Intended Learning Outcomes

and Content of Unit 4

• Use standard protocol in handling and collecting specimen
• Promote ethical and social responsibilities in dealing with patients.
• Collaborate with other health care professionals for methods and protocols of specimen
handling and patient preparations needed for each determination.
• Communicate properly the laboratory procedures and requirements to patients and physicians.

1. Types of Specimen
1.1. Collection and Labeling
1.2. Handling, Transport processing, Storage, and Preservation
2. Specimen variables
2.1. Pre-collection
2.1.1. Patient identification and preparation
2.1.2. Anticoagulants and preservatives
2.2. Collection
2.3. Post-collection 2
 Types of Specimen

• Body fluids: blood, CSF, urine, sweat, gastric juices, etc.

• Tissues

• Organs

• Others: hair, nail, skin scrapings, etc.

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TYPES OF BLOOD SPECIMEN
1. Serum
 liquid portion of clotted blood
 clearer than plasma

2. Plasma
 Liquid portion of unclotted
blood

3. Whole Blood
 plasma and red cells
 with anticoagulant
Taken from Bishop et al., 7th Edition, 2013, p. 29

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3 ways of obtaining
blood specimen
1. Venipuncture
 purplish venous blood

2. Arterial Puncture
 bright red arterial blood
 used for ABG test

3. Skin Puncture
 usually contaminated with tissues juices
 method of choice for pediatric and geriatric patients,
extremely obese adults, severe burn patients, and those
with thrombotic tendencies (bleeding disorders)

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 VEINS ARTERIES
• Thinner walls than arteries • Thick walls

• Collapse easily • Higher pressure: pulse

• Less pressure inside *no need to pull the plunger

CAPILLARIES
• One cell thick to allow exchange of
gases

• For micromethod collection only

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7
Venipunctur
e
sites
1. Antecubital fossa
 Median cubital
 Cephalic
 basilic

2. Other veins
 Brachial
 Femoral
 Radial
 Ankle veins
 Veins of the dorsal
hand
 Etc.
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 Inappropriate
venipuncture sites
• Arm on side of mastectomy

• Edematous areas

• Hematomas

• Arm in which blood is being transfused

• Scarred area

• Arms with fistulas or vascular grafts

• Sites above an IV cannula

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 Skin puncture sites
• lateral or at the medial surface of the heel
• ring finger
• ear lobes

How to puncture?
• Clean the area
• One quick deep stab!!!
• Perpendicular to the finger prints

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 METHODS OF BLOOD
Collection based on amount

1. Macromethod – 1.0 mL and above

2. Micromethod – 0.1 to 0.9 mL

3. Ultramicromethod – 0.01 to 0.09 mL

4. Nanoliter method – 0.001 to 0.009 mL

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Evacuated tubes

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 EFFECT OF
INCORRECT
ANTICOAGULANT

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PROPER ORDER OF DRAW

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Rationale of the
order of draw

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 Blood collection
procedure: open system
1. Check request slip
2. Identify the patient
3. Verify diet restrictions/fasting
4. Put on gloves and assemble the equipment
5. Reassure and position the patient
6. Apply tourniquet
7. Select the venipuncture site
8. Cleanse the area
9. Inspect the needle and syringe
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 Blood collection
procedure: open system
10. Tie the tourniquet
11. Perform venipuncture
12. Remove tourniquet before pulling out the needle.
13. Apply cotton/bandage
14. Transfer blood collected to appropriate tubes (mix if
nicessary)
15. Label tubes
16. Dispose contaminated materials
17. Transport specimen immediately

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 Blood collection
procedure
1. Check request slip
2. Identify the patient
3. Verify diet restrictions/fasting
4. Put on gloves and assemble the equipment
5. Reassure and position the patient
6. Apply tourniquet
7. Select the venipuncture site
8. Cleanse the area
9. Inspect the needle and syringe
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 Blood collection
procedure
10. Tie the tourniquet

11. Perform venipuncture

12. Fill the tubes and mix if necessary

13. Release the tourniquet before withdrawing the

needle

14. Apply bandage

15. Label tubes

16. Dispose contaminated materials

17. Transport specimen immediately

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 Specimen Variables
Prepare materials
& collect blood • Pre-analytical
Label specimen
• Analytical
Receipt of
lab. request
• Post-analytical
Forward blood
inside the lab

Patient ID
Inside the lab

YES

Patient confirmation
NO
Encode results
Check request & & sign
Technologist
patient preparation places specimen
in CC racks

yes
Meet patient prep

no
Politely explain why & Release results
give correct instructions
end
end

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 Pre-COLLECTION

• Patient preparation

• Patient’s request

• Blood collection

• Specimen Labeling

• Entry to logbook

• Specimen preparation

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PATIENT PREPARATION

1. Exercise
2. Fasting
3. Diet
4. Tourniquet Application
5. Drugs
6. Tobacco smoking
7. Alcohol intake
8. Posture
9. Stress
10.Diurnal Rhythms
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 EXERCISE
• involves any form of physical activity
• with short term or transient effect
• within one hour after exercise
• increases lactate (glycolysis: breakdown of glucose to
pyruvate and lactate)
• increases fatty acids and alanine
• long term effect
• increase enzymatic activity of enzymes
• CK
• AST
• LDH
• ALD

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 FASTING

• depends on the laboratory test

• Glucose Test (FBS) – 6 to 8 hours
• PPBS – 2 hours after eating full meal
• OGTT – 6 to 8 hours
• OGCT – 6 to 8 hours or none

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 DIET (FOOD INTAKE)

• Caffeine
• increases release of NEFA (non-esterified fatty acid)
• increases plasma catecholamines from adrenal
medulla and the brain tissue

• Protein diet
• increases BUN and ammonia levels

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 TOURNIQUET
APPLICATION
• < one minute only (max of 2 minutes)

• long torniquet application:

• hemostasis – stop blood
• hemoconcentration – increases formed elements of he
blood
• anaerobiosis – affects pH, O2 tension, CO2 tension of
blood (ABG test)

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Drugs/Alcoho Tobacco
l Smoking
• affect the liver • Acute effects
 increases plasma
• induce hepatic catecholamines and
microsomal enzyme cortisol due to
release nicotine
• Chronic effects
Alcohol  increase WBC count
esp. Monocyte
• increases acetate and
 increase
acetaldehyde level in carboxyhemoglobin
the blood (COHb)
 increase MCV
• increases GGT

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POSTURE
 leads to efflux or
transfer of filterable
substances from the
intravascular space to
the interstitial
 increases TP, Bilirubin,
Lipids, and enzymes
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STRESS
 affect secretions of
adrenal hormones
 leads to
hyperventilation
 disturbance of acid-
base balance –
affecting ABG test
 Diurnal rhythms

• body fluids and analytes’ fluctuations during the

day

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31

Taken from Bishop et al., 7th Edition, 2013, p. 29

Specimen collection

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Specimen collection

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Effect of hemolysis

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Needle insertion

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Procedural ERRors
• Hematoma: rapid swelling at or near the venipuncture site
due to blood leaking into the tissues
• Iatrogenic anemia: anemia as a result of treatment
• Inadvertent arterial puncture
• Infection
• Nerve injury
• Reflux
• Vein damage

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 Patient
complications
• Allergy

• Excessive bleeding

• Fainting/syncope

• Nausea or vomiting

• Pain

• Petechiae

• Seizures/convulsion

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 POST-COLLECTION

• Mixing

• Labeling

• Transport into the laboratory: protection

• Specimen handling and processing

• Centrifugation
• Rimming/ringing
• Transfer of serum/plasma: aliquot

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 Changes that occur if there
is delay in separation

1. Glycolysis
2. Enzymatic degradation: self destruction of enzymes (ACP)
3. Hemolysis
4. Extravascular interchange/Electrolyte shift
extracellular: Na+, Cl-
intravascular: K+, Mg2+
enzymes: ACP, AST, LDH (red cells)

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Changes that occur if there
is delay in separation

5. Changes in Lipid Concentration (Lipolysis)

6. Increase Plasma Protein
7. Blood gas changes
Open system: pO2, pCO2, pH
Closed system: pO2, pCO2, pH

8. Changes in PO43- due to hydrolysis of organic phosphate

esters
9. Bacterial changes
 glycolysis
 decreased Urea concentration
 increased NH3

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 THE END ...
•QUIZ next meeting
•Next topic Quality Management

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