Long Quiz 1

• K₂EDTA

• K₃EDTA

Anticoagulant for Lavander

• Immunohematology

• Blood Donor Screening

• CBC

Lavander Tube is used for?

Spray-coated K₂EDTA

Anticoagulant in Pink Tube

Pink Tube

Tube used for Blood Bank

• _{^{WHITE - Plasma Prepration Tube (PPT)}}

• _{^{LIGHT GREEN - Plasma Separator Tube (PST)}}

• _{^{ORANGE - Rapid Serum Tube (OST)}}

• _{^{GOLD - Serum Separator Tube (SST)}}

Also known as PLASMA PREPARATION TUBE (PPT)

• _{^{WHITE - Plasma Prepration Tube (PPT)}}

• _{^{LIGHT GREEN - Plasma Separator Tube (PST)}}

• _{^{ORANGE - Rapid Serum Tube (OST)}}

• _{^{GOLD - Serum Separator Tube (SST)}}

Also known as PLASMA SEPARATOR TUBE (PST)

• _{^{WHITE - Plasma Prepration Tube (PPT)}}

• _{^{LIGHT GREEN - Plasma Separator Tube (PST)}}

• _{^{ORANGE - Rapid Serum Tube (OST)}}

• _{^{GOLD - Serum Separator Tube (SST)}}

Also known as RAPID SERUM TUBES (OST)

• _{^{WHITE - Plasma Prepration Tube (PPT)}}

• _{^{LIGHT GREEN - Plasma Separator Tube (PST)}}

• _{^{ORANGE - Rapid Serum Tube (OST)}}

• _{^{GOLD - Serum Separator Tube (SST)}}

Also known as SERUM SEPARATOR TUBE (SST)

• LIGHT BLUE

  • 3.2% Sodium Citrate

  • 9:1 (Blood:Anticoagulant)

• BLACK

  • 3.8% Sodium Citrate

  • 4:1 (Blood:Anticoagulant)

Anticoagulant and Blood Anticoag ratio for:

• Light Blue

• Black

Light Blue (3.2% Sodium Citrate)

Tube used for Coagulation Studies

Black (3.8% Sodium Citrate)

Tube used for Westergren Sedimentation Rate

Green (Hepatrin + Lithium/Sodium/Ammonium)

Tube used for STAT CHEMISTRY TEST

• Lithium Heparin

• Sodium Heparin

• Ammonium Heparin

3 different anticoagulant in GREEN TUBE

Light Green (Lithium Hepatin + Sepator gel)

Tube used for Potassium Determination

Lithium Heparin + Separtor gel

Additive is LIGHT GREEN TUBE

Gray (Sodium Flouride)

Tube used for Blood Alcohol Level

• Sodium Flouride

  • may contain:

    • Potassium Oxalate

    • Na2EDTA

Anticoagulant for GRAY TUBE

Royal Blue

Tube used for Toxicology, Trace Metal, Nutritional Analyses

Tan (K2EDTA)

Tube used for Lead Determination

Yellow (ASD) —basta related to genetics or DNA

Used for Cellular Studies, HLA phenotyping, DNA and Paternity Test

Yellow (SPS)

_{^{yellow (asd) —genetics or DNA}}

Used for Blood Culture _{^{(inihibits phagocytosis and complement action)}}

Orange

^{Green = STAT PLASMA CHEMISTRY}

Tube used for STAT SERUM CHEMISTRY

Gold

Tube used for MOST CHEMISTRY TEST

Thrombin + Seperation Gel

Anticoagulant in Orange tube

Weekly

How often should phlebotomy trays be emptied and disinfected

Hypodermic Needle

Type of needle used in syringe method

• Gauge 18 —blood transfusion

• Gauge 21 —routine venipuncture

• Gauge 25-27 —subcutaneous puncture

What are the uses of each of these needle gauge:

• Gauge 18

• Gauge 21

• Gauge 25-27

Blood Pressure Cuff

What can be use instead of tourniquet

• EDTA

• Cirtrate

• Oxalate

Anticoagulant that prevents clotting by Binding in Calcium

Heparin

Anticoagulant that prevents clotting by inhibiting THROMBIN (factor IIa) in coagulation cascade

1. 70% isoprophyl alcohol

2. 1-10% povidone iodine pads/ tincture of iodine/ chlorhexidine

(30-60 secods)

Two-Step Cleansing for Blood Culture Specimen collection

Ask physicians permission

What should be done if collecting though the veins of the feet?

Skin Puncture

Technique of choice to obstain blood from newborns and pediatric patients

• Severe Burns

• Veins are being reserved

• Extremely obses

• Elderly patients

Skin puncture procedure may be used for adult patients with:

• .

• .

• .

• .

Lateral or Medial plantar surface of the heel

Skin puncture collection site for INFANTS (under 1 year)

Palmar surface of distal portion of 3rd and 4th finger (NON DOMINANT HAND)

Skin puncture collection site for Children (>1yr) and Adults

perpendicular

When skin puncture, the puncture should be _____ to the fingerprint

Microcollection Tube

In Skin Puncture, what must be filled first? Capillary tubes or Microcollection Tube

warmed in incubator at 37*C for 30minutes

Sample for patients with COLD AGGLUTININS must be?

• Bilirubin

• Beta-carotene

• Vitamin A

• Vitamin B6

• Vitamin B12

• Folate

• Porphyrins

Photosensitive Analytes

Chain of Custody

Refers to the Documentation of sample handling

• Soap and Water

• Benzalonium Chloride (Zephiran Chloride) —_{^{non alcohol}}

When collecting blood of Blood Alcohol test, what must be used to cleanse the site?

30-60 seconds

70% alcohol should be scrubbed to the site for ______

Threatens the intergrity of fistula and vascular graft, leading to serious complicaitons

Why should arm with fistula never be collected for blood?

Alteration of result (both blodd vessels have diff blood composition)

Why should artery never be punctured in venipucnture?

High risk of nerve, tendon, and arterial injury

Why should veins on wrist (lateral and palma surface) never be collected for blood sample

26

COLOR CODE FOR LANCETS:

• Green

28

COLOR CODE FOR LANCETS:

• Purple

30

COLOR CODE FOR LANCETS:

• Blue

32

COLOR CODE FOR LANCETS:

• Blue-green

plastic tubes and Mylar-coated glass

OSHA suggest the use of capillary tube made of ______ or ______ to avoid injury by broken glass and exposure to bloodborne pathogens

• Blood Gas —-rotate between palm

• EDTA ——10

• Lithium Heparin ——10

• Lithium Heparin (w/ gel separator) ——10

• Sodium Flouride/ Potassium Oxalate ——10

• Serum (w/ clot activator) —— 5

• Serum (no additive) —— 0

• Newborn Blood Spot Card ——collected separately

CAPILLARY TUBE ORDER OF DRAW (w/ inversion)

• Ammonia

• Lactic Acid

• Acetone

• Free Fatty Acids

• Pyruvate

• Glucagon

• Gastrin

• ……

Analytes that require chilling

binds to calcium

How do EDTA prevents blood from clotting

Within 6 hours of collection

_{^{4*C = 24hrs}}

When shoud CBC test at ROOM TEMPERATURE

Within 24hrs of collection

_{^{Room Temp = 6hrs}}

When should CBC be tested at 4*C CELSIUS

Within 3hrs of collection

When should peripheral blood films (PBF) be prepared?

• Counts exceed the linearity of instrument

• Instrument is nonfunctional

• Remote Laboraties

• Disaster Situation

When should Manual Cell Count be done?

• Hayem’s

• Gower’s

• Toisson’s

• Bethel’s

• Dacie’s Fluid —BEST RBC DILUTING FLUID

• NSS

• 3.8 Sodium Citrate

RBC Diluting Fluids (what is preferred)

1:200

_{^{(TWO HUNDRED HA!!)}}

Ratio of RBC:Diluting Fluid

• THOMA PIPETTE:

  • Markings: 0.5, 1, 101

  • Volume = 100uL

Markings and Volume of THOMA PIPETTE

16 Squares

How many squares are there in EACH WBC SQUARE?

25 squares

How many squares are there in EACH RBC SQUARE?

• WBC = 1mm²

• RBC = 0.4mm²

Area of each WBC and RBC Squares

_{^{5 squares x 0.2mm =}} 0.2 mm²

Total counting Area for RBC Squares

10

Depth Factor

RBC Count Calculations

1mm³ = 1 microliter (uL)

1 liter = 1 uL x 10⁶

1mm³ = ???

1 liter = ???

Packed Cell Volume (PCV)

Other term for Hematocrit

• Percentage

• Liters / Liter

Hematocrit is reported as _____ or _____

0.05 mL

Volume of Blood in Microhematocrit Tube (Capillary Tube)

• Insufficient Centrifugation

• Including the Buffy Coat

• RBC Disorders

• Blood Loss

• Dehydration

HEMATOCRIT SOURCE OF ERROR:

• Flase Increase

• Improper Sealing

• Short Draw

• Improper Collection

• Increase Centrifugation

HEMATOCRIT SOURCE OF ERROR:

• Flase Decrease

Cyanmethemoglobin Method

Preferred method for HEMOGLOBIN DETERMINATION

Drabkin Solution

• _{^{Potassium Ferricyanide}}

• _{^{Potassium cyanide}}

• _{^{Sodium Bicarbonate}}

• _^Surfactant

What diluent is used for Cyanmethemoglobin Method

• It lyses the RBC to release hemoglobin

  • Potassium Ferricyanide = _{^{oxidizes hemoglobin to methemoglobin (Fe3+)}}

  • Potassium Cyanide = _{^{converts methemoglobin to cyanmethemoglobin}}

Drabkin solution is used for Hemoglobin Determination (Cyanmethemoglobin). What is its principle?

Hemoglobin x 3 = Hematocrit ± 3

Rules of Three?

Blood Film should be examined for abnormal RBC

Rules of Three _{^{(Hemoglobin x 3 = Hematocrit ± 3)}}

• What must be done if values do not agree?

• Microcytic = 80 fL (femtoliters)

• Macrocytic = 100 fL (femtoliters)

Mean Cell Volume:

• Microcytic

• Macrocytic

26 to 32 pg (pictograms)

Mean Cell Hemoglobin:

• Normal Range

• Hypochromic = <32 g/dL

• Normochromic = 32-36 g/dL

• Hyperchromic = >36 g/dL

Mean Cell Hemoglobin Concentration:

• Hypochromic

• Normochromic

• Hyperchromic

Spherocytes

MCHC between 36-38 g/dL must be checked for _______

_{^{NOTE: normal range is 32-36 g/dL}}

error in hemoglobin value

MCHC between 38 g/dL must be checked for _______

_{^{NOTE: normal range is 32-36 g/dL}}

Mean Cell Hemoglobin Concentration

Presence of COLD AGGLUTININS can cause an increase of what RBC INDICES?

1 day - _{^{peripheral blood ha!}}

How long does a RETICULOCYTE normally spends time in peripheral blood before developing to mature RBC

Reticulocyte _{^{(last immature RBC stage)}}

RBC stage that is used to asses the erythropoietic activity of the bone marrow

• New Methylene Blue (NMB)

• Brilliant Crysel Blue (BCB)

Supravital stains for RBC

Non-Nucleated RBC with particles of blue-stained granular filamentous material

How can you describe a RETICULOCYTE under a microscope, stained with supravital stain (e.g. NMB)

(# Reticulocyte ÷ 1000) x 100 = Reticulocyte (%)

Formula for Reticulocyte percentage

Erythrocyte Sedimentation Rate (ESR)

This test is ordered with other tests to detect and monitor the course of INFLAMMATION _{^{(non specific test)}}

Distance of mililiters that the RBC fall in one hour

(unit = mm/hr)

Principle of ESR