Principles of Medical Laboratory Science, Lecture notes of Medical Sciences

Download Principles of Medical Laboratory Science and more Lecture notes Medical Sciences in PDF only on Docsity! Bianca Adrianne C. Carilla | MLS 1-4 PMLS 2 Laboratory Familiarization to Phlebotomy & Order of Draw PHLEBOTOMY or venesection act of opening a vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician's request. ▪ phlebos which means vein, and ▪ temnein which means to cut. - Phlebotomy is the process of making an incision or puncture to collect blood samples Evolution of Phlebotomy ▪ Stone Age – used crude tools to cut vessels and drain blood from the body. ▪ Ancient Egyptians – a form of "Bloodletting" (1400 B.C.) ▪ Hippocrates (460 - 377 BC) – balance of the four humors, removing the excess by bloodletting. ▪ Middle ages – used to treat illness and performed by barber-surgeons ▪ Patients with Polycythemia Vera, heart problem with overproduction of RBCs, monthly phlebotomy for treatment ▪ 17th and 18th century – treated as major therapy Cupping ▪ alternative medicine ▪ application of special heated suction cups on the patient's skin ▪ used to ease pain ▪ incision using a fleam or lancet Leeching ▪ known as Hirudotherapy ▪ uses leeches for bloodletting ▪ used for microsurgical replantation Role of Phlebotomist (1) for diagnosis and treatment using blood samples Ex: Bacterial infection – antibiotic, to measure effectivity of antibiotic (2) for transfusion, to remove blood at the donor center (3) for removal of blood for polycythemia or therapeutic purposes Credentials ▪ important to maintain professionalism, recognition and certification from accredited body that is required by the healthcare institution ✔ Certification ✔ Licensure ✔ Continuing education Patient – Client Interaction (1) Reassuring and pleasant (2) Able to communicate well - despite social and cultural differences (3) Maintain positive customer relations - smooth process, proper identification, politeness, and proper orientation (4) Understand the diversity of the patients and be able to adjust accordingly Qualities of Professionalism (1) Professional appearance - wearing conservative clothing and proper personal hygiene, must be presentable (2) Self-confidence - the ability to trust ourselves in making a personal decision (3) Integrity - honesty and consistency as part of values and beliefs (4) Compassion - being sensitive to the needs of others (5) Self-motivation - having the positive attitude and initiative to follow through task and continuously look for areas of improvement (6) Dependability - taking personal responsibility for our actions (7) Ethical Behavior - conforming with the standards to avoid harming patients Communication in the healthcare setting o Verbal Communication • expressing ideas through words o Nonverbal Communication • facial expressions, kinesics or body motions, body language o Active listening • able to listen and comprehend what must be done from instructions Bianca Adrianne C. Carilla | MLS 1-4 Elements in healthcare communication ✔ Empathy ✔ Control ✔ Respect ✔ Confirmation ✔ Trust Verbal Communication Loop in Health care setting Health care worker ▪ maintain calmness Clinical analysis areas and the types of procedures Hospital • with permanent inpatient beds • 24-hour nursing service • Managed by organized medical team 2 major divisions 1) Anatomical and Surgical Pathology area 2) Clinical analysis area Clinical analysis areas 1. Hematology 2. Coagulation 3. Chemistry 4. Serology 5. Urinalysis – clinical microscopy 6. Microbiology – bacteriology 7. Blood bank/immunohematology HEMATOLOGY – blood and blood forming tissues NAME OF TEST AND PROCEDURES ▪ Complete Blood Count (CBC) 1. Hematocrit (Hct) checks the hemoglobin level and the red cell count. 2. Hemoglobin (Hgb) tests the value to rule out anemia. 3. Red Blood Cell (RbC) count is used to measure the erythropoietic activity. 4. White Blood Cell (WbC) count checks the leukocyte response 5. Platelet (Plt ct) count usually used to monitor chemotherapy and radiation conditions. 6. Differential White Count (Diff) monitors changes in the appearance or quantity of specific cell types 7. Indices shows the changes in RBC size, weight and Hgb content 8. Mean Corpuscular hemoglobin (MCH) gives the weight of the hemoglobin in the cell. 9. Mean Corpuscular volume (MCV) shows the size of the cell. 10. Mean Corpuscular hemoglobin concentration (MCHC) gives information on the concentration of the hemoglobin per unit volume of RBCs. 11. Red blood distribution width (RDW) measures the size differences of the RBCs COAGULATION – ability of blood to form and dissolve clots NAME OF TEST AND PROCEDURES 1. Activated partial thromboplastin time (APTT) reflects the adequacy of herapin therapy. 2. D-dimer checks the thrombin and plasmin activity – to diagnose Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE) 3. Fibrin split products (FSP) measures if the level is high because it results to FDP fragments. 4. Fibrogen tests are performed to check any fibrogen deficiency. 5. Prothrombin Time (PT) or International Normalized Ratio (INR) evaluates liver diseases or deficiency in Vitamin K CHEMISTRY – performs most lab test for plasma, white blood, urine, etc. NAME OF TEST AND PROCEDURES 1. Alanine amino tranferase (ALT) is used to monitor liver disease. 2. Alpha-fetoprotein (AFP) checks levels especially for prenatal screening 3. Alkaline phosphatase (ALP) determines level to check obstructions and bone disease. 4. Ammonia measures the level which could indicate cirrhosis and hepatitis. 5. Amylase checks the enzyme level which could indicate liver disease, cholesystitis, etc. 6. Aspartate amino-transferase (AST) measures the level which is indicative of liver dysfunction. 7. Bilirubin shows the level in the bloodstream that shows red blood destruction Bianca Adrianne C. Carilla | MLS 1-4 Order of draw and stopper color Example order: Blood culture, CBC, CRP, Na, K, Cl, Ionized Calcium - Bottles: Blood culture (yellow), CBC (EDTA – purple), CRP & NA, K, Cl (yellow/red), Ionized Calcium (green) - Order of Draw: from sterile to prevent contamination (yellow, light blue, red, so on) 1. Blood Culture 2. CRP & Na, K, Cl 3. Ionized Calcium 4. CBC Order of Draw Tube stopper color Blood Culture (sterile collections) Yellow SPS (Sodium polyanethole sulfonate) Coagulation tube Light Blue Glass non-additive tube Red Plastic clot activator tube Red Serum separator tube (PSTs) Red and grey rubber, Gold top Heparin tube Green and grey rubber, Light green top EDTA tube Lavender, pink or purple Plasma-preparation tube (PPTs) Pearl top Oxalate/fluoride tubes Gray 1. Yellow SPS ▪ Additive: Sodium Polyanethol Sulfonate (SPS) ▪ Department: Microbiology (Blood Culture) 2. Light Blue ▪ Additive: Sodium Citrate ▪ Department: Hematology (Coagulation - PT, PTT, APTT) 3. Red / Red Rubber ▪ Glass Nonadditive tube ▪ Department: Chemistry, Blood Bank and Serology 4. Red and Gray Rubber, Gold or yellow - Gold top is more common ▪ Additive: Serum Separator Tubes ▪ Department: Chemistry 5. Light Green (Plasma barrier tubes) ▪ Additive: Lithium heparin or Sodium heparin with Gel Separator ▪ Department: Chemistry 6. Lavender ▪ Additive: EDTA (Ethylene Diamine Tetra acitic Acid) ▪ Department: Hematology (CBC) 7. Gray ▪ Additive: Sodium fluoride (with potassium oxalate) ▪ Department: Chemistry (Blood glucose and alcohol) ORDER OF DRAW (Simplified) MNEMONICS A PHLEBOTOMISTS SHOULD… ❖ THE ORDER OF DRAW SHOULD…. ❖ Be Loving, Respectful, Gracious, Lighthearted, and Gentle. ▪ Blood Culture ▪ Light Blue ▪ Red ▪ Green ▪ Lavender ▪ Gray Blood Collection Equipment, Additives, and Order of Draw Equipment and Supplies Used in Venipuncture General Blood Collection Equipment and Supplies 1) Blood – Drawing Station 2) Phlebotomy Chair 3) Equipment carrier 4) Gloves and glove liners 5) Antiseptics 6) Disinfectants 7) Hand sanitizer& wall-mounted hand sanitizer dispenser Bianca Adrianne C. Carilla | MLS 1-4 8) Gauze Pads 9) Bandages 10) 1x3 inches glass microscope slides 11) Pen with non smear ink 12) Watch with timer 13) Needle and sharps disposal containers 14) Biohazard bags Venipuncture Equipment 1) Vein-Locating Devices 2) Tourniquet 3) Needles 4) Needle gauge 5) Evacuated Tube System (ETS) Antiseptics and Disinfectants used in Venipuncture Disinfectants Antiseptics • EPA - registered sodium hypochlorite • 1:100 dilution and 1:10 dilution for spills prior to clean- up procedures • contact time required is 10 minutes. • 70% ethyl alcohol, • 70% isopropyl alcohol, • Benzalkonium chloride, • Chlorhexidine gluconate, • Hydrogen peroxide, • Povidine-iodine and tincture iodine Phlebotomy Needles • Multi-sample Needles • Hypodermic • Winged Infusion Phlebotomy Needles Needle Gauge Uses 16 and 18 IV infusion of fluids or blood products or removal of blood during donor process 22, 21, and 20 Routine venipuncture 22 Small veins and for pediatric patients 23 Combination with a butterfly collection set 25 Intramuscular injection 27 Purified protein derivative (PPD) tuberculosis skin test Bianca Adrianne C. Carilla | MLS 1-4 Syringe System and Evacuated Tube System (ETS) Components Categories of Additives used in Blood Collection 1) Anticoagulants 2) Special – use anticoagulants 3) Anti – glycolytic agents 4) Clot activators 5) Thixotropic gel separator 6) Trace element – free tubes Actions of Additives Additives or Anticoagulants Actions 1. Potassium oxalate Precipitates Calcium 2. Sodium fluoride Inhibits glycolysis 3. Sodium citrate Binds Calcium 4. Sodium polyanethol sulfonate Binds Calcium and allows bacteria to grow for culture 5. Solutions A and B (ACD) Binds Calcium 6. EDTA Binds Calcium 7. Lithium heparin; sodium heparin; and ammonium heparin Inhibits prothrombin to thrombin 8. Silica/glass particles and Thrombin Accelerates clotting 9. Silicon Promotes faster centrifugation and a sample with fewer cells 10. No additive Natural formed clot