What are the labeling requirements for blood bank specimens?
Patient's full name (incl. middle initial)
Patient's hospital id number
Patient's d.o.b.
Date and time of collection
Phlebotomist's initials
Room number and bed number (optional)
What 4 key facts are needed for blood product validation?
Clinician's identity
Patient's identification scanned from the bar code on the patient's wristband
Product's unique bar-coded donor id on the blood unit
The blood product's bar code on the blood unit
What is blood compatibility?
Suitability to be mixed
What is agglutination?
Clumping blood
What is lysis?
Rupturing of the rbc's
Blood banks follow guidelines set by whom?
American Association of Blood Banks (AABB)
Who is the AABB regulated by and why?
FDA
Blood and blood byproducts are considered pharmaceuticals
What determines donor eligibility?
Between ages of 17 - 66
Weigh at least 110 lbs
Minors must have written permission from parents
Over the age of 66 my be allowed at the discretion of the blood bank physician
Donor must give written permission for the use of their blood
What is typically used in collecting units of blood for transfusion? (chemicals)
CPD
Citrate phosphate dextrose
What is a lookback program?
All components of the unit of donated blood must be traceable to the donor
What is Autologous donation?
A person donates blood for his or her own use.
72 hours between donation and surgery
What is bacteremia?
Bacteria in the blood
What is septicemia?
Microorganisms or their toxins in the blood
When is the best time to collect blood when bacteremia is suspected?
30 minutes to 2 1/2 hours prior to the fever peak
What does aerobic mean?
With air
What does anaerobic?
Without air
When a butterfly is used to collect blood which blood culture bottle is filled first?
The aerobic bottle because of the air in the line
When a syringe is used to collect blood which blood culture bottle is filled first?
The anaerobic bottle
What is skin antisepsis?
The destruction of microorganisms on the skin
What is antimicrobial therapy?
Antibiotics
What chemicals are in a blood culture bottle?
SPS
Sodium Polyanethol Sulfonate
What does FBS stand for?
Fasting Blood Sugar
What is postprandial (pp) mean?
After a meal
What is a glucose tolerance test (gtt) used for?
To diagnose problems of carbohydrate metabolism
What is increased blood glucose levels called?
Hyperglycemia (diabetes mellitus)
What is decreased blood glucose levels called?
Hypoglycemia
How is the GTT performed?
Give pt dose of glucose
Must finish it w/in 5 minutes
Collect first blood specimen 30 minutes later
Collect next specimens at 1 hour, then 2 and 3 hours
If the patient vomits during the GTT procedure what should you do?
Contact their physician to determine if the test should be continued
What is a lactose tolerance test for?
To determine if a patient lacks the enzyme (mucosal lactase) that is necessary to convert lactose into glucose and galactose
Does paternity testing require a chain of custody protocol?
Yes.
Needs a photo i.d. Mother, father and child are all tested.
What is therapeutic drug monitoring (TDM) used for?
Testing of drug levels at specific intervals to help establish a drug dosage, maintain the dosage at a therapeutic level and avoid drug toxicity
What are peak levels?
Screen for drug toxicity.
30 minutes after iv administration
60 minutes after intramuscular administration
1-2 hrs after oral intake
What are trough levels?
Monitored to ensure that levels of the drug stay within the the therapeutic range. Usually collected immediately prior to administration of the next scheduled dose.
What is polycythemia?
Overproduction of RBC's
What is hemochromatosis?
Excess iron deposits in the tissues
What is chain of custody?
When forensic specimens are collected, a special protocol must be strictly followed.
Normally who orders a blood alcohol (ethanol {ETOH}) test?
A doctor
What is a BAC?
Blood Alcohol Concentration
What is the most frequently used antiseptics for ETOH specimen collection?
Povidone-iodine and benzalkonium chloride (BZK)
What should you NOT use for a ETOH?
70% isopropyl alcohol or any antiseptic whose name ends in "ol" or has "tincture" in its name because they have alcohol in them and can compromise results
What tube do you use for ETOH?
Gray-top sodium fluoride tube
What are the urine drug screen patient preparation requirements defined by the National Institute on Drug Abuse (NIDA)?
Explain the test purpose and procedure
Advise the patient of his or her legal rights
Obtain a witnessed, signed consent form
What are the urine drug screen collection requirements defined by the National Institute on Drug Abuse (NIDA)?
A special area must be maintained for urine collection.
A proctor is required to be present at the time of collection to verify that the specimen came from the correct person.
A split sample may be required for confirmation or parallel testing.
Te specime
What does point-of-care testing (POCT) do?
Brings laboratory testing to the location of the patient
Everyone who performs POCT must meet whose requirements for testing?
CLIA
Everyone who performs POCT follow whose guidelines for specimen handling?
OSHA
The College of American Pathologists (CAP) requires that external liquid control be performed when?
Only as specified by the manufacturer's instruction
POCT Act test analyzes what?
Intrinsic coagulation factors and used to monitor heparin therapy
POCT PT/INR test analyzes what?
Monitor warfarin (coumadin) therapy. Extrinsic coagulation.
POCT PTT test analyzes what?
Used to screen for bleeding disorders prior to surgery, investigate bleeding or clotting disorders, detect clotting factor deficiencies and monitor low-dose heparin therapy.
POCT bleeding-time (BT) test?
Evaluates platelet plug formation
Where is the BT test performed on the patient?
on the volar (inner) lateral surface of the forearm
what pressure is the blood pressure cuff set at for a bt test?
40mm Hg
POCT arterial blood gasses - which blood gasses can be tested this way?
pH, partial pressure of carbon dioxide (Pco2), oxygen saturation (So2), and partial pressure of oxygen (Po2)
POCT electrolytes - what are the most common electorlytes tested this way?
sodium (Na), potassium (K), chloride (Cl), biocarbonate iron (HCO2), and ionized calcium (iCa2)
reduced sodium levels are called what?
hyponatremia
elevated sodium levels are called what?
hypernatrenia
what are decreased blood potassium levels called?
hypokalemia
what are increased blood potassium levels called?
hyperkalenia
POCT - what two protiens specific to the heart can be test this way?
cardiac troponin T (TnT)
troponin I (TnI)
this blood level of a cardiac protein begins to rise within 4 hours of myocardial damage and may stay elevated for up to 14 days?
Troponin (TnT)
this cardial protein blood level will rise within 3 - 6 hours and return to normal in 5 - 10 days?
TnI
POCT lipid testing - which lipid tests can be performed this way?
cholesterol, triglycerides, low-density lipoprotein (ldl), and high-densidy lipoprottein (hdl)
POCT B-Type natriuretic peptide (BNP) - what is this test for?
this is a cardiac hormone produced by the heart in response to ventricular volume expansion and pressure overload.
BNP is the firstobjective measurement for what?
congestive heart falure (CHF)
POCT C-reactive protein (CRP) - what does this test for?
CRP is used in the detection and evaluation of infection, tissue injury, and inflammatory disorders
what is the most common POCT procedure?
glucose testing
All of the analyzers approved for hospital use have what in common?
Sample types used may be venous, arterial, or capillary.
They allow data for the glucose meter to be downloaded to a data management program.
They require the use of a patient and/or authorized operator identification number.
They require QC.
POCT Tight glycemic control (TGC) - What is TGC used for?
Intensive insulin therapy
POCT glycosylated hemoglobin - What is this test used for?
Monitor diabetes therapy. Hgb levels reflect the average glucose level over 4-6 week period and can be used to evaluate long-term effective of diabetes therapy.
POCT hematocrit (Hct) or packed cell volume (PCV) - What is this test used for?
It is a measure of the volume of RBCs in a patient's blood. Screens for anemia or polycythemia
POCT hemoglobin - What is this test used for?
Managing patients with anemia
POCT lactate - What is this test used for?
Tests for hyperlactatemia (severe sepsis or septic shock)
POCT occult blood (guaiac) - What is this test used for?
Detection of occult (hidden) blood in stool (feces)
POCT pregnancy testing - What does this test detect?
Human chorionic gonadotropin (hCG)
POCT skin tests - What is this test used for?
To determine if an individual has come in contact with a specific antigen and developed antibodies against it
What is induration?
Hardness
What is erythema?
Redness
POCT strep testing - What is this test used for?
Detection of group A streptococci on throat swab specimens
POCT urinalysis - What does this test consist of?
Physical (look at it)
Chemical (dipstick)
Microscopic (spin and look at it microscopically)