Kinns chp 54 Hematology/Phlebotomy – Flashcards
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Plasma
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The liquid portion of anticoagulated whole blood (contains coagulation proteins) 90% water, 10% solutes Supernatant Accounts for about 55% of draw P comes before S - plasma comes first...it is inside your body and outside if it is unclotted
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Serum
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The liquid portion of clotted blood samples (lacks most coagulation proteins) 90% water, 10% solutes S comes after P - it comes after...serum is after it is outside your body & clotted
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What departments use venous blood samples?
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Hematology, Chemistry (routine and special), and Serology
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Glass tubes are more stable or less stable than plastic?
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Glass tubes tend to be more stable over time and do not lose vacuum pressure.
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Shelf life of an evacuated tube is determined by:
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Stability of the additive and vacuum retention Should be at right pressure to ensure correct amount of draw
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Name 3 examples of anticoagulants:
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EDTA Sodium Citrate Heparin
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Name 3 examples of additives:
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Thrombin Sodium Fluoride Gel
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Name the order of draw for evacuated tubes collections:
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First- draw sterile specimen Second- draw for coagulation testing bc of tourniquet Third- serum (clot factor) Fourth- other anticoagulants 1-yellow 2-light blue 3-gold or red/gray, red, or orange 4-light green or green/gray 5-lavender 6-white, white 7-gray
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Describe the YELLOW top tube:
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#1 order of draw Most sterile specimin drawn first bc of possible carry over Blood cultures-SPS-aerobic and anaerobic Goes to Micro
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Describe the LIGHT BLUE top tube:
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#2 order of draw Anticoagulant: sodium citrate Coagulation testing (plasma) Ratio of blood to anticoagulant critical Precipitates calcium required for blood coagulation Best for preserving coagulation factors Unacceptable for calcium or sodium analysis
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Describe the GOLD or RED/GRAY top tube:
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#3 order of draw BD vacutainer SST gel separator tube Serum separator No anticoagulant May have clot activator Contains inert polymer barrier gel Separates serum from cells For serum tests (most chemistry tests)
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Describe the RED top tubes:
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#3 order of draw Serum tubes (plastic-clot tube, or glass-no clot activator) No anticoagulant May have clot activator Chemistry and serology testing Serum must be removed from the clot ASAP Dilution is not an issue
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Describe the ORANGE top tube:
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#3 order of draw BD vacutainer rapid serum tube (RST)
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Describe the LIGHT GREEN or GREEN/GRAY top tube:
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#4 order of draw BC vacutainer PST gel separator tube with heparin Anti thrombin
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Describe the GREEN top tube:
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#4 order of draw Heparin (anticoagulant) In form of Sodium Heparin or Lithium Heparin Increases activity of Anti thrombin III (inhibits blood coagulation) Needs to be shielded from the light Unacceptable for blood cell evaluation Many Chemistry tests require plasma Including pH, electrolytes, blood gases, ionized calcium tests
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Describe the LAVENDER/PURPLE top tube:
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#5 order of draw EDTA (Anticoagulant) Chelates calcium which is required for blood coagulation best for preserving blood cell integrity Blood bank and Hematology testing Unacctable for calcium, sodium, or potassium analysis
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Describe the WHITE top tubes:
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# 6 order of draw First white tube: BD vacutainer PPT separator tube Second white tube: K2 EDTA with gel
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Describe the GRAY top tube:
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#7 order of draw Fluoride (glucose) tube Contains glucose preservative sodium fluoride Stops the metabolism of glucose Anticoagulant: potassium oxalate preserves alcohol glucose and blood alcohol testing
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Describe the DARK (ROYAL) BLUE top tube:
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Anticoagulant: none, EDTA, or Heparin Toxicology or trace metals Plasma or serum Used primarily for specialty testing
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What are the 5 potential adverse side effects of using the wrong amount or improper additive/anticoagulant?
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-interference with the assay -removal of constituents -effect on enzyme action -alteration of cellular constituents -incorrect amount of anticoagulant
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What are the big 3 unacceptable specimens?
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-hemolyzed specimens -icetric specimens -lipemic specimens
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What is a hemolyzed specimen?
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Red or reddish color Red blood cells have ruptured Possible traumatic venipuncture RBC lyced. Due to draw, storage, transport, etc. What should be inside cell is now outside cell. Unless pt is suspected of having inter vascular hemolysis.
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What is an icetric specimen?
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Artificially colored bright yellow to brownish Due to high levels of Bilirubin Jaundice, possible liver disease Rejected for photo metric/spectrometry tests bs these absorb/reflect light based in wavelength so if starting specimin will interfere with test, it's rejected. Hematology, red blood cell counts fine.
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What is a lipemic specimen?
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Milky appearance Indicates a non-fasting specimen Fat after meal from high lipid content Clogs equipment
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Name two examples of CONTACT precautions:
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Gowns Gloves (protects provider)
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Name an example of AIRBORNE precautions:
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Respirators (finer aspiration type mask than with droplet precautions) To filter out aspirations (pathogens suspended in air) (also add on contact precautions) Airborn
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Name an example of DROPLET precautions:
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Masks (dust mask type) To filter out respirations Ie: Cough, sneeze (also add on contact precautions) Droplet
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SST
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Additive Serum Separator Tube Inert polymer barrier gel Separates from cells Does not affect lab results
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EDTA
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Anticoagulant Ethylenediaminetetraacetic Acid Chelates calcium which is required for blood coagulation (removes by capture/sequester) Best for preserving blood cell integrity Unacceptable for calcium, sodium, or potassium analysis
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Sodium Citrate
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Anticoagulant Precipitates calcium required for blood coagulation Best for preserving coagulation factors Unacceptable for calcium or sodium analysis
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Heparin
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Anticoagulant In form of Sodium Heparin or Lithium Heparin Enhances activity of Anti-thrombin III. ATIII inhibits blood coagulation. Unacceptable for blood cell evaluation Uses include: pH, electrolytes, blood gases, ionized calcium tests Change of morphology of RBC
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What is the most sterile tube and should be drawn first?
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Yellow top You draw the most sterile specimine first so as to not contaminate it Tourniquet on so coagulate so we draw early
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Which tubes use anticoagulants?
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EDTA: Lavender, white, dark (royal) blue
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Which tubes use additives?
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Thrombin: Important in coagulation Sodium fluoride: Gel: Gold or red/gray
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Which tube has an additive that preserves glucose?
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Gray top Sodium fluoride Antiglycolitic agent Inhibits glycolysis so glucose levels stay (Potassium Oxalate)
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What tubes can be used for coagulation testing?
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Light blue Gold or red/gray Red Orange
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Which tubes are unacceptable for blood cell evaluation?
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Heparin tubes Light green or gray/green Green Dark royal blue
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Which tubes are unacceptable for sodium or calcium tests?
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Light blue Lavender
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Which tubes are unacceptable for potassium tests?
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Lavender
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In which tubes does the serum need to be removed from the clot ASAP?
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Red tubes (plastic and glass)
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Which tube tests for trace metals (minerals)?
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Dark royal blue
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Which tubes are best for preserving blood cell integrity?
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EDTA tubes Lavender, white, and dark royal blue
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Which tube needs to be shielded from light?
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Light green or green/gray Green top
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Which tube needs to be out on ice?
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Gray
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Infection control considerations
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Size of particle Length of time airborn
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Buffy coat (Buffy layer)
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Top portion of cellular/formed element fraction WBCs and Platelets Hematocrit does not include Buffy Coat (just RBCS component)
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What additive is a STAT serum test?
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Thrombin
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What are we interested in with the clot tube?
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Only interested in the serum, not cells
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Which additives removes calcium?
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EDTA and Sodium Citrate But by different mechanisms EDTa chelates (captures) calcium SC precipitates calcium -we out calcium back in for test-
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Can you send a red top tube to hematology?
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No. It's coagulated. Can't count the cells. Hematology is for blood cell counting and sizing.
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What are 3 major drawbacks to using a butterfly set?
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Because of the smaller gauge needle, -takes longer -elevates blood counts -therefore altering composition ratios
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How do you determine the infection control precautions needed?
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The size of the particle & how long it stays in the air
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Aspirations
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Stay suspended in air Airborne precautions Respirators
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Respirations
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Droplets Droplet precautions Masks
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Infection control precautions protect
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The provider
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Red Blood Cells
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RBCs erythrocytes
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White Blood Cells
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WBCs Leukocytes
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Platelets
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Thrombocytes
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Liquid fraction
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Plasma or serum Water, minerals, nutrients, wastes, hormones, antibodies, proteins
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Formed element fraction
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Cellular fraction RBCs, WBCs, & platelets
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Supernatent
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Leftover liquid portion at top of specimin collection tube
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What is the liquid portion of circulating blood?
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Plasma
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If plasma still contains coagulation proteins it is
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Not coagulated/not clotted/anticoagulated
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What is the liquid portion of clotted blood samples?
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Serum
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Anticoagulated
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Blood is not clotted
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Anticoagulate
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Draws blood without clotting it
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Blood drawn with an anticoagulate is
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Anticoagulated And therefore plasma
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A clotted blood sample goes from being what to what?
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Plasma to serum
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Platelets are an active part of
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Coagulation They must be in motion. If motion ceases, platelets are activated.
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If you want an unclotted sample, you must introduce a
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Chemical anticoagulant
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Short draw
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Dilutiin ratio inaccurate
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How do you know how much blood to draw into an evacuated tube?
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There is a gas in the tube that determines the correct amount of blood drawn due to pressure
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Why do glucose levels in a specimin decline over time?
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Blood consumes glucose outside of the body
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What is the best tube for alcohol testing?
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Gray bc anticoagulant Potassium Oxalate preserves alcohol
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What is the best tube for glucose testing?
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Gray bc it contains sodium fluoride, a glucose preservative
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What tube goes for routine blood testing?
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Lavender/purple
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What tube is best for coagulation testing?
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Light blue
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What tube is best for Chem tests requiring plasma?
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The green tube Bc it has the anticoagulant Heparin that keeps it whole blood but no need to preserve cells since serum is all that's needed
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Are short draws rejected because of ratios on the red tops?
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No. Dilution is not an issue because there is no additive, no anticoagulation. There is just the specimin.
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Name 4 reasons for unacceptable specimens besides the big 3:
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Clots present in anticoagulated specimin Improper blood collection tube Short draws/wrong volume Discrepancy between specimin and test
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Name the 2 needle parts that attach to vacutainer tube:
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Needle end with sheath Tube holder
