PMTP QUIZ 2 (8&9)

• Cross-matching


  Checks for coagulation or hemolysis/lysis to prove mismatch
• Sepsis


  The clinical name for blood poisoning by bacteria. It is the body's most extreme response to an infection.
• Preferred specimen for patients suspected of chronic THC use

  • Hair
• Cultures in aerobic bottles are filled first if winged-set blood collection is to be done
• Anti-microbing device


  Consists of resins, which completely removes the antibacterial activity of a range of antibiotics without affecting the recovery of contaminated bacteria
• When the trough level is required, the blood sample should be drawn right before the next dose is administered
• Pneumatic Tube


  Systems that propel cylindrical containers through networks of tubes by compressed air or by partial vacuum. They are used for transporting solid objects, as opposed to conventional pipelines which transport fluids.
• When particulate matter is suspended in a gas

  It is called an aerosol
• To prevent the formation of aerosol, a tube being centrifuged must be capped as per OSHA
• QNS


  Quantity not Sufficient
• RPM


  Revolutions per Minute
• Special Procedures


  • Requires special preparation, equipment, handling, timing, and additional collection
  • Performed in blood and other body substances

  
• Blood bank


  A place where blood is collected and stored before it is used for transfusions
• Blood bank specimen collection

  1. Perform tests to ensure blood from donors and other blood products are safe before blood transfusion

  2. Blood typing and screening

  3. Cross-matching procedures

  4. Compatibility testing, selection of safe blood for transfusion
• Blood bank specimen collection

  • One or more lavender/pink top *EDTA tubes
  • Strict patient identification and specimen labelling procedures
  • Non-additive glass red-stoppered tubes used in some cases

  
• Blood bank specimen labelling requirements

  • Patient's full name (including middle initial)
  • Hospital identification number (or social security number for outpatients)
  • Date of birth of the patient
  • Date and time of collection
  • Phlebotomist's initials
  • Room number and bed number (optional)
• Blood bank special identification systems

  • ID bracelets containing patient information: Barcoded ID number
  • Blood product validation: BBID Form from the FlexiBlood System
• Blood bank tests


  • ABO typing and Rh typing
  • Screening for infections and unexpected RBC antibodies
  • Major cross-match – testing of donor cells with patient/recipient's serum
  • Minor cross-match – Testing of donor's serum with patient/recipient's RBCs
• Blood bank donor collection

  • Collecting of blood to be used for blood transfusion procedures rather than for diagnostic procedures
  • Donor units are normally collected from a large antecubital vein
  • 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 16- to 18-gauge needle
  • The bag fills by gravity and must be placed lower than the patient's arm
  • The collection bag contains an anticoagulant and preservative solution and is placed on a mixing unit while the blood is being drawn
  • The unit is normally filled by weight but typically contains around 450 mL of blood when full

  
• Autologous donation


  Pre-donation of patient's own blood (Pre-operative blood transfusion)
• Blood cultures


  Performed to test the presence of bacteremia and septicemia
• Blood culture collection


  1. Collected 30 minutes to 2 ½ hours prior to the fever peak

  2. 2 sets of specimens: Aerobic and Anaerobic

  3. Ratio of blood to broth = 1:5 – 1:10
• Blood culture specimen requirements

  • For adults or people weighing >80 lbs: 20 to 30 mL per culture with a minimum of 10 mL per draw
  • For pediatric patients: <1kg = 2mL, 2kg = 4mL, 12.7kg = 6mL, 36.3kg = 10mL, >36.3kg = 2—30mL

  
• Antiseptic or sterile technique for blood culture

  1. 30- 60-second FRICTION SCRUB

  2. Iodine, chlorhexidine gluconate* and a povidone/70% ethyl alcohol combination

  3. 10% povidone or 1%-2% tincture of iodine compounds in a swab sticks OR benzalkonium chloride cleaning pads
• Coagulation specimens


  • Trisodium citrate (1 : 9 ratio of citrate to blood) is the anticoagulant of choice
  • Blood samples should be collected by clean atraumatic venipuncture, and excessive application of vacuum should be avoided to minimize activation of platelets
• 1. Hour Postprandial Glucose Blood

  • Measurement of blood glucose exactly 2 hours after eating a meal
  • Screening test for diabetes mellitus
  • Monitoring of insulin levels
• 1. Hour Postprandial Glucose Blood preparation

  1. High-carbohydrate diet for 2 to 3 days prior to the test (150 grams)

  2. Patient should be tested for FBS (8-10 hrs of fasting)

  3. The patient should eat a meal (100g high carb meal)

  4. Blood sample for glucose testing is then drawn 2hrs after the patient finishes eating
• Lactose Tolerance Test


  Used to determine if a patient lacks the enzyme necessary to convert lactose, or milk sugar, into glucose and galactose
• Paternity/Parentage Testing


  • Done to determine the probability that a specific individual fathered a particular child
  • Requires chain-of-custody protocol and specific identification procedures that may include fingerprinting
  • The mother, child, and alleged father are all tested
• Therapeutic Drug Monitoring (TDM)


  Used in the management of patients being treated with certain drugs in order to establish and maintain a drug dosage, thus avoiding toxicity
• Point-of-care testing (POCT)
• Requirements for special tests
• Glucose and galactose


  Products of lactose digestion
• Mucosal lactase


  Enzyme that digests lactose
• If the patient is lactose intolerant (lacking the enzyme lactase)


  The glucose curve will be flat, rising no more than a few mg/dL from the fasting level
• Paternity/Parentage Testing


  Done to determine the probability that a specific individual fathered a particular child
• Paternity/Parentage Testing


  1. Requires chain-of-custody protocol and specific identification procedures that may include fingerprinting

  2. The mother, child, and alleged father are all tested

  3. Blood samples are preferred for testing

  4. Alternative: buccal/cheek swabs

  5. Blood sample testing usually includes ABO and Rh typing

  6. Determines other red cell antigens, red cell enzymes and serum proteins, white cell enzymes, and HLA (human leukocyte antigen), or white cell antigens

  7. DNA profiling
• Therapeutic Drug Monitoring (TDM)

  1. Timing of blood sample collection is critical

  2. When the trough level is required, the blood sample should be drawn right before next dose is administered

  3. For peak levels, drawing blood sample 1 hour after oral administration is the rule of thumb

  4. Draw blood sample 0.5 hour after completion of IV administration

  5. Most drugs can be quantified using immunoassay techniques or chromatography

  
• Therapeutic Drug Monitoring (TDM)

  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
• Therapeutic Phlebotomy


  Withdrawal of approximately 500 mL of blood