Hemostasis Specimen Collection Flashcards by Queenie Mae

• Laboratory procedures are performed on _______________ by a ________.

venous whole blood collected
venipuncture

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• mixed 9:1 with a 3.2% solution of _____________.

sodium citrate anticoagulant

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• The specimen is maintained as well-mixed whole blood for platelet function testing or centrifuged to provide _______________

platelet poor plasma

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Clotting / Bleeding History

Blood group O – High risk vWD
Pregnancy ( Prothrombotic)
Liver / Kidney disease
leukemia / anemia

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Clotting / Bleeding Characteristic

Location
Frequency
Volume

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Drug History

Anticoagulant ( blood thinners)

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Antiplatelet (aspirin)

Contraceptives

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Dietary / Over the counter / Dietary Supplement

Garlic , Ginger

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discontinue non prescription drug at least a week blood collection

Vit K

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_________ such as _______ or _____________ and antiplatelet drugs such as ASA or clopidogrel are continued when the purpose is to assess their efficacy.

Anticoagulant
Coumadin
direct oral anticoagulants

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Patients need only fast under arranged circumstances but are advised to avoid caffeine
and exercise for 2 hours and smoking for 30
minutes before collection. Patients should be
inactive for 5 minutes before collection.

Fasting

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Adult with good veins, specimen less than or equal 25 mL

20 or 21 gauge, thin-walled, 1.0 or 1.25 inches long

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Adult with good veins, specimen greater than or equal 25 mL

19 gauge, 1.0 or 1.25 inches long

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Child or adult with small, friable, or hardened veins

23 gauge, winged-needle set:
apply minimal negative pressure

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Transfer of blood from syringe to tube

19 gauge, slowly inject through tube closure

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Syringe with winged-needle set

20, 21, or 23 gauge, thin walled:
use only for small, friable, or hardened veins or specializes coagulation testing

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Most hemostasis specimens are collected in
_________ (________, _________) sterile evacuated blood collection tubes containing a measured volume of ________________________ anticoagulant.

Hemostasis Specimen Collection Tubes
plastic blue-stopper
(blue-top, blue-closure)
0.105 to 0.109 M (3.2%) buffered sodium citrate

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◦ Sodium Citrate
◦ The anticoagulant used for hemostasis testing is buffered 3.2% (0.105 to 0.109 M) __________, _________.
◦ The anticoagulant solution is mixed with blood to produce a 9:1 ratio: __________________.
◦ In most cases, 0.3 mL of anticoagulant is mixed with 2.7 mL of whole blood,

Anticoagulant used for Hemostasis
sodium citrate, Na3C6H5O7
9 parts whole blood to 1 part anticoagulant

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The _______________ is effective, provided the patient’s hematocrit is 55% or below.

9:1 blood-to-anticoagulant ratio

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In __________ the decrease in plasma volume relative to whole blood unacceptably raises the anticoagulant-to-plasma ratio, which causes
falsely prolonged results for clot-based coagulation tests.

polycythemia

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The _________ must prepare specially marked tubes with relatively reduced anticoagulant volumes for collection of blood from a patient whose hematocrit is known to be ___________.

phlebotomist
55% or higher

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The amount of anticoagulant may be computed by using this formula:

C= (1.85 x10-3) (100-HCT) V

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• Remove the stopper from a 3-mL blue closure
collection tube, pipette and ______________ of anticoagulant, leaving 0.19 mL.

discard 0.11 mL from the 0.3 mL

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Collect blood in a syringe and ___________________, ___________, and _____________ at least three times.

transfer 2.81 (2.8) mL of blood to the tube
replace the stopper
immediately mix by gently inverting

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- Don’t preserve _________ - Inhibits ___________ - Only for _________ - not for ___________

- EDTA - labile clotting factors - thrombin-fibrinogen reaction - platelet count - coagulation studies

- Binds with ________ - Inhibits ______________ - For __________/___________

- Heparin - anti-thrombin III - all reactionsin coagulation - platelet retention test/glass bead retention test only

- Shortened clotting time because it forms insoluble ________/_________ - Affects _______________

- Oxalates - complexes/precipitates - photo-optical clot detection

Although _________ discourages the practice, specimens may of necessity be collected from ______ or ________, ports in __________, ____________, ______________, or ____________.

- CLSI Standard - heparin or saline locks - intravenous (IV) lines - peripherally inserted central catheters (PICC tubes) - central venous catheters - dialysis catheters

•Before blood is collected for 8 __________, the line must be flushed with _________, and the __________, or ____________________, must be _________ and __________.

- hemostasis testing - 5 mL of saline - first 5 mL of blood - six times the volume of the blood collection tube - collected and discarded

• The key to ______________________.

accurate capillary PT/INR measurement is a free- flowing puncture

Often it is necessary for the collector to __________________ to the fingertips.

warm the patient’s hand to increase blood flow

The collector ___________ (“_______”) ________, because this ______________

- avoids squeezing ("milking") the finger - raises the concentration of tissue fluid relative to plasma and blood

Short draw

Whole-blood volume less than 90% of required volume or less than manufacturer specified minumum

Clot in specimen

Each specimen musy be visually inspected prior to centrifugation; the presence of even a small clot requires that the specimen be recollected.

Visible hemolysis

Hemolysis, pink or red plasma indicates in vitro activation of platelets and coagulation. Results are unreliable.

Lipemia or icterus

Optical instruments may not measure clots in cloudy or highly colored specimens, specially chromogenic substrate methods. The practitioner must employ a mechanical instrument.

Prolonged tourniquet application

Stasis elevates the concentration of von Willebrand factor and factory Vlll; falsely decreases fibrinolyric parameters, and falsely shorten clot-based results

Specimen storage at 1°C to 6° C

Storage at refrigerator temperatures causes preciptation of large von Willebrand factor multimers, activation of coagulation factor Vll, and destroys platelet integrity

Specimen storage at more than 25° C

Storage at above standard room temperature causes coagulation factors V and Vll! to deteriote

___________________ whole blood specimens are placed in a rack and allowed to stand in a vertical position with the closure intact and uppermost.

Sodium citrate-anticoagulated

Maintaining the blood collection tube seal minimizes ________, which otherwise allows the pH to rise, falsely prolonging the __ and ____.

- CO2 diffusion - PT and PTT

Specimens are maintained at ambient temperature, __________, never at refrigerator temperatures or on ice.

15° C to 25°C

Storage at _______________, _____________, and __________________.

- 1° C to 6° C activates factor VII - activates platelets - precipitates large VWF multimers

Specimens are never stored or transported at temperatures ______________ because heat deteriorates coagulation factors ___ and ____.

- greater than 25° C - V and VIII

Specimens collected for PT testing may be held at _____________ and ____________ of the time of collection.

- 18° C to 24° C - tested within 24 hours

PT with no UFH

- 15° C-25° C - Test within 24 hr, maintain upright and sealed

PTT with no UFH

Test within 4 hr, maintain upright and sealed

PTT for monitoring UFH

Centrifuge to separate plasma within 1 hour, test within 4 hr

PT when UFH is present

Centrifuge to separate plasma within 1 hour, test within 4 hr

Factor assays

Test within 4 hr, maintain upright and sealed

Optical platelet aggregometry using PRP

Wait 30 min after centrifugation, test within 4 hr of collection

Whole-blood aggregometry

Test within 4 hours of collection, maintain upright and sealed

Storage in household freezer

- -20° C - 2 weeks

Storage for 6 months

- -70° C - 6 months or indefinite

• Whole-Blood Specimens Used for ___________ • Must be collected with ___________ and held at __________ • Aggregometry should be started immediately and must be completed within ______ of specimen collection • Most specimens for whole-blood aggregometry are mixed 1:1 with normal saline before testing, although if the platelet count is less than ___________ the specimen is tested undiluted.

- Preparation of Hemostasis Specimens for Assay - Platelet Aggregometry - 3.2% sodium citrate and 18°C to 24° C until testing - 4 hours - 100,000/mL

PPP

Platelet Poor Plasma

Plate count: ___________

<10x10⁹ platelets/L

Centrifuge: ____________

10-15 min, 2000-2500rpm

Test within _________

2 hours

Refrigerated temp: ___________

<4 hours

Freezing temp: ____________

-20 to 070° C

Used for ____________

coagulation studies

PRP

Platelet Rich Plasma

Platelet count: ___________ Centrifugation: ___________

- 250x109 platelets/L - 10-15min, 60- 100rpm

Used for ________

platelet studies

Stored at ____________

room temperature

- Inhibits cyclooxygenase - Platelet aggregation test: - no intake within 7 days - Bleeding time: - no intake within 24 hours

Aspirin

- Affects cyclooxygenase - Inhibits most clotting factors

Heparin

• Antagonist of prothrombin group and vitamin K dependent clotting factors • Prevents gamma carboxylation of ◦ Vitamin K on clotting

Warfarin / Coumadin

◦ Alters blood vessels • Induces hemolysis

Penicillin

- most potent penicillin capable of affecting platelet - function

Carbenicillin

- Prematurely actives clotting process (extrinsic pathway) - Must only be activated when reagent is added

Tissue thromboplastin contamination

Associated with collagen for in vitro activation of clotting process (instrinsic pathway)

Glass surfaces

- FV and FVlll: deteriorates if left at room temp for extended period of time - FVll and FXl: prematurely activates at ref temp (4C)

Temperature

- Released tissue thromboplastin like substance that will activate clotting system - Release ADP that causes platelet aggregation

Hemolysis

- Prolonged tourniquet application causes venous stasis - Activates clotting factors

Tourniquet application

- Associated with loss of carbon dioxide that deteriorates clotting factors - Sample must be unopened and tested within 6 hours

Increased pH

- Increases hematocrit by >50% - Prolongs clotting time test

Polycythemia vera

- Blood to AC ration: 9:1 using 3.2% sodium citrate; 0.109m - Citrate: anticoagulant of choice for coagulation studies - Incomplete filling of tubes can result to increased amount of citrate (prolonged)

Amount of anticoagulant

Hemostasis Specimen Collection Flashcards

(79 cards)