Pmls 2 Midterms Notes by K.novero Bmls1-1

PREP BY: K.
NOVERO BMLS1-1 LESSON 8-10 FROM ACTIVITIES MIDTERMS PT 2 COPY
PMLS 2 MIDTERMS NOTES PT2

ADDITIONAL NOTES (based on the activities)
BY: K. NOVERO
BMLS1-1
Note to readers:
This only contains what is given in the
activities. Therefore, it is still
encouraged to read from the book of the
missing information. Nonetheless, I had
included to the most topics other
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important information from other

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references.
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PREP BY: K. NOVERO BMLS1-1 LESSON 8-10 FROM ACTIVITIES MIDTERMS PT 2 COPY
LESSON 8: SPECIAL COLLECTION AND POINT-OF- autologous blood are less stringent, since autologous
CARE TESTING blood is used blood for the benefit of the donor (patient).
LESSON 9: HANDLING AND PROCESSING OF
Autologous blood may be donated every 3 days, up to 3
BLOOD SPECIMEN FOR LAB TESTING
LESSON 10: HANDLING AND PROCESSING OF days prior to elective surgery. The patient’s hematocrit
NON-BLOOD SPECIMEN FOR LAB TESTING must exceed 33% prior to each donation.
LESSON 8: SPECIAL COLLECTION AND POINT-

OF-CARE TESTING
SPECIAL COLLECTION
Special collection procedures are non-routine
laboratory tests that may not only involve additional
preparation and procedure but may require other
specimens such as urine or feces.
BLOOD BANK SPECIMENS

✓ Use lavender-top or pink-top EDTA Tube
✓ red top non additive glass as an alternative
Importance:
Blood bank specimens are vital in the determination of the
blood product that is safe to use for the transfusion of
blood.
CRITERIA FOR DONATION
Blood donations may be allogeneic (for another person),
autologous (for later transfusion back to the patient), or
directed (designated for a particular recipient). The Food
and Drug Administration establishes criteria for REQUIREMENTS TO BE ABLE TO
acceptability of blood donors. DONATE BLOOD FOR TRANSFUSION
1. Must be 17 – 66 years old
These include measures to protect the donor’s health 2. With weigh minimum of: 110 lbs. / 49.89 kgs
(e.g., minimum hematocrit, minimum time between 3. Must complete physical exam and declare
donations) and those to protect the recipient (e.g., donor
medical history
history or risk factors for transmitting infectious
diseases). Donors undergo a focused medical history,
limited physical examination, and laboratory screening.
AUTOLOGOUS DONATION VS.
For allogeneic (including directed) donation. ALLOGENEIC DONATION
Having an autologous donation is the collection of the
The hematocrit must exceed 38%, and donations may be patient’s whole blood or blood components to be
no more frequent than every eight weeks. The exclusion reinfused again with the permission of the physician and
of paid donors and the deferral of potential volunteer under a minimum of 72 hours from surgery; while,
donors who have risk factors for infectious disease allogeneic donations are the type of blood collection that
transmission along with laboratory testing of units involves finding a compatible donor instead.
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donated, have been the most important factors in

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advancing blood safety. Criteria for donation of
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CELL SALVAGING
Is the process of collecting blood to be salvaged,
washed, and re-infuse it to the same patient in
scenarios like surgeries (intraoperative). In this
process, the blood is filtered and washed; moreover,
tested for residual free hemoglobin. Hence, a high
free hemoglobin means there is too much destroyed
RBCs during the salvaging process.
BOOK SUMMARY
List of SPECIAL COLLECTION PROCEDURE
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STERILE TECHNIQUE IN BLOOD to the identification of the condition’s origin, or

etiology, the phlebotomist plays a very significant
CULTURE role in ensuring the accuracy of this important test.
✓ Collection should have 2 to 4 blood culture sets Blood cultures are usually ordered just before the
placed in special bottles- one aerobic (with air) beginning of antimicrobial therapy in a series of three
and one anaerobic (without air)- that were drawn draws. The cultures are collected in a series of three
30 to 60 minutes apart and site of collection was because that makes it more likely that the organism
noted (e.g. left arm, right foot, left hand) will be detected. In some cases, it may be possible
✓ Skin antisepsis is crucial in the blood collection that the septicemia is caused by a localized infection.
procedure. If this is suspected, the physician will order the series
BLOOD CULTURE COLLECTION to be collected all at one time but from three different
sites, rather than at three different times. Blood
PROCEDURE.
cultures are drawn in sets of two bottles. One bottle
• IDENTIFY patient and EXPLAIN THE is the aerobic bottle for those microorganisms that
PROCEDURE require oxygen to grow. The second bottle is called
• SELECT venipuncture site, RELEASE an anaerobic bottle for microorganisms requiring
tourniquet within 60 sec the absence of oxygen to grow.
• ASSEMBLE equipment, FOLLOW aseptic
technique
• REMOVE flip-off cap, check for defects;
hence, the bottle should draw at least 8cc
• AIR DRY 30 sec
• 60 sec FRICTION RUB
• CLEAN bottle stopper
• CHECK fill lines and determine the
minimum and maximum levels of the bottle MEDIA INOCULATION METHODS
• REAPPLY tourniquet and administer
VENIPUNCTURE THREE WAYS TO INOCULATE THE
• if IODINE is used, CLEAN the site MEDIUM
• INOCULATE the medium • Directly into the bottle (during collection)
• DISCARD used and contaminated materials • Collected in a syringe (after collection)
• THANK patient and DECONTAMINATE • Through an intermediate collection tube (in
hands the laboratory)
• SEND TO LAB for testing 1. DIRECT INOCULATION
Collect specimen directly into blood culture
BLOOD CULTURES medium
Blood cultures are ordered by physicians to rule out Use butterfly & specially designed holder
A butterfly and a specially designed holder are used; the
or confirm septicemia, a condition in which a
special holder is connected to the Luer connector of the
microorganism has invaded the bloodstream. This
butterfly collection set; and, that is connected to the
condition can lead to the death of a patient. The aerobic bottle first.
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correct collection of blood cultures is extremely

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important. Because the results of these cultures lead

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2. SYRINGE INOCULATION
Transfer blood to bottles after draw is
COAGULATION SPECIMENS
- Prothrombin Time (PT) with INR
completed
- Activated Partial Thromboplastin Time
Safety transfer device is required
(aPTT)
The blood must be transferred to the culture bottles after
the draw is completed using a safety transfer device. The - Thrombin Time (TT)
safety transfer device is attached to the syringe system;
PT w/ INR
and the bottle is pushed into the safety transfer device as
the needle reaches the stopper of the bottle.
WHAT IS THE PT AND INR TEST?
The PT and INR blood test measures the time it takes your
INTERMEDIATE COLLECTION TUBE blood to form a clot. Other names for the PT test are
Sometimes used in place of blood culture prothrombin time and pro time. INR stands for international
bottle normalized ratio.
Yellow-top SPS tube is acceptable
WHY IS THIS TEST DONE?
The PT/INR test is usually done when you are taking a blood
thinner (anticoagulant) medicine, such as warfarin
(Coumadin), to prevent blood clots. Clots can block blood
vessels and possibly cause a heart attack or stroke. This test
measures the effect of the anticoagulant. If the dosage is too
high, you may bleed too easily and if it’s too low, your blood
may clot too easily. The test helps your healthcare provider
find the right dosage of medicine.
The PT test may also be done to diagnose a bleeding disorder
if you have abnormal bleeding or clotting.
Use is discouraged, however, because:
- Final concentration of SPS is increased
WHAT DOES THE TEST RESULT
- Presents another opportunity for MEAN?
contamination increased exposure risk to
A PT/INR value higher than normal means your blood is
lab staff
taking longer than normal to form a clot. If you are taking a
blood thinner, it means that the medicine is working.
If you are not taking a blood thinner and your values are
higher than normal, you may:
• Have liver disease

• Need more vitamin K (vitamin K is important for
the formation of blood clots)
• Have an inherited blood disorder
• Have had a lot of heavy bleeding recently
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aPTT
APTT tests for intrinsic pathway deficiencies in
factors prekallikrein, HMWK, and factors XII,
XI, IX, X, VIII, V, II, and I.
Principle. A citrated plasma sample is TT
preincubated with the phospholipid reagent to
initiate contact activation factors in the intrinsic Measures time required for thrombin to convert fibrinogen to
pathway. Following incubation, calcium chloride fibrin. Prolonged with hypo- or dysfibrinogenemia, heparin,
reagent is added as a separate reagent to initiate FDPs.
the clotting cascade. The time required for fibrin ✓ Thrombin is an enzyme in blood that acts on the
clot formation to occur is measured. clotting factor fibrinogen to form fibrin, helping blood
Reference range. The APTT assay has an to clot. The thrombin time (TT) assesses the activity of
approximate normal range of 25 to 40 seconds, fibrinogen.
but it is important for each laboratory to establish ✓ When an injury occurs and bleeding begins, the body
its own range begins to form a clot at the injury site to help stop the
Normal PTT test results bleeding. Small cell fragments called platelets adhere
PTT test results are measured in seconds. Normal results are typically to, aggregate, and are activated at the injury site. At the
25 to 35 seconds. This means that it took your blood sample 25 to 35 same time, the coagulation cascade begins and
seconds to clot after adding the chemicals. proteins called coagulation factors, including
The exact standards for normal results may vary depending on your
fibrinogen, are activated. Fibrinogen is then converted
doctor and lab, so ask your doctor if you have any concerns.
by thrombin into insoluble threads called fibrin that
Abnormal PTT test results
Remember that an abnormal PTT result doesn’t diagnose any
crosslink together to form a fibrin net that adheres to
particular disease. It only provides insight about the time it takes for the injury site. Along with the platelets adhering, this
your blood to clot. Multiple diseases and conditions can cause forms a stable blood clot and prevents additional blood
abnormal PTT results. loss, remaining in place until the injury has healed.
A prolonged PTT result may be due to: ✓ For a stable clot to form, there must be enough
• reproductive conditions, such as recent pregnancy, current normally functioning platelets and coagulation factors.
pregnancy, or recent miscarriage
If there are dysfunctional factors or platelets, or too
• hemophilia A or B
few of them, it can lead to bleeding episodes and/or to
• deficiency of blood clotting factors
• von Willebrand disease (a disorder that causes abnormal inappropriate blood clotting (thrombosis).
blood clotting) ✓ The thrombin time evaluates that part of
• disseminated intravascular coagulation (a disease in which the hemostatic process where soluble fibrinogen is
the proteins responsible for blood clotting are abnormally changed into fibrin threads. It measures the time
active) required for a fibrin clot to form following the addition
• hypofibrinogenemia (deficiency of the blood clotting
of a standard amount of thrombin to plasma. It is
factor fibrinogen)
affected by the level and/or function of fibrinogen and
• certain medications, such as the blood thinners heparin and
warfarin the presence of inhibitors (e.g., heparin,
• nutritional issues, such as vitamin K deficiency and fibrinogen/fibrin degradation products, direct
malabsorption thrombin inhibitor). With the addition of thrombin to
• antibodies, including cardiolipin antibodies the test sample, the thrombin time bypasses the rest of
• lupus anticoagulants the coagulation factors and focuses on the function of
• leukemia fibrinogen.
• liver disease
The wide range of possible causes for abnormal results means that this
test alone is not enough to determine what condition you have. An
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abnormal result will probably prompt your doctor to order more tests.
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Coagulation Specimen Collection Procedure

1. IF ONLY THE COAGULATION
SPECIMEN
- clear tube 1-2 ml and discarded prior to
collection
- then, collected with light blue top: 3.2% citrate
with (9:1) blood to coag ratio
2. INVERT 3-4 TIMES
- to ensure proper mixing immediately after
collection
- If ETS is used
- collect the coagulation sample secondarily
3. If INDWELLING CATHETER is used
- draw and discard 5ml blood before specimen
collection
- when heparin is introduced to the line: flush with
5ml saline before drawing and discarding
4. ADJUST sodium citrate concentration
- of patients with 55% hematocrit values
5. TRANSPORT
- if unable to reach lab within 4 hours: centrifuge
and freeze the plasma of the specimen
ADDITIONAL INFO:
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2- HOUR POST PRANDIAL GLUCOSE If your blood glucose level is still high two hours after
you've eaten, or if it is high one hour after a gestational
(2HOUR PP) diabetes glucose tolerance test, it could mean you have
diabetes.
For patient with diabetes and to monitor patients under
insulin therapy.
This is a blood test to check for diabetes. If you have 2-PP Specimen Collection Procedure.
diabetes, your body doesn't make enough insulin to keep • Patient on High-Carbohydrate Diet 2-3 Days
your blood sugar in check. This means your blood sugar Before Test
levels are too high, and over time this can lead to serious
health problems including nerve and eye damage. • Patient Fasts10 Hours Before Test
• Fast Glucose Specimen Collected Before
This test is done to see how your body responds to sugar
and starch after you eat a meal. As you digest the food Procedure
in your stomach, blood glucose, or blood sugar, levels • 100g Glucose Special Breakfast Or Beverage
rise sharply. In response, your pancreas releases insulin
On The Day Of The Test
to help move these sugars from the blood into the cells
of muscles and other tissues to be used for fuel. Within • Blood Glucose Specimen Collection2 Hours
two hours of eating, your insulin and blood glucose After Meal
levels should return to normal. If your blood glucose
levels remain high, you may have diabetes.
What other tests might I have with this test?

Your healthcare provider may order other tests to confirm
or evaluate whether you have diabetes. These may
include:
Fasting blood glucose test. This measures the
amount of sugar in your blood.
A1C (glycosylated hemoglobin) test. This
measures your average blood sugar level over the
last 2 to 3 months.
Glucose tolerance test. This measures your
body's ability to use sugar after drinking a
standard amount in a sugary drink.
What do my test results mean? GLUCOSE TOLERANCE TEST (GTT)
Test results may vary depending on your age, gender, • Also called Oral Glucose Tolerance Test
health history, the method used for the test, and other (OGTT)
things. Your test results may not mean you have a • Used to evaluate the ability of the body to
problem. Ask your healthcare provider what your test metabolize glucose by measuring the tolerance
results mean for you. level to high glucose level.
Test results vary by age and are usually measured in
• Insulin response to a measured dose of glucose
milligrams per deciliter (mg/dL). Normal results for the
is recorded by specimen collection at given
two-hour postprandial test based on age are:
intervals.
For those who do not have diabetes: less than 140
• The GTT length is 1 hour for gestational
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mg/dL
diabetes while it is 3 hours for other evaluation.
For those who have diabetes: less than 180
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mg/dL
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GTT PROCEDURE If GGT is normal and ALP is high, bone

1. Identify Patient and Explain Procedure; Only disease is likely present.
Patients with acute pancreatitis exhibit
Water Is Allowed
increased GGT levels. In persons with
2. Draw Fasting Specimen and Check Glucose diabetes, GGT is typically increased as
Levels: triglyceride levels rise.
Must Not Be Over 200 Mg/Dl Because alcohol has enzyme-inducing
properties, the most useful application for
3. Let Patient Collect Urine Specimen GGT is in the detection of alcoholism and the
4. Give Glucose Beverage Dose: monitoring of alcohol intake by patients during
Adult: 75g treatment.
Why Get Tested?
Children: 1g/Kg of Weight
To evaluate for a possible liver disease or bile duct
Gestational Diabetes: 50-75g
disease or to differentiate between liver and bone disease
5. Ingestion of Beverage: 5mins as a cause of elevated alkaline phosphatase (ALP);
6. Record Time When the Drink Was Finished; sometimes to screen for or monitor alcohol abuse
Time Test Collected: What is being tested?

- 30mins, 1 Gamma-glutamyl transferase (GGT) is an enzyme that is
- hr, and found in many organs throughout the body, with the
highest concentrations found in the liver. GGT is elevated
- 2hrs, So Forth in the blood in most diseases that cause damage to the
7. Provide Patient Copy of Collection Time liver or bile ducts. This test measures the level of GGT in
a blood sample.
8. Write Exact Collection Time and Interval;
With Patient Identification Info Normally, GGT is present in low levels, but when the liver
is injured, the GGT level can rise. GGT is usually the first
9. Transport Immediately Within 2 Hours liver enzyme to...
GGT transfers a γ -glutamyl residue to an amino acid
- Doctors use the GGT test to diagnose liver problems.
(transpeptidation). This function is involved in peptide
Doctors will measure GGT if they suspect damage to
and protein synthesis.
the liver or bile ducts, chronic alcohol abuse, or certain
1. Distribution. Tissue sources of GGT include bone diseases.
kidney, brain, prostate, pancreas, and liver. Urine - In the GGT (gamma-glutamyl transferase) test, a
contains significant amounts of GGT. healthcare professional measures the levels of GGT in
2. Measurement of total activity is by the Szasz a sample of blood. High levels of GGT in the blood
assay. In this reaction, the substrate is γ -glutamyl- can indicate damage to the liver or bile ducts. Normal
p-nitroanilide, with the release of p-nitroaniline. ranges suggest that there is no liver damage.
3. The clinical significance of GGT is as follows.
The liver contains the highest levels of GGT, while the
GGT levels are elevated in almost all
blood and some other organs contain minimal quantities.
hepatobiliary disorders or biliary tract
obstructions as well as in patients taking High levels of GGT in the blood could indicate that the
enzyme-inducing drugs like warfarin, enzyme is leaking out of the liver cells and into the blood,
phenobarbital, and Dilantin. suggesting damage to the liver or bile ducts.
GGT levels are often examined with ALP A typical range for GGT levels in adults and children
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levels. If both GGT levels and ALP values are is between 0 and 30 international units per liter (IU/L).
high, some type of liver disorder is suspected.
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Newborn infants will have significantly higher levels

right after birth.
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A person with a normal GGT test probably does not have LACTOSE TOLERANCE TEST
liver disease. When someone who is in treatment for
alcohol use disorder has a normal reading, this likely Measures the ability of the body to process lactose
means that they have not had an alcoholic drink recently. and determines if the patient lacks mucosal lactase
(enzyme that converts lactose into glucose or
GGT levels will rise according to the amount of liver
galactase)
damage a person has.
Gastrointestinal distress and diarrhea follow, after
High GGT levels indicate that something is damaging ingestion of milk or food containing lactose for
the liver, though it does not diagnose the specific problem. those who lack the lactase enzyme.
A person will often need follow-up tests to find out the
THE PRINCIPLES FOR THE LACTOSE TOLERANCE
reasons for the elevated GGT levels.
TESTING
A doctor may order a GGT test as part of regular blood
testing during a yearly physical examination, if a person 1. A day before lactose tolerance test;
is taking a medication that has potentially toxic effects on recommendation for a 2-hour GGT test be
the liver, or if someone has symptoms of liver disease.
administered.
Symptoms of liver damage include: 2. Substitute lactose equally with glucose; the test
- jaundice, which causes yellow skin, eyes, or follows the GGT procedure
mucous membranes
3. Draw the glucose specimen at the same time as
- dark urine
- nausea the previous GGT procedure
- vomiting 4. If the patient has mucosal lactase: GGT and
- abdominal pain
Glucose curve are similar.
- light-colored stool
5. Patient is lactose intolerant: yields “flat curve”;
Diseases that can cause liver damage include:
glucose levels slightly rise over fasting levels
- hepatitis
6. False positive results shown by patients with
- cirrhosis
- diabetes slow gastric emptying, Crohn’s disease, and
- pancreatitis cystic fibrosis
- congestive heart failure
- exposure to toxins
- alcohol abuse
Why Get Tested?

Lactose intolerance test examines whether lactose is formed normally To help diagnose lactose intolerance in individuals who
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in gastric cells. The procedure involves ingestion of a lactose cocktail

followed by glucose analysis. Little or no increase in serum glucose have difficulties digesting dairy products, or sometimes
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indicates lactase deficiency→ as part of an investigation of malabsorption
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Sample Required? There are two types of exclusions

A series of breath samples exhaled into a collector, or a 1. Direct or first-order exclusion is established when a
series of blood samples drawn from a vein in your arm child inherits a trait that neither the alleged mother nor
the alleged father has.
What is being tested? 2. Indirect or second-order exclusion is established
Lactose tolerance tests measure hydrogen in the breath or when:
changes in the level of glucose in the blood after a person a. The alleged father is homozygous for an antigen
is given a drink containing a standard amount of lactose, that the child does not have.
thus determining whether the individual is capable of b. The child is homozygous for an antigen that the
proper digestion of lactose. mother has but the alleged father does not have.
Lactose is a sugar with a complex structure (a c. The child does not have two antithetical antigens
disaccharide). It is found in milk and many other dairy that the alleged father has.
products. Before it can be absorbed and used by the body,
it must be broken down into two simpler sugars, glucose THERAPEUTIC DRUG MONITORING (TDM)
and galactose (monosaccharides). This digestion step is Measures drug levels at designated intervals so that the
performed by lactase, an enzyme produced by cells lining appropriate dosage can be established and maintained
the small intestine. for the patient thus avoiding toxicity
If an individual does not produce enough lactase (lactase
deficient), then undigested lactose passes through the single most important variable to consider in
small intestine to the large intestine, where bacteria break collecting specimen for TDM
it down, producing hydrogen gas and lactic acid. This Prescription of initial dosage is an important variable in
process can cause the affected person to experience TDM specimen collection and testing; especially
abdominal pain and bloating, flatulence (passing gas), and considering the drug´s highest therapeutic
diarrhea within 30 minutes to 2 hours of consuming milk concentration ('peak' level), or its lowest ('trough' level)
or other dairy products. in specific times.
why this is the most important variable to consider?
It is quite important to ensure that the levels are within
PATERNITY/PARENTAGE TESTING
therapeutic range and over all avoids toxicity.
Performed to exclude the possibility of paternity of a Therapeutic drug monitoring (TDM) is performed to
child. determine patient compliance to the drug-taking regimen,
PRINCIPLES FOR THE PATERNITY TESTING to monitor drug interactions, and to monitor drugs that are
1. Submit government issued photo ID, and used for a preventive effect.
completed chain-of-custody form; also, photos 1. Changes in drug concentrations in the body, which
of all tested parties. occur with time, are related to the course of the
2. Collect Buccal samples from inner-cheek, pharmacologic effects. The change in drug
loose inner-cheek skin cells. concentration over time is described by the following
3. Transport to lab sealed and with tamper- steps.
evident package. a. Liberation is the release of this ingredient, followed
4. Receive results within 48 hours via mail. by the process of the drug passing into solution.
b. Absorption is the process by which the drug molecule
HLA-A and HLA-B typing in combination with RBC is taken up into systemic circulation. Following
antigen testing can exclude an individual as a father in
absorption through the intestinal mucosa, a drug
95% of cases.
traverses the hepatic system, where some drugs
undergo substantial metabolism and elimination. This
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is called first-pass elimination or metabolism.

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c. Drug molecules can be confined to the blood, leave the Monitored Drugs by Category
bloodstream, and enter the extravascular space, or they There are several categories of drugs that require
can migrate into various tissues. This is referred to as monitoring, as summarized here.
distribution, a process that typically occurs between a DRUG
DRUGS
TREATMENT
CATEGORY USE
period of 30 minutes and 2 hours. The bioavailability
Digoxin, digitoxin, amiodarone,
of a drug is the amount of drug that is absorbed into lidocane, quinidine, Congestive heart
Cardiac
the system and is available for distribution. procainamide, N-acetyl- failure, angina, ar
drugs
procainamide (a metabolite of rhythmias
d. Metabolism is the process of transformation of the procainamide)
parent drug molecule to its metabolite(s). Metabolites Infections
Aminoglycosides (gentamicin,
are usually water soluble and can be easily excreted. with bacteria that
tobramycin,
Antibiotics are resistant to
Most of the metabolism occurs in the liver, where amikacin), vancomycin,
less toxic
chloramphenicol
enzymes catalyze oxidation, reduction, or hydrolysis antibiotics
Phenobarbital, phenytoin, valproi
of the drug. c acid, carbamazepine,
e. Elimination is the process of excretion of the drug ethosuximide, sometimes
from the body. Drugs are typically excreted in the gabapentin, Epilepsy,
lamotrigine, levetiracetam, prevention of
urine but also can be eliminated in the feces, sweat, Antiepileptics topiramate, zonisamide, seizures,
expired air, and saliva. eslicarbazepine acetate, sometimes to
felbamate, lacosamide, stabilize moods
oxcarbazepine, pregabalin,
rufinamide, stiripentol, tiagabine,
vigabatrin
Asthma, chronic
obstructive
Bronchodilat pulmonary
ors
Theophylline, caffeine
disorder
(COPD), neonata
l apnea
Prevent rejection
Cyclosporine, tacrolimus, sirolim
Immunosupp of transplanted
ressants
us, mycophenolate mofetil,
organs, autoimm
azathioprine
une disorders
Psoriasis, rheuma
toid arthritis,
2. Basic principles. TDM measures drug concentrations Anti-cancer Methotrexate, all cytotoxic various cancers,
drugs agents non-hodgkin
during therapy with pharmaceutical agents. lymphomas,
1. A steady-state drug level (complete with peaks osteosarcoma
and troughs) exists for each drug. When a single Lithium, valproic acid, some Bipolar disorder
Psychiatric antidepressants (imipramine, (manic
dose of a drug is administered orally, the blood drugs amitriptyline, nortriptyline, depression),
level changes markedly over time and, at some doxepin, desipramine) depression
time, the concentration in the plasma reaches its THERAPEUTIC PHLEBOTOMY
peak (highest point) and then declines. Performed by drawing a large volume of blood about
Immediately before the next dose of medication, 500 milliliters from a patient as part of the treatment
a trough level occurs. procedure for polycythemia and hemochromatosis.
- For single-dose administration, the rate of decline HEMATOCRIT TEST
in concentration is expressed in terms of half-life, Used to check the RBC Level
which is the time required for the concentration of
the drug to decrease by 50% (Figure 1–6). The half-
life is different for each drug.
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- At steady-state levels, the rate of administration of

the drug is equal to the rates of metabolism and
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excretion, allowing the drug level to remain constant.

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POLYCYTHEMIA - Spurious (false) polycythemia is related to

It is the harmful overproduction of RBC chronic smoking. Nicotine induces a loss of
Hematocrit test checks production of RBC; hence, plasma volume.
high Hematocrit levels advices blood removal to b. Absolute polycythemia refers to an
maintain Blood levels. increase in the total RBC mass in the
It refers to elevated hemoglobin (Hgb) and body. This is a true erythrocytosis caused
hematocrit (Hct) levels in peripheral blood. by marrow erythroid hyperplasia or,
For men, Hgb > 16.5 g/dL and Hct > 49% while for secondarily, by an increase in
women Hgb > 16 g/dL and Hct > 48% erythropoietin (EPO)
comprise polycythemia HEMOCHROMATOSIS
Polycythemia vera (PV) is a chronic clonal disorder with increased Characterized by excess Fe deposits in tissues which
hematocrit, elevated red blood cell mass, and erythropoietin levels
below the normal reference range. could be due to problems with iron metabolism caused
Polycythemias by multiple blood transfusions or excessive intake of
characterized by an increase in iron.
Hct >53% in men and 51% in women. Sometimes it's called “iron overload.” Normally, your
1. Clinical symptoms are caused by hypervolemia intestines absorb just the right amount of iron from the
or hyperviscosity. foods you eat. But in hemochromatosis, your body
a. Hyperviscosity can cause sluggish flow absorbs too much, and it has no way to get rid of it.
of blood and a tendency toward Iron disease states include:
thrombosis and disseminated 1. Iron deficiency anemia, which is usually caused by
intravascular coagulation (DIC). blood loss (menstrual cycle, ulcer, tumor)
• (The decreased oxygen flow to tissues is 2. Iron overload, including:
compensated for by the higher Hct and increased - Hemosiderosis (no tissue injury)
blood volume (i.e., hypervolemia), which - Hemochromatosis
increases vessel diameter and therefore results in a. Hereditary hemochromatosis is an autosomal
increased tissue perfusion. recessive disease in which iron is deposited directly in
• This is not a benefit, however, because cardiac the liver, heart, and kidney, leading to organ failure.
work is increased to deliver the same amount b. Sideroblastic anemia is caused by iron overload of
of oxygen as normal. unknown cause.
b. Hypervolemia increases blood-vessel c. Acquired hemochromatosis follows thalassemias or
diameter and therefore results in lead poisoning. This disorder also occurs with chronic
increased tissue perfusion. This can excessive absorption of normal iron intake.
cause increased cardiac work, which is
dangerous for an individual who is
predisposed to heart problems.
2. Types of polycythemia include relative and
absolute. Absolute polycythemia must be
differentiated from relative polycythemia before
treatment can ensue.
- Relative polycythemia refers to a condition in
which the total RBC mass is normal but the Hct
is elevated because the plasma volume is
decreased.
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- Relative polycythemia can be caused by acute

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dehydration resulting from severe diarrhea,

burns, or chronic diuretic therapy.
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TOXICOLOGY SPECIMENS - Split sample may be required

- Specimen must be labeled, sealed, & placed in a
- Clinical toxicology (detection of toxins and
clocked container
treatment)
- Forensic toxicology (legal consequences of toxin FORENSICS SPECIMENS
exposure) - Most common specimen: breath and blood for
- Specimens: blood, hair, urine, other substances alcohol
from the body - Urine: drug screening
- Purpose: Determine the presence of toxins - Blood: drugs and DNA Analysis
General - Chain of custody: special protocol/
- Toxicology: scientific study of toxins (poisons) documentation showing the full process of
- Concerned with detection of toxins & treatment acquisition, transfer, handling and disposition of
of effects physical or electronic materials.
Forensic blood alcohol (ethanol) specimens Important information about the collection of
- Often requested by law enforcement officials specimens found in the chain of custody form:
- Used to determine levels in breath, urine, or blood 1. The Type of specimen
- Specimen collection must follow chain of custody 2. The Phlebotomist who obtained the specimen
- Forensic toxicology is concerned with legal 3. The Technician who processed the specimen
consequences of toxin exposure 4. Details of collection, i.e.; time, date, and place
Clinical blood alcohol (ethanol) specimens 5. Signature of specimen owner
- Normally ordered by physician for treatment
BLOOD ALCOHOL (ETHANOL (ETOH))
purposes Chain of custody not required, but
follow standard protocol SPECIMENS
- Required in connection to on-the-job injury, - ETOH Test for Treatment: don’t require chain of
employee insurance programs, & employee drug custody
screening - Blood Alcohol Concentration (BAC) test for
- Skin preparation: don’t use alcohol-based industrial and legal samples: should follow the
disinfectant chain of custody protocol
- Specimen requirements: gray-top sodium - Antiseptic used: aqueous povidone-iodine and
fluoride tube; fill tube until vacuum is exhausted aqueous benzalkonium chloride (BZK) (water and
& don’t remove stopper soap as alternative)
Drug screening - Antiseptics to be avoided: isopropyl alcohol,
- Required by many healthcare organizations, tincture of iodine
sports associations, & major companies - Gray top tube for specimen collection
- May be random, pre employment, post-accident - Tube stopper should always remain in place because
- May detect a specific drug or screen for up to 30 alcohol could evaporate.
drugs BEST VENIPUNCTURE METHOD FOR BLOOD
- Typically performed on urine rather than blood ALCOHOL SPECIMENS
- Chain of custody is required For this kind of testing, where alcohol in the specimen
Patient preparation requirements can evaporate (thus, it needs to be contained
- Explain test purpose & procedure properly), it is advisable to use the ETS method;
- Advise patient of his or her legal rights where blood is directly vacuumed into the gray
- Obtain a witnessed, signed consent form stopper tube to avoid evaporation of the alcohol, and
Specimen collection requirements
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for better accuracy of results. This is with regards,

- Special area for urine collection also, to the aseptic used prior to the principles of the
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- Proctor present at time of collection test.

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DRUG SCREENING
- Pre-employment requirement
- Could be a random screening without prior
notice
- Specimen: Urine
- Chain-of custody is strictly implemented
PATIENT PREPARATION REQUIREMENTS FOR

DRUG SCREENING
- Explain to the patient the purpose and procedure
- Advice the patients about his/her legal rights
- A witness should be present at the signing of form
SPECIMEN COLLECTION REQUIREMENTS FOR
DRUG SCREENING
- A designated special area for urine collection
- A proctor must be present to ensure that the
specimen came from the correct person
- Split sample may be used for parallel testing
- To establish chain-of-custody, follow proper
labeling
- Specimen must be protected from tampering. It
should be sealed in a lock container to be sent
immediately to the laboratory; and
documentations should be handled carefully.
TRACE ELEMENTS
- Aluminum, arsenic, copper, lead, iron, zinc
- Royal blue top
- Indicate the additive when labeling the
specimen
- To avoid contamination, change the transfer
device before filling the tube.
Tests for aluminum, arsenic, copper, lead, iron, &

zinc
Measured in small amounts
Traces of them in glass, plastic, or stopper material
can leach into specimen
Special trace element–free tubes must be used (royal
blue & contain EDTA, heparin, or no additive)
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MONITORING FOR WARFARIN AND HEPARIN

POINT-OF-CARE TESTING (POCT) THERAPY
POCT is any analytical test that is done outside WARFARIN
the centralized laboratory and near the site where
The goal of warfarin therapy is to decrease the
the patient receives treatment.
clotting tendency of blood, but not to prevent
Also called alternate site testing (AST), bedside
clotting completely.
testing, near patient testing, remote testing,
What is warfarin? Warfarin is an anticoagulant
satellite testing and rapid diagnostics
(blood thinner). Warfarin reduces the formation
Convenient and also shorten the turnaround time
of blood clots. Warfarin is used to treat or
(TAT)
prevent blood clots in veins or arteries, which
QUALITY AND SAFETY IN POCT can reduce the risk of stroke, heart attack, or
other serious conditions
✓ Electronic Quality Controls (EQCs)- included in HEPARIN
POCT instruments that detect specimen related What is heparin injection? Heparin is
problems to ensure quality of results done an anticoagulant (blood thinner) that prevents the
through POCT. formation of blood clots. Heparin is used to
✓ Daily External liquid QC Checks – for non- treat and prevent blood clots caused by certain
instrument tests, makes sure that there is medical conditions or medical procedures. It is
adherence to the use of required techniques and also used before surgery to reduce the risk of
the generated results are accurate. blood clots.
✓ POCT Instruments may help in the transmission Heparin is an anticoagulant (blood thinner) that
of infection in the facility. Disinfect instruments prevents the formation of blood clots. Heparin is
using 10% bleach. used to treat and prevent blood clots caused by
DIFFERENT POINT-OF-CARE TESTS certain medical conditions or medical procedures.
1. Coagulation Monitoring It is also used before surgery to reduce the risk of
2. Bleeding Time blood clots
3. Arterial Blood Gasses
4. Electrolytes
5. Multiple Test Panel Monitoring
BLEEDING TIME (BT)
6. Pregnancy Testing - Non-instrumented test
7. Others - Use to evaluate the capillaries for platelet plug
formation and problems in capillary integrity.
- Used also for pre-surgical screening and
COAGULATION MONITORING BY POCT detection of problems in hemostasis.
✓ Monitoring for warfarin and heparin therapy The bleeding time test involves making an incision
✓ PT with INR, APTT OR PTT, ACTIVATED on the volar surface of the forearm under
CLOTTING TIME (ACT) and Platelet function
standardized conditions (i.e., with a blood pressure
List of POCT INSTRUMENTS FOR COAGULATION
cuff inflated to 40 mmHg) and monitoring the time it
MONITORING
takes for the bleeding to stop (normal range is 2 – 8
Cascade- POC-ACT, APTT, PT/INR
min). It is prolonged in many patients with von
CoaguChek XS Plus- PT/INR
Willebrand’s 147 disease, disorders of platelet
GEM Premier 4000- ACT, APTT, PT/INR function and when platelet counts are less than
I-STAT- ACT, PT.INR 70,000/ul, and in certain connective tissue disorders
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Verify Now- platelet function like pseudoxanthoma elastica and scurvy. It is not
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used frequently any more due to its variability.
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ARTERIAL BLOOD GASSES (ABG)

- This test measures the level of oxygen, carbon
dioxide, and acid-base (pH) in the blood
- Test for lung, heart and kidneys
- ABGs measured by POCT includes, pH, partial
pressure from carbon dioxide (PCO2), partial
Bleeding Time Test Procedure pressure of oxygen (PO2), and oxygen saturation
1. Patient identification and proper hand hygiene (SO2)
2. Ask patient of: aspirin intake, or any
pH
3. Salicylate-containing drugs in the past 2 weeks
-
Refers to the concentration of hydrogen
4. Inform of possibilities of scarring
ions in a solution.
5. Support patient's arm on steady surface - Checks the balance of the acid-base level,
6. Chose a site: forearm's volar lateral; 5cm distal which shows metabolic and respiratory
to the antecubital area. status of the patient
7. If necessary: shave the area - Blood pH normal range 7.35-7.45
PARTIAL PRESSURE FROM CARBON
8. Make sure: area does not have surface veins,
DIOXIDE (PCO2)
scars, bruises, or edema.
- Indicator of how well, air is exchanged
9. Around the arm, place the blood pressure cuff between the blood and lungs
10. Clean the selected area with alcohol and air-dry - Shows the measure of pressure exerted by
11. While air-drying; put-on gloves and prepare dissolved CO2 in the blood plasma in
equipment
proportion with to the PO2 in the alveoli.
- Hypoventilation- when PCO2 level
12. Open puncture device and keep blade sterile
increases to an abnormal level
13. Inflate bp cuff; 40 mm hg - Hyperventilation- when PCO2 level
14. Position forearm; remove safety clip decreases
15. Depress trigger; start the timer PARTIAL PRESSURE OF OXYGEN (PO2)
16. The blade retracts; remove device and discard to - Representative of the pressure exerted by
the dissolved O2
sharps properly
- Used to monitor ability of the lungs to
17. Blot the blood flow for 30 sec using filter paper;
diffuse oxygen through the alveoli
without touching wound, wick the blood - Used to measure the effectiveness of an
18. When bleeding stops (no more stains), stop timer oxygen therapy
19. When bleeding persists 15 mins; stop the test OXYGEN SATURATION (SO2)
20. Remove blood pressure cuff, clean the arm; keep - Used to evaluate the oxygenation status of
the patient.
the site dry and bandage (24 hrs.)
- Measures the percentage of the binding
21. Record bleeding time; sites of the hemoglobin that is occupied by
22. Proper disposal of used and contaminated oxygen in the blood
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supplies - Normal SO2- 98%

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23. THANK THE PATIENT
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ELECTROLYTES Bicarbonate (HCO3-)

✓ Helps in transportation of CO2 to the
- Aid in moving nutrients in the body and remove
wastes in the cells of the body. lungs; and blood pH regulation
- Sodium, Potassium, Chloride, Bicarbonate, and ✓ Removal of CO2 from lungs = reduction
ionized calcium. in H+ ion; increase blood pH
Sodium (Na+) ✓ HYPOVENTILATION→ higher
✓ Keeps normal balance of fluids and plays concentration of CO2, higher
a role in transmitting nerve impulses. development of mor H+ ions = ACIDOSIS
✓ Helps maintain the balance of water in ✓ HYPERVENTILATION→ reduction of CO2
and around your cells. It's important for concentration = ALKALOSIS
proper muscle and nerve function. It also ✓ a negatively charged ion that is used by
helps maintain stable blood pressure the body to help maintain the body's
levels. acid-base (pH) balance. It also works with
✓ HYPERNATREMIA→elevated sodium the other electrolytes (sodium,
level; potassium, and chloride) to maintain
✓ HYPONATREMIA →insufficient/ reduced electrical neutrality at the cellular level.
sodium level Ionized Calcium (iCa2+)
Potassium (K+) ✓ comprises about 45% blood calcium
✓ Helps nerve conduction and muscle ✓ helps: muscular and cardiac function,
function blood clotting, and nerve transmission
✓ Acid-base balance regulation and function of the body
osmotic pressure ✓ It increases the strength of your bones
✓ HYPERKALEMIA→ increased blood and teeth and helps your muscles and
potassium; HYPOKALEMIA→ decrease nerves function. A serum calcium blood
blood potassium test measures the total calcium in your
✓ It helps regulate fluid balance, nerve blood. There are several different forms
signals and muscle contractions. of calcium in your blood. ... Ionized
Chloride (Cl-) calcium, also known as free calcium, is
✓ Maintains integrity of cells by: balancing the most active form.
osmotic pressure; acid-base and water
balance
✓ It helps keep the amount of fluid inside
and outside of your cells in balance. It
also helps maintain proper blood volume,
blood pressure, and pH of your body
fluids
✓ HYPERCHLOREMIA→ increased levels of
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Cl; HYPOCHLOREMIA→ decreased Cl

levels
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MULTIPLE-TEST PANEL MONITORING Pregnancy Test Procedure

BY POCT 1. Proper patient identification
- Composed of small, portable testing devices that 2. Write patient id in the specimen cup
measure analytes.
3. Explain collection procedure prior to urine
- These instruments play an important role in
emergency conditions because of the short specimen collection
turnaround time of the test results. 4. Remove test device from safety pouch and place
TURNAROUND TIME (TAT)- Time from on a flat surface
ordering a test through analysis 5. Place 3 drops in the sample well using the given
in the laboratory to the charting of the report
dropper
NAME OF THE ANALYTES/ BLOOD 6. 3 mins: wait reaction time;
INSTRUMENT GAS VALUES THAT ARE 7. Set time stated by manufacturer
TESTED 8. Read results from cassettes's windowwhen the
GEM Premier - LACTATE
- POTASSIUM timer goes off
- BUN,
- CREATININE
i-STAT - BUN ➢ Cardiac Troponin I and Cardiac
- GLUCOSE Troponin T
- HBG AND HCT Gauge the effectiveness of thrombolytic therapy being
- ACT VALUES administered to patients who have suffered from heart
AVOXIMETER - THb attacks
- SO2 ➢ Lipid Testing
- O2Ct
Measures alanine transferase (ALT) under lipid-
- COHb
lowering medication
- MetHb
- O2Hb ➢ B-Type Natriuretic Peptide (BNP)
ABL80 FLEX - Ph Differentiates chronic obstructive pulmonary disease
- PCO2 (COPD) and congestive heart failure (CHF)
- PO2
- can ➢ C-Reactive Protein (CRP)
- cCa2+
Detects and evaluates infection tissue injury, and other
- cCl-
- Ck+, inflammation orders.
- Hct ➢ Glucose
- cGlu Monitors glucose level of patients with diabetes
mellitus
➢ Glycosylated Hemoglobin (HbA1C)
PREGNANCY TESTING Diagnostic tool for diabetes therapy monitoring.
- Pregnancy could be detected as early as 10 ➢ Hematocrit
days from conception by checking the presence Measures volume of RBC
of ß- Human Chorionic Gonadotropin (hCG) in
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the urine or serum

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➢ Hemoglobin Transporting Specimens

Checks the hemoglobin level to manage patients
suffering from anemia
➢ Lactate
Evaluates the severity of lactic acid disorder and the
areas response of the patient
➢ Occult Blood (Guaiac)
Detects gastrointestinal (GIT) bleeding
➢ Skin test
Contact with allergens and determines if body has
developed antibodies. Skin tests could be tuberculin
test (TB), Aspergillus, coccidioidomycosis (cocci), and
histoplasmosis (histo)
➢ Strep Testing
Detects the presence of group A streptococci
➢ Urinalysis
Involves physical, chemical, and microscopic analyses
of the urine specimen
- Specimen tubes should be transported with the

LESSON 9: HANDLING AND PROCESSING OF stopper
BLOOD SPECIMEN FOR LAB TESTING - The tubes are placed in liquid tight closure
plastic bags with visible biohazard symbol
STEPS INVOLVED IN PROCESSING logo and slip pocket for appropriate paperwork
or docs.
AND HANDLING DIFFERENT TYPES Why must we properly transport a
specimen?
OF SPECIMENS
ROUTINE HANDLING Handling specimens for transport to the lab
must be done properly because rough handling
Mixing Tubes by Inversion can lead to undesirable conditions which might
hemolyze the specimens, activate platelets,
affect coagulation and even break the glass
tube.
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Now, CF is known as a cold-precipitable protein

SPECIAL HANDLING complex composed of fibrin, fibrinogen and fibrin split
Special care is needed when handling blood specimen to products found in plasma but not in serum of some
protect its condition and quality. individuals. Further, cryofibrinogenaemia is now
suspected to be associated with acute and chronic
1. Body Temperature inflammatory diseases, lymphoproliferative disorders,
- Below body temperature- the specimen will and vascular complications. However, it is true to say
precipitate or agglutinate. that up to now, CF has been best known as a risk factor
- Tubes- should be pre-warmed at 37degC and for thrombo-embolic complications.
portable heat blocks are used during transport. DEFINE CRYOGLOBULINS AND GIVE THE PROPER
- Portable heat blocks – hold the temperature for STORAGE DURING SAMPLE PREPARATION.
15 minutes from removal from the incubator.
- Heel Warmer- used for specimens that can Cryoglobulins are immunoglobulins that precipitate at
withstand a temperature slightly higher than low temperatures and redissolve upon rewarming.
37degC. Sample may require pre-warmed tube, and must be
IMMEDIATELY placed in warm environment upon
GIVE ANOTHER FUNCTION OF A HEEL WARMER collection and maintained for transport and processing.
Heel warming is used to increase blood flow in the 2. Chilled specimens

capillaries. If the heel is to be warmed, - Chilling slows the metabolic process.
using warm water submersion is risky unless you
tightly control the temperature. - Specimen tubes should be completely
submerged in crushed ice and water slurry
DEFINE COLD AGGLUTININ IN RELATION TO during transport and immediately tested or
TEMPERATURE IN TRANSPORTING SAMPLES. refrigerated.
- Analytes needed to be chilled: ACTH, acetone,
Cold agglutinins are autoantibodies produced by a ACE, ammonia, catecholamines, Free fatty
person's immune system that mistakenly target red acids, gastrin, glucagon, homocysteine, lactic
blood cells (RBCs). They cause RBCs to clump acid, PTH, pH/ Blood gas, pyruvate, renin
together when a person is exposed to cold temperatures
and increase the likelihood that the affected RBCs will WHY SPECIMENS FOR AMMONIA TEST
be destroyed by the body. It's triggered NEEDS TO BE CHILLED.
by cold temperatures; therefore, sandwich specimens
between two phlebotomy heat packs (activate them Chilling slows the metabolic process, which could
first). Place heat packs with specimens and transport to affect the results for some specimens.
lab for immediate processing.
The instability of ammonia in venous blood in vitro has
Moreover, sample may require pre-warmed tube, and been recognized as a pre-analytical source of error
must be IMMEDIATELY placed in warm environment since methods to measure its concentration were
upon collection and maintained for transport and established. Numerous studies have shown that plasma
processing. ammonia levels increase in vitro over time and may be
DEFINE CRYOFIBRINOGEN AND HIGHLIGHT THE falsely elevated if the specimen is not chilled “on-ice”
EFFECT OF THIS SUBSTANCE IN PHLEBOTOMY prior to processing and analysis.
"CRYOFIBRINOGEN (CF)" is an abnormal protein,

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which is reversibly cold-precipitable in anticoagulated

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blood and could form fibrin and clot with thrombin.
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3. Light sensitive specimen volume to unreliable testing and results; or,

complete the worse, incompletion of analysis.
Exposure to light can affect the test specimen, like
test
bilirubin.
3. Hemolysis Hemolysis due to the breakdown
of red blood cells is important to
the laboratory because it can
have an effect on laboratory
results. The effects can be the
result of products liberated from
the red cells themselves, or due
to interferences with laboratory
analyzers. This may vary from
OTHER ANALYTES THAT NEED TO BE one test to another depending on
PROTECTED FROM LIGHT IN THE TESTING the formulation of the reagent.
CYCLE
4. Wrong tube Specific anticoagulants must be
- Bilirubin
for collection used for each test that requires
- carotene is used plasma or whole blood. If the
- Red cell folate blood is drawn into a tube with
- Serum folate the wrong additive, patient
results may be adversely
- Vitamin B2, B6, B12, C affected. For example, the test
- Urine porphyrins for lithium usually requires a
- Urine porphobilinogen serum sample. If instead of a
serum tube, the phlebotomist
used a tube that contained
BLOOD SPECIMEN PROCESSING lithium heparin, the lithium
result for the patient would be
AND REASONS FOR SPECIMEN falsely elevated.
REJECTION 5. Tube used is Expired tube may have a

- Collected specimens are transported to the outdated decreased vacuum, resulting in a
short draw and leading to an
central processing for screening and
improper blood to additive ratio.
prioritizing. Expired tubes may also have
- They are (1) identified (2) logged (3) sorted changes to their additive which
(evaluated) can affect test results.
- Any specimens will be rejected for the
following reasons: 6. There is an Specimen Integrity is dependent
improper on accurate pre-analytical
handling processes to include patient
1. Specimen is Errors resulting from a preparation, specimen
not identified failure in this labeling can, collection, handling, and
properly at best, provide results of transportation. Improper
no clinical value and, at collection and handling of
samples can give erroneous
worst, lead to the most
results and compromise the care
adverse of patient outcomes of the patient. These guidelines
cover some of the key steps in
24
2. It has Insufficient volume of specimen handling blood samples to

inadequate may lead to ineffective/
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provide optimal specimens for level. A neonatal bilirubin

testing. specimen should be obtained in
a dark-colored (amber)
7. Specimen is A compromised specimen could container. Alternately, a clear or
contaminated include a sample transported at white container can be
the incorrect temperature, an immediately wrapped in
inappropriate sample type for aluminum foil following the
the test ordered, or a sample blood collection, preventing the
“contaminated” with something blood from exposure to light.
that could interfere with specific
tests. The failure to comply to the
11. Procedure did
not follow test’s time limit will affect
8. Quantity not There is not enough specimen results and extend turnaround
for the lab tests ordered to be testing time
sufficient time. The results would possibly
performed. In the case limits.
(QNS) be altered of too much time in
of Vacutainers or other tubes preparation, processing or
with pre-added anticoagulant, procedure.
the amount of blood invacuated
into the tube at the time 12. There is a Transport delays to the
of phlebotomy was insufficient
to attain the correct blood:
delay or error laboratory can give rise to
anticoagulant ratio. This can in processing clinically important errors if
transport conditions are not
cause false results in assays such optimized.
as coagulation assays (causing
falsely increased clotting times) Errors in specimen
or blood cell differentials processing can lead to adverse
(causing a false increase events which include; delays in
in poikilocytes, particularly burr patient diagnosis and
cells.) management.
9. Collection Timed samples are susceptible

time is to many preanalytical errors, DELIVERY TIME LIMITS AND
incorrect which have consequently
influence on laboratory results EXCEPTIONS FOR DELIVERY AND
and can lead to misdiagnosis and
improper therapy. PROCESSING SPECIMENS
1. Delivery Time Limits
10. Specimen is Some specimens routinely - Specimen should be transported immediately after
exposed to collected for testing by using a collection.
light capillary puncture are adversely
affected by exposure to light. - Routine blood specimen- reach the laboratory within
One example is a specimen 45 minutes.
collected for bilirubin testing - Centrifugation- should be done in 1 hour.
that is obtained from a newborn. - Hematology specimens with EDTA- should not be
When obtaining the specimen centrifuged.
for this testing, it is important for
the phlebotomist to recognize
2. Time Limit Exceptions
the effect of light on the
specimen. Room light or - STAT/ EMERGENCY- priority over all other
sunlight can metabolize the specimens in terms of transportation, processing and
25
bilirubin in the specimen to a testing.

different compound. This will
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cause a falsely lower bilirubin

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Tests Time limit • Stoppers left on the tube before and during
1. Blood smear from 1 hour from collection centrifugation—to avoid contamination,
EDTA specimen evaporation, aerosol formation, and pH changes
2. EDTA specimen for 6 hours analysis; 24 • Tubes should be balanced—tubes of the same
CBC hrs stable from size and volume of specimen should be opposite
collection at room
temp • Process of centrifugation should not be
3. EDTA specimen for 4 hours tested—room repeated
erythrocyte temp • Plasma specimen with anticoagulants—
sedimentation rate 12 hours tested— centrifuge immediately; with no delay
refrigerated • Serum specimen—needs to be clotted
4. EDTA specimen for 6 hours stable—room completely
reticulocyte counts. temp
72 hoursstable— • Tube stopper should be removed by pulling it
refrigerated straight up
5. Glucose test drawn in 24 hours stable—
NaF room temp 4. Aliquot Preparation
48 hours stable— What is an aliquot?
refrigeratedm @ 2°c -
8°c An aliquot of a specimen refers to a portion of a
6. Prothrombin time 24 hours stable specimen taken for chemical analysis or testing.
7. Partial 4 hours—analysis
thromboplastin time from collection An aliquot is a type of sub-sample that is taken or
What are the things to consider when preparing extracted from an original sample. If we think of
aliquot of a plasma as specimen? fractions, we can compare aliquots to the concept of
Specimens with different anticoagulants should not be
part and whole. That is, an aliquot is the fractional part
put in the same aliquot tube.
3. Centrifugation of an entire whole sample. ... Both of these parts are
sub-samples, or aliquots.
- A centrifuge is an apparatus that us used to
separate cells, plasma, or serum of blood
specimens.
- Achieved by spinning the blood tubes inside the
vessel at a high speed such that the centrifugal
force causes the separation of the specimens
HOW TO PROPERLY CENTRIFUGE A SPECIMEN

TUBE WITH BLOOD INSIDE?
OSHA ACT (RA 11058)- REQUIRED PROTECTIVE
EQUIPMENT WORN WHEN PROCESSING
SPECIMEN
ACCORDING TO RA 11058 What are the

required PPE to wear when processing
specimens in the laboratory?
- GLOVES
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- LABORATORY GOWNS/ COATS
- MASKS
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LESSON 10: HANDLING AND PROCESSING OF NON-BLOOD SPECIMEN FOR LAB TESTING
NON-BLOOD CHARACTERISTI DIFFERENT TYPES OF THIS COLLECTION METHOD
SPECIMEN CS/DESCRIPTION SPECIMEN
• Most • First morning / 8-hr sample • Regular voided: patient voids into clean container
frequently • Random sample • Midstream: patient voids into toilet first, then container
analyzed • Double-voided sample • Midstream clean-catch: requires special cleaning of genital area before
nonblood body • Timed sample collection. Used to detect UTI
Urine • Catheterized: collected from sterile catheter inserted through urethra into bladder
fluid • 24-hour sample
• Readily • Catheterized urine collection • Suprapubic aspiration: collected by inserting needle directly into bladder &
available, easy aspirating
• Chain-of-custody urine
to collect, & • Pediatric: collected in plastic bag, for children not potty trained
• Urine culture collection • 24-Hour Urine Collection Procedure
inexpensive to
• Clean-catch (midstream) 1. Void into toilet as usual on waking
test urine sample/ CCMS 2. Note time & date on label, place on container, begin timing
3. Collect all urine voided for next 24 hrs
4. Refrigerate specimen throughout collection period (if required)
5. Collect urine before anticipated bowel movement, not after
6. Drink normal amount of fluid unless instructed otherwise
7. Void one last time at end of 24 hrs. Keep last void
8. Seal container, place in cooler, transport to lab ASAP
PROPER PURPOSE/ COMMON TESTS TRANSPORTATION CONSIDERATIONS

CONTAINER
• sterile Its analysis can aid in: Accurate results depend on:
containers for • Providing info. on many of body’s major metabolic functions • Collection method
C&S testing • Monitoring wellness • Container used (some are
• Diagnosis & treatment of urinary tract infections sterile)
• Detection & monitoring of metabolic disease
• Specimen transportation &
• Determining effectiveness or complications of therapy
Common Urine Tests handling
• Urine drug screening • Timeliness of testing
• Urine cytology studies Roles in collection
• Routine urinalysis (UA) • Inpatient collection typically
• Culture & sensitivity handled by nurses
• Urine glucose & ketone testing : To screen for diabetes & monitor glucose & ketone levels • Outpatient collection often
in diabetics – Urine pregnancy testing handled by phlebotomists
• Tests for HCG, a hormone appearing in urine after conception: First morning specimen is
preferred due to higher concentration – Other urine tests
27
• Electrophoresis, heavy metals (copper & lead), myoglobin clearance, creatinine clearance, &
porphyrins
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NON-BLOOD CHARACTERISTICS/DESCRIPTION COLLECTION METHOD
SPECIMEN
Clear fluid that fills membrane • Collected after 15 weeks gestation
Amniotic surrounding & cushioning fetus • Obtained by physician in transabdominal amniocentesis
Fluid • Needle is inserted into mother’s abdominal wall into uterus
• About 10 mL of fluid from amniotic sac is aspirated

CONTAINER
Must be Analyzed to detect genetic disorders & problems in fetal development protected from light, & delivered to
collected in lab ASAP
sterile container
NON-BLOOD CHARACTERISTICS/DESC COLLECTION METHOD
SPECIMEN RIPTION
Clear, colorless liquid that Specimens are obtained by physician via lumbar puncture
Cerebrospinal surrounds brain & spinal
Fluid cord
PROPER CONTAINER PURPOSE/ COMMON TESTS TRANSPORTATION CONSIDERATIONS
Use a sterile syringe and needle to inoculate 0.5-1.0 Used to diagnose: • It should not be refrigerated, but
ml of CSF into the T-I medium. The •Meningitis • Brain abscess should be maintained at room
remaining CSF should be kept in the collection • CNS cancer • Multiple sclerosis temperature (20-25°C) before
tube. Routine tests: cell counts, chloride, glucose, & total protein Gram staining and other tests.
SPECIMEN
Medical Definition of gastric juice. : a thin watery acid Basal gastric analysis (phlebotomist only assists)
Gastric digestive fluid secreted by the glands in the mucous • Tube is passed through mouth & throat (or nose & throat) into
Fluid/Gastric membrane of the stomach and containing 0.2 to 0.4 stomach after fasting
Analysis percent free hydrochloric acid and several enzymes (as • Sample of gastric fluid is aspirated
pepsin) • Sample is tested to determine acidity prior to stimulation
• Stimulant is administered by IV
• Several more samples are collected at timed intervals
Gastric Fluid Container/Tube: • Examines stomach contents for abnormal substances Gastric specimen must be in liquid
Sterile collection cup. Minimum • Measures gastric acid concentration to evaluate production state.
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volume: 3 mL.
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SPECIMEN
From nasal cavity & pharynx – Collected using sterile Dacron or cotton-tipped flexible wire swab
Nasopharyngeal – Swab is inserted into nose & passed into nasopharynx
Secretions – It is rotated, removed, placed in sterile container, labeled, sent
Collect the specimens in sterile Cultured to detect presence of If specimens will be examined within 48 hours after collection, keep specimen
vials microorganisms causing: at 4ºC and ship on wet ice or refrigerant gel-packs, otherwise store frozen at ≤-
Label each specimen container with • Diphtheria 70ºC and ship on dry ice. Avoid freezing and thawing specimens. Viability of
the patient’s name, ID number, • Meningitis some pathogens (e.g. respiratory syncytial virus) from specimens that are frozen
specimen type, and the date • Pertussis (whooping cough) and then thawed is greatly diminished and may result in false-negative test
collected. • Pneumonia results.
SPECIMEN
Fluid secreted by glands in mouth Can be collected quickly & easily in a noninvasive manner
Saliva
Collection container(s) in a clear case (includes a tube Used to monitor hormone levels It is best-practice to move samples into cold storage immediately
with attached funnel and separate cap & detect alcohol & drug abuse after collection. Samples stored for more than 6 months should
ideally be moved to a – 80 C freezer.
SPECIMEN
Sperm-containing fluid discharged Normally, you ejaculate into a collection cup in a private room at your doctor's office. Sometimes
Semen during male ejaculation you can collect your sample at home, though you have to keep it at room temperature and get it to
your doctor or lab within 1 hour

CONTAINER
Collected in Analyzed to assess fertility or effectiveness of sterilization – Examined for forensic reasons in kept warm, & protected from light
sterile criminal sexual investigations
containers
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NON-BLOOD CHARACTERISTICS/DESCRIPTION DIFFERENT TYPES OF THIS SPECIMEN COLLECTION METHOD

SPECIMEN
Found between double-layered membranes enclosing Types of serous fluid should be indicated on label: Can be aspirated for
Serous pleural, pericardial, & peritoneal cavities • Pleural fluid (lungs) testing purposes by
Fluid Allows membranes to slide past one another w. minimal • Peritoneal fluid (abdominal cavity) physician
friction • Pericardial fluid (heart)

CONTAINER
It is essential to Pleural fluid analysis is used to help diagnose the Pleural fluid ph must be collected in a blood gas syringe. The sample must not be
put Hematology cause of accumulation of fluid in the chest cavity exposed to air (i.e. Collect anaerobically and expel all bubbles). Do not send other
samples into (pleural effusion) fluids in syringes (with or without needles attached).
EDTA Peritoneal fluid analysis is a lab test. It is done to Do not send fluids in transfusion bags, or iv. Bottles for hematology or chemistry
immediately look at fluid that has built up in the space in analysis.
the abdomen around the internal organs. Do not send large volumes of fluid. Pour into appropriate containers or contact
Pericardial fluid is the serous fluid secreted by the laboratory for direction.
serous layer of the pericardium into Do not send fluids in medquest prevac containers for cytopathology.
the pericardial cavity.
NON-BLOOD CHARACTERISTIC DIFFERENT TYPES OF THIS SPECIMEN COLLECTION METHOD
SPECIMEN S/DESCRIPTION
Mucous or phlegm Specimen types. Acceptable lower respiratory – First morning specimens are preferred (larger volume)
Sputum ejected from tract specimens include sputum, tracheal aspirate, – Collect at least 1 hr after a meal to avoid gagging or
trachea, bronchi, & BAL fluid, pleural fluid, or lung biopsy. vomiting
lungs Specimens with less chance for upper airway – Patient removes dentures & gargles w. water
contamination (i.e., BAL fluid, pleural fluid, lung – Patient takes 3 or 4 deep breaths & then coughs
biopsy) are preferred. forcefully, expelling sputum into container
CONTAINER
A sputum Collected for diagnosis or Store fixed cells at room temperature. If unfixed specimens will be examined within 48 hours after
specimen monitoring of lower collection, keep specimen at 4ºC and ship on wet ice or refrigerant gel-packs, otherwise store frozen at ≤-
container respiratory tract infections 70ºC and ship on dry ice. Avoid freezing and thawing specimens. Viability of some pathogens from
(tuberculosis) specimens that were frozen and then thawed is greatly diminished and may result in false-negative test
results.
SPECIMEN
Sweat (not Sweat is perspiration that makes you feel cooler when Under one sweat-collection method, the stimulated skin area is covered by a
done in all it evaporates off the surface of your skin — or the preweighed, salt-free, gauze pad which is held in place by a sheet of plastic
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giving-off of this liquid. If you exercise hard, you sealed to the patient such that the sweat produced in the covered area
hospitals) will sweat. is collected in the gauze pad.
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CONTAINER
microsample Analyzed for chloride content in diagnosis of cystic fibrosis Transport Room temperature. Transport
cup provided in – Sweat chloride test temperature: immediately.
collection kit • Pilocarpine (sweat-stimulating drug) is transported into skin by electrical Specimen Room temperature: 72 hours.
stimulation (iontophoresis) stability:
• Sweat is collected, weighed, & analyzed for chloride content
– Also used to detect illicit drug use; collected via skin patches
SPECIMEN
– Clear, pale-yellow, viscous fluid that Synovial fluid is collected by arthrocentesis, an aspiration of the joint using a syringe,
Synovial lubricates movable joints moistened with an anticoagulant, usually 25 units of sodium heparin per mL of synovial
Fluid – Normally occurs in small amounts fluid.
– Increases when inflammation is present
– Typically collected in 3 tubes: – Can be tested to identify or differentiate Specimen Immediately transport all specimens
• EDTA/heparin: for cell counts, ID of crystals, smear arthritis, gout, & other inflammatory processing to the laboratory to optimize
prep. conditions instructions: bacterial recovery.
• Sterile: culture & sensitivity
• Nonadditive: macroscopic appearance, chemistry, &
Transport Room temperature.
immunology tests & to observe clot formation
temperature:
Specimen ATM or ESwab < 72 hours.

stability: Sterile container or tube: ASAP, < 1
hour optimal.
Rejection Improperly labeled/identified

criteria: specimen. Improperly collected
specimens. Expired transport
device. Grossly contaminated
specimens. Delay in transport or
transport at the wrong temperature
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.
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SPECIMEN
Buccal – Less invasive, painless alternative to blood collection for – Phlebotomist gently massages mouth on inside of cheek w. swab
(Cheek) Swabs obtaining cells for DNA analysis – DNA is extracted from cells on swab
Cyto-Pak container with A buccal swab is a collection of cells on the inside of a person's cheek. Buccal Place all swabs in a labeled bag with
label swabs are frequently used as a way to collect DNA samples for testing. orders.

SPECIMEN
Bone marrow is the spongy tissue inside some of your bones, such as your hip and – Physician inserts large-gauge needle into bone
Bone thigh bones. It contains stem cells. The stem cells can develop into the red blood cells marrow in hip bone or sternum
Marrow that carry oxygen through your body, the white blood cells that fight infections, and the – 1.0 to 1.5 mL of specimen is aspirated using
platelets that help with blood clotting. syringe
PROPER CONTAINER PURPOSE/ COMMON TRANSPORTATION CONSIDERATIONS
TESTS
Smears should be bagged separately from formalin-fixed – Aspirated & Specimen should be stored at room temperature
specimens. Double-bag the specimen containers with the examined to Specimen must be received in the laboratory, as soon as possible,
requisition on the outside of the plastic bag.Place the double- detect & identify but no later than 8 hours after collection
bagged specimen into a box (primary container) with adequate blood diseases Specimen should be transported at room temperature • Completed
absorbent material in case of leakage. Surgical Pathology Request Form must accompany the specimen.

SPECIMEN
Breath the air taken into or expelled from the lungs. Breath specimens are collected as exhaled breath condensate or exhaled breath vapor
Samples (EBV), and can be used for detection of volatile organic compounds [VOCs (13)].
BreathTek® UBT for H. pylori can identify an active infection in your stomach.
During the test, you simply breathe into a small collection bag to capture a baseline
sample of your breath.
PROPER CONTAINER PURPOSE/ COMMON TESTS
breathe into a small – C-urea breath test

collection bag to capture a • Used to detect H. pylori (bacteria that damages stomach lining)
– Hydrogen breath test
baseline sample of your breath. • Helps identify problems w. digestion of lactose & fructose
• Thought to be most accurate lactose tolerance test
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• Also used to detect bacterial overgrowth in small intestine
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SPECIMEN
Clostridium Diffcile (C Diff): frequently found in place something in the toilet to catch the poo, such as a potty or an empty plastic food
Feces (Stool) hospitalized patients and is implicated as a container, or spread clean newspaper or plastic wrap over the rim of the toilet
causative agent in hospital acquired diarrhea. make sure the poo doesn't touch the inside of the toilet
Extremely contagious. use the spoon or spatula that comes with the container to collect the poo, then screw
the lid shut
Stool specimens are transported Occult blood cannot be seen by the naked eye Specimens contained in a holding medium can
in a cardboard container and – Useful in evaluation of gastrointestinal disorders be transported to the proper laboratory at room
placed in a polyethylene bag. – Stool specimens can be: temperature and then stored at 2–4°C for less than 3
• Evaluated for presence of intestinal parasites & their eggs days prior to processing. If specimens are not going to
• Checked for fat & urobilinogen content be tested within 3 d ays, store frozen at -80°C.
• Cultured to detect presence of pathogenic bacteria & viruses
• Tested for presence of occult blood using stool test
SPECIMEN
– Easy to obtain & cannot easily be altered or Use an alcohol wipe on your scissors, select a long thin strip of hair and cut as
Hair tampered with close to the scalp as possible. Minimum hair length must be half inch, you
can collect from any part of the head. If you do not have approximately one
hundred strands or pencil diameter then cut from another spot.
Collection Foil and place in the Hair – Collected for trace & heavy time period covered by the test is determined by the length of the
Specimen Pouch metal analysis & detection of sample –½ inch =1 month
drugs
Seal Pouch with the Hair Pouch Seal from the – Shows evidence of chronic
C.C.F rather than recent drug use
NON-BLOOD CHARACTERISTICS/DESCRI COLLECTION METHOD
SPECIMEN PTION
the throat is the front part – Nurses collect from inpatients, phlebotomists from outpatients
Throat of the neck, positioned in 1. Wash hands & don gloves (may wear mask & goggles)
Swabs front of the vertebra. It 2. Open container & remove swab 3. Stand back or to side of patient
contains the pharynx and 4. Instruct patient to tilt head back & open mouth wide 5. Direct light onto back of throat (flashlight)
larynx. 6. Depress tongue w. tongue depressor, have patient say “ah”
7. Swab tonsils, back of throat, inflamed areas; avoid lips, tongue 8. Maintain tongue depressor position
while removing swab
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9. Place swab in transport tube, embed in medium, secure cover
10. Label specimen 11. Remove gloves & sanitize hands
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12. Arrange transport or deliver to lab ASAP
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sterile polyester-tipped swab in covered transport tube – Collected to aid in diagnosis Specimens should be collected within 3 days of symptom onset
containing transport medium of strep infections and no later than 7 days from all patients meeting the case
-A throat swab and transport tube definition identified during the outbreak, ideally prior to the
initiation of antimicrobial chemoprophylaxis or therapy.
NON-BLOOD CHARACTERISTI DIFFERENT TYPES OF THIS SPECIMEN COLLECTION METHOD
SPECIMEN CS/DESCRIPTION
Tissue Tissue Larger specimens include whole organs or parts thereof, Biopsy: removal of tissue sample for examination
Specimens sampling refers to which are removed during surgical operations – Most arrive at lab in formalin or other solution & only
various Pieces of tissue rather than whole organs are removed need to be accessioned & sent to proper department
procedures to as biopsies, which often require smaller surgical – Some, however, may not be in proper solution
obtain bodily procedures that can be performed whilst the patient is still – Phlebotomist should check procedure manual to
fluids awake but sedated. determine proper handling for any unfamiliar specimen
or tissue (e.g. Fluid and very small pieces of tissue (individual cells rather – Improper handling can ruin a specimen
bone, muscle, than groups of cells, e.g. within fluid from around the lung)
etc.) for analysis. can be obtained via a fine needle aspiration (FNA).
Tissue biopsy: send in sterile leakproof container with Histopathology is the diagnosis issue specimens from the collection site to the laboratory is an
a small amount of sterile saline added to prevent and study of diseases of the important component of processing. Specimens should be
drying tissues, and involves examining protected from direct exposure to light.
tissues and/or cells under a For analysis of unstable constituents such as ammonia, plasma
microscope. Histopathologists renin activity, and acid phosphatase, specimens must be kept at 4°
are responsible for making tissue C immediately after collection and transported on ice.
diagnoses and helping clinicians
manage a patient's care.
Study questions:
1. Study the mode of transmission of SARS-COV 2. What do you think is the best specimen for the detection of the virus? Why?
2. Given the known risk pose by SARS-COV-2 what are your recommendations in proper specimen transport for the detection of this virus?
3. Is there any needed patient preparations before collection of gastric fluid? If there is/ are please specify.
4. Identify the analyte that differentiates seminal fluid from other body fluids. Give the reason why.
5. Differentiate exudates and transudates.
34
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1. Mode of transmission of SARS-COV 2 What do you think is the best specimen for the detection of
the virus? Why?
SARS-CoV’s transmission is primarily from person to
person. It appears to have occurred mainly during the Respiratory specimens can be used best when the virus
second week of illness, which corresponds to the peak of is transmitted in droplets (larger or smaller), as well as
virus excretion in respiratory secretions and stool, and it being airborne. As I’m researching, I came to
when cases with severe disease start to deteriorate perceiving that, following the track of transmission and
clinically. Most cases of human-to-human transmission acquiring the virus, it is indeed best choice to consider
occurred in the health care setting, in the absence of respiratory swabs for culture and detection of the virus.
adequate infection control precautions. Implementation of Yet going deeper into studying the possibilities of the
appropriate infection control practices brought the global virus’s transmissions. Virus shedding patterns are not
outbreak to an end. yet well understood and further investigations are
In general it is considered that viral respiratory infections needed to better understand the timing,
spread by direct contact, such as touching an infected compartmentalization and quantity of viral shedding to
person or the surfaces and fomites that the person has inform optimal specimen collection.
either touched, or on which large virus-containing And so, though respiratory samples have the greatest
droplets expired by the person have landed , and there the yield, the virus can be detected in other specimens,
virus can remain stable for days. The droplets can also be including stool and blood.
deposited directly on a person in close proximity to the
infected person. According to WHO, the best choice of specimen to be
collected for SARS-COV-2 are
It is perceived that it is also possible that immediately
after droplets are expired, the liquid content starts to • UPPER RESPIRATORY SPECIMENS:
evaporate, and some droplets become so small that - nasopharyngeal and oropharyngeal swab or wash in
transport by air current affects them more than ambulatory patients
gravitation. Such small droplets are free to travel in the air • and/or LOWER RESPIRATORY SPECIMENS:
and carry their viral content meters and tens of meters - sputum (if produced) and/or endotracheal aspirate
from where they originated
or bronchoalveolar lavage in patients with more
severe respiratory disease.
References:
1. WHO: Laboratory testing for coronavirus
disease 2019 (COVID-19) in suspected human
cases. Interim guidance 2 March 2020
https://apps.who.int/iris/bitstream/handle/10665/331329/
WHO-COVID-19-laboratory-2020.4-eng.pdf
2. CDC: SPECIMEN COLLECTION
Larger droplets with viral content deposit close to the
GUIDELINES
emission point (droplet transmission), while smaller can
travel meters or tens of meters long distances in the air https://www.cdc.gov/urdo/downloads/SpecCollectionGu
indoors (aerosol transmission). idelines.pdf
References: 2. Given the known risk pose by SARS-COV-2 what
1. Airborne transmission of SARS-CoV-2: The are your recommendations in proper specimen
world should face the reality by LidiaMorawska transport for the detection of this virus?
35
2. WHO: https://www.who.int/ith/diseases/sars/en/
Ensure that adequate SOPs (Standard Operating
Page
Procedure) are in use and that staff are trained for

appropriate specimen collection, storage, packaging and
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transport. All specimens collected for laboratory Seminal fluid is set apart from other body fluids because
investigations should be regarded as potentially it contains sperm (spermatozoa).
infectious. Ensure that health care workers who collect
5. Differentiate exudates and transudates.
specimens adhere rigorously to infection prevention and
control guidelines. Transudate is fluid pushed through the capillary due to
high pressure within the capillary, while, Exudate is fluid
Reading into the WHO’s Lab Guide, I have perceived that
that leaks around the cells of the capillaries caused by
the problems came from the health care worker’s lack of
inflammation.
experience to match up the demand of lab competency
against the virus. It is recommended, according to the Reference:
same paper of WHO, that workers must be trained in
advanced environments to enhance their work 1. https://www.khanacademy.org/science/health-
competency. and-medicine/respiratory-system-diseases/pleural-
effusion-2/v/transudate-vs-exudate
Another that I have taken down from the situation, is the
communication in the labs. Alerting the laboratory
before sending specimens encourages proper and timely
processing of samples and timely reporting. Specimens
should be correctly labelled and accompanied by a
diagnostic request form
References:
1. WHO: Laboratory testing for coronavirus
disease 2019 (COVID-19) in suspected human
cases Interim guidance 2 March 2020
https://apps.who.int/iris/bitstream/handle/10665/331
329/WHO-COVID-19 -laboratory-2020.4-eng.pdf
3. Is there any needed patient preparations before
collection of gastric fluid? If there is/ are please
specify.
1. Patient to be NPO after midnight.
2. The family should come to the clinic first thing in the
morning. Any family members who could possibly have
active TB should wear masks to prevent transmission to
health care workers.
3. Place NG tube in patient. Do not use surgilube – it is
bacteriostatic. Use as large a bore NG tube as is
comfortable (minimum 10 french). Avoid too deep a
placement to prevent passage through the pylorus.
Reference:
THIS REVIEWER IS WRITTEN BY: K. NOVERO
https://www.currytbcenter.ucsf.edu/sites/default/files/ga_patient_prep
.pdf
4. Identify the analyte that differentiates seminal fluid Please do not copy and resend without permission.
36
from other body fluids. Give the reason why.

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NOTES:
37
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NOTES:
38
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PREP BY: K.

NOVERO BMLS1-1 LESSON 8-10 FROM ACTIVITIES MIDTERMS PT 2 COPY

PMLS 2 MIDTERMS NOTES PT2

important information from other

LESSON 8: SPECIAL COLLECTION AND POINT-

BLOOD BANK SPECIMENS

donated, have been the most important factors in

advancing blood safety. Criteria for donation of

STERILE TECHNIQUE IN BLOOD to the identification of the condition’s origin, or

correct collection of blood cultures is extremely

important. Because the results of these cultures lead

• Have liver disease

Coagulation Specimen Collection Procedure

What other tests might I have with this test?

GTT PROCEDURE If GGT is normal and ALP is high, bone

Time Test Collected: What is being tested?

Newborn infants will have significantly higher levels

Why Get Tested?

in gastric cells. The procedure involves ingestion of a lactose cocktail

indicates lactase deficiency→ as part of an investigation of malabsorption

Sample Required? There are two types of exclusions

is called first-pass elimination or metabolism.

- At steady-state levels, the rate of administration of

excretion, allowing the drug level to remain constant.

POLYCYTHEMIA - Spurious (false) polycythemia is related to

- Relative polycythemia can be caused by acute

dehydration resulting from severe diarrhea,

TOXICOLOGY SPECIMENS - Split sample may be required

for better accuracy of results. This is with regards,

- Proctor present at time of collection test.

PATIENT PREPARATION REQUIREMENTS FOR

Tests for aluminum, arsenic, copper, lead, iron, &

MONITORING FOR WARFARIN AND HEPARIN

used frequently any more due to its variability.

ARTERIAL BLOOD GASSES (ABG)

supplies - Normal SO2- 98%

23. THANK THE PATIENT

ELECTROLYTES Bicarbonate (HCO3-)

Cl; HYPOCHLOREMIA→ decreased Cl

MULTIPLE-TEST PANEL MONITORING Pregnancy Test Procedure

the urine or serum

➢ Hemoglobin Transporting Specimens

- Specimen tubes should be transported with the

Now, CF is known as a cold-precipitable protein

Heel warming is used to increase blood flow in the 2. Chilled specimens

"CRYOFIBRINOGEN (CF)" is an abnormal protein,

which is reversibly cold-precipitable in anticoagulated

blood and could form fibrin and clot with thrombin.

3. Light sensitive specimen volume to unreliable testing and results; or,

REJECTION 5. Tube used is Expired tube may have a

2. It has Insufficient volume of specimen handling blood samples to

provide optimal specimens for level. A neonatal bilirubin

9. Collection Timed samples are susceptible

bilirubin in the specimen to a testing.

cause a falsely lower bilirubin

HOW TO PROPERLY CENTRIFUGE A SPECIMEN

ACCORDING TO RA 11058 What are the

- LABORATORY GOWNS/ COATS

PROPER PURPOSE/ COMMON TESTS TRANSPORTATION CONSIDERATIONS

PROPER PURPOSE/ COMMON TESTS TRANSPORTATION CONSIDERATIONS

PROPER CONTAINER PURPOSE/ COMMON TESTS TRANSPORTATION CONSIDERATIONS

PROPER CONTAINER PURPOSE/ COMMON TESTS TRANSPORTATION CONSIDERATIONS

PROPER CONTAINER PURPOSE/ COMMON TESTS TRANSPORTATION CONSIDERATIONS