lec finals

• Blood Bank Specimens


  Specimen requirements
• Specimen requirements


  • Lavender- or pink-top EDTA tubes
  • Non additive glass red-top maybe used
• Identification & labeling requirements

  • Patient's full name
  • Patient's hospital ID# or SS#
  • Patient's date of birth
  • Date & time of collection
  • Phlebotomist's initials
  • ID bracelet w. self-carbon adhesive label for specimen
  • Blood ID-band with linear bar-coded BBID #'s
  • Siemens Patient Identification Check-Blood Administration
• Laboratory Procedures


  Type, Screen, and Cross-Match

  • Blood type (ABO) & Rh factor (+ or -) & screen
  • Cross-match to determine compatibility between patient & donor

  2. Blood Donor Collection

  • Collected for transfusions, not diagnostic testing
  • Collected in "units" from volunteers
  • Requires special training & skills

  3. Blood Cultures

  • Determine presence & extent of infection
  • Identify type of organism responsible & best antibiotic to use
  • Should be ordered on basis of patient having a condition in which bloodstream invasion is possible & presence of fever

  4. Coagulation Specimens

  5. 2-Hour Postprandial Glucose

  6. Glucose Tolerance Test (GTT)

  7. Lactose Tolerance Test

  8. Paternity/Parentage Testing

  9. Therapeutic Drug Monitoring

  10. Toxicology Specimens

  11. Trace Elements

  12. Point-of-Care Testing
• Donor eligibility


  • Between ages 17 & 66 years
  • Weight at least 110 lbs
  • Physical exam & medical history required
  • Written permission from donor required
• Lookback program


  • All blood components of unit must be traceable to donor
  • Requires notification to all blood recipients when a donor is shown to be positive for a transmissible disease
• Autologous donation


  Person donates blood for his/her own use (e.g., for elective surgeries)
• Cell salvaging


  • Patient's blood can be salvaged, washed, & reinfused
  • Salvaged blood must be tested for residual free hemoglobin
• Blood Cultures


  • Skin antisepsis: Most important part of collecting
  • Destroy skin microorganisms
  • Prevent misinterpretation of microorganism as pathogenic
• Acceptable antiseptics


  • chlorhexidine gluconate
  • Tincture of iodine or povidine
  • Requires 30- to 60-seconds friction scrub
• Media inoculation methods


  • Direct inoculation
  • Syringe inoculation
• Intermediate collection tube


  • Yellow-top SPS tube is acceptable
  • Use is discouraged because: Final concentration of SPS is increased, Presents another opportunity for contamination, Increased exposure risk to lab staff
• Antimicrobial Neutralization Products


  • Removes or neutralizes antimicrobials/antibiotics from blood
  • Prevents antimicrobials from inhibiting growth of microorganisms
• Coagulation Specimens


  • A "clear" or discard tube is required for coagulation tubes (PT/PTT) drawn with butterfly
  • Sodium citrate tubes must be filled until vacuum is exhausted. If not filled completely they will be rejected. Must be 9:1 ratio of blood to anticoagulant.
  • Never pour 2 partially filled tubes together
  • Cooling on ice during transport may be required
  • When drawing from an indwelling catheter: A draw & discard 10 mL must be drawn by the RN

  
• 1. Hour Postprandial Glucose


  • Glucose in diabetics is significantly increased 2 hrs after meal
  • Excellent screening test for diabetes
• Glucose Tolerance Test (GTT)


  • Used to diagnose problems of carbohydrate metabolism
  • Monitors patient's tolerance to high levels of glucose
  • Hyperglycemia: increased blood glucose level
  • Hypoglycemia: decreased blood glucose level
• Glucose Tolerance Test (GTT) - GTT procedure

  Follow normal ID protocol & explain collection procedure; advise of fasting requirements

  b. Draw fasting specimen & check for glucose

  c. Ask patient to collect fasting urine specimen (if needed)

  d. Give patient determined dose of glucose beverage

  e. Remind patient to finish beverage within 5 min.

  f. Note time patient finishes, start timing, calculate collection times

  g. Give a copy of collection times to patient (not necessary, pt does not leave area)

  h. Collect blood & urine specimens at computed times

  i. Label all specimens with collection times, intervals, patient ID

  j. Deliver or send specimens to lab ASAP
• Lactose Tolerance Test


  • Determines lack of enzyme that converts lactose into glucose/galactose
  • Performed in same manner as 2-hr GTT, only w. lactose
• Paternity/Parentage Testing


  • Excludes possibility of paternity rather than proves it
  • Requires a chain-of-custody protocol & specific ID procedures
  • Mother, child, & alleged father are all tested
  • Blood samples are preferred, but cheek swabs are increasing
  • Blood sample testing includes ABO & Rh typing
• Therapeutic Drug Monitoring


  • Establishes & maintains drug dosage at therapeutic level
  • Such as blood thinners, seizure meds etc
  • Avoids drug toxicity
• Therapeutic Phlebotomy


  Withdrawal of large volume of blood to treat (500ml)
• Polycythemia


  Body's over production of RBCs
• Hemochromatosis


  Excess iron deposits in tissues
• Toxicology


  • Scientific study of toxins (poisons)
  • Concerned with detection of toxins & treatment of effects
• Forensic blood alcohol (ethanol) specimens


  • Often requested by law enforcement officials
  • Used to determine levels in breath, urine, or blood
  • Specimen collection must follow chain of custody
  • Forensic toxicology is concerned with legal consequences of toxin exposure
• Clinical blood alcohol (ethanol) specimens

  • Normally ordered by physician for treatment purposes
  • Chain of custody not required, but follow standard protocol
  • Required in connection to on-the-job injury, employee insurance programs, & employee drug screening
  • Skin preparation: don't use alcohol-based disinfectant
  • Specimen requirements: gray-top sodium fluoride tube; fill tube until vacuum is exhausted & don't remove stopper
• Drug screening


  • Required by many healthcare organizations, sports associations, & major companies
  • May be random, pre-employment, post-accident
  • May detect a specific drug or screen for up to 30 drugs
  • Typically performed on urine rather than blood
  • Chain of custody is required
• Patient preparation requirements for drug screening

  • Explain test purpose & procedure
  • Advise patient of his or her legal rights
  • Obtain a witnessed, signed consent form
• Specimen collection requirements for drug screening

  • Special area for urine collection
  • Proctor present at time of collection
  • Split sample may be required
  • Specimen must be labeled, sealed, & placed in a clocked container

  
• Trace Elements


  • Tests for aluminum, arsenic, copper, lead, iron, & zinc
  • Measured in small amounts
  • Traces of them in glass, plastic, or stopper material can leach into specimen
  • Special trace element–free tubes must be used (royal blue & contain EDTA, heparin, or no additive)
• Point-of-Care Testing


  • Brings lab testing to location of patient
  • Made possible by development of small, portable testing devices
  • Offers convenience to patient & short turnaround time
  • Requires carrying out quality-control & maintenance procedures necessary to ensure that results are accurate
• Patient preparation requirements


  1. Explain test purpose & procedure

  2. Advise patient of his or her legal rights

  3. Obtain a witnessed, signed consent form
• Specimen collection requirements


  1. Special area for urine collection

  2. Proctor present at time of collection

  3. Split sample may be required

  4. Specimen must be labeled, sealed, & placed in a clocked container

  
• Trace elements tested


  • Aluminum
  • Arsenic
  • Copper
  • Lead
  • Iron
  • Zinc
• Trace elements


  Measured in small amounts
• Traces of trace elements in glass, plastic, or stopper material can leach into specimen
• Special trace element–free tubes

  Royal blue & contain EDTA, heparin, or no additive
• Point-of-Care Testing (POCT)


  • Brings lab testing to location of patient
  • Made possible by development of small, portable testing devices
  • Offers convenience to patient & short turnaround time
  • Requires carrying out quality-control & maintenance procedures necessary to ensure that results are accurate
• Quality and Safety in POCT


  • Waived vs. non-waived quality control checks
  • Electronic quality control (EQC) built into POC instruments
  • Specimen collection & handling not checked by EQC
  • Daily external liquid QC for non-instrumented POCT
  • POC instruments become possible fomites for disease
  • Disinfect with 10% bleach
  • Reduce cross-contamination between patients
• Coagulation tests monitored by POCT

  • Prothrombin time (PT) & international normalized ratio (INR)
  • Activated partial thromboplastin time (APTT or PTT)
  • Activated clotting time (ACT)
  • Platelet function