HEMA1 MIDTERMS P1

• SPECIMEN COLLECTION


  The accuracy of laboratory testing begins with the quality of the specimen received by the laboratory. This quality depends on how a specimen was collected, transported, and processed.
• 70% of errors that occurs in the laboratory are attributed in the pre-analytical stage. So, it is very important in the laboratory that the preanalytical stage should be error free.

  
• Preanalytic factors


  • Patient-related variables (diet, age, sex, etc.)
  • Specimen collection and labeling techniques
  • Specimen preservatives and anticoagulants
  • Specimen transport
  • Processing and storage
• Incorrect test ordered


  This has something to do with proper test ordered; usually happens in the reception area; could be the fault of the doctor's order or the fault of the patient who relate the information (eg. illegible handwriting)

  
• Inadequate patient preparation


  E.g. not fasting; In hematology, fasting is not required but we need to remember that lipemia which could occur after having a heavy fatty rich meal can affect your hemoglobin determination because our reference method for hemoglobin is dependent on Spectrophotometry Analysis -- which involves light absorption. If the sample is lipemic--its turbid because of the fats that can affect your hemoglobin determination.
• Misidentification of patient


  Considered almost a sin to misidentify a patient; How to properly identify the patient?: Let the patient state his/her name
• Wrong container/Wrong additive


  E.g. CBC = bear what tube or anticoagulant to use; Remember the Order of Draw: Boys (Blood Culture) Love (Light Blue) Roses (Red); Girls (Gold) Love (Light Green) Daisies (Dark Green), Lilac (Lavender), and Gardenias (Gray)
• Short Draws


  A short draw is excusable depending on the type of tube but in the case of hematological analysis (for example EDTA where there is proper indicated line up to which level the blood should be; Coagulation test such as for Prothombin time and Activated Partial Thromboplastin time, the proper anticogulant/blood ratio must be observed because it has an effect on the RBC in the case of your EDTA - because excess EDTA can makes your RBCs spherocytic; Excessive EDTA produces shrinkage of erythrocytes, thus affecting tests; Prothombin time & Activated Partial Thromboplastin Time follow 1:9 blood to anticoagulant ratio
• Hemoconcentration


  Proper tourniquet in venipuncture should be observed and must stay not more than 2-3 minutes on the patients' arm, otherwise it will cause hemoconcentration which can affect hemoglobin level
• Hemolysis


  E.g forcing blood through needle, pull plunger too hard, draw via intravenous line
• Inadequate mixing/clots


  It is important to mix the tube immediately after draw; otherwise, will be a clotted sample which a big NO to hematology section because it will cause prolong results; Clotted samples can be allowed in chemistry section because serum will be use
• Mislabeling the specimen


  Connected to misidentifying the patient
• Improper transport to the lab


  Delayed delivery can also affect CBC processes or some other hematological test like ESR (Erythrocytes Sedimentation Rate); ESR is very dependent on having a fresh sample and must be process within 2 hours; Prolonged standing of the blood can trigger changes in blood cells
• Posture Changing


  Changing from supine (lying) to a sitting or standing position results in a shift of body water from inside the blood vessels to the interstitial spaces; Upright position = hydrostatic pressure = plasma volume = proteins; Drastic change in position can result to increase of hydrostatic pressure by increasing the hydrostatic pressure, it will cause a decrease in plasma volume which we call hemoconcentration that will lead to an increase in the proteins; An upright position increases hydrostatic pressure, causing a reduction of plasma volume and increased concentration of proteins
• Hemoglobin


  The analyte that is most affected by posture; Hemoglobin would decrease after prolonged bedrest and amplified by intravenous fluid administration
• After bed rest in the hospital, a patient's hemoglobin (Hb) can decrease from the original admitting value enough to falsely lead a physician to suspect internal hemorrhage or hemolysis
• Patients should be advised to avoid changes in their diet, consumption of alcohol, and strenuous exercise 24 hours before having their blood drawn for laboratory testing.
• Diurnal Rhythm


  Daily blood fluid fluctuations that occur with some constituents of the blood; AM: Cortisol, TSH, iron; PM: Eosinophil count; If considering iron deficient anemia, the best time to extract iron is in the morning; Eosinophil count decrease in the morning;increase in the afternoon because that's the time we usually transfer from the tissue to the blood stream
• Exercise


  Increase various constituents in the blood such as creatine, total protein, creatine kinase, myoglobin, aspartate aminotransferase, white blood cell count, and HDL-cholesterol; May activate coagulation, fibrinolysis, and platelets; Strenuous activity migrates WBC count from the tissue to the blood stream; These changes are related to increased metabolic activities for energy purposes and usually return to preexercise levels soon after exercise cessation; Long-term effects of exercise may increase CK, aldolase, AST, and LD values; Chronic aerobic exercise is associated with lesser increases in plasma concentration of muscle enzymes such as CK, AST, alanine aminotransferase (ALT), and LD; Decreased levels of serum gonadotropin and sex steroid concentrations are seen in long-distance athletes, while prolactin levels are elevated
• Stress


  Anxiety and excessive crying in children can cause a temporary increase in the white blood cell count; Hyperventilation affects acid-base balance and elevates leukocyte counts, serum lactate, of free fatty acids
• Diet


  Fasting means no food or beverages except water for 8 to 12 hours before blood draw; LIPEMIA = affecting some tests that require photometric measurement, such as the hemoglobin concentration and coagulation tests performed on optical detection instruments
• The method that we use for hemoglobin determination, which is photometric, lipemia should be avoided. And if you are using optical method for your coagulation test, lipemia should be considered
• Chronic alcohol abuse


  High MCV is a consideration in megaloblastic anemia
• Age Group


  • Newborn
  • Childhood to puberty
  • Adult
  • Elderly adult
• Newborn


  High Hgb F; has the highest hemoglobin value & age affects WBC count; High WBC count due to the presence of nucleated RBC or immature RBCs; Newborn: 20 g/dl of Hemoglobin is normal; Bilirubin concentration rises after birth and peaks at about 5 days; On the first 24 hours of a newborn, high differential count is dominated by neutrophils. And after several days, the differential will be dominated by lymphocytes
• Childhood to puberty


  High Hgb A
• Adult


  Uric acid levels peak in men in their 20s but do not peak in women until middle age
• Elderly adult


  The elderly secrete less triiodothyronine, parathyroid hormone, aldosterone, and cortisol; After age 50, men experience a decrease in secretion rate and concentration of testosterone, and women have an increase in pituitary gonadotropins, especially follicle-stimulating hormone (FSH)
• Blood-drawing station


  • Phlebotomy chairs
  • Handheld Carries/ Phlebotomy Carts
  • Gloves and glove liners
  • Antiseptics (will depend whether its for blood culture or not)
  • Gauze pads/cotton balls
  • Bandages
  • Needle & sharps disposal containers
  • Slides
  • Pen
  • Watch
• Antiseptics


  70% isopropyl alcohol (ROUTINE COLLECTION)<|>70% isopropyl alcohol + 1%-10% povidone-iodine pads, tincture of iodine, chlorhexidine (BLOOD C/S)

  
• The phlebotomist cleans the phlebotomy site in a circular motion, beginning in the center and working outward, then allowed to air dry before venipuncture is perform. So that the patient would not experience a burning sensation after nedle insertion and to prevent contamination of the specimen with alcohol.
• Tourniquet


  A device that is applied or tied around a patient's arm prior to venipuncture to restrict blood flow; EITHER: Elastic strap, a heavier Velcro strap, or a blood pressure cuff; Sterile, disposable, and designed for a single use only; Take Note: Applied 3-4 inches above the venipuncture site; left on for no longer than 1 minute
• Needles


  EITHER: multisample needles, hypodermic needles, and winged infusion (butterfly) needles; 1 or 1.5 inches in length; Most common needle size for adult venipuncture is 21 gauge with a length of 1 inch; 21 gauge allows the RBC to enter in a more controlled flow and minimizes the risk for possible hemolysis; Bevel – end that pierces the vein; punctures the skin [BEVEL UP]; Shaft – long cylindrical portion of the needle [1 inch in length]; Hub – attaches to the blood collection device; Bore – internal space of the needle; needle hole

  
• Common Venipuncture Needle Gauges with Needle Type and Typical Use

  • 15-17 gauge: Special needle attached to collection bag - Collection of donor units, autologous blood donation, and therapeutic phlebotomy
  • 18 gauge: Hypodermic - Used primarily as a transfer needle rather than for blood collection; safety issues have diminished use
  • 20 gauge: Multisample Hypodermic - Sometimes used when largevolume tubes are collected, or large-volume syringes are used on patients with normal-size veins
  • 21 gauge: Multisample Hypodermic - Considered the standard venipuncture needle for routine venipuncture on patients with normal veins for syringe blood culture collection

  
• 21 gauge


  Allows the RBC to enter in a more controlled flow and minimizes the risk for possible hemolysis
• Bevel


  • End that pierces the vein; punctures the skin [BEVEL UP]

  
• Shaft


  • Long cylindrical portion of the needle [1 inch in length]
• Hub


  • Attaches to the blood collection device
• Bore


  • Internal space of the needle; needle hole
• Evacuated Tube System


  • Flange - part of the tube holder; where we anchor our finger to push the tube into
  • Multisample needle - one needle but it can insert a lot of tubes which allows you to collect multiple samples