SPECIAL COLLECTIONS

Overview • Product’s barcode on unit

- Some laboratory tests require specific - BBID can remain on a pa5ent for at least
and unique collec3on procedures 3 days
- Collec5ng specimens may require Type, Screen, and Crossmatch
special prepara5on, equipment, - Determine the safety of the blood that
handling, and 5ming will be transfused
- Blood types of donor and recipient
Blood Bank Specimens must match
Blood Bank Blood Type
- Division of the lab where blood • Determine pa5ent’s blood type
products are stored and processed for (ABO) and Rh factor (+ or -)
transfusion • An5body Serum Reagent: An5-
- Yield informa5on that determines A (Blue), An5-B (Yellow), An5-D
which blood products can be (White)
transfused safely into a pa5ent
- Requirement
• EDTA (lavender or pink)
• Red top
Iden3fica3on and Labelling Requirements
- Strict pa3ent ID and specimen labelling
- Recollec5on if there are errors
- Undetected errors can result into
administra5on of incompa5ble blood
product and possible fatal transfusion
reac5on
ü Pa5ent’s full name (including
middle ini5al)
ü Pa5ent’s hospital iden5fica5on
number (or social security
number for outpa5ents)
ü Pa5ent’s date of birth
ü Date and 5me of collec5on Crossmatch
ü Phlebotomist’s ini5als • Performed using pa5ent’s type
ü Room number and bed number and screen results to find a
(op5onal) donor
- Special iden5fica5on systems • Body s5ll has minor an3gens,
Blood bank ID bands (BBIDs) needed to be crossmatched
• ID bracelet with self-carbon • Pa3ent’s plasma/serum is mics
adhesive label for specimen with donor’s red blood cells
• Blood ID-band with linear • Agglu3na3on and lysis means
barcoded BBID numbers (LIS) incompa5ble
• Siemens Pa5ent Iden5fica5on Screening
Check-Blood Administra5on • Donors are screened for
- Nurse ini5ates blood product valida5on Transfusion Transmissible
by gathering the following: Infec5ons (TTI)
• Healthcare provider’s iden5ty • HIV, Hepa55s B & C, Syphilis,
from ID card and Malaria
• Pa5ent’s iden5fica5on from
wristband Blood Donor Collec3on
• Products unique barcoded - Involves screening and collec3ng blood
donor iden5fier on unit for transfusion purposes, not diagnos5c
 - Collected blood is referred to as a unit
(450 mL) Used to correct
- Requires special training (skin to vein deficiency in
puncture) coagula5on factors
- Blood donor centers – facili5es that or to treat shock
provide blood products due to plasma loss
• Regulated by American from burns or
Associa5on of Blood Banks and massive bleeding
FDA (blood products are
considered pharmaceu5cals) 1 year in freezer
Donor Eligibility Concentrate of Remaining platelet
- 18–60 years old Platelets from centrifuged
- If individual is regular donor (2–4 plasma
dona5ons), he/she can be over 60 years
- 16 years with wri_en parental Can be used for
permission dengue pa5ents.
- Over 66 years at blood center Used to treat or
physician’s discre5on prevent bleeding
- 76 years need wri_en approval from due to low platelet
their physician levels. To correct
- At least 110 lbs (s5ll compared to func5onal platelet
height) problems.
- Physical exam and medical history
required (cannot donate if you have 5 days at room
undergone needle puncture) temp (with platelet
- Wri_en permission from donor agitator to avoid
required clumping)
- Hemoglobin must not be below 12.5 Cryoprecipitate Acquired from
g/dL centrifuged fresh
- Hematocrit must not be less than 38% frozen plasma
Poten3al of Human Blood
- Whole blood is collected from dona5on To treat fibrinogen
Component Composi3on deficiencies
Red Blood Cells RBC’s remain aaer
centrifuga5on of 1 year in freezer
whole blood Principles of Donor Unit Collec3on
- Collected from large antecubital vein
Used to increase - 16–18 gauge needle
the amount of red - Bag fills by gravity, must be below arm
blood cells aaer - Bag contains an5coagulant and
trauma or surgery preserva5ve
or to treat severe • Citrate-phosphate-dextrose
anemia ü Citrate – prevents clofng
ü Phosphate – stabilizes pH
42 days in ü Dextrose – provides energy
refrigerator or 10 to cells
years in freezer Autologous Dona3on
Fresh Frozen Plasma acquired - A person donates blood for his or her
Plasma aaer own use
centrifuga5on of - Done preopera5vely, 3 days to several
plasma with weeks prior to surgery
concentrated - Hemoglobin is at least 11 g/dL and
platelets hematocrit is equal or greater than 33%
 - Sterile – free from all living
Cell Salvaging microorganisms
- During opera5on, blood is passed - 30–60 secs fric5on rub to get bacteria
through a system where blood is beneath dead skin cells (3–4 inches
washed and reinfused into the body diameter)
- Washed with saline - Acceptable an5sep5cs:
- Must be tested for residual-free ü Tincture of iodine
hemoglobin ü Chlorhexidine gluconate
- High free hemoglobin indicates red cells ü Povidone/70% ethyl alcohol
were destroyed or lysed, which can - 3 5mes disinfec5on (alcohol – betadine
cause renal dysfunc3on – alcohol) to wash out iodine
Media Inocula3on Methods
Blood Culture 1. Direct Inocula3on
- Microorganisms may enter the • Collect directly into blood
circulatory system from extravascular culture medium
sites like lymph vessels • Use bu_erfly and specially
- Blood cultures determine the presence designed holder
and extent of infec3on in the blood: • Fill aerobic first because
• Bacteremia – bacteria in the bu_erfly tube has air
blood • Avoid backflow, put bo_le
• Sep3cemia – microorganisms or lower than the site (standing
toxins in the blood posi5on)
- Iden5fies type of organism responsible • Mix bo_le aaer
and an3bio3c to which it is suscep5ble 2. Syringe Inocula3on
- Asses effec3veness of an5bio5c • Use safety transfer device
therapy (zone of inhibi5on) • Inoculate anaerobic bo_le
- Ordered based on whether the pa5ent first
has a condi5on in which blood stream • Allow blood to be drawn by
invasion is possible the vacuum, do not push the
- Sepsis – response of the body to blood plunger (can hemolyze and
infec5ons that triggers inflammatory produce aerosol); you may
responses, leading to 5ssue damage, stop the plunger to ensure
organ failure, and death. Can lead to proper amount
sep3c shock and low blood pressure • Disinfect the bo_le cap when
Specimen Requirements you uncap it
- 2–4 blood cultures (contains nutrient 3. Intermediate Collec3on Tube
broth) • Yellow-top sodium
- Paired aerobic and anaerobic blood polyanethol sulfonate (SPS)
culture bo_les • Reduces ac5on of protein
- Drawn 30–60 mins apart (unless pa5ent called complement that
is cri5cal, just use different sites) destroys bacteria
Skin An3sepsis
• Slows down inges3on of
- Most important in collec5ng blood
bacteria by leukocytes
cultures
• SPS in tube increases final
- Destruc5on of microorganisms on the
concentra3on of SPS
skin
• Transfer of blood presents
- Laboratory must report all
opportunity for
microorganisms detected for the
contamina3on
physician to determine whether they
• Exposure risk to laboratory
are significant or not
staff
An3sep3c or Sterile Technique
- Minimize the risk of contamina5on of • Citrate, heparin, EDTA, and
the blood culture collec5on oxalate are toxic to bacteria
An3microbial Neutraliza3on Products • A fas3ng glucose specimen may be
- When pa5ents are on an3bio3cs, collected before the start of the test.
which can inhibit growth of • The pa5ent is instructed to eat a
microorganism high-carbohydrate breakfast (75 to
- Removes or neutralizes 100 g of glucose) or given a measured
an5microbials/an5bio5cs dose of glucose beverage
- Prevent inhibi5on of growth of • Aaer the meal, nothing else should
microorganisms be consumed before the test. The
- Fas5dious an5microbial neutraliza5on pa5ent should rest during the 2-hour
(FAN) – contains ac3vated charcoal wai5ng period; no exercise.
which neutralizes an5bio5cs • A blood glucose specimen is collected
- An5microbial removal device (ARD) – 2 hours ager the pa5ent finishes
contains resin to remove an5microbials ea5ng.
from blood
Glucose Tolerance Test
Coagula3on Specimens - Diagnose problems of carbohydrate
- Light blue-top sodium citrate metabolism
• 9:1 ra5o blood to an5coagulant - Evaluate body’s ability to metabolize
• Too li_le blood is diluted; too glucose
much is concentrated - Major disorders involving glucose
- An3-factor Xa are in light blue top CTAD metabolism:
(citrate, theophylline, adenosine, and • Hyperglycemia – increased
dipyridamole) glucose levels, as in diabetes
- CTAD inhibits thrombocyte forma5on mellitus
- Clear or discard tube is required • Hypoglycemia – decreased
(bu_erfly) glucose levels
- Discard first 5 mL if drawing from VADs - Evaluates insulin response
- On ice, especially for coagula5on - 1 hour–3 hours
factors Prepara3on
- PT and aPTT don’t need ice • Eat balanced meals containing
- Factors V and VIII must be centrifuged approximately 150 g of carbohydrate
and plasma frozen if cannot be tested for three days before the test.
within a few hours • Fast for at least 12 hours but not
- Never pour two par5ally filled tube more than 16 hours prior to the test.
together • Be allowed to drink water during the
fast and during the test to avoid
Two-Hour Postprandial Glucose dehydration and because urine
- Postprandial – aaer a meal specimens may be collected as part
- Screening test for diabetes and of the procedure; no other foods or
gesta3onal diabetes, and other beverages are allowed.
metabolic problems • Be discouraged from engaging in
- Monitor insulin therapy excessive exercise for 12 hours
- Correct 5ming is crucial before the test.
Principles of 2-Hour Postprandial Specimen • Not to smoke or chew gum for at
Collec3on least eight hours before or during the
• Pa5ent is placed on a high test, as these activities stimulate the
carbohydrate diet for 2–3 days prior digestive process and may cause
the test erroneous test results.
• The pa5ent fasts for at least 10 to 12 • Receive both verbal and written
hours before the test. No ea5ng, instructions to ensure compliance.
smoking, or drinking other than Procedure
water • Draw fas3ng specimen
 • Give the pa5ent glucose beverage, • Blood samples for glucose tes5ng are
normally 75 g (may depend on drawn at the same 5me used in the
physician’s request) for adults and 50 previous GTT test.
to 75 grams for gesta5onal diabetes; Results
children and small adults are given 1 •If the pa5ent has mucosal lactase,
g of glucose per kilo of weight (drank the resul5ng glucose curve will be
within 5 minutes) similar to the GTT curve. (result is
• Note the 5me pa5ent finishes nega3ve)
drinking • If the pa5ent lacks the enzyme (is
• Collect every 30 minutes, 1 hour, 2 lactose intolerant), glucose levels will
hours, and 3 hours rise only slightly from the fas5ng
CAUTION: If a pa5ent vomits in the first hour level, resul5ng in a “flat” curve.
of a GTT, the test is typically stopped, (result is posi3ve)
rescheduled, and the pa5ent’s healthcare • False-posi3ve results have been
provider no5fied. If vomi5ng occurs aaer demonstrated in pa5ents with small
that, the healthcare provider must be bowel resec5ons and disorders such
consulted to determine if the test should be as slow gastric emptying, Crohn
con5nued. disease, and cys5c fibrosis.
Results Hydrogen Breath Test
- In normal pa5ents, blood glucose peaks - Noninvasive lactose tolerance test
within 30 mins to 1 hr aaer glucose - Pa5ent drinks special beverage with
inges5on, and goes down to fas5ng measured lactose and if not properly
levels within 2 hours digested will ferment in the colon and
- Diabe5c pa5ents peak at higher levels release larger than normal levels of
and are slower to return to fas5ng hydrogen
levels
Paternity Tes3ng
- Uses DNA profiling (gene5c
fingerprin5ng)
- Determine the probability that two
specific individuals have a gene3c
parent-child rela3onship
- Determine parentage of alleged mother
(maternity test) or father (paternity
test)
Lactose Tolerance Test - Results are reported as percentage,
- Determine if pa5ent lacks mucosal with highest being 99.9% probability
lactase for conver5ng lactose into - Paternity tests exclude the possibility
glucose and galactose of parentage rather than prove it
- A person who lacks the enzyme is - Requested by physicians, lawyers, child
lactose intolerant and suffers from support enforcement bureaus, or
gastrointes5nal distress and diarrhea individuals
upon inges5on of milk and lactose- - Follows chain-of-custody protocol and
containing foods specific ID procedures (may include
Principles of Lactose Tolerance Tes3ng fingerprin5ng and photo iden5fica5on,
• It is suggested that a 2-hour GTT be usually passport)
performed the day before the lactose - Mother, child, and poten3al father are
tolerance test. tested
• A 2-hour lactose tolerance test is - Blood samples are preferred; but
performed in the same manner as buccal swabs can be used
the GTT; however, an equal amount - Blood typing and Rh typing are
of lactose is subs5tuted for the performed (O is recessive)
glucose.
 Therapeu3c Drug Monitoring
- Tes5ng of drug levels in the blood
stream at specific intervals
- Used to:
• Test drugs with narrow therapeu3c
ranges (small level between toxic
level and therapeu5c level)
• Establish drug dosage
• Adjust drug dosage
• Iden5fy noncompliant pa5ents
• Maintain dosage at therapeu5c
level
• Avoid drug toxicity
• Collect blood at peak and trough
levels
- Peak (maximum) level must not exceed
toxic level
• 30 mins aaer IV
• 60 mins aaer IM
• 1–2 hrs aaer oral intake Therapeu3c Phlebotomy
- Through (minimum) level must remain - Withdrawal of large volumes of blood
within the therapeu5c range (500 mL)
• Prior to administra5on of next - Used as a treatment for certain medical
dose condi5ons such as polycythemia and
- Avoid tubes with gel separators (may hemochromatosis
affect results), just red top Polycythemia
- Collec5on 5ming for aminoglycoside - Overproduc3on of RBCs
drugs such as amikacin, gentamicin, - Detrimental to health
and tobramycin, which have short half- - Most common reason for performing
lives therapeu5c phlebotomy
• Half-life - the 5me required for - RBC levels are monitored by hematocrit
the body to metabolize half the test
amount of the drug. - Periodic removal of blood once
- Timing is less crucial for phenobarbital hematocrit exceeds a certain level
and digoxin Hemochromatosis
- Excess iron deposits in the 5ssues,
especially those of the heart, liver, and
pancreas
- Primary or hereditary
hemochromatosis – caused by gene5c
defect in iron metabolism that causes
body to absorb too much iron from
food
- Secondary hemochromatosis –
nonhereditary iron overload, caused by
other problems like mul5ple blood
transfusions, hemoly5c disorders, iron
supplements, or excess iron intake from
food
- Periodic removal of single units (450 to
500 cc) depletes iron stores, because
the body then uses the stored iron to
make new RBCs
 - Chela3ng drugs that bind with iron to - Check the temperature of urine
facilitate its removal from the body are - Use gray-top glass tubes (sodium
also available for those unable to fluoride)
tolerate blood draws.

Toxicology Specimens
Toxicology – scien5fic study of toxins
Clinical Toxicology
- Concerned with detec3on of toxins and
treatment for the effects
Forensic Toxicology
- Forensic – involving the use of scien5fic
methods in crime inves3ga3on
- Concerned with legal consequences of
toxin exposure: inten5onal and
accidental
- Blood, hair, urine, and other
substances
- Oaen requested by law enforcement
officials
- Alcohol: breath or blood (do not use
alcohol disinfectant; only benzalkonium
chloride or chlorhexidine or povidone-
iodine or soap and water)
- Drug: urine or blood
• Health care organiza5ons
Trace Elements
• Sports associa5ons
- Aluminum, arsenic, cadmium,
• Major companies
chromium, copper, iron, lead, mercury,
• May be random, pre-
selenium, and zinc
employment, or post-accident
- Measured in such small amounts
• May detect up to 30 drugs - Traces in glass, plas5c, or stopper
• Typically on urine material may leach into the specimen
- Blood for DNA analysis - Special trace element-free tubes must
- Follow chain-of-custody protocol that be used (royal blue: contains EDTA or
requires detailed documenta5on, heparin or no addi5ve)
tracking specimen from 5me of - Tan-top tubes containing K2EDTA for
collec5on un5l results are reported lead analysis
- Specimen must be accounted for at all - Micrograms or nanograms
5mes - Best to draw the test by itself or use a
- Presence of witness upon collec5on syringe (change the transfer device
Pa3ent Prepara3on before filling the tube)
- Explain test purpose and procedure
- Advise pa5ent of his or her legal rights
- Obtain a witnessed, signed consent
form
Specimen Collec3on Requirement
- Special area for urine collec5on (no
source of water)
- Proctor present at 5me of collec5on
- Split sample may be required
(confirma5on purposes)
- Specimen must be labeled, sealed, and
placed in a locked container