MLPAO Exam Review PDF

Standard of Practice (8-10%) 1.Lab Director: Responsible for the administration of the scientific and technical operation of the lab including the supervision of tests and the reporting of the results. 2.Lab Supervisor: Person under the general supervision of a laboratory director supervises labor...

Standard of Practice (8-10%) 1.Lab Director: Responsible for the administration of the scientific and technical operation of the lab including the supervision of tests and the reporting of the results. 2.Lab Supervisor: Person under the general supervision of a laboratory director supervises laboratory personnel and who may perform tests requiring special scientific skills. 3.Lab Technologist: Person who under general supervision performs tests which require the exercise of independent judgment 4.Lab Technician: Person who under direct supervision performs laboratory tests which require limited technical skill and responsibilities. RHPA ( Regulated Health Professions Act of 1991): -Ontario law and includes 26 regulatory colleges that regulate 29 distinct professions - over 300 000 healthcare professionals in Ontario. -MLTs are regulated under the RHPA , MLA/Ts are NOT. Lab Technicians: Section 1 of Ontario Regulation 682 :Defines a laboratory technician as a person who under direct supervision performs lab tests which require limited technical skill and responsibilities. Ontario Regulation 860: includes the WHMIS regulations for all workplaces covered by OHSA. The ministry of labor is responsible for both federal and provincial WHMIS legislation. PIPEDA (Personal Health Information Protection and Electronic Documents Act.: Applies to any private sector business that deals with someone's personal information. PHIPA (Personal Health Information Protection Act): Patient information that is specific to their health. It is our responsibility to protect patients information and follow guidelines regarding sharing their personal health information. The only time it is okay to share information is implied consent, Express consent, Substitute decision makers. Health care professionals that can order tests: All blood tests must be ordered under a Licensed Doctor or Nurse. Health Care Consent Act 1996 (HCCA): Legislation that deals with capacity to consent to treatment. Makes it clear that a person has the right to consent or refuse treatment if they have the mental capacity. Mental Capacity is defined as: capable with respect to a treatment, admission to or confining in a care facility or a personal assistance service to make a decision about the treatment, admission , confining or personal assistance service, as the case may be and able to appreciate the reasonably foreseeable consequences of a decision or lack of. Presumed capacity: A person is presumed to be capable with respect to treatment, admission to or confining in a care facility and personal assistance services. Exception: A person is entitled to rely on the presumption of capacity with respect to another person unless he or she has reasonable grounds to believe that the other person is incapable with respect to the treatment, the admission, the confining or the personal assistance service, as the case may be. No treatment without consent. Who can order blood tests: Physicians and nurse practitioners. 1.General Expectations of Medical Laboratory Assistants/Technicians: -Cooperate with other members of the team to provide effective patient care. -Ensure and protect confidentiality of all patient information. -Take responsibility for work done -Know the laws and regulations governing Medical Laboratory Technology and apply it to the profession - Practice within the scope of competence and seek help when task is beyond. Difference between direct supervisor and general supervisor and how it relates to the work we do: Section 9 (1): The owner and the operator of the laboratory shall ensure that the staff of the lab: Examine human specimens only : 1. At the request of a legally qualified medical practitioner or a dentist. 2. At the request of a midwife, in respect of a test specified in Appendix B. 3. At the request of an insurer or an agent within the meaning of the insurance act, in respect of HIV Antibody testing. 4. At the request of the registered nurse who holds an extended certificate of registration under the nursing act,1991 or 5. At the request of a person who is a participant in the provincial colorectal cancer screening program, in respect of a test or tests for the purposes of the program; -report the results of tests performed as a part of the provincial colorectal cancer screening  program to cancer care Ontario for the purposes of the Ontario cancer screening registestry; -Except in the case of a person described under sub clause 1 and 5, report the results of a test directly to the person who requested the it and include in the report the name of the lab that received the specimen and the name and address of the lab in which the test was performed; 9. Duties of Lab Technicians: The ministry of health and long term care lab branch has listed examples of duties of lab techs in a ministry procedure manual prepared June 1996. The following is an excerpt from the manual: Lab Technicians: Section 1 of Ontario Regulation 682 :Defines a laboratory technician as a person who under direct supervision performs lab tests which require limited technical skill and responsibilities In accordance with this a lab tech may, under direct supervision of an appropriately qualified MLT , respiratory therapist (RT), Medical Radiation Technologist (MRT), lab supervisor or director, perform tests which require limited technical skill and responsibilities, and which do not require interpretation, assessment or require of independent judgment. Specific work assignments should only be undertaken subsequent to thorough training and instructions by qualified supervisory personnel. A technician functions in accordance with predetermined criteria, which are used to recognize unexpected results, errors and problems. Any such difficulties or problems encountered during the performance of the day's work must be brought to the immediate attention of the personnel providing the supervision. A techs duties may include the following: - blood sample procurement - sample preparation for analysis eg. separation , numbering (including referral specimens) - reagent preparation - media preparation, smear preparation I.e blood films - staining of smears - cover slipping of slide preparation - concentration of stood samples for parasitology examinations - planting and streaking of microbiology specimens and controls, including set up of anaerobic and CO2 jars for reading by an MLT. - Subculturing of stock cultures in bacteriology - titration using the PH meter - urinalysis (excluding microscopic) - recording quality control results for interpretation and approval by qualified staff as listed above. - operation of automated instruments after proper functioning has been established by qualified staff listed above. - Set up erythrocyte sedimentation rates.  - Set up micro hematocrits. - Set up simple tests such as occult blood and pregnancy tests ( to be read and interpreted immediately by an MLT) - routine equipment maintenance - temperature monitoring of thermally controlled equipment. - transcription of results from worksheets to reports - filing of record and retrieval of files. - glassware washing, housekeeping - preparation of kits and may include many more tasks that don’t require an MLT or above. MLA/T shall: -Demonstrate knowledge of pertinent theoretical and practical items in the OSMT common core competency guidelines. - - Share knowledge with colleagues in the interest of optimal patient care - - Know and understand the ethical and legislative framework that influences the practice of Medical Laboratory Technology - - Know and apply institutional policies and procedures - 3. Safety: MLA/T shall conduct their professional practice in accordance with current safety guidelines and legislation. MLA/T shall: -Apply health and safety measures at all times to ensure the safety of patients, co-workers and themselves and for the protection of the environment. - Know and promote the proper use of appropriate safety equipment - - Cooperate with other members of the health care team regarding safety issues. -Follow the procedures for preservation and safe shipment of biological specimens in accordance with current government legislation. -Dispose of biological specimens and other hazardous waste safely in accordance with institutional policies and government regulations - -Understand and review all emergency response plans. 4. Specimen Procurement and Handling: MLA/Ts shall know and understand and follow standard procedures for the collection and handling of specimens and/or provide all the necessary information to those responsible for collection. MLA/Ts shall: -Show an understanding of specimen collection requests ( e.g. which health professionals can order tests and the specimen requirements of specific test requests) -Provide the information necessary for patients to understand the specimens collection procedure - Show courtesy, consideration and professionalism when dealing with patients. - Follow institutional protocol for the collection of specimens, ensuring proper identification of patients and specimens - Follow institutional protocol for specimen accessioning and handling, ensuring appropriate identification of specimens and documentation that is readily retrievable. 5. Testing: MLA/Ts shall know and understand the various steps of the techniques they perform and ensure the accuracy of their work by adhering to appropriate quality control protocols. MLA/Ts shall; -Have basic knowledge of the principles of the techniques they perform -Know and follow the various steps involved in the techniques they perform -Be proficient with the use, operation and maintenance of the equipment they use - Know the reference ranges, critical values and dectection limits of the techniques they use. -Know about possible interferences and refer problems to MLT. -Ensure that control protocols are followed for each test. -Know the principles of point of care testing procedures such as blood glucose and be aware of the requirements for operator training and instrument verification. 6. Quality Management: MLA/Ts shall work under the supervision of an MLT in a timely and accurate and effective manner. 7. Ethics: Ethics are defined as principles of conduct governing an individual or group. MLA/Ts shall: -Hold in confidence and protect all the information relating to patients. -Work with other health care professionals to provide quality effective patient care. -Promote the image and status of their contribution to the practice of laboratory medicine by maintaining high standards in their work habits and through active support of the OSMT -Work within legislated scope of practice and seek direction where required. - Endeavor to maintain and improve their skill and knowledge. - - Use safe work practices at all times.  Medical Terminology (5-7%) Suffixes, roots, prefixes and combining Vowels: Prefix: comes before the root word and defines or changes the meaning of the root. Root: The root is the foundation of a word and is usually based in Latin or Greek. Often both Latin and Greek terms are used to describe one English word. Two roots may be needed for one word meaning. Suffix: The suffix follows the root word and extends its meeting. Root words to describe color: White: Alb or Alb or Albin/o - Albinism - Consition of white hair, skin, eyes. White: Leuk/o - Leukocte - White cell Blue: Cyan/o - Cyanosis - Condition of blue Red: Erythr/o - Erynthrocyte - Red Cell Red: Rub/i - Rubeosis - Condition of redness Black: Melan/o - Melanoma - Black tumor Grey: Pol/o - Poliosis - Condition of grey Green: Verd/i - Biliverdin - A substance (Billirubin) that when exposed to light turns into another substance called biliverdin that turns into serum or urine a green color. Green: Chlor/o - Chloropsia - Green vision, rare condition of digitalis poisoning. Yellow: Cirr/o - Cirrhosis - Condition of liver damage, which turns the patient skin yellow. Yellow: Ict/o - Ictotest - Tables used for testing urine for bilirubin (yellow). Yellow: Lut/e - Corpus luteum - Left over ovarian follicle that produces hormones and is called the “yellow body” Yellow: Zantac/o - Zanthochromia - Yellow colour associated with urine or serum. Colour: Chrom/o - Polychormatic - Condition of many colours. Root words for Body Parts: Extremities: Acr/o - Acromegaly - Enlargement of extremities Gland: Aden/o - Adenitis - Inflammation of the gland Fat: Adip/o - Adipocele - Hernia of fat Vessel: Angi/o - Angioplasty - Repair of a vessel (blood or lymph) Artery: Arteri/o - Arteriole - Little artery Joint: Arthr/o - Arthrodynia - Pain in the joint Armpit: Axill/o - Axillary - Pertaining to the armpit Pressure: Bar/o - Barometer - Instrument to measure pressure Sprouting: Blast/o - Blastocyst - The sprouting or begging in of a new cell Arm: Brachi/o - Branchial - pertaining to the arm Heart: Cardi/o - Cardiologist - Heart specialist Head: Cephal/o - Cephalagia - Pain in the head Neck: Cervic/o - Cervicobrachialgia - Pain in the neck and arm Brain: Cerebr/o - Cerebral hemmorhage - Abnormal flow of blood in the brain Cartilage: Chrondr/o - Chrondrocyte - Cartilage cell Large intestine/ colon: Col/o - Colposcopy - Procedure to view the large intestine Body: Corp/o - Corpus luteum - Yellow body Skull: Carin/o - Craniotomy - Incision into the skull Release or Secrete: Crine/o - Endocrine - To release or secrete inside the body Bladder/sac: Cyst/o- Cystalgia - Bain in the bladder Cell: Cyt/o - Cytology - Study of cells Elbow: Cubit/o - Anticubital - in front of the elbow Skin: Cutane/o - Cutaneous - Pertaining to the skin Brain: Encephala/o - encephalitis - inflammation of the brain Small intestine: Enter/o - enteric - pertaining to the small intestine Normal: Eu- -Eupnea - normal breathing Stomach: Gastr/o - Gastritis - Inflammation of the stomach Female reproductive organs: Gynec/o - Gynecopathy, Disease of the female reproductive organs Blood: Hemat/o, Hem/o - Hematoma - Tumor of the blood Liver: Hepat/o - Hepatitis - Inflammation of the liver Tissue: Hist/o - Histology - study of tissues Same: Home/o - Homeostasis - the body in a steady or constant state. Groin: Inguin/o , Inguinal, Pertaining to the groin Voice box: Laryng/o - Laryngeal - Pertaining to the voice box Abdomen: Lapar/o - Laparoscope - Instrument to view abdomen Lower back: Lumb/o - Lumbodynia - pain in the lower back Lower jaw: Mandibul/o - Mandibular - Pertaining to the lower jaw Upper jaw: Maxill/o - Maxillomandibular - Pertaining to the upper and lower jaw Marrow or spinal cord: Myel/o - Poliomyelitis - Inflammation of the grey marrow Muscle: My/o - Myograph - Instrument to record the muscle Kidney: Nephr/o - Nephritis - Inflammation of the kidney Nerve: Neur/o - Neuralgia - pain in the nerve Ovary: Oophor/o - Oophorectomy - Surgical removal of an ovary Eye: Ophthalm/o - Ophthalmic - Pertaining to the eye Mouth: Or/o, Os/o - Oral - pertaining to the mouth Bone: Oste/o - osteogenic - bone producing Ear: Ot/o - Otalgia - pain in the ear Vein: Phleb/o - Phlebotomy - Incision into the vein Foot: Pod/o - Podiatrist - Foot specialist Rectum: Proct/o - Proctoscope - instrument to view the rectum Mind: psych/o - psychiatrist - doctor of the mind Lung: Pulmon/o, pneum/o - Pulmonary - pertaining to the lungs Kidney: Ren/o - Renal - Pertaining to the kidney Nose: Rhin/o - Rhinitis - inflammation of the nose Fallopian/uterine tubes: Salping/o - Salpingitis - inflammation of fallopian tubes Flesh or connective tissue: Sarc/o - sarcoma - tumor of the flesh or connective tissue Lower vertebrae: Sacr/o - Sacrum - location of the lower vertebrae Chest: Thrac/o - Thracostomy - making an opening in the chest Urine: ur/o - hematuria - condition of blood in the urine Vein: Ven/e,Ven/i, Ven/o - Venipuncture - puncture of the vein Non human or foreign: Xen/o - zenograft - non human or foreign transplanted tissue into a human More root words: Slow: Brady - Bradycardia - Condition of a slow heart Cancer: Carcin/o - Carcinogenic - Producing cancer Bile/gall: Chol/e - Cholecystistis - Inflammation of the bile (gall) bladder Sugar: Glyc/o - Hyperglycemia - Condition of high blood sugar Water: Hydr/o - Hydrocephalus - Water in the head Billirubin: Ict/o - ictotest - test that measures billirubin Tying or binding: Lig/o - ligation - process of typing or binding Fatty: Lip/o - lipoma - fatty tumor Stones: Lith/o - lithectomy - removal of stones Change: mut/a - mutagen - the Fungus: myc/o - mycology - study of fungus Cancer: onc/o - oncologist - specialist of cancer Oxygen: oxy - hypooxyia - condition of low oxygen Disease: path/o - pathology - study of disease Swallowing or eating : Phag/o - dysphagia - condition of difficult swallowing or eating Breathing: pnea - hypopnea - low breathing False: Pseud/o - pseudopod - false foot Pus: py/o - pyorrhea - flow of pus Fire or Fever: pyr/o -pyrpgenic - fever producing Hard: scler/o - arteriosclerosis - condition of hard arteries Fast: Tachy - Tachycardia - condition of a fast heart Heat: Therm/o - thermometer - instrument to measure heat Blood clot: thromb/o - thrombophlebitis - inflammation of a vein due to blood clot Prefixes: Without or absence: A- , An- - Acephalus - without a head Defective formation or incomplete development: Atel- - Atelectasis - Failure of part of the lung to expand Two: Bi- - Biparental - pertaining to two parents Spout or begin to form: Blast- - bastocyte - an early stage of embryonic development Cold or freezing: Cry/o - Cryogen- generate cold Two: di-, diplo- - Dicephalous - two headed Painful or difficult: Dys- - Dyspnea - Painful or difficulty breathing Half: Hemi- - Hemiplegis - paralysis of half the body Exessive, more than normal: Hyper- - Hpyertrophy - excessive growth or development Under low or below normal: Hypo- -Hypodermic - under the skin Medical treatment: Latro- - latrogenic - a condition that has resulted from medical treatment Large: macro- - macroscopic - large view, visible to the naked eye Severe or big: Mega- - megalgia - severe pain, big pain Middle: meso- - mesosternum - middle of the breastbone Small: Micro- - microscope - instrument to view small objects One-thousandth: Milli- - Milligrams - one thousandth of a gram. One: Mono- - mononeuritis - inflammation of one nerve Shape: morph- morphology- study of shape or structure Scanty or little: Oligo- - Oliguria - scanty urination Straight: Ortho- Orthopedic - correcting deformities cause by disease or damage to the bones and joints Children: Pediatr- -Pediatric - general medicine for children Many: Poly- - polyarteritis - inflammation of the arteries Four: Quadri- - Quadriplegia - paralysis of 4 limbs Half: Semi- - Semicircular - half of a circle Three: Tri- - Tricuspid - three points One: uni- - unioocular - one eye piece Prefixes for Locations: Against: Anti- - Antidiuretic - Against diuresis (urination) In front of: Ante- - Antecubital - In front of the elbow Through: Dia- - - Diarrhea - Flow through Apart or separate: Dis- - Dissect - to cut apart or seperate Outside: Ec-, Ecto-,Ectop- - Ectopic pregnancy - pregnancy outside the uterus Inner: En-, Endo- - Endocarditis - pertaining to the inner heart On top of: Epi- - Epirenal - pertaining to ontop of the kidney Out: Exo-, Ex- - Exopthalmia - eyes protruding out Outside: Extra- - Extracellular - outside of the cell Below: Infra- - Infraternal - below the breastbone Within: Intra- - Intradermal - within the skin Beside: Para- - Parathyroid - beside the thyroid Around: Peri- - Pericardium - around the heart After: Post- - Postpartum - after birth Before: Pre-, Pro- - Prolactin - before lactation Behind: Retro- - Retrocervical - behind the neck Beneath or below: Sub- - Suburethral - below or beneath the urethra Above: supra- - suprasternal - above the sternum Across: Trans- - Transdermal - Across the skin Suffixes for medical procedures: Aspirate fluid from: -centesis - Amniocentesis - Aspirate fluid from the amniotic sac To kill: -cide - Germicide - To kill germs To release or secrete: -crine - Endocrinology - stude of glands that secrete or release To cut out or remove: -ectomy - Appendectomy - to cut out or remove your appendix Dilation of tubular structures: -ectasis - bronchiectasis - dilation of the bronchi Medical study or specially: -iatry - psychiatry - study or specialty of the mind Record: -gram - Electrocardiogram - Record of electricity of the heart (printout) Machine to record: -graph - electrocardiograph - machine to record electricity to of the heart Process of recording: -graphy - electrocardiography - process of recording electricity of the heart Study of: -logy- Cardiology - Study of the heart Examination: -oscopy - hysteroscopy - examination of the uterus Making a surgical opening: -Ostomy - colostomy - making a surgical opening of the large intestine Cut or incision: -otomy - neurotomy - cut or incision of the nerve Surgical repair: -plasty- rhinoplasty - surgical repair of the nose Fix (suture): - pexy - nephropexy - to surgically dis kidney into place Out of anatomical place: -ptosis - pytosis - a condition in which an internal organ falls out of anatomical place. Instrument to view: -scope - microscope - instrument to view small objects Stopping or controlling: -stasis, -stat - Homeostatis - stopping or controlling blood (bleeding) Treatment: -therapy - chemotherapy - treatment by drugs or chemicals Suture: -rrhaphy - dermarraphy - to suture or stitch the skin Pain: -algia- cephalgia - head pain Hernation: -cele- enterocele - herniation of small intestine Pain: -dynia - cardiodynia - pain in the heart Vomiting: -emesis - hematemesis - vomiting blood Blood condition: -emia- hyperproteinemia - condition of high protein in blood Formation: -genesis - osteogenisis - formation of bone Producing: -genic - carcinogenic - producing cancer Condition: -ia- Arthralgia - condition of joint pain Abnormal condition: -iasis, lithiasis - abnormal condition of having stones Condition: -ism - Alcoholism - Condition due to alcohol Inflammation: -itis - Phlebitis - Inflammation of the veins Breakdown: -lysis - Hemolysis - Breakdown of blood cells Seizure: -plepsy - Epilepsy - upon seizure Softening: -malacia - Oseomalacia - softening of the bone Enlargement: -megaly - Cardiomegaly - englargement of the heart Tumor: -oma - carcinoma - cancerous tumor Condition: -osis - sclerosis - condition of hardening Lack of: -penia- thrombocytopenia - lack of platelets Speaking: -phasia - dyspasia - difficulty in speaking Fear: -phobia -hydrophobia - fear of water Development or growth: -plasia, aplasia, without growth or development Matter or tissue: -plasm - neoplasm - new matter or tissue Paralysis: -plegia -gastroplegia - paralysis of the stomach Formation: -poeisis - hematopoiesis - formation of blood Exessive flow: -rrhage, -rrhagia - Hemorrhage - exessive flow of blood Flow: -rrhea - pyorrhea , flow of pus Poisoning: -toxic - hematoxic - blood poisoning Development or function: -trophy - hypertrophy - exessive development or function Sugar or carbohydrate: -ose - glucose - a sugar or carbohydrate required for energy An enzyme: -ase -amylase - an enzyme for carbohydrate metabolism  Basic Biology, Anatomy and Physiology (4-6%) Atoms and molecules: at the chemical level Cells: contain organelles Tissue: 4 kinds; epithelial, muscular, nervous and connective tissue Organs: Liver, heart, kidney Organ systems: cardiovascular, digestive (14 total) Organism: A whole person Body Systems: 1. Urinary; Bladder and Kidney 2. Digestive; Stomach and Liver 3. Circulatory; Heart, arteries 4. Reproductive; Ovary, Testes 5. Respiratory; Lungs, Bronchial passages 6. Nervous; Brain, spinal cord 7. Immune; Antibodies 8. Lymphatic; lymph nodes, nodules, spleen 9. Skeletal; Bones 10. Muscular/ articular; Muscles/ joints 11. Endocrine; Hormones 12. Reticuloendothelial; Special WBC in reticular tissue 13. Hematopoietic; Bone marrow 14. Integumentary; (Skin, hair and nails) and special senses. Plains of the body: The body consists of right and left halves that are mirror images and exhibit bilateral symmetry. Humans have a cranium or skull and a vertebral column or spike. Humans are mammals , have hair, mammary glands and four limbs and five digits bearing nails. Major Body Cavities of the body: Ventral Body Cavity : 1.Thoracic Cavity: -Mediastinum: Trachea, Heart -Pleural Sacs: Lungs 2. Abdominal Cavity: Liver, Gallbladder, Stomach, Spleen, Pancreas, Small intestine, Part of large intestine, Kidneys. 3. Pelvic Cavity: Part of large intestine, urinary bladder, female reporductive organs. 4. Scrotal Cavity: Male reproductive organs Dorsal Body Cavity: 1.Cranial Cavity: Brain 2. Spinal Cavity: Spinal Cord Body regions: Axial Region: Head, neck and torso Appendicular Region: Upper and lower extremities (arms and legs) Groin: Hipe area Pectoral: Chest area Costal: Rib Body planes: Sagittal plane: divides the body into a left and right half. Transverse plane: divides the body into top and bottom half. Frontal or coronal plane: divides the body into front and back half. Anatomical Terms: Superior or cranial: top or above Inferior: below Anterior or ventral: in front of the body Posterior or dorsal: the back of the body Medial or midline: towards the middle Lateral: towards the side Proximal: chooser to the point of attachment to the trunk Distal: Far away from attachment point to the body Superficial: near the surface Deep: inside the tissue Supine: patient lying face up Prone: patient laying face down Bilateral symmetry: same on both sides if cut down the center. Hydrogen + Oxygen = water Carbon: basic building block to build proteins, carbs and fats. Nitrogen: the principal compound of immuno acids and helps with protein synthesis. Tissues: 4 groups that preforms all a specific function: 1. Epithelial 2. Connective 3. Muscle 4. Nervous 1.Epithilial Tissue: Simple squamous: Structure: Single layer of flattened cells Function: Diffusion, filtration and osmosis. Stratified squamous: Structure: Many layers of flattened cells. Function: Protection Simple columnar: Structure: Single layer of tall narrow cells Function: Protect, secretion, transport Stratified transitional: Structure: Many layers of varying shapes, able to stretch Function: Protect Pseudostratified: Structure: Single layer of tall cells that wedge together and appear as more than one layer. Function: Protection Simple cuboidal: Structure: Single layer of cells that are as tall as they are wide Function: Secretion and Absorption 2.Connective Tissue: the most abundant type of tissue on the body, varies in structure and function. It differs from other tissues due to the presence of intercellular material or matrix. Areolar: Structure: Loose arrangement of collagen fibers, elastic fibers and cells. Function: Connection Adipose: Structure: Cells contain large fat vesicle. Function: Protection, insulation, nutrient reserves Reticular: Structure: Net like arrangement: thin, delicate fibers Function: Support soft tissue, filteration Dense Fibrous: Structure: Dense arrangement of collagen fiber bundles Function: Flexible strong connection Bone: Structure: hard calcified matrix arrangement in osteons. Function: Support, protect Cartilage: Structure:Hard Fibrous matrix with embedded chondrocytes Function: Firm, Flexible support Blood: Structure: Liquid matrix with flowing red and white cells. Function: Transportation Hematopoietic: Structure: Liquid matrix with dense arrangement of blood cell producing cells. Function: Blood cell formation 3,Muscle Tissue: Skeletal (Striated Voluntary): Structure:Long thread like cells with multiple nuclei and striations Function: Movement of bones, eye movement. Cardiac (Striated involuntary): Structure: Branching interconnected cylinders with faint striations Function: Contraction of the heart Smooth ( non-striated involuntary): Structure: Thread like cells with a single nucleus and no striations Function: Movement along the tracts and ducts (peristalsis), change diameter of vessels. 4.Nervous tissue: Specialized for the rapid communication that is required by the nervous system. The tissue is comprised of nerve cells with large cell bodies and thin extensions. Supportive glial cells act as scaffolding for the nerve cells. 9 major vital organs: 1. Heart: main organ of cardiovascular system, size of a fist located just behind slightly to the left of the breast bone. It pumps blood through a network of arteries and veins throughout the body. 2. Brain: one of the most complex organs of the body, made of more than 100 billion nerves that help other organs communicate with each other. 3. Lungs: the lungs are a pair of spongy, air filled organs that are part of the respiratory system and located on either side of the chest (thorax). 4. Kidneys: are a pair of bean shaped organs that are a part of the urinary system and located on either side of the spine below the ribs and deep on the abdomen. 5. Liver: largest internal solid organ in the body located on the right side of the abdomen. It has multiple functions, the most important being energy production and metabolism. 6. Skin: the skin acts as a protective barrier against bacteria or fungi from entering the body. It maintains body temperature and PH balance. 7. Bones: Bones not only support organs and muscles but also play a major role in calcium metabolism in the body. 8. Adrenal Glands: these glands secrete hormones that help the body deal with stress. If these organs fail the body may go into a potentially fatal shock. 9. Hematopoietic system: Blood consists of red and white cells and platelets. If these organ systems fail, it can lead to severe bleeding or death from severe infection. Organ profile ( Liver, Cardiac, Anemia, Thyroid, Kidney, Lipid) Electrolytes can be red top tube if not STAT or SST/PST if STAT. Liver profile: AST (SGOT), ALT, Alk phos, Total protein, A/G Ratio, Billirubin, Direct and indirect, GGT, Ammonia - SST Chemistry (Gold and light green) Cardiac profile: Enzyme tests: AST, CPK and its isoenzymes, CKMB (CK2) - Heart, LDH and its isoenzymes, LD1- Heart/ Kidney/ RBC, LD2- Heart/Kidney/RBC - SST or PST (Gold and dark green) Protein tests: Myoglobin, Troponin 1 (Gold) Anemia Profile: CBC, Hemoglobin electrophoresis, Iron and TIBC, Reticulocyte count - Blood count - Lavender , SST for ferritin/iron (Gold and lavender) Thyroid profile: TSH, T3,T4 - SST,RIA (Gold) Kidney profile: BUN(urea), Creatinine, Uric acid, Electrolytes: Na Sodium, K Potassium and Cl Chloride. , Mg Magnesium, Ca++ Calcium urinalysis (Gold) Lipid profile: Chol, Trig, HDL, LDL, Lipoprotein electrophoresis - SST Chemistry (Gold)  Lab Mathematics, Statistics and Quality Assurance (8-10%) Coefficient of Variation (CV): is useful when comparing two or more tests methods.CV assesses which method is most precise. The CV expresses the standard deviation as percentage of the mean (average) value and is a more reliable mean of comparing the precision at different concentration levels. The precision of a method varies inversely (opposite) with the CV. The lower the CV the greater is the precision. Mode: The number that occurs most frequently in a given set of numbers. Ex: 15,16,17,18,15,18,19,15,20,15 the number 15 is the mode. Median: the middle value. Ex: 15, 16, 17, 18, 19 the number 17 is the middle value. Mean: the average value. Ex: 4,5,6,9 number 6 is the average. It can be calculated by adding 4+5+6+9 = 24 /4 (4 numbers in the set) = 6. Accuracy: The closeness of a result to the true or actual value. Accuracy is accessed by running an control sample at the same time of the test samples. A control result must fall within 2 standard deviations above average (mean) in order to be considered valid. If the control result is accurate, the test samples are assumed to be accurate. Controls ar run every few samples, depending on the type of testing being done. Precision: Refers to the reproducibility or repeatability of a test on the same specimen. Performing tests in duplicate or repeating the test at another times assesses precision. The results must match exactly. An auto-analyzer could be malfunctioning, which might cause patient results to be 20% higher or lower than they actually are. The results could be reproductive but not accurate. Accuracy vs. Precision: Accuracy is achieved by standardized procedures, the use of controls and proper documentation. Precision of a test can be calculated from the standard deviation or from the coefficient of variation (CV). Standard Deviation (SD): SD is statistical analysis of how much spread above or below average control results fall. A graph called a frequency or Gaussian curve represents a normal distribution curve. The curve is divided into 1,2 and 3 SDs. One standard deviation is defined as the areas where 68% of the tests values of a population studied would occur above or below the average result. These results are said to fall within 1+-SD. Two standard deviations represent 95% of the test values occurring equally above and below the average test result. These results are said to fall within 2+-SD. Three standard deviations are where 99.7% of the test values occur equally above or below the average test result. These results are said to fall within 3+-SD. This also includes a lot of abnormal test values, so any control sample results that fall into the 3+-SD are unacceptable. Significant Figures: Numbers can either be exact or inexact. Counting will gibe an exact number while taking measurements will produce an inexact number. Rounding the number is about keeping a number consistent with the lever of our confidence with that number. Three rules of rounding off numbers: 1. If the number(s) to be dropped is greater than five, increase the remaining digit by 1. 2. If the number(s) to be dropped are less than 5, leave the last remaining digit unchanged. 3. If the number(s) to be dropped is 5, leave the last remaining digit an even number. Rules for significant figures: Dealing with Zeroes: 1. Leading zeroes are never significant Ex: 0.00682 has 3 significant figures. 2. Imbedded zeroes are always significant. Ex: 1.072 has 4 significant figures. 3. Trailling zeroes are significant only if the decimal point is specified Ex: 300. Has 3 significant figures. Addition and subtraction: The last digit retained is set by the first doubtful digit. Ex: 25.6321 1.48 +2.776 = 29.8781 Answer with the correct number of significant digits is = 29.88 The answer should be rounded to the hundredths place as this is the place of the least accurate digit (1,48) Multiplication and Division: The answer contains no more significant figures than the least accurately known number. Ex: 12,3568 x 1,23 = 15,19788 Answer with the correct number of significant digits is = 15.2 The final answer should not exceed the smallest number of significant figures in any one factor. Temperature Conversion: Celsius to Fahrenheit: F = 9/5 (C )+32 F=1.8( C) +32 Ex: Convert 40C to F F=9/5(40C)+32 F=1.8(40C) +32 F= 72 + 32 F= 104 Fahrenheit to Celsius: C= 5/9(F-32) C=0.556(F-32) Ex: Convert 140 F to C C= 5/9 (140F -32) C=0.556 (140F-32) C= 5/9 (108). C=0.556 (108) C=59.99. C= 60.05 Rounded C= 60 C=60 Preparation of Reagents and Solutions: Reagents are substances used in the laboratory for testing. Reagents are to be prepared by dissolving a solid substance in a liquid to make a solution or by diluting a liquid with another liquid to make a weaker solution. Expression of Concentration: Weight per Unit Volume: When solid (weight) is being dissolved into a liquid (volume) solvent = w/v (mg/ml) Molarity and Molality: Both are used to describe the concentration of moles. A mole corresponds to Avogrados number 6.02x10^23. In chemistry one mole of a substance means there are 6.02x10^23 of those molecules present. The molar weight of a compound is determined from the atomic weights of the elements, found on the periodic table. Formula for Moles: Gram weight of the solute Mole= ———————————- Gram molecular weight of the solute The gram molecular weight (GMW) is how many atoms of which elements make up the compound. Molarity: molar concentration, number of moles of substance per liter of solution. Solutions are labeled with their molar concentration denoted with a capital M (1.0M solution contains 1.0 moles per liter of solution, 12.0M contains 12 moles per liter of solution) Molarity (M)= Moles of solute ——————— Liters of solution Molality: number of moles per kilogram of solvent. (12M means that for every kilogram of solvent 12 moles of solute was dissolved) Molality (M) = Moles of solute ——————— Kg of solvent To determine Molarity you need to know the number of moles of the solute and the amount of solution. If the number of moles of solute was not provided we would need to figure out the gram weight and gram molecular weight first, and then use the amount of solution given in the question. 1. Gram weight of the solute (how many atoms of each element) 2. Gram molecular weight of the solute (obtained from the periodic table) 3. The quality of solvent Ex: What is the Molarity of a solution that contains 2.50M of hydrochloric acid HCL in 100L of solution? M = 2.50M ——— 1.00L M= 2.50M the solution has a concentration of 2.50M or this solution has the Molarity of 2.50. Normality: Another way to measure concentration. Using the number of equivalent weights per unit volume where the equivalent weight divided by the valance. Valance is a number associated with each element. Normality = (Number of Gr of solute Gram equivalent Number of Equivalent weights weight of solute) ————————————— = —————————— Unit Volume Unit Volume Ex: Find the normality in 1.50 L of solution whose number of equivilant weights is. 8.5 g of solute ——————- 38.2 geqw of solute (8.50 / 38.2 geqw) ———————— 1.50L = 1.48 eqw Preparation of Reagents from liquid (V/V): A certain volume of one concentrate solution is added to a specific volume of diluent to make a second solution with a lower concentration. C1V1 = C2V2 C1= concentration of solution one V1= volume of solution one C2= concentration of solution two V2= volume of solution two Ex: C1= 4% V1= 100ml C2= 20% V2= unknown quantity of 20% acetic acid (4)(100) = (20)(V2) 400 = (20)(V2) 400 = (20)(V2) ——————— 20 20 20ml =V2 How to prepare this solution: Equipment needed: - 100ml Volumetric flask - a beaker - a 10ml or 20ml pipette 1. Measure less than 80ml of distilled water into the volimetric flask. 2. Pipette 20ml of 20% acetic acid into the flask of distilled water. 3. Using a Pasteur pipette, add the final drops of distilled water to the flask until the meniscus of the liquid reaches the etched line on the flask of distilled water. 4. Stopped the flask. Mix thoroughly by inverting several times. If the solution exhibits excess foaming, the flask must be rotated, rather than inverted. 5. Transfer the solution to a storage container it it is not used right away. Some solutions need to be protected from the light and should be put in an amber colored glass bottle. Strong bases must be stored in plastic bottles as they form silicates with glass. 6. Label the bottle clearly. Include concentration and name of the solution, preparation date and your initials. Preperation of Reagent from a Solid (W/V): A solids substance is accurately weighted and diluted in an amount of solvent to make a solution known concentration. This concentration is normally expressed as a percentage. W1 —- V1 X V2 = W2 W1= weight of the solute V1= volume of solvent; for a percentage solution, it is always 100ml V2= required volume W2= weight of solute needed for the required volume Ex: W1= 0.85g V1= 100ml V2= 400ml W2= unknown quantity of sodium chloride crystals 0.85 ——- 100. X400 = W2 0.0085 x 400 = W2 3.40g = W2 How to prepare this solution: 1. Fill a 400 ml volumetric flask about half full of diluent, distilled water. 2. Weight out 3.4g of sodium chloride in a weigh boat. Add it directly to the flask using a funnel. This ensures that no particles are lost in the transfer. 3. Rinse the weigh boat with water and pour the rinse water into the flask via funnel. 4. Swirl or invert the flask gently until the NaCl is dissolved. An option is to gently heat on a hot plate to speed up the dissolving time (some reagents cannot be heated - check the MSDS) 5. Fill the flask almost to the etched line with distilled water, using a beaker. Add the last few drops with a Pasteur pipette until the meniscus reaches the etched line (at eye level) 6. Stopper the flask and label appropriately. Ratios and Dilutions: Some lab procedures require testing on diluted specimens. Ex. White blood cell count is performed on whole blood that is diluted 1/20. A ratio expressed the relationship in number between two items. A dilution expressed the relationship between one item and the total number of items. Ex: Adding 1ml of blood to 19ml of diluent makes 1/20 dilution. The ratio of blood to diluent is 1:19. Ex: 0.2ml of serum is added to 9.8ml of water. What is the final dilution: Sample volume ——————— Sample volume + Diluent Volume 0.2ml ——— 0.2ml + 9.8ml 0.2. 1 —. =. —- 10. 50 Ratio = Sample volume: Diluent Volume 0.2:9.8 OR 1:49 Guide to calculations : Laboratory Controls: Known controls: supplied by manufacturer and known to the lab, plotted daily on a graph. Must be within 2SD before patient results can be reported. Assure the tests and personnel are running properly. (Commercial controls, in house pools) Unknown Controls: Control values are unknown to staff performing test; results of the controls assessed off site. (Blind duplicate patient samples) Different water grades: Type 1 (Ultrapure water): purest form of water to be produced. Used for critical application and advanced analytical procedures. ( Cell and tissue cultures, Liquic chromatography, Gas Chromatography, Inductively coupled plasma mass spectrometry, Molecular biology) Type 2: Doesn’t have the same prunes of Type 1, but still maintains high levels of purity. Used for general lab practices , microbiology analysis and preparation , electrochemistry. Can also be feed water for Type 1 production. Type 3 (RO water): Water produced through the purification technology reverse osmosis. Of all the pure water types it has the lowest level of purity, typical starting point for basical lab applications. Cleaning glassware, heating baths and media preparation. Can also be feed water for Type 1 production. Deionized water: Used to prepare solutions in the lab. Distilled water: Lab equipment feeding, lab glassware ringing after tests. Chemicals and their grades: USP/ GenAR : A line of chemicals manufactured under cGMP, meet the requirements of the 1995 USP 23 etc. BP: Pharmaceutical Grade chemicals, similar to USP grade. Conform to standards based on level of purity and lack of contaminant as in substance. CP (Chemically Pure): Products of purity suitable for used in general applications.  Specimen Procurement, Processing and Data Collection (12-16%) Blood Componants: Red Blood Cells (RBCs) 45% White Blood Cells (WBCs) under 1%, Platelets , Serum (if no anticoagulant),under 1% Plasma (if anticoagulant has been used) 55% Red Blood Cells: main function is to carry hemoglobin, the oxygen transport protein that give the RBCs their red color, unique shape called biconcave disk, no nucleus in mature RBCs. White Blood Cells: known as Leukocytes, Primary function is to protect the body from infection, two main categories: Granulocyte and Mononuclear Leukocytes. Platelets: Known as Thrombocytes, not actually cells, main function is coagulation. Plasma: Known as Thrombocytes, Extracellular matrix, yellowish fluid that suspends the cellular components of blood. Protein reservoir for the human body, vital role in homeostasis balancing electrolytes, Present in the blood that has anticoagulant. Serum: Is blood plasma without fibrinogens, if blood is collected without using anticoagulant, this will yield a blood clot and serum. Supplies for Phlebotomy: - Hand sanitizer - Gloves - Tourniquet - Needle adapter - Tubes being collected in order of draw - Needle in correct size for patient - 16-18 : Largest needle available. Often used for donation. - 21: Average adult - 22: Smaller Adult veins - 23:Butterfly for elderly or children - 25: Butterfly for babies - Blood culture bottles Aerobic and anaerobic - used only with a butterfly - cotton ball with tape or bandaid - Sharps container Where to locate a good vein to draw blood: Median cubital, cephalic and basilic is ideally where we want to puncture the patient. Tube additives: Anticoagulants: prevents clotting Clot activators: help blood coagulate quicker Polymer gel: acts as barrier to separate the cells from the serum or plasma. Hemostasis: when tissue is injured and begins to bleed, it initiates a sequence of clotting activities, called the clotting cascade that ultimately leads to the formation of a blood clot. How does anticoagulants work? EDTA strongly and irreversibly chelates (binds) calcium ions preventing blood from clotting. Some other anticoagulants do not cleat as strongly and can be reversed in clotting testing. Order of draw: 1. Yellow setrile 2. Light blue 3. Red 4. Golden or molted red, grey 5. Green 6. Lavender 7. Grey Yellow Serile/ Blood Culture: Aerobic, Anerobic Contains: Anticoagulants: SPS, Inhibits Phagocytosis, provides nutrients for bacterial growth. Additives: Resin bead/ Charcoal, absorbed antibiotic Inversions: 8 times for Vaccutainer, 4 times for bottles Department: Microbiology Light blue: Contains: Anticoagulant 9:1 Sodium citrate (9 parts blood to 1 part CTDA) -Reversibly chelating agent, CTDA: Citrate, theophylline, adenosine, dipyridamole Inversions: 3-4 times Red: Contains: Silica spray-clot activator Inversions: 5 times Sample Type: Serum Centrifuged: Sit up right for 60mins spin @3000-3500 for 15 mins. Serum and RBC clot. Department: Chemistry Blood Bank Royal blue (with red label): Sample Type: Serum Centrifuged: Sit up right for 60 mins spin @3000-3500 for 15 mins. Serum RBC clot. Department: Chemistry - Toxicology Gold/SST: Contains: Clot activators Inversions: 5 Times Sample types: Serum Centrifuged: Sit up right for 60mins spin @3000-3500 for 15mins. Department: Chemistry RST : Contains: Clotting factors thrombin Additive: Gel Inversions: 8 times Sample type: Serum Centrifuged: Sit up right for 60mins spin @3000-3500 for 15mins, serum, gel, RBC clot Department: STAT Chemistry Green: Contains: Anticoagulant heparin Additive: Gel Inversions: 8 times Sample type: Plasma Centrifuged: Sit up right for 60mins spin @3000-3500 for 15mins, Plasma, Buffy coat, RBCs Department: Chemistry LT green/PST mint: Contains: Anticoagulant heparin Additive: Gel Sample type: Plasma Centrifuged: Sit upright for 60mins spin @3000-3500 for 15mins, Plasma, gel, RBCs Department: STAT Chemistry Lavender: Contains: Anticoagulants: K2 EDTA, irreversible chelating agent Inversions: 8 times Sample Type: Whole blood, sometimes plasma Centrifuged: Sit upright for 60mins spin @3000-3500 for 15mins, Plasma, Buffy coat, RBCs. Department: Hematology Royal blue/ Lavender: Royal blue hemograd lid: indicates this tube is sent to heavy metals department within chemistry (Toxicology) The lavender label indicates the tube contains the same additive and anticoagulants as the lavender top tube. The tube contains EDTA but please note that K2EDTA is most commonly used. Sample type: Plasma Centrifuged: Sit upright for 60mins spin @3000-3500 for 15mins , Plasma, buffycoat, RBCs. Pink: Contains: Anticoagulants: K2 EDTA, irreversible chelating agent Inversions: 8 times Sample type: plasma Centrifuged: Sit upright for 60mins spin @3000-3500 for 15mins, Plasma, Buffy coat, RBCs Departments: Blood bank BBO Grey: Contains: Anticoagulants: potassium oxalate Additives: Sodium fluoride antiglycolytic agent Inversions: 8 times Sample type: Plasma Centrifuged: Sit upright for 60mins spin @3000-3500 for 15mins, Plasma, buffy coat, RBCs Department: Chemistry ( tube is used for glucose, blood alcohol, lactose testing. Mixing/inverting tubes: -Generally, tubes with no anticoagulants; gold, red invert 5-6 times. -Tubes with anticoagulants invert 8 times to mix the blood completely with anticoagulants, see back of phlebotomy book. -Will need to be mixed again before analysis. Needle disposal Containers (Sharps container): -rigid plastic containers -always needle tip first -never try to pull anything out of the container -Do not overfill -Lock when filled Requisitions: -Sample must match the requisition, if there is any discrepancy it must be cleared up by phoning OHIP or looking into the OHIP system. -Info -Patient identifier -Tests requested -Once a test is requested, proper steps to enact special handling can be taken. Sample handling: -Certain specimens must remain cool so they are placed in ice-water mixture. -Specimens to be kept warm and protected from light can be wrapped in tin foil. Chilled samples: Light Sensitive: -Ammonia. - Beta Carotene -Arterial Blood Gasses (ABG). - Bilirubin -Lactic acid. - Porphyrins -Glucagon. -Vitamin A -Gastrin. -Vitamin B6 -Adrenocorticotropic hormones. - Urine Porphyrins Chain of custody: -Patient must sign consent form -Patient must be present or be identified -Samples must be labeled appropriately to establish COC -Sealed with tamper proof seal -Placed in a locked container before transporting to site. -Signature of a responsible person through the chain of custody. Handling of documentation and personal information: Be careful who you are sharing the patient's information with. Make sure they are authorized before sharing sensitive information. When throwing away anything with personal information be sure to shred paper documents and black out labels. Be sure that over the phone you are verifying who you are speaking to and if they have authorization to the infromation. ( Ex husband etc.) Capillary Collections: - Lancet or skin puncture device. - Finger 3mm , Heel is 2mm can’t go beyond 2.4mm - A wider cut is more important than a deep cut. - Assemble the equpement , check the tube types and minimum amounts required.  - Use a warming device (warm face cloth) on the area, at least 3mins if area is cold to the touch. - Clean the site, and allow alcohol to dry completely , no blowing - Message the area gently, do not squeeze. - Hold the finger or heel firmly. - Make the puncture. - Discard the lancet - Wipe away the first drop of blood - Hold the finger in downwards position to encourage flow. - Milk the finger, alternating massaging and allow capillary refill. - Hold the micro container by the drop of blood and do not scrape it. - Tap the container to move the blood to the bottom, remember to invert the little tube, just as important as with a regular tube. - Apply pressure to the site, do not use a band aid on children under 2. - Label the tube. Reasons for performing Capillary collection: - Also can be called a dermal puncture. - Good for small volumes and point of care testing (POC) like blood glucose monitoring. - Can be used for obese patients and burn patients or those at risk of venous thrombosis, iatrogenic, anemia, hemorrhage, infection, organ or tissue damage, arteriospasm. Capillary Constrictions: - Some tests cannot use capillary collections; Blood culture, coagulation testing. - Dehydrated patients' capillary blood may not reflect an accurate picture of patients results. - Should not be performed on swollen areas, or on the same side as recent surgery ie. mastectomy. Venus vs Capillary: -Capillary collections are mixed of venous and arterial blood, as well as smattering of tissue fluid ( especially in the 1st drop) - Most blood levers are the same from capillary to venous, however not all substances remain the same. Levels higher in venous: Calcium, total protein, potassium (plasma) Levels higher in capillary: Glucose, hemoglobin, potassium (serum) Capillary collection site considerations: - Only use warm skin - Must have clearance from bone, if bone comes in contact with lancet it could lead to osteochondritis or osteomyelitis. - Pucture depth and width, width should not exceed 2.4mm this is more important than depth. - Finger 3,0mm , Heel 3,0mm , Infant heel, neonate: 0.65-0.85mm, Bleeding time: 1.0mm  - On adults and older children, the non dominant hand is usually used, the third and fourth fingers, the index finger has more nerve endings, so would be more painful, not the thumb as it is usually callused. Warm samples: - Cold agglutinins - Cytoglobins - Keep these warm by collecting the in a prewarmed tube with not gel ( put in incubator for 30mins prior) then after collection wrap with a hand warmer pack and sent to lab ASAP. Venipuncture complications: - Finding the patients - Emergency requisition/ patient identification - Patients are sleeping or unconscious, require consent, consult a nurse or supervisor, Treat them as if they are awake after you get the go ahead from the nurse. Continue to introduce yourself and chat with them, they may be able to hear you. - Language barriers, you still need consent for the procedure, if you cannot make it clear you may need to get a translator for deaf patients. - Find the nurse and explain it is the patients right to refuse. - The nurse may ask you to return with them, if they refuse again, document the refusal with the nurses name , time and date. Site selection problems: - Hardened or scleroses veins: Feels hard or cordlike, can be inflammation, chemotherapy, disease, IV therapy or drug use. These veins are susceptible to infection and may give erroneous results. - Hematomas: Caused by needles passing through a vein or the bevel partially in a vein. The blood is not fresh and it can contaminate the draw. - Edematous tissue: do not draw blood from swollen arm, results will not be valid. - Burns, scars or fresh tattoos: are to be avoided if possible. - Mastectomy & IV sites: Avoid if possible. - Rashes and track marks: Avoid if possible. Other issues that may arise: - Site cleaning issue, cannot use alcohol wipes when doing blood alcohol testing, Require Povidone iodine or chlorhexidine wipes. If an alternative is used, note it on the requisition. Providing-iodine is not recommended for capillary collections because it can elevate results for Bulirubin, uric acid, phosphorus and potassium. Torinquet Application: Hemoconcentration from leaving tourniquet on too long, plasma filters into the tissue, altering the results, increasing the RBCs and iron level and affecting the potassium and lactic acid as well as plasma proteins enzymes and lipids. Can be avoided by releasing the tourniquet as soon as the blood has begun to flow. Sample spinning and separation: - Sample that requires separation should have this done within 2 hours of collection, if there is a gel in the tube it can be spun and dose not need to be removed. - Glucose samples in the gray tubes are stable for 24 hours at room temperature. And 48 hours when cold (fridge). - EDTA are stable for 24 hours but blood smears may need to be done within an hour. Venipuncture process: 1. Greet the patient, tell them what you are going to do. 2. Identify patient by health card, or hospital bracelet, get 2 identifiers Name, DOB and compare the information to the requisition and verify it is the correct patient. 3. Inquire if the patient is fasting 4. Put your tray or equipement on a flat surface, not a bed or movable table. 5. Ensure the patient is comfortable comfortable. 6. Support the arm issuing a phlebotomy chair or if using a bed use a pillow. 7. Explain the procedure and get verbal consent. 8. Explain the pinch and that they need to stay still , distract them if they are nervous. 9. Perform hand hygiene and put on gloves. 10. Apply the tourniquet 3-4 inches above the intended puncture site. DO NOT LEAVE ON FOR MORE THAN A MIN. 11. Asses the veins, the best choices are median cubical, cephalic and basilic 12. Can also use my hand with a butterfly needle. 13. Palpate the veins, feel more than sight to determine the direction of the vein. 14. Release the tourniquet 15. Assemble your equipment, check expiry date on the tubes. 16. Attach the needle adapter to the needle size of choice. 17. Clean the site using 70% isopropyl alcohol or another type of antisptic. 18. Allow the site to dry for 30-60 seconds, this will prevent it from stinging and avoiding hemolysis. Do not blow on it. Reapply tourniquet. 19. Examine the needle bevel up. 20. Perform the venipuncture. 21. Anchor vein. 22. Angle the needle 15-30 degrees above skin. 23. Insert needle bevel up in a smooth quick motion, you will feel a slight give when the needle meets the vein. 24. Hold the needle assembly steady 25. Fill the first tube with the hand that anchored the vein, while holding the tube steady, have the label down so that you can see the blood flowing into the tube. 26. Remove the tube when blood stops flowing and gentaly mix it as soon as it is removed. 27. Insert another tube if needed. 28. Remove the tourniquet , can do it once blood starts flowing but MUST be removed before the last tube is taken out and before the needle is removed.  29. Withdraw the needle at the same angle it was inserted. 30. Activate safety shield. 31. Apply cotton ball or bandaid pressure should be applied until bleeding stops 32. Dispose of needle in sharps container. 33. Label the tubes, use any special handling instructions. 34. Check on the patient and thank them. 35. Deliver sample to the lab Hemoconcentration: increase in the ratio of formed elements (cells) to plasma, can alter some test results. Hemolysis: making the RBCs burst and the plasma or serum would be tinged red and can lather tests results with potassium Petechiae: small red spots (micro bruising) caused by the tourniquet. Blood Culture procedure: 1. Cleanse the site with alcohol for 30 seconds. 2. Cleanse the site with Batadine (Iondine) for one minute in circular motion. Air dry. DO NOT PALPATE 3. Cleanse the culture bottle rubber tops or SPS tube tops with alcohol. ** DO NOT USE IODINE ON BOTTLE 4. Label the bottles. 1. Aerobic. 2.Anaerobic 5. If blood collection is by needle and holder: lower patients arm until it is in a vertical position. The vaccine tube and stopper must be held vertically below the venipuncture site. The broth must not contact the stopper during venipuncture. 6. If blood collection is by butterfly: A vertical arm position is not required. 7. Tighten the tourniquet and perform venipuncture. 8. If the needle is in the vein, blood will flow into the culture bottle. If blood does not flow remove the culture broth container and needle immediately. Repeat Venipuncture. 9. Once blood begins to flow into the tube, loosen tourniquet. 10. Collect the Aerobic bottle first then the Anaerobic if using a butterfly needle. 11. After blood stops flowing immediately remove the tube from the needle. Collect the second specimen in the same manner. 12. If additional samples are not required, remove the needle from the vein. If additional samples are required they are collected after the BC. NEVER BEFORE. 13. Label tubes. with appropriate information and transport to microbiology. 14. Do not refrigerate blood culture specimens. If broth enters patient blood, called reflux the actively growing bacteria would use it as a food source and it would enhance their growth in the patients blood. Blood culture samples are done in 2 sets 20 mins apart. Physicians will be very specific regarding time frames. Some bacteria have very short reproductive cycles, as short as 20mins. When bacteria flood the patients system after replicating the patient will have a spike in temperature, this is the best time to collect the blood samples. Blood culture bottles come in pediatric size and adult. For patient less than 6 a 20ml bottle is often used which will draw 2ml of blood. For patients 6 and older, a 50ml bottle is often used to withdraw 10ml of blood. Blood culture procedure may differ from facility to facility. Follow protocol established by your institution. Ova and Parasite (O&P) Procedure: 1. Patients must not be given any laxatives or antidiarrheal drugs containing castor oil, mineral oil, bismuth or magnesium or any antibiotics for at least 5-7 days prior to collection. 2. The container has a small amount of SAF preservative in it, SAF= Sodium Acetate, Acetic acid and formalin. The SAF preservative is require since some forms of parasites disintegrate quickly. The preservative is mildly irritating to skin and mucus membrains so care should be taken to avoid skin contact. 3. The specimen should be collected in a clean dry container. The feces should not be mixed with urine or water from the toilet. 4. Using a wooden applicator stick, place small portions from the middle and each end of the fecal sample on the container containing SAF preservative. Place the lid on securely and shake vigorously until the specimen is completely and thoroughly mixed. 5. Label container with patients name, date and time of collection. 6. Do not freeze specimens. Precautions: - Avoid contaminating the stool with urine as it can destroy trophozoites. - Do not collect stool from a toilet bowl ( water is toxic to trophozoites and may contain organisms) - Use a container that contains SAF solutions. - Include macroscopic worms or worm segments, bloody and mucous portions of the stool specimen. Fecal Occult Blood (FOB) Procudure: Colorectal cancer is the third most common cancer. It is prevalent in people firfty years of age with a history of rectal prolapse or a family history of ulcer colitis. Cool tall cancer is associated with high fat and low fiber diets. Symptoms include changes in bowel habits, constipation, followed by diarrhea, Pencil thin stools, abnormal cramps, a sensation of a mass in the rectum, rectal pain, blood in stool. FOB is one of the best screening tests for early detection of colorectal cancer. Feces are collected into a dry clean container or smeared onto a Hemoccult II slide. Occult mean minute or hidden quality of blood that can be detected only by means of chemical testing. Occult blood is often present in stool of patients with gastrointestinal lesions. The test detects GI bleeding which may occur in ulcers , carcinoma, colitis, dysentery or internal hemorrhage. It’s an important screening test as 80% of patients show positive results. Further tests such as barium swallow, gastric analysis and endoscopy are necessary to identify the site and extent of the bleeding. Equipment: - FOB card, Often given in sets of 3. - 1 or 3 wooden applicator sticks, depending on how many FOB cards the doctor ordered. - Developing reagent. Diet requirements for test: - Do not eat red meat or horseradish. - You can eat chicken, pork and fish. - Do not take aspirin or non.steroidal anti inflammatory drugs for 7 days prior to testing. - Do not take Vitamin C (Ascorbic Acid) a max of 250mg per day. - Eat plenary of high fiber foods ( peanuts , corn, bran muffin) - Eat high fiber cereal daily. - If any foods are known to cause severe gastrointestinal symptoms please notify physician. Best method of collection to insure stool is not contaminated: - grease proof paper or Saran Wrap over the toilet bowl and seat down. Or a urine/stool pan that fits under the toilet seat. - Spread a very thin smear onto Box A of the first slide. Repeat on different portions of the stool for Box B. Do this for each consecutive bowl movement if the doctor has requested more than one specimen. Use a different card for each collection. - Most commonly collected for 3 days. - With a wooden applicator stick, collect a small amount of stool. - Complete all the information on the front of each side. - Do not collect during your period or if you have bleeding hemorrhoids. - Protect slides from heat, light and chemicals. - When the patient returns test refrigerates until testing is performed. Quality control for FOB: Control area of the card is the two small round windows in the Orange coloured area at the bottom of the card. The only positive sign should be blue and the one with the negative sign should be brown within 10 seconds. If control circles are not correct test needs to be redone. Source of Error: False positives results can be obtained if: - you have bleeding hemorrhoids. - On your period. - Taken aspirin greater than 326mg/per day. - Eaten read meat , horseradish or raw fruits and vegetables. - Not testing the control or reporting patients results if the control did not read correctly. - Exposing the card to direct sunlight, heat or chemicals. False negative: - Vitamin C consumed in excess of 250mg/day - Outdated reagents Patient Result Reporting: Reporting results is the MLT duty and is outside of the scope of practice of a MLA/T. Panic Values or Critical Values are to be reported immediately. Delay could result in serious consequences. When critical values are found, always check the critical value list. Not all abnormal results are critical. If a result is abnormal but not critical it is circled, flagged or highlighted. STAT tests are done immediately. Results of a STAT test are always phoned to the physician immediately, even if they are within a normal range. Not reporting a STAT is serious and life threatening. Table of Critical Values: Chemistry Tests: *STAT: Bicarbonate (HCO3) (ABG): Low: 40 mmol/L = Anoxemia Blood Urea Nitrogen: Low: N/A Hight: > 100mmol/L = Renal Insufficiency Billirubin, Total (New Born): Low: N/A High: >310 umol/L = Brain Damage Calcium: Low: 3.70mmol/L = Coma Creatine Kinase (CK): Low: N/A High: > 1800 lu/L = MI (Heart Attack) Creatinine: Low: N/A High: >359mmol/L = Coma Digoxin: Low: N/A High: >5.0mmol/L Glucose (Fasting): Low: 25.0mmol/L = Diabetic Coma Glucose (New Born): Low: 30.0mmol/L = Diabetic Coma Lead: Low: N/A High: >40.0mmol/L = Coma, Death *STAT: PCO2 (Arterial Blood Gases): Low: 9.31Kpa = Anoxemia *STAT: PH (Arterial Blood Gases): Low: 7.60= Anoxemia *STAT: PO2 (Arterial Blood Gases): Low: 250umol/L = Coma Potassium: Low: 6.5mmol/L = Arhythmias Salicylates: Low: N/A High: 2.20mmol/L = Toxicity Sodium: Low: 160mmol/L = Dehydration , Heart Failure Theophylline: Low: N/A High: >120umol/L = Siezures Hematology Tests: Hematocrit: Low: