Unit 8 - Special Collection & Point-Of-Care-Testing (POCT) Flashcards
Yield information that determines which blood products can be transfused safely into a patient.
Blood bank specimens
Blood bank tests require the collection of one or more __________ tubes In some cases, __________ tube is used.
Lavender- or pink-top EDTA
Nonadditive glass red-stoppered tube is used.
T/F
Blood bank specimens require strict patient identification and specimen labeling procedures.
T
T/F
Specimens that have labeling errors of any kind or are unlabeled will not be accepted for testing.
T
T/F
An error in specimen identification or labeling requires recollection of the specimen and causes a delay in patient treatment.
T
T/F
An undetected error can result in administration of an incompatible blood product and the possibility of a fatal transfusion reaction.
T
T/F
One system uses a special ID bracelet such as the PDC Securline Blood Bank, which is attached to the patient’s wrist.
T
In a special ID bracelet system, the patient’s identity is confirmed and the information written on a self-carbon adhesive label on the special bracelet contains a ___________.
Unique ID number
Labeling requirements for blood bank specimens.
– Patient’s full name (including middle initial)
– Patient’s date of birth
– Date and time of collection
– Phlebotomist’s initials
- Room number and bed number (optional)
- Patient’s hospital identification number (or social security number for outpatients)
A place where blood is collected and stored before it is used for transfusions.
Blood bank
Perform tests to ensure that blood from donors and other blood products are safe before blood transfusion.
Blood bank
We use blood bank specimens for _____ and _____.
Compatibility testing
Screening for blood-borne pathogens
Compatibility testing
Blood typing
Screening for unexpected cell antibodies
Screening for blood-borne pathogens
Hepatitis viruses
HIV
HTLV
Syphilis
West nile virus
Malaria
What are the special identification systems in blood bank specimens?
ID bracelet
Blood product validation
ID bracelet with barcoded ID number contains _____ information.
Patient
Blood product validation contains what?
Clinician identity
Patient identity
Donor identifier
Blood product’s barcode on the blood unit
Commonly performed tests in blood banking.
Blood typing and screening
T/F
In blood bank tests, we screen for infections and unexpected RBC ANTIGENS.
F. It should be RBC ANTIBODIES
Procedure for compatibility testing and selection of safe blood for transfusion.
Cross-matching
Testing of donor’s red cells with patient’s serum to detect antibodies in the patient.
Major cross-match
Testing of patient’s serum with donor’s red cells.
Major cross-match
Testing of donor’s serum with patient’s red cells to detect antibodies in the donor serum.
Minor cross-match
Testing of donor’s serum with patient’s red cells.
Minor cross-match
In cross matching procedures, we check for blood _____ and _____.
Agglutination
Hemolysis
Manifestation of incompatibility.
Agglutination
Hemolysis
T/F
In blood bank donor collection, we collect blood to be used for blood transfusion procedures rather than for diagnostic procedures.
T
During a regular donation, we give around how much blood?
450 mL of whole blood
T/F
Presence of anxiety, drug or alcohol to the donor should be deferred.
T
Donor eligibility check for AGE.
17 to 66 y/o
Donor eligibility check for TEMPERATURE.
37.5 C or 99.5 F
Donor eligibility check for WEIGHT.
Minimum weight of 110 lbs or 49.8 kg ~ 50 kg
Donor eligibility check for NORMAL BLOOD PRESSURE.
180 mmHg (systolic pressure)
100 mmHg (diastolic pressure)
Donor eligibility check for NORMAL PULSE RATE.
50 to 100 bpm
Donor eligibility check for ACCEPTABLE HEMOGLOBIN LEVELS.
12.5 g/dL
Donor eligibility check for ACCEPTABLE HEMATOCRIT LEVELS.
Atleast 38%
T/F
A donor is eligible if he or she doesn’t have skin lesions or any skin disorders that are not cause for deferral like ivy and other rashes.
T
The anticoagulant and preservative used in collecting units of blood for transfusion purposes.
Citrate Phosphate Dextrose (CPD) or CPD plus adenine (CPDA1)
It prevents clotting by chelating calcium.
Citrate
A compound that stabilizes the pH.
Phosphate
It provides energy to the cells and helps to keep them alive.
Dextrose
T/F
Donor units are normally collected from a large antecubital vein.
T
The vein is SELECTED in a manner similar to routine _____ and CLEANED in a manner similar to _____ collection.
Venipuncture
Blood culture
The collection unit is a sterile, closed system consisting of a bag to contain the blood connected by a length of tubing to a sterile _____ needle.
16G to 18G
T/F
The bag fills by gravity and must be placed lower than the patient’s arm.
T
T/F
The collection bag contains an anticoagulant and preservative solution and is placed on a mixing unit while the blood is being drawn.
T
The unit is normally filled by weight but typically contains around _____ of whole blood when full.
450 mL
T/F
Only one needle puncture can be used to fill a unit. If the unit only partially fills and the procedure must be repeated, an entire new unit must be used.
T
The process by which a person donates blood for his or her own use.
Autologous donation
T/F
Autologous donation is done for elective surgeries when it is anticipated that a transfusion will be needed.
T
T/F
Using one’s own blood eliminates many risks associated with transfusion, such as disease transmission and blood or plasma incompatibilities.
T
Although blood is normally collected several weeks prior to the scheduled surgery, the minimum time between donation and surgery can be as little as _____ hours.
72 hours or 3 days
T/F
To be eligible to make an autologous donation, a person must have a written order from a physician.
T
A blood bank procedure that reduces the chance of hemolytic reactions and transmission of blood-borne diseases.
Autologous donation
We perform blood cultures to test the presence of _____.
Bacteremia
Septicemia
It helps to determine the PRESENCE AND EXTENT of infection as well as indicating the type of ORGANISM responsible and the ANTIBIOTIC to which it is most susceptible.
Blood culture
Blood culture if collected _____ prior to fever peak, before the body can eliminate some of the microorganisms.
30 minutes to 2 and 1/2 hours
In detecting bacteria in blood, aside from performing blood culture, we do _____ testing.
Susceptibility or sensitivity
The medium used in special collection bottles.
Nutrient broth
What are the sets of specimens used in blood culture?
Aerobic bottle
Anaerobic bottle
It allows preferential growth of AEROBIC and FACULTATIVE ANAEROBIC microorganisms.
Aerobic bottle
Allowing preferential growth of strict anaerobic bacteria.
Anaerobic bottle
Microorganisms that needs oxygen to survive.
Aerobic bacteria
Microorganisms that can survive with or without oxygen.
Facultative anaerobic bacteria
Microorganism that survive in the absence of oxygen because it is toxic to them.
Obligate anaerobic bacteria
Anticoagulant used in blood culture.
0.025% to 0.050% Sodium Polyanethol Sulfonate (SPS)
Tubes that inhibits the growth of microorganism.
Sodium citrate
Heparin
EDTA
How many blood cultures are needed to optimize the detection of microorganisms in the blood.
2 to 4 blood cultures
Blood cultures are drawn _____ apart.
30 to 60 minutes
T/F
Blood cultures are drawn consecutively and immediately from different sites.
T
Blood-broth ratio.
1:5 – 1:10
T/F
For adults, the patient weighing greater than 80 lbs or 36 kg is required.
T
Recommended blood volume for blood culture.
20 to 30 mL
minimum of 10 mL per draw
Recommended draw for pediatric patients weighing less than 1 kg.
2 mL
Recommended draw for pediatric patients weighing 2 kg.
4 mL
Recommended draw for pediatric patients weighing 12.7 kg.
6
Recommended draw for pediatric patients weighing 36.3 kg.
10 mL
Recommended draw for pediatric patients weighing greater than 36.3 kg.
2 to 30 mL
Some pediatric bottles may be supplemented with _____ to enhance the recovery of _____.
X and V factors
Haemophilus influenzae
Antiseptic or sterile technique is done to minimize the risk of the _____ of the skin.
Normal flora
Duration of friction scrub.
30 to 60 s
Antiseptics used for blood culture collection.
Tincture of iodine
Chlorhexidine gluconate*
Povidone/70% ethyl alcohol combination
Antiseptics in a form of swab sticks.
10% povidone iodine
1% to 2% tincture of iodine
Antiseptics in a form of cleaning-pad kits.
Benzalkonium chloride
The area covered should be _____ at the puncture site.
3 to 4 in. in diameter
Tests performed in evaluation of hemostasis.
Activated Partial Thromboplastin Time (APTT)
Prothrombin Time (PT)
Anticoagulant of choice in evaluation of hemostasis.
Trisodium citrate
Ratio of citrate to blood.
1:9
Ratio of blood to citrate.
9:1
Blood samples for coagulation testing should be collected by clean atraumatic venipuncture, and excessive application of vacuum should be avoided to minimize activation of ______.
Platelets
Cooling on ice during transport may be required for some test specimens to protect the _____.
Coagulation factors
Tests should be performed within __ hours of sample collection.
4
Plasma should be frozen within __ hour of harvesting.
1
Tube used for special coagulation testing.
Blue-top CTAD tube
Anticoagulants in CTAD tubes.
Sodium citrate
Theophylline
Adenosine
Dipyridamole
CTAD tube is used to inhibit _____ activation between collection of the blood and performance of the test.
Thrombocyte
All anticoagulant tubes must be gently inverted three or four times immediately after collection to avoid _____, which can invalidate test results.
Microclots
It means after a meal.
Postprandial (PP)
Excellent screening test for diabetes and other metabolic problems
2-hour PP
T/F
Glucose levels in blood specimens obtained 2 hours after a
meal are rarely elevated in normal persons but may be significantly increased in diabetic patients.
T
A 2-hour PP test is also used to monitor _____.
Insulin therapy
T/F
Correct timing of specimen collection is very important.
T
T/F
Glucose levels in specimens collected too early or late may be falsely elevated or decreased, respectively, leading to
misinterpretation of result
T
In 2-hour PP specimen collection, the patient is placed on a high-carbohydrate diet for _____ days prior to the test.
2 to 3 days
T/F
In 2-hour PP specimen collection, the patient fasts prior to the test. This means no eating, smoking, or drinking other than water for at least ___ hours before the test.
10
T/F
In 2-hour PP specimen collection, a fasting glucose specimen may be collected before the start of the test.
T
T/F
In 2-hour PP specimen collection, the patient is instructed to eat a special breakfast or given a measured dose of glucose beverage on the day of the test.
T
T/F
In 2-hour PP specimen collection, a blood glucose specimen is collected 2 hours after the patient finishes eating.
T
Used to diagnose problems of carbohydrate metabolism.
Glucose Tolerance Test (GTT)
The major carbohydrate in the blood and is the body’s source of energy.
Glucose
GTT is also called as _____.
Oral Glucose Test (OGTT)
T/F
OGTT evaluates the body’s ability to metabolize glucose by
monitoring the patient’s tolerance to high levels of glucose without adverse effects.
T
Major types of disorders involving glucose metabolism.
Hyperglycemia
Hypoglycemia
Blood glucose level is increased, as in diabetes mellitus.
Hyperglycemia
Blood glucose level is decreased.
Hypoglycemia
Produced by the pancreas, is primarily responsible for regulating blood glucose levels.
Insulin
Used to determine if a patient lacks the enzyme that is necessary to convert lactose (milk sugar) into glucose and galactose.
Lactone tolerance test
Enzyme that is necessary to convert lactose into glucose and galactose.
Mucosal lactase
T/F
A person lacking the enzyme suffers from gastrointestinal distress and diarrhea following the ingestion of milk and other lactose-containing foods. Symptoms are relieved by eliminating milk from the diet.
T
T/F
If the patient has mucosal lactase, the resulting glucose curve will be similar to a GTT curve, and the result is considered negative.
T
T/F
If the patient is lactose intolerant, the glucose curve will be flat, rising no more than a few mg/dL from the fasting level.
T
If the person is lactose intolerant, the symptoms are relieved by eliminating ___ from the diet.
Milk
Performed to determine the probability that a specific individual fathered a particular child.
Paternity or parentage testing
T/F
Generally paternity test results exclude the possibility of paternity rather than prove paternity.
T
Which of the following is/are people that requests paternity testing.
A. Physician
B. Lawyer
C. Child support enforcement bureaus
D. Individuals
E. All of the above
E
Paternity testing requires _____ and specific identification procedures that may include fingerprinting.
Chain-of-custody protocol
T/F
The mother, child, and alleged father are all tested.
T
T/F
Blood samples are preferred for testing; however, buccal (cheek) swabs are increasingly being used.
T
T/F
Blood sample testing usually includes ABO and Rh typing.
T
The paternity or parentage testing determines other _____.
Red cell antigens
Red cell enzymes
Serum proteins
White cell enzymes
White cell antigens or Human Leukocyte Antigen (HLA)
The paternity or parentage testing determines other _____.
Red cell antigens
Red cell enzymes
Serum proteins
White cell enzymes
White cell antigens or Human Leukocyte Antigen (HLA)
DNA extracted from the cells is “mapped” to create a _____.
DNA profile
Used in the management of patients being treated with certain drugs to establish and maintain a drug dosage, thus avoiding toxicity.
Therapeutic Drug Monitoring (TDM)
_____ of blood sample collection is critical in TDM.
Timing
T/F
When a patient takes a drug dose, the amount in the bloodstream rises initially.
T
For a drug to be beneficial, the peak (maximum) level must not exceed toxic levels, and the trough (minimum) level must remain within the therapeutic range.
T
T/F
Timing of specimen collection in regard to dosage administration is critical for safe and beneficial treatment and must be consistent.
T
It involves the withdrawal of large volumes of blood usually measured by the unit (as in blood donation), or approximately 500 mL.
Therapeutic phlebotomy
Therapeutic phlebotomy is used to treat conditions such as?
Polycythemia
Hemochromatosis
A disease involving the body’s overproduction of RBCs, which is detrimental to the patient’s health and the most common reason for performing therapeutic phlebotomy.
Polycythemia
The patient’s RBC levels are monitored regularly, usually by the _____ test.
Hematocrit
T/F
Periodic removal of blood when the hematocrit exceeds a certain level is used to help keep the patient’s RBC levels within the normal range.
T
A disease characterized by excess iron deposits in the tissues.
Hemochromatosis
It can be caused by a defect in iron metabolism or result from multiple blood transfusions or excess iron intake.
Hemochromatosis
T/F
In treating hemochromatosis, periodic removal of single units of blood from the patient gradually depletes iron stores, because the body then uses the iron to make new RBCs to replace those removed.
T
The detection of toxins and treatment for the effects
they produce.
Clinical toxicology
Concerned with the legal consequences of toxin exposure, both intentional and accidental.
Forensic toxicology
Which of the following is/are toxicology tests examine.
A. Blood
B. Hair
C. Urine
D. Other body substances for the present of toxins
E. All of the above
E
Tests may detect a specific drug or screen for up to __ different drugs, depending upon the circumstance.
30
Drug screening is typically performed on _____ rather than blood because it is easy to obtain and a wide variety of drugs or their metabolites (products of metabolism) can be detected in urine for a longer period of time.
Urine
Trace elements or metals includes?
Lead
Iron
Zinc
Arsenic
Aluminum
Copper
It is measured in such small amounts that traces of them in the glass, plastic, or stopper material of evacuated tubes
may leach into the specimen, causing falsely elevated test
values.
Trace elements
Trace elements must be collected in?
Trace element-free Royal Blue Top
T/F
It is important to prevent introducing even the smallest
amount of the contaminating substance into the royal blue top tube .
T
POCT is also known as?
Alternate site testing (AST)
Ancillary
Bedside
Near-patient testing
It brings laboratory testing to the location of the patient.
POCT
T/F
POCT utilizes small, portable, and often handheld testing devices.
T
T/F
One of the benefits of POCT include convenience to the patient and a short turnaround time (TAT) for results that allow healthcare providers to address crucial patient needs, deliver prompt medical attention, and expedite patient recovery.
T
T/F
POCT is performed where patient care is delivered including physician office testing, various hospital locations outside the laboratory, such as the emergency department, operating room, and intensive care unit.
T
T/F
Equipment, if needed, must be evaluated in POCT.
T
T/F
In POCT, a person of sufficient managerial authority is designated as being responsible for the site.
T
T/F
In POCT, persons performing the test must be trained and competency assessed, and this must be. documented.
T
T/F
In POCT, a written procedure must be available and followed.
T
T/F
In POCT, calibrations and quality control samples must be run at regular intervals.
T
T/F
In POCT, all patient results must be documented, and the relationship to quality control measures must be clear.
T
T/F
In POCT, appropriate action must be taken and documented on all out-of-range quality control results.
T
T/F
In POCT, appropriate action must be documented on all abnormal patient results.
T
The PT test is used to monitor _____ therapy.
Warfarin
Prothrombin time measures the activity of coagulation factors involved in _____ coagulation pathway
Extrinsic
It tests on whole blood from a fingerstick to provide timely
laboratory results.
Prothrombin time (PT)
International Normalized Ratio (INR)
Test is used to screen for bleeding disorders prior to surgery, investigate bleeding or clotting disorders, detect clotting factor deficiencies.
Activated Partial Thromboplastin Time
APTT is used to monitor unfractionated _____ therapy.
Heparin
APTT is used to screen for _____ pathway deficiencies.
Intrinsic
APTT is used to screen for _____ anticoagulant.
Lupus
APTT is clot-based screening test for _____ coagulation.
Intrinsic
This analyzes activity of the intrinsic coagulation factors and is used to monitor heparin therapy.
Activated Clotting Time (ACT)
Whole-blood clotting time test often used in cardiac surgical suites
Activated Clotting Time (ACT)
It is also used to monitor high-dose unfractionated heparin therapy.
Activated Clotting Time (ACT)
It is also used to monitor high-dose unfractionated heparin therapy.
Activated Clotting Time (ACT)
Testing allows the clinician to determine a patient’s response to medication before open heart surgery or cardiac catheterization.
Platelet function
Time required for blood to stop flowing from a standardized puncture on the inner surface of the forearm.
Bleeding-time (BT)
It evaluates platelet plug formation in the capillaries to detect platelet function disorders and capillary integrity problems.
Bleeding-time (BT)
Time interval in BT is required for blood to stop flowing from a puncture wound on the _____ surface of the
forearm.
Volar
It is performed to evaluate vascular and platelet function.
BT
BT is performed on the volar (inner) lateral surface
of the forearm, using a blood pressure cuff (__ mmHg) to standardize and maintain a constant pressure.
40
Arterial blood gases (ABGs) measured by POCT methods include?
pH
Partial pressure of CARBON DIOXIDE (PCO2)
Partial pressure of OXYGEN (O2)
Oxygen saturation (SO2)
An abbreviation for potential hydrogen, a scale representing the relative acidity or alkalinity of a solution.
pH
A measure of the body’s acid–base balance and indicates his or her metabolic and respiratory status.
Arterial blood pH
The normal range for arterial blood pH.
pH 7.35 to 7.45
Below-normal pH is referred to as _____.
Acidosis
Above-normal pH is referred to as _____.
Alkalosis
A measure of the pressure exerted by dissolved CO2 in the blood plasma and is proportional.
Partial pressure of carbon dioxide
An indicator of how well air is being exchanged between the blood and the lungs.
Partial pressure of carbon dioxide
T/F
CO2 levels are maintained within normal limits by the rate and depth of respiration.
T
An abnormal increase in PCO2 is associated with _____ and a decrease with _____.
Hypoventilation
Hyperventilation
A measure of the pressure exerted by dissolved O2 in the blood plasma and indicates the ability of the lungs to diffuse O2 through the alveoli into the blood.
Partial pressure of oxygen
It is used to evaluate the effectiveness of oxygen therapy.
Partial pressure of oxygen
A measure of the percentage of hemoglobin binding sites occupied by oxygen in the bloodstream.
Oxygen saturation
It is used by physicians to determine a patient’s oxygenation status.
SO2
A normal, healthy individual will usually exhibit oxygen saturation around __%
98%
A person with an arterial SO2 below 90% is said to have _____ (a low oxygen level in the blood) and may be _____.
Hypoxemia
Cyanotic
The most common electrolytes measured by POCT.
Sodium (Na+)
Potassium (K+)
Chloride (Cl-)
Bicarbonate ion (HCO3-)
Ionized calcium (iCa2+)
Most plentiful electrolyte in the blood.
Na+
It plays a major role in maintaining osmotic pressure and acid–base balance and in transmitting nerve impulses.
Na+
Reduced sodium levels are referred to as _____.
Hyponatremia
Elevated sodium levels are referred to as _____.
Hypernatremia
Primarily concentrated within the cells, with very little found in the bones and blood.
K+
It is released into the blood when cells are damaged.
K+
Plays a major role in nerve conduction, muscle function, acid–base balance, and osmotic pressure.
K+
Influences cardiac output by helping to control the rate and force of heart contraction.
K+
The presence of a _____ on an electrocardiogram indicates potassium deficiency.
U wave
Decreased blood potassium.
Hypokalemia
Increased blood potassium.
Hyperkalemia
Responsible for maintaining cellular integrity by influencing osmotic pressure and both acid–base and water balance.
Cl-
Chloride must be supplied along with _____ when hypokalemia is being corrected.
Potassium
Plays a role in transporting carbon dioxide (CO2) to the lungs and in regulating blood pH.
HCO3-
Can be used by the body for such critical functions as muscular contraction, cardiac function, transmission
of nerve impulses, and blood clotting.
iCa2+
Proteins specific to heart muscle.
Cardiac troponin T (TnT)
Troponin I (TnI)
Analytes that are utilized to assess the
occurrence of myocardial infarction (MI) or the extent of
damage produced by cardiovascular disease.
Cardiac markers
One of the most common POCT procedures and is most often performed to monitor glucose levels of patients with diabetes mellitus.
Glucose
T/F
Glucose analyzers predominantly use whole-blood specimens obtained by routine skin puncture.
T
In glucose testing, drop of blood is applied to the test
strip or _____.
Microcuvette
T/F
Analyzer determines the level of glucose in the blood, and the result appears on a display screen.
T
Primary constituent of red blood cell cytoplasm and transports molecular oxygen from the lungs to the tissues and returns carbon dioxide to the lungs.
Hemoglobin (Hb)
T/F
In measuring the Hb, a small amount of blood sample is placed in a special microcuvette and inserted into
the machine for a reading.
T
A diagnostic tool for monitoring diabetes therapy.
Glycosylated hemoglobin
Hct is also called _____.
Packed cell volume (PCV)
A measure of the volume of RBCs in a patient’s blood.
Hct or PCV
T/F
The measurement of hemoglobin (hgb) levels is an important part of managing patients with anemia.
T
Pregnancy tests detect the presence of _____.
Human chorionic gonadotropin (hcG)
A hormone produced by the placenta.
hcG
hcG appears in
Urine and serum
hcG appears in both urine and serum beginning approximately _____ days after conception.
10
T/F
Most rapid pregnancy testing is performed on blood.
F
Peak urine levels of hcG occur at approximately how many weeks of gestation?
10 weeks of gestation
Consists of a physical and chemical analysis of the specimen as well as microscopic analysis if indicated.
Urinalysis
