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:

    <p>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</p> Signup and view all the answers

    Specimens rejected due to improper handling cannot be identified properly.

    <p>False</p> Signup and view all the answers

    What is the purpose of the hydrogen breath test?

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

    What type of specimen is collected to determine gastrointestinal disorders?

    <p>Feces</p> Signup and view all the answers

    Hair samples can be used to detect chronic drug abuse.

    <p>True</p> Signup and view all the answers

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

    <p>preferred</p> Signup and view all the answers

    Match the following arteries with their risk of hematoma:

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

    What is the purpose of a Glucose Tolerance Test?

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

    How is a 24-hour urine collection procedure conducted?

    <p>Empty the bladder upon waking up.</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>Cerebrospinal Fluid (CSF)</p> Signup and view all the answers

    Match the fluid with the corresponding collection method:

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

    What is the cause of Hematoma in arterial puncture?

    <p>Increased pressure forcing blood to enter tissues</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>arterial</p> Signup and view all the answers

    Match the donor blood type with its corresponding requirements:

    <p>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</p> Signup and view all the answers

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

    <p>Chagas disease, HIV 1 and 2, Hepatitis B, Hepatitis C, Syphilis, West Nile virus, Human T-cell lymphotropic virus</p> 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.

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