WPC &=}:6 =W<|WncJn&# cZ $k%"Pr< b˫1ƨY7 pF:. <;P?ʁ ]#͋;ǍQtJ+k5hX]F;/(F|?5I>6 }-6fG j}9Us5qfiOa4ZĖ ]594+!܍.B F)sLέbworg>hViJQVf3ѥgd~T y/L@ZjkZ+<"E?R$Kg ́yْh%ēpe#ӥ rҗu \od!OE=BIkmgNŵQ3#yI>raZ~Uս63 ZֈeZu+l(̜=U6V %n$ 04N U: wA 4E Y = U4? s my 0P 0c fC aE #Y U N"^ pl|f^NNEs 0P! 1uq B  i D3" D3U B* 72 0w 0[ C 0 0 0S 0 0 0D 1( 72 i7<\  `(Roman 10cpiX' Lab #12: Specimen Asseccioninglab12&sq  0 .   3|x<\  `(Roman 10cpiXx\  @ X@( U$  ,  AZ"Arial Regular`,= )   _HHA) xdEHWH!A X Exercise16:SpecimenProcessingArial BoldHU((3$ U!   (;3$2#  0  .3  0  TABLE AHPE438C7 (HP Officejet J6400 series)0(9 Z6Times New Roman Regularn=   bTRX3' LetterX3' Letter3' Letter3'TX \\R3'Letter\ T )   HH i *   _9    1  ((3$ U!   3#37=CIQYag1.a.i.(1)(a)(i)1)a) d"'dxd####'dxd&0 d di)(O;$0  2#  a  .3  0` (#(#(b$0  0` (#(#2#   .3  0 ` (#` (# d(xir$0  0` (#(#0 ` (#` (#2#(  0  )3  0 (# (#($0  0` (#(#0 ` (#` (#0 (# (#2#(  a  )3  0h(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2#(   )3  0h(#h(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2#  0  )3  0(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#2#     )3  0p(#p(# %&()*+,xFGaeimquy}Bullet ListBullets List.-!'-% U!   _XXHH XXXX UXX 8 N XXdd8EXERCISE16:0 SPECIMENPROCESSING X $ $ #XX U#XfXXXSkills:0  15pointsx $$ Objectives:0  0P $$PP $P $  (#33"3"  32#  1  .3  0    Explainhowacentrifugeworks.3݌($$ Ќ  "3"  32#  2  .3  0    Namefivetypesofcentrifugesandtellwhateachisusedfor.3݌ $$ Ќ  "3"  32#  3  .3  0    Safelyandcorrectlydemonstratetheproperuseofaclinicalcentrifuge.3݌ $$ Ќ  "3"  32#  4  .3  0    Distinguishbetweenserumandplasma.3݌  $$ Ќ  "3"  32#  5  .3  0    Definehemolysis,icterus,and_lipemia_Ԁandexplaintheireffectsonlaboratorytests.3݌ $$ Ќ  "3"  32#  6  .3  0    List14reasonsthataspecimenwouldberejectedbythelaboratory.3݌ l $$ Ќ  "3"  32#  7  .3  0    Explaintheimportanceofverifyingthebloodspecimenidentificationwiththerequisitionslip.3 ݌ X $$ Ќ  "3"  3 2#  8  .3  0    Demonstrateproperaccessioningoflaboratorysamplesbycorrectlyfillingintheaccessioninglog D  sheet.3 G ݌0 $$ Ќ  "3"  3` 2#  9  .3  0    Demonstrateappropriatespecimenprocessingbycomparingrequisitionswithsamplesandnotingany t discrepancies,problemswithsamplesuitability,and/ormissingsamples.3` ݌`$$ Ќ  "3 "  3 2#  10  .3  0    Safelyandaccuratelyseparateserumorplasmafromcellsusingappropriate_PPE_..3  ݌L$$ Ќ  xHXXf Discussion #XfXxH## $  SerumversusPlasma  4 Wholebloodiscomposedofcellularelements(redbloodcellsorRBC,whitebloodcellsorWBC,and   plateletsorPLT)andtheliquidcomponent,whichiseitherserumorplasma.Ingeneral,adultbloodhasabout  40%cellularelementsand60%serumorplasma.   Serum istheliquidexpressedfrom clotted blood(blooddrawnintoatubewithnoadditive).Inthiscase, d bloodisallowedtoclotandfibrinogenalongwithsomeoftheothercoagulationfactorsareusedinthe T formationoftheclot.Serum,therefore,doesnotcontainfibrinogenorothercoagulationfactors.Serumis @ thepreferredspecimenformostchemistry,bloodbankandserologytestsbecausefibrinogenmaycause , interferenceinthetestprocedureperformed,removingitpreventsthisproblem.Someadditivesmayalso p interferewiththeseanalysesanditisbestthattheynotbepresent. \    Plasma istheliquidportionofthebloodpresentin anticoagulated specimens.Plasmacontainsallthe 4"" coagulationfactorsexceptcalcium.Calciumisnotpresentinplasmaasmostanticoagulantsprevent $# # coagulationbybinding(chelating)thecalcium.Heparinisanaturallyoccurringanticoagulantwhichactsas $!$ anantithrombin.Thrombinisanotheressentialcomponentofthecoagulationmechanism.Theeffectsof $"% heparinareshortlived,blooddrawninheparinwillbegintoclotinapproximately48hours.Plasmatends %#& tobesomewhatmorehazythanserum. &|$'  Centrifuges  (T&) Centrifugesareinstrumentsusedtospinsamplesofbloodorotherbodyfluidsathighratesofspeed,forcing *,(+ theheavierparticlestothebottomofthecontainer.Themostfrequentlaboratoryuseofthecentrifugeisto p+), separatethecellularcomponentsofbloodfromtheliquidsothattheliquidmaybeusedfortesting. \,*-  H-*. ЇCentrifugesvaryinsize,capacity,andspeedcapability. Clinicalcentrifuge isthenamegiventotabletop X modelswhichcanbeusedforurinalysisorserumseparation.Theseusuallyhaveaspeedcapacityofupto H 3000rpms(revolutionsperminute),andwillholdtubesrangingfrom5to50mLsizes,dependingonthe 4 adapters.A serofuge isasmallcentrifugeusedinbloodbankingaserologytospinserologicaltubes.    _Microcentrifuges_Ԁor_microfuges_ arealsobecomingwidelyused.Thesewillspinspecial_microtubes_Ԁ1.5cm  capacityathighspeeds,usuallyabout12,000rpm.The microhematocrit centrifugeisavariationofthe  _microfuge_;itspinscapillarytubesathighspeedssothathematocritscanbemeasured.  Othertypesofcentrifugesinclude highspeedcentrifuges whichrotateatspeedsupto20,000rpmand  \   ultracentrifuges whichrotateatspeedsover50,000rpm.Thesecentrifugesarespeciallyequippedsothat  L  samplesmaybekeptcoolwhilebeingcentrifuged.Centrifugessuchasthesearetypicallyusedonlyin  <  researchlaboratoriesandarenotrequiredforroutineclinicaltesting.  (   OperatingtheCentrifuge  X  Themanufacturer'sinstructionsmustalwaysbefollowedwhenusingacentrifugeoranyothertypeof 0 equipment.Somegeneralrulestofollowintheoperationofallcentrifugesare:  1.0  Donotoperatecentrifugeswiththelidsopen.$$ 2.0  Balancethecontentsofthecentrifugebeforeoperating.Forexample,ifthereisonlyonesampleto  becentrifugedatubeidenticalinsizeandvolumeofsolutioncontainedmustbeplacedintherotor t oppositethesampletube.Therotoristhepartofthecentrifugewhichholdsthetubesandrotates ` duringtheoperationofthecentrifuge.Foreverysampleplacedintherotor,theremustbeabalancing L sampleplaceddirectlyopposite.8$$ 3.0  Donotopenthecentrifugeliduntiltherotorhasstoppedspinning.|$$$ 4.0  Spinsampleswithlidsontoavoidcreatingaerosols.h$$ 5.0  Useonlytubesthatarespecifiedasappropriateforthatparticularcentrifuge.T$$  PreventiveMaintenance  , Centrifugesshouldbecheckedandhavemaintenanceperformedonaregularbasis.Theroutinechecksof  revolutionsperminuteandtimeofcentrifugationusingeitheratachometerorastroboscopeareabsolutely   essentialforconsistentresultsthatmeetqualitycontrolstandards.  !  SeparationofSerum  "\ # Wholebloodthatisanticoagulatedismostoftennotcentrifugesandseparated,butusedaswholebloodfor $4"% suchtestsascellcounts,hemoglobin/hematocrit(H&H)determinations,etc.Clottedbloodmustbe x% #& centrifugedandtheserumseparatedfromthecellssothatitcanbeusedinvariousanalyses.Itiscriticalthat d& $' theserum not becontaminatedwithredbloodcellsasthiscouldcausefalselyincreasedordecreasedresults. P'$( Serumcanbeseparatedfromthecellsintwoways: ,)&* ! ! (#33 "3"  3&2#  1  .3  0    Aredtoppedtubeiscentrifugedandtheserumiscarefullypipettedoffintoanotherclean,properly *'+ labeledtesttubewithacleanpipette.Caremustbetakennottocontaminatetheserumwithrbcs.3& '݌+(,$$ Ќ  "3"  3(2#  2  .3  0    Aserumseparatortube(SST)hasapolymergel.Thebloodisdrawnintothetubewhichisthen +)- centrifuged.Thiscausesthegeltomoveabovetheclottoformaphysicalbarrierbetweentheserum ,*. andclot.Theserumcanthenbepouredoffwithoutcontaminationbyredbloodcells.3((݌-p+/$$ Ќ  SpecimenAppearance  X Ifserumorplasmaistransferred,itshouldbeintoaclean,dry,properlylabeledglassorplastictubewitha 0 clean,dryglassorplasticpipette.Observetheserumorplasmaitshouldbecleartohazyandpaleyellow  incolor.Thereareseveraldifferentappearanceoneshouldbeawareof:  1.0  Hemolysis isaredorreddishcolorintheserumorplasmawhichwillappearasaresultofredblood  cellsrupturingandreleasingthehemoglobinmolecules.Hemolysisis usually duetoatraumatic x venipuncture(ie,veincollapsesduetoexcessivepressureexertedwithasyringe,"digging"forveins,  h ornegativepressuredamagesinnatelyfragilecells.Grosshemolysis(serumorplasmaisbrightred)  T  affectsmostlabtestsperformedandthespecimenshouldberecollected.checkthespecificlabtest  @  toseewhateffecthemolysishasonit.Slighthemolysis(serumorplasmaislightlyred)affectssome  ,  tests,especiallyserumpotassiumandLDH(lactatedehydrogenase).Redbloodcellscontainlarge p   &?V%XXfamountsofbothofthesesubstancesandhemolysiswillfalsely#XfX%&?V/#Ԁ&?V%XXfelevatetheirmeasurementstoagreatextent.#XfX%&?V0#\ $$ 2.0  Icterus .Serumorplasmacanbebrightyelloworevenbrownishduetoeitherliverdiseaseordamage 4  orexcessiveredcellbreakdowninsidethebody.Icteruscan,likehemolysis,affectmanylabtests, $ butunfortunately,recollectionisnotanoptionsincethecolorationoftheserumorplasmaisdueto  thepatient'sdiseasestate.However,appearanceshouldbenotedonthelabreportas" serumicteric" .  Handleictericserumwithextremecautionduetothepossibilitythatthepatientmayhavehepatitis.$$ 3.0  Lipemia .Rarelyserumorplasmamayappearmilky.slightmilkinessmaybecausedwhenthe l specimenisdrawnfromanonfastingpatientwhohaseatenaheavymeal.Athickmilkyappearance \ occursinrarecasesofhereditarylipemia.Aswithicterus,theappearanceshouldbenotedonthelab H reportas" serumlipemic ".4$$  SpecimenRejection  h Thefollowingarecausesofsamplerejection: @ ! ! (#33"3"  352#  1  .3  0    Discrepancybetweenspecimen(s)andlabrequisition(s).35"6݌$$ Ќ  "3"  362#  2  .3  0    Namemisspelledorwrongname.36"7݌$$ Ќ  "3"  372#  3  .3  0    Identificationnumberdoesnotmatchtonumberonrequisition.37 8݌ $$ Ќ  "3"  382#  4  .3  0    Dateofcollection,timeofcollectionand/orphlebotomistsinitialsaremissing.389݌ !$$ Ќ  "3"  3:2#  5  .3  0    Unlabeledtubes.3:.:݌!p"$$ Ќ  "3"  3:2#  6  .3  0    Wrongtubecollected.3:;݌"\ #$$ Ќ  "3"  3;2#  7  .3  0    Fastingsamplenotcollectedonfastingpatient.3;;݌#H!$$$ Ќ  "3"  3<2#  8  .3  0    Timedsamplenotcollectedatcorrecttime.3<<݌$4"%$$ Ќ  "3"  3=2#  9  .3  0    Quantitynotsufficient(QNS)inadequatevolume.3==݌x% #&$$ Ќ  "3 "  3>2#  10  .3  0    Samplehemolyzed.3>>݌d& $'$$ Ќ  "3 "  3?2#  11  .3  0    Anticoagulatedsampleclottedorhasclotsinit.3??݌P'$($$ Ќ  "3 "  3~@2#  12  .3  0    Impropertransport(time,temperature,lightexposure).3~@@݌<(%)$$ Ќ  "3 "  3A2#  13  .3  0    Outdated(expired)supplies.3AA݌()&*$$ Ќ  "3 "  3eB2#  14  .3  0    Contaminatedspecimens.3eBB݌*'+$$ Ќ  Standyourgroundandrejectimproperlylabeledand/orcollectedsamples. +)- __ -l+/  SpecimenStorage  X Ifthespecimenistobestoredintherefrigeratororfreezer,thetubeshouldbetightlycappedortightlysealed 0 with_parafilm_.Ifthespecimenistobefrozen,theidealfreezerisatruelaboratoryfreezerwhichmaintains  constanttemperature.Regularkitchenrefrigeratorfreezersaregenerallyfrostfreeandgothroughfreezeand  thawcycles,whichmayadverselyaffectthespecimen.   AccessioningSpecimens  t Everylabhasaproceduretoaccessionspecimensinthelab.Patientnamesandidentificationnumbersare  L  loggedinonacomputeroronalogsheetorbookalongwiththetest(s)tobeperformed.Thisaccessioning  8  servesasarecordoftestsdoneandisaconvenientwaytocheckifthespecimenhasactuallyarrivedinthe | $  labfortestingintheeventthatthephysicianornursecallstocheckontheresults.Itisextremelyimportant h   thatallpatientinformationiscorrectlytranscribed,thatincludesspellingofthepatient'sfirstandlastnames T  andthecorrectidentificationnumbers.Remember,mostlaberrorsareclericalinnature,someonemisspelled @  anameortransposednamesornumbers.Becareful!You will begradeddownifyoumakeclericalerrors. ,   Procedure   ! ! (#33"3"  3J2#  1  .3  0    Theinstructorwillgiveeachstudentrequisitionslipsandspecimens.3JJ݌$$ Ќ  "3"  3K2#  2  .3  0    Checkthenamesandidentificationnumberson each tubewiththenamesandidentificationnumbers t ontherequisitionslip.Ifanyerrorsareidentified,notetheproblemonyour"SpecimenAccession d Log"anddescribetheactionwhichmustbetakentoresolvetheproblem.3KK݌P$$ Ќ  "3"  3M2#  3  .3  0    Makesurethatyouhavethecorrectspecimenforeachtestordered.Noteonthelogifspecimensare < missingorinappropriatespecimenwasdrawnanddescribetheactionwhichmustbetakentoresolve ( theproblem.3MM݌l$$ Ќ  "3"  3nO2#  4  .3  0    Fillinthedate/timecolumnswith todaysdateandthecurrenttime .3nOO݌X$$ Ќ  "3"  3P2#  5  .3  0    Writethepatient'sname,identificationnumber,andlisteachtestorderedonthespecimenonthe H SpecimenAccessionLog.3PP݌4$$ Ќ  "3"  3Q2#  6  .3  0    Ifaproblemisidentifiedlisttheproblemandtheresolution.3Q R݌ $$ Ќ  "3"  3R2#  7  .3  0    Centrifugeeachofthetubesinoneofthecentrifuges.Bluecoagulationtubesmustbecentrifugedin   theSerofuge,allothersinthelargetabletopcentrifugebythesink.Makesureeachtubehasone  directlyoppositefromitwithidenticalsizeandbloodvolume.Ifnomatchisfoundcreateabalance   tube.3RS݌ x!$$ Ќ  "3"  3'U2#  8  .3  0    Oncethecentrifugeisfullspinfor710minutes.3'UTU݌!d"$$ Ќ  "3"  3$V2#  9  .3  0    Labelatesttubeforeachspecimentobeseparatedwithpatient'snameandidentificationnumber,and "P # whetheritisserumorplasma.3$VQV݌#y݌&& Ќ  "3 "  3fz2#  10  .3  0    WhyisplasmafromanEDTAtubenotbeusedforaplasmacalciumlevel.%  (1point)3fzz݌"D #&& Ќ       P     X "3 "  3{2#  11  .3  0    Whatactionmustbetakenifadiscrepancyexistsbetweentheinformationonthetubeofbloodandthat $(%) foundontherequisitionslip?(1point)3{|݌)&*&& Ќ       P     X      P     X      `