Components Of Blood

1
Components Of Blood

• Whole blood includes erythrocytes, leukocytes,
  platelets, and plasma. Leukocytes and
  thrombocytes make up the buffy coat.
• The liquid portion of blood includes plasma which
  contains all formed elements and clotting factors
  and serum which contains no clotting factors and
  no formed elements.
• Plasma is mostly composed of water (90) but also
  contains protein, enzymes, hormones, lipids, and
  slats. Plasma normally appears hazy and pale
  yellow (contains coagulation proteins) and serum
  normally appears clear and straw colored(contains
  no coagulation proteins).

2
Phlebotomist

• The phlebotomist collects blood from patients for
  lab analysis.
• The most common body fluid analyzed in the
  hematology section is whole blood. A whole blood
  specimen is obtained by using a collection tube
  with an anticoagulant to prevent
  clotting.(Ex.EDTA lavender top).
• Immediate inversion of this tube is critical to
  prevent clotting.
• Chemistry tests are performed primarily on serum
  collected in serum separator tubes (varigated
  orange-red tops)or red, green, gray, or royal
  blue.
• Serum separator tubes contain an inert gel that
  prevents contamination of the specimen by RBCs or
  their metabolites.
• Specimen must be allowed to clot before
  centrifuging.
• Coagulation studies are performed from light blue
  top tubes.

3
Order of Draw

• When collecting multiple specimens and specimens
  for coagulation studies, the order in which tubes
  are drawn can affect some test results. Tubes
  must be collected in a specific order to prevent
  invalid test results by bacterial contamination,
  tissue fluid contamination, or carry-over of
  additives or anticoagulants between tubes.
• Suggested
• Red.
• Blue.
• Clot activated.
• Gray or gold.
• Green.
• Lt. Green.
• Lavender.
• Yellow.

4
Requisitions

• All procedures begin with the receipt of a test
  requisition
• Should include patients name and ID number
• Healthcare provider name
• Tests requested
• Collection information (fasting)

5
Greeting the Patient

• Professional demeanor instills confidence and
  trust
• Introduce yourself and say that you are from the
  lab and explain that you will be collecting a
  blood specimen
• Check ID
• Reassurance of the patient begins with the
  greeting and continues throughout the procedure
• Give brief explanation
• Do not tell them that it will be painless
• Politely direct question to healthcare provider
  if questioned about tests ordered
• Verify requirements such as fasting has been
  fulfilled
• Never draw from a standing patient

6
Equipment

• Have all equipment ready before beginning
  procedure
• Tourniquet should only remain for no more than 1
  minute to prevent hemoconcentration (increasing
  the ratio of cellular elements to plasma) if
  necessary, redo tourniquet after vein selection

7
Selection

• Although the preferred site is the antecubital
  that is located anterior to the elbow, the median
  cubital and the cephalic and the basilic could be
  located
• The lower down the vein, normally the smaller and
  less well anchored and punctures are more painful
• Veins can be located by sight and
  touch(preferred) that is referred to as palpation
• The ability to feel is much more important that
  the ability to see a vein
• Palpate with the index finger
• Rigid is usually tendon cords, should have a
  spongy feel
• Do not make a hole in the index finger glove
• Place equipment within easy reach

8
Bevel UP

• Check needles for barbed ends
• Hold barrel with thumb up in the dominant hand
• Brace fingers against patient arm for stability
  after insertion
• Use the thumb of the non dominant hand to anchor
  the vein during insertion
• Veins will roll if not anchored (sometimes)
• Notice a feeling of less resistance when entering
  the vein
• Take the anchoring hand and push the tube into
  the barrel using the thumb to push the tube while
  the index and middle fingers grasp the flared end
  of the barrel

9
Bevel UP

• The hand used to hold the needle assembly should
  remain braced when tubes are being inserted or
  removed
• To prevent blood refluxing back into the needle,
  tubes should be held at a downward angle while
  they are being filled and have slight pressure
  applied to them
• Failure to remove the tube before removing needle
  causes blood to drip from needle
• Allow tubes to fill until vacuum is exhausted to
  ensure ratio
• Try keeping your dominant hand free when
  completing venipuncture to stop procedure
• Pull tourniquet before needle to prevent hematoma
• Pressurebandaidcleanupneedle disposal

10
I Have Failed!

• Not all venipunctures result in the appearance of
  blood
• Temporary setback!
• Some can be corrected by a slight movement of the
  needle (partially in vein, collapsed vein, too
  far, on wall of vein)
• Slowing advancing or pulling back a needle may
  correct
• Should be at approximately a 30 degree angle
• Errors in performance account for hemolyzed
  specimens

11
QC

• Is important to determine if controls fall within
  expected range
• To ensure random patient values are accurate
• To provide data for QA program
• Provide data for decision making especially in
  taking corrective actions
• Gaussian curve is used to show changes in
  standard deviations(mean, variance, etc.) which
  can be caused due to changes in reagent vendors,
  instrument problems, bad controls or poor
  techniques

12
Westgard Rules

• Used to interpret control charts and to detect
  error
• Controls are rejected when the criteria is not met

13
Levey Jennings Chart

• Used to plot lab QC results by time, day and
  month
• This graph will show data that is out of control,
  sudden changes of data, and gradual changes such
  as shifts or trends
• Controls(2 levels) are ran each shift or every 8
  hours
• Made from pooled sera
• Accuracy and precision should be achieved
• (Although)precision can be obtained without
  accuracy

14
Now..

• Obtain a monthly quality control sheet from
  office door
• Use the results of 190, 190, 130, 145, 160, 182,
  175, and 134 to do calculations
• Define (in detail)
• Serum sera
• Plasma hemoconcentration
• Whole blood buffy coat
• Order of draw
• Gaussian curve
• Levey jennings chart
• Precision
• Accuracy
• hemolyzed
• Westgard rules
• Venipuncture technique(begin to finish in your
  wordsnot mine!) Due next class
  period!!!!
• This is a gradedo not share assignment!