spec handling, proc, trans, collct

• Routine handling

  • Adhere to time limits set for delivery of specimen to the laboratory
  • Mixing tubes by inversion - usually between 3 to 10 inversion
  • Transporting specimens - should be transported with the stopper:
• 1. Avoid contact between contents and the stopper,
  2. Minimize agitation of the specimen,
  3. Aid clot formation for serum tubes
• • Body temperature

  1. Specimen that precipitate or agglutinate if allowed to cool below body temperature should be transported at near body temperature which is 37 C
  2. The tubes should also be pre-warmed at 37 
  3. A heel warmer can be used for specimen that can withstand a temperature slightly higher than 37 C
• special handling

  Examples:

  Cold agglutinin, cryofibrinogen, and cryoglobulins
• Chilled specimens

  • Slows the metabolic process
  • Completely submerged in crushed ice and water slurry during transport and immediately tested or refrigerated
• chilled specimens

  Examples:

  • Adrenocorticotropic hormone, acetone, angiotensin-converting enzyme, ammonia, catecholamines, free fatty acids, gastrin, glucagon, homocysteine, lactating acid, parathyroid hormone, ph blood gas, pyruvate, renin 
• Light sensitive specimens

  • The phlebotomist should wrap the tube with aluminum foil or use light blocking amber colored container

   Examples:

  • Bilirubin, carotene, red cell folate, serum folate, vitamin B2, vitamin B6, vitamine C
• • The collected specimen is transported to the central processing or triage for screening and prioritizing. The specimen are:
  • Identified
  • Logged or accessioned
  • Sorted by department and type of processing
  • Evaluated for specimen suitability which is necessary for accurate reasons
• Criteria for specimen rejection

  • Specimen is not identified properly
  • Hemolysis
  • Wrong tube for collection
  • Outdated tube
  • Improper handling (Improper mixing)
  • Contaminated specimen
  • Insufficient specimen or “quality not sufficient (QNS
  • Incorrect collection time
  • Exposure to light
  • Did not follow testing time limits
  • Delay or error in processing
• Time constraints and exceptions for delivery and processing of specimens

  Delivery time limits

  • Transported to the lab immediately after collection
  • Routine blood specimen = within 45 minutes
  • For specimen that needs centrifugation = 1 hr
  • Hematology specimen with EDTA = should not be centrifuged  (whole blood)
• Time limit exceptions

  “STAT” or “emergency”

  • Priority over all other specimen in terms of transportation, processing and testing

  Exceptions:

  1. Blood smear from EDTA specimen
  2. EDTA specimen for CBC
  3. EDTA specimen for erythrocyte sedimentation rate (ESR) determination
  4. EDTA specimen for reticulocyte counts
  5. Glucose test drawn in sodium fluoride tubes
  6. Prothrombin time (PT)
• OSHA (Occupational Safety and Health Administration)  required protective equipment worn when processing specimen

  • Includes wearing gloves to prevent contact with blood, lab gown ,lab coats, and masks
• Plasma

  • Specimen collected in tubes with anticoagulants
• Serum

  • Needs to be completely clotted
  • Complete clotting takes around 30 to 60 minutes at room temperature
• Aliquot preparation

  • Aliquot
  • A portion of a sample specimen taken for chemical analysis or testing
  • Prepared when multiple tests are ordered on a single specimen
• Urine

  • Most analyzed non-blood specimen
  • Inexpensive
  • The urine analysis also helps in 

  1. Monitoring wellness
  2. Determination and treatment of urinary tract infections
  3. Detection and monitoring progress of treatment metabolic diseases
  4. Determines the effectiveness of an administered therapy well s checking if the patients exhibited any therapy related complications
• The accuracy of urine analysis results will largely depend on several factors such as:

  • The collection method
  • Container use
  • Transportation and handling of specimen
  • The timeliness of the testing
• Common urine tests

  • Routine urinalysis (UA)
  • Frequently ordered urine test
  • Screens the patient for any urinary or systematic disorders
  • Physical analysis (color, clarity, and odor)
  • Chemical analysis ( ph, specific gravity (1.04), detection, bacteria, etc.) can be done within 60-120 seconds
  • Microscopic analysis (urine components such as cells, crystals and microorganisms)
• Midstream collection

  • Recommended and ideal to ensure that there is no contamination caused by genital secretions, pubic hair or bacteria surrounding the urinary opening
• Specimen container: clear and dry with tight -fitting lids and they should be chemically cleaned

  • Could be held at room temperature for 2 hrs
  • Make sure that the specimen is protected from light
• Culture & sensitivity (C&S)

  • Requested if the patient has symptoms of a urinary tract infection (UTI)
  • 18 to 24 hours
• Urine cytology studies

  • To detect cancer, cytomegalovirus, and other viral and inflammatory diseases in the urinary system
  • Fresh clean-catch specimen
  • Stained using the Papanicolau (PAP) method
  • The specimen is preserved by adding an equal volume of 50% alcohol 
• Urine drug testing

  • Many drugs are detected in the urine but not in the blood. This test is performed to detect:

  1. Illicit use of recreational drugs
  2. Use of anabolic steroids to enhance performance in sports
  3. Unwarranted use of prescription drugs
• Urine glucose and ketone testing

  • Performed to screen diabetes and determine the glucose level for patients who are already diabetics
  • The urine ketone level test is used to determine if the patient is suffering from diabetic ketoacidosis
• Urine pregnancy testing

  • Used to confirm pregnancy which can be detected to 8 to 10 days from conception
  • First morning urine specimen for highest concentration of human gonadotropin (HCG)
• Types of urine specimens

  1. Random: collected at any time
  2. First morning/ 8-hr urine specimen: collected immediately upon waking up from an 8 hrs of sleep 
  3. Timed: collected at specific times or pooled throughout a specific time period
  4. Tolerance test (glucose) - fasting, ½ hr , 1 hr, etc.
  5. 2 hr postprandial - 2 hrs after a meal
  6. 24-hr- collection and pooling of all urine which is voided in 24 hrs 
  7. Double- voided - wait for specific time (30 minutes) after emptying the bladder
• Urine collection methods

  1. Regular voided
  2. Midstream 
  3. Midstream clean-catch
  4. Catheterized
  5. Suprapubic aspiration
  6. pediatric
• Amniotic fluid

  • A clear and slightly yellowish liquid contained in the amniotic sac that is surrounding and cushioning the fetus during pregnancy
  • Collected using transabdominal amniocentesis preferably 15 weeks after gestation
  • Procedure is guided by the ultrasound machine
  • 10ml fluid
  • Detect any genetic disorder, problem in fetal development and verify the gestational age
• Cerebrospinal fluid

  • Liquid that surround brain and spinal cord
  • Used to diagnose meningitis and other disorders such as brain abscess, CNS cancer and multiple sclerosis

  Collected in 3 special sterile tubes:

  • First tube: chemistry and immunology test
  • Second tube: microbiology studies
  • Third tube: cell counts

  Procedure: lumbar puncture
• Gastric fluid/ gastric analysis

  • To check the contents of the stomach for abnormal substances and evaluate the production of acid by evaluating the gastric acid concentration
• Nasopharyngeal secretions

  • Collected and cultured to determine the presence of bacteria that causes:

  1. Diphtheria
  2. Meningitis
  3. Pertussis (whooping cough)
  4. pneumonia
• Saliva

  • Used to check the hormone levels and also determine alcohol and drug or substance abuse
  • The specimen needs to be frozen to ensure stability
• Semen

  • A thick yellowish-white fluid that contains sperm released during the male ejaculation
  • To evaluate the fertility
  • Assess the effectiveness of sterilization after a vasectomy procedure
  • Light sensitive
• Serous fluid

  • Found between the membrane that encloses that pleural, pericardial, and peritoneal cavities
  • EDTA tubes are used for cell counts and smears
  • Heparin or sodium fluoride tubes for chemistry tests
  • Non-anticoagulant tubes for biochemical tests
  • Heparinized for cultures
• Sputum

  • Used to diagnoses and/or monitor lower respiratory tract infections like tuberculosis
  • The collection procedure is repeated until adequate amount is collected which is about 3 to 5 ml
• Sweat

  • Used to analyze the chloride content of patients under the age of 20 with symptoms of cystic fibrosis (exocrine gland disorder)
  • During the sweat chlorides test, electrical stimulation in the forearm or thigh (iontophoresis) is used to transport the pilocarpine (sweat stimulating drug) into the skin.
• Synovial fluid

  • Viscous fluid that lubricates movable joints
  • Determine conditions such as arthritis, gout and other inflammatory conditions increase in volume is attributed to inflammation. These are collected in 3 tubes:
  • EDTA/heparin: for cell counts, ID of crystals, smear preparation
  • Sterile: culture and sensitivity
  • Non-additive: macroscopic appearance, chemistry, immunology tests and observing the clot formation
  • Effusion: increased in volume of synovial fluid due to inflammation 
• Buccal (cheek) swabs

  • Used to obtain loose cells inside the cheek for purposes of DNA analysis
• Bone marrow

  • Examined to identify blood diseases
  • The physician inserts a large-gauge needle into the sternum (breastbone) or iliac crest (hip bone) and aspirates 1.0 to 1.5 ml of specimen
• Breath samples

  • After the collection of the baseline breath sample, the patient is asked to drink a special substance that has a synthetic urea
  • Two types of test:

  C-urea breath test (C-UBT)

  • Px is asked to breathe into a Mylar balloon at specified intervals.
  • The breath specimens are analyzed for carbon-13 which confirms the presence of Helicobacter pylori. 

  Hydrogen breath test

  • Helps in the detection of carbohydrate digestion problems such as lactose (milk sugar) and fructose (fruit sugar).
  • Detect bacterial overgrowth in the small intestine