HEMA LAB PRELIM GRAHHHHPAPAPAPA

Gloves

Must be worn when handling biological specimens; do not touch non-contaminated areas/equipment with dirty gloves. [1]

Biological Hazard Rule - Handwashing

Wash hands immediately if contaminated, regardless of whether gloves were worn. [1]

Biological Hazard Rule - Mouth Pipetting

Strictly prohibited in the laboratory; use mechanical pipetting devices. [1]

Biological Hazard Rule - Slides

Unfixed or unstained slides must always be considered infectious and handled with caution. [2]

Chemical Hazards - Fume Hood

Used for flammable or explosive chemicals to draw toxic fumes away from the workspace. [3]

Chemical Hazards - Acid Prep

Always add concentrated acid to water slowly, NEVER add water to concentrated acid to prevent splashing. [4]

Chemical Hazards - Reagent Labeling

Must include name, concentration, initials of preparer, prep date, storage requirements, and expiration date. [4]

Chemical Hazards - Disposal

Dispose of chemicals by pouring directly into the drain followed by copious amounts of water to avoid splashing. [4]

Electrical Hazards - Repairs

Always disconnect the instrument from the electrical supply before beginning any minor repair work. [5]

Electrical Hazards - Centrifuge Lid

Never open the centrifuge lid until the rotor has come to a complete and total stop. [6]

Mechanical Hazards - Sharps Disposal

Glass and sharp objects (needles, capillary tubes, pipets) must be discarded in puncture-proof containers. [6]

Random Error

Mistakes without a definable pattern or frequency that affect precision and increase scatter around the true value. [7]

Minor Random Error

Unavoidable errors caused by factors completely beyond the laboratory technologist's control. [7]

Major Random Error

Haphazard mistakes or accidents with significant impact on patient care, severely reducing precision and accuracy. [8]

Systematic Error (Bias)

Determinate errors affecting all specimens in a batch equally; detectable via controls and often due to uncalibrated instruments or bad reagents. [8, 9]

Non-Analytical Factor - Physiological Variations

Patient-specific variables like posture, diurnal rhythms, exercise, stress, diet, and smoking that affect results before testing. [9-11]

Physiological Variation - Posture Change

Shifting from supine to sitting/standing causes an increase in lipids, enzymes, and proteins due to water shifts. [10]

Physiological Variation - Diurnal Rhythm

Daily body fluid fluctuations; afternoon samples show decreased hormones but increased iron and eosinophils. [10]

Physiological Variation - Exercise

Strenuous activity increases creatinine, protein, CK, AST, LDH, and transiently elevates platelet and WBC counts. [10]

Physiological Variation - Smoking

Triggers acute increases in WBC count and cortisol levels; long-term smoking leads to elevated Hemoglobin (Hb) levels. [10, 11]

Skin Puncture - Capillary Blood

A mixture of capillary, venous, and arterial blood along with interstitial and intracellular fluids. [12]

Skin Puncture Site - Neonates

Lateral or medial plantar surface of the heel; or the plantar surface of the big toe. [13]

Skin Puncture Site - Adults/Older Children

Palmar surface of the last digit of the 2nd, 3rd, or 4th finger; or margin of the earlobe for older pediatrics. [13]

Skin Puncture Dimensions

Must be 0.85 to 2.0 mm deep and 1.75 to 3.0 mm in length to prevent bone contact while ensuring blood flow. [14]

Skin Puncture First Drop

Must be wiped away/discarded because it contains tissue juices that can contaminate the specimen. [14]

Venipuncture Site - Neonates

External jugular vein, temporal vein, or superior longitudinal sinus. [15]

Venipuncture Site - Toddlers (18mo - 3yr)

Long saphenous vein, femoral vein, popliteal vein, or ankle vein. [15, 16]

Venipuncture Site - 3 Years to Adult

Median cubital vein (primary choice in antecubital fossa because it is large, close to skin, and anchored), basilic vein, or cephalic vein. [16]

Arterial Puncture Purpose

Used specifically to measure Arterial Blood Gases (ABGs) including CO2 tension, O2 tension, and pH. [17]

Arterial Puncture Sites

Radial artery (preferred), brachial artery, or femoral artery. [18]

Order of Draw (Standard)

1. Blood Culture (yellow) -> 2. Non-additive/Serum (red) -> 3. Coagulation (blue) -> 4. Heparin (green) -> 5. EDTA (lavender) -> 6. Fluoride/Glycolytic Inhibitor (gray). [11, 19]

Blue Stopper Tube - Additive & Use

Contains Sodium Citrate (removes calcium); used for Coagulation studies (like PT/APTT). [11, 19, 20]

Green Stopper Tube - Additive & Use

Contains Heparin (prevents prothrombin to thrombin conversion); used for chemistry and general testing. [11, 19, 20]

Lavender Stopper Tube - Additive & Use

Contains EDTA (removes calcium); used for CBC, RBC/WBC counts, and ESR. [9, 11, 19, 20]

Gray Stopper Tube - Additive & Use

Contains Sodium Fluoride or Lithium Iodoacetate (glycolytic inhibitor to prevent glucose consumption); used for Glucose testing. [11]

Defibrination

The manual removal of fibrin from a whole blood specimen; preferred for osmotic fragility, autohemolysis, and acid serum tests. [18, 21]

Siliconized Glassware

Prevents blood clotting by preventing platelet adhesion, breakage, and the subsequent release of Platelet Factor 3 (PF3). [21]

Ecchymosis (Bruise)

Most common venipuncture complication; caused by fluid leakage around tissue. Prevent by applying direct pressure. [22]

Syncope (Fainting)

Second most common complication. Action: remove needle immediately, lower patient's head, apply cold compress, loosen tight clothing. [22]

Hematoma

Swelling caused by large fluid leakage. Action: remove needle immediately and apply firm pressure for at least 2 minutes. [23]

Petechiae

Small red spots showing minor skin bleeding; alerts the phlebotomist to possible underlying coagulation disorders and prolonged bleeding. [24]

Edema

Swelling from abnormal fluid in tissues; avoid because veins are obscured and tissue fluid will contaminate the specimen. [24]

Hemoconcentration

Increased concentration of large molecules due to water shift; caused by leaving a tourniquet on too long (limit to 1 minute). [25, 26]

Hemolysis

Rupture of RBCs releasing hemoglobin, coloring plasma/serum pink or red. Prevent by avoiding too-small needles, rapid plunger pulling, or hard shaking. [26]

Mastectomy Phlebotomy Rules

Avoid venipuncture on the mastectomy side due to lymphostasis risks; if double mastectomy, use hand veins without tourniquet, or do skin puncture. [27]

Bone Marrow Smear - Slip/Cover Glass Method

Marrow is dropped on one coverslip, a second coverslip is placed on top star-shaped, and they are slid apart horizontally with no wrist rotation. [28]

Serum vs Plasma Separation

Must separate within 2 hours of collection. Wait 20-30 minutes for complete clotting before centrifuging serum to avoid automated microclot jams. [29]