CLSI (clinical and laboratory standards instiute)
what is an international, nonprofit organization that publishes standards and guidelines representing a consensus of expert opinion on good laboratory practice and publishes standards on collection of blood by venipuncture, capillary and arterial puncture
OSHA (occupational safety and health administration)
what mandates safety policies and procedures for the protection of health care workers from occupational exposure to blood borne pathogens
FDA (food and drug administration)
what regulates devices such as blood collection devices and sharps containers.
EPA (Environmental protection agency)
what regulates certain aspects of medical waste such as the emissions from incineration of medical waste, and medical waste treatment technologies involving chemicals.
NJ DEP (department of environmental protection)
what regulates the disposal of medical waste (needles, lancets, gloves, blood, blood-stained materials, cultures, etc)
arteries, veins, capillaries
what are the three ways that blood may be collected from
arterial
clinical laboratory techs and scientists do not collect what type of samples
prothrombin
when blood is clotting the inactive plasma coagulation factor is what that is converted into thrombin
fibrin clot
thrombin functions in convertinf fibrinogen into what
EDTA, sodium citrate, potassium oxalate, acid citrate dextrose (ACD), sodium polyanethol sulfonate (SPS)
what anticoagulants function by binding to chelating/calcium (5 things)
sodium polyanethol sulfonate (SPS)
what anticoagulant is used for collection of blood cultures since it also inhibits complement, phagocytosis and decreases activity of certain antibiotics
acid citrate dextrose (ACD)
what anticoagulant is used in donor blood collection. Dextrose serves as a nutrient for stored red blood cells
heparin
what anticoagulant binds to antithrombin and enhances its ability to inhibit thrombin . Coagulation factors Xa, IXa, XIa and XIIa are also inhibited. The inhibition of these factors, particularly thrombin, prevents the formation of the fibrin clot.
plasma
when blood is collected with an anticoagulant what is (top layer) contains all coagulation factors
buffy coat
when blood is collected with an anticoagulant what is the (middle layer) consisting of white blood cells
RBC
when blood is collected with an anticoagulant what is (lower layer)
serum
when blood is collected without an anticoagulant and allowed to clot what is the top layer that LACKS fibrinogen (Factor I) and coagulation factors II, V, VIII, and XIII
Red cell clot
when blood is collected without an anticoagulant and allowed to clot what is the lower layer that HAS fibrinogen and factors II, V, VIII, and XIII are bound in the clot
arms
Phlebotomy chairs must have WHAT to prevent the patient from falling out of the chair if they loose consciousness.
yes
should you have a different lab coat from the one you use in the laboratory and the one that you use when collecting samples from patients
alcohol (70%) or chlorhexidine (or providone iodine)
what must the arm that is going to be punctured be cleaned with prior to puncture
single-sample
what type of needle is used to draw only one evacuated tube
multi-sample
what type of needle is used when drawing more than one evacuated tube, these have a rubber sleeve at the back end of the needle (the end of the needle that inserts into the collection tube). the rubber sleeve prevents blood from escaping out the back end
bevel
what is the stained end of the needle
shaft
what is the long part of the needle
gauge
what indicates the diameter of the bore (lumen) of the needle and is inversely proportional to the size of the bore of the needle, The higher the number, the smaller the bore of the needle, the range is from 19 to 23, however, 22 to 23 are often used in p
shorter
what end of the needle with the rubber sleeve is located inside the holder
SESIP (sharps with engineered sharps injury protection) or NSD (needle safety devices)
what are used to decrease the possibility of an accidental needle stick to the health care professional or patient. It involves a modification of the holder/adapter or needle that covers the needle after venipuncture. After the needle is withdrawn from th
winged collection or butterfly needle (called this bc of the tabs to hold it look like a butterfly)
what consists of:
-A needle with plastic tabs for holding during insertion into the vein
-Tubing attached to the needle
-A multiple-sample needle at the end of the tubing that attaches to the plastic adapter for filling of evacuated tubes.
buttergly needle
what is used occasionally when a holder/adapter assembly may prevent easy access to a vein and should only be used for difficult draws or for special equipment adapted for it, such as blood culture bottles.
syringe
what consistes of a plastic barrel, plunger, and needle
syringe
what is rarely used and is only for venipunture on patients with "fragile" veins
same needle
After blood is drawn into a syringe, it must be transferred into appropriate evacuated tubes. However, WHAT cannot be used for venipuncture and piercing the stoppers of evacuated tubes due to the risk of accidental needlestick injury.
plunger of a syringe
what should never be pushed to fill an evacuated tube since it may affect the ratio of blood to anticoagulant or may cause overfilling, pushing the stopper out of the tube and causing the blood to splatter.
syringes
what are the following disadvantages to:
-Draws blood at a slower rate of speed
-Does not have the capacity of withdrawing a large volume of blood needed to fill multiple tubes
-Blood must be transferred to the evacuated test tubes
-Transfer process may d
tubes
what are composed of glass or plastic; plastic are generally preferred since glass can break and contaminate health care personnel.
-they are sterile and disposable; they can be siliconized or non-siliconized
-Volumes available: 2, 3, 5, 7, 10, 15 mL
-may
anticoagulants
what are the following examples of that can be contained in tubes:
-Sodium citrate: available as 3.2% (0.105 M) or 3.8% (0.129 M) sodium citrate
-EDTA: available as K 2 EDTA, K 3 EDTA, or Na2 EDTA
-Heparin: available as lithium heparin or sodium heparin
clot activators
what are the following examples of that can be contained in tubes:
-initiates clotting using particles such as glass or silica gel
separator gels
what are the following examples of that can be contained in tubes:
-used to create a physical barrier btwn the serum and the cells
-After collection, tube is inverted 5 times, blood allowed to clot for 30 minutes, then centrifuged
-During centrifugation,
sodium fluoride
what are the following examples of that can be contained in tubes:
-Used to preserve glucose in a blood sample
-When whole blood is left in a tube, the blood cells will utilize the glucose for their metabolism via the glycolysis pathway. this inhibits the
thrombin
what are the following examples of that can be contained in tubes:
-Initiates clotting by conversion of fibrinogen to the fibrin clot
-Promotes rapid clotting of the specimen (usually within 5 minutes)
-Used when blood needs to be analyzed quickly after c
red
what color would this stopper be:
-no additive (glass tube)
-serum
-used in blood bank, chemistry, serology
red
what color would this stopper be:
-clot activator (plastic tube)
-serum
-used in chemistry, serology
red-black/gold
what color would this stopper be:
-separator gel and clot activator
-serum
-used in chemistry
lavendar/pink
what color would this stopper be:
-potassium EDTA
-serum
-used in hematology
light blue
what color would this stopper be:
-sodium citrate
-serum
-used in coagulation
green
what color would this stopper be:
-Sodium heparin or lithium heparin
-plasma
-used in plasma chemistries (ammonia, plasma, hemoglobin)
green-gray, light green
what color would this stopper be:
-lithium heparin and gel for plasma separation
-plasma
-used in plasma chemistries (ammonia, plasma, hemoglobin)
gray
what color would this stopper be:
-Sodium fluoride
-serum
-used in glucose, lactate
gray
what color would this stopper be:
-Potassium oxalate
-plasma
-used in glucose, lactate
yellow
what color would this stopper be:
-Sodium polyanethol
-whole blood
-used in blood culture
yellow
what color would this stopper be:
-acid citrate dextrose
-WBCs
-used in HLA typing, paternity testing
royal blue
what color would this stopper be:
-Sodium heparin, Sodium EDTA, none
-serum
-used in trace elements, toxicology and nutritional testing, tube has low levels of trace elements
yellow marbled or orange
what color would this stopper be:
-Thrombin
-serum
-used in stat chemistry
tan
what color would this stopper be:
-Sodium heparin
-plasma
-used in lead
first
what number in the order is blood culture tubes or vials ( yellow stopper ). They must have the most sterile conditions for collection.
second
what number in the order is the sodium citrate tube ( light blue stopper ). This tube is used for coagulation studies, and the tests done on this sample would be adversely affected by carryover contamination of additives from other tubes. It is especially
third
what number in the order is the serum tubes with or without clot activator, with or without gel separator ( red , gold , s pe c k le d stoppers ).
-Glass red stopper tubes do not have additives, however, the newer plastic red stopper tubes have additives
fourth
what number in the order is the heparin tubes (green stopper)
fifth
what number in the order is the Potassium or sodium EDTA tubes ( lavender stopper).
-If an EDTA tube is drawn before a blue stopper tube, the carry-over of the EDTA into the blue stopper tube can adversely affect coagulation tests.
-If an EDTA tube is dra
sixth
what number in the order is the sodium fluoride tubes (gray stopper)
blue stopper
what colored stopper tube should never be the first tube collected from a butterfly needle or winged infusion set since the air in the tubing, when pushed into the tube, will take up space and result in under fillingof the tube. It is important that the b
blue stopper
if what colored stopper tube is the first tube or the only tube to be collected with a butterfly needle, blood should be drawn into a discard tube first until the blood fills the tubing connected to the butterfly needle. This is called "priming the line
red
what color glass top tubes have no additives and can be collected prior to a blue top tube if an institution establishes that policy.
Blood test request form
what should all of this information be inc on:
-Patient's name and age
-Birthdate
-Identification number
-Date and time the specimen was obtained
-Accessioning number
-Doctor's name
-Department and/or unit for which the work is being done
-Name or initial
consent
what is given orally or when the patient provides his or her arm for the procedure
proper patient identification
what is the most important step in the phlebotomy process
inpatients
for who that are conscious: A
-Ask the patient to give their full name, address and identification number or birthdate.
-Then compare that with the information on the patient's wristband and on the request form.
-The wristband must be attached to the pati
inpatients w/o a wristband
for which patients:
-You MUST NOT rely on the name tag on the bed or outside the hospital room door.
-ask a nurse, family member or friend to identify the patient by full name, address, identification number or birthdate.
-If unable to get that informatio
unconscious, mentaly incapacitate, young patients, or those that do not understand the language of the phlebotomist
for which patients:
-Ask the patient's nurse, family member or friend to give their full name, address and identification number or birthdate.
-Then compare that with the information on the patient's wristbandand on the request form.
-IF THERE IS ANY DISC
outpatients
for which patients:
-The patient should be asked to give their full name, address and id-number or birthdate.
-This information should be compared to the information on request form.
- Always ask the patient to tell you their name. Never ask "Are you Mr.
unidentified emergency patients
for which patients:
-You must positively identify the patient.
-The patient should be given a temporary idnumber in accordance with institutional policies, and that identification must be attached to the patient's body.
sleeping/unconscious
Determine that the patient is conscious and alert before, during, and after the procedure. WHAT type of patient may suddenly move and push the needle more deeply into the arm causing injury.
-Obtain help from the nursing station
-Report any injury or unus
nursing station
If the patient is not in the room, consult with WHO as to the whereabouts of the patient and their availability for phlebotomy. The missing patient may be in another department of the hospital for testing, or on another area of the floor. Again respect th
downward
when performing venipuncuture the patient's arm should be in what position to prevent reflux or backflow of blood into the needle and should not be significantly bent at the elbow
standing
never draw blood from someone who is in what position
antecubital fossa
The major veins for venipuncture are located in the WHAT, the area that is anterior to the bend of the elbow
not be used
Veins are located by moving the finger along the skin and gently pushing or "palpating" the area. Veins are recognized by their elasticity or "give". Veins that are very hard or move ( "roll" ) excessively when touched should WHAT
median cubital vein
what vein is the first choice:
-Usually the largest and best anchored vein
-Usually closest to the surface and has the least risk of injury if the vein is missed
-Less painful to use
-IMPORTANT:You must check both arms for this vein before proceeding to t
cephalic vein
what vein is the second choice:
-can be difficult to locate, but usually well anchored
basilic vein
what vein is the third choice:
-easy to locate
-not well anchored, often rolls and is easily bruised
venipunture more painful at this site
basilic vein
precautions for what vein are:
-bc it is located near the median nerve and brachial artery, there is a possibility of accidental puncture of those structures.
-Extreme care must be taken to locate the brachial artery to avoid accidental puncture.
-Arteria
when the veins in the antecubital fossa are unaccessible
when should the wrist veins (not on underside), forarm veins, back of the hand veins be used
physician
venipuncture from the leg, ankle, and foot should be done by whom
arterial puncture
what is not an acceptable substitute for venipuncture
never
when should these sites be used for venipuncture:
-Areas w edema, scars, healed burns,
hematomas, vascular grafts
-Arm with IV blood transfusion
-Arm on same side as a mastectomy unless the physician has approved (can have complications of lymphostasis)
-
before performing phlebotomy
when should you identify the patient's dietary restrictions
fist
how should the patients hand be when drawing blood
3-4 inches above and less than a minute
where should the tourniquet be relative to the venipuncture site and how long should it be on
tourniquet
prolonged what application causes local venous stasis and cause erroneous results for cell counts, hematocrit, and some protein-based analytes.
circular
what type of motion should you use when cleaning the arm prior to venipuncture and moving from center to periphery
-Failure to do so may contaminate the sample with alcohol causing hemolysis, and will also cause the patient to experience a stinging pain w
re-cleansed
If the site of venipuncture is touched with the gloved finger after cleansing, the area has to be what
up
after removing the needle sheath inspect the needle for damage and ensure that the needle bevel is where and then place the first tube to be collected into the holder without releasing the vacuum
thumb
Anchor vein with what at a point 1 to 2 inches below the selected needle entry site.
30
The needle MUST be at an angle of WHAT degrees or less for entry. The needle bevel must be up.
evacuated tube
Carefully and steadily push WHAT into the back end of the needle without moving the needle in the vein. and then as soon as possible after the blood begins to flow, Release and remove tourniquet and
Instruct patient to open hand.
stops
you should fill additive tubes until what happens to the flow and this is critical with anticoagulated tubes to preserve the appropriate ratio of blood to anticoagulant.
downward
keep tubes in what position during filling to prevent backflow into the needle
stopper
Do not allow contents of tubes to contact WHAT while the needle is in place.
additives
Mix tubes with WHAT immediately (3-10 gentle inversions depending on the tube). Failure to do so may affect the integrity of the sample.
holder
Change tubes (if multiple tube collection). The rubber sleeve at the back of the needle will cover the opening and prevent the release of blood into the holder. Take precautions to anchor WHAT firmly when changing tubes to avoid movement of the needle.Use
back
after the last tube is filled pull the tube out from the WHERE of the needle to disengage the vacuum before removing the needle from the vein. Failure to do so may result in blood release from the needle upon removal from the vein.
needle is removed
Loosely place gauze over the puncture site. Do not apply pressure to the site until WHEN
safety device
after removing the needle immediately activate what and then apply mild pressure to the gauze on the arm and the patient's arm should remain out-stretched, and not bent at the elbow
back
The multi-sample rubber sleeve covering WHAT end of the needle inside the holder does not protect against this type of injury.
hematoma
Check the patient's arm to ensure the bleeding has stopped. Also check for what that means bleeding under the skin observed as a swelling or discoloration
5
If the patient bleeds longer than how many minutes, alert a nurse. Never leave a patient bleeding.
15
Place a bandage on the patient's arm (hypoallergenic bandages should be available for allergic patients) . Instruct the patient to keep the bandage in place for at least how many minutes.
label tubes
what should be done to the tubes BEFORE performing the venipuncture and includes:
-Patient first name and last name
-Identification number
-Date
-Time of draw (as required by the institution)
-Id of person collecting the sample
-Blood collected for transf
failure to obtain blood
what may be caused by:
-Needle bevel against the vein wall
-Needle is too deep
-Needle is not deep enough
-Needle has slipped beside the vein
-Needle position cannot be determined
-Collapsed vein
probing
If venipuncture is unsuccessful:
-Change position of the needle slightly
-Pull back a bit, or advance it a bit, or slightly turn the needle
-WHAT with the needle is not permitted
-Try another tube in case the one being used has a defective vacuum
-Remove
2
do not attempt a venipuncture more then how many times on a patient
2
if you do not have any other option but to collect blood from an arm with an IV ask a nurse if the fluid can be turned off for at least how long prior to venipuncture
below
where should the tourniquet be placed in relationship to the IV site
above
blood collected where in relationship to the IV site can result in contamination of the sample with IV fluid, even if the IV was turned off prior to the venipuncture.
cleared
Drawing blood from an IV line requires that the line be WHAT of fluid before specimens are drawn for diagnostic testing Withdraw and discard blood drawn from the IV line as follows:
-2x deadspace volume for non-coagulation testing
-6X deadspace volume or
alcohol-free antispetic
when checking for blood alcohol level must remember to cleanse the site with what such as chlorhexidine to prevent contamination of the specimen
airborne, droplet, contact
what are the three transmission-based isolation precautions
removed
when drawing blood from a patient in isolation equipment brought into the room cannot be what and phlebotomy trays are never taken in, what needs to be used should be brought in a placed on a paper towel, and all cleaning should be done before leaving the
STAT
what word is this:
-From Latin meaning, immediately
-Only used when a patient is critical or the results are urgently needed
-Is the highest priority request
-Should be drawn, delivered and tested immediately
medical emergency
what word is this:
-Indicates a life or death situation
-Adopted by some institutions because of the overuse/abuse of the term STAT
timed specimens
what word is this:
-Specimens collected at a particular time
-Collect as close as possible to scheduled time
-Example: cardiac enzyme or a therapeutic drug level
ASAP
what word is this:
-"As Soon as Possible"
-Patient is not critical, but the physician requests results as soon as possible in order to determine a treatment plan
fasting
what word is this:
Some tests (e.g. glucose, triglycerides) are affected when a patient does not fast; patient should not eat or drink, except water, preferably for 12 hours for a fasting specimen
NPO (nothing by mouth)
what word is this:
-In this case the patient is not allowed anything by mouth (food or water)
-Usually this is ordered if the patient is going to surgery or some other procedure
pre-op/post-op
what word is this:
-Results are needed before or after surgery
-Patients may report to the hospital a few days before surgery to have pre-operative blood specimens collected so that surgery will not be delayed on the scheduled day
routine
what word is this:
-The majority of the test requests are this
-They are collected during floor rounds or on an outpatient basis
-Most are collected during the first morning rounds (reflects patients' basal metabolic state)
hemoconcentration
what word is this:
-a false increase of blood constituents (e.g. proteins, cells, coagulation factors)
Caused by:
-Prolonged application of the tourniquet (if it is left on the arm longer than one minute)
-Rapid opening and closing (pumping) of the hand
hemolysis
what word is this:
-the rupture or lysis of red blood cells
-It falsely decreases the red blood cell count, and the cellular contents that are released may adversely affect the blood levels of various analytes
Caused by several factors:
-Failure to allow
partially filled tubes
what caues this:
-Additive tubes must have the proper amount of blood to anticoagulant ratio, and must be allowed to fill until the blood stops flowing into the tube
-Under filling of an additive tube can lead to erroneous test results
-Proper filling is
specimen contamination
what is caused by:
-Powder from the gloves on a pre cleaned site
-Using the wrong antiseptic to clean the site prior to venipuncture
-Failure to allow the alcohol to dry prior to puncture
-Carry-over of additives from other tubes due to improper order of
45 min-1 hour
ideally specimens should be delivered within what time frame after collection and less time is recommended for glucose, enzymes, cortisol, coagulation
2
serum and cells should be separated within how many hours
excessive bleeding
what can be caused by:
-anticoagulant therapy
-coagulation factor problems
-platelet problems
hematoma
what is commonly called a bruise. caused by blood leaking under skin into surrounding tissue during venipuncture procedure. can be painful and unsightly. As soon as it begins to form, release tourniquet and withdraw needle. They may form if:
-The vein is
accidental arterial puncture
During venipuncture, what may be pierced. If this occurs the phlebotomist:
-Must place direct pressure over the site for at least five minutes
-Notify the nursing staff and physician
probing
doing what with the needle can lead to a nerve injury, and in sometimes can cause permanent damage. Law suits have been filed in cases of nerve damage occurring during a phlebotomy
petechiae
what are pinpoint red hemorrhagic spots on the patients skin. They may occur once the tourniquet is applied. This does not reflect poor technique by the phlebotomist, but it may indicate a bleeding problem
reflux of anticoagulant/additive
what may happen during the venipuncture procedure, if the tube is not in a downward position, the anticoagulant or additive from the tube may travel down the needle and into the patient's vein.
seizure
what can occur during phlebotomy procedure and should be handled by:
-Immediately remove tourniquet, withdraw needle, and apply pressure w gauze at the puncture site.
-Try to prevent the patient from injuring themself
-Alert appropriate medical personnel.
vein collapse
what can happen if the suction from the tube is too much for the vein. can occur w small or fragile veins. A butterfly needle and smaller tube size is alternative procedure to draw specimen. A syringe collection may also be used but less preferable due to
vein damage
what can happen to patients who continually receive venipuncture in the same site, can develop scaring of the vein over a period of time & obtaining a blood sample will be difficult. Other factors that can lead to this:
-Excessive blind probing
-Harsh med
nausea
If the patient complains about WHAT, stop the procedure, make the patient comfortable, and instruct them to breathe slowly and deeply. A cold compress may be applied to forehead. If patient vomits, give him or her an emesis basin or carton. Provide tissue
skin puncture sample
what is a mixture of blood from arterioles, venules, capillaries and tissue fluid and it resembles arterial blood more than venous blood
skin puncture
what should be done for newborns and pediatric patients under 2 years of age and is recommended bc small but adequate amounts can be obtained for testing and in infants it is hard and potentially hazardous to do it the other way and can lead to anemia als
skin punture
what may be preferred for adults under the following conditions:
-Severely burned patients
-Extremely obese patients
-Geriatric patients
-Other adult patients in whom superficial veins are not accessible or are very fragile
-Patients performing tests at h
skin puncture
what may be inappropriate for patients that are dehydrate or have poor peripheral circulation from other causes
total protein, calcium, and potassium
what is higher in a skin puncture vs a venous puncture
glucose and WBC
what is higher in a venous vs a skin puncture
skin puncture
the following tests cannot be determined by what:
-Erythrocyte sedimentation rate(ESR)
-Coagulation studies
-Blood cultures
-Tests that require a large volume of blood
lancet
what is a sterile, disposable, pointed instrument used to pierce the skin to obtain drops of blood for testing. Various devices are used for the finger and the heel stick there are also laser versions of this. Devices should be equipped with safety featur
microcollection containers/tubes
what are small plastic, sterile tubes with caps that correspond to the color code on evacuated tubes,
available with or without additives, are designed to collect 250uL to 500uL of blood, and some require plastic capillary tubes to aid in collection
capillary tubes
what are disposable, narrow bore plastic-coated glass or plastic designed to hold 50-75 uL of blood
Tube are available with:
-Heparin anticoagulant (red ring at one end) used to collect blood for the microhematocrit test and blood should fill 2/3 to 3/4 o
heel warming device
what is a device that uniformly warms the foot, increasing the blood flow to the area (used for heel sticks in infants), and should not exceed 42C or can use a towel dampened w warm water
skin puncture
the site for what should be warm, pink and free of scars, cuts, bruises or rashes. Do not choose a cold, cyanotic (blue) or edematous (swollen) site.
heel
what is the site of choice for infants less than 1 year old and You MUST use the lateral (outside) or medial (inside) surface of the plantar side on (bottom) or plantar surface of the big toe may also be used if the infant has large enough feet
finger
what site is used for older children and adults. and MUST not be done on infants since the lancet can cause serious bone injury to the infant.
Use the palmar surface of the distal potion of the third (preferred) or fourth, not thumb since it has a pulse,
2.0 mm
The depth of the puncture in the heel should be no greater that how many mm. A greater depth carries a risk of bone injury and possible infection.
first
what drop of blood after the puncture must be wiped away and not used since it may have excessive tissue fluid
3 minutes
The heel or finger must be warm so that there is adequate blood flow in the area and the Max temp is 42C and max warming time is how many mins
free flowing
For skin puncture, mild pressure may be applied to the surrounding tissue to increase blood flow. A hand may also be lowered to increase blood flow to the finger. The sample should be doing WHAT? Strong pressure such as excessive squeezing or "milking" of
bandages
For infants, maintain pressure on the site until the bleeding stops. WHAT should not be placed on babies since they can cause a choking hazard.
first
what is the order of draw for EDTA specimen in microcollection tubes
second
what is the order of draw for other additive specimen in microcollection tubes
last
what is the order of draw for specimens requiring serum in microcollection tubes
hemolysis
what error can occur in a skin puncture from:
-Failure to allow the alcohol to dry
-Excessive squeezing of the puncture site
-Excessive mixing of tubes
-Exposure to excess heat or cold
contamination of specimen
what error can occur in a skin puncture from:
-Failure to allow the alcohol to dry
-Failure to wipe away the first drop of blood may result with excess tissue fluid
failure to obtain blood
what error can occur in a skin puncture from:
-Collection from improper site (edema, scarring)
-Improper use of lancet (inadequate puncture depth)
-Use of cold fingers or heels (warming the finger or the heel will increase blood flow)
altitude
what at high amount makes available oxygen in air decreased and body responds by increasing the hormone erythropoietin, which results in an increase in the number of RBC, hemoglobin, and thus oxygen carrying capacity
drugs
what can affect normal metabolism and also cause false increases and decreases in the blood levels of analytes
exercise
what increases muscular activity which elevates certain blood analytes such as lactic acid, protein, certain enzymes such as creatine kinase and lactate dehydrogenase. and depending on the analyte, levels may return to normal a few hours to more than 24 h
dehydration
what causes a decrease in the fluid of the body and is caused by inadequate water intake or excessive water loss. caused by prolonged diarrhea or vomiting, or excessive exercise. It concentrates some constituents of the blood causing falsely increased res
water retention
what dilute some constituents in the blood causing falsely decreased results.
hemolysis
what results in the loss of red blood cells and the release of the contents of the red blood cells into the plasma. analytes that are sig affected by this: potassium, magnesium, coagulation tests, RBC counts, lactate dehydrogenase, aspartate aminotransfer
icteric serum
what is visually observed as a dark orange color of the serum. It is caused by a high level of bilirubin in the serum. Assays that use spectrophotometry to measure the analyte may be falsely elevated unless a serum blank is used
lipemic
what is visually observed as a turbidity in the serum. caused by an increased amount of lipids in the plasma.The turbidity of the sample causes false increases in analytes that are measured by spectrophotometry. Hyperlipidemia can also inhibit some enzyme