Hematology Basics and Pioneers
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Questions and Answers

In finger puncture, puncture is made __________ to the fingerprint lines.

perpendicular

Sepsis is considered a complication associated with phlebotomy.

True

What is the mode of action of EDTA as an anticoagulant?

  • It reversibly binds iron ions.
  • It inhibits platelet aggregation.
  • It removes ionized calcium through an irreversible process. (correct)
  • It prevents the formation of fibrin clots.

    • What is the liquid form of Tri-potassium EDTA known as?

    <p>K3 EDTA</p> Signup and view all the answers

    Match the anticoagulant forms with their descriptions:

    <p>Dry form = EDTA powder for laboratory use Liquid form = Ready-to-use EDTA solution Disodium salt = Known as EDTA-2Na Tri-potassium salt = Known as K3 EDTA</p> Signup and view all the answers

    Which vein is the most commonly used site for venipuncture?

    <p>Median Cubital Vein</p> Signup and view all the answers

    A larger gauge needle has a larger internal bore diameter.

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

    What is the standard angle for venipuncture?

    <p>15-30 degrees</p> Signup and view all the answers

    The Greek word for blood is '__' and for study is ''.

    Signup and view all the answers

    The standard disinfectant used for venipuncture is __________.

    <p>70% isopropyl alcohol</p> Signup and view all the answers

    Match the needle gauge with its corresponding color code:

    <p>White = 27 gauge Pink = 20 gauge Black = 22 gauge Blue = 24 gauge</p> Signup and view all the answers

    What is the ideal position for a patient during venipuncture?

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

    Blood should be drawn from a vein in the arm with a cannula.

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

    What should be the maximum number of attempts for venipuncture before calling another Medtech?

    <p>2 attempts</p> Signup and view all the answers

    A yellow bag is used for __________ waste disposal.

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

    Which method is the most common form of skin disinfection for blood culture?

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

    What is the preferred anticoagulant for platelet count and evaluation of blood cell morphology?

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

    EDTA is suitable for coagulation tests.

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

    What occurs if the concentration of EDTA exceeds 2mg/ml of whole blood?

    <p>Platelets may swell and fragment, leading to a false increase in platelet count.</p> Signup and view all the answers

    The phenomenon of ____________ may occur when using EDTA.

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

    Match the effects of EDTA with their descriptions:

    <p>Inhibits fibrinogen-thrombin reaction = Affects coagulation tests False increase in platelet count = Excessive concentration of EDTA Platelet satellitosis = Forms a ring around leukocytes Not stable = Labile factors like Factor V</p> Signup and view all the answers

    What is the anticoagulant of choice for most chemistry tests?

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

    Sodium citrate binds calcium to form an insoluble complex.

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

    What is the ratio of blood to anticoagulant for sodium citrate?

    <p>9:1</p> Signup and view all the answers

    The anticoagulant for ESR testing is _________.

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

    What can potassium oxalate, when used in a 3-part solution, cause?

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

    Match the anticoagulant with its associated characteristic:

    <p>Sodium Citrate = Preserves factor V and VIII Oxalate = Binds calcium to form insoluble calcium oxalate Heparin = Natural anticoagulant Potassium Oxalate = Most widely used oxalate form</p> Signup and view all the answers

    Heparin is only used as an in vivo anticoagulant.

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

    What is the concentration range for using sodium citrate?

    <p>0.105 M to 0.109 M</p> Signup and view all the answers

    What year did the first observation of red blood cells occur?

    <p>1674</p> Signup and view all the answers

    Blood coagulates in vivo within 5-10 minutes.

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

    What is the average pH level of blood?

    <p>7.40</p> Signup and view all the answers

    The solid portion of blood is approximately _____ grams per 100 ml.

    <p>20</p> Signup and view all the answers

    Match the following blood components with their descriptions:

    <p>Plasma = Fluid portion of anticoagulated blood Serum = Slightly hazy appearance Whole blood = Contains all coagulation factors Buffy coat = Contains white blood cells and platelets</p> Signup and view all the answers

    Which year is associated with the development of Wright stain for blood examination?

    <p>1902</p> Signup and view all the answers

    Venous blood is considered oxygenated and appears bright red in color.

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

    Blood is approximately _____ times thicker than water.

    <p>5</p> Signup and view all the answers

    Study Notes

    Hematology Basics

    • Hematology is a study of blood, its formation, and the diseases that affect it
    • Blood is a vital component of the body, transporting oxygen, nutrients, and waste products

    Pioneers in Hematology

    • Jan Swammerdam (1657) described "worms" in the blood - likely referring to red blood cells
    • Anton van Leeuwenhoek (1674) was the first to view red blood cells, calling them "small round globules"
    • William Hewson (1800) described platelets as "petites plaques"
    • James Homer Wright (1902) developed the Wright stain, significantly improving blood smear microscopy for diagnosis

    Composition of Blood

    • Solid portion: 20 g/ 100 ml of blood (formed elements)
    • Red blood cells (RBCs) - transport oxygen
    • White blood cells (WBCs) - fight infection
    • Platelets - help with clotting
    • Fluid portion: 90% water, 10% proteins, carbohydrates, salts, hormones, and other substances
    • Plasma: fluid portion of anticoagulated blood
    • Serum: fluid portion of clotted blood, lacking clotting factors

    General Characteristics of Blood

    • Blood exists in a fluid state in vivo, but coagulates within 5-10 minutes in vitro
    • Blood is thick and viscous, about 4-5 times thicker than water
    • The average blood pH is 7.4
    • A normal blood sample has a specific gravity of:
      • Whole blood: 1.045 to 1.065
      • Serum: 1.025 to 1.035
      • Plasma: 1.027 to 1.032
    • Color
      • Arterial blood: Bright red (oxygenated)
      • Venous Blood: Dark red (deoxygenated)

    Blood Collection Methods

    • Venipuncture: most common method, using:
      • Syringe
      • Evacuated tube system (ETS)
      • Winged blood collection set/butterfly
    • Capillary or Skin Puncture: useful for small blood volumes
    • Arterial Puncture: used for blood gas analysis

    Typical Venipuncture Sites

    • Antecubital Fossa (elbow crease)
      • Median Cubital Vein
      • Cephalic Vein
      • Basilic Vein
    • Other sites:
      • Ventral forearm
      • Wrist area
      • Back of the hand
      • Ankle
      • Foot

    Essential Venipuncture Knowledge

    • Needle Gauge: Larger gauge = smaller needle bore diameter (and vice versa)
    • Needle Length: Standard length is 1 inch
      • Color Coded Needle Length by Gauge:
        • White: 23 gauge
        • Pink: 22 gauge
        • Cream: 21 gauge
        • Yellow: 20 gauge
        • Green: 19 gauge
        • Black: 18 gauge
        • Blue: 17 gauge
        • Medium Purple: 16 gauge
        • Orange: 14 gauge
    • Venipuncture Angle:
      • Standard = 15-30 degrees
      • Preferred angle = 15 degrees
    • Tourniquet:
      • Should not exceed 1 minute of application
      • Applied 3-4 inches above venipuncture site
    • Disinfection:
      • Standard disinfectant: 70% Isopropyl alcohol
      • Blood culture disinfection: Povidone-iodine (Betadine)
      • Ethanol testing requires a specific protocol
    • Blood Pressure Cuff as Tourniquet:
      • Standard = 70 mmHg
      • Range = 60 - 100 mmHg
    • Number of Attempts: Two unsuccessful attempts warrant calling another medical professional
    • Patient Position:
      • Lying down: Decreases packed cell volume (PCV) by 8% and WBC count
      • Standing: Increases PCV by 8% and WBC count
    • Waste Disposal: Use appropriate color-coded waste bags:
      • Yellow: Infectious sharps waste
      • Orange: Pathological waste
      • Red: Infectious waste
      • Yellow with black band: Chemical waste
      • Green: Non-infectious wet waste or biodegradable waste
      • Black: Non-infectious dry waste or non-biodegradable waste
    • Special Considerations:
      • Never draw blood from an arm with a dialysis access device (cannula) or fistula
      • Finger punctures are made parallel to the fingerprint lines
      • Falsely increased results: prolonged tourniquet application
      • Falsely decreased results: inadequate blood flow

    Hematology Complications

    • Bleeding
    • Hematoma
    • Bruising
    • Pseudo-aneurysm
    • Thrombosis
    • Reflex Arteriospasm
    • Arteriovenous Fistula formation
    • Cellulitis (tissue inflammation)
    • Phlebitis (blood vessel inflammation)
    • Sepsis
    • Septic Arthritis
    • Osteomyelitis (bone infection)
    • Orthostatic hypotension
    • Syncope
    • Shock
    • Cardiac Arrest
    • Iatrogenic (physician- induced) anemia (blood loss)
    • Diaphoresis (excessive sweating)
    • Seizure
    • Pain
    • Nerve Damage
    • Allergic reaction to Iodine
    • Necrosis (tissue death)
    • Basal cell carcinoma
    • Scarring

    Anticoagulants in Hematology

    • Ethylene Diamine Tetra Acetic Acid (EDTA)
      • Used in concentrations of 1.5 to 2 mg per ml of whole blood
      • Mode of action: Irreversibly removes ionized calcium (Ca2+) through chelation, forming an insoluble calcium salt. This prevents coagulation
      • Forms:
        • Dry form: Di-sodium and Tri-potassium (K3EDTA) EDTA
        • Liquid form: Tri-potassium (K3EDTA)
      • The preferred anticoagulant for hematology tests, as it minimizes RBC shrinkage and volume changes in the blood sample
      • Use for routine cell counts, blood smear preparation, platelet counts, and morphology assessment
      • Not for coagulation tests
      • Excess EDTA can lead to platelet swelling and fragmentation, causing falsely elevated platelet counts
      • Can falsely decrease ESR and hematocrit values if the concentration is too high
      • Inhibits fibrinogen-thrombin reaction
    • Sodium Citrate
      • Binds calcium to form a soluble complex
      • Preferred anticoagulant for coagulation studies
      • Ratio of blood to anticoagulant: 9:1
      • Concentration: 0.105 M to 0.109 M
      • Preserves clotting factors V and VIII
      • Used in:
        • Coagulation testing (black top tubes)
        • ESR testing
      • Not recommended for routine coagulation tests, as it can lead to falsely prolonged coagulation times

    Other Anticoagulants

    • Oxalates:
      • Used in concentrations of 1-2 mg/ml
      • Bind calcium to form insoluble calcium oxalate
      • Forms:
        • Potassium oxalate
        • Double balanced oxalate
          • Ammonium Oxalate (Winthrobe's): 2 parts, can cause RBC crenation (abnormal shape)
          • Potassium Oxalate (Paul Heller's): 3 parts, can cause RBC shrinkage
    • Heparin:
      • Also known as "Natural anticoagulant"
      • Action: Acid mucopolysaccharide that inhibits thrombin, thus preventing coagulation
      • Used as both in vitro and in vivo anticoagulant
      • Preferred anticoagulant for most chemistry tests
      • Optimum concentration: 15-20 U/ml of blood or 15-30 U/ml of blood (0.2 mg/ml of blood)
      • Used during percutaneous transluminal coronary angioplasty (PTCA) and cardiopulmonary bypass (CPB) to prevent clot formation

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    Explore the fundamentals of hematology, including the study of blood, its formation, and the historical figures who contributed to our understanding of blood components. Learn about the composition of blood and how various cells, such as red and white blood cells, play vital roles in the body.

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