MEDT 25: VIRTUAL INTERNSHIP
CLINICAL CHEMISTRY SECTION
Name: VARIAS, Maureen G.
Instruction: Analyze each case carefully and answer the given questions. Back-up your
answers by providing reliable references. Use APA 7th edition.
Case
A medical technologist
experienced difficulty in blood
extraction. On the second
attempt, the tourniquet was
applied almost 10 minutes while
in fist clenching before the vein
was hit and blood flows in the
syringe.
a. Do you think there are blood
analytes that can be affected in
this way of blood collection? If
yes, what are these specific
blood analytes in blood
chemistry test that can be
altered? What is the expected
result in these analytes and
explain how this happen?
b. How can you correct the
medical technologists blood
collection procedure? What is
the standard guideline?
ACTIVITY # 2:
Date: December 08, 2022
Answer
a. Yes, there are blood analytes affected when the
application of the tourniquet has already been this long,
and also when the patient is asked to do a fist clench
during blood extraction. Fist clenching affects Lactate,
Potassium, and Phosphate levels of the patient;
specifically, it increases these analytes. According to
Dietzen (2012), muscle exertion (fist clenching) results in
increased local production of lactate. On the other hand,
prolonged tourniquet application will cause a slowdown in
the diffusion and clearance of lactate. Potassium, on the
other hand, increases because when we clench our fists, it
also causes the contraction of our forearm muscles. Now,
this muscle contraction will result to the local release of
potassium (Don et al., 1990). Rodriquez (2018) indicated
that phosphate also increases; and this is what was taught
to us during our clinical chemistry seminar, conducted by
Sir Jed Calunsag. But, from a study of Lima-Olivera et al.
(2016) where they subjected 16 healthy adults for their
study, they found that fist clenching is associated with
significant decrease in phosphate (-5% p=0.014).
Prolonged tourniquet application can cause
hemoconcentration because the water escapes from the
tissues; anaerobiosis wherein low O2 will result to
bacterial multiplication (remember that there are bacteria
underneath our skin that will not die no matter what kind of
aseptic technique you do); and the increase of analytes –
Calcium, Cholesterol, Lactate, Enzymes, Ammonia,
Albumin, and Potassium (Rodriguez, 2018).
 b. I can correct the medical technologist by simply telling
him or her that excessive fist clenching is not advised
when collecting blood, and that a simple fist formation is
enough to make the veins more prominent (World Health
Organization, 2010). With regards to the tourniquet
application, it must only be tied on the arms of the patient
for 1 minute so that you can locate and palpate the vein. If
you were not able to find or feel the vein, you will have to
remove the tourniquet and wait for another 2 minutes
before reapplying it.

Reference(s):
Dietzen, D. J. (2012, August 09). Lactate and Lactic
Acidemia. https://www.aacc.org/science-and-
research/clinical-chemistry-trainee-council/trainee-
council-in-english/pearls-of-laboratory-medicine/
2012/lactate-and-lactic-acidemia
Don, B. R., et al. (1990, May 03). Pseudohyperkalemia
Caused by Fist Clenching during Phlebotomy. N
Engl J Med, 322: 1290-1292. doi:
10.1056/NEJM199005033221806
Lima-Olivera, G., et al. (2016, July 17). Estimation of the
imprecision on clinical chemistry testing due to fist
clenching and maintenance during venipuncture.
Clin Biochem.
http://dx.doi.org/10.1016/j.clinbiochem.2016.07.007
Rodriguez, M. T. T. (2018). Clinical Chemistry Review
Handbook for Medical Technologists.
World Health Organization. (2010). WHO guidelines on
drawing blood: best practices in phlebotomy.
http://whqlibdoc.who.int/publications/2010/9789241
599221_eng.pdf

Demetrio went to the hospital Reference(s):

due to high blood pressure. The
patient’s BP in the ER is
180/100. This patient is given a
clonidine to lower the blood
pressure. The patient’s Total
protein, albumin and globulin
are normal as well as the Na, K,
Cl- and GFR. The other
important blood chemistry test is
listed below:

Lab Test Result Ref Value

FBS 170 70-110
mg/dL
Cholesterol 340 <200 mg/dL
Triglycerides 240 <150 mg/dL
Creatinine 90 80-115
umol/L
BUN 15 8-23 mg/dL
AST 7.2 5-37 U/L
ALT 9.5 6-37 U/L

This patient was admitted in the

hospital and monitored the
blood pressure and glucose
level. The doctor administered
insulin to control the blood
sugar, prescribed maintenance
Amlodipine to control the blood
pressure as well as fenofibrate
and simvastatin to lower the
cholesterol and triglyceride of
the patient.

After 4 days of admission, the

patient’s BP stabilizes. He was
discharged in the hospital and
advice to come back for follow
up check-up and repeat blood
chemistry test after 4 weeks of
medication.

After 4 weeks of medication, the

patient come back to the
laboratory for blood analysis.
This time the medical
technologists notice increase in
serum creatinine (139 mg/dL)

a. If you’re the medical

technologists who run this
patient’s sample, how can you
correlate the elevation in
creatinine result based on the
above patient’s history,
assuming that patient is in his
usual diet and body activity and
previous serum creatinine and
BUN results are normal with no
history of renal disease?
Explain?

A 28-year-old obese female was Reference(s):

admitted in hospital due to
uncontrolled high blood
pressure, easy bruising and
muscle weakness. Base on her
statement during the
consultation, she is currently
taking oral contraceptive. The
doctor noticed that this patient
has an increase fat around the
base of the neck that is why the
doctor requested twice blood
collection for serum cortisol
analysis.
a. If you’re the medical
technologist when did you
collect blood from the patient?

b. How will you instruct the

patient for his /her preparations
before the blood collection?
Why?

c. What collection tube are you

going to use for the blood
collection?

The patient from ward has Reference(s):

lactate test. Before blood
collection unfortunately the
machine was having
malfunctions. The blood sample
to be extracted is not possible to
run immediately after collection.
If you’re the medical
technologist how will collect the
blood sample?

A doctor requested blood Reference(s):

chemistry test (FBS, BUN,
Creatinine, SGPT, and SGOT)
from diabetic patient in ICU.
This patient has double IV line.
Venous cut did not recommend
to patient since veins of patient
is not dehydrated and veins are
not collapse. Femoral vein is not
accessible since both legs are
injured and infected with ulcers.
a. If you’re the medical
technologists what is the best
course of action to collect 5mL
of blood in this patient?

A 36-year-old woman was Reference(s):

admitted with 9-month history of
amenorrhea and admission
serum B-hCG value of 3800
mIU/mL. Xray studies revealed
a lesion in the left lung, and a
CT scan demonstrated small
lesions in the frontal and left
parietal lobes of the brain.
Biopsies confirmed the
presence of choriocarcinoma.
The patient received radiation
and chemotherapy treatment,
and serum B-hCG values
returned to normal. Three
months later a modest increase
in the serum B-hCG signaled a
possible recurrence of tumor.

To confirm this, a specimen was

sent out to another laboratory
and the HcG result from an
outside laboratory turned to be
negative. X-ray studies revealed
a tumor in the right lung.

As a medical technologist which

is the most likely molecule that
the outside laboratory measures
only and why?
 a. Intact hCG
b. Beta core fragment
c. Beta-hCG
d. Intact hCG and Free
beta-hCG
e. Free beta hCG

A 34-year old man complains of Reference(s):

weight loss, palpitations at night,
sweats, anxiety and a dry
mouth. His wife adds that he
talks much rapidly than he did
six months ago. On
examination, he is indeed
sweaty but his body temperature
is not raised. However, blood
pressure are 148/86 and the
pulse rate is 93 beats per
minute.

RESULT:
RERERENCE RANGE
TSH <0.1mU/L 0.27-4.2
T3 9.5pmol/L 4.0-6.5
T4 31.2pmol/L 12-22

a. Based on Laboratory
Result, as a medical
technologist determined
what type of thyroid
disease?

b. What type of collection

tube are you going to
use for the blood
collection?
A 31-year old woman delivered Reference(s):
a 9.5lb infant. The infant was
above the 95th percentile for
weight and length. The mother’s
history was incomplete; she
claimed to have had no medical
care through her pregnancy.
Shortly after birth, the infant
became lethargic and flaccid. A
whole blood glucose and ionized
calcium were performed in the
nursery.

a. As a medical
technologist what is the
possible explanation for
the infant’s large birth
weight and size.
b. If the mother was had
been monitored during
pregnancy, what
laboratory tests should
have been performed
and what criteria would
have indicated that she
had gestational
diabetes?

A 63-year-old man with frequent

urination was seen by his
primary care physician. The
following laboratory work was
performed.

a. What is the probable

diagnosis of this patient?
b. As a medical
technologist what other
tests should be
performed to confirm
this? Which is the
preferred test? Reference(s):
c. After diagnosis, what
tests should be
performed to monitor his
condition?