MLS 1113 Unit 4

Yield Serum (clotted blood)

Red top, Gold top (SST)

Yields Plasma

- Light Blue (citrate),

- Green top (heparin) (green sometimes have separator so PST)

- Lavender (EDTA or K2/EDTA) (yields plasma but most often used for whole blood

- anything with anticoagulant,

- Black (sodium citrate)

- Gray (Sodium Fluoride preservative, also contain anticoagulant)

Purple/Lavender top anticoagulant

EDTA or K2/EDTA (binds calcium)

Green top anticoagulant

anticoagulant = Heparin (binds thrombin).

3 flavors: 1) Sodium heparin, 2) Ammonium Heparin, 3) Lithium Heparin.

Lithium Heparin tube most commonly used unless testing specifically for lithium.

Red top additive/anticoagulant

none (sometimes have silica particles to help blood clot faster)

Light Blue anticoagulant

anticoagulant = Sodium citrate (binds calcium)

Gold top anticoagulant/additive

No anticoagulant (yields serum). Additive is polymer gel for separating serum (SST).

Light Blue (citrate) top uses

Coagulation studies (add calcium back in to make blood clot, then measure clotting time, etc.)

- PT/PTT

- thrombin, fibrinogen

- factor assays

- INR

- requires FULL draw (preserve anticoagulant ratio)

red top (plain top, clot tube) uses

chemistry,

toxicology (most common - good because no additives so no interference with drug tests)

immunology

Green top (PST, mint green) uses

Chemistry requiring heparinized blood

Purple/lavender top uses

- hematology: CBC, full blood count (FBC), hemoglobin/hematocrit, differential

(good for blood count tests because gentle to RBCs - but even though gentle to cells, cells still only good for 24-48 hrs)

- blood bank

- yields plasma but most often used for whole blood

Gold top (SST) uses

serum tests (when you don't need cells)

chemistry serum tests

even separator gel interferes with tests so no drug testing

black top additive/anticoagulant

anticoagulant = sodium citrate (same as light blue) - binds calcium

- yields plasma

black top uses

ESR (sedimentation rate)

light yellow top additive/anticoagulant

anticoagulant = ACD (acid citrate dextrose)

light yellow top uses

DNA analysis (example paternity testing), rarely used

royal blue top uses

heavy metal testing (e.g. lead)

royal blue top additive/anticoagulant

anticoagulant = sodium heparin

gray top additive/anticoagulant

sodium fluoride preservative (preserves glucose), also contain anticoagulant (different ones available)

gray top uses

glucose tolerance tests, glucose testing

blood culture bottles

contain broth that mimics blood environment (promotes bacteria growth), tablet that changes color if bacteria present

- carefully disinfect to avoid contaminants

syncope

fainting - patient will get pale, face turns green. have patient put head down, cold compress on back of neck, or lie down and put feet up

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1. blood culture

2. light blue (citrate)

3. red (plain)

4. gold (SST)

5. light green (Lithium Heparin)

6. dark green (Sodium Heparin)

7. lavender (EDTA)

8. gray (Sodium Flouride)

9 light yellow (ACD)

syringe order of draw

1. blood culture

2. light blue (citrate) (has to be full)

3. Other anticoagulants (do first so blood won't clot)

4. tubes without anticoagulants (red tops and gold SST's)

vacutainer order of draw

1. blood cultures

2. light blue (citrate) (has to be full)

3. tubes with no additives (so no residue from anticoagulant /additive)

4. heparin (green)

5. EDTA (purple)

6. Other additive tubes

purpose of phlebotomy

quality blood

most important part of phlebotomy

patient identification

preferred phlebotomy site

antecubital

veins of choice

1. medial cubital vein (best)

2. cephalic (roll easier and hurt more)

3. basilic (roll easier and hurt more - close to artery)

factors that influence type and location of phlebotomy

- edema

- mastectomy (use opposite arm of where lymph nodes were removed)

- burns/scarring

- children (to capillary or heel stick if test allows)

- IV (use other arm if at all possible - otherwise draw BELOW IV line)

Causes for hemolyzed blood sample

1. shaking tube too hard

2. bevel right on vein wall (you can tell because blood comes slow)

3. tourniquet too tight

Angle for blood draw

15 to 20 degrees

23 - 25 gauge

butterfly

21 gauge

vacutainer

19 gauge

syringe

16 gauge

blood donations

the larger the gauge number

the smaller the needle

what you should do for capillary puncture

wipe first drop of blood

purpose of semen analysis

- fertility assessment

- vasectomy verification

- donation

- forensic

sperm are produced in the

testicles

sperm are stored in and mature in the

epididymis

ejaculation

move from epididymus to vas deferens where they are carried to ejaculatory duct

ejaculatory duct

- where fluid from seminal vesicles is added (high in nutrients like flavin and fructose)

- prostate also adds to total volume of ejaculate

urethra

between ejaculatory duct and outside world

required time for abstinence before collection of semen

2-5 days

normal semen volume

2-5 mL

semen volume

#mL (measured to 0.1 mL)

normal viscosity

viscous (should be a little more liquid than egg whites)

abnormal if runny (non-viscous) or lumpy (increased viscosity)

raw count calculation

(dilution factor) (count in 5 squares) (50,000) = sperm/mL (express as 10^6, not million)

normal raw count

20-250 x 10^6/mL

absolute count calculation

raw count * volume (express as "per ejaculate")

normal forward progression

2+ or higher

normal motility

50% or higher

calculation for motility

(total sperm - non-motile) / total sperm X 100

(need to count 200 minimum)

normal morphology

50% or higher (counted as % normal forms)

morphology method

- stained and looked at under 100X objective (count 200 minimum)

- normal must have tail attached and tail should be 3X length of head

morphology calculation

(total - abnormal forms) / total X 100 = % normal forms

examples of abnormal morphology

large head, pin head, tapering head, double head, amorphous head (popcorn head), constricted head, spermatid (no tail)

sperm vitality

assessed when count is normal but motility is low (e.g. less than 40%)

sperm vitality method

- eosin-nigrosin stain smear: non viable sperm stain red, living remain blue-white

normal sperm vitality

50% or more

post-vasectomy analysis

less involved, monthly checks beginning at 2 months post vasectomy until 2 consecutive checks show "no sperm present"

blood culture prep

Use iodine swab instead of alcohol swab

What is the most important aspect of blood drawing?

Proper patient identification

What is the correct order of draw for a vacutainer phlebotomy?

Blue top, Red top, green top, purple top

Heparin works by binding __________.

Thrombin

Which of the following are acceptable collection containers for a semen analysis? Check all that apply.

Sterile cup and Silaste condom

True or false: Patients have the right to know their lab results so if they ask it is your responsibility to tell them

False

Where are sperm produced and stored?

Sperm are produced in the testicles and stored in the epididymus

A sperm count of 15 x 10^6/ml is

Decreased