PMLS 2

TOPIC 1
10. Attendance at continuing education
PHLEBOTOMY .
programs

Phlebotomy- incision into a vein

Decentralization- either cross-training per-
Bloodletting is now called “therapeutic
sonnel working in the patient units to perform
phlebotomy” and is used as a treatment for only
phlebotomy or transferring phlebotomists to the
a small number of blood disorders.
patient units and cross-training them to perform
basic patient care tasks.
PHLEBOTOMY NOW .
Additional Duties
At present, the primary role of phlebotomy is the 1. Training other personnel to phlebotomy
collection of blood samples for laboratory 2. Monitoring the quality of samples collected
analysis to diagnose and monitor medical 3. Evaluation of protocols associated with
conditions. sample collection
4. Performing and monitoring point-of-care
DUTIES OF A PHLEBOTOMIST . testing (POCT)
5. Performing electrocardiograms
A phlebotomist is a person trained to obtain 6. Performing patient’s vital signs
blood samples primarily by venipuncture and 7. Collection of arterial blood samples
microtech-niques; must have technical, clerical, 8. Collection of samples from central venous
and inter- personal skills, also organizational access devices (CVADs)
skills to handle a heavy workload efficiently.
PHLEBOTOMIST CHARACTERISTIC
Traditional Duties
1. Correct identification and preparation of the
patient before sample collection
2. Collection of the appropriate amount of blood
by venipuncture or dermal puncture
3. Selection of the appropriate sample containers
4. Correct labeling of all samples
5. Appropriate transportation of samples back to
the laboratory in a timely manner
6. Effective interaction with patients and
hospital personnel
7. Processing of samples for delivery to the
appropriate laboratory departments
8. Performance of computer operations and
record-keeping pertaining to phlebotomy
9. Observation of all safety regulations, quality
control checks, and preventive maintenance
procedures
COMMUNICATION SKILLS .
-Verbal skills
- Listening skills
- Nonverbal skills or body language
PHLEBOTOMY EDUCATION AND
CERTIFICATION
HEALTHCARE DELIVERY SYSTEM .
Hospital Services and Departments
Nursing Services- deals directly with patient
care, consists of cardiac care unit (CCU),
central supply, emergency department (ED),
hospital patient-care units, infection control,
intensive care unit (ICU), nursery, social
services, and the operating room (OR).
Support Services- maintain the hospital and
include communications systems, food
. service/dietary,housekeeping/environmental
. services, laundry, engineering and
maintenance, and security.
Fiscal Services- manage the business
aspect of a hospital. Included in this service
are accounting, admitting,business office,
credit and collection, data process- ing,
health information management, planning,
and public relations departments that
include marketing and outreach programs.
Support and Fiscal Service Departments
Engineering and Maintenance- maintains
hospital’s physical plant inc.communications
and clinical equipment
Housekeeping/Environmental Services-
maintains a sanitary and safe hospital:
laundry, cleaning of patient rooms, and
disposal of biological waste
Dietary/Food Services- food and provides
nutrition care and education
Business Office- performs daily business
functions; patient accounts, paying bills, and
payroll
Admitting- processes patient admissions
and discharges
Marketing/Public Relations-promote hospital
services to the community
Health Information Management- maintains
patient records and hospital legal and
regulatory documents
Human Resources- recruits, interviews, and
orients new employees.
Volunteer Services-coordinates activities of
hospital volunteers
Central Supply- sterilizes, stores, and
distributes sterile supplies

PROFESSIONAL SERVICE
DEPARTMENT
Radiology and Diagnostic Imaging
-uses various forms of radiant energy to
diagnose and treat disease.
-techniques include x-rays of teeth and bones,
computerized axial tomography (CAT or CT
scan), contrast studies using barium sulfate,
cardiac catheterization, fluoroscopy, ultrasound,
magnetic resonance imaging (MRI), and
positron emission tomography (PET scan).
Radiation Therapy
-uses high-energy x-rays or ionizing radiation to
stop the growth of cancer cells.
Nuclear Medicine
-uses the characteristics of radioactive
substances in the diagnosis. In vitro tests
analyze blood and urine samples using
radioactive materials to detect levels of
hormones, drugs, and other substances. In vivo
tests involve administering radioactive material
to the patient by intravenous (IV) injection and
measuring the emitted rays to examine organs
and evaluate their function. (eg. bone, brain,
liver, and thyroid scans.)
Occupational Therapy
-teaches techniques that enable patients with
physical, mental, or emotional disabilities
Pharmacy
-dispenses the medications prescribed by
physicians.
Physical Therapy
-provides treatment to patients who have been
disabled as a result of illness or injury by using
procedures like water, heat, massage, ultrasound,
and exercise.
Respiratory Therapy
-provide treatment in breathing disorders and
perform testing to evaluate lung function.
-may also perform the arterial punctures used to
evaluate arterial blood gases
Cardiovascular Testing
Cardiac technicians under the supervision of a
cardiologist evaluate cardiac function using
electrocardiograms, stress tests, and imaging
techniques.
Clinical Laboratory
-provides data to the health- care team to aid in
determining the diagnosis, treatment, and
prognosis of a patient.
OTHER HEALTH-CARE SETTINGS .
Physicians Office Laboratories (POLs)
and Group Practices
Group practices, comprising primary care
physicians or specializing in fields like
pediatrics or cardiology, may work
independently or be affiliated with a hospital.
Health Management Organizations
-managed care group practice centers that
provide a large variety of services: physicians’
offices,a clinical laboratory, radiology, physical
therapy, and outpatient surgery
Reference Laboratories
Large, independent, contract with health-care
providers and institutions to perform both
routine and highly specialized tests.
Government and Hospital Clinics
Hospital-sponsored specialty clinics, such as
cancer, urology, and pediatric clinics, provide
more cost- effective delivery of health care to
more patients.
Home Health Care
Clinical laboratory is divided into 2 areas:
● Anatomical- responsible for the
analysis of surgical specimens, frozen
sections, biopsies, cytological
specimens, and autopsies. Sections
include cytology, histology, and
cytogenetics.
● Clinical
CYTOLOGY SECTION
Cytologists process/examine tissue and body
fluids for the presence of abnormal cells. The
Papanicolaou(Pap) smear is one of the most
common tests
HISTOLOGY SECTION .
Histology technicians/ technologists process and
stain tissue obtained from biopsies, surgery,
autopsies, and frozen sections. A pathologist
then examines the tissue.
CYTOGENETICS .
Chromosome studies are performed to detect
genetic disorders. Blood, amniotic fluid, tissue,
and bone marrow specimens are analyzed.
CLINICAL AREA .
Divided into specialized sections:
hematology, coagulation, chemistry, blood bank
(immunohematology), serology (immunology),
microbiology, urinalysis, phlebotomy, and
sample processing.
CLINICAL LAB PERSONNEL .
Laboratory Director (Pathologist)
- usually a pathologist, a physician
completed a 4- to 5-year pathology
residency.
- works in both clinical pathology and
anatomical pathology.
- liaison between the medical staff and the
laboratory staff
- direct responsibility for the anatomical
and clinical areas of the laboratory
- Responsibilities include working with
the laboratory administrator to establish
laboratory policies, interpret test results,
perform bone marrow biopsies and
. autopsies, and diagnose disease
- has one or more associate pathologists
 - may also be a laboratory specialist who
possesses a doctorate degree.
Laboratory Manager (Administrator)
- responsible for overall technical and
administrative management of the lab,
including personnel and budgets.
- usually a (MLS) with a master’s degree
and 5 or more years of laboratory
experience.
- acts as a liaison among the laboratory
staff, the administrator of professional
services, and the laboratory director.
Technical Supervisor
- an MLS with experience
- Many have a specialty certification
- is accountable to the laboratory
administrator.
- Responsibilities include reviewing all
laboratory test results; consulting with
the pathologist on abnormal test results;
scheduling personnel; maintaining
automated instruments by implementing
preventive maintenance procedures and
quality control measures; preparing
budgets; maintaining reagents and
supplies; orienting, evaluating, and
teaching personnel; and providing
research and development protocols for
new test procedures.
Medical Laboratory Scientist
- has a bachelor’s degree in medical
technology or in a biological science
and 1 year of training
- performs laboratory procedures that
require independent judgment and with
minimal technical supervision;
maintains equipment and records;
performs quality assurance and
preventive maintenance activities related
to test performance; may function as a
supervisor, educator, manager, or
researcher within a medical lab setting.
- Additional duties are to evaluate and
solve problems related to the collection
of samples, perform complex laboratory
procedures, analyze quality control
data, report and answer inquiries
regarding test results, troubleshoot
equipment, participate in the evaluation
of new test procedures, and provide
education to new employees and
students.
Medical Laboratory Technician
- usually has a 2-year associate degree
from an accredited college medical
laboratory program.
- performs routine lab procedures under
the supervision of a technologist,
supervisor, or laboratory director.
- collecting and processing biological
samples for analysis, performing routine
analytic tests, recognizing factors that
affect test results, recognizing abnormal
results and reporting them to a
supervisor, recognizing equipment
malfunctions and reporting them to a
supervisor, performing quality control
and preventive maintenance procedures,
maintaining accurate records, and
demonstrating laboratory technical skills
to new employees and students.
Laboratory Assistant
- has training in phlebotomy, sample
receiving and processing, quality control
and preventive maintenance of
instruments, and computer data entry
and can perform basic “waived”
laboratory testing.
- aids the MLS or MLT by preparing
samples for testing.
Phlebotomist
 - collects blood from patients Sample Collection and Handling
- must have a high school diploma and The most common body fluid analyzed is
usually has completed a structured whole blood (a mixture of cells and plasma).
phlebotomy training program. The liquid portion of blood is called plasma
if anticoagulated. If clotted, the liquid
Additional Laboratory Personnel
portion is called serum.Plasma contains
- educational coordinator to direct a
medical technology
the protein fibrinogen and serum does not.
- a point of care coordinator evaluates
new point of care procedures and
protocols, reviews quality assessment,
and conducts competency assessments:
works closely with nurses and other lab
personnel performing POCT.
- LIS manager has a clinical laboratory
science background and education in
computer operations.
- A quality assessment coordinator
collects and evaluates quality control
data.
Tests Performed in the Hematology
Section
Personnel title changes . Complete blood count (CBC)- primary
1. Clinical laboratory technicians, CLT analysis performed in the hematology
(NCA), and medical laboratory technicians, section. Very often ordered on a STAT basis.
MLT (ASCP), are now both MLT(ASCP).
2. Clinical laboratory scientists, CLS (NCA),
and medical technologists, MT (ASCP), are
now both medical laboratory scientists,
MLS(ASCP)cm.
3. Certification maintenance (cm) through
documentation of a required amount of
continuing education has been required of all
certified in 2004 and later. Medical
technologists certified prior to 2004 must
complete the required continuing education or
their designation will remain MT (ASCP).

HEMATOLOGY SECTION .

The study of the formed (cellular) elements COAGULATION SECTION .

of the blood.
-sometimes a part of the hematology section, but
in larger laboratories it is a separate section.
-the overall process of hemostasis is evaluated;
inc. platelets, blood vessels, coagulation factors,
fibrinolysis, inhibitors, and anticoagulant
therapy (heparin and Coumadin).
-light blue stopper that contains the
anticoagulant sodium citrate
CHEMISTRY SECTION .
-most automated area of the lab
-divided into areas such as general or automated
chemistry, electrophoresis, toxicology
(therapeutic drug monitoring and the
identification of drugs of abuse are performed.),
and immunochemistry (uses enzyme
immunoassay (EIA) techniques)
Sample Collection and Handling
-Performed primarily on serum collected in gel
barrier tubes, but serum may also be collected in
tubes with red, green, gray, or royal blue
stoppers.
-Also performed on plasma, urine, and other
body fluids.
-Serum and plasma are obtained by
centrifugation performed within 1 to 2 hours of
collection.
-Specimens of concern include hemolyzed
specimens that appear red, icteric specimens that
are yellow because of excess bilirubin, and
lipemic specimens that are cloudy.
-Serum separator tubes contain inert gel that
prevents contamination of the specimen by
RBCs or their metabolites.
-Samples must be allowed to clot fully before
centrifugation
BLOOD BANK SECTION .
-blood may be collected, stored, and prepared
for transfusion.
-also called immunohematology section
-blood from patients and donors is tested for its
blood group (ABO) and Rh type, the presence
and identity of abnormal antibodies, and its
compatibility (crossmatch) for use
in a transfusion
Sample Collection and Handling
-collected in plain red (serum), lavender, or pink
(plasma) stopper tubes.
-Serum separator tubes containing gel are not
acceptable because the gel will coat the RBCs
-Patient identification is critical in the blood
bank
IMMUNOSEROLOGY SECTION .

-performs tests to evaluate the body’s immune

response
-detect the presence of antibodies to bacteria,
fungi, parasites, viruses, and antibodies
produced against body substances
(autoimmunity).

Sample Collection and Handling

-collected in tubes with red stoppers. Serum
separator tubes are not used when the gel will
interfere with the antigen-antibody reactions. URINALYSIS SECTION .

-detect disorders and infections of the kidney

and to detect metabolic disorders such as
diabetes mellitus and liver disease.
-routine UA consists of physical, chemical, and
microscopic examination of the urine.

MICROBIOLOGY SECTION .

-identification of pathogenic microorganisms

and for hospital infection control.
-may be divided into bacteriology, mycology,
parasitology, and virology.
-culture and sensitivity (C & S) test is the
primary procedure performed used to detect and
identify microorganisms and to determine the
most effective antibiotic therapy.
REGULATORY ISSUES . health-care organizations and programs in the
US.
Clinical Laboratory Improvement -The mission of the JC is to continuously
Amendments of 1988 (CLIA’88) improve the safety and quality of care provided
to the public through the provision of
-governmental regulatory agency administered accreditation and services that support
by the Centers for Medicare and Medicaid performance improvement in health-care
Services (CMS) and the Food and Drug organizations.
Administration (FDA). -published the Joint Commission Patient Safety
-stipulates that all laboratories must be licensed Goals:
and obtain a certificate from the CMS. Goal 1 Improving the Accuracy of Patient
- classifies laboratory tests into four categories: Identification
Goal 2 Improving the Effectiveness of
Communication among Healthcare Givers
Goal 7 Reduce the Risk of
Healthcare-Associated Infections
Goal 13 Encourage Patients’ Active
Involvement in Their Own Case as a Patient
Safety Strategy

College of American Pathologists (CAP)

-an organization of board-certified pathologists
that advocates high-quality and cost-effective
medical care.
-provides laboratory accreditation and
proficiency testing for laboratories.

ETHICAL AND LEGAL ISSUES .

Principles of right and wrong, called the code of

ethics. Medical ethics or bioethics focus on the
patient to ensure that all members of a
Clinical and Laboratory Standards
health-care team possess standards necessary to
Institute (CLSI)
serve the patient.
-a nonprofit organization that publishes
Professional agencies such as the American
recommendations by nationally recognized
Society for Clinical Pathology (ASCP),
experts for the performance of laboratory
American Society for Clinical Laboratory
testing.
Science (ASCLS), and the National Phlebotomy
-CLSI standards are considered the standard of
Association (NPA) have developed codes of
care for laboratory procedures. \
ethics for laboratory personnel.
Joint Commission (JC)
The Patient’s Bill of Rights
-an independent, not-for-profit organiza-
A document first published by the American
tion that accredits and certifies more than 15,000
Hospital Association (AHA) in 1973 and
amended in 1992 called the Patient’s Bill of 11. Patients have the right to examine and
Rights: receive an explanation of their bill, regardless of
1. Patients have the right to considerate and the source of payment.
respectful care. 12. Patients have the right to know what hospital
2. Patients have the right to obtain from their rules and regulations apply to their conduct as
health-care provider complete current informa- a patient
tion about their diagnosis, treatment, and prog-
nosis in terms that patients can be reasonably
expected to understand.
3. Patients have the right to receive from a
healthcare provider the information necessary to
give informed consent before a procedure. The
patient has a right to information about
medically significant alternatives.
4. Patients have the right to refuse treatment and
to be informed of the medical consequences of
their action.
5. Patients have the right to privacy in their
medical care. Case discussion, consultation,
examination, and treatment should be conducted
discreetly. Those not directly involved with a
patient’s care must have the patient’s permission
to be present.
6. Patients have the right to expect
Legal Issues Relating to Medicine
confidentiality.
Medical law regulates the conduct of members
7. Patients have the right to expect the hospital
of the health-care professions. A criminal
to make a reasonable response to their request
lawsuit is an action initiated by the state for
for services and to provide evaluation, service,
committing an illegal act against the public
and referral as indicated.
welfare. A civil lawsuit is a court action between
8. Patients have the right to obtain information
parties seeking monetary compensation for an
as to any relationship of their hospital with
offense.
other health-care and educational institutions,
insofar as their care is concerned, and to the
Tort Law
professional relationship among individuals
A wrongful act committed by one person against
who are treating them.
another that causes harm is called a tort. Can be
9. Patients have the right to be advised if the
intentional (Assault, battery, and defamation)
hospital proposes to engage in or perform human
and unintentional (negligence and malpractice)
experimentation affecting their care or treat-
ment. Patients have the right to refuse to
● Assault is the threat to touch another person
participate in research projects.
without his or her consent and with the intention
10. Patients have the right to expect continuity
of causing fear of harm.
of care after discharge.
● Battery is the actual harmful touching of a
per-
son without his or her consent.
● Defamation is spoken or written words that
can injure a person’s reputation.
● Libel is false defamatory writing that is
published.
● Slander is a false and malicious spoken word.
● Invasion of privacy is the violation of the
patient’s right to be left alone and the right to be
free from unwanted exposure to public view.
● Release of confidential information is
considered an invasion of privacy. Entering a
patient’s room without asking permission may
be considered a physical intrusion and an
invasion of privacy.
The Health Insurance Portability
and Accountability Act of 1996 (HIPAA)
Primary goals of the legislation
are to:
● Protect workers with pre-existing conditions
from losing health insurance when changing
jobs
● Provide easier detection of fraud and abuse
● Reduce paperwork by requiring electronic
data transactions
● Guarantee the privacy of individual health
information
The release of patient test results now falls under
the HIPAA.
Malpractice
Medical malpractice is misconduct or lack of
skill by a health-care professional that results in
injury to the patient.
Negligence, which is defined as failure to give
reasonable care by the health-care provider
Four factors must be proven to claim negligence:
1. Duty: Indicates that there was an established
standard of care and proof that it was not
followed.
2. Breach of Duty: The plaintiff (patient) must
show what actually happened and that the de-
fendant (phlebotomist) failed to perform.
3. Causation: Indicates that the breach of duty
directly caused the injury and that no other
factors could have contributed.
4. Damages: Actual physical, emotional, or
financial injury had to occur to the plaintiff
(patient) because of the negligent act.
The most common phlebotomy events that may
initiate litigation are nerve injury, hemorrhage
from an accidental arterial puncture or
inadequate pressure to the vein, drawing from
inappropriate locations such as the same side as
a mastectomy, injuries occurring when a patient
faints, or death of a patient caused by
misidentification of a patient or sample and
wrong diagnosis or mistreatment of a patient due
to sample collection errors.
Patient Consent
Different types of patient consent in health care
include informed consent, expressed consent,
minor consent, implied consent, and HIV
consent.
Informed Consent requires that the health-care
professional explain all about the medical
procedure. Vital to consent is the patient’s belief
that the health-care professional is competent to
perform the procedure.
Consent may be expressed or implied.
Expressed Consent required for invasive
procedures but can include phlebotomy.The
patient then gives consent in writing or verbally.
The most common and safest method for
obtaining expressed consent is in writing.
Implied Consent is very common in blood
collection. PAtient gives consent by extending
the arm or rolling up the sleeve.
Consent for Minors and Incapacitated
Patients requires consent of their parents or
legal guardians.
Consent for Testing for HIV
In some states an accidental needlestick is con
sidered a significant exposure to the health-care
worker, and HIV testing can be ordered by a
healthcare provider without patient consent. In
this situation, the HIV results are not entered
into the patient’s chart.
Respondeat Superior
“let the master answer,” establishes that
employers are responsible for their own acts of
negligence as well as their employees’ acts.
Risk Management
Risk management departments develop policies
to protect patients and employees from
preventable injuries and the employer from
financial loss. One commonly used tool
in the phlebotomy department is the incident
report.
Preventing Medical Errors
National Academy of Sciences’ Institute of
Medicine (IOM) issued a report entitled “To Err
is Human: Building a Safer Health
System.” They stress out that most of the
medical errors are system related and are not
caused by individual negligence or misconduct.
Sentinel Events
- is defined as an unexpected occurrence
involving death or serious injury, or the risk
thereof.
Sentinel events must be documented for the JC.
The report must include a root cause analysis
and an action plan. Format for the report
includes:
1. The event
2. A root cause analysis of the processes leading
to the event
3. An action plan
TOPIC 2 Nosocomial/Health-Care–Acquired
Infections

Nosocomial infection has been used to designate

BIOLOGICAL HAZARDS
All health-care facilities have developed
procedures to control and monitor infections
occurring within their facilities. This is referred
to as infection control.
an infection acquired by a patient during a
hospital stay. A newer term
health-care–acquired infection (HAI) refers to
an infection acquired by a patient as the result of
a procedure that may or may not require a
hospital stay (e.g. following an outpatient
. phlebotomy procedure if proper precautions
were not followed.)
Although some HAIs are caused by visitors, the
majority are the result of personnel not
following infection control practices.

The Chain of Infection

Transmission Prevention Procedures

Procedures used to prevent microorganism

transmission include hand hygiene, the wearing
of personal protective equipment (PPE),
isolation of highly infective or highly
susceptible patients, and proper disposal of
contaminated materials. Strict adherence to
guidelines published by the CDC and the
Occupational Safety and Health Administration
(OSHA) is essential.
Hand Hygiene
Hand contact is the number one method of
infection transmission. Hand hygiene includes
both hand washing and the use of alcohol-based
antiseptic cleansers.
(Clostridium difficile has become a major source
of HAIs.)
Hands should always be washed:
● Before patient contact
● When gloves are removed
● Before leaving the work area
● At any time when they have been knowingly
contaminated
● Before going to designated break areas
● Before and after using bathroom facilities
The CDC has developed hand washing
guidelines to be followed for correct routine
hand washing.
Step 1. Wet hands with warm water. Do not
allow parts of body to touch the sink.
Step 2. Apply soap, preferably antimicrobial.
Step 3. Rub to form a lather, create friction, and
loosen debris. Thoroughly clean between the
fingers and under the fingernails for at least 20
seconds; include thumbs and wrists in the
cleaning.
Step 4. Rinse hands in a downward position to
prevent recontamination of hands and wrists.
Step 5. Obtain paper towel from dispenser.
Step 6. Dry hands with a paper towel.
Step 7. Turn off faucets with a clean paper towel
to prevent recontamination.
Personal Protective Equipment (PPE)
Gloves are mandated by the National Institute of
Occupational Safety and Health (NIOSH) for
phlebotomy procedures.
Replacing latex gloves with nitrile or vinyl
gloves provides an acceptable alternative for
those who have latex allergy.
Gowns
Fluid-resistant gowns should be worn when the
possibility of encountering splashes or large
amounts of body fluids is anticipated. Gowns tie
in the back at the neck and the waist and have
tight-fitting cuffs.
Masks, Goggles, and Face Shields
Masks are worn to protect against inhalation of
droplets containing microorganisms
Respirators
Respirators may be required when collecting
blood from patients who have airborne diseases,
such as tuberculosis. The NIOSH approved
respirator is the N95.
Donning and Removing PPE
Apparel is put on before entering a room and
removed and disposed of before leaving the
room. An exception to these procedures is
observed for patients requiring sterile
conditions.
Standard Precautions
- were developed by the CDC by combining the
recommendations of Universal Precautions and
Body Substance Isolation procedures.
-assumes that every person in the health-care
setting is potentially infected by an organism
that could be transmitted.
-applies to all blood and body fluids, mucous
membranes, and nonintact skin and stresses hand
washing
Transmission-Based Precautions
The type of PPE worn by phlebotomists when
entering an isolation room is determined by the
isolation classification.
The three isolation categories used in
transmission-based precautions are airborne,
droplet, and contact.
Airborne precautions are necessary when
microorganisms can remain infective while
being carried through the air. PPE may include a
respirator. Filtration systems may be required in
the patient’s room
Droplet precautions are required for persons
infected with microorganisms that can be
transmitted on moist particles such as those
produced during coughing and
sneezing.
Contact precautions are used when patients
have an infection that can be transmitted by
direct skin-to-skin contact or by indirect contact
Gowns are worn when entering the room and re-
moved before leaving the room. After removing
the gown and washing the hands, care must be
taken to avoid touching objects in the room
(Technical Tip. Respiratory hygiene is a recent
addition to Standard Precautions)
Phlebotomy Procedures in Isolation
All equipment, including PPE, taken into the
room must be left in the room and, when
appropriate, deposited in labeled waste
containers.
Protective/Reverse Isolation
-may be required for severely burned patients,
patients receiving chemotherapy, and organ and
bone marrow transplant patients and in the
nursery. All PPE must be sterile instead of the
routinely used PPE is removed after leaving the
room.
Biological Waste Disposal
Phlebotomy supplies contaminated with blood
and body fluids must be disposed of in
containers clearly marked with the biohazard
symbol or red or yellow color coding
Contaminated non disposable equipment, blood
spills, and blood and body fluid processing areas
must be disinfected. The most commonly used
disinfectant is a 1:10 dilution of sodium
hypochlorite (household bleach).
SHARP HAZARDS .
The number one personal safety rule when using
needles is to never recap a needle.
Bloodborne Pathogens
Of primary concern are human
immunodeficiency virus (HIV), hepatitis B virus
(HBV), and hepatitis C virus (HCV).
Use of Glass Capillary Tubes
1. Capillary tubes wrapped in puncture-resistant
film
2. Plastic capillary tubes
3. Sealing methods that do not require pushing
the tubes into a sealant to form a plug
4. Methods that do not require centrifuging of
capillary hematocrit tubes.
Postexposure Prophylaxis
Any accidental exposure to blood must be
reported to a supervisor and a confidential
medical examination must be started
immediately. Evaluation of the incident must
begin immediately to ensure appropriate
postexposure prophylaxis (PEP) is initiated
within 24 hours.
CHEMICAL HAZARDS .
Chemicals should never be mixed together w/o
specific instructions
Acid should always be added to water
When skin or eye contact occurs, the best first
aid is to flush the area with water for at least
15 minutes and then seek medical attention.
Do not try to neutralize chemicals spilled on the
skin.
Must know the location of and how to use the
emergency shower and eyewash station in the
laboratory
An MSDS contains information on physical and
chemical characteristics, fire, explosion
reactivity, health hazards, primary routes of
entry, exposure limits and carcinogenic
potential, precautions for safe handling, spill
clean-up, and emergency first-aid information
RADIOACTIVE HAZARDS .
Exposure to radiation is dependent on the
combination of time, distance, and shielding.
ELECTRICAL HAZARDS . PHYSICAL HAZARDS .

When electrical shock occurs, remove the TOPIC 3

electrical source immediately. Turning off the
circuit breaker and moving the equipment using
1. Anticoagulant - tube additive that prevents
a nonconductive glass or wood object are safe blood clotting
procedures to follow. 2. Basal State - resting metabolic state of the
body early in the morning after fasting for a
FIRE HAZARDS . minimum of 12 hours.
3. Clot activator - tube additive that accelerates
clotting
Initial steps to follow when a fire is discovered 4. Diurnal variation - normal daily fluctuations
are identified by the code word RACE. in body chemistry related to hormonal cycles,
1. Rescue sleep-wake cycles, and other regular patterns of
change
2. Alarm 5. Hemolysis - rupture or destruction of Red
3. Contain Blood Cells
4. Extinguish/Evacuate 6. Icteric - a serum or plasma sample that is
bright to dark yellow due to excess bilirubin
7. Lipemia - a turbidity of the serum or plasma
PASS for the steps in the extinguisher operation.
sample caused by increased lipids, specifically
1. Pull pin the lipoprotein Chylomicrons.
2. Aim at base of fire 8. Hemoconcentration - a decrease in plasma or
3. Squeeze handles serum volume, increase in the concentration of
4. Sweep nozzle, side to side red blood cells and other commonly tested
constituents of the blood
9. Hemodilution - decreased concentration of
cells resulting in a gain of plasma or serum
10. Preanalysis - involves all the complex steps
that must take place before a sample can be
analyzed.
11. Turn-around Time - the amount of time to
The multipurpose ABC fire extinguishers are the complete a whole process (from pre-analysis to
most common post-ana)

The Standard System for the Identification of the PRE_COLLECTION VARIABLES .

Fire Hazards of Materials, NFPA 704:
1. Patient-Related Variables

A. PHYSIOLOGY

1. Diurnal Variation- maybe encountered when

testing for hormones, iron, acid phosphatase, and
urinary excretion of most electrolytes such as
sodium, potassium, and phosphate.

2.Exercise - transient changes include: initial

decrease followed by an increase in free fatty
acids, lactate. Elevated creatine phosphokinase
(CK), aspartate aminotransferase (AST), and
lactate dehydrogenase (LD) and may activate
coagulation, fibrinolysis, and platelets
-Long-term changes include: increase CK,
aldolase, AST, and LD values.
3.Diet -
Examples:
1. Glucose (blood sugar) levels increase with
the ingestion of carbohydrates/ sugar but return
to normal within 2 hours
2. Ingestion of lipids (butter and cheese)
increases blood lipid content, a condition called
lipemia. Lipemia can be present for up to 12
hours,
3. Some test methods that detect occult (hidden)
blood in stool specimens also detect similar
substances in meat and certain vegetables.
4. Fluid intake affect can decrease Hemoglobin
levels, and alter electrolyte balance.
Consumption of caffeine affect cortisol levels.
Consumption of large amounts of alcohol
can cause hypoglycemia, and increased
triglycerides.
4. Stress - production of adrenocorticotropic
hormone (ACTH), cortisol, and catecholamines.
Total cholesterol increases with mild stress, and
HDL cholesterol decreases.Hyperventilation
affects acid- base balance and elevates leukocyte
counts, serum lactate, or free fatty acids.
Increase in Alkaline Phosphatase in skeletal
growth. Increase creatinine in muscle
development.
3. Most serum constituents remain constant
during adult life.
4. Menopausal women and middle aged men -
Increases of about 2 mg/dL (0.05 mmol/L)
per year in total cholesterol and 2 mg/dL (0.02
mmol/L) per year in triglycerides.
5. The elderly secrete less triiodothyronine,
parathyroid hormone, aldosterone, and
cortisol.
6. After age 50, men experience a decrease in
secretion rate and concentration of
testosterone, and women have an increase in
pituitary gonadotropins, especially follicle-
stimulating hormone (FSH).
7. Gender - Women: lower Magnesium,
Calcium, albumin, Hemoglobin, serum iron, and
ferritin
Men: higher Alkaline Phosphatase,
Aminotransferases, Creatine kinase, and
aldolase

5. Posture - Elements that are affected by

postural changes are albumin, total protein,
enzymes, calcium, bilirubin, cholesterol,
triglycerides, and drugs bound to proteins.

Examples:
1. Upright position increases hydrostatic
pressure, causing a reduction of plasma volume
and increased concentration of proteins
2. A change from supine to upright increases
Albumin and Calcium
3. After bed rest in the hospital, a patient’s
hemoglobin (Hb) can decrease

6.Age -
Examples:
1. Newborn - much of the Hemoglobin is Hb F,
not Hb A. Bilirubin concentration rises after
birth and peaks at about 5 days. High Uric Acid
but decreases for the first 10 years until the age
of 16.
2. Infants - lower glucose level than adults B. COMMON INTERFERENCES
because of their low glycogen reserve.
B1.In Vivo
A.tobacco smoking
 - A test order should have a complete patient
demographics that include patient name, sex,
age, date of birth (DOB), date of admission (for
inpatients), date of test order, location (in-patient
or out-patient), and physician.
- In collection, ensure:
* Proper identification of the patient
B.2. In Vitro * Complete labeling of the specimen
* Patient consent and privacy
a.Hemolysis * to follow Chain of custody (Tests that require
COC are the ff: HIV, Drug Testing, Nucleic
Causes: Acid Tests, Networking Tests/Send-out tests)
1. needle that is too small
2. pulling a syringe plunger back too fast C2. Time of Collection
3. expelling the blood vigorously into a tube
4. shaking or mixing the tubes vigorously - “ASAP” in a request form means “As soon as
5.performing blood collection before the alcohol possible” and have to prioritized
has dried at the collection site - “Stat” (from the Latin word, statim) means
False Increase: “Immeadiately” ; STAT specimens are given
1. Potassium the highest priority
2. Magnesium - Timed specimens are ordered for monitoring
3. Iron purposes
4. Lactate Dehydrogenase
5. Phosphorus C3. Specimen Acceptability and Identification
6. Ammonium Issues
7. Total Protein - The first goal of The Joint Commission 2015
Laboratory National Patient Safety Goals is to
b. Hemoconcentration - caused by extended “identify patients correctly”
application of tourniquet resulting into increased - Failure to follow specific procedures can result
concentrations of analytes and cellular in specimen rejection.
components

c. Hemodilution - usually caused by short draw

of blood during venipuncture

Note: To avoid problems with

hemoconcentration and hemodilution, the patient
should be seated in a supine position for
15 to 20 minutes before the blood is drawn. POLICY FOR HANDLING MISLABELED
SPECIMEN
d. Icterus - appears bright to dark yellow due to
increased bilirubin.

e.Lipemia - occurs when serum triglyceride

levels are elevated causing turbid sample. The
increase may cause artifactual values such as
amylase, urate, urea, Creatine Kinase, Bilirubin,
and total protein
C. SPECIMEN COLLECTION
C1. The Test Order
C4. Specimen Collection Overview
4.1. Blood Collection
- Blood is the most common specimen received
in the lab
4.1.a. Blood Collection Devices
a.Needles (multisample, hypodermic, and
winged blood collection needle) with safety
shield
b.Needle holder/adapter
c. Sharps Disposal Container
d.Collection tubes (evacuated tubes, microtainer
tubes, capillary tubes)
e.Syringe
f. Winged blood collection set
g. Blood transfer device
4.1.b. Tube Additives
Ethylenediaminetetraacetic acid (EDTA)
- Prevents clotting by chelating Calcium
- anticoagulant of choice for hematology cell
counts and cell morphology
- commonly available in LAVENDER-TOP
tubes as a liquid or spray-dried dipotassium
EDTA (K2EDTA) or tripotassium EDTA
(K3EDTA)
- K2EDTA in plastic is spray-dried
- K3EDTA in glass is in liquid form
- also available in PINK spray-dried EDTA for
ABO grouping, Rh typing, Antibody
screening and crossmatching; and WHITE for
molecular diagnostics
Sodium Citrate
- Prevents clotting by chelating Calcium
- available in BLUE-TOP used in coagulation
studies) ex. Prothrombin Time and Activated
Partial Thromboplastin Time) (correct
anticoagulant:blood ratio is 1:9)
- also available in BLACK-TOP that is
generally used in Westergren Erythrocyte
Sedimentation Rate (ESR) with
anticoagulant:blood ratio of 1:4
Heparin
- available in GREEN-TOP as Lithium Heparin
(LiHep) or Sodium Heparin (NaHep)
- Prevents clotting by binding to Thrombin
- Does not affect levels of Calcium
- Preferred anticoagulant for Plasma Potassium
measurement, Arterial Blood Gas, Ammonia
Determination and other routine chemistry tests
- Used especially when a chemistry test is
STAT
- Do not use LiHep for Lithium and Folate
Determination
- Do not use NaHep for Sodium determination;
but it can be used for trace elements, Lead, and
Toxicology testings
- NaHep is the injectable form used for
anticoagulant therapy
Sodium Fluoride
- It is NOT an anticoagulant, but a preservative
with antiglycolytic property
- Prevents glycolysis of glucose for 72 hours
- available in GRAY-top tube
- If the gray-top tube is labeled with Sodium
fluoride only, then it will yield a SERUM
sample
- If plasma sample is needed an anticoagulant
must be present in the form of Potassium
Oxalate (common), or Na2EDTA. Both
prevent clotting by binding to Calcium.
- Sodium fluoride destroys enzymes. Therefore,
do not use this when performing enzymatic tests
Plain/Non-additive tubes
- available in RED-TOP tubes
- NO anticoagulant
- can be used for most chemistry, blood bank,
and immunology assays
- yields a SERUM sample after a complete
clotting of 60 mins.
Separator Tubes
- tubes with THIXOTROPIC GEL (silica,
polyester and acrylic gels are available)
- Silica and Polyester gels are not recommended
for Therapeutic Drug Monitoring because they
may absorb certain drugs which may falsely
lower results
- Not used in Immunohematology because gels
interfere with the reactions
- Serum Separator Tubes (SSTs) contain
thixotropic gel and may or may not contain clot
activators; available in RED-GRAY or
RED-BLACK, GOLD-TOP, and
ORANGE-TOP tubes. Clotting process is
shortened to 30 minutes, and tubes with clotting
activators such as Thrombin (Orange tube) clots
in 5 minutes
- Plasma Separator Tubes (PSTs) contain gels
and anticoagulants such as Heparin. Available in
LIGHT GREEN color.
Royal Blue Top
- available in spray coated silica clot activator
for serum or with K2EDTA or sodium
heparin for plasma
- used for toxicology, trace metal, and nutritional
analyses
Tan Top
- contains K2EDTA for Lead determination
Yellow Top
- Two types:
1. Yellow top with Acid Citrate Dextrose (ACD)
- RBC preservative used for cellular studies in
blood bank, human leukocyte antigen (HLA)
phenotyping, and DNA and paternity testing.
2. Sterile yellow top with Sodium Polyanethol
Sulfonate (SPS)
- SPS is an anticoagulant used for blood culture;
binds to Calcium; also an anti-complement,
anti-phagocytosis and prevents the action of
certain antibiotics; may contain ARD
4.1.c. Blood Storage and Preservation
Storage requirements vary widely by analyte.
- Examples:
1. Glucose decreases in an unseparated serum
due to glycolysis by RBCs. To prevent this
separate serum immediately from the cells or use
Sodium fluoride tube.
2. Potassium is stable for 24 hours but rapidly
increases after.
3. Unseparated serum and plasma yield
clinically significant increases in total bilirubin,
sodium, urea, nitrogen, albumin, calcium,
magnesium, and total protein.
4.2. Collection of Other Body Fluids
4.2.a. Urine
- 2nd most common specimen received in the
lab
- most common manner of collection is
“Mid-stream Clean Catch” (MSC)
- MSC Procedure:
1. Clean the external genitalia with an antiseptic
wipe
2. Begin urination, and discard the first portion
of urine
3. Collect the mid-stream portion of the urine in
a clean container.
4. Do not collect the end portion of the urine.
5. Tightly seal vessel and label correctly.
- Routine urine is collected in a sterile,
disposable, 200-mL plastic container.
- Use pediatric urine collector for pedia patients
4.2.b. Cerebrospinal Fluid (CSF)
-collected via Lumbar Puncture (between 3rd
and 4th lumbar or 4th and 5th)
- Follow correct order of tube distribution
(Tube 1: Chemistry or Immuno-serology; Tube
2: Microbiolology; and Tube 3: Hematology)
4.3.c. Synovial Fluid
- Ultrafiltrate of plasma found in the joints
- Tube Distribution:
1. Sterile Tube: Microbiology
2. EDTA Tube: Hematology
3. Red Tube: Chemistry
4.3.d. Pleural, Pericardial and Peritoneal Fluid
- Pleural fluid is collected via thoracentesis
(a surgical procedure to drain fluid (effusions)
from the thoracic cavity)
- Pericardial fluid is collected via
pericardiocentesis
- Peritoneal fluid/Ascitic fluid is collected via
peritoneocentesis
Transport
- accounts 1/3 of the Total Turn-around Time
(TAT)
- Excessive agitation of blood specimens must
be avoided to minimize hemolysis.
- Specimens should be protected from direct
exposure to light, which causes breakdown of
certain analytes
- Ammonia, plasma renin activity, and acid
phosphatase, specimens must be kept at 4°C
immediately after collection and transported on
ice.
- Specimens requiring refrigeration must be
maintained at between 2°C and 10°C
- Large-volume urine specimens should be
collected in a leak-proof, 3- to 4-L container.
- To mail a specimen in the frozen state, solid
carbon dioxide (dry ice) may be packed in a
polystyrene container with the specimen, which
can be kept frozen at temperatures as low as
−70°C.
- Labeling is required on all containers,
containers are required to have a
“BIOAHZARD” label
- Some hospitals/labs have a “Pneumatic”
Transport system that improves the turn-around
time
Processing
- includes 3 phases:
1. Pre-centrifugation
2. Centrifugation
3. Post-centrifugation

- Centrifuge is a machine that uses centrifugal

force to separate phases of suspensions by
different densities.
- urine is centrifuged to get sediments for
microscopic analysis
- Centrifugal force is calculated using the
formula:
RCF = (1.118 x 10-5)(r)(rpm)^2
Where: RCF = Relative Centrifugal Force
1.118 x 10-5 is constant
Rpm = speed in revolutions per minute
- After centrifugation of a blood sample the
following layers are observed

TOPIC 4

BASIC MEDICAL TERMS .

Prefix- added to the beginning of a root word

Suffix- added to the end of a root word
Word roots- main part of a word
Combining form- a vowel, usually an “o,” used
to facilitate pronunciation

PREFIXES
SUFFIXES
COMBINING FORMS AND ASSOCIATED
BODY SYSTEMS
 PLURAL FORMS
- diacritical marks, the macron and breve, may
be used for long and short vowel pronunciations,
respectively

ABBREVIATIONS

NOTE: When defining a medical term, begin at

the suffix , then define the prefix, and, last,
define the middle or the word root.