CC PART 7 (SPECIMEN) Flashcards by Toni Mae Inductivo

The following analytes are affected by hemolysis:

KLAMPAT

○ K+: Potassium
○ L: LDH
○ A: AST, ACP, Aldolase
○ M2+: Magnesium
○ PO4-: Phosphate
○ A: Albumin
○ T: Total Protein

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The primary intracellular anion

K+: Potassium

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2ND MOST ABUNDANT ICF (Intracellular Fluid Cation)

M2+: Magnesium

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■ MOST AFFECTED ENZYME in Hemolysis
■ Increased LD1 in RBC

L: LDH

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■ MOST ABUNDANT ICF (Intracellular Fluid Cation)

PO4-: Phosphate

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(3) Characteristics of Lipemia

○ Creamy
○ Turbid
○ Clear

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● Chylomicrons
● EXOGENOUS Tg
● APO B48, non-fasting

If the sample looks like a creamy or opaque layer

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● ≥ 400 mg/dL = sample will
appear turbid
● The highest lipid is triglycerides.
● The lipoprotein is VLDL.
● ENDOGENOUS, APO B100,
Fasting

If the sample looks turbid

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● This is considered a rare case
because commonly, triglycerides are higher than cholesterol in
hyperlipidemia.
● Cholesterol can be collected
even without fasting.
● Use tube EDTA plasma since it
is done without fasting

If increase cholesterol = clear only, no turbidity

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Ice for blood gases

IMPROPER TRANSPORT CONDITIONS

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ABG sample is not transported with ICE; it will:

● Decrease ___
● Increase ____
● Decrease ___

● Decrease pH
● Increase pCO2
● Decrease pO2

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● Short draws
● Wrong volume

IMPROPER BLOOD COLLECTION TUBE

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Which level of triglyceride is difficult/hard to measure?

A. 600 mg/dL
B. 400 mg/dL
C. 200 mg/dL
D. 100 mg/dL

A. 600 mg/dL: This is already considered “milky.”

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Remedy for Milky specimen:

Dilute sample

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In the Friedewald equation, how many hours of fasting are needed for a lipid profile?

A. 10 hours
B. 12 hours

B. 12 hours

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Reference range of Fasting for Lipid Profile is

10-12 hours.

● Explanation: In lipid metabolism, if you ate at 12PM
○ Food will be digested from the stomach down to the liver and to the small intestine in 1-3 hours. It takes 6–9 hours for a complete transport from the liver, then the
lipids’ level will return to its normal value.
○ However, ideally, 10–12 hours is the reference range of lipid profile.

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TRUE OR FALSE:

● You can measure cholesterol without fasting? In what sample?

TRUE, in EDTA plasma, not
serum.

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If bilirubin, hemoglobin, and lipids are high, what will you use?

Use Sample Blank

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If the sample is icteric, lipemic, or hemolyzed?

Use Sample Blank

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Which 3 analytes are the most seriously affected by hemolysis?

Potassium, LDH, and AST

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● Liquid portion of the blood (plasma) from arterial and
venous
● Purpose: For STAT and POCT

WHOLE BLOOD

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● Liquid of unclotted or anticoagulated blood (with
fibrinogen)

PLASMA

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● Best Sample of Choice for STAT:

Lithium Heparin

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● Best Sample of Choice for STAT: Lithium Heparin
● However, ______ is not used in enzyme assays because
it inhibits the enzymes.

PLASMA

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● Most blood chemistry is run on blank serum samples.

SERUM

● Liquid portion of clotted blood without fibrinogen

SERUM

Why serum over plasma?

○ Serum is clearer than plasma. ○ It has no anticoagulant, which is a source of interference.

Ideally, ___ glucose tests should be performed alongside ____ protein tests

CEREBROSPINAL FLUID (CSF) WHY? This test is used to differentiate between meningitis, tuberculosis, and other clinical microscopy-related diagnoses.

CSF glucose =

CSF protein

3 TUBES of CEREBROSPINAL FLUID (CSF)

1. Immunosero and Clinical Chemistry 2. Microbiology 3. Cell Count in Hematology

For GFR or creatinine clearance ○ If a person does not have kidney disease, you can compute the GFR, or creatinine clearance. ○ However, if the person is diabetic or has other conditions, creatinine clearance can no longer be used. ■ Instead, it is estimated GFR (eGFR).

24 HOUR URINE

________ and _______ are good markers of GFR without computing eGFR.

Cystatin C and creatinine

DIURNAL VARIATION CORTISOL ● Peaks at 4-6 AM ● Lowest 8 PM-12 AM ● 50% lower at 8 PM than 8 AM

● Peaks at _____ ● Lowest _____ ● 50% lower at 8 PM than_____

● Increases with stress

CORTISOL

CORTISOL ● Best time to collect:

6 am to 8 am (morning)

Cushing Disease

pituitary problem

is higher in the morning.

CORTISOL

Cushing Syndrome

adrenal problem

Cortisol ↑ ACTH ↑

Cushing Disease

● Lower at Night ● Higher value while standing than supine

PLASMA RENIN ACTIVITY

Cortisol ↑ ACTH - Not affected

Cushing Syndrome

● Lower at night ● Increases with stress

ACTH

● Lower at night

ALDOSTERONE AND INSULIN

● Higher in the afternoon and evening

GH AND ACP

● Increase with stress

THYROXINE

● Higher with stress ● Higher levels at 4 and 8 am and 8 - 10 pm

PROLACTIN

Drawn in successive days to avoid diurnal variation

Serum iron

● Peaks early to late morning, decreases up to 30% during the day

IRON

● 4% decrease when in supine position

CALCIUM

Increase ● ACTH ● Catecholamines ● Cortisol ● Albumin ● Insulin ● Prolactin ● Lactate Decrease ● HDL ● Respiratory alkalosis

STRESS

Increase ● Albumin ● Cholesterol ● Ca2+ when standing ● Aldosterone ● Bilirubin ● Cortisol ● Total Protein ● Triglycerides ● Rbcs ● Wbcs ● Thyroxine (T4) ● Plasma Renin ● Catecholamines Decrease ● Lipids due to hemodilution

POSTURE

concentration of these analytes increased within 10 minutes from supine to standing

Catecholamines

A marker for chronic alcoholism is

GGT

Increase ● Tg and GGT Decrease ● Glucose due to ethanol

ALCOHOL

Increase ● Glucose ● Insulin ● Gastrin ● Tg ● Na ● Uric Acid ● Iron ● Ld ● Ca2+ Decrease ● Chloride ● Phosphate ● K+

RECENT FOOD INTAKE

● Bilirubin ● CK ● Steroid Hormones ● Tg

DAY TO DAY VARIATION

● The patient can drink water during fasting, unless the order is NPO.

FASTING

FASTING: ↑ Plasma Tg; ↓ glucose

72 Hours

FASTING: ↑ Bilirubin

48 Hours

Increase ● Glucose ● Triglycerides ● Aspartate aminotransferase (AST) ● Bilirubin ● Blood Urea Nitrogen (BUN) ● Phosphorus ● Uric Acid ● Growth Hormone ● Cholesterol ● Lipoproteins ○ High-Density Lipoprotein (HDL) ○ Low-Density Lipoprotein (LDL)

NON-FASTING

Urea increases

High-protein diet

Ketones increase

High protein and low CHO

○ Urine 5-HIAA (5-hydroxyindoleacetic acid)

Serotonin-rich food

■ Banana ■ Tomato ■ Pineapple ■ Avocado ■ Chocolate ■ Coffee ■ Tea

Serotonin-rich food examples

● Increases sample turbidity ● 400 mg/dL or more TAG = turbid serum; lipemia

TRIGLYCERIDES > 400 mg/dL

Most common error in hemoglobin measurement

Hgb & Total Bilirubin

Tourniquet may be reapplied after 2 minutes to avoid hemoconcentration

PROLONGED TOURNIQUET > 1 MINUTE

● Cardiac muscles: ● CK-MB = 20% ● CK-MM = 80% ○ Increased

IM INJECTIONS

most cardiac-specific enzyme (first enzyme to increase during cardiac arrest)

CK-MB = 20%

JAUNDICE: The normal value of Hgb in plasma is

2-4 mg/dL

≥ 2 mg/dL

indicative of Jaundice

25 mg/dL

indicative of Icteric

If there is diurnal variation, there is a systematic error. Who has cushing’s syndrome? ● Patient 1; AM - 100; PM - 50 ● Patient 2; AM - 100; PM - 100

Patient 1 has loss of diurnal ACTH.

Which analyte is significantly affected by a change in posture from supine to a sitting or standing position? A. Protein B. Calcium C. Aldosterone D. Magnesium

Protein, increase 10% when standing.

Which serve as first responders to stress by acting within seconds? A. Cortisol B. DHEA C. Aldosterone. D. Catecholamine

Catecholamine, Epinephrine, and Norepinephrine; cortisol increases within minutes.

The level of cortisol in the morning __________. A. Higher B. Lower C. No effect. D. None of the choices

A. Higher

What is the best time to collect a sample?

Basal state (early morning)

How to determine if you have a high protein diet

If stool does not float, fiber is insufficient.

Nothing to eat or drink (except water) for at least 8 hours (except lipids).

Fasting

Place in a slurry of crushed ice and water. Do not use ice cubes alone because RBCs may lyse

Chilling

Use a 37-degree C heat block, heel warmer, or hold in hand. Cryoglobulins are proteins that precipitate at low temperatures.

Warming

Wrap in aluminum foil. Bilirubin is photosensitive.

Protection from direct light exposure

LD 4 and 5 are labile at low temperature = falsely decreased.

Freezing of sample

Fill out the chain of custody form.

Chain of custody

Centrifuged within 1 hour or up to 2 hours Minimize glycolysis

Delivery time

If you’re the phlebotomist, which of the following will you prioritize? a. FBS b. Cortisol c. CBC

a. FBS Rationale: FBS and cortisol are both timed, but the most correct answer is A. FBS. If FBS was not prioritized, the patient might become hyperglycemic or miss intake of their medicines or procedures.

Serial bilirubin determination are charted below with the bet explanation for the results due to: a. Sample hemolysis and hemoglobin deterioration b. Sample exposure to light c. Sample left in unwarm location d. Reagent deterioration

b. Sample exposure to light Notice the time difference bet the collection time and assayed time. The Shift of values from day one, lowered in day 2, then increased on day 3, signifies the error and the point of investigation, which should be on day 2

a photosensitive form, can cause brain damage (kernicterus) if it crosses the blood-brain barrier. Newborn babies often struggle to break down B1 into a soluble form in their liver.

B1 bilirubin Exposing babies to morning sunlight helps convert B1 into a soluble form, preventing it from entering the brain and causing harm

● Use the opposite arm or perform fingerstick if possible. ● Stop IV for 2-5 minutes

● Draw from opposite arm

Fistula

● Draw first 5 mL then discard. ● Draw blood below the IV line if nothing is being transfused.

Indwelling lines and catheters, heparin locks, cannulas

● Select other site

Sclerosed veins

● Draw below

Hematoma

● Hold pressure until bleeding has stopped

Streptokinase/Tissue plasminogen Activator (TPA)

● Select another site

Edema, Scars, Burns, Tattoos

● Draw from the opposite arm

Mastectomy

● Ask nurse to ID before drawing

Unidentified patient

Stop IV for

2-5 minutes

Exposing babies to morning sunlight helps convert B1 into a ___________, preventing it from entering the brain and causing harm.

soluble form

The intern drew blood from the patient's arm, resulting in a hematoma, even though the intern was considered the best phlebotomist in the lab. What went wrong when the intern drew blood from the patient?

○ The patient's folded his/her arm after the blood draw, combined with their antithrombotic therapy, led to a hematoma. ○ Always ask the patient if they are taking any medications such as warfarin, coumadin, etc.

CC PART 7 (SPECIMEN) Flashcards

(100 cards)