LABORATORY DIAGNOSIS

SECTION A: Mondays, 1–3 PM; SECTION B: 3–5 PM

Aurelia D. Navarro, MD
• SEMESTRAL Subject
• 2 hour lecture once a week
- PPT to be e-mailed to class
president
• GRADES: 90% Exams; 10%
Attendance
• 3 LONG Exams: MPL of 60
- Scheduled
- Photocopy fee to be collected
by class treasurer
• ATTENDANCE: Signature on
attendance sheets; UNannounced
short quizzes
- Signing in the attendance sheet
BUT NOT actually attending
class  automatic ZERO score
in attendance
 TOPIC GUIDE
DATE TOPIC AND EXAM SCHEDULE
Sept 3, 2018 Introduction to the Course and Specimen Collection
Sept 10 Hematology and Hematopoiesis
Sept 17 Red Blood Cell Disorders
Sept 24; Oct 1 White Blood Cell Disorders
Oct 8, 15 Coagulation Disorders and Special Hematologic Tests
Oct 22 LONG EXAM 1 (100 Points)
Oct 29; Nov 5 Transfusion Medicine
Nov 12, 19 Urinalysis and Other Body Fluids
Nov 26 LONG EXAM 2 (100 Points)
Dec 3 Clinical Chemistry Methodologies
Dec 10 Renal and Liver Function Tests
Dec 17 Cardiac Markers, Lipid Profile, Serum Electrolytes,
Tumor Markers; Thyroid Profile
Jan 7, 2019 LONG EXAM 3 (100 Points)
 REFERENCE BOOKS
• Henry’s Clinical Diagnosis and Management
by Laboratory Methods
• Urinalysis and Body Fluids by Susan King
Strasinger
• Modern Blood Banking and Transfusion
Medicine by Denise Harmening
• Hematology: Principles and Procedures by
Barbara Brown
LABORATORY DIAGNOSIS
 LABORATORY DIAGNOSIS
• CLINICAL PATHOLOGY
• A medical specialty concerned with the diagnosis of
disease based on the laboratory analyses of body
fluids such as blood and urine as well as tissues, using
the tools of hematology, clinical chemistry and
microscopy, microbiology, serology, blood banking
and molecular pathology
• a diagnosis made by a chemical, microscopic,
microbiologic, immunologic, or pathologic study of
secretions, discharges, blood, or tissue.
 BLOOD
SPECIMEN COLLECTION
GENERAL CONSIDERATIONS

“No Laboratory test can be better than its

manner of specimen collection”
– PATIENT IDENTIFICATION
– PATIENT PREPARATION
– SPECIMEN IDENTIFICATION
– COLLECTION TECHNIQUE
– SPECIMEN CONTAINER
– ADDITIVES
 Blood Specimen Collection

• PHLEBOTOMIST
– With good interpersonal skills
– Professional attitude
– Ensure Patient confidentiality
 MACROSAMPLE

Venipuncture
• Syringe Method
• Vacutainer Method
Arterial Puncture
– Radial
– Brachial
– Femoral
 MACROSAMPLE
Equipment Needed
• Tourniquet
• Antiseptic solution
• Syringe and needle
• Vacutainer set
• Butterfly Infusion Set
 Blood Collection
Macrosample Collection
Blood Collection
Open System
 Open System
Components needed
Blood
taken
transfer
into ...

Syringes of Containers of
different sizes different sizes
Open System
Blood Collection
Closed System
 Closed System
3 Basic Components :
Blood flows straight into tubes ...

BD Vacutainer® BD Vacutainer® BD Vacutainer®

Multi Sampling Standard Holder Evacuated Tubes
Needle
21G (Green), 22G (Black)
CLOSED SYSTEM
Blood Collection
Closed System
 ADVANTAGES OF VENIPUNCTURE
– allows repetition of tests/follow up
– avoids tissue juices
– can be mailed
– Fastest method from a large number of patients

DISADVANTAGES OF VENIPUNCTURE
 More complications may arise
 Hard to do on some patients
Blood Collection
Macrosample Collection
SITES OF COLLECTION
• NB up to 18 months
– Superior Longitudinal
sinus vein
– External jugular vein
– Temporal vein
 Blood Collection
Macrosample Collection

SITES OF COLLECTION
• Older than 18 months – 3 y/o
– Femoral vein
– Long Saphenous vein
– Ankle vein
– Popliteal vein
– External Jugular vein
– Temporal vein
 Blood Collection
Macrosample Collection

SITES OF COLLECTION
• Older than 3 y/o
– Veins on the antecubital fossa
– Wrist vein
– Veins of the dorsal hand
– Veins of the Foot
 Blood Collection
Macrosample Collection
 Blood Collection
Macrosample Collection
 Blood Collection
Macrosample Collection
Specimen Collection by Venipucture

• Patient Identification
• Note Isolation Restrictions
• Note Dietary Restrictions
• Reassure patient
• Position the patient
• Select venipuncture location
• Assemble Supplies
• Apply the tourniquet
• Cleanse the site
• Inspect needle
• Perform venipuncture
• Release tourniquet
• Withdraw needle & apply pressure
• Post Phlebotomy Procedures
– Proper disposal
– Label specimen
– Check patient
Complications of Venipucture
1. Immediate Local complication
– Hematoma
– Hemoconcentration
– Circulatory failure
– Syncope
– Failure of blood to enter the syringe
Complications of Venipucture
2. Late Local Complications
– Thrombosis
– Thrombophlebitis

3. Delayed General Complications

– HIV
– Hepatitis
 Situations in Phlebotomy
Situation Action

Fistula  Draw from opposite arm.

Indwelling lines and  Usually not drawn by lab.

catheters, heparin locks, Lab may draw below heparin lock if nothing is being

cannulas
infused.
 The first 5 mL of blood drawn should be discarded.
Order of Draw: Catheter lines
 Culture tube, EDTA-Hep-Citrate-Clot tubes

31
 Situations in Phlebotomy
Situation Action
Sclerosed veins  Select another site.
Scars, burns,
tattoos
Edema
Hematoma  Draw below.

32
 Situations in Phlebotomy

Situation Action

Mastectomy  Draw from opposite arm.

Patient refuses  Try to persuade.

 If unsuccessful, respect wishes and
notify nurse.

Unidentified patient  Ask nurse to properly identify patient

before drawing.

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Reasons for Specimen Rejection
• Hemolysis/Lipemia
• Clots in an anticoagulated specimen
• Nonfasting specimen when test requires fasting
• Wrong volume
• Improper transport conditions
• Discrepancies bet requisition & specimen label
• Unlabeled or mislabeled specimen
• Contaminated specimen/Leaking container
 Anticoagulants
• Anticoagulants inhibit clot formation.
• As soon as blood is removed from a vessel, activation
of coagulation begins.
• Although blood drawn directly into an evacuated
tube contacts the anticoagulant, it is necessary to
immediately and gently invert the tube
 Specimen Processing

 Serum or plasma should be separated from cells

within 2 hours of collection (unless collected in a gel
separator tube).

47
Tests Requiring a Fasting
Specimen
Fasting blood sugar
Glucose tolerance test
Triglycerides
Lipid panel
Gastrin
Insulin
 Specimens Requiring Special Handling

Requirement Tests Comments

Chilling Arterial blood gases, ACTH, Place in crushed ice or

ammonia, gastrin, glucagon, a mixture of ice and
lactic acid, parathyroid water
hormone (PTH), renin
 Specimens Requiring Special Handling

Requirement Tests Comments

Warming Cold agglutinins, Use 37°C heat block,

cryoglobulins heel warmer, or hold
on hand.

Protection from Bilirubin, carotene, Wrap in aluminum

light vitamin A, vitamin B12 foil.
 Specimens Requiring Special
Handling

Requirement Tests Comments

Chain of custody Any test used as evidence in Chain of custody form;

legal proceedings ; lock boxes may be
(blood alcohol, drug screens, required.
DNA analysis)