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Handling and Processing of Blood Specimens For Laboratory Testing Group 1

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47 views5 pages

Handling and Processing of Blood Specimens For Laboratory Testing Group 1

pmls2

Uploaded by

Hanna Kristel Joy Cayogyog
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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LESSON 9: HANDLING AND PROCESSING OF BLOOD SPECIMENS FOR LABORATORY

TESTING

STEPS INVOLVED IN PROCESSING AND HANDLING DIFFERENT TYPES OF SPECIMEN

- The result of a test is compromised when the proper collection, procedures,


storage, processing, and transporting protocol are not followed in the pre-
analytical phase.

a. Routine Handling
- Phlebotomist should have the knowledge and skills to perform routine
venipuncture.
- They should be careful in mixing tubes and preparing specimen for transport
to the laboratory.
- They should adhere time limits set for delivery of specimen to the laboratory
Except for cases such as emergency specimen or other conditions mentioned
in the time limit exceptions.

● Mixing Tubes by Inversion


- Some tests require gentle inversion of the specimen to evenly distribute
additive.
- The number of inversion depends on the type of additive
- Usually 3 to 10 gentle inversion.

● Transporting Specimens
- Handling specimens for transport to the laboratory should be done
properly.
- Rough handling can lead to undesirable conditions which might
hemolyze the specimens, activiate platelets, affect the coagulation,
and even break the glass tube.

The specimens tubes should be transported with the stopper to:


● Avoid contact between contents and the stopper.
● Minimize the agitation of the specimen.
● Aid clot formation for serum tubes.
b. Special Handling
- Special care is needed when handling blood specimen to protect its
condition and quality.

● Body Temperature
- The specimen will precipitate or agglutinate if allowed to cool below
body temperature of 37°C.
- The tubes should also be pre-warmed at 37°C and portable heat
blocks are used during transport, which could hold the temperature for
15 minutes from removal from the incubator.
- A heel warmer can be used for specimens that can withstand a
temperature slightly higher than 37°C.
- Examples include: cold agglutinin, cyrofibrinogen, and cryoglobulins.

● Chilled Specimen
- Chilling slows the metabolic process, which could affect the results for
some specimens.
- The specimen tube should be completely submerged in crushed ice
and water slurry during transport and immediately tested or
refrigerated, if necessary.
- Examples include: adrenocorticotropic hormone (acth), acetone,
angiotensin-converting enzyme (ace), ammonia, catecholamines, free
fatty acids, gastrin, glucagon, homocysteine, lactic acid, parathyroid
hormone (pth), ph/blood gas, pyruvate, and renin.

● Light-sensitive Specimen
- There are cases when exposure to light can affect the result of a
specimen, like bilirubin.
- The phlebotomist should wrap the tube with aluminum foil or use light-
blocking, amber-colored container.
- Examples include: Bilirubin, carotene, red cell folate, serum folate,
vitamin B6, vitamin B12, vitamin C, urine porphyrins, and urine
porphobilinogen.
BLOOD SPECIMEN PROCESSING AND REASONS FOR SPECIMEN REJECTION

- The specimens are transported to the central processing or triage for


screening and prioritizing. They are identified, logged or accessioned, sorted
by department and type of processing, and evaluated for specimen
suitability which is necessary to get accurate results.

Any specimen will be rejected for the following reasons:


1. Specimen is not identified properly.
2. It has inadequate volume to complete the test.
3. There is hemolysis.
4. Wrong tube for collection is used.
5. Tube used is outdated.
6. There is improper handling (improper mixing).
7. The specimen is contaminated.
8. Specimen is insufficient or “quality not sufficient” (QNS).
9. Collection time is incorrect.
10. Specimen is exposed to light.
11. Procedure did not follow testing time limits.
12. There is a delay or error in processing.

DELIVERY TIME LIMITS AND EXCEPTIONS FOR DELIVERY AND PROCESSING SPECIMENS

Delivery Time Limits


- The specimen should be transported to the laboratory immediately after
collection.
- Routine blood specimen is expected to reach the laboratory within 45
minutes.
- Centrifugation needed by the specimen should be done in 1 hour.
- Hematology specimens with EDTA, which are placed in tubes with lavender or
purple stopper, should not be centrifuged.

Time Limit Exceptions


- The delivery time limit has some exceptions.
- A specimen that is marked as STAT or EMERGENCY takes priority over all other
specimens in terms of transportation, processing, and testing.
Other exceptions to the time limit rules:
1. Blood smear from EDTA specimen
- prepared 1 hour from collection.
2. EDTA specimen for CBC
- analyzed within 6 hours but is stable 24 hours from collection if stored at
room temp.
3. EDTA specimen for erythrocyte sedimentation rate (ESR) determination
- tested 4 hours (room temp) and 12 hours (refrigerated).
4. EDTA specimen for reticulocyte counts
- stable for 6 hours (room temp) and 72 hours (refrigerated).
5. Glucose test drawn in sodium fluoride tubes
- stable for 24 hours (room temp) but stable up to 48 hours (refrigeratyat
2°C to 8°C).
6. Prothrombin time (PT)
- stable for 24 hours and partial thromboplastin time (PTT) should be
analyzed within 4 hours from collection.

Centrifugation
- A centrifuge is an apparatus that is used to separate cells, plasma, or serum of
blood specimens.
- Centrifugation is achieved by spinning the blood tubes inside the vessel at a
high speed such that the centrifugal force will cause the separation of the
specimens.
- It is important to leave the stoppers on the tube before and during
centrifugation to avoid contamination, evaporation, aerosol formation, and
pH changes, which will affect the accuracy of results.
- Tubes should be balanced in a centrifuge.
- Tubes of the same size and volume of specimen should be placed opposite
one another.
- The process of centrifugal should not be repeated.
- The plasma specimen collected in tubes with anticoagulants should be
centrifuged immediately without delay.
- Serum specimen needs to be completely clotted prior to centrifugation.
(complete clotting takes around 30 to 60 mins at room temp)
- Most of the processes require the stopper to be removed to obtain the serum
or plasma.
- If there is a need to remove the stopper manually, a face shield or splash
shield should be used.
- A gauze or tissue is used to cover the stopper to catch drops of blood that
may leak.
- The tube stopper should be removed by pulling it straight up and off the tube.

Aliquot Preparation
- An aliquot of specimens refers to a portion of a sample specimen taken for
chemical analysis or testing.
- It is prepared when multiple tests are ordered on a single specimen.
- The preparation is done by transferring a portion of the specimen into one or
more tubes that are labeled with the same information as the original
specimen tube using a disposable transfer pipette.
- Specimens with different anticoagulants should not be put in the same
aliquot tube.
- The phlebotomist must see to it that the tube is covered as soon as it is filled.

OSHA ACT (RA 11058)-REQUIRED PROTECTIVE EQUIPMENT WORN WHEN PROCESSING


SPECIMEN

- When processing specimens in the laboratory, the health worker is exposed to


blood and other potentially infectious materials.
- For this reason, healthcare institutions should comply with the appropriate
protective equipment set by the Occupational Safety and Health Standards
Act (RA 11058).
- The protective equipment includes gloves, laboratory gowns/coats, and
masks.

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