1. What is Hemolysis of sample? Hemolysis is the breakdown of red blood cells.

Red blood cells normally live for about 120 days. After that, they die and break down. Some diseases cause red blood cells to break down too soon. Red blood cells carry oxygen to all of the body. If red blood cells are breaking down abnormally, there will be fewer of them to carry oxygen. 2. Enumerate several causes of hemolysis of sample during processing. Most causes of In vitro hemolysis are related to specimen collection. Difficult collections, unsecure line connections, contamination, and incorrect needle size, as well as improper tube mixing and incorrectly filled tubes are all frequent causes of hemolysis. Excessive suction can cause the red blood cells to be literally smashed on their way through the hypodermic needle owing to turbulence and physical forces. Such hemolysis is more likely to occur when a patient's veins are difficult to find or when they collapse when blood is removed by a syringe or a modern vacuum tube. Experience and proper technique are key for any phlebotomist or nurse to prevent hemolysis. In vitro hemolysis during specimen collection can cause inaccurate laboratory test results by contaminating the surrounding plasma with the contents of hemolyzed red blood cells. For example, the concentration of potassium inside red blood cells is much higher than in the plasma and so an elevated potassium level is usually found in biochemistry tests of hemolyzed blood. In vitro hemolysis can also occur in a blood sample because of prolonged storage or storage in incorrect conditions (i.e., too hot or too cold). 3. What is a lipemic specimen? In blood samples, these are identified as having milky serum (the normally clear or yellowish portion of the blood) after being centrifuged. Depending on the tests being done and the methodology used, this can interfere with test results. However, most labs have procedures for working around this problem. 4. What is the cause of lipemic specimen? The most prevalent cause for lipemia is an increase in triglyceride concentration in plasma/serum. This can be due to food intake, an altered lipid metabolism or to infusion of lipids. After enteral absorption, plasma triglycerides are present in the circulation as chylomicrons and their metabolic products (remnants) for 6 to 12 hours.

One, 2, 3 and 4 hours after intake of a Continental or American breakfast, plasma triglyceride concentrations increase substantially. As they cause turbidity of the sample, the patient should be requested to fast, before investigations are made that are affected by lipemia. Metabolic disorders causing hypertriglyceridemia can hardly be distinguished from lipid infusions, cold agglutinins and monoclonal immunoglobulins. In addition post-centrifugal coagulation of serum samples of heparinized patients can also be the cause of turbidity. 5. What is icteric specimen? Serum or plasma can be bright yellow or even brownish due to either liver disease or damage or excessive red cell breakdown inside the body. Icterus can, like hemolysis, affect many lab tests, but unfortunately, recollection is not an option since the coloration of the serum or plasma is due to the patient's disease state. However, appearance should be noted on the lab report as "serum icteric". 6. Why is serum more preferred as specimen for analysis in chemistry? Serum is clearer than plasma because of fewer proteins. Fibrinogen- a protein- is present in plasma and not found in serum. Proteins are sometimes considered as interfering substances in some tests as they react with the reagent and thereby yield inaccurate results. The presence of more protein components would render the supernatant fluid more turbid. 7. Why is prolonged contact of serum or plasma with blood cells avoided? Prolonged contact of serum or plasma with blood cells should be avoided to minimize glycolysis and/or shift of constituents from cells to serum or plasma. 8. Why must adequate clotting be in serum achieved in serum preparation? Inadequate clotting time, improper mixing, and failure to place the tube in an upright position can lead to incomplete clot formation. Following centrifugation, the resulting sample may appear satisfactory with a defined layer of cells at the base of the tube and a clear layer of serum above. Despite this appearance, the clotting process may not have been completed prior to transportation, centrifugation, and placement of the specimen on the analyzer. Further coagulation in the serum may subsequently occur,leading to the production of latent fibrin, which can interfere with the quality of a result.

9. Cite 5 examples of test affected by delayed processing of specimens. Concentrations of albumin, apolipoproteins A1 and B (apoA1 and apoB), cholesterol, high density lipoprotein (HDL), total protein, and triglycerides changed by less than 4%, and low density lipoprotein (LDL) by less than 7%. Whilst alanine transaminase (ALT), creatine kinase (CK), creatinine, and -glutamyl transferase (GGT), requires immediate processing. 10. Cite 5 examples of tests affected by hemolysed specimens. Examples include Potassium (K+), Lactate Dehydrogenase (LD), AST, Troponin T, ALT, CK, Iron, Coagulation tests