MLS 1113 Exam 4

The most important aspect of phlebotomy

Patient identification

Steps involved with ordering, drawing and processing of samples for testing in the lab

A requisition from the patients physician must be received

Tests are entered by a nurse or PA using a computer system

Do procedure

Test requisition must include

Patient's full name, unique identifier, DOB, tests to be performed, date of request/test (time test ordered in lab), floor and room and bed #, physician name or code, test status ( routine, STAT, timed, etc)

At what degree should the needle be inserted

15-20 degree angle

The larger the needle #

The smaller the needle size

Capillary blood draw: what it is, preferred site, when it is usually performed

Finger poke

Ring finger, thumb if small

Small children

Arterial blood draw: when would it be performed and by who

When testing for blood gases

Respiratory therapists

Factors that influence type and location of phlebotomy

Mastectomy

Burns/scars

Small children

IV use

16 gauge is used for

Blood donations

18 and 21 gauge is used for

Vacutainer syringe

23 or higher gauge is used for

Butterfly

Red top common names

Clot tube, plain red, plain top, serum tube

Red top additive

No additives, silica helps with Clot activator

Red top liquid portion

Serum (clotting factors not in it since it already clotted)

Plasma vs Serum

plasma doesn't clot so when spun down it still has the clotting factors in it and serum doesn't have the clotting factors since it already has clotted

Red top tests

Chemistry, immunology (blood bank), toxicology (serum tests)

Blue top common names

Light blue, sodium citrate

Blue top additive

Anticoagulant- buffered sodium citrate

• Binds calcium and take it out of the equation and keeps the blood from clotting, calcium is needed for clotting

Blue top liquid portion

Plasma

Blue top uses

Coagulation studies that study how long it takes for blood to clot or the other forms that play a role in clotting

Blue top special requirements

Tube must be full - 9 parts of blood to 1 part anticoagulant

Purple top common names

Lavender top, EDTA tube

Purple top additive

EDTA - binds calcium in blood same as sodium citrate

EDTA gentle on cells

KEDTA- binds potassium in blood

Purple top liquid portion

Plasma

Purple top tests

Plasma or whole blood

Green top common names

Mint green top, heparin top

Green top additive

Anticoagulants: lithium heparin (most commonly used), lithium heparin with gel, sodium heparin, ammonium heparin

anticoagulant in green top

Heparin binds thrombin

Green top liquid portion

Plasma

Green top uses

Chemistry tests that require while blood (except hematology)

Any test that requires plasma

Gold top common names

Serum separator tube (SST), gold top, tiger top

Gold tube additive

SPS, acid sitrate dextrose - both activate coagulation

Polymer Gel- heavier than plasma but lighter than cells

Gold tube liquid portion

Serum

Gold tube uses

Any test that requires serum (except for toxicology)

Chemistry

Immunology

Royal blue top test

Heavy metal testing: Lead

Black top test

Sodium citrate ESR test

Gray top (looks like cream/beige) test

Glucose

Yellow top test (not gold) light yellow

Paternity testing (DNA)

Blood culture bottles

Petridish in a bottle, Tablet turns pink if bacteria are present

blood culture broth

mimics environment bacterial growth

You have been asked to draw a potassium level on a patient. The SOP states that the sample of choice is serum. Which tube is the best choice?

Gold/SST

A patient taking lithium for bipolar disorder comes into the lab for her standing lithium level check. What is the tube of choice?

Red

Correct order of draw

Blood culture, blue sky (light blue), black rain cloud, STOP light ( red top, yellow-gold top, green top), lavender bush (any tubes with additives)

4 major purposes for semen analysis

1. Fertility assessment

2. Vasectomy verification

3. Donation

3. Forensic

path of sperm from production to ejaculation

Testosterone

Testicles (sperm are produced here)

Epididymis (stored here, mature and become motile here)

Vas deferens (bus)

Prostate

Urethra

Outside world

Seminal fluid is high in nutrients like

Flavin and fructose

Seminal fluid is added by

Seminal vesicles and prostrate

Requirements for abstinence

2-5 days - counts will be lower if too short or too long of a wait

Collection method

Masturbation into sterile cup

Transportation to the lab

Within 30 mins of collection

Evaluation time

1 hour from collection get to it in 30 mins

Volume test and normal results

Measured to .1ml using a graduated cylinder or pipette

marking on collection cup

Normal: 2-5 ml

Viscosity test and normal/abnormal

Measured by dripping or pouring the sample

Normal: viscous - liquidy egg white

Abnormal: increased to non viscous

Count test and normal range

Measured using a hemacytometer

(containing 10um) count both sides and give average count of both

1:20 dilution 1 semen/ 19 water

Normal: 20-160 x 10^6 (million) per ml

Counting sperm

always done last on 40x

5 squares (top left and diagonally downward) of the middle square

count only the sperm heads

(20-dilution factor)(count of 5 small squares)(50,000)= sperm per ml

Counted on

40x

Raw count

Count / ml (hemacytometer)

Absolute count

Count/ejaculate

Motility test and equation

Place a drop of semen on a slide (with coverslip) 40x and count a minimum of 200 sperm using a counter. Total sperm - nonmotile / total sperm x 100 =

Motility normal is

50% or higher

progressive motility

Progressive motility when sperm leaves field

non-progressive when sperm stays in the field

Forward progression normal

2+ or higher forward direction

Acceptable condom for sperm collection

Silastic condom

Morphology test

Generally stained and looked at under 100x objective - follow the same counting process as motility

normal vs abnormal

Total sperm - abnormal sperm/ total sperm x 100 =

Morphology normal

50% or higher normal sperm

Sperm vitality is typically assessed when

Numbers are adequate but motility is low (less than 40%)

Sperm vitality test

Eosin nigrosin stain smear

Non-viable sperm stains red, living remains blue-white

Sperm vitality normal

50% or more viable sperm is normal

Large number of viable /non motile sperm may indicate

Defective flagellum

post vasectomy

no sperm should be present

What is the most important aspect of blood drawing?

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.

A sterile urine container

A condom without spermacides

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

False

True or false: Patients have the right to know their lab results within 30 days

True

Which is true regarding sperm production and storage?

Sperm are produced in the testicles and stored in the epididymus

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

Decreased

You are asked to draw a potassium, PT, and blood cultures on a patient. You choose to use the vacutainer method. According to what was taught in class, which order of draw would apply?

1. Blood Cultures, 2. Citrate tube, 3. SST tube

Which tube (s) yield plasma after centrifugation? Check all that apply.

Green Top, Blue Top, Purple/Lavender