Processing and Handling of Blood Specimens

48%, 68%

Studies show that approximately ___ to ____ of laboratory result failures are due to prior to analysis phase mishandling or error.

Routine Handling

Phlebotomist should adhere to time limits set for delivery of specimen to the laboratory except for cases such as emergency specimen or other conditions.

Routine Handling

Mixing tubes by inversion

Mixing tubes by inversion -

usually between 3 to 10

1. contact between contents and the stopper

2. minimize agitation of the specimen

3. aid clot formation for serum tubes

Transporting specimens should be transported with the stopper to avoid:

37 ˚C.

Body temperature: Specimen that precipitate or agglutinate if allowed to cool below body temperature should be transported at near body temperature which is ___

37 ˚C.; 15 minutes

Body temperature: The tubes should also be pre-warmed at ___ and portable heat blocks are used during transport which could hold the temperature for ___ from removal from the incubator.

heel warmer

Body temperature: A ____ can be used for specimen that can withstand a temperature slightly higher than 37 ˚C

• Cold agglutinin

• cryofibrinogen

• cryoglobulins

Special handling: Body Temperature examples

Chilled specimens

Chilling slows the metabolic process which could affect the results for some specimen.

crushed ice; water slurry

Chilled specimens: It should be completely submerged in _____ and _____ during transport and immediately tested or refrigerated if needed

• ACTH

• Acetone

• ACE

• Ammonia

• Catecholamines

• free fatty acids

• Gastrin

• Homocysteine

• lactic acid

• PTH

• ph/blood gas

• Pyruvate

• renin

Special handling: Chilled specimens examples

Light-sensitive specimens

There are cases when exposure to light could affect the result of a specimen, like bilirubin.

Light-sensitive specimens

The phlebotomist should wrap the tube with aluminum foil or use light-blocking ambercolored container.

• Bilirubin

• Carotene

• Red cell folate

• serum folate

• Vitamin B2

• Vitamin B

• Vitamin B12

• Vitamin C

• urine porphyrins

• urine porphobilinogen

Special handling: Light-sensitive examples

• identified

• logged or accessioned

• sorted by department and type of processing

• evaluated for specimen suitability which is necessary for accurate reasons

The collected specimen is transported to the central processing or triage for screening and prioritizing. The specimen are:

• Specimen is not identified properly.

• It has inadequate volume to complete the test.

• Hemolysis

• The use of wrong tube for collection.

• Outdated tube o Improper handling (improper mixing)

• Contaminated specimen

• Insufficient specimen or "Quality Not Sufficient" (QNS)

• Incorrect collection time

• Exposure to light

• Did not follow testing time limits

• Delay or error in processing

The specimen is rejected if it did not meet a specific criterion such as:

45 minutes

Delivery time limits: The specimen should be transported to the laboratory immediately after collection. Routine blood specimen is expected to reach the laboratory within ____

1 hour

Delivery time limits: For specimen that needs centrifugation, it should be done in ____

Hematology specimen

Delivery time limits: _____ with EDTA which are placed in tubes with lavender or purple stopper should not be centrifuged.

Time Limit Exceptions

The delivery time limit has some exception such as specimen that are marked as "STAT" or "emergency", it takes priority over all other specimen in terms of transportation, processing and testing

• Blood smear from EDTA specimen

• EDTA specimen for CBC

• EDTA specimen for erythrocyte sedimentation rate (ESR)

• EDTA specimen for reticulocyte counts

• Glucose test drawn in sodium fluoride tubes

• Prothrombin time (PT)

Other exceptions to the time limit rule are as follows:

• Gloves

• Laboratory gown/laboratory coats

• masks

OSHA-Required Protective Equipment Worn When Processing

Occupational Safety and Health Administration

OSHA

centrifuge

_____ is an apparatus that is used to separate cells, plasma or serum of blood specimen which is achieved by spinning the blood tubes inside the vessel at a high speed

• contamination

• evaporation

• aerosol formation

• pH changes

It is important to leave the stoppers on the tube before and during centrifugation to avoid ______,______,_____, and _____ which will affect the accuracy of the results

anticoagulants

The plasma specimen collected in tubes with ____ should be centrifuged immediately and without any delay

plasma specimen

The ____ collected in tubes with anticoagulants should be centrifuged immediately and without any delay.

serum specimen

____ needs to be completely clotted prior to centrifugation. Normally, complete clotting takes around 30 to 60 minutes at room temperature.

30 to 60 minutes

serum specimen needs to be completely clotted prior to centrifugation. Normally, complete clotting takes around ______ at room temperature.

stopper

Most of the test needs the ____ to be removed to obtain the serum or plasma

gauze or tissue

A ______ is used to cover the stopper to catch drops of blood that may leak or to catch aerosol that maybe release during the process

aliquot

An ___ of specimen refers to a portion of a sample specimen taken for chemical analysis or testing

ALIQUOT PREPARATION

This is prepared when multiple tests are ordered on a single specimen

one or more tubes; disposable transfer pipettes

Aliquot preparation: The preparation is done by transferring a portion of the specimen into ____ that are labeled with the same information as the original specimen tube using a _____

different anticoagulants

Aliquot preparation: Do not put specimen with ______ in the same aliquot tube

tube

Aliquot preparation: Make sure to cover the ____ as soon as it is filled