PATIENT PREPARATION

Increased: GU2FTC2L3A5P2
 GH
 Urea
 Urinary protein (Proteinuria)
 Fatty acid
 Testosterone
 CPK (muscle)
 Lactate
 LH
 LD (muscle)
Exercise
 ACP
 Aldolase (muscle)
 AST
 ALT
 Ammonia
 Pyruvate
 Prolactin

Decreased:
 Glucose
Increased: “LPP”
 Lactate
Fist clenching
 Potassium
 Phosphate
8-16 hrs:
 Glucose (6-8 hrs)
 Lipids
 Lipoproteins
Fasting
Increased:
 Bilirubin (48 hrs)
 Triglycerides (72 hrs)
“G-TEC”
 Glucose
 Lipids
Basal state collection  Urea (high protin diet)
 Caffeine (increases glucose)
 Catecholamines
 5-HIAA (from serotonin)
Turbidity/ Lactescence Triglyceride >400 mg/dL
Icterisia Bilirubin: 25.2 mg/dL
Interfere with: “TACGu”
 Total Protein
Icteric samples  Albumin
 Cholesterol
 Glucose
Preferred position
Upright/ Supine (lying)
position Patient should be seated/ supine at least 20 mins BEFORE blood collection to prevent
HEMODILUTION & HEMOCONCENTRATION
Vasoconstriction: Reduced plasma volume

Increased: “ECA”
Supine Sitting/ Standing
 Enzymes
 Calcium
 Albumin
Sitting Supine Hemoconcentration
 Increased: “P(u)BLIC”
 Proteins
 BUN
 Lipids
 Iron
 Calcium
Hemodilution

Decreased: “TLC”
Standing Supine
 Triglycerides
 Lipoproteins
 Cholesterol
Increased: K+ (muscles)
Prolonged standing
Decreased: Albumin (Fluid retention)
Tourniquet Recommended: 1 minute application
Hemoconcentration

Anaerobiosis

Increased: “C2LEA2K”
Prolonged tourniquet  Calcium
application  Cholesterol
 Lactate
 Enzymes
 Ammonia
 Albumin
 K+
Increased: “TUNG2C3”
 Triglycerides
 Urea
 Non-esterified fatty acid
Tobacco smoking
 Glucose
(Nicotine)
 GH
 Catecholamines
 Cortisol
 Cholesterol
Increased: “THUG”
 Triglycerides
Alcohol ingestion  Hypoglycemia (chronic alcoholism)
 Uric acid/ Urates
 GGT
Ammonia Increases by 100-200 ug/L/cigar
Increased: “LAGIC”
 Lactate
 Albumin
Stress
 Glucose
 Insulin
 Cholesterol
Medications affecting plasma volume can affect Protein, BUN, iron, calcium

Drugs Hepatotoxic drugs: Increased liver function enymes

Diuretics: Decreased Na & K+

“CA3PI2TG”
 Cortisol
Diurnal variation
 ACTH
 ACP
  Aldosterone
 Prolactin
 Iron
 Insulin
 Thyroxine
 GH

SPECIMEN PREPARATION

Sleeping patients Must be awakened BEFORE blood collection

Ask nurse or relative
Unconscious patients
Identification bracelet
Venipuncture Median cubital (1st) Cephalic (2nd) Basilic (3rd)
Velcro or Seraket type
Torniquet 3-4 inches ABOVE the site
NOT exceed 1 minute
Bevel up
Needle 15-30˚ angle
Length: 1-1.5 inches (Butterfly needle: ½ to ¾ inch)
Cotton site
After blood collection
Apply pressure for 3-4 minutes
BP cuff as tourniquet Inflate to 60 mmHg
Benzalkonium chloride Disinfect for ethanol testing
(Zephiran) Dilution – 1:750
Discontinue IV for 2 minutes
IV line on BOTH arms Collect sample BELOW the IV site
Initial sample (5ml) discard
Increased:
 Glucose
 Chloride
 Potassium
 Sodium
IV contamination

Decreased:
 Urea
 Creatinine
 BUN
Renin blood level Collected after a 3 -day diet, from a peripheral vein
Early morning blood collection
Blood state collection
12 hours AFTER the last ingestion of food
Lancet 1.75 mm: preffered length to avoid penetrating the bone
<2.0mm: Infants and children
Incision (Skin puncture)
2-3mm: Adults
1.5-2.4mm Distance from the skin surface to bone or cartilage (middle finger)
Earlobe: Preffered site
Arterialized capillary blood
Lateral plantar heel surface: most commonly used site
Indwelling umbilical artery Best site for blood gas analysis (newborns)
1000-3000 RCF for 10 mins Centrifugal requirement
Increased:
“KLA6MP ITC2”
Hemolysis
 K+
 LDH (150x)
  ACP
 ALP
 Aldolase
 ALT
 AST
 Albumin
 Mg2+
 Phosphorus
 Iron
 Total protein
- Affects bilirubin levels
- Inhibits lipase
Required for: “ABCGLRP2”
 Ammonia
 Blood gases
 Catecholamines
 Gastrin
 Lactic acid
 Renin
Refrigeration/ chilling
 PTH
(low temp)
 Pyruvate

Decreased:
 LD 4 & 5

Increased:
 ALP
Bilirubin
Beta carotene
Photosensitive analytes Folate
Porphyrins
Vitamins A & B6
Insoluble salt
Oxalate
1-2 mg/ml blood
Non-ionized form
Citrate
3.2-3.8 g/dL (1:9 ratio)
Chelation
1-2 mg/ml blood
EDTA
Versene: disodium salt
Sequestrene: dipotassium salt
Weakly dissociated calcium component
Fluoride 2mg/ml blood: anti-glycolytic
10mg/ml: anticoagulant
a.k.a Mucoitin polysulfuric acid
Universal anticoagulant
Heparin
Antithrombin
0.2 mg/ml blood
Lithium heparin For glucose, BUN, ionized calcium, electrolytes studies (K: best) and creatinine
Orange top tube Additive: Thrombin
Additives:
Royal blue top tube None;
Na2EDTA
 Sodium heparin
Brown top tube Lead testing
Tan top tube Lead testing
Additive: Buffered sodium citrate
Black top tube
For ESR
Respinning gel tubes Increases potassium
Gel separator (SG: 1.04)
Thixotropic gel Serum (SG: 1.03)
RBC (SG: 1.05)