Phlebotomy Part 4

Review GDoc named "Phlebotomy 7/31/25" and the order of draw chart

How long do RBCs (erythrocytes) live?

80 to 120 days

How long does a platelet (thrombocyte) live?

6 days

How long does a WBC (leukocyte) live?

1 day or less

Protective isolation

Protects an immunocompromised patient who is a high risk of acquiring micro-organisms from either the environment or from other patients, staff, or visitors

What is the dorsal aspect?

Back of the hand

What gauge is a green butterfly needle?

21

What gauge is a sea green/light blue butterfly needle?

23

What is the result of prolonged tourniquet application (longer than 1 minute)?

It causes hemoconcentration

Hemoconcentration

• An increase in the ratio of certain analytes to plasma

• biochemical changes take place in the slowed blood

What would you expect to be elevated if hemoconcentration occur?

Potassium

Polycythemia

A disease state in which the hematocrit (the volume percentage of RBC in the blood) is elevated

What diseases need therapeutic phlebotomy?

Polycythemia and hemachromatosis

What is the normal pH range of blood?

7.35 to 7.45

If you are doing a lipid panel or a cholesterol profile, how long does the patient need to fast?

10 to 12 hours

If you are doing a glucose test, how long does a patient need to fast?

6 to 8 hours

Therapeutic drug range

• dosage range or blood plasma/serum concentration expected to achieve the desired therapeutic effect

• maintain a therapeutic threshold

Glucose tolerance test (GTT)

• diagnose diabetes mellitus/insulin resistance

• OGTT = oral glucose tolerance test

Does serum have clotting factors (fibrinogen)?

NO

Does plasma have clotting factors?

YES

True or False; the larger the number, the larger the needle guage?

FALSE; the SMALLER the number, the LARGER the needle gauge

What is another name for an evacuated tube system (ETS)?

Vacutainer system (NOT a syringe)

Anticoagulants

Substances that prevent blood from clotting

What are the anticoagulants used?

• EDTA (Ethylenediamineteraacetic acid)

• Citrates

• Heparin

• oxalates

• sodium polyanethole sulfonate (SPS)

EDTA (Ethylene-diamine-tetra-acetic acid)

• prevents clotting by chelating (binding) to calcium

• needed to run a CBC (complete blood count)

What does EDTA stand for?

• ethylene

• diamine

• tetra

• acetic acid

Citrate

• prevent coagulation by chelating calcium, but not as strongly as EDTA

• sodium citrate (light blue tubes) is used for PT, PTT, and INR coagulation test

What is the ratio of blood to anticoagulant needed with sodium citrate?

9:1

What is the problem with sodium citrate not in a 9:1 ratio to blood

Under-filled tubes cause false, prolonged clotting times and will be rejected

Heparin

Prevents clotting by inhibiting thrombin formation

Oxalates

Prevents clotting by precipitating calcium

Sodium polyanethole sulfonate (SPS)

• prevents blotting by binding calcium

• used for blood culture collection

• it reduces the action of complement protein that destroys bacteria, slows down phagocytosis, and reduces activity of certain antibiotics

• need immediate mixing

What is the clot activator in serum separator tubes (SST) and plastic red-top tubes?

• silica particles

  • cause blood to clot within 15 to 30 minutes

• needs to be centrifuged

If you are drawing a bilirubin test, what color tube (NOT the top) does it have to be in?

Amber

What is the anticoagulant and the use for a pink top tube?

• Anticoagulant: EDTA

• Use: Blood banking (blood type/cross screen/match)

What is the anticoagulant and the use for a royal blue top tube?

• Anticoagulant: EDTA

• Use: Metals (lead levels) and toxicology

What happens when you fill tubes in the wrong order?

It can lead to interference in testing from additive carryover, tissue thromboplastin, or microbes

Tissue thromboplastin

A substance present in tissue fluid that activates a coagulation pathway and can interfere with coagulation tests

Describe microbe contamination with blood culture bottles

• blood cultures detect microbes in the blood and require special site cleaning measures prior to collection to prevent contamination from bacteria normally found in skin

• sterile bottle are drawn first

For all tubes, after you do the inversions, how long do you let the tube rest?

30 to 60 minutes

For all tubes, after it has rested, how long do you centrifuge?

30 minutes