Blood Specimen Handling and Processing for Lab Testing

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Questions and Answers

What should the phlebotomist be careful about in routine handling of blood specimens?

Mixing tubes carefully (correct)

Preparing specimens for transport

Transporting specimens with stoppers

Identifying patients

What should be done to chilled specimens during transport to maintain stability?

Specimens should be completely submerged in crushed ice and water slurry during transport and immediately tested or refrigerated if necessary.

The phlebotomist is responsible to follow all appropriate steps required for each test that they are scheduled to perform in __________ handling.

Routine

Match the following light-sensitive specimens with appropriate handling methods:

Bilirubin = Wrap the specimen tube with aluminum foil or use light-blocking, amber-colored container Vitamin B6 = Wrap the specimen tube with aluminum foil or use light-blocking, amber-colored container Red Cell Folate = Wrap the specimen tube with aluminum foil or use light-blocking, amber-colored container Signup and view all the answers

Specimens rejected due to improper handling cannot be identified properly.

False Signup and view all the answers

What is the purpose of the hydrogen breath test?

Detection of carbohydrate digestion problems such as lactose and fructose intolerance, and detection of bacterial overgrowth in the small intestine. Signup and view all the answers

What type of specimen is collected to determine gastrointestinal disorders?

Feces Signup and view all the answers

Hair samples can be used to detect chronic drug abuse.

True Signup and view all the answers

What is the most preferred site for arterial puncture? Radial artery is the ______ site.

preferred Signup and view all the answers

Match the following arteries with their risk of hematoma:

Radial Artery = Less chance of hematoma Brachial Artery = Increased risk of hematoma Femoral Artery = Moderate risk of hematoma Signup and view all the answers

What is the purpose of a Glucose Tolerance Test?

It is done to monitor glucose levels after fasting and at specific time intervals to diagnose diabetes. Signup and view all the answers

How is a 24-hour urine collection procedure conducted?

Empty the bladder upon waking up. Signup and view all the answers

Amniotic fluid is collected through transabdominal amniocentesis at around 15 weeks of gestation.

True Signup and view all the answers

______ is used to diagnose meningitis and other disorders like brain abscess and CNS cancer.

Cerebrospinal Fluid (CSF) Signup and view all the answers

Match the fluid with the corresponding collection method:

Semen = Masturbation Saliva = Freezing to ensure stability Sputum = First thing in the morning Synovial Fluid = Arthrocentesis Signup and view all the answers

What is the cause of Hematoma in arterial puncture?

Increased pressure forcing blood to enter tissues Signup and view all the answers

Thrombus formation in arterial puncture can be prevented by using smaller-gauge needles.

False Signup and view all the answers

Bright red blood and pulsation are common signs of accidental __________ puncture.

arterial Signup and view all the answers

Match the donor blood type with its corresponding requirements:

Whole Blood Donation = Donation Frequency: 56 days Power Red Donation = Donation Frequency: Every 112 days, 3 times per year Platelet Donation = Donation Frequency: Every 7 days, up to 24 times per year Signup and view all the answers

What infectious diseases are tested for in each unit of donor blood?

Chagas disease, HIV 1 and 2, Hepatitis B, Hepatitis C, Syphilis, West Nile virus, Human T-cell lymphotropic virus Signup and view all the answers

Study Notes

Handling and Processing of Blood Specimens for Laboratory Testing

Routine Handling

Phlebotomist's roles:
- Perform routine venipuncture
- Prepare specimens for transport to the laboratory
- Adhere to time limits for delivery of specimens

Steps Involved in Processing and Handling

Patient identification
Blood collection
Choice of tubes
Phlebotomist's responsibilities for each test

Mixing Tubes by Inversion

Cap color and number of inversions:
- Red (Glass): 0x
- Light Blue: 3-4x
- Red (Plastic), Gold/Tiger Top: 5x
- Light Green, Green, Lavender, Pink, Gray, Tan, Yellow, Orange, Royal Blue: 8x

Transporting Specimens

Avoid hemolysis, platelet activation, and coagulation
Transport with stopper to:
- Avoid contact with the content
- Minimize agitation
- Aid clot formation

Special Handling

Body temperature: transport at near body temperature (37°C) for certain specimens
Chilled specimens: slow down metabolic process for certain specimens
Light-sensitive specimens: protect from light to avoid affecting test results

Blood Specimen Processing and Reasons for Specimen Rejection

Specimen processing:
- Identification
- Logging
- Sorting by department
- Evaluation for specimen suitability
Reasons for specimen rejection:
- Inadequate identification
- Inadequate volume
- Hemolysis
- Wrong tube for collection
- Outdated tube
- Improper handling/mixing
- Contamination
- Insufficient specimen (QNS)
- Collection time incorrect
- Specimen exposed to light
- Procedure did not follow testing time limits
- Delay or error in processing

Delivery Time Limits and Exceptions

Delivery time limits:
- Routine blood specimens: 45 minutes
- Centrifugation: 1 hour
- Hematology specimen (EDTA tube): should not be centrifuged
Time limit exceptions:
- STAT or emergency specimens
- Specific exceptions for certain tests (e.g., blood smear, EDTA specimen for CBC, etc.)

Centrifugation

Importance of leaving the stopper on the tube before centrifugation
Balancing tubes in the centrifuge
Preparation of plasma and serum specimens

Aliquot Preparation

Definition of aliquot
Preparation of aliquot for chemical analysis or testing

OSHA Act Requirements

Required protective equipment for handling specimens
Includes gloves, gown/coats, and masks

Handling and Processing of Non-Blood Specimens

Urine

Most analyzed non-body fluid
Inexpensive to test
Importance of urine analysis in health monitoring and disease diagnosis

Urine Collection Methods

Random
Midstream
Catheterized
Suprapubic aspiration
Pediatric

Urine Tests

Routine urinalysis
Urine culture and sensitivity
Urine cytology studies
Urine drug testing
Urine glucose and ketone testing
Urine pregnancy testing
Other urine tests (e.g., electrophoresis, heavy metals, myoglobin clearance, etc.)

Types of Urine Specimens

Random
First morning/8-hour urine specimen
Fasting
Timed
24-hour urine collection
Double-voided

Urine Collection Procedure

Empty bladder upon waking up
Affix label and write down time and date
Start timing
Discard line output at first hour
Collect all urine for the next 24 hours
Refrigerate specimen during collection period
Collect urine prior to bowel movement
Drink fluids as needed to avoid dehydration
Take one last void at the end of 24-hour collection period
Seal the container before transporting to the lab

Other Non-Blood Specimens

Amniotic fluid
Cerebrospinal fluid (CSF)
Gastric fluid/gastric analysis
Nasopharyngeal secretions
Saliva
Semen
Serous fluid
Sputum

Note: The above notes are a concise summary of the key points and focus on the most important information.### Sweat

Used to analyze the chloride content of patients under 20 with symptoms of cystic fibrosis
Sweat Chloride Test:
- Iontophoresis (electrical stimulation) in the forearm or thigh to stimulate sweat production
- Pilocarpine (sweat-stimulating drug) is used
- Sweat is collected, weighed, and analyzed for chloride content
Can also be used to detect illegal drug use by placing patches on the skin for an extended period

Pilocarpine Iontophoresis

Test site is cleaned and dried, then a piece of pre-weighed filter paper is placed over the test site
Sweat is collected for 30 minutes
Filter paper is retrieved and weighed to determine the weight of sweat collected

Synovial Fluid

Viscous fluid that lubricates movable joints
Tested to determine conditions such as arthritis, gout, and other inflammatory conditions
Collected in three tubes:
1. EDTA/Heparin tube for cell counts, crystal identification, and smear preparation
2. Sterile tube for culture and sensitivity
3. Non-additive tube for macroscopic appearance, chemistry, immunology tests, and observing clot formation

Arthrocentesis

A procedure to collect synovial fluid from a joint

Buccal (Cheek) Swabs

Used to obtain loose cells inside the cheek for DNA analysis
Less invasive and painless alternative to blood collection
Sample is collected by placing the swab inside the cheek and gently massaging the area
Swab is sent to the lab where DNA is extracted from the cells

Bone Marrow

Examined to identify blood diseases
Physician inserts a large-gauge needle into the sternum or iliac crest (hip bone) and aspirates 1-1.5 mL of specimen
Hematology technologist makes special slides from the first marrow aspiration

Breath Samples

C-Urea Breath Test (C-UBT):
- Checks for the presence of Helicobacter pylori bacteria that damages the stomach lining
- Patient drinks a special substance with synthetic urea, then breathes into a Mylar balloon at specified intervals
- Breath specimens are analyzed for carbon-13, which confirms the presence of H. pylori
Hydrogen Breath Test:
- Helps detect carbohydrate digestion problems, such as lactose (milk sugar) and fructose (fruit sugar)
- Detects bacterial overgrowth in the small intestine
- Most accurate tolerance test
- Patient must not take antibiotics two weeks prior to the test and should fast on the day of the test

Feces

Collected to:
- Determine gastrointestinal disorders
- Analyze for the presence of intestinal ova and parasites
- Culture and examine for the presence of pathogenic bacteria and viruses
- Check fat and urobilinogen content
- Test for the presence of occult blood
Collected in a clean and wide-mouth container, sealed, and sent to the lab

Hair

Used to analyze for trace and heavy metals
Used to detect chronic drug abuse

Throat Swabs

Mostly collected to aid in streptococcal infection detection
Special kit contains a sterile polyester-tipped swab and a covered transport tube
Tube contains transport medium

Tissue Specimen

Usually collected using biopsy through which the tissue sample is removed for examination
Phlebotomy should check the proper handling procedure, particularly if the specimen delivered is not immersed in a solution
For genetic analysis, tissue samples should not be placed in formalin

Arterial Puncture

Used to collect blood specimens for ABG analysis to manage cardiopulmonary disorders and maintain acid-base balance of the body
Arterial blood is the ideal specimen for respiratory function evaluation due to the consistency of its composition and high oxygen content
Composition of Arterial Blood:
- Uniform throughout the body
- Tests requiring arterial blood include blood gases (O2 and CO2), lactic acid, and ammonia

Arterial Puncture Equipment

Collection Kits:
- Syringes: preanticoagulated, plastic, 1-5 mL based on instrumentation and tests
- Needles: 20- to 25-gauge, 5/8 to 1.5 inches
Anticoagulant:
- Heparin used to coat the plastic syringes, tested within 30 minutes
- Glass syringes used for tests longer than 30 minutes, lubricated, and heparinized by collector
- Tightly fitting cap for syringe Luer tip

Arterial Puncture Sites

Sites:
1. Radial Artery (most preferred site)
2. Brachial Artery
3. Femoral Artery
Order of Preference: Radial > Brachial > Femoral
Gauge of Needle Required: a. Brachial Artery: 18-20 gauge b. Radial Artery: 23-25 gauge### Adverse Events in Blood Donation
Healthcare personnel must monitor donors for adverse effects during and after blood collection
Donors should remain seated for a few minutes to ensure they are not suffering from dizziness

Donor Care Post Phlebotomy

Venipuncture sites should be inspected
Refreshments should be offered to donors before they leave the area

Donor Blood Processing

Collected blood units are prepared and placed in proper containers for transport to the processing area

Donated Blood Labeling

Information on the blood unit label must be double-checked, complete, and accurate

Requirements by Donation Type

Whole Blood Donation

Donation frequency: 56 days
Must be in good health and feeling well
Must be at least 16 years old
Must weigh at least 110lbs

Power Red Donation

Donation frequency: Every 112 days, 3 times per year
Must be in good health and feeling well
Male donors: at least 17 years old, 5'1" tall, and 130lbs
Female donors: at least 19 years old, 5'5" tall, and 150lbs

Platelet Donation

Donation frequency: Every 7 days, up to 24 times per year
Must be in good health and feeling well
Must be at least 17 years old
Must weigh at least 110lbs

Donation Intervals

Wait at least 8 weeks between whole blood donations
Wait at least 7 days between platelet donations
Wait at least 16 weeks between Power Red donations

Who can donate?

Women with menstruation (if they can)
People who take vitamins (except those taking antibiotics)

Infectious Disease Tested for on Each Unit of Donor Blood

Chagas disease (Trypanosoma cruzi)
HIV 1 and 2
Hepatitis B (Hepatitis B Virus)
Hepatitis C (Hepatitis C Virus)
Syphilis
West Nile virus (West Nile Virus)
Human T-cell lymphotropic virus (HTLV)

Minimum Requirements for Venipuncture Blood Donation

BP monitors
Scales
Donor couches
Chairs
Beds
Blood Collection Mixers
Blood Bag Sealers
Blood Transportation Boxes
Blood Bank Refrigerators
Furniture and equipment must be made of cleanable surfaces, kept clean, and disinfected with sodium hypochlorite bleach solution
Closed collection system with a sterile blood collection bag containing anticoagulant with attached tube and needle

Donor Collection

Cleansing
One-step procedure
Two-step procedure
Needle sizes: usually 15-17 G
Veins of choice: veins of the antecubital fossa
Fist clenching: speed flow of blood
Completion of Donation

One-Step Procedure

Duration: about 1 minute
Material: 2% chlorhexidine gluconate in 70% isopropyl alcohol
Procedure:
- Wash the site using firm gentle pressure
- Make sure the whole skin site is covered and in contact with the disinfectant for at least 30 seconds
- Allow the site to dry completely or for at least 30 seconds

Two-Step Procedure

Duration: about 2 minutes
Material: 70% isopropyl alcohol and tincture of iodine or chlorhexidine (2%)
Procedure:
- Follow the steps in the one-step procedure
- Use either tincture of iodine or chlorhexidine (2%)
- Start from the center, then move downward, and outward applying firm but gentle pressure
- Contact should be about 30 seconds
- Then, allow the area to dry completely or for about 30 seconds

Venipuncture

After confirming that bleeding has stopped, phlebotomist should place a sterile gauze/bandage and instruct the donor to keep it on for 4 hours

Apheresis Blood Donation

Involves the collection of red cells, platelets, or plasma
Can be autologous or allogenic

Autologous Blood Donation

Autologous: involving one individual as both donor and recipient
Purpose: patients scheduled for surgery donate their own blood for own use to prevent transmission of blood-borne pathogens
Qualifications:
- Time between donations: as often as 72 hours with doctor's approval
- Hemoglobin level: at least 11.0 g/dL
- Hematocrit: 33%
- Autologous units are only designated to autologous donor

Therapeutic Phlebotomy

Removal of blood
Formerly termed as bloodletting
Used for polycythemia (increased RBCs) and hemochromatosis (increased iron levels)

Patient Instruction

Collection instructions
Verbal and written
Prepared to answer questions
Collection on site or at home
Confirm with patients that they have understood the instructions

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Description

This quiz covers the roles of a phlebotomist in routine handling of blood specimens for laboratory testing, including steps involved in processing and handling different types of specimens.