Pmls

• Special collection procedures


  • Non-routine laboratory tests that may not only involve additional preparation and procedure, but may require other specimens such as urine or feces
  • Applied for special cases such as blood donation
• Blood bank specimens


  Very important in determining which blood product can be safely used for blood transfusion
• Blood bank specimen collection

  • Lavender or pink top or EDTA tube; red top non-additive glass (alternative)
  • Ensure NO errors that could lead to incompatibility causing fatal reaction to the recipient
• Ensuring blood is safe for transfusion


  1. Blood typing (ABO and Rh)

  2. Screening for infectious diseases

  3. Cross-matching
• Blood donor requirements


  • 17-66 y.o.; at least 110 lbs
  • Completed their medical exam and declared their medical history (look-back program)
  • Autologous donation: for elective surgeries
  • Cell salvaging: blood is salvaged (during surgical procedure, washed and reinfused)
• Sterile technique in blood culture

  • Checks the blood for pathogens for patients who have fever of unknown origin (FUO)
  • Checks for bacteria (bacteremia) or microorganism and toxins (septicemia)
  • Probability of bloodstream microorganism invasion best antibiotic prescription
• Blood culture collection procedure

  1. Identify the patient properly and explain the collection procedure clearly

  2. Select the venipuncture site and release the tourniquet within 60 seconds

  3. Assemble the equipment and make sure to follow the 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 it for defects. Bottle should draw at least 8 cc

  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 levels of the bottle

  9. Reapply the tourniquet and perform the venipuncture. Make sure that the site is not touched

  10. Inoculate the medium

  11. To mix the blood with the medium, invert the bottle a couple of times

  12. If iodine is used in the arm, clean the patient's skin

  13. Observe proper labeling procedures. Make sure to include information about the site where the blood has been collected

  14. Discard used and contaminated materials properly

  15. Thank the patient courteously. 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


  • Directly into the bottle (during collection)
  • Collected in a syringe (after collection)
  • Through an intermediate collection tube (in the laboratory)
• Coagulation specimens


  • Assess blood clotting functions if the patient has unexplained bleeding
  • Prothrombin time (PT), activated partial thromboplastin time (aPTT) and thrombin time (TT)
• 1. hour postprandial glucose (2HPP)


  1. The patient is on a high-carbohydrate diet 2 to 3 days prior to the test

  2. The patient should fast for at least 10 hours before the test

  3. Fasting glucose specimens may be collected before the start of the procedure

  4. A special breakfast containing an equivalent of 100 g glucose or a glucose beverage is given on the day of the test

  5. Blood glucose specimens are collected 2 hours after the meal
• Glucose tolerance test (GTT)

  1. Begin with the normal identification protocol. Explain the procedure and advise the patient that only water is allowed during the whole test period

  2. Draw the fasting specimen and check the glucose level. It should not be over 200 mg/dL for the test to proceed

  3. Let the patient collect the fasting urine specimen if ordered

  4. Give the patient the glucose beverage dose. Adult dose is 75 g while children are given 1 g glucose per kilogram of weight. For gestational diabetes, the dose should be between 50 g to 75 g

  5. Let the patient ingest the beverage within 5 minutes

  6. Record the time when the drink was finished, then start timing the test which is collected within 30 minutes, 1 hour, 2 hours, and so forth

  7. Provide the patient with a copy of the collection time

  8. If applicable, make the collection time for other specimens such as urine coincide with the computed collection time

  9. Write the exact collection time and the time interval on the label along with the patient identification information

  10. Transport the specimen immediately or within 2 hours to the laboratory for accurate results
• Lactose tolerance test


  • Measures the ability of the body to process lactose and determines if the patient lacks mucosal lactase
  • Similar to the GTT procedure, the difference is that lactose is substituted for glucose
• Paternity/parentage testing


  1. All involved parties need to submit a government issued photo identification along with the completed chain-of-custody form. The photos of all tested parties are also taken

  2. Buccal samples are collected using a swab that was rubbed inside the cheek where loose cheek skin cells can be gathered

  3. Sealed and tamper-evident package is used to hold the specimen during transport to the laboratory

  4. The test results are ready after 48 hours and are usually sent via mail
• Therapeutic drug monitoring (TMD)


  • Measures drug levels at designated intervals so that the appropriate dosage can be established and maintained for the patient, thus avoiding toxicity
  • To optimize clinical outcomes while considering the drug dosage, history of dosage given, the recorded response of the patient, and desired outcome
• Therapeutic phlebotomy


  Drawing large volume of blood (about 500 ml) from the patient as part of the treatment procedure for polycythemia(overproduction of RBCs) and hemochromatosis (excess iron deposits in the tissues)
• Toxicology specimens


  • 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
  • Forensics specimens – ordered by law-enforcement agencies for legal and forensic purposes
• Trace elements


  • Check for the presence of aluminum, arsenic, copper, lead, iron and zinc
  • Element-free tube or royal blue top
• Point-of-care testing (POCT)


  • Analytical test done outside the centralized laboratory and near the site where the patient receives treatment
  • Ranges from a simple procedure (e.g. glucometer) to automated molecular test using portable analyzers and imaging systems
  • Convenient and shorter turn-around time(TAT)
  • Warfarin and heparin therapy can be evaluated using coagulation POCT analyzer
  • Common coagulation tests: PT and International Normalized Ratio (INR), aPTT, activated clotting time (ACT), and platelet function
• Bleeding time


  • Non-instrumented test used to evaluate the capillaries for platelet plug formation
  • For pre-surgical screening and detecting hemostasis-related problems
• Arterial blood gases


  • Measures the level of oxygen, carbon dioxide and acid-base (pH) in the blood
  • Status of the function of the lungs, heart and kidneys
• Electrolytes


  • Determine level of sodium, potassium, chloride, bicarbonate and ionized calcium
  • Sodium: helps keep the normal balance of fluids in the body and plays a role in transmitting nerve impulses
  • Potassium: helps in nerve conduction and muscle function; regulates the acid-base balance and osmotic pressure
  • Chloride: maintains integrity of cells by helping in balancing the osmotic pressure, as well as the acid-base and water balance of the body
  • Bicarbonate ion: helps transport CO2 to the lungs and regulate pH
  • Ionized calcium: helps in the muscular function, cardiac function, blood clotting, and nerve transmission function
• Multiple-test panel monitoring by POCT


  • Composed of small, portable testing device that measure analytes such as Na, K, Cl, and HCO3, as well as blood gas values for potential H, partial pressure of O or CO2, O saturation, BUN, glucose, hemoglobin, hematocrit, ACT, lactate and troponin
  • Emergency conditions which needing TAT results
• Pregnancy test by POCT

  1. Implement the proper patient identification

  2. Write the patient ID information in the specimen cup

  3. Explain the collection procedure to the patient prior to the collection of the urine specimen

  4. Place the test device on a flat surface after removing it from the safety pouch

  5. Using the dropper supplied in the pouch, place about 3 drops in the sample well

  6. Wait for the reaction time for about 3 minutes. Likewise, set the timer to the time stated by the manufacturer when a negative test must be read

  7. Read the result from the cassette's window when the timer goes off
• Point-of-Care Testing (POCT)


  Analytical test done outside the centralized laboratory and near the site where the patient receives treatment
• Other names for POCT

  • Alternate site testing (AST)
  • Bedside testing
  • Near-patient testing
  • Remote testing
  • Satellite testing
  • Rapid diagnostics
• POCT


  • Ranges from a simple procedure (e.g. glucometer) to automated molecular test using portable analyzers and imaging systems
  • Convenient and shorter turnaround time (TAT)
• Warfarin and heparin therapy

  Can be evaluated using coagulation POCT analyzer
• Common coagulation tests


  • PT and International Normalized Ratio (INR)
  • aPTT
  • Activated clotting time (ACT)
  • Platelet function
• Bleeding time


  Non-instrumented test used to evaluate the capillaries for platelet plug formation<|>For pre-surgical screening and detecting hemostasis-related problems
• Arterial Blood Gases


  Measures the level of oxygen, carbon dioxide and acid-base (pH) in the blood<|>Status of the function of the lungs, heart and kidneys
• Electrolytes


  • Sodium
  • Potassium
  • Chloride
  • Bicarbonate
• Sodium


  Helps keep the normal balance of fluids in the body and plays a role in transmitting nerve impulses<|>↑ Na – hypernatremia<|>↓ Na - hyponatremia
• Potassium


  Helps in nerve conduction and muscle function; regulates the acid-base balance and osmotic pressure<|>↑ K – hyperkalemia<|>↓ K – hypokalemia
• Chloride


  Maintains integrity of cells by helping in balancing the osmotic pressure, as well as the acid-base and water balance of the body
• Bicarbonate ion


  Helps transport CO2 to the lungs and regulate pH
• Point-of-Care Testing (POCT)


  Analytical test done outside the centralized laboratory and near the site where the patient receives treatment
• Other names for POCT

  • Alternate site testing (AST)
  • Bedside testing
  • Near-patient testing
  • Remote testing
  • Satellite testing
  • Rapid diagnostics
• POCT


  • Ranges from a simple procedure (e.g. glucometer) to automated molecular test using portable analyzers and imaging systems
  • Convenient and shorter turnaround time (TAT)
• Warfarin and heparin therapy

  Can be evaluated using coagulation POCT analyzer
• Common coagulation tests


  • PT and International Normalized Ratio (INR)
  • aPTT
  • Activated clotting time (ACT)
  • Platelet function