Plasma

Plasma The liquid portion of anticoagulated whole blood (contains coagulation proteins) 90% water, 10% solutes Supernatant Accounts for about 55% of draw P comes before S - plasma comes first...it is inside your body and outside if it is unclotted Serum The liquid portion of clotted blood samples (lacks most coagulation proteins) 90% water, 10% solutes S comes after P - it comes after...serum is after it is outside your body & clotted Diffuse To scatter or spread

Hematology, Chemistry (routine and special), and Serology Glass tubes are more stable or less stable than plastic? Glass tubes tend to be more stable over time and do not lose vacuum pressure. Shelf life of an evacuated tube is determined by: Stability of the additive and vacuum retention Should be at right pressure to ensure correct amount of draw Name 3 examples of anticoagulants: EDTA Sodium Citrate Heparin Name 3 examples of additives:

The size of a needle bore

Thrombin Sodium Fluoride Gel

Hematoma

Name the order of draw for evacuated tubes collections:

Collection of blood just under the skin

First- draw sterile specimen Second- draw for coagulation testing bc of tourniquet Third- serum (clot factor) Fourth- other anticoagulants 

Gauge

Hemolysis Break down of blood cells

The surgical puncture of a vein

1-yellow 2-light blue 3-gold or red/gray, red, or orange 4-light green or green/gray 5-lavender 6-white, white 7-gray

Puncture

Describe the YELLOW top tube:

A hole made by something pointed

#1 order of draw Most sterile specimin drawn first bc of possible carry over Blood cultures-SPS-aerobic and anaerobic Goes to Micro

Lancet Used for skin puncture Phlebotomy

Sterile Without any organisms Venipuncture The surgical puncture of a vein Venous Pertaining to a vein What departments use venous blood samples?

Describe the LIGHT BLUE top tube: #2 order of draw Anticoagulant: sodium citrate Coagulation testing (plasma) Ratio of blood to anticoagulant critical Precipitates calcium required for blood coagulation Best for preserving coagulation factors Unacceptable for calcium or sodium analysis

Describe the GOLD or RED/GRAY top tube: #3 order of draw BD vacutainer SST gel separator tube Serum separator  No anticoagulant May have clot activator Contains inert polymer barrier gel Separates serum from cells For serum tests (most chemistry tests) Describe the RED top tubes: #3 order of draw Serum tubes (plastic-clot tube, or glass-no clot activator) No anticoagulant May have clot activator Chemistry and serology testing Serum must be removed from the clot ASAP Dilution is not an issue Describe the ORANGE top tube: #3 order of draw BD vacutainer rapid serum tube (RST) Describe the LIGHT GREEN or GREEN/GRAY top tube: #4 order of draw BC vacutainer PST gel separator tube with heparin Anti thrombin Describe the GREEN top tube: #4 order of draw Heparin (anticoagulant) In form of Sodium Heparin or Lithium Heparin Increases activity of Anti thrombin III (inhibits blood coagulation) Needs to be shielded from the light Unacceptable for blood cell evaluation Many Chemistry tests require plasma Including pH, electrolytes, blood gases, ionized calcium tests Describe the LAVENDER/PURPLE top tube:

# 6 order of draw First white tube: BD vacutainer PPT separator tube Second white tube: K2 EDTA with gel Describe the GRAY top tube: #7 order of draw Fluoride (glucose) tube Contains glucose preservative sodium fluoride Stops the metabolism of glucose  Anticoagulant: potassium oxalate preserves alcohol glucose and blood alcohol testing Describe the DARK (ROYAL) BLUE top tube: Anticoagulant: none, EDTA, or Heparin Toxicology or trace metals Plasma or serum Used primarily for specialty testing What are the 5 potential adverse side effects of using the wrong amount or improper additive/anticoagulant? -interference with the assay -removal of constituents -effect on enzyme action -alteration of cellular constituents -incorrect amount of anticoagulant What are the big 3 unacceptable specimens? -hemolyzed specimens -icetric specimens -lipemic specimens What is a hemolyzed specimen? Red or reddish color Red blood cells have ruptured Possible traumatic venipuncture RBC lyced. Due to draw, storage, transport, etc. What should be inside cell is now outside cell. Unless pt is suspected of having inter vascular hemolysis. What is an icetric specimen?

#5 order of draw EDTA (Anticoagulant) Chelates calcium which is required for blood coagulation best for preserving blood cell integrity Blood bank and Hematology testing Unacctable for calcium, sodium, or potassium analysis

Artificially colored bright yellow to brownish Due to high levels of Bilirubin Jaundice, possible liver disease Rejected for photo metric/spectrometry tests bs these absorb/reflect light based in wavelength so if starting specimin will interfere with test, it's rejected. Hematology, red blood cell counts fine.

Describe the WHITE top tubes:

What is a lipemic specimen? Milky appearance Indicates a non-fasting specimen

Fat after meal from high lipid content Clogs equipment

calcium tests Change of morphology of RBC

Name two examples of CONTACT precautions:

What is the most sterile tube and should be drawn first?

Gowns Gloves (protects provider)

Yellow top You draw the most sterile specimine first so as to not contaminate it Tourniquet on so coagulate so we draw early

Name an example of AIRBORNE precautions: Respirators (finer aspiration type mask than with droplet precautions) To filter out aspirations (pathogens suspended in air) (also add on contact precautions) Airborn Name an example of DROPLET precautions: Masks (dust mask type) To filter out respirations Ie: Cough, sneeze (also add on contact precautions) Droplet SST Additive Serum Separator Tube Inert polymer barrier gel Separates from cells Does not affect lab results EDTA Anticoagulant Ethylenediaminetetraacetic Acid Chelates calcium which is required for blood coagulation (removes by capture/sequester) Best for preserving blood cell integrity Unacceptable for calcium, sodium, or potassium analysis Sodium Citrate Anticoagulant Precipitates calcium required for blood coagulation Best for preserving coagulation factors Unacceptable for calcium or sodium analysis Heparin Anticoagulant In form of Sodium Heparin or Lithium Heparin Enhances activity of Anti-thrombin III. ATIII inhibits blood coagulation. Unacceptable for blood cell evaluation Uses include: pH, electrolytes, blood gases, ionized

Which tubes use anticoagulants? EDTA: Lavender, white, dark (royal) blue Which tubes use additives? Thrombin: Important in coagulation Sodium fluoride: Gel: Gold or red/gray Which tube has an additive that preserves glucose? Gray top Sodium fluoride Antiglycolitic agent Inhibits glycolysis so glucose levels stay (Potassium Oxalate) What tubes can be used for coagulation testing? Light blue Gold or red/gray Red Orange Which tubes are unacceptable for blood cell evaluation? Heparin tubes Light green or gray/green Green Dark royal blue Which tubes are unacceptable for sodium or calcium tests? Light blue Lavender Which tubes are unacceptable for potassium tests? Lavender In which tubes does the serum need to be removed from the clot ASAP?

Red tubes (plastic and glass) Which tube tests for trace metals (minerals)? Dark royal blue Which tubes are best for preserving blood cell integrity?

How do you determine the infection control precautions needed? The size of the particle & how long it stays in the air Aspirations

EDTA tubes Lavender, white, and dark royal blue

Stay suspended in air Airborne precautions Respirators

Which tube needs to be shielded from light?

Respirations

Light green or green/gray Green top

Droplets Droplet precautions Masks

Which tube needs to be out on ice? Gray Infection control considerations Size of particle Length of time airborn Buffy coat (Buffy layer) Top portion of cellular/formed element fraction WBCs and Platelets Hematocrit does not include Buffy Coat (just RBCS component) What additive is a STAT serum test? Thrombin What are we interested in with the clot tube? Only interested in the serum, not cells Which additives removes calcium? EDTA and Sodium Citrate  But by different mechanisms EDTa chelates (captures) calcium SC precipitates calcium -we out calcium back in for test-

Infection control precautions protect The provider Red Blood Cells RBCs erythrocytes White Blood Cells WBCs Leukocytes Platelets Thrombocytes Liquid fraction Plasma or serum Water, minerals, nutrients, wastes, hormones, antibodies, proteins Formed element fraction Cellular fraction RBCs, WBCs, & platelets Supernatent

Can you send a red top tube to hematology?

Leftover liquid portion at top of specimin collection tube

No. It's coagulated. Can't count the cells. Hematology is for blood cell counting and sizing.

What is the liquid portion of circulating blood?

What are 3 major drawbacks to using a butterfly set? Because of the smaller gauge needle, -takes longer -elevates blood counts  -therefore altering composition ratios

Plasma If plasma still contains coagulation proteins it is Not coagulated/not clotted/anticoagulated What is the liquid portion of clotted blood samples?

Serum

What tube is best for Chem tests requiring plasma?

Anticoagulated

The green tube Bc it has the anticoagulant Heparin that keeps it whole blood but no need to preserve cells since serum is all that's needed

Blood is not clotted Anticoagulate Draws blood without clotting it Blood drawn with an anticoagulate is Anticoagulated And therefore plasma A clotted blood sample goes from being what to what? Plasma to serum Platelets are an active part of Coagulation They must be in motion. If motion ceases, platelets are activated. If you want an unclotted sample, you must introduce a Chemical anticoagulant Short draw Dilution ratio inaccurate How do you know how much blood to draw into an evacuated tube? There is a gas in the tube that determines the correct amount of blood drawn due to pressure Why do glucose levels in a specimen decline over time? Blood consumes glucose outside of the body What is the best tube for alcohol testing? Gray bc anticoagulant Potassium Oxalate preserves alcohol What is the best tube for glucose testing? Gray bc it contains sodium fluoride, a glucose preservative What tube goes for routine blood testing? Lavender/purple What tube is best for coagulation testing? Light blue

Are short draws rejected because of ratios on the red tops? No. Dilution is not an issue because there is no additive, no anticoagulation. There is just the specimen. Name 4 reasons for unacceptable specimens besides the big 3: Clots present in anticoagulated specimen Improper blood collection tube Short draws/wrong volume  Discrepancy between specimen and test Name the 2 needle parts that attach to vacutainer tube: Needle end with sheath Tube holder