U2 LEC: SPECIMEN COLLECTION AND HANDLING Flashcards
Types of Blood Samples
- Arterial
- Venous
- Capillary
Types of Samples for CC
- Blood
- Urine
- CSF
- Paracentesis fluids
- Amniotic fluid
This is an ultra filtrate of plasma.
Cerebrospinal Fluid (CSF)
This refers to the general term for body cavity fluids.
Paracentesis fluids
Paracentesis fluids include?
- pleural (lungs)
- pericardial (heart)
- peritoneal (abdominal)
- synovial fluid (joint)
This is used for Amniocentesis.
amniotic fluid
This is present inside the placenta, and is checked for Fetal Lung Maturity and Hemolytic disease.
amniotic fluid
What should be checked before and after centrifugation?
Color
1.0mL and above
Macro method
0.1 to 0.9mL
Micro method
0.01 to 0.09mL
Ultramicro method
0.001 to 0.009mL
Nanoliter method
Collection method for purplish venous blood
Venipuncture
Collection method for bright red arterial bood
Arterial puncture
Arterial blood is used for?
Arterial Blood Gas (ABG) Test and pH
Artery of choice for Arterial puncture?
Radial artery
This is usually contaminated with tissue juices.
Skin puncture
Skin puncture is a method of choice for?
- pediatric and geriatric patients’
- extremely obese adults
- severe burn
- thrombotic tendencies
In what finger is capillary puncture done in adults?
Ring or middle, lateral
Endothelium
Tunica intima
Smooth muscle
Tunica media
Connective tissue
Tunica adventitia
This refers to the plasma and cellular components, mixed with anticoagulant.
Whole Blood
Whole blood requires what following blood collection?
immediate mixing
This is the clear supernatant on top upon settling of whole blood.
Plasma
Liquid portion of unclotted blood
Plasma
Liquid portion of clotted blood
Serum
T/F: Plasma is clearer than serum.
False
Serum is clearer than plasma
T/F: Plasma has a shortened TAT.
True
No need to clot
Serum requires what, and how many minutes before centrifugation?
complete clotting, 30 minutes
Serum is the only liquid portion that undergoes?
rimming
Why is serum lighter than plasma?
Decreased fibrinogen
Type of blood in EDTA
Whole Blood
Centrifugation must be done for
1000 to 2000g for 10 minutes
Alternative centrifugation speed and time
2200 to 2500rpm for 15 minutes
T/F: You should not mix specimens in red tube top even with clot activators.
False
Pwede i mix basta may clot activators, and also not vigorously
Sepration of serum and RBCs must be ASAP because serum results would be?
False increase (↑)
Inclusions of RBCs will seep out, masasama sa serum
Gel in yellow tube top
Thixotropic gel
Veins in the Antecubital fossa
- Median cubital
- Cephalic
- Basilic
Other veins for Venipuncture sites
- Brachial vein
- Femoral vein
- Radial vein
- Ankle veins
- Veins of the dorsal hand
Inappropriate venipuncture site
Involves breast removal and lymphedema
Arm on the side of mastectomy
Inappropriate venipuncture site
Areas with fluid accumulation
Edematous areas
Inappropriate venipuncture site
This refers to clots of saturated or concentrated blood in superficial skin
Hematomas
Inappropriate venipuncture site
- Arm in which blood is being transfused
- Scarred area
- Arms with fistulas or vascular grafts
- Sites above an IV cannule
Inappropriate venipuncture site
Instructions for blood collection in IV site
- Turn off IV for 2 minutes
- Apply tourniquet below IV site
- Collect 5mL then discard first to avoid contamination
- Catch method (using tube or aspirate using syringe)
Red (glass)
- No ac, MOA
- Serum for Serology, CC
Red (plastic)
- Clot activator
- Serum for Serology, CC
- Silica clot activator
Lavender (glass)
- K3EDTA, liquid
- Whole blood for Hematology
- Chelates/binds calcium
Lavender (plastic)
- K2EDTA, spray dried
- Whole blood for Hematology
- Chelates/binds calcium
Pink
- K2EDTA, Spray dried
- Whole blood for Hematology, Molecular Diagnostics
- Chelates/binds calcium
White
- EDTA and gel
- Plasma for Molecular Diagnostics
- Chelates/binds calcium
Light blue
- Sodium citrate
- Plasma for Coagulation
- Chelates/binds calcium
Light blue
- Thrombin and soybean trypsin inhibitor
- Plasma for Coagulation
- Fibrin degradation products
Black
- Sodium citrate
- Plasma for ESR, Hematology
- Chelates/binds calcium
Light green / black
- Lithium heparin and gel
- Plasma for chemistry
- Inhibits thrombin formation
Green
- Lithium heparin, sodium heparin
- Plasma for chemistry
- Inhibits thrombin formation
Royal blue
- Sodium heparin, K2EDTA
- Plasma for chemistry and toxicology
- Inhibits thrombin formation, Binds calcium
Gray
- Sodium fluoride, Potassium oxalate (anticoagulant)
- Plasma for glucose testing
- Inhibits glycolysis
Yellow
- Sodium polyanetholsulfate
- Serum for microbiology culture
- Aids in bacterial recovery by inhibiting complement, phagocytes, and certain antibiotics
Yellow
- Acid citrate dextrose
- Plasma for blood banking, Human Leukocyte Antigen (HLA), phenotyping, paternity testing
- WBC preservative
Tan (glass)
- Sodium heparin
- Plasma for lead testing
- Inhibits thrombin formation
Tan (plastic)
- K2EDTA
- Plasma for lead testing
- Chelates/binds calcium
Yellow, gray, and orange
- Thrombin
- Serum for chemistry
- Clot activator
Red, gray and gold
- Clot activator separation gel
- Serum for chemistry
- Silica clot activator
Incorrect anticoagulant
EDTA
- ALP, Creatinine, Leucine aminopeptidase, Calcium and Iron: Decrease ↓
- PT and PTT: Increase ↑
- Platelet aggregation: prevent
Incorrect anticoagulant
Oxalate
- Acid phosphatase, ALP, Amylase, LD, Calcium: Decrease ↓
- Sodium and potassium: Increase ↑
- Cell morphology: Distorted
Citrate
- ALT, AST, ALP, Amylase, Calcium: Decrease ↓
- Acid phosphatase, Sodium and potassium: Increase ↑
- Labile coagulation factors: Preserved
Heparin
- Triiodothryonine, Thyroxine, PT and PTT, Lithium (LiHep), Sodium (NaHep): Increase ↑
- Wright’s stain = blue background
Fluorides
- Acid phosphatase, ALP, Amylase, CK, ALT, AST = Decrease ↓
- Cell morphology: Distorted
Tests done without tourniquet
- Ammonia
Troubleshooting
Bevel on upper wall
increased angle
Troubleshooting
Bevel on lower wall
atras
Troubleshooting
Collapsed
Through & through (apply pressure)
Phases of Laboratory Testing
- Pre Analytical
- Analytical
- Post-Analytical
Under physiologic considerations
Patient preparation
Under specimen collection, transportation, preparation/processing, and storage
- Laboratory request
- Entry to logbook
Physiological factors
- Diet
- Medication or herbal supplements
- Circadian rhythm
- Patient posture
Patient preparation factors
- Fasting
- 24 hour urine collection
Collection and sample processing factors
- Venipuncture technique
- Tube selection
- Tourniquet use
- Specimen transport and storage
Higher in afternoon and evening
- Growth hormone (matulog ng hapon)
- Acid phosphatase (boner sa umaga)
Peaks early in the morning
- Iron (plantsa ng uniform)
Decreased supine
- Calcium (gatas)
Lower at night
- ADH
- Plasma renin
- Aldosterone
- Insulin
Higher with stress
- Cortisol
- Prolactin
Higher with exercise
- Thyroxine
This involves any form of physical activity.
Exercise
What is increased and decreased in short term effects (one hour after) exercise?
- Lactic acid, fatty acids, alanine: Increase ↑
- Glucose: Decrease ↓
What is increased and decreased in long term effects of exercise?
- LDH, ALD, CK, AST: Increase ↑
LAKAS
This affects the liver.
Drugs/Alcohol
The liver is characterized by?
first-pass metabolism
Drugs
Hepatic microsomal enzyme release: Increase ↑
Alcohol
- Acetate, Acetaldehyde, Gamma-glutamyl transferase (GGT): Increase ↑
Acute effects of Tobacco Smoking due to Nicotine
Plasma catecholamines (Epinephrine, Norepinephrine), Cortisol: Increase ↑
Chronic effects of Tobacco Smoking
WBC count, Carboxyhemoglobin, MCV: Increase ↑
What specific WBC is elevated in chronic effects of tobacco smoking?
Monocyte
Stress
Cortisol, adrenal hormones (catecholamines): Increase ↑
Stress leads to?
hyperventilation
This is the disturbance of acid-base balance, which affects ABG test.
hyperventilation
Age
- ALP, Albumin, Phosphorous, Cholesterol
Gender
Males: CK
Females: Cholesterol
Posture
Albumin, cholesterol, aldosterone, Ca
Activity
LD, Lactic acid, Creatinine, CK, AST
Decreased: Cholesterol, triglycerides
Race
Cholesterol, triglycerides
Require fasting
- FBS
- Glucose tolerance test (GTT)
- Triglycerides
- Lipid panel
- Gastrin
- Insulin
- Aldosterone/Renin
Anaerobic (require Ice slurry)
- Lactic acid
- Ammonia
- Blood gas
Decrease in pH and po2
How to transfer serum/plasma?
Aliquot
Hemolysis is caused by?
Hemoglobin
Icterus is caused by?
Bilirubin
Lipemia is caused by?
fat
This is the result from prolonged tourniquet time?
Hemoconcentration
This is the self destruction of enzymes or Acid Phosphatase.
Enzymatic Degradation
Extracellular
Na, Cl
Intravascular
K, Mg
Enzymes
ACP, AST, LDH
This is the increased lipid concentration.
Lipolysis
Open system
- Syringe
- ↑ pO2, ↑ pH, ↓ pCO2
Closed system
- ETS
- ↓ pO2, ↓ pH, ↑ pCO2
Hydrolysis of organic phosphate esters cause changes in?
Changes in PO3-4 (Phosphate)
Under bacterial changes include the following:
- Glycolysis
- Urea concentration: Decrease ↓
- NH3: Increase ↑
This is the rapid swelling at or near the venipuncture site due to blood leaking into the tissues.
Hematoma
This is anemia as a result of treatment, or frequent blood draws.
Iatrogenic anemia
This refers to the blind insertion of central venous catheter (CVC).
Inadvertent arterial puncture
Lactate dehydrogenase
16:1, 272.0
Aspartate aminotransferase
4:1, 220.0
Potassium
23:1, 24.4
Alanine aminotransferase
6.7:1, 55.0
Patient complications
- Allergy
- Excessive Bleeding
- Fainting/syncope
- Nausea or vomiting
- Pain
- Petechiae
- Seizures/convulsions
What specimen is protected from light?
Bilirubin
Storage of specimen
- Refrigeration at 4C for 8 hours
- Freezing at 20C for longer periods
This refers to all lab tests related to crime or accident.
Forensic testing