MOD 8

• Blood Bank: Blood type & Screen

  Determine the BLOOD GROUP

  no special requirement
• Blood Bank: Cross-match test

  Checks the compatibility of the blood between the donor and the recipient

  SR: Patient's serum or plasma and donor's RBCs
• Blood Culture

  Determines the presence of infection, and bacteria and measures the extent of infection

  SR: Blood volume should be 20 to 30 mL per culture with a minimum of 10 mL per draw for patients weighing more than 80 pounds. For infants, it should be only 1 to 4% of the total blood volume.
• Coagulation test

  Evaluates the _____ function

  SR: Microclots are avoided by gently inverting anticoagulant tubes three or four times from collection.
• 2-hour Postprandial glucose

  Screening for ____ and other metabolic disorders

  SR: Must be obtained 2 hours after meal
• Glucose Tolerance Test (GTT) and Oral Glucose Tolerance Test (OGTT)

  Checks the ability to metabolize ____thru the tolerance level

  SR: 1 hour for gestational diabetes and 3 hours for other glucose metabolism evaluation.
• Lactose Tolerance Test

  Determine the lack of mucosal____ which is responsible for the conversion of lactose into glucose.

  SR: Same procedure as 2-hour GTT but an equal amount of lactose is substituted for glucose.
• Paternity/Parentage Testing

  Verifies the ____ that the patient fathered a particular child.

  Follows the chain-of custody protocol and specific identification procedures.
• Therapeutic Drug Monitoring

  Tests the ____ at specific interval to establish proper drug dosage and avoid toxicity

  SR: Collection timing should include the peak and trough level.
• Therapeutic Phlebotomy

  Used as treatment to ______and hemochromatosis

  SR: Involves withdrawal of approximately 500 mL as part of the treatment.
• Toxicology test

  Checks the presence of TOXINS in the blood, hair, urine, and other substances

  SR: Toxins usually exist in very small amounts
• Trace elementsChecks for the presence of aluminum, arsenic, copper, lead, iron, and zinc

  SR: Measured in small amounts
• Blood Bank Specimens       

  The following information must be included in blood bank identification and labeling procedure:

  1. Full name including middle initial
  2. Hospital ID Number
  3. Social Security Number for outpatients
  4. Date of Birth
  5. Date & time of collection
  6. Initials of the phlebotomist.
• Blood banks can use different special identification systems and make tests in the lab to ensure that the donated blood are safe for blood transfusion. This includes typing the blood for transfusion and screening for infectious diseases.
• Blood Cultures

              For optimum results, the collection  should have 2-4 blood culture sets placed in special bottles, one aerobic (with air) and one anaerobic (without air), that were drawn 30 to 60 minutes apart. 
• 1.The patient should be properly identified and the collection procedure should be explained clearly.
• 2.Select the venipuncture site and release the tourniquet within 60 seconds.
• 3.Assemble the equipment and make sure to follow proper aseptic technique.
• 4.Perform the friction rub for about 60 seconds.
• 5.Wait for 30 seconds to allow the site to dry.
• 6.Open the culture bottle by removing the flip-off cap while checking the same for defects. Bottle should draw at least 8cc and should be in date.
• 7.Clean the bottle stopper while waiting for the site to dry.
• 8.Check the fill lines on the bottle to determine the minimum and maximum level of the bottle.
• 9.Tourniquet should be reapplied and perform the venipuncture. Make sure that the site is not touched.
• 11.To mix the blood with the medium, invert the bottle a couple of times.
• 12.If iodine is used in the arm, the patient's skin should be cleaned.
• 13.Observe proper labeling procedures. Make sure to include information about the site where the blood was collected.
• 14.Discard used and contaminated materials properly.
• 15.Courteously thank the patient. Remove the gloves and decontaminate the hands with hand sanitizer.
• 16.Transport the specimen promptly to the laboratory for analysis and processing.
• Media Inoculation Methods

              There are three ways to inoculate the medium: (1) directly into the bottle (during collection), (2) collected in a syringe (after collection), and (3) through an intermediate collection tube (in the laboratory).
• Coagulation Specimens

              A physician requests coagulation tests if the patient has an unexplained bleeding. This test could be prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT) which is a close approximation of the hemostatic system.
• 2-hour Postprandrial Glucose

              This blood test is done to check if the patient is suffering from diabetes and other metabolic problems. The 2-hour PP test is also used to monitor insulin therapy.
• Glucose Tolerance Test

              A patient who could be suffering from carbohydrate metabolism problems is subjected to the glucose tolerance test GTT/ OGTT to evaluate the ability of the body to metabolize glucose by measuring the tolerance level to high glucose level. 
•   A lactose tolerance test measures the ability of the body to process lactose. Gastrointestinal distress and diarrhea follows after ingestion of milk or food containing lactose for those who lack the lactase enzyme.
•     Parentage testing or paternity testing is performed to exclude the possibility of paternity of a particular child. Before the advent of DNA parenting testing, testing for parentage involves ABO and Rh typing, and basic red cell antigen testing. Should the result does not exclude alleged parent further test is performed which include human leukocyte antigen (HLA). 
•    The Therapeutic drug monitoring (TDM) measures drug levels at designated intervals so that the appropriate dosage can be established and maintained for the patient thus avoiding toxicity.  TDM begins with prescription of the initial dosage appropriate for the patient's clinical condition.
• Therapeutic phlebotomy is performed by drawing a large volume of blood from the patient about 500 mL  as part of the treatment procedure for polycythemia and hemochromatosis.
• Toxicology Specimens

              A phlebotomist plays a role in both clinical toxicology and forensic toxicology (legal consequences of toxin exposure) because toxicology test involves collection of blood, hair, urine and other substances from the body for the purpose of determining the presence of toxins which could be in very small amounts.
•   For forensic specimen, there is a need to track the specimen from the time of collection until the time that the results are released using a special protocol called chain of custody. Important information about the collection of the specimen is recorded in a form.