing the stopper
* aerosol formation
* pH changes (loss of CO2 which can increase pH)
* evaporation (leads to concentration of analytes)
* contamination
161
In centrifugation:
* _______ should remain on the tubes
* drop of sweat, interferes with _____ results
* powder from gloves, interferes with ______
* Stoppers
* electrolyte
* calcium determinations
162
To balance tubes in a centrifuge, equal-size tubes with _______ of specimen must be placed opposite one another in the centrifuge
equal volumes
163
This results in the ff: break specimen tubes, ruin specimens and cause the contents to form aerosols
unbalanced centrifuge
164
In centrifugation, lid should remain closed during operation. _______ before opening
Complete stop
165
Should specimen be centrifuged more than once?
No
166
What can result from repeated centrifugation
* hemolysis, and analyte deterioration
* alter test results
167
What to do to specimens that require chilling?
* processed in a temperature-controlled refrigerated centrifuge
168
Centrifuge maintenance:
* Regular maintenance should be scheduled according to manufacturer instructions to check the _______ (4)
* balance
* braking mechanism
* centrifuge speed, and
* timer
169
An instrument used to measuring rpm (for centrifuge)
tachometer
170
Other than tachometer, what is used to check for the speed of centrifuge?
strobe light
171
Tubes that should be centrifuged without delay?
tubes containing anticoagulants
172
Tube for STAT chemistry tests?
Green top
173
Why is a green top tube used for STAT chemistry tests?
* heparin tubes to save time;
* reduce turn-around time (TAT)
174
* PSTs or other heparin containing gel tubes - to maintain ______ after centrifugation
specimen stability
175
Post-centrifugation: No ___ should be visible in the serum or plasma
RBCs
176
Post-centrifugation: Serum or plasma should be separated from the ____ as soon as possible
cells
177
Specimens in gel barrier tubes do not normally require ______
manual separation
178
Post-centrifugation: physical barrier prevents ______
glycolysis
179
serum on gel barriers can be stored up to ____ hours at ___°C
* 48
* 4
180
Stopper Removal
◦ Use of devices or robotics
◦ Manual removal of stopper
◦ Cover the stopper with _____
◦ ______ to prevent release of aerosol:
* not _____ using a thumb roll technique
◦ Wear _______
* gauze or tissue
* Pull straight up
* “popped” off
* face shield
181
After centrifugation (Specimen condition): pale yellow
normal
182
After centrifugation (Specimen condition): dark yellow
* High bilirubin
* icterus (icteric serum)
183
After centrifugation (Specimen condition): cloudy, turbid
* high lipids
* lipemia (lipemic serum)
184
After centrifugation (Specimen condition): pink or red
* Hemolysis (hemolyzed serum)
* patient has underlying condition
* errors in specimen collection
* high potassium, ammonia, phosphate, enzymes
185
a portion of a specimen used for testing
aliquot
186
method of dividing or separating specimens into separate containers
aliquoting
187
prepared when multiple tests are ordered on a single specimen
aliquot
188
Aliquot Preparation
* Use a ______
* Never put serum and plasma, or plasma from specimens with different anticoagulants, in the ______
* Aliquot tube should be ____ or _______ as soon as it is filled
* disposable transfer pipette
* same aliquot tube
* covered or capped
189
Pouring the serum or plasma into aliquot tubes is not recommended because it increases the possibility of _____ or ____
aerosol formation or splashing
190
What should you do after transferring aliquot?
Properly label the transfer tubes
191
Required Protective Equipment Worn when Processing Specimen according to OSHA Act RA 11058
◦ Gloves
◦ Laboratory gowns/coats
◦ Masks
◦ ** Goggles/face shield
192
Required Protective Equipment Worn when Processing Specimen are:
◦ Gloves
◦ Laboratory gowns/coats
◦ Masks
◦ ** Goggles/face shield
According to what?
OSHA Act RA 11058
