Blood Sample Analysis

• The information pertains to the collection and distribution of biological samples, specifically blood samples.

Blood Samples - General Characteristics and Composition

• Blood is a specimen commonly used for analytical studies due to its rich data, functionality, and ease of extraction.
• The type of sample required depends on the study being conducted (whole blood, plasma, or serum).
• Blood is a viscous fluid pumped by the heart throughout the organism.
• It reaches all body parts through the vascular system to perform its functions.
• Blood:
  • Appears Viscous
  • Feels smooth
  • Is red in color
  • Has a temperature of 38°C, effectively transmitting heat due to its components
  • Between pH 7.35 and 7.45

Functions of Blood

• Blood has varied functions and is a special tissue due to its composition in formed elements, as well as its serous and plasma based components
• Blood:
  • Transports oxygen from the respiratory system and nutrients from the digestive system to cells.
  • Regulates body temperature, pH, and conserves internal homeostasis.
  • Protects via cellular and serous immune systems, preventing damage through coagulation and platelet aggregation.

Blood Composition

• Formed components from soluble components need to be differentiated
• Blood plasma accounts for 50-55% of total blood volume
• Plasma
  • A yellowish liquid matrix mainly composed of water (90-92%).
  • Contains minerals and proteins (7-8%).
    • Each has a specific function
• Despite both having a yellowish appearance and being extracted via blood sample centrifugation, serum differs from plasma in that it lacks fibrinogen.

Blood Samples - Plasma vs Serum

• Plasma or serum is preferred over whole blood for most biochemical determinations.
• Interferences from anticoagulants aren't an issue with serum while also being easier to manipulate

Blood Components table

• Water = 900 grams/liter

  • Transports substances and regulates temperature

• Minerals = 8.95 grams/liter

  • Regulate water flow in and out of cells

• Albumins = 40 grams/liter

  • Stores food

• Globulins = 32 grams/liter

  • Provides defense

• Fibrinogen = 3 grams/liter

  • Coagulates blood

• Lipids = 6 grams/liter

  • Offer energy to cells

• Glucose = 1 gram/liter

  • Provides energy to cells

• Debris = 2 grams/liter

  • Uric acid
  • Delivers to excretory system to be eliminated

Plasma Proteins

• Plasma proteins account for roughly 7% of blood volume

• Albumins

  • Synthesized in liver
  • Maintain colloid osmotic pressure to prevent excessive fluid leaving to tissues within blood capillaries
  • Functions as a transporter for various enzymes, hormones, and metabolites

• Globulins divide into fractions

• Gamma globulins are most important since it contains immunoglobulins

• Responsible for the body's immunological defense

• Made by B lymphocytes

• Helps facilitate microorganism elimination by macrophages, by binding to microorganisms

• Beta globulins

  • Transports hormones, metallic ions, and lipids
  • Transferrin combines with iron, copper, and zinc
  • Primarily transports the iron

• Coagulation Plasma Factors

  • Work with platelets
  • Maintain vascular endothelium/part of process of homeostasis
  • Circulates in an inactive state
  • Fibrinogen has high concentration

Blood Formed Elements

• Second main component of blood
• Accounts for around 45-50% of total blood
  • Erythrocytes (45% of volume
  • Leukocyte
  • Lymphocyte
  • Monocyte
  • Eosinophils/basophils and macrophages
  • Platelets

Blood Formed Elements table

• Erythrocytes
  • Biconcave without a nucleus
  • Transports oxygen to the cell via hemoglobin.
• Leukocytes
  • Rounded shape
  • Defends organisms
• Platelets
  • Cell fragments
  • Coagulates blood

Vascular Anatomy

• Blood circulation forms a closed network of vessels to deliver the blood to organism areas, which the heart pumps: through the arterial and venous vascular systems
• Arteries:
  • Flexible and elastic tubes that transport oxygenated blood.
  • Start from the heart, and are different sizes
  • Size and thickness progressively reduce into arterioles
• Microscopic dimensions
  • Endothelial cells make up boundary between the arterial and venous systems
• Veins:
  • Larger diameter
  • Less elastic than arteries
  • Transport deoxygenated blood from tissues to heart
• Capillaries
  • Fine vessels that reach almost all body cells
  • Are branched with gradual size decreasement, and lose thickness. This thinning enables transit of exchanging substances and nourishing cells.

Blood Type Differences (Arterial, Venous, Capillary)

• Arterial blood has generally uniform composition throughout the body
• Venous blood varies based on metabolic activity in the irrigated tissue or organ.
• The puncture site affects composition.
• Venous blood differs from arterial blood which has to be considered during tests:
  • Oxygen concentration
  • pH
  • Carbon dioxide
  • Hematocrit
  • Variations can happen within glucose, lactic acid, chlorine, and ammonia

Blood Sample Types

• Used for veinous, arterial, and capillary samples

• Blood samples represent a significant volume and provide critical data for establishing and identifying diseases.

• Extraction and analysis of a blood sample should be essential

• The 3 Methods of Blood Access:

  • Veinous
  • Arterial
  • Capillary

Obtaining Samples - Veinous Access

• Used because:
  • Less chance of patient trauma, eases access, provides greater volumes
  • Important to know extraction site to guarentee the quality of the sample
• Personnel should be well-versed in the location
• Ideal zone : the antecubital fossa beneath elbow, in the anterior arm
• 70% of users experience a "H" shape distribution along cephalic, median cubital, and basillic veins
• In 30% of users, there is a "M" assembly containing connecting veins
• Cephalic and median cubital are used
• Inaccessable veins = Dorsal of hand

Otaining Samples - Arterial Access

• Used less because:
  • Painful
  • Risk of hemorrhaging
  • Difficult to perform The Puncture spot used here is: radius artery. Inner carpal area or the humeral, near the elbow fold

Obtaining Samples - Capillary Access

• The way to measure is made using a dry chemical
• The volume isn't significant
• The easy access and chance for little trauma for patients
• Used in: Neonatology, because venous is limited

Blood Sample Processing Phases

• Each analytical process submits to a work method to guarentee the quality
• Phases the sample is collected include, requests from health care professionals. until the tubes are being processed

Pre-analytical Phase

• 70% of mistakes are made during this pre-analytical Phase
• This phase
• Starts with requests, that physicians comply with
• Includes instructions and preparations of the patient
• Depends on the pre-condition of extraction and procedures
• Six stages can be subdivided during preanalytical phase such as:
  • Request analysis
    • Fill form
  • Electronically request
  • Receive Sample
  • Quote to sample
  • Transfer to tubes
  • Specimen Transport
  • Pneumatic tube
  • Manual and highway (road)
  • Verify labeling
  • Aliquot
  • Sample preperate
  • Pretreat
• Centrifuge
• Transport sample
• Principal Laboratory

Pre-Analytical Phase - Correct indication

• Critical that a request is completed by a medical practitioner because it should come with proper requisites To prevent errors: all analysis requests have requirements for identification of user, identification facilities, preliminary diagnosis and solicitations

Fases del processament de les mostres sanguínies continued

All requests should add

• Data from users
• Requesting medical officer
• Preliminary diagnosis
• Solicited determinations
• Inappropriate requests lead to errors
• Health Officers should be familiar following instructions pre extraction should there be preparation ahead of time.

Blood Sample Extraction

• Correct method from room condition, extraction technique and preperation of tubes is to be followed for extraction in general. Blood Sample Extraction Requirements
• In a position with arms resting properly
• The area temperature is to be
• between 18 and 24 and 45-60% air, relative humidity
• A patient extraction is to be done by trained professional to follow procedure:
  • Patient identification with name and date of birth, with conscious personnel
  • Uncoscious persons should be idendified with an appropriate guardian Patient medical analysis
• Doctors should follow steps of previous information
• The sample should'nt show any symptoms

Processing Phases - Pre-Analytical Phase - Actions that must be Performed

• Present the patient and clearly explain the course of action
• Identify the petition and sample code, and then the source of the scan
• Before the collection it’s necessary to understand what tests the doctor is requesting, the appropriate materials are readied
• The material prepared should be sterile
• Gloves
• Compressors
• Alcohols for medical sterilization are to be used

Vacuum process with needles, as well as double, when collecting

• Racks and different tube types

Processing Phase - Tube Uses

• Tubes are in different proportions of adjusted additives
• Small pediatric tubes, or if they require minor collection
• Side part indicates the capacity of the tube

Using an anticoagulant for sampling, follow specific attention

• Mix tubes for even distribution of the blood from a proper source

Processing Phases Continued

• Store
  • Tub with serum using a silicone based gel separator with a coagulation
• For haemogram with 2 EDTA use
• For specific circumstances a neutral Samples
• Must be transferred for aerobious and anaebic blood

Analytes

Without additives for specific

• Biochemistry
• Serology

Tap with Heparin for

• Cytogenetics
  • Recompilations

EDTA tap for

• Cytologic testing
• hematologic

To test citrates

• determine glucose levels

Correct Blood Extraction Steps

First wash hands with gloves

• The compressors are to be used at a specific number of 7.5 to 10 CM Prevent the backflow of blood with no interference
• A incorrect narrow torniquet can trigger a Hyperkalemia
• The compressor exceeds a minute before releasing, inappropiate issues can cause the values ​​that lead to errors, as well as blood clotting

Palpating the vein is key after extraction

• With patient at arm extension, start to examine the arm from the area to the forearm

Sterilization

• Use a light circle on the skin while disinfecting with cotton and antiseptic

• The vacuum seals are a more secure inoculation For great qualities, use a atraumatic puncture.

• Some veins are difficult to maintain a tourniquet

• Always ask for clenching of the fist as directed

Processing blood samples cont.

Emulsification:

• Ensure the full vacuum is secured
• Exact proportions for the analytic process
  • invert tubes for better transfusion

Hemorrhage Control

While extracting the needle, a cotton or gauze bandage is enforced

• Request that all raise the arm

Hazardous Disposal

Needles should be assembled for a proper biohazard disposal

• Blood extractions with needle and syringe: Obtain samples though needle, or vacutainer can obtain blood through the skin

Activity

• The tubes follow a specific order of filling with motives The vessels are obtained in:

• Armpits

• Median vein

• Subclavian area When removing the needle, all should invert in the appropriate fashion

Some things the tubes should collect

• Coagulation citrate is always before

If the sample is 5 ML (minimum) transfer, a tube first

Collection of arteryal Blood

Site

• Femoral
• Brachial
• Radial.

Newborn extraction

• Umbilical or scalp

Gas is preferred to avoid air bubbles, or with plastic

Clean the puncture sight and position heparin. Ensure a small portion of blood about 2 ML

• Punctuar should be done experiental and tested immediately after for best results

Capillary blood extractions

Easy trauma that small children can experience

A mix of bloods with more arterial samples

• Finger and heel for children under 1.5

Pre extraction

• Add gloves
• Clean the puncture

Action

Apply lanch Dispose of contaminated material If there's a tub you can also seal it and maintain a correct blood pressure Do not use pressure. Always check with identification

The blood is for:

Pre analytics

The laboratory test on the process is well registered during the clinical procedure The hour of extraction

• Should be written down properly

An inaccurate sample will be hard to analyse

• Sample
• Clot Wrong labeling can lead to extra complications later on

Specimens contamination

It can be a lack of material to get the proper tube, or be a cross contamination during the tubes being filled

Transportation

Transports should have a controlled refrigerator and proper atmosphere

The liquid must be stable and clean

Obtaining blood for coagulation study

• The right anticoagulants And correct proportion for the extraction process

Citrate is standard

Extraction is sensitive to blood samples

Some tubes require protein and the proper pH levels

Specimen procession for clotting

It must exlude all clots with some tubes and mix the anticoagulant

• Specimens are to be in 200G for minutes and 10 minutes, to ensure clot factors haven't been activated

It's important to get rid samples

A proper transport process

Must take place with stable tubes at the proper temprature - never open the blood cells The interferences can affect: The age, origin, or life style

Sample Extraction - Common Errors

• The correct medication has to be given and prepared for measurement 15% above. The volume that the test indicates should be about correct

• Inadequate specimen preparations

• Transport

Hemolysis effects cellular integrity:

• Visible and can't perform any tests

With an important degree of 200MMML

• The sample must have hemotrocrisia

To prevent further mistakes

• The samples identification with the specific requests
• Most data and specific needs

Transportation is needed with appropriate personnel

When there are issues of hemolysis and the specimens are bad, it indicates certain results

Analytes with significant interferences on results indicate blood results must be redone.

These all can have an effect on how we'd treat patients

Analytes and the issues with: High levels of hematic lipemia (The blood is thick, it isn't clear, it's opaque)

Can create all kind of analytes issues

Albulin and cholesterol

• If it contains less potassium, the sample can be re extracted with a citrate, or proper mix for it to mix well

And if not mixed, one won't know

The samples in proper condition are more reliable