Study Flashcards
PTT
Lt Blue Top: Partial Thromboplastin Time test evaluates the blood clotting process.
PT
Lt Blue Top: Prothrombin Time test measures how long it takes for blood to clot.
FDP
Lt Blue Top: Fibrin Degradation Products test measures the level of fibrinolysis in the body.
INR
Lt Blue Top: International Normalized Ratio test standardizes the PT results for monitoring blood clotting.
Blood type
Red Top (Glass): Determines the ABO and Rh blood group of an individual.
BHCG
Red Top (Glass): Beta Human Chorionic Gonadotropin test detects pregnancy hormone in blood.
TDM
Red Top (Glass): Therapeutic Drug Monitoring assesses drug levels in the blood to optimize dosage.
Hep B
Red Top (Glass): Hepatitis B test detects antigens or antibodies related to Hepatitis B virus.
HIV
Red Top (Glass): Human Immunodeficiency Virus test detects antibodies or antigens related to HIV infection.
CMP
Gold Top (SST): Comprehensive Metabolic Panel test evaluates kidney and liver function, electrolyte levels, and blood sugar.
BMP
Gold Top (SST): Basic Metabolic Panel test assesses kidney function, blood sugar, and electrolyte balance.
LDL
Gold Top (SST): Low-Density Lipoprotein test measures the amount of cholesterol carried by LDL particles.
HDL
Gold Top (SST): High-Density Lipoprotein test measures the amount of cholesterol carried by HDL particles.
TRIG
Gold Top (SST): Triglycerides test measures the level of triglycerides in the blood.
Cardiac Electrolytes
Green Top: Tests for electrolyte levels related to heart function, such as sodium, potassium, and calcium.
Ammonia Levels
Green Top: Measures the level of ammonia in the blood, which can indicate liver or kidney dysfunction.
Plasma Determination
Green Top: Determines the levels of various substances in the blood plasma, such as proteins and waste products.
Cardiac Enzymes
Lavender Top: Tests for enzymes released during heart muscle damage, such as troponin and creatine kinase.
CBC/Differential
Lavender Top: Complete Blood Count with Differential test provides detailed information about different blood cell types.
PLT
Lavender Top: Platelet count measures the number of platelets in the blood, important for clotting.
ESR
Lavender Top: Erythrocyte Sedimentation Rate test measures inflammation in the body.
CK
Lavender Top: Creatine Kinase test evaluates muscle damage, particularly in the heart.
FBS
Gray Top: Fasting Blood Sugar test measures glucose levels after a period of fasting.
GTT
Gray Top: Glucose Tolerance Test assesses the body’s ability to metabolize glucose.
BAT
Gray Top: Blood Alcohol Test measures the concentration of alcohol in the blood.
Yellow (SPS) tube
Blood Culture
Lt Blue tube
Sodium Citrate
Red tube (glass)
No Additive
Red tube (plastic)
Clot Activator
Gold tube
Clot Activator
Green tube
Sodium Heparin, Lithium Heparin, Ammonium Heparin
Lt Green tube
Lithium Heparin
Lavender tube
EDTA
Grey tube
Potassium Oxalate & Sodium Fluoride
Yellow tube
ACD
The Circulatory system
The function of this system is to deliver oxygen, nutrients, hormones, and enzymes to
the cells (exchange is done at the capillary level) and to transport cellular waste such
as carbon dioxide and urea to the organs (lung and kidneys, respectively) where they
can be expelled from the body. It is a transport system where the blood is the vehicle,
the blood vessels, the tubes, and the heart work as the pump
Pulmonary circulation
This carries deoxygenated blood from the right
ventricle to the lungs (oxygenation takes place at the alveoli) and returns
oxygenated blood from the lungs to the left atrium.
Systemic circulation
This carries oxygenated blood from the left ventricle
throughout the body.
Each side of the heart (right and left)
Is composed of an upper chamber, the atrium,
and a lower chamber, the ventricle.
The tricuspid valve
this is an atrioventricular valve, being situated between the right atrium
and right ventricle.
The pulmonic valve
a semi-lunar valve situated between the right ventricle and the
pulmonary artery.
The mitral valve (also known as the bicuspid valve)
this is another atrioventricular valve, being situated between the left atrium, and left ventricle.
The aortic valve
a semi lunar valve situated between the left ventricle and the
aorta.
The heart has three layers
Endocardium, Myocardium, Epicardium
Endocardium
The endothelial inner layer lining of the heart.
Myocardium
The muscular middle layer. This is the contractile layer of the
heart.
Epicardium
The fibrous outer layer of the heart. The coronary arteries, which
supply blood to the heart, are found in this layer.
The blood vessels
Aorta, arteries, arterioles, capillaries, venules, veins, superior
and inferior vena cava.
Vena Cava
The largest vein in the human body. Returns deoxygenated blood to the
right atrium.
Aorta
The largest artery in the human body. Takes blood away from the left ventricle
to the entire body.
Pulmonary artery
The only artery in the body that carries deoxygenated blood.
Pulmonary veins
The only veins that carry oxygenated blood.
The blood vessels, except for the capillaries, are composed of three layers
The outer connective tissue layer is called the tunica adventitia. The middle smooth muscle layer is called the tunica media. The inner endothelial layer is called the tunica intima.
Aorta, arteries, and arterioles
Carry oxygenated blood from the heart to the various parts of the body; while the venules, veins, and superior and inferior vena cava carries deoxygenated blood back to the heart.
The capillaries
Composed only of a layer of endothelial cells, connect the arterioles
and venules. As such, capillary blood is a mixture of arterial and venous blood. The
thin walls allow rapid exchange of oxygen, carbon dioxide, nutrients, and waste
products between the blood and tissue cells.
Avg Adult Blood
5-6L
Avg pH adult blood
pH between 7.35-7.45.
Plasma 55%
The cellular portion is called the “formed elements‟. Plasma comprises 55% of the circulating blood and contains proteins, amino acids, gases, electrolytes, sugars, hormones, minerals, vitamins, and H20 (90%). 45% Erythrocytes (TBV), <1% buffy coat (WBC/Platelets) words used- has/contain
Serum
Liquid Portion of blood containing clotted blood. no formed elements, no fibrinogen used words -lacks
Urea
The waste product is destined for excretion by the kidneys.
Plasma 45%
45% of the blood. They are erythrocytes (red blood cells), which comprise 99% of the formed elements, the leukocytes (white blood cells), and the thrombocytes (platelets).
Pericardium
A fibrous sac that encloses the heart and great vessels.
Visceral Pericardium
It envelopes the heart and forms the epicardium – the most superficial layer of the heart.
Parietal Pericardium
The outer layer of the pericardium is a thin sac of tissue that surrounds the heart.
Veins
Brings blood towards the heart, Deoxygenated blood (CO2), have valves, low-pressure system
Arteries
Takes blood away from the heart, oxygenated blood (O2), no values, high pressure system
Superior vena cava
Return deoxygenated blood to the heart from the head and arms above naval area
Inferior vena cava
Return deoxygenated blood to the heart from all body regions below the diaphragm. everything else
All blood cells
Originate from stem cells in the bone marrow.
Reticulocyte
Immature red blood cells with a nucleus (2-3 days cell wall drop nucleus)
Hemoglobin
O2 binding protein
Erythrocytes
Mature red blood cell, lacks a nucleus, and contain hemoglobin (life expectancy 120 days)
Leukocytes
The function is to provide the body protection against infection. (fastest dividing cells ) (4.5-10.5 range) Assist the body in fighting pathogens
Avg Adult WBC
5,000 to 10,000 per ML
Leukocytosis
Which is an increase in WBCs, is seen in cases of infection
and leukemia.
Leukopenia
Which is a decrease in WBCs, is seen with viral infection or
chemotherapy.
Five types of WBCs in the blood
Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
Neutrophils
The most numerous, comprise about 40% to 60% of WBC
population. They are phagocytic cells, meaning, they engulf and digest
bacteria. Their number increases in bacterial infection, and often, the first one
on the scene. Most abundant
Lymphocytes
The second most numerous, comprising about 20% to 40% of the WBC population. Their number increases in viral infection, and they play a role in immunity. Responsible for carrying antibodies (response to foreign things in the body)
Monocytes
Comprising 3% to 8% of the population, they are also the largest
WBCs. They are monocytes in the circulating blood, but when they pass
into the tissues, they transform into macrophages and become powerful
phagocytes. Their number increases in intracellular infections and tuberculosis. Largest of all white blood cells (phagocytes)
Eosinophils
Represent 1% to 3% of the WBC population. They are active
against antibody-labeled foreign molecules. Their numbers are increased in
allergies, skin infections, and parasitic infections.
Basophils
Account for 0% to 1% of WBCs in the blood. They carry
histamine, which is released in allergic reactions only. Histamine is released causing capillaries to dilate and increase temperature creates a barrier around the area destroying it (heating it up)
Thrombocytes (platelets)
Small irregularly shaped packets of cytoplasm formed in the bone marrow from megakaryocytes. Essential for blood coagulation, the average number of platelets is 140,000 to 440,000 per micro liter of blood. They have a life span of 9 to 12 days.
Hemostasis
Is the process by which blood vessels are repaired after injury. This
process starts from vascular contraction as an initial reaction to injury, then to clot
formation, and finally, removal of the clot when the repair to injury is done.
4 stages of Hemostasis
Stage 1: Vascular phase (Vasoconstriction)
Stage 2: Platelet phase
Stage 3: Coagulation phase
Stage 4: Fibrinolysis Phase
Stage 1: Vascular phase (Vasoconstriction)
Injury to a blood vessel causes it to constrict decreasing the flow of
blood.
Stage 2 – Platelet phase
Injury to the endothelial lining causes platelets to adhere to it.
Additional platelets stick to the site finally forming a temporary platelet
plug in a process called “aggregation‟.
The vascular phase and platelet phase comprise the primary hemostasis. The bleeding time test is used to evaluate primary hemostasis.
Stage 3 – Coagulation phase
This involves a cascade of interactions of coagulation factors that
convert the temporary platelet plug to a stable fibrin clot. The
coagulation cascade involves an intrinsic system and an extrinsic system,
which ultimately come together in a common pathway.
Activated partial thromboplastin time (APTT) – a test used to evaluate
the intrinsic pathway. This is also used to monitor heparin therapy.
Prothrombin time (PT) – a test used to evaluate the extrinsic pathway.
This is also used to monitor Coumadin therapy.
Stage 4 – Fibrinolysis Phase
This is the breakdown and removal of the clot. As tissue repair starts,
plasmin (an enzyme) starts breaking down the fibrin in the clot. Fibrin
degradation products (FDPs) measurement is used to monitor the rate
of fibrinolysis.
Pathogen
Disease carrying microbes
CBC/differential
measures in 100s to 1000s
Fibrinogen
Clotting protein
Hemostasis
Cessation/stoppage of bleeding
Repair of damaged blood vessels
Three major veins
Are in the antecubital fossa Median cubital vein, Cephalic vein, Basilic vein
Median cubital vein
The vein of choice because it is large and does
not tend to move when the needle is inserted.
Cephalic vein
The second choice. It is usually more difficult to locate
and tends to move, however, it is often the only vein that can be
palpated in the obese patient.
Basilic vein
The third choice. It is the least firmly anchored and
located near the brachial artery. If the needle is inserted too deep, this
artery may be punctured.
Unsuitable veins for venipuncture are
Sclerosed veins
Thrombotic veins – veins with clots due to multiple sticks.
Tortuous veins – These are winding or crooked veins. These veins are
susceptible to infection, and since blood flow is impaired, the specimen
collected may produce erroneous test results.
Sclerosed veins
These veins feel hard or cordlike. Can be caused
by disease, inflammation, chemotherapy, or repeated venipunctures.
Thrombotic veins
Veins with clots due to multiple sticks.
Tortuous veins
These are winding or crooked veins. These veins are
susceptible to infection, and since blood flow is impaired, the specimen
collected may produce erroneous test results.
Do not draw blood from
Do not draw blood from an arm with IV fluids running into it. The
fluid will alter the test results. Select another site. Do not draw blood from
AV fistula sites such as those surgically implanted for dialysis patients,
chemotherapy, or from the side of a mastectomy.
Supplies for Venipuncture
Laboratory requisition slip and pen.
Antiseptic, Vacutainer tubes, Vacutainer needles, Needle adapters, Winged infusion sets, Sterile syringes and needles, Tourniquets, Chux, Specimen labels, Gloves, Needle disposal container
Antiseptic
Prepackaged 70% isopropyl alcohol pads are the most commonly
used.
For collections that require more stringent infection control such as
blood cultures, Povidone-iodine (Betadine) solution is commonly
used.
For patients allergic to alcohol; iodine, chlorhexidine gluconate or
benzalkonium chloride is used.
Vacutainer tubes
Color-coded for specific tests and available in adult and pediatric
sizes. Must follow the order of draw.
Vacutainer needles
These are disposable and are used only once both for single-tube
draw and multidraw (more than one tube).
Needle sizes differ both in length and gauge. 1-inch and 1.5-inch
long are routinely used.
The diameter of the bore of the needle is referred to as the gauge.
The smaller the gauge the bigger the diameter of the needle; the
bigger the gauge the smaller the diameter of the needle (i.e. 16
gauge is a large bore and 23 gauge is small bore.) Needles smaller
than 21 gauge are not used for drawing hematology tubes because
they can cause hemolysis.
Needle adapters
Also called the tube holder, or needle holder. One end has a small
opening that connects the needle, and the other end has a wide
opening to hold the collection tube.
Winged infusion sets
Used for venipuncture on small veins such as those in the hand.
They are also used for venipuncture in the elderly and pediatric
patients.
The most common size is 23 gauge, ½ to ¾ inch long.
Sterile syringes and needles
A 10-20 ml syringe is used when the Vacutainer method cannot be
used.
Tourniquets
Prevents the venous outflow of blood from the arm causing the veins
to bulge thereby making it easier to locate the veins.
The most common tourniquet used is a non-latex strip. (Creates venous resistance)
To prevent hemoconcentration needle insertion <60sec
Antiseptic
Use on living tissue
Antimicrobial substance or compound that is applied to living tissue to reduce the possibility of sepsis, infection, or putrefaction
Disinfectant
Used on nonliving things
Chemical substances or compounds used to inactivate or destroy microorganisms on inert surfaces.
Bacteriostatic
A biological or chemical agent that stops bacteria from reproducing, while not necessarily killing them otherwise. Depending on their application, bacteriostatic antibiotics, disinfectants, antiseptics, and preservatives can be distinguished.
70% Isopropyl Alcohol
Is bacteriostatic inhibits growth or reproduction of bacteria but doesn’t kill them (antiseptic)
Alternatives to Isopropyl Alcohol
Povidone/iodine (Betadine), Benzalkonium chloride (zephiran chloride), chlorhexidine gluconate
Povidone/iodine (Betadine)
Do not use for special tests ie thyroid test
Benzalkonium chloride (zephiran chloride)
Used for blood culture and for patients sensitive to iodine not used for those younger than 2 months
Chux
An impermeable usually a (blue) pad used to protect the patient’s
clothing and bedding.
Specimen labels
To be placed on each tube at the end of the venipuncture collection.
Gloves
Must always be worn when collecting the blood specimen part of the
PPE (personal protection equipment) as per OSHA.
Needle disposal container
Must be a marked red SHARPS puncture-resistant biohazard
disposal container.
NEEDLES MUST NEVER BE RECAPPED.
21g needle
Most common used
Diameter of Needle
As the diameter head increases the gauge decreases (25g)
As the diameter head decreases the gauge increases (16g)
Antecubital
Anterior of the cubical front of the elbow
Anticoagulant
Any chemical/substance that will prevent blood from clotting
Aseptic
Without disease/infection
Collapsed Vein
Person veins may not tolerate the vacuum of the tube
Concentric Circle
Cleaning in circles, cleaning from center to outward
Ecchymosis
Bruise
Edematous
Fluid swelling in the tissue (not due to injury)
Exsanguination
Loss of a lot of blood we taken out (over drawing blood on the patient)
Hematoma
Tumor blood seepage of blood into the tissues
The most common complication of phlebotomy procedure. This
indicates that blood has accumulated in the tissue surrounding the vein. The
two most common causes are the needle going through the vein, and/or failure
to apply enough pressure on the site after needle withdrawal.
Hemolysis
Breakdown of red blood cells
Hemoconcentration
Prolong the needle for more than 60s
The increase in the proportion of formed elements to
plasma is caused by the tourniquet being left on too long. More than (1) minute
prior to needle insertion.
Iatrogenic anemia
Anemia caused by phlebotomist overdrawing blood
Lymphostasis
Do not draw blood on that side lymphatic fluid
Palpate
Act of touch
Petechiae
Capillaries that burst under the skin due to the tourniquet being too tight
These are tiny non-raised red spots that appear on the skin from
rupturing of the capillaries due to the tourniquet being left on too long or too
tight.
Sclerosis veins
That will palpate that are hard and stiff to touch
Syncope
passing out/fainting
Venous reflux
Blood sucked back up when drawing (tube back to the body)
Hematocrit
Separate blood
Hematology
Study of blood
Phlebitis
Inflammation of a vein as a result of repeated venipuncture on that
vein.
Thrombus
This is a blood clot usually a consequence of insufficient pressure
applied after the withdrawal of the needle.
Thrombophlebitis
Inflammation of a vein with formation of a clot
Trauma
This is an injury to underlying tissues caused by probing the
needle.
Edema
Is the accumulation of fluid in the tissues. Collection from edematous
tissue alters test results.
Fistula
Is the permanent surgical connection between an artery and a vein.
Fistulas are used for dialysis procedures and must never be used for
venipunctures due to the possibility of infection.
