SPECIMEN QUALITY CONCERNS

Question 1

HEMOCONCENTRATION

Answer 1

Decrease in fluid content or plasma volume

● Caused by stagnation of the normal venous blood flow because of
torniquet application
● Increased concentration of RBCs and other non filterable large
molecules
● Increases albumin, ammonia, calcium, cholesterol, coagulation factors,
enzymes, iron, potassium,and total protein

Question 2

● Decrease in fluid content or plasma volume

Answer 2

HEMOCONCENTRATION

Question 3

HEMOCONCENTRATION
● Decrease in ___

Answer 3

fluid content or plasma volume

Question 4

Caused by stagnation of the normal venous blood flow because of
torniquet application

Answer 4

HEMOCONCENTRATION

Question 5

Increased concentration of RBCs and other non filterable large
molecules

Answer 5

HEMOCONCENTRATION

Question 6

Increases albumin, ammonia, calcium, cholesterol, coagulation factors,
enzymes, iron, potassium,and total protein

Answer 6

HEMOCONCENTRATION

Question 7

HEMOCONCENTRATION
Increases ____

Answer 7

albumin, ammonia, calcium, cholesterol, coagulation factors,
enzymes, iron, potassium,and total protein

Question 8

HEMOCONCENTRATION
Increased ____

Answer 8

concentration of RBCs and other non filterable large
molecules

Question 9

Ways To Help Prevent Hemoconcentration During Venipuncture

● Release the tourniquet within ___

Answer 9

1 minute.

Question 9

Ways To Help Prevent Hemoconcentration During Venipuncture

Answer 9

● Ask the patient to release the fist upon blood flow.
● Do not allow the patient to pump the fist.
● Do not excessively massage the area in locating a vein.
● Do not probe or redirect the needle multiple times in search
of a vein.
● Release the tourniquet within 1 minute

Question 10

“hemolyzed” specimen

Answer 10

HEMOLYSIS

Question 10

RBCs are damaged or destroyed and the hemoglobin escapes into the
fluid portion of the specimen

Answer 10

HEMOLYSIS

Question 11

serum or plasma appears pink (slight hemolysis)
○ dark pink to light red (moderate hemolysis)
○ dark red (gross hemolysis)

Answer 11

HEMOLYSIS

Question 12

slight hemolysis

Answer 12

serum or plasma is pink

Question 13

moderate hemolysis

Answer 13

dark pink to light red

Question 14

gross hemolysis

Answer 14

dark red

Question 14

● Failure to wipe away the first drop of capillary blood (alcohol residue)

Answer 14

CAUSES OF SPECIMEN HEMOLYSIS

Question 15

Drawing blood through a hematoma or from a vein with a
hematoma

Answer 15

CAUSES OF SPECIMEN HEMOLYSIS

Question 16

● Forceful aspiration of blood during a syringe draw

Answer 16

CAUSES OF SPECIMEN HEMOLYSIS

Question 17

● Horizontal transport of tubes

Answer 17

CAUSES OF SPECIMEN HEMOLYSIS

Question 17

● Forcing the blood from a syringe into an evacuated tube

Answer 17

CAUSES OF SPECIMEN HEMOLYSIS

Question 17

● Frothing of blood caused by improper fit of the needle on a syringe

Answer 17

CAUSES OF SPECIMEN HEMOLYSIS

Question 18

● Mixing additive tubes vigorously

Answer 18

CAUSES OF SPECIMEN HEMOLYSIS

Question 19

● Drawing blood through a hematoma or from a vein with a
hematoma
● Failure to wipe away the first drop of capillary blood (alcohol residue)
● Forceful aspiration of blood during a syringe draw
● Forcing the blood from a syringe into an evacuated tube
● Frothing of blood caused by improper fit of the needle on a syringe
● Horizontal transport of tubes
● Mixing additive tubes vigorously
● Partially filling a sodium fluoride tube
● Pulling back the plunger too quickly
● Rough handling during transport
● Squeezing the site (capillary blood collection)
● Syringe transfer delay in which partially clotted blood is forced into a
tube
● Using a large-volume tube with a small-diameter butterfly needle
● Using a needle with a diameter that is too small

Answer 19

CAUSES OF SPECIMEN HEMOLYSIS

Question 19

CAUSES OF SPECIMEN HEMOLYSIS ● Partially filling a ___

Answer 19

sodium fluoride tube

Question 20

CAUSES OF SPECIMEN HEMOLYSIS Using a needle with a diameter that is ______________

Answer 20

too small

Question 21

CAUSES OF SPECIMEN HEMOLYSIS ● Using a ______ with a _____

Answer 21

large-volume tube with a small-diameter butterfly needle

Question 22

Never pour two partially filled additive tubes together to fill one tube (affects the blood-to-additive ratio)

Answer 22

PARTIALLY FILLED TUBES or SHORT DRAW

Question 22

CAUSES OF SPECIMEN HEMOLYSIS ● Under-filled anticoagulant tubes:

Answer 22

blood-to-additive ratio

Question 22

Under-filled anticoagulant tubes: blood-to-additive ratio

Answer 22

PARTIALLY FILLED TUBES or SHORT DRAW

Question 22

Short-draw serum tubes generally acceptable

Answer 22

PARTIALLY FILLED TUBES or SHORT DRAW

Question 23

● Alcohol, glove powder, baby powder, or urine from wet diapers

Answer 23

SPECIMEN CONTAMINATION

Question 23

● Glove powder on blood films (slides)

Answer 23

SPECIMEN CONTAMINATION

Question 24

● Dripping perspiration into capillary specimens

Answer 24

SPECIMEN CONTAMINATION

Question 25

● Wrong antiseptic

Answer 25

SPECIMEN CONTAMINATION

Question 26

● Not following proper antiseptic procedure

Answer 26

SPECIMEN CONTAMINATION

Question 27

WRONG OR EXPIRED COLLECTION TUBE * Expiration dates of tubes must be checked ____ and expired tubes discarded.

Answer 27

routinely

Question 28

WRONG OR EXPIRED COLLECTION TUBE * Formation of ____

Answer 28

microclots

Question 29

WRONG OR EXPIRED COLLECTION TUBE * __- and ____

Answer 29

serum and plasma

Question 30

WRONG OR EXPIRED COLLECTION TUBE * Additives in ___ may not work properly

Answer 30

expired tubes

Question 31

SPECIMEN QUALITY CONCERNS (5)

Answer 31

Hemoconcentration Hemolysis Partially filled tubes or short draws Specimen contamination Wring or expired collection tube