CLINICAL CHEMISTRY 1

Source: Book,PPT,Discussion
Types of Blood Specimen
Phlebotomy and Specimen Considerations
Whole blood
Introduction - There is still plasma and cellular component
Pre-Analytical (Sample Processing) - When collected must be put in tube containing
 Patient anticoagulant
 MD test order - Arterial- for pH and blood gases, tube must have
 Collection heparin (syringe only)
 Transport - Venous
Analytical (Chemical Analysis) Plasma
 Analysis - 90% water, 9% organic compound, 1% dissolved
 Data flow gases
Post-Analytical (Data Management) - Liquid portion of anticoagulated blood
 Interpretation by MD - The yellowish part in whole blood (anticoagulant)
 Diagnosis and treatment - With fibrinogen
Phlebotomy Serum
- Process of collecting blood “to cut vein” - Liquid portion of clotted blood
- 2 main procedures: - Clotting factor is active
 Venipuncture- used of needle attached - No fibrinogen
to a collecting device
 Capillary puncture- collect through Venipuncture Equipment
skin puncture; micro capillary tube Tourniquet - Made of pliable
-Insert needle types- and lancet- rubber
- Strip with Velcro
The Vascular System - Locate the patient’s
- Network of arteries, vein and capillaries vein
- Arteries and Vein: - Must not be left for 1
 Tunica intima- inner min
 Tunica media- middle, thickest Needle - Size: gauge and
 Tunica adventia- outer layer bore are inversely
- Capillaries: related
 Only have one layer of tissue. - 21 gauge is the
Arteries - Arterial blood in standard for routine
bright res venipuncture
- Oxygenated blood -
- Collected through 90 Evacuated Tube - Multiple sample
degrees. System - Tube holder
- Performed by (barrel/adapter)
physician or RT - Evacuated tubes
Vein - Venous blood is Needle and syringe - Syringe needle
dark red - Syringe
- Deoxygenated blood - Transfer device
Capillaries - Smallest blood Winged Infusion Set - Luer fitting
vessels (Butterfly) (for syringe)
- One cell thick to - Luer adapter
allow for gas and (for ETS)
nutrient exchange Tube and a. Anticoagulant
Tube additives  Light blue
Phlebotomy sites (citrate)
- Cephalic- second choice  Green
- Median cubital- most preferred site (heparin)
- Basilic vein- least favorable site; near to brachial  Lavender
artery, nerves and tendon; do not anchor. (EDTA)
- Other sites: hand vein- small, less anchored, b. Antiglycolytic
painful agents
 Gray (sodium
fluoride)
c. Clot Activators
 Red (silica)

MA. PATRICIA VILLANUEVA 1

CLINICAL CHEMISTRY 1
Source: Book,PPT,Discussion
 Orange Plasma Preparation - Pearl top
(thrombin) Tube - EDTA, thixotropic
d. Thixotropic Gel gel
 Gold (serum) - Molecular
 Light green diagnostics
(plasma) Fluoride tubes - Gray
 Pearl or white - Na fluoride / K
oxalate
Order of Draw - Chemistry
- Reduce the risk of specimen contamination by ESR tubes - Black
microorganisms and additive carry over - Na citrate
- Hematology

ACD tubes - Yellow

- Na3 citrate, citric
acid dextrose
Trace element tubes - Royal blue, tan, light
brown
- Plain Na heparin
- Toxicology
- Tan/Light brown
- K2 EDTA, Na
heparin
- Lead testing
Blood donor bags

Blood Culture tubes
Coagulation tubes
Glass- non additive tube
Plastic clot activator tube
Serum separator Tubes
Plasma separator tube
Heparin tubes
EDTA tubes
Pre-analytic Consideration
Problem sites:
 Burns
- Yellow  Scars tattoos
- Sodium Polyanethol  Damaged veins
Sulfonate SPS  Hematoma- cold compress treatment then hot
- Microbiology  Edema
- Light blue  Mastectomy
- Sodium citrate  IV Therapy
- Hematology  Heparin and Saline Locks
- Red  Fistulas
- No additive Procedural Error Risk:
- Chemistry,BB,  Hematoma
Serology  Iatrogenic anemia
- Red  Infection of the site
- Silica particles  Nerve injury
- Chemistry  Inadvertent arterial puncture
- Gold plastic/red &  Reflux
gray rubber Patient Conditions and Complications:
- Silica particles/  Allergies to supplies and equipment
thixotropic gel  Excessive bleeding
- Chemistry  Syncope
- Light  Nausea or vomiting
green/green/gray  Obese patients
rubber  Pain
- Lithium heparin,  Petechiae
thixotropic gel  Seizures/convulsion
- Chemistry
- Green
- Lithium heparin
- Chemistry
- Lavender/pink
- EDTA
- Hematology and BB

MA. PATRICIA VILLANUEVA 2

CLINICAL CHEMISTRY 1
Source: Book,PPT,Discussion
Capillary Specimen Collection  Hemolyzed- destruction of RBC result in
- Blood is collected using lancet or skin puncture. pinkish to red of serum and plasma; affect
Collection site: potassium and enzyme testing
 Outer area of heel  Icteric- yellowish
 Fingers Stopper removal
 Earlobe  Stopper removal devices
Materials:  Face shield
 Lancets  Splash shield
 Warming device Aliquot Preparation
 Micro collection tubes - For multiple test in a single specimen
 Microhematocrit tubes - Stored at 4 or -20 degrees for 8 hrs.
 Sealants
Capillary Order of Draw
 Blood gases (heparin)
 EDTA
 Sodium Heparin
 Other additive
 Non additive
Indications of Capillary Puncture
 Inaccessible veins
 Fragile veins
 Thrombotic tendencies
 POCT
 Small blood volume
 Prevent injury
Newborn Screening
- Collected by heel puncture.

Specimen Processing

Routine handling
Mixing tubes:
- Invert 3-8 x
Transporting Specimens:
- Plastic bag with logo of biohazard
Delivery time limits:
- 45 minutes after collection
- Centrifuged within 1-2 hour

Special Handling
- Maintained at 37 degrees (heat block)
- Chilled (using crushed ice)
- Wrapped on foil

Specimen Suitability
- Hemolyzed
- Collection in wrong tube
- Failure to follow timing and handling requirements
- Quantity not sufficient
- Clotting in WB or plasma specimen

Centrifugation
- Specimens must be completely clotted within 30-
60 minutes at room temp.
- Visually check:
 Lipemic- cloudy, turbid appearance,
presence of lipid and a non-fasting
specimen; interferes with colorimetric
analysis

MA. PATRICIA VILLANUEVA 3