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MLAB 123 > Tests and profiles > Flashcards

Tests and profiles Flashcards

1
Q

Biochemistry Tests

A

Lithium Heparin (Light Green) or Gold (clot activator and serum separator)

Serum or plasma is the specimen of choice for biochemistry.

Heparin inhibits the action of thrombin and prevents coagulation for up to 24 hours

Cannot be used for hematology because it causes background staining.

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2
Q

General chemistry tests:

A

PST tubes, SST
Sodium (Na) Potassium (K) Chloride (Cl) and Bicarb (HCO2) (Electrolytes)
Ammonia, Magnesium (Mg) Phosphate (P) calcium (Ca) , arterial blood gas

Enzymes such as Amylase , CK, LD, AST, ALT, GGT, Acid Phos. Cholinesterase, Alk Phos, CKMB

Proteins such as Urea (BUN) creatinine, Total Protein, Albumin, Troponin, Bilirubin, Glucose, uric acid, cryofibrinogen

Lipids such as Cholesterol, Triglycerides, HDL, LDL

Alcohol - in gray and keep on ice

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3
Q

Tube: EDTA (Tan)

A

Tubes with tan stoppers contain EDTA and are chemically cleaned and certified to contain less than 0.01ug/mL lead. These tubes are used to determine lead levels in cases of suspected lead poisoning

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4
Q

Tube : Serum (Red or Brick )

A

Serum tubes do NOT contain an anticoagulant . They may contain additives called clot activators (plastic tubes) and silicone (glass tube) that speed up the clotting process. Activators are substances that increase platelet activation and include silica, cellite, and glass particles.

Another additive that may be found is a gel-like substance that forms a barrier between the cells and serum on centrifugation..

Serum is used in chemistry for specialized tests that would include.

  • Hormones such as Aldeterone, Thyroid function TSH, Free T4, Free T3 Total T4, and estradiol
  • Protein electrophoresis
  • Immunoglobulin IgG, IgA, IgM, IgE, IgD
  • Serum HCG (pregnancy test)
  • Iron studies Ferritin, TIBC, Iron B12 and serum Folate
  • Immunology CRP, Mono, Hepatitis
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5
Q

Tube: Serum and Plasma (Royal Blue

A

Royal Blue serum tubes have been chemically cleaned, so they can be used for TDM (therapeutic drug monitoring) , toxicology, trace metal assays, and nutritional analysis. They may contain an anticoagulant (Disodium EDTA or a clot activator)

Serum used for the following tests:

Drugs; Digoxin, Gentamicyn, Valproic Acid, Tobramicyn, Phenytoin, Carbamazipane, phenobarb, salysiataes, acetaminophen and alcohol

Plasma used for the following tests
Aluminum
Arsenic
Mercury

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6
Q

Tube: Potassium oxalate and Sodium Fluoride (Gray)

A

Tubes with gray stoppers are used for glucose tests and contain both an anticoagulant and a cell preservative. They may contain either potassium oxalate and sodium fluoride or Sodium fluoride/EDTA or only sodium fluoride. The additives (sodium fluoride) inhibit the glycolytic activity of cells which helps maintain the glucose level for a minimum of 24 hours. Oxalates remove calcium to prevent clotting. Fluoride is a powerful enzyme poison. Concentration 10mg/1mL blood it is a powder

The Gray top blood tube is also for lactic acid , pyruvate tests, glucose tolerance and alcohol levels : tube are placed in a icy water slurry (a cup with ice and water to keep the sample cold)

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7
Q

Tube: EDTA (lavender)

A

RBC folate and glycosylated hemoglobin (Hbg A1C) require whole blood and are tested in the Chemistry or Special Hematology labs. Catecholamine test also.

Tubes with lavender-colored stoppers contain sodium or potassium ethylenediaminetetraacetic acid. EDTA is an anticoagulant that prevents blood from clotting by binding calcium, and it also prevents platelet aggregation (clumping), and preserves the shapes of blood cells. Too much EDTA to blood will rupture the platelets

Used for ;
•	CBC’s Complete blood counts, smears, 
•	ESR
•	Hemoglobin electrophoresis
•	Renin activity (transport on ice)
•	Reticulocyte count
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8
Q

CBC profile includes:

A

Hematocrit (HCT), Hemoglobin (HGB), Red blood count(RBC), White blood count(WBC), Platelet count (PLT), Mean cell hemoglobin(MCV), Mean cell hemoglobin concentration (MCHC), Mean cell volume (MCV) and Automated or Manual differential

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9
Q

Tube: Sodium Citrate (light Blue)-COAGULATION

A

Tubes with light blue stoppers are used of coagulation studies. These tubes contain the anticoagulant sodium citrate, which prevents coagulation by binding calcium. EDTA cannot be used for coagulation studies because it affects coagulation factor V one of the proteins involves in coagulation. It is always important to fill evacuated tubes completely, but it is even more important for coagulation studies. The ratio of sodium citrate to blood in the typical adult sized tube should be 9 parts blood to 1 part anticoagulant (4.5 ml blood to .5 anticoagulant) .If the tube does not fill completely coagulation results will be prolonged.

Coagulation studies include
•	PT 
•	APTT
•	Factor assays Factor V, Factor VIII
•	Activated protein C 
•	Antithrombin III
•	D-dimer
•	Fibrinogen
•	Platelet function tests
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10
Q

Tube: Sodium Citrate (Black)-ESR test

A

Tubes with black stoppers also contain sodium citrate, but the ratio of blood to anticoagulant is 4:1 . The greater ratio is needed for the automated Westergren Sedimentation Rate

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11
Q

Tube: Acid Citrate Dextrose (Yellow)

A

This tube has an additive in a solution called ACD. This solution is either solution A or solution B. The difference in the solutions depends on the concentration of trisodium citrate, citric acid and dextrose solution. The tube has a variety of uses in blood bank , tissue typing (HLA), DNA testing, tissue typing and paternity testing.

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12
Q

Pink (EDTA) or Serum (Red) are also used for Blood grouping

A

Blood Bank Tests include the following:

1) ABO/Rh testing
2) Antibody screen AKA indirect antiglobulin test (IAT).
3) Type and Screen (T&S)
4) Crossmatch
5) Direct Antiglobulin Test (DAT or DC)
6) Rh Immune Globulin (RHIG) or Rhogam workup
7) Antibody titer
8) Antigen typing
9) Requests for components such as RBCs, platelets, cryoprecipitate (CRYO) and fresh frozen plasma (FFP) will be delivered to the blood bank.

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13
Q

Tube : Blood Culture tubes( Yellow)

A 
Microbiology Tests
Yellow tubes for blood cultures contain the additive sodium polyanetho sulfonate (SPS) and sodium chloride. Do not confuse this tube with the yellow acid citrate dextrose tube.  Blood can also be collected directly into vacuum vials that contain culture media.  This type of collection minimizes the risk of specimen contamination.  Used for blood culture tests.
Other Microbiology Tests
1) Acid-fast bacilli (AFB) smear
2) AFB culture
3) fungus direct smear
4) Culture and sensitivity
5) Gram stain
6) GC (gonococcal) culture
7) Pinworm prep
8) Ova and parasite (O&P)
9) Occult blood
10) Strep screen
11) Fungus culture
12) Throat culture
13) Urine culture
14) Blood culture
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14
Q

Serology department (red stoppered tube):

A

1) Cold agglutinins (CAG) - specimen must be kept warm at 37º C.
2) Anti-streptolysin O titer (ASO) or screen such as Streptozyme
3) Infectious Mononucleosis (IM) tests such as Monospot
4) Rheumatoid arthritis (RA)
5) VDRL, RPR or FTABS to diagnose syphilis
6) Haptoglobin (HP)
7) Rubella
8) Pregnancy Testing
9) C-Reactive Protein (CRP)

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15
Q

Light sensitive analytes- (Amber colour tube or wrap in foi or special light protection tube holder)

A
  • Bilirubin
  • Erythrocyte Protoporphyrin
  • Carotene
  • Vitamin A
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16
Q

Chilled specimens (ON ICE

A
  • ACTH
  • Acetone
  • ACE angiotensin converting enzyme
  • Aldosterone
  • Ammonia
  • Catecholamine
  • Free fatty acids
  • Lactate
  • Pyruvate
  • Renin activity
  • DHEA
  • Vitamin C
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17
Q

PreWarm specimens (sample must remain at body temp- use pre-warming container 37ºC)

A
  • Cold agglutinins

* Cryoglobulin

18
Q

Test for :
(pH, PCO2, PO2, TCO2,
HCO3, Base Excess, sO2

A

Ordered on patients with:
• Mild to moderate shortness of breath
• Chronic, diagnosed disease(s) with change in status or exacerbation in condition

  • STAT test
  • Deliver to the lab on ice.
  • Test done within 10-30 minutes according to lab protocol
19
Q

Collection methods of blood glass

A
  1. Arterial- heparinized syringe. not done by lab personnel
  2. Venous – heparinized syringe –done by lab personnel
  3. Capillary- done by lab personnel
20
Q

Factors Affecting blood test results: Stress

A

Failure to calm a patient prior to specimen collection may increase
Levels of adrenal hormones and markedly affect ABG results.
Elevated WBC count on children crying must wait 60 mins before taking blood
insulin, fibirinogen , albumin

21
Q

Factors Affecting blood test results Posture

A

Lying to sitting causes water to shift from inside the veins to the outside
Enzymes proteins lipids iron calcium are large molecules and cannot move easily
albumin, aldosterone, bilirubin, Ca , TP, R/WBC

22
Q

Factors Affecting blood test results Medication

A

Varying effects on blood and urine results
Always record patient meds on requisition
e.g. ASA birth control pills

23
Q

Factors Affecting blood test results Meals

A

Fasting/non-fasting

Alter many chemistry results

24
Q

Factors Affecting blood test results Basal state

A

Metabolic condition after 12 hours of fasting and lack of exercise

25
Q

Factors Affecting blood test results Exercise

A

Transient strenuous exercise and prolonged exercise or weight training affect test results differently. Test results affected by transient exercise include primarily the enzymes associated with muscles and the WBC count associated with the release of cells attached to the venous walls into the circulation. The values usually return to normal within several hours after relaxation. Prolonged exercise also increases the muscle related waste products and the sex hormones. Lactic acid, creatinine, fatty acids, proteins, CK, AST, LD coagulation.

26
Q

In vivo Specimen related concerns

A

Diseases: liver disease, hemolytic anemia, Transfusion reaction

27
Q

In Vitro Specimen related concerns

A 
	Too small needle gauge
	Forcing blood through a needle-improper transfer
	Pulling syringe too fast
	Shaking tube vigorously
	Drawing from hematoma
	Frothing/foaming
	Difficult draw
28
Q

Non-sufficient quantity (NSQ) Specimen related concerns

A

): not enough blood drawn to perform tests

29
Q

Icteric:

A

yellow from the presents of excess bilirubin

30
Q

Lipemia

A

cloudy because of increased lipids

31
Q

Diaurinal variations

A

cortisol, serum, iron, wbc
testosterone decreases in the afternoon
TSH increases in the evening as well as Serum Fe

32
Q

Tobacco

A

catecholamines, cortisol, hemoglobin, WBC

33
Q

Statin

A

lowers cholesterol , impacts lier function and increases liver enzymes in the blood

34
Q

ambulatory

A

walking around

35
Q

geographic location

A

high traffic areas = increase in lead and carboxyhemoglobin

Hard h2O = increase in lipid and mg

36
Q

hemoconcentration

A

false increase in K, Mg, LDH, Ph, Ammonia, Total protein

can be caused by dehydration, if tourniquet is too tight or left on too long

37
Q

Tourniquet too long

A

false increase in plasma, cholesterol, Fe, lipid, protein and K

38
Q

Fist pumping

A

false increase = K, lactate, Ph

39
Q

Hemolysis

A

False increase in K, Mg, Fe, LDH, pH Ammonia and TP

40
Q

Atlitude

A

increased RBC, hemoglobin urates -protein degradation due to RBC turnover

41
Q

B12 and erythromycin

A

give urine and blood orange tinge

MLAB 123 (11 decks)

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