● The tubes should also be pre-warmed at 37°C and portable

OUTLINE heat blocks are used during transport, which could hold the
I. Specimen Handling
temperature for 15 minutes from removal from the incubator.
II. Routine Handling
III. Special Handling
● Temperature-sensitive specimens that can withstand
IV. Blood Specimen Processing and Reasons for Specimen temperatures slightly higher than37 C can be wrapped in an
Rejections activated heel warmer for transport
V. Delivery Time Limits and Expectations for Delivery and
PRocessing Specimens CHILLED SPECIMEN
VI. Centrifugation
● Chilling slows the metabolic process, which could affect the
VII. Osha Act (RA 11058)
results for some specimens.
● The specimen tube should be completely submerged in
I. SPECIMEN HANDLING crushed ice and water slurry during transport and immediately
● Proper handling from the time a specimen is collected until the tested or refrigerated, if necessary.
test is performed helps ensure that results obtained on the
specimen accurately reflect the status of the patient LIGHT SENSITIVE SPECIMEN
● A critical part of pre-analytical phase ● Analytes are broken down by light, resulting in falsely
➢ Preanalytical errors are factors that alter test results that decreased values.
are introduced into the specimen before testing,including ● Most common of these is bilirubin, which can decrease by up to
before, and during collection, and during transport, 50% after 1 hour of light exposure.
processing, and storage ● An easy way to protect a blood specimen from light is to wrap it
in aluminum foil.
● Light-blocking,amber-colored microcollection containers are
II. ROUTINE HANDLING
available for collection of infant bilirubin specimens.
● Phlebotomists should have the knowledge and skills to perform
routine venipuncture.
● They should be careful in mixing tubes and preparing IV. BLOOD SPECIMEN PROCESSING AND REASONS
specimens for transport to the laboratory. FOR SPECIMEN REJECTIONS
● They should adhere to time limits set for delivery of specimens
BLOOD SPECIMEN
to the laboratory except for cases such as emergency
● The collected specimens are transported to the central
specimens or other conditions mentioned in the time limit
processing or triage for screening and prioritizing.
exceptions.
They are
MIXING TUBES BY INVERSION (1) identified;
● Some tests require gentle inversion of the specimen tube to (2) logged or accessioned;
evenly distribute the additive. The number of inversion (3) sorted by department and type of processing; and
depends on the type of additive, but it is usually between 3 to (4) evaluated for specimen suitability which is necessary to get
10 gentle inversions. accurate results.
● Blood in contact with tube stoppers can be a source of
TRANSPORTING SPECIMENS specimen contamination and can contribute to aerosol (a fine
● Handling specimens for transport to the laboratory should be mist of the specimen)formation during stopper removal.
done properly because rough handling can lead to undesirable ● Blood specimen tubes are typically placed in plastic bags for
conditions which might hemolyze the specimens, activa transportation to the laboratory.
platelets, affect the coagulation, and even break the glass tube. ● Nonblood specimens should be transported in leak-proof
containers with adequately secured lids.
● All specimens transported through pneumatic tube systems
III. SPECIAL HANDLING should be protected from shock and sealed in zipper-type
● When blood leaves the body it is exposed to the effects of plastic bags to contain spills
temperature and light that can negatively affect analytes.
Specimens for those significantly affected require special
handling to protect them. V. DELIVERY TIME LIMITS AND EXPECTATIONS
BODY TEMPERATURE FOR DELIVERY AND PROCESSING SPECIMENS
● The specimen will precipitate or agglutinate if allowed to cool DELIVERY TIME LIMITS
below body temperature ● All specimens should be transported to the laboratory without
● It should be transported at a near body temperature of 37°C. delay

PMLS Handling and Processing of Blood Specimens for Laboratory Testing 1 of #

● Within 45 minutes of collection
● Centrifuged within 1 hour of arrival in the lab.
● Prompt delivery and separation minimize the effects of
metabolic processes
TIME LIMIT EXPECTATIONS
● "STAT" or "medical emergency" specimens take priority over all
other specimens and should be transported, processed, and
tested immediately.
Other Exceptions:
➢ Blood smears made from EDTA specimens must be
prepared within 1 hour of collection to preserve the
integrity of the blood cells and prevent artifact formation
due to prolonged contact with the anticoagulant.
➢ EDTA specimens for CBCs should be analyzed within 6
hours, but are generally stable for 24 hours at room
temperature. CBC specimens collected in microcollection
containers should be analyzed within 4 hours.
➢ EDTA specimens for erythrocyte sedimentation rate
(ESR) determinations must be tested within 4 hours if left
at room temperature or within 12 hours if refrigerated.
➢ EDTA specimens for reticulocyte counts are stable up to
6 hours at room temperature and up to 72 hours if
refrigerated.
➢ Glucose test specimens drawn in sodium fluoride tubes
are stable for 24 hours at room temperature and up to 48
hours when refrigerated at 2 C to 8 C.
➢ Prothrombin time (PT) results on unrefrigerated and
uncentrifuged specimens are reliable for up to 24 hours
after collection. Partial thromboplastin time (PTT) test
specimens require analysis within 4 hours of collection
regardless of storage conditions.
o May be centrifuged without delay
● Serum Specimens
o Allow to clot first
STOPPER REMOVAL
● Stoppers can be removed using commercially available stopper
removal devices or by use of robotics
● Wear a full-length face shield or the tube should be held behind
a splash shield when the stopper is removed
● Stopper should be covered with a gauze or tissue to catch
blood drops or aerosol that may be released as it is removed
● All tube stoppers should be pulled straight up and off
● Do not "pop" off using a thumb roll technique.
ALIQUOT PREPARATION
● Aliquot - a portion of a specimen used for testing
● 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.
● Disposable transfer pipettes should be used when transferring
serum or plasma into aliquot tubes
VI. OSHA ACT (RA 11058)
● 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.

VI. CENTRIFUGATION
● A machine that spins blood and other specimens at a high
number of revolutions per minute (rpm).
● The centrifugal force created causes the cells and plasma or
serum in blood specimens to separate
● Specimens for tests that require serum or plasma samples must
be centrifuged
TUBES AWAITING CENTRIFUGATION
● Stoppers should remain on tubes awaiting centrifugation.
o Removing the stopper from a specimen can cause loss of
CO2 and an increase of pH
o Leaving the stopper off exposes the specimen to evaporation
and contamination.
● Evaporation leads to inaccurate results because of
concentration of analytes
● Sources of Contamination
o Drop of sweat
o Powder from gloves
CENTRIFUGE OPERATION
● Crucial that tubes be "balanced" in a centrifuge
o Equal-size tubes with equal volumes of specimen must be
placed opposite one another in the centrifuge
o Unbalanced centrifuge may break specimen tubes, ruining
specimens and causing the contents to form aerosols
● Lid to the centrifuge should remain closed during operation and
should not be opened until the rotor has come to a complete
stop.
● Plasma specimens

PMLS Handling and Processing of Blood Specimens for Laboratory Testing 2 of #