Download Lab Procedures Chapter 47: Phlebotomy/Blood Collection (3rd

Lab Procedures
Chapter 47: Phlebotomy/Blood Collection (3rd edition)
Chapter 48: Hematology (3rd edition)
Professor Fowler
Chapter48
Introduction
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
___________________: the study of blood and the tissues that produce it
Blood and its components are studied to detect pathological conditions and to determine the
appropriate course of treatment
The Medical Assistants Role
1.
2.
3.
4.
Know values of lab results
Collect the specimen per OSHA, CDC and CLIA regulations
Label correctly
Properly stored
Blood Formation and Components
1. _______________________________: formation of blood
a. Occurs primarily in bone marrow of adult
b. Lymphocytes are produced in the lymph nodes
2. Cellular formation and components
a. Red blood cells( _______________________________)
i. Contain hemoglobin (transports oxygen)
1. ____________________: carrying oxygen
2. _______________________________________: carrying carbon dioxide
ii. ________________________: hormone that controls RBC production and is
secreted by the kidneys in an adult and by the liver in a fetus
iii. Decreased erythropoietin = RBCs will not be formed in proper amounts resulting in
certain types of anemia
iv. RBCs last 4 months and continually reproduced by body
v. Tests
1. Count
a. Normal count is adult male is 5.0-6.0 million per mm3 and 4.5-5.0
million per mm3 in females
b. Increase = polycythemia
c. Low = anemia
2. Erythrocyte sedimentation rate (______) - also called sed rate – is the rate
at which RBCs settle at the bottom of a tube (procedure 48-3 (47-9 black
WB) – video)
3. ______________________ (PKU) is a congenital disease caused by a
defect in the metabolism of the amino acid phenylalanine (procedure 48-6
(47-10 black WB) – video)
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4. Mono Testing – also known as mononucleosis spot test
a. Used to help determine whether a pt has
______________________________________________
(Procedure 48-7 (47-11 black WB) – video)
b. Mono is commonly referred to as the “kissing disease” and is a
contagious viral infection frequently passed through oral contact
5. Microhematocrit Procedure
a. Hematocrit performed on an extremely small quantity of blood by
use of capillary tube
b. Provides MD info about pts RBC volume
c. Low = anemia or hemorrhage
d. High = dehydration or polycythemia
e. Normal is 40-50% is males and 35-45% in females
f. Procedure 48-2 (47-6 black WB) (video)
6. Hemoglobin (Hgb) Determination
a. Provides MD info regarding the amount of hemoglobin present in
the sample
b. Low = iron-deficiency anemia
c. High = polycythemia and extreme burns
d. Normal for adult male is 14-18 g/dL and for adult females 12-16
g/dL
e. Procedure 48-1 (47-7 black WB) (video)
b. White blood cells (_____________________________)
i. Defend against infection
ii. Neutrophils: combat infection by phagocytosis (surround, swallow and digest)
iii. _______________: presence of large number indicates parasitic infection or
presence of certain allergic conditions
iv. Basophils: produce heparin (substance that prevents clotting) – increased
amounts may be found in those with their spleen removed or excessive exposure
to radiation – may have a connection to severe allergic reactions
v. Lymphocytes: produces antibodies against foreign substances
vi. _________________: assist in phagocytosis (substances that neutrophils can not
ingest), assist in cleaning up after infection – increase may mean TB, typhoid, or
Rocky Mountain spotted fever
vii. Tests
1. Count
a. Normal count in adults range from 4500 to 11000 per mm3
b. Elevated = infection or if grossly elevated = possible leukemia
c. Low = viral infection or autoimmune deficiency
2. Differential Count
a. Determines the percentages of each type of WBC, RBC
morphology and platelet estimation
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c. Platelets (____________________): smallest formed cells – assist with clotting process
i. Clotting process: injured area, platelets and tissue release thromboplastin, this
combines with other elements in blood to produce thrombin, thrombin acts on a
protein in the blood called fibrinogen resulting in the formation of fibrin, fibrin is tiny
threads that create a mesh that catches RBCs and other cells to form clot
ii. Tests
1. Count
2. PT/INR
3. PTT
3. Liquid blood formation and components
a. Liquid portion of blood is plasma
b. 55% of the composition of blood
c. Carries cellular elements and other substances
d. Transports
e. 90% of plasma is water and other 10% is solid substances called solutes (plasma proteins,
electrolytes (NA+, K+, CL-), glucose, amino acids, lipids and carbohydrates, metabolic
waste products (urea, lactic acid, uric acid), creatnine, oxygen and carbon dioxide,
hormones, antibodies, enzymes, vitamins and mineral salts
4. Other blood tests
a. Profiles (Panels or Groups) table 48-1
i. Liver
ii. Lipid
iii. OB
iv. Electrolyte
v. CMP
b. Common lab tests with normal values – table 48-2
c. Common Blood Chemistry Tests – table 48-3
d. Comprehensive Metabolic Panel: screening to evaluate organ function, check for common
disorders and/or to monitor progress of current conditions and response to medications
i. Glucose, BUN, creatinine, Ca+, Na+, K+, CO2, Cl-, albumin, total protein, bilirubin,
ALP, AST, ALT
e. Diabetic tests
i. Blood sugar (procedure 47-5 black WB)
ii. HbgA1C – Procedure 48-5
iii. Glucose tolerance test (in lab)
f. CBC
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Chapter 47
The Function of Blood
1. Transportation
a. Carries oxygen and nutrients to body and removes waste products to liver, kidneys and
skin for elimination
2. Protection
a. White blood cells work with immune system to fight pathogens
3. Heart, arteries, veins and capillaries
a. Heart pumps blood
b. ____________: blood away from the heart
i. Thick walls that allow to withstand pressure sustained when heart is pumping
ii. Blood contains oxygen
c. ____________: blood towards the heart
i. Blood contains high carbon dioxide
d. ______________: where arteries meet veins – smallest vessels
4. Blood regulates body temperature
a. Warm: dilate to release heat
b. Cold: constrict to retain heat
Blood Specimen Collection
1. Blood and body fluid collection strictly regulated by OSHA regulations and CDC standard
precautions
2. CLIA sets standards that all labs must adhere to
3. Always follow guidelines established by these organizations
4. Venipuncture
a. Sites
i. Figure 47-4
ii. Antecubital space (depression in front of elbow) is the most commonly used site
iii. Four large veins in antecubital with easy access making this site ideal
iv. Most common vein used is median cephalic vein
b. Methods
i. Vacuum tube
1. Most common method
2. Use large vein as small veins can collapse
3. Procedure 47-3 (mannequin arm and live – practical)
ii. Syringe and needle
1. Uses smaller vein and needle to get less blood
2. Procedure 47-2 on mannequin arm
iii. Butterfly
1. Used for small veins using smaller needle, tubing and vacuum tube
2. costly
c. Equipment
i. Figure 47-3
ii. Wear PPE(gloves and lab coat/gown)
iii. Should be assembled and expiration dates checked before attempting use
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iv. Important to fill the tubes in the order of draw recommended by Clinical Laboratory
Standards Institute (CLSI) in order to prevent contamination of the tubes with skin
bacteria or additive from another blood tube
v. Vacuum tubes come in 5mL, 7mL, 10mL and 15mL
vi. Invert the tube 6-8 times so the anticoagulant and blood have mixed properly – DO
NOT SHAKE as this will hemolyze the blood
d. Order of draw
i. Table 47-1
ii. Figure 47-16 tube colors, additives, inversions, and lab uses
iii. Some labs may use additional tubes like pink, tan-black, and royal blue
e. Patient preparation
i. Fasting (lipid, GTT, FBS)
ii. Anxious patients
iii. Children
f. Challenges (Chapter 47)
i. Hematoma
ii. Patient refusal
iii. Stress
iv. Failure to Obtain Blood
v. Specimen Problems
vi. Blood Cultures
g. Unexpected events
1. Fainting – immediately withdraw needle, and request pt lower head and
arms or lie down – ammonia is available to help revive pts – if does not
respond, call another member
2. Nauseous – pt breathe deeply through mouth and provide basin
3. Excessive anger – remain calm and reassuring – if continues or is
disruptive, stop procedure
4. Uncontrollable bleeding – apply pressure and call for assistance
h. Complications
1. Small veins (warm compress applied)
2. Rolling veins (place one finger below where needle to go)
3. Incomplete draw/not enough blood (may request more experienced
professional)
5. Capillary puncture (manual) – Procedure 47-1 (47-4 black WB)
a. Puncture sites
i. Figure 47-8
ii. Adults: fingers and earlobes
iii. Infants: heels
b. Equipment and supplies
i. Figure 47-9
c. Preparing blood slides – procedure 48-4 (47-8 black WB)
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