SPECIMEN COLLECTION, HANDLING AND PROCESSING

Points to consider before releasing a lab result

1. Is it normal?
- Normal in range
- Consider the panic value or the critical value
- Blood specimen (green or prompt machine) STAT report
o Panic value can cause sepsis or complications
- Electrolytes (potassium)
o 3.5 to 5.0
o 5.5 hyperkalemia
o 6.5 heart problems
o Less than 3 panic value

2. It is significantly different from its previous result?

- Patient have previous test result must check it (DELTA CHECK)
- POST ANALYTICAL Processing
o Delta Check
o Releasing of lab result
- PRE-ANALYTICAL
o Specimen Collection
- ANALYTICAL
o Testing of specimen

3. Is it consistent with the clinical findings? Or the other clinical findings?

- If not do PATTERN RECOGNIGTION
o Check the ALT/AST ↑ (liver problem) do a pattern recognition
o PATTERN RECOGNIGTION
 CHECK SIMILAR OTHER LIVER CHECK

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  Check PT/APTT↑
 Sensitize coagulation factors
 Prolong PT/APPT (correct lab result jive with the liver problem)

4. Is your machine Accurate and Precise?

- Quality control every shift is important w/c ensure the accuracy and
precision of the machine before the test release
- In doubt perform randomize duplicate testing
o Patient sample will be tested many times and the result must be
the same and the variations is not far with each other

DIFFERENT COMPONENTS

1. Test request
- Most common error starts with pre-analytical (CLERICAL ERROR)

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 - Clerical error
o Labelling, identifying patient, lab result, switching patient

- Test request must be requested by physician, patient, nurse

o Check the name (patient must state), sex, and patient birth
o Not sure of name check the wristband or hospital number
o Check the requesting physician
o Check the test if there is fasting or special preparation
o Determine what kind of specimen (blood, urine, plasma, csf)
o Patient preparation (tourniquets less than 1 minute)
 ↑ albumin, potassium, total protein, cholesterol, ammonia
 Hemoconcentration

- Interference of alcohol in test do not used isopropyl alcohol or ethyl but

used Benzalkonium chloride (used as antiseptic)
o Disinfectant – inanimate objects
o Antiseptic – living tissues

2. Patient
- Some analytes are affected by variables:
o Age (normal values for diff age: child, young adult, senior)
o Ethnicity
o Pregnancy
o Posture (standing or bedridden: diff factors affect)
o Exercise (vigorous)
o Stress
o Drugs

* PRE-ANALYTICAL can also be affected the test result

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CONSIDERATIONS BEFORE PERFORMING LAB TEST

a. Absorption the glass or plastic tube

- Some of the tube redtop/ SST (cannot be with trace elements)
- Protein denaturation (cause by heat/ freezing: thaw or chilling)
o Used by ice careful because of denaturation of RBC/ protein
- Evaporation of volatile compounds
- Hemoconcentration (prolong tourniquet)
- blood stack in the arm & cannot flow
- Increase lab result ↓ O2 & pH
- ↑ potassium, total protein, lactate, cholesterol, ammonia

3. Specimen
- Factors to be noted:
a. Hemolysis
o May interfere the result (potassium)
o ↑ Primary intracellular cation burst RBC may release potassium
o LDH many in RBC, hemolysis ↑ value
o ↑ AST/ALT & Aldolase
o ↑ magnesium (second most abundant intracellular cation)
o ↑ phosphorus (most abundant intracellular anion)
o Total protein

b. Lipemia
o Centri the red top tube (separate serum and Packed cell)
o Serum = milky (lipemic)
 ↑ chylomicron, triglycerides, cholesterol
 Creamy/ Opaque - ↑ chylomicron
 Turbid - ↑ triglycerides greater than 400
Other value greater than 600 === milky

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 c. Non-fasting/fasting specimen
o Check the clot formation
o Place the blood to the tube
 Uncapped it and put in the upright position to avoid the
leakage of anticoagulant
 Swirling or invert the evacuated tube so mix evenly the
anticoagulant and the blood (no clot)

d. Discrepancy between Requisition or Specimen label

o Check the difference bet requisition and the specimen tube
o Do not write in the specimen bottle cap (may switch)

e. Contamination of specimen or leaking of the container

o Check for leakage (recollect because of contamination)

f. Short draws/ Improper blood collection tube

o Check test and the specimen required (plasma, serum)
o Purple – Hematology
o Blue – PT/APTT coagulation studies
o Green – arterial blood gas analysis
o Yellow- - microbiology

- Some sample required large volume of the blood

- Few blood put in the microtainer
- Wrong volume (coagulation studies critical)
o Ratio of volume & anticoagulant (1:5)
o Wrong volume cause prolong coagulation

g. Clot present in anticoagulated specimen

o Infinity or up down inversion
o No vigorous shaking cause may cause hemolysis

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