Theory Blood Drawing

Order of Draw

The Sky, The Sun, The Grass, The Flowers, The Pavement

(1st) Yellow Additive

SPS

(1st) Yellow Common Labs

Blood Cultures

(1st) Yellow Invert

8-10 times

(2nd) Blue Additive

Sodium Citrate

(2nd) Blue Common Labs

PT, PTT, INR, D-dimer

(2nd) Blue Invert

3-4 times

(3rd) Red Additive

Usually none, but some have clot activator

(3rd) Red Common Labs

Serum tests, serology/immunology (HIV, hepatitis C), therapeutic drug levels (Phenytoin – seizure medication)

(3rd) Red Invert

5 times

(4th) Gold (Tiger Top, SST – serum separator tube) Additive

Clot activator + gel that creates a barrier between serum and blood after centrifuge

(4th) Gold (Tiger Top, SST – serum separator tube) Common Labs

Comprehensive metabolic panels (CMP), basic metabolic panels (BMP), lipid panels, liver and thyroid function tests

(4th) Gold (Tiger Top, SST – serum separator tube) Invert

5 times

(5th) Green Additive

Heparin

(5th) Green Common Labs

Comprehensive metabolic panels (CMP), basic metabolic panels (BMP), electrolytes like sodium, potassium, chloride, and STAT tests (clot prevention allows for quick analysis)

(5th) Green Invert

8-10 times

(6th) Lavender Additive

EDTA

(6th) Lavender Common Labs

Complete blood count (CBC), hemoglobin and hematocrit, hemoglobin A1C

(6th) Lavender Invert

8-10 times

(7th) Pink Additive

Spray dried potassium EDTA

(7th) Pink Common Labs

Blood typing, cross matching, antibody screening (used for blood banks)

(7th) Pink Invert

8-10 times

(8th) Gray Additive

Sodium fluoride and potassium oxalate

(8th) Gray Common Labs

Glucose (additives keep levels stable and prevent glycolysis), lactic acid, blood alcohol content

(8th) Gray Invert

8-10 times

Complete Blood Count (CBC) --- LAVENDER TOP RBC

Females 4.0-5.5 million per microliter, Males: 4.5-6.1 million per microliter

Complete Blood Count (CBC) --- LAVENDER TOP WBC

4,000-11,000 per microliter

Complete Blood Count (CBC) --- LAVENDER TOP Platelets

150,000-450,000 per microliter

Complete Blood Count (CBC) --- LAVENDER TOP Hemoglobin (Hgb)

Females: 12-16 g/dL, Males 14-18 g/dL

Complete Blood Count (CBC) --- LAVENDER TOP Hematocrit (HCT)

Females 36-48%, Males 40-54%

Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours.--- GREY TOP Normal/healthy

70-99 mg/dL

Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours.--- GREY TOP Prediabetes

100-125 mg/dL

Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours.--- GREY TOP Diabetes

126 mg/dL or higher (a 2nd test is needed for diagnosis)

Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours.--- GREY TOP If LOW

Hypoglycemia, insulin overdose

Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours.--- GREY TOP if HIGH

diabetes, stress, infection

Random Blood Glucose – Not Fasting --- GREY TOP Normal

200 mg/dL or higher & symptoms likely means the patient is diabetic

Random Blood Glucose – Not Fasting --- GREY TOP Symptoms

frequent urination, excessive thirst, blurred vision, fatigue

Hemoglobin A1C Level – Determined by average glucose levels over approximately 3

months --- LAVENDER TOP Normal

BELOW 5.7%

Hemoglobin A1C Level – Determined by average glucose levels over approximately 3

months --- LAVENDER TOP Prediabetes

5.7%-6.4%

Hemoglobin A1C Level – Determined by average glucose levels over approximately 3

months --- LAVENDER TOP Diabetes

6.5% or higher

Sodium (Na+) --- GOLD TOP (SST, TIGER)

135-145 mEq/L

Sodium (Na+) --- GOLD TOP (SST, TIGER) if LOW

overhydration, kidney disease

Sodium (Na+) --- GOLD TOP (SST, TIGER) if HIGH

dehydration

Potassium (K+) --- GOLD TOP (SST, TIGER)

3.5-5.0 mEq/L

Potassium (K+) --- GOLD TOP (SST, TIGER) if LOW

Vomiting, potassium-wasting diuretics, will see muscle weakness and heart rhythm abnormalities

Potassium (K+) --- GOLD TOP (SST, TIGER) if HIGH

Kidney disease, acidosis, will see dangerous cardiac arrhythmias

Calcium (Ca) --- GOLD TOP (SST, TIGER)

8.6-10.2 mg/dL

Calcium (Ca) --- GOLD TOP (SST, TIGER) if LOW

Hypoparathyroidism, vitamin D deficiency, will see muscle spasms

Calcium (Ca) --- GOLD TOP (SST, TIGER) if HIGH

Hyperparathyroidism, cancer

Calcium (Ca) --- GOLD TOP (SST, TIGER)

You have 4 small parathyroid glands behind your thyroid that regulate blood calcium. This is done through bones releasing or reabsorbing calcium.

AST – Liver Function --- GOLD TOP (SST, TIGER)

10-40 U/L

AST – Liver Function --- GOLD TOP (SST, TIGER) if HIGH

liver damage, muscle injury

ALT – Liver Function --- GOLD TOP (SST, TIGER)

7-56 U/L

ALT – Liver Function --- GOLD TOP (SST, TIGER) if HIGH

liver disease, hepatitis

Alkaline Phosphate (ALP) – Liver Function --- GOLD TOP (SST, TIGER)

44-147 U/L

Alkaline Phosphate (ALP) – Liver Function --- GOLD TOP (SST, TIGER) if HIGH

Liver or bone disease

Total Bilirubin – Liver Function --- GOLD TOP (SST, TIGER)

0.1-1.2 mg/dL

Total Bilirubin – Liver Function --- GOLD TOP (SST, TIGER) if HIGH

liver disease, hemolysis

Thyroid Stimulating Hormone (TSH) --- GOLD TOP (SST, TIGER)

0.4-4.0 mIU/L

Thyroid Stimulating Hormone (TSH) --- GOLD TOP (SST, TIGER) if LOW

Hyperthyroidism

Thyroid Stimulating Hormone (TSH) --- GOLD TOP (SST, TIGER) if HIGh

Hypothyroidism

Prothrombin Time (PT) – Coagulation Studies --- LIGHT BLUE TOP

11-13.5 seconds

Prothrombin Time (PT) – Coagulation Studies --- LIGHT BLUE TOP if HIGH

clotting disorders, liver disease

Partial Thromboplastin Time (PTT) – Coagulation Studies --- LIGHT BLUE TOP

25-35 seconds

Partial Thromboplastin Time (PTT) – Coagulation Studies --- LIGHT BLUE TOP if HIGH

heparin therapy, clotting disorders

INR – Coagulation Studies --- LIGHT BLUE TOP (for individuals who aren’t on anticoagulants)

0.8-1.2

INR – Coagulation Studies --- LIGHT BLUE TOP (for individuals who are on a therapeutic dose of Warfarin therapy, such as patients with atrial fibrillation or deep vein thrombosis)

2.0-3.0

INR – Coagulation Studies --- LIGHT BLUE TOP if HIGH

warrain theory, bleeding risk

Total Cholesterol – Lipid Panel --- GOLD TOP (SST, TIGER)

less than 200 mg/dL

Total Cholesterol – Lipid Panel --- GOLD TOP (SST, TIGER) if HIGH

cardiovascular risk

Low Density Lipoprotein (LDL) – “Bad Cholesterol” on a Lipid Panel – LOWER is better. --- GOLD TOP (SST, TIGER)

less than 100 mg/dL

Low Density Lipoprotein (LDL) – “Bad Cholesterol” on a Lipid Panel – LOWER is better. --- GOLD TOP (SST, TIGER) if HIGH

Atherosclerosis risk (chronic disease where fatty cholesterol plaques develop in arteries, causing them to narrow, harden, and restrict blood flow)

High Density Lipoprotein (HDL) – “Good cholesterol” on a Lipid Panel – HIGHER is better. --- GOLD TOP (SST, TIGER)

greater than 40 mg/dL

High Density Lipoprotein (HDL) – “Good cholesterol” on a Lipid Panel – HIGHER is better. --- GOLD TOP (SST, TIGER) if LOW

cardiovascular risk

High Density Lipoprotein (HDL) – “Good cholesterol” on a Lipid Panel – HIGHER is better. --- GOLD TOP (SST, TIGER) if HIGH

protective

Triglycerides – Lipid Panel – Fats in the blood --- GOLD TOP (SST, TIGER)

less than 150 mg/dL

Triglycerides – Lipid Panel – Fats in the blood --- GOLD TOP (SST, TIGER) if HIGH

Risk for cardiovascular disease, heart attack, stroke, increased risk of diabetes

Blood Urea Nitrogen (BUN) --- RED TOP OR GOLD TOP (SST, TIGER)

7-20 mg/dL

Blood Urea Nitrogen (BUN) --- RED TOP OR GOLD TOP (SST, TIGER) if LOW

overhydration, malnutrition, or a very low protein diet

Blood Urea Nitrogen (BUN) --- RED TOP OR GOLD TOP (SST, TIGER) if HIGH

kidney disease, high protein intake, dehydration

Creatinine --- RED TOP OR GOLD TOP (SST, TIGER)

0.6-1.3 mg/dL

Creatinine --- RED TOP OR GOLD TOP (SST, TIGER) if LOW

decreased muscle mass, malnutrition, liver disease

Creatinine --- RED TOP OR GOLD TOP (SST, TIGER) if HIGH

kidney disease

Glomerular Filtration Rate (GFR) --- RED TOP OR GOLD TOP (SST, TIGER)

greater than 60 mg/min

Glomerular Filtration Rate (GFR) --- RED TOP OR GOLD TOP (SST, TIGER) if LOW

kidney disease