Blood sample collection & anti-coagulation
Materials:
- Syringe.
- Lancets.
- 70% Ethanol.
- Cotton.
- Tourniquet.
- Adhesive dressing
Precautions:
- Wear disposable plastic or thin rubber gloves.
- Disposable syringes, needles and lancets should not be reused. They should be
placed (without separating needles from syringes) in a puncture resistant
container for disposal.
- Specimens should be sent to the laboratory in individual closed plastic bags,
separated from the request forms to prevent their contamination.
Procedures:
1. Venous blood:
- Blood is best withdrawn from anti-cubital vein by means of either an evacuated
tube or a disposable plastic syringe.
- The needles should not be too fine or too long; those of 19 or 21G are suitable for
adults and 23G for children.
- In obese patients, it may be easier to use a vein on the dorsum of the hand, after
warming it by immersion in warm water.
- The arm should be elevated after withdrawal of the needle and pressure should be
applied for several minutes before an adhesive dressing is placed over the puncture
site.
- Insure adequate labelling of sample tubes before collection; the identification
should include at least patient’s name (triple) and lab number.
- Mix the sample gently by repeated inversions (at least 4 times), don’t shake the
tubes vigorously.
1.1. Blood tubes used for venous blood samples:
- K3EDTA for blood counts, Retics count, sickilling and direct coomb’s tests (1.2
mg/ml blood ratio).
- Tri-sodium citrate for ESR (1 : 4 citrate/blood ratio).
- Lithium Heparin for osmotic fragility (20 iu/ml blood ratio).
- Tri-sodium citrate for coagulation tests (1:9 citrate/blood ratio).
- Plain tubes (without anti-coagulant) for blood grouping & cross matching.
Sources of error:
Prolonged usage of tourniquet will result in hemoconcentration, and alteration
of laboratory results.
Improper blood withdrawal speed (two rapid withdrawal may associate with
hemolysis while two slow withdrawal may associate with Plate lets aggregation
and partial clotting).
Improper selection of the anti-coagulant as:
EDTA is absolutely unsuitable for coagulation tests as it permanently
removes calcium ions and so interfere with clotting process.
Heparin is unsuitable for blood counts and film as it cause clumping of
WBCs (false low TWBCs), and blue background of stained blood film.
Improper blood : anti-coagulant ratio as:
Excess EDTA may cause cells shrinkage, decrease in PCV and increase
in MCHC.
Excess Tri-sodium citrate may associate with false prolongation of
coagulation tests, false high ESR.
Insufficient anti-coagulant (of any type) in relation to blood volume may
associate with partial clotting of the sample.
Insufficient of blood sample with the anti-coagulant immediately after
collection, this also may result in total or partial clotting of the sample.
The use of improperly stored or expired blood collection tubes, as they may loss
their anti-coagulant capacity.
2. Capillary (peripheral) blood:
- Skin puncture is carried out with a needle or lancet.
- In infants, satisfactory samples can be obtained by a deep puncture of the
plantar surface of the heel after warming.
- Clean the area with 70% alcohol and allow drying. Puncture the skin to a depth
of 2-3mm with sterile disposable lancet.
- Wipe away the first drop of blood with sterile gauze. If necessary squeeze very
gently to encourage a free flow of blood.
Sources of error:
In adequate preparation of the site of collection i.e. insufficient pre-warming,
this may associate with poor flow of blood at the site of incision.
Quality of incision (superficial incision may yield insufficient blood, while too
deep incision causes more pain and excess blood flow).
Excessive squeezing after incision (to force the blood for coming out), this
result in blood dilution with interstitial fluid and variations in blood tests
results.
Delay in handling of blood sample may associate with partial or total clotting of
the sample (for that the procedure should started immediately at or near the site
of blood collection).