UNIT VI: PRE-ANALYTICAL TYPES OF AFFECTED

FOOD/DRINK TAKEN PARAMETERS

CONSIDERATIONS IN PHLEBOTOMY
IN EXCESS
Pre-examination phase HIGH PROTEIN ELEVATED NPN
COMPOUNDS
- First line to ensure quality laboratory CAFFEINE ELEVATED
results CORTISOL, ACTH &
NEFA
Consideration CHO ELEVATED
GLUCOSE & INSULIN
- Physiological variables FATTY FOODS ELEVATED LIPID
- Puncture sites PRFILE
- Complications and special EXCESS WATER AND DECREASE
conditions OTHER FLUIDS HEMOGLOBIN
- Specimen quality

PHYSIOLOGICAL VARIABLES DIURNAL/CIRCADIAN VARIATION

Age: PARAMETER DIURNAL VARIATION,

STRESS & POSTURE
PARAMETERS EFFECTS ON AGE CORTISOL  Peaks 4-6 AM
RBC COUNT Higher in younger  Lowest 8 PM – 12 AM
WBC COUNT patients  50% lower at 8 PM
RENAL FUNCTION Decrease with age than at 8 AM
TEST  INCREASED with
STRESS
ACTH  LOWER at night
Altitude:  INCREASE with STRESS
Plasma Renin  LOWER at night
PARAMETERS EFFECTS activity  HIGHER STANDING
RBC COUNT ELEVATED in higher than supine
HEMOGLOBIN altitude INSULIN LOWER @ NIGHT
HEMATOCRIT ALDOSTERONE
C-REACTIVE Growth Higher in the afternoon
PROTEINS Hormone & evening
URIC ACID Acid
CREATININE DECREASE in higher Phosphatase
altitude Thyroxine INCREASE with exercise
Prolactin  HIGHER with stress
 HIGHER levels at 4
Dehydration: and 8 AM
 HIGHER at 8 and 10
PARAMETERS EFFECTS PM
RBC COUNT ELEVATED IRON  PEAKS early to late
IRON morning
CALCIUM  Decrease up to 30%
during the day
CALCIUM 4% DECREASE supine
DIET
DRUG THERAPY Sometimes magkasama ang blood bank
sa blood donation area.
DRUG EFFECTS
Chemotherapy DECREASE in Blood Specimen Requirements
drugs Cells (WBC,
Platelets) - Require the collection of one or
NSAID, Anti-TB  Elevated liver more lavender/pink-top EDTA tubes
enzymes (Pink is especially for Blood Bag
 Decrease Specimens)
clotting factors
- In some cases, a nonadditive glass
OPIATES  Elevated Liver &
Pancreatic red-stoppered tube is also used
Enzymes
In most labs they also use red top together
ORAL  Elevated ESR
with pink top
CONTACEPTIVES  DECREASED
levels of Vitamin Identification and Labeling Requirements
B12
STEROIDS &  Elevated - Requires strict patient identification
DIURETICS AMALYSE & and specimen labeling procedures
LIPASE
Thiazide DIURETICS  Elevated Labelling Requirements for Blood Bank
calcium & Specimens
glucose
 DECREASED - Patient’s full name (including middle
sodium & initial)
potassium - Patient’s hospital identification
number (Social Security Number for
UNIT VIII: SPECIAL COLLECTIONS AND OUTPATIENTS)
- Patient’s date of birth
POINT-OF-CARE TESTING
- Date and Time of Collection
Blood Bank Specimens - Phlebotomist’s initials
- Room number and bed number
- Yield information that determines the (optional)
blood products that can be
transfused safely into a patient. Special Procedure

Blood bank is a place where blood is - Blood Bank specimens – special

collected and stored before it is used for identification systems
transfusion - ID bracelets containing patient info:
Barcoded ID number
Perform tests/screening - Blood product validation
Screening of the patient’s blood o Clinician’s identity, scanned
from the bar code on his/her
Screening of the donor’s blood identification card
 o The product’s unique Pilot Tube – naka-attach sa blood bag
barcoded donor identifier on ata?
the blood unit
Transfusion set – nagrerelase nurses na
Type, Screen and Cross Match
Blood Donor Collection
- Blood type and screen is one of the
- Involves collecting blood used in
most common tests performed in a
transfusion rather than for diagnostic
blood bank.
testing from VOLUNTEERS
- ABO and Rh factor
- Amounts are called units
Cross match Is performed using the - Donor collection requires special
patient’s type and screen results training and exceptional
venipuncture skills.
- Patients plasma/serum and the
donor’s RBC are mixed together Donor Blood Bank – provide blood
which determines COMPATIBILITY products for transfusion purposes
(suitability to be mixed)
Donor Eligibility
- MAJOR cross-match: testing of donor Brief physical examination and complete
cells with patient/recipient’s serum medical history
detect ANTIBODIES in the patient
Temperature: Must be less than or equal to
- MINOR cross-match – testing of 37.5 Celsius or 99.5 Fahrenheit
donor’s serum with
Age Range: Between 17-66 years
patient/recipient’s RBC to detect
ANTIBODIES in donor serum - Minors must have written permission
from their parents
- - Adults over the age of 66 donate at
the discretion of the blood bank
physician
Pag napasa yung isa pero yung isa hindi
pwede naman lalo na kung emergency Weight: Weighing 110 lbs
cases.
- 10.5 mL of blood/kg of donor weight
Pagkalabas ng blood sa blood bank, for WHOLE BLOOD COLLECTION
before transfusion, itetest ulet
Normal Blood Pressure: 180mm Hg systolic
Transfusion of incompatible blood can be pressure; 100mm Hg diastolic pressure
fatal because of agglutination (clumping)
Normal Pulse Rate: between 50 di tama
and lysis (rupturing) or RBCs in the
to-100 bpm
circulatory system
Acceptable hemoglobin levels: greater
Expiration of Blood Bag: 30-40 days
than or equal to 12.5 g/dl; HCT = 38%
Absence of Skin Lesions: Skin disorders that - Usually done prior to elective surgery
are not cause for deferral: ivy or other  scheduled surgery
rashes - Collected several weeks prior
scheduled surgery (Pwede rin 72
Number of hours of Sleep: 6-8
hours before)
Tattoo na 10 years: Pwede naman (1-2 - Reduces the chances of hemolytic
years kasi) reactions and transmissions of blood-
borne diseases
Puyat: Di pwede
You should prepare for your donation! And
Make sure the bp is NORMAL meet all requirements
Pwedeng bumaba ng 110/80 or 110/70 BLOOD CULTURES
pwede rin 130/90
- Performed to test the presence of
You want the best blood to the patient! o Bacteremia (bacteria in
blood)
Principles of Donor Unit Collection (SELF
o Septicemia (microorganisms or
STUDY DAW TO)
their toxins in blood)
- Donor units are normally collected o Fungemia (fungi)
from a LARGE antecubital vein - Helps determine the PRESENCE and
- Vein is selected in a manner similar EXTENT of infection as well as
to routine venipuncture indicating the type of ORGANISM
- Cleaned in a manner similar to blood involved and the antibiotic to which
culture collection it is most susceptible
- A blood bag is connected by a - Collected 30 minutes to 2 ½ hours
length of tubing to a sterile 16-18- prior to the FEVER peak, before the
gauge needle body can eliminate some of the
- Bag is filled by gravity and must be microorganisms
placed LOWER than the patient’s
Collected at the height of fever
arm.
- Collection bag contains an Special Collection Bottles
anticoagulant and preservative
solution and is placed on a mixing - This is with a nutrient broth/medium
unit while blood is being drawn
Antimicrobial Removal Device – removes
- 450 ml is the volume of the blood
antimicrobial agents like antibiotic para
bag (if the unit only partially fill and
marecover bacteria
the procedure is repeated, an entire
new unit must be used) 1 SET of SPECIMENS: AERO and ANAERO

Autologous Donation - Aerobic - allowing preferential

growth of aerobic facultative
- Pre-donation of patient’s own blood
anaerobic microorganisms; filled
 FIRST IF WINGED BLOOD COLLECTION Antiseptic or Sterile Technique for Blood
IS DONE Culture
- ANAERO – allowing preferential
- Done to minimize the normal flora of
growth of STRICT ANAERO Bacteria
the skin
Mga nagtitipid na hospitals 1 bottle lang - 30-60 friction scrub
o Iodine, chlorhexidine
Pag height of fever preferably 2 sets
gluconate and a
Kelangan icheck sa 2 sets kung sinong povidone/70% ethyl alcohol
may positive result sa 2 bote ng isang set combination
ba or dalawang bote sa magkahiwalay na o 10% povidone or 1%-2%
sets tincture of iodine compounds
in a swab sticks or
Anticoagulant Present: 0.025% - 0.050% SPS Benzalkonium chloride
(Sodium Polyanentholsulfonate) cleaning pads
- Covers 3-4 inches in diameter at the
Tubes with heparin, EDTA, sodium citrate
puncture site
inhibits the growth of microorganisms
Same Procedure parang Venipuncture
Specimen Requirements:
- Iba yung antisepsis (friction scrub)
- 2-4 blood culture are needed to
- Disinfect the cap 1st when the site is
optimize the detection of
being air dried
microorganisms in the blood
- Drawn 30-60 minutes apart Evaluation of Hemostasis (COAGULATION
- Drawn consecutively and TESTS)
immediately from diff sites (pwede
rin sa same site pero preferably diff) - Example: APTT, PT
- Ratio Blood to Broth is 1:5 – 1:10
Most coagulation tests, trisodium citrate
For adults or people weighing > 80 lbs (1:9 ratio of citrate to blood) is the
Recommended volumes for blood cultures anticoagulant of choice BLUUUUU
are 20-30 ml per culture with a minimum of
Blood sample for coagulation testing
10 ml per draw
should be collected by clean atraumatic
Lumalabas na 40-60 ml kinukuha sa adult venipuncture, and excessive application of
vacuum should be avoided to minimize
For pediatric patients* activation of platelets.
<1 kg 2 ml If the only test is coagulation there should
2 kg 4 ml be a discard tube
12.7 kg 6 ml
36.3 kg 10 ml Cooling on ice during transport may be
> 36. 3 kg 2-30 ml required for some test specimens to
protect the coagulation factors (bibihira
na to)
Tests should be performed within 4 hours of - If the patient is lactose intolerant, the
sample collection, or plasma should be glucose curve will be flat, rising no
frozen within 1 hour of harvesting more than a few mg/dl from the
fasting level
2-hour postprandial glucose blood (Di na
prinapractice na masyado) Paternity/Parentage Testing

- Measurement of blood glucose - Done to determine the probability

exactly 2 hours after eating a meal that a specific individual fathered a
- Screening test for diabetes mellitus particular child
- Monitoring of insulin levels - Requires CHAIN-OF-CUSTODY
PROTOCOL and SPECIFIC
Preparation:
IDENTIFICATION PROCEDURES that
- High-carbohydrate diet for 2-3 days includes fingerprinting
prior to the test (150 g)
Pag napupunta sa ibang medtech
- Patient should be tested for FBS (8-10
sinusulat pangalan!! Yan yung Chain-Of-
hrs of fasting)
Custody
- The patient should eat a meal (100 g
high carb meal) - Mother, Child, Alleged father are
- Blood Sample for glucose testing is tested
then drawn 2 hours after the patient - Blood samples are preferred for
finishes eating testing
o Alternative: Buccal/Cheek
In normal patients, blood glucose levels
swabs
peak within 30 minutes to 1 hour following
- Blood sample testing usually includes
glucose ingestion
ABO and Rh typing
The peak in glucose levels triggers the - Determines other red cell antigens,
release of insulin, which brings glucose red cell enzymes and serum proteins,
levels back down to fasting levels within white cell enzymes, and HLA (human
about 2 hours and no glucose spills over leukocyte antigen) or white cell
into the urine antigens
- DNA profiling
- Hyperglycemia: increases than
normal glucose Therapeutic Drug Monitoring (TDM)
- Hypoglycemia: lower than normal
- Used in the management of patients
glucose
being treated with certain drugs in
Lactose Tolerance Test order to establish and maintain a
drug dosage, thus avoiding toxicity
- Used to determine if patients lack
the necessary to convert lactose, or Timing if blood sample collection is critical
milk sugar, into glucose or galactose in TDM
- Mucosal lactase
When trough level is required, the blood - Clinical Toxicology – the detection of
sample should be drawn right BEFORE NEXT toxins and treatment for the effects
DOSE is administered they produce
- Forensic Toxicology – concerned with
Sample collection for peak levels
the legal consequences of toxin
- Drawing blood sample 1 hour after exposure
oral administration is the rule of
Toxicology tests examine blood, hair, urine
thumb.
and other body substances for the
- Draw blood sample 0.5 hour after
presence of toxins, which often exist in
completion of IV administration.
very small amounts.
Most drugs can be quantified using
Drug Screening
immunoassay techniques or
chromatography - Testing is typically performed on
urine rather than blood because it is
For a drug to be beneficial, the peak (max)
easy to obtain and a wide variety of
level must not exceed toxic levels, and the
drugs or their metabolites
trough (min) level must remain within the
therapeutic range 60 mll ng urine kinkuha HAHAHA

Therapeutic Phlebotomy Pag nagpadrug test ka tas gustomong

magparetest after 1 month de pwede kasi
- Withdrawal of approximately 500 ml
may connected information system kaya
of blood
di pwedeng magmadali
Used to treat conditions such as
Kundi yan PDEA, DOH hahaha
- Polycythemia - Myeloproliferative
Patient Preparation Requirements:
neoplasm in which a somatic
mutation leads to a marked increase - Explain the test purpose and
in the RBC count, hematocrit, procedure
hemoglobin, white blood cell count, - Advise the patient of his/her legal
platelet count, and total blood rights
volume. RBC precursors are - Obtain a witnessed, signed consent
hypersensitive to erythropoietin form
- Hemochromatosis - Disease of iron
Specimen Collection Requirements
metabolism that is characterized by
excess deposition of iron in the - A special area must be maintained
tissues. The disease may be inherited for urine collection.
or may develop as a complication - A proctor is required to be present at
of a hemolytic anemia, such as the time of collection to verify that
sickle cell anemia. the specimen came from the correct
person.
Toxicology Specimens
 - A split sample may be required for - AKA alternate site testing, ancillary,
confirmation or parallel testing. bedside, near-patient testing,
- The specimen must be labeled patient-focused testing
appropriately to establish a chain of - Utilizes small, portable and often
custody. handheld testing devices.
- To avoid tampering, a specimen - Does not need a machine?
must be sealed and placed in a - Convenience & short turnaround
locked container during transport time = deliver prompt medical
from the collection site to the testing attention and expedite patient
site. Documentation must be recovery
carefully maintained from courier to - Performed where patient care is
receiver. delivered including physician office
testing, various hospital locations
Trace Elements
outside the laboratory, such as the
*tested in a toxicology lab emergency dept., OR and ICU

- Metals include aluminum, arsenic, Point-of-Care Checklist

copper, lead, iron, and zinc.
1. Equipment, if needed, must be
- Measured in such small amounts that
evaluated
traces of them in the glass, plastic, or
2. A person of sufficient managerial
stopper material of evacuated tubes
authority is designated as being
may leach into the specimen,
responsible for the site
causing falsely elevated test values.
3. Persons performing the test must be
- Must be collected in special trace
trained and competency assessed,
element–free Royal Blue Top
and this must be documented
- It is important to prevent introducing
4. A written procedure must be
even the smallest amount of the
available and followed
contaminating substance into the
5. Calibrations and quality control
tube
samples must be run at regular
- Best to draw it by itself if using a
intervals
needle/tube assembly, or a syringe
6. All patient results must be
may be used.
documented, and the relationship to
- Change the transfer device before
quality control measures must be
filling the royal-blue tube
clear
POINT-OF-CARE TESTING 7. Appropriate action must be taken
and documented on all out-of-
Aralin niyo nalang yung principle nila like range quality control results.
anong kinukuha and san ilalagay tas 8. Appropriate action must be
anong madedetect parang magkakaroon documented on all abnormal
ng enzymatic rxn ganun) patient results
Pag matagal na yung glucometer pwede  Time interval required for blood to
mong dalin sa physician tapos pacompare stop flowing from a puncture wound
nalang on the volar surface of the forearm.
 Performed to evaluate vascular and
Examples of POCT (Copy Paste na to
platelet function.
tinamad din magturo si ma’am)
 The test is performed on the volar
HEMOSTASIS MONITORING: (inner) lateral surface of the forearm,
using a blood pressure cuff to
Prothrombin time (PT) and international standardize and maintain a constant
normalized ratio (INR) pressure.
 The incision is made with a sterile
 The PT test is used to monitor warfarin
automated incision device that
(e.g., Coumadin) therapy
controls the width (5.0 mm) and
 Measure the activity of coagulation
depth (1.0 mm) of the incision
factors involved in extrinsic
coagulation pathway ARTERIAL BLOOD GASES AND ELECTROLYTES
 tests on whole blood from a
fingerstick to provide timely  Arterial blood gases (ABGs)
laboratory results measured by POCT methods include
pH, partial pressure of carbon
Activated partial thromboplastin time (APTT dioxide (Pco2), oxygen saturation
or PTT) (So2), and partial pressure of oxygen
(PO2).
 Used to monitor unfractionated
 The most common electrolytes
heparin therapy, to screen for
measured by POCT are sodium (Na),
intrinsic pathway deficiencies, and
potassium (K), chloride (Cl),
to screen for lupus anticoagulant.
bicarbonate ion (HCO3), and ionized
 Clot-based screening test for intrinsic
calcium (iCa2).
coagulation
CARDIAC TROPONIN T AND I
Activated clotting time (ACT)
 Cardiac troponin T (TnT) and troponin
 Whole-blood clotting time test often
I (TnI) are proteins specific to heart
used in cardiac surgical suites
muscle.
 Used to monitor high-dose
o Cardiac Markers are analytes
unfractionated heparin therapy.
that are utilized to assess the
Platelet function occurrence of myocardial
infarction (MI) or the extent of
 Platelet function testing allows the
damage produced by
clinician to determine a patient’s
cardiovascular disease.
response to medication before open
heart surgery or cardiac GLUCOSE
catheterization.
 Glucose testing is one of the most
Bleeding Time common POCT procedures and is
 most often performed to monitor UNIT IX: SPECIMEN HANDLING AND
glucose levels of patients with PROCESSING
diabetes mellitus.
 Glucose analyzers predominantly Organizations
use whole-blood specimens
- CLSI (Clinical Laboratory Standards
obtained by routine skin puncture.
Institute)
 A drop of blood is applied to the test
- OSHA (Occupational Safety and
strip/microcuvette.
Health Association)
 Analyzer determines the level of
glucose in the blood, and the result SPECIMEN HANDLING
appears on a display screen.
- A critical phase in obtaining quality
HEMOGLOBIN results
- Pre-analytical – prior to analysis
 Hemoglobin is the primary
- Estimated that 46% to 68 % of all
constituent of red blood cell
laboratory errors occur prior to
cytoplasm and transports molecular
analysis
oxygen from the lungs to the tissues
- Proper handling from the time a
and returns carbon dioxide to the
specimen is collected until the test us
lungs.
performed helps ensure that results
 A small amount of blood sample is
obtained on the specimen
placed in a special microcuvette
accurately reflects the status of the
and inserted into the machine for a
patient.
reading.
Improper handling is a PREANALYTICAL
PREGNANCY TESTING
ERROR
 Tests detect the presence of human
Preanalytical Errors When?
chorionic gonadotropin (hCG)
 Uses urine (rapid testing) or blood  Before collection
 hormone produced by the placenta o Age of patient
that appears in both urine and o Altitude
serum beginning ~ 10 days after o Dehydrated patient
conception. o Duplicate test orders
o Exercise
URINALYSIS
o Gender of patient
Describes the results of a series of screening o Inadequate fast
tests capable of detecting (in a semi- o Incomplete requisition
quantitative manner) renal, urinary tract, o Medications
metabolic and systemic diseases. o Patient stress
o Pregnancy
o Smoking
o Strenuous exercise
 o Treatments (e.g., intravenous o Failure to centrifuge specimen
medications, radioisotopes) according to test requirements
o Wrong test ordered o Failure to separate fluid from
 At time of collection cells
o Short draw o Incomplete centrifugation
o Misidentified patient o Mislabeled aliquot
o Antiseptic not dry o Multiple centrifugation
o Expired tube o Rimming of clots
o Failure to invert additive tubes  During specimen storage
properly o Exposure to light
o Faulty technique o Temperature change outside
o Improper vein selection defined limits
o Inadequate volume of blood
You receive the sample narealize na
o Inappropriate use of plasma
lipemic. Saang stage?
separator tube (PST) or serum
separator tube (SST) Before collection BEST ANSWER
o Incorrect collection tube
o Incorrect needle position MIXING TUBE BY INVERSION
o Incorrect needle size
- 3 to 10 gentle inversions which
o Mislabeled tube
depends on THE TYPE OF TUBE and
o Mixing tubes too vigorously
- THE MANUFACTURER’S INSTRUCTIONS
o Nonsterile site preparation
as SOON AS THEY ARE DRAWN.
o Patient position
o Prolonged tourniquet BD TUBE INVERSION GUIDE
application
o Underfilled tube
o Wrong collection time
 During specimen transport
o Agitation-induced hemolysis
o Delay in transporting
o Exposure to light
o Failure to follow temperature
requirements
o Transport method (e.g., hand
vs. pneumatic tube)
 During specimen processing
o Contamination (e.g., dust or
glove powder)
o Delay in processing or testing
o Delay in fluid separation from
cells
o Evaporation
 - Gentle inversion helps to distribute Pneumatic tube systems – where may
the additive evenly while minimizing conveyor. Specimen lalagay sa tube tapos
the chance of hemolysis. matratransport (should be protected from
- VIGOROUS shaking can cause shock and sealed in zipper-type plastic
hemolysis and should be avoided. bags to contain spills)

Examples of tests that cannot be DELIVERY TIME LIMITS

performed on hemolyzed specimens are
- Specimen should be transported
- K without delay
- Mg - Routine blood specimen should
- Enzyme tests arrive @ lab within 45 mins of
collection
Inadequate mixing of anticoagulant tubes
- Specimens that require separation of
leads to MICROCLOT FORMATION
the serum/plasma from the cells
Inadequate mixing of gel separation tubes should be centrifuged within 1 hour
may prevent the additive from functioning of arrival in the lab
properly and CLOTTING may be
CLSI guideline
incomplete
- Time limit for separating serum and
Nonadditive tubes do not require mixing
plasma from the cells at 2 hours from
TRANSPORTING SPECIMENS time of collection

Rough handling and agitation can Glycolysis by erythrocytes and leukocytes

hemolyze specimens, activate platelets in blood specimens can falsely lower
and affect coagulation tests (Even break glucose values at a rate of up to 200 mg/L
tubes) per hour.

Transport specimen stopper up to reduce *Hematology test specimens drawn in

agitation, aid clot formation in serum tubes lavender or purple stopper (EDTA) tubes
and prevent contact of the tube contents and specimens for other tests performed
with the tube stopper on whole blood should never be
centrifuged
Blood in contact with tube stoppers can
be a source of specimen contamination TIME LIMIT EXCEPTIONS
and can contribute to aerosol (a fi ne mist
- STAT or medical emergency
of the specimen) formation during stopper
(immediately)
removal.
- Blood smears made from EDTA
Blood Specimen Tubes placed in a plastic specimens must be prepared within
bag with biohazard logo 1 hour (Preserves integrity of blood
cells)
Nonblood specimens - Transported in a
leak-proof container with adequately
secured lids
 - EDTA specimens for CBCs should be Central Processing or Triage
analyzed within 6 hours, generally
- Processing areas where specimens
stable for 24 hours @ room temp
are centrifuged
- CBC specimens collected in
- Separated from the cells to protect
microcollection containers should be
analyte stability
analyzed within 4 hours
- EDTA specimens for (Erythrocyte *In the ER may triage area to screen
Sedimentation Rate) ESR within 4 patients whether emergency cases or OR
hours if left at room temp OR 12 cases determines san pupunta na test
hours if refrigerated hematology ganun
- EDTA specimens for reticulocyte
counts 6 hours @ room temp OR up Triage Area – marks the request form kung
to 72 hours if refrigerated saan pupunta yung specimen kung sa
- Glucose tests drawn in NaF are hematology or clinical chemistry
stable for 24 hours and up to 48
SPECIMEN PROCESSING
hours when refrigerated @ 2-8
degrees Celsius (you don’t retest  Specimen suitability
same samples)  Centrifugation
- PT (Prothrombin time) result up to 24  Aliquot Preparation
hours whether unrefrigerated or
Reasons for rejection:
uncentrifuged
- PTT (Partial Thromboplastin Time) 4 - Hemolysis (Most Common)
hours regardless of storage - QNS (Quantity not Sufficient)
conditions - Ratio of additive with blood
- Contaminated specimen
SPECIAL HANDLING
- Wrong tube
 Body temperature: 36.4C–37.6C(37C - Outdated tube
average) - Exposure to light (Bilirubin)
 Room temperature: 15C–30C - Delay
 Refrigerated temperature: 2C–10C
The most frequent reason for rejection of
 Frozen temperature: −20C or lower
hematology specimens is clotting.
(some specimens require −70C or
lower) CENTRIFUGATION

Under ice (chilled specimens in 2-10 C) – Centrifuge - machine that spins blood and
heparinized, alcohol other specimens at a high number of RPM

*slows down metabolic processes and *Rotor for handling the tube
protects analyte
TUBES AWAITING CENTRIFUGATION
Light Sensitive like bilirubin – wrap in
aluminum foil Stoppers should remain on tubes while
awaiting centrifugation:
SPECIMEN SUITABILITY
 - To prevent loss of CO2 affects CO2  StatSpin Express 2 centrifuge (Sodium
tests Citrate Tube)
- Increase of pH affects pH tests  Done without delay
- Exposes to contamination and
CENTRIFUGING SERUM SPECIMENS
evaporation (conc. of analytes)
In centrifuging serum specimens, it must be
*Also Acid Phosphatase
clotted before centrifuging
This also prevents:
Complete clotting normally takes 30 to 60
- Contamination minutes at room temperature (22C–25C)
o A drop of sweat test affected
Specimens from patients on anticoagulant
electrolytes
medication, such as heparin or warfarin
o Powder from gloves test
(i.e., Coumadin), specimens from patients
affected calcium
with high white blood cell counts, and
determinations
chilled specimens may take longer to clot
- Interfering substances
If clotting is not complete when a
CENTRIFUGE OPERATION
specimen is centrifuged, latent fibrin
Crucial that tubes be “balanced” in a formation may clot the serum and interfere
centrifuge with the performance of the test

*an unbalanced centrifuge may break STOPPER REMOVAL

specimen tubes, ruining specimens and
All tube stoppers should be pulled straight
causing contents to form aerosols
up and off
The lid to the centrifuge should remain
Stopper sometimes must be removed to
closed during operation and should not be
obtain serum or plasma needed for tests.
opened until the rotor has come to a
complete stop. Stoppers can be removed using
commercially available stopper removal
A specimen should never be centrifuged
devices.
more than once because it can cause
HEMOLYSIS and ANALYTE DETERIORATION Either way, the stopper should be covered
AND ALTER TEST RESULTS. with a gauze or tissue to catch blood drops
or aerosol that may be released as it is
Once the serum or plasma has been
removed
removed, the VOLUME RATIO OF PLASMA
TO CELLS CHANGE ALIQUOT PREPARATION
CENTRIFUGING PLASMA SPECIMENS - portion of a specimen used for
testing
Specimens for tests that require serum or
- for multiple tests
plasma samples must be centrifuged.
Sometimes aliquot are created when
multiple tests are ordered on a single
specimen and the tests are performed on
different instruments or in different areas of
the testing department

Aliquots are prepared by transferring a

portion of the specimen into one or more
tubes labeled with the same ID information
as the specimen tube.

OSHA
“all procedure involving blood or
potentially infectious materials shall be
performed in a manner as to minimize
splashing, spraying, splattering and
generation of droplets of these substances”

Transfer of specimens into aliquot tubes has

an inherent risk of error. Great care must
be taken to match each specimen with
the corresponding aliquot tube to avoid
misidentified samples.

Consequently, disposable transfer pipettes

should be used when transferring serum or
plasma into aliquot tube

Pouring the serum or plasma into aliquot

tubes is not recommended because it
increases the possibility of aerosol
formation or splashing.

Serum and plasma are virtually

indistinguishable once they have been
transferred into the aliquot tubes

Never put serum and plasma, or plasma

from specimens with different
anticoagulants, in the same aliquot tube.

Each aliquot tube should be covered or

capped as soon as it is filled.