NHA prep

🧪 IN-DEPTH STUDY GUIDE – PHLEBOTOMY TUBES & ORDER OF DRAW

Based on your Order of Tubes slides

🔹 SLIDE 1-2: Order of Draw Overview

✅ Correct Order of Draw (Venipuncture)

1. Blood Culture Bottles / Yellow SPS – Sterile

2. Light Blue – Coagulation

3. Red, Gold, Tiger – Serum

4. Green – Heparin

5. Lavender, Pink, Royal Blue, Tan – EDTA

6. Gray – Fluoride/Oxalate (glucose)

🧠 Tip to Remember:
"Boys Love Roses, Girls Like Glitter"
(Blood Culture, Light Blue, Red, Green, Lavender, Gray)

🔬 SLIDE 3: BLOOD CULTURE TUBES

1. BOTTLE – Microbiology

• Additive: Broth (keeps bacteria alive)

• Tests: Blood cultures

• Inversion: 4–5 times

• Special Instructions:

  • Scrub with chlorhexidine for 30 seconds

  • Draw from 2 different sites, 15 mins apart

  • Order matters: Aerobic first (with butterfly), anaerobic first (with syringe)

  • Pediatric bottles: Use pink

2. Yellow SPS Tube

• Additive: Sodium Polyanethol Sulfonate (SPS) – prevents bacteria from dying

• Note: Not preferred — contamination risk

• Used for: Blood culture transfer if no bottles

📌 Department: Microbiology
📌 Why First? It must be sterile — any contamination ruins it

🔵 SLIDE 4: LIGHT BLUE – Coagulation

• Additive: Sodium Citrate – binds calcium to prevent clotting

• Invert: 3–4 times

• Tests: PT, PTT, INR, Fibrinogen, D-Dimer

• MUST be 100% filled (9:1 blood-to-additive ratio)

🧠 If using butterfly needle, use a discard tube to avoid underfill
📌 Department: Coagulation/Hematology
📌 Why second? Any other additive can alter clotting tests

🔴 SLIDE 5: RED TUBE – Serum (NO additive)

• Glass tube = No additive

• Plastic = Silica clot activator

• Invert: Glass – don’t. Plastic – 5 times

• Let blood clot: 30–60 mins (max 2 hours)

• Tests: Type & Cross, Drug Levels (TDM), Toxicology

📌 Department: Chemistry or Blood Bank
📌 Used for: Cleanest serum sample (no interference from gels)

🟡 SLIDE 6: GOLD / TIGER TOP – SST (Serum Separator Tube)

• Additive: Clot activator + gel (separates serum during centrifuge)

• Invert: 5 times

• Clot time: 30–60 mins

• Tests:

  • CMP, BMP

  • Lipids, Cholesterol

  • Electrolytes (Na, K)

  • Bilirubin (protect from light)

  • Thyroid (TFT), Troponin (cardiac enzyme)

📌 Department: Chemistry
📌 Why after red? Less clean serum than red (because of gel)

🟠 SLIDE 7: ORANGE TUBE – RST (Rapid Serum Tube)

• Additive: SST-like, clots in 5 mins

• Used for: STAT chem tests (fast processing)

📌 Department: Chemistry
📌 Used when speed is critical

🟢 SLIDE 8: GREEN – Heparin

• Additive: Heparin (Sodium or Lithium)

• Invert: 8–10 times

• Variants: Light Green = PST (plasma separator tube)

• Tests:

  • Ammonia (on ice)

  • Troponin

  • CK (Creatine Kinase)

  • Metabolic Panels

  • Vitamin B1/B6

  • Chromosomes

📌 Department: Chemistry
📌 Plasma-based tests

🟣 SLIDE 9-10: LAVENDER – EDTA

• Additive: EDTA (binds calcium to prevent clotting)

• Invert: 8–10 times

• Tests:

  • CBC (RBC, WBC, Hb, PLT)

  • ESR

  • HbA1c

📌 Department: Hematology (A1C → tested in Chemistry)
📌 Why later? EDTA can interfere with clotting & other tests

💗 SLIDE 11: PINK – EDTA

• Additive: EDTA

• Tests:

  • Type & Screen / Crossmatch (blood bank)

  • BNP (Chemistry)

📌 Department: Blood Bank (hand label required)

⚫ SLIDE 12: BLACK – EDTA

• Additive: EDTA + Sodium Citrate (1:4)

• Tests: ESR (Westergren method)

📌 Specialized ESR tube

⚪ SLIDE 13: GRAY – Fluoride/Oxalate

• Additive: Sodium Fluoride + Potassium Oxalate

• Invert: 8–10 times

• Tests:

  • Glucose

  • GTT

  • Blood Alcohol (ETOH)

  • Lactic Acid (must be on ice)

📌 Department: Chemistry
📌 Why last? Strong preservatives interfere with other tests

💛 SLIDE 14: YELLOW ACD

• Additive: Acid Citrate Dextrose (ACD)

• Invert: 8–10 times

• Tests: DNA, Paternity

• Department: Blood Bank / Reference Lab

👑 SLIDE 15: ROYAL BLUE – Trace Elements

• Additive: None or EDTA (depends on label)

• Tests: Zinc, Copper, Selenium, Chromium

• Department: Toxicology

📌 Used for trace metals to avoid contamination from standard tubes

💉 SLIDE 17: Capillary Order of Draw

Order is different from venipuncture:

1. Blood Gas

2. EDTA (Lavender)

3. Green

4. Other Additives

5. Serum (Red)

📌 Why EDTA first? To avoid clotting which can ruin tiny capillary samples

❄ SLIDES 18–19: Special Specimen Handling

🧊 Transport on Ice Slurry:

• Ammonia (Green)

• Lactic Acid (Gray)

• ABGs

• Other: ACTH, ACE, Acetone, PTH, etc.

☀ Protect from Light:

• Bilirubin

• Vitamins A & B

• Beta-carotene, Folate, Porphyrins

📌 Use foil or amber tubes to block ligh

🩸 BLOOD STUDY GUIDE – Mock Test Prep Version

🧬 Slide 1-2: Basics of Blood

• Terminology:

  • Hem/o, hemat/o = blood

  • -emia = blood condition (like anemia)

What is Blood?

• A fluid connective tissue that:

  • Carries oxygen, nutrients, hormones

  • Removes waste like CO₂ and urea

  • Moves through heart and blood vessels

🔁 Slide 3: 5 Key Functions of Blood

1. Delivers: O₂, nutrients, hormones, vitamins

2. Removes: CO₂, nitrogen waste (urea)

3. Fights: infections (WBCs = immunity)

4. Stops bleeding: via clotting (platelets + plasma proteins)

5. Stimulates blood production: bone marrow makes new cells (hematopoiesis)

🧠 Tip: D.R.F.S.S. – “Doctors Remove Fluids, Stop Stuff”

🛑 Slide 4-5: Hemostasis (Stopping Blood Loss)

Hemostasis = the body’s process to stop bleeding It happens in 3 steps:

1. Vasoconstriction – blood vessels constrict

2. Platelet plug – platelets stick to the site

3. Coagulation – clot forms

🧠 Think: “Very Painful Cut” (VPC)

🧪 Slide 6-9: Components of Blood

Blood = Plasma (55%) + Formed Elements (45%)

🔹 Plasma

• Mostly water (91%)

• Carries:

  • Proteins (clotting, immune)

  • Nutrients, hormones, electrolytes

• Transports waste

🔸 Formed Elements = Floating Cells:

1. RBCs (Erythrocytes) – oxygen delivery

2. WBCs (Leukocytes) – fight infection

3. Platelets (Thrombocytes) – clotting

🧠 Tip: Plasma is the Uber, the cells are the passengers

❤ Slide 15-16: RBCs – Red Blood Cells

• Made in red bone marrow

• Contain hemoglobin (heme = iron)

• Function:

  • Carry O₂ to cells

  • Carry CO₂ out

💡 Anemia = low RBCs or hemoglobin
🧠 Erythr/o = red | Cyt/o = cell

🩸 Slide 18-19: Platelets – Thrombocytes

• Made from megakaryocytes (in bone marrow)

• Form clots to prevent blood loss

🧠 Thromb/o = clot | Cyt/o = cell
📌 Low platelets = Thrombocytopenia

🛡 Slide 20–26: WBCs – White Blood Cells (Leukocytes)

• Fight bacteria, viruses, parasites, allergens

• Made in bone marrow

• Types:

  • Granulocytes: neutrophils, eosinophils, basophils

  • Agranulocytes: lymphocytes, monocytes

🧠 WBC Types – With Fun Analogies

🧊 Neutrophils (60-70%)

➡ First responders to infection
🧠 “Police officers” – quick but short-lived

🦠 Eosinophils (4-6%)

➡ Attack parasites & allergic reactions
🧠 “Fumigators” – spray chemicals on invaders

🔥 Basophils (1%)

➡ Cause inflammation, release histamine & heparin
🧠 “Firefighters” – bring the heat

🦾 Monocytes (3-8%)

➡ Turn into macrophages/dendritic cells
🧠 “Riot police” – slow, strong, long-lasting

🧬 Lymphocytes (20-25%)

➡ Make antibodies (B & T cells)
🧠 “Special Forces” – powerful, trained, specific

🧠 Memory Trick for Order of WBCs (most to least common):
"Never Let Monkeys Eat Bananas"
➡ Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils

🦴 Slide 27-28: Immune System Overview

• WBCs are your defenders:

  • 1st Line: Physical barriers (skin)

  • 2nd Line: Inflammation, phagocytes

  • 3rd Line: Antibodies & lymphocytes

🩻 Slide 30: The Spleen

• Filters blood, destroys old blood cells

• Stores extra blood

• Recycles iron

• Helps immune function

⚔ Slide 32: Antigen vs. Antibody

• Antigen = invader (on bacteria/viruses)

• Antibody = “Y” shaped protein your body makes to neutralize the antigen

• Antibiotic = medicine that kills bacteria

🧠 Antigen = enemy | Antibody = defense

🅰🅱 Slide 34-36: Blood Types & Rh Factor

ABO Groups:

• A, B, AB, O
  ➤ Your blood type depends on which antigens you have

• Type O = universal donor

• Type AB = universal recipient

Rh Factor:

• + or –
  ➤ If you have the Rh protein = Positive
  ➤ If not = Negative

• Example: A+ has A antigen and Rh

🧠 Blood Type = Antigen Identity Tag

🧪 URINALYSIS STUDY GUIDE – Mock Test Prep Version:

🧪 Slide 1-2: What is Urinalysis (U/A)?

• U/A = Test of urine for disorders like:

  • UTI

  • Kidney disease

  • Diabetes

• Checks: Appearance, concentration, content

🧠 Why Urinalysis?

• Health check (routine, pregnancy, pre-surgery)

• Diagnose (pain, blood in urine, urinary problems)

• Monitor (kidney disease, urinary tract disease)

🚰 Slide 3: Urine Sample Collection

• Clean Catch Midstream:

  1. Clean urinary opening (front to back for women)

  2. Start urinating into toilet

  3. Midstream: Collect 30–59 mL (1–2 oz)

  4. Finish urinating in toilet

• Label the container (NOT the lid!)

🛡 Preservation:

• Test within 1–2 hours

• If delayed: Refrigerate at 39°F (no more than 24 hrs)

• Use biohazard bag ➡ Bring back to room temp before testing

🔍 Slide 4-5: The 3 STEPS of Urinalysis

1. Physical Exam – look, smell, measure

2. Chemical Exam – dipstick test strips

3. Microscopic Exam – microscope check

🧠 Memory Tip: "Pee Comes Mostly" → Physical, Chemical, Microscopic

🌈 Slide 6: Physical Exam of Urine

🧠 Weird Odor? Think Disease or Diet!

🧪 Slide 7-9: Chemical Exam (Test Strips)

• Check expiration date and if sealed!

🧠 Dip Strip = Instant Color Clues!

🔬 Slide 10: Microscopic Exam (Under Microscope)

• Done only if abnormal findings from physical or chemical exams

• Centrifuge the sample ➡ Sediment on slide ➡ Microscope view

🧠 Microscopic = Major Clues!

⚖ Slide 11: Quantitative vs Qualitative

🧠 Quick Trick:

• Qualitative = Quality (Presence)

• Quantitative = Quantity (Amount)

📚 FINAL TIP:

• Physical = Look, Smell, Measure

• Chemical = Strip Test

• Microscopic = Zoom In

Memory Shortcut:

"Pee Comes Mostly" ➡ Physical → Chemical → Microscopic