Lesson 1 (Hema Lab)

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WaterIt takes up 90% of the whole liquid componentDissolved SubstancesIt takes up the 10% of the whole liquid componentcarbohydrates, lipids, fats, proteins, vitamins, hormonesComposition of carbohydratesplasmathe fluid portion of unclotted bloodserumthen fluid portion of clotted blood- plasma contains fibrinogen while serum contains fibrinogen - plasma is part of unclotted blood while serum is clottedDifferentiate plasma and serumDifferentiate Oxygenated Vs. DeoxygenatedDifferentiate Clotted vs Unclotted BloodDifferentiate Arterial Vs. Venous BloodDifferentiate RBC VS WBCdifferentiate Granulocyte vs Agranulocytedifferentiate Medularry vs ExtramedullaryTransport Respiratory Excretory Nutritional Body Temperature Buffering ActionFunctions of the Blood- fluid (in vivo) - 1.055 specific gravity - slighlty alkaline - thick and viscous (3.5 - 4.5 thicker than water) - Makes up 75 to 85 ml blood/ kg body weight - Total solid ~ 20gms./100ml of bloodCharacteristic of BloodExercise Diet Smoking Posture Diurnal Rhythm StressPhysiological Factors Affecting Test ResultIncrease WBC, Platelet, Lactate DehydrogenaseWhat increases when you exercise?Lipid Diet Increases Alkaline Phospatase, Hgb (Spectro method)What increases when you diet?Increase Hgb, WBC, CortisolWhat increases when you smoke?shift in posture causes varied resultsWhat effects does posture do in the test result?In the night, Increase eosinophil Decrease ACTH & cortisolWhat is the effect of Diurnal Rhythm in the test result?Increase WBC, fibrinogen, factor 1,5,8,10What does stress increase?Skin PunctureUsed only when small amount of blood is neededAvoid squeezing, pressure 2mm recommended depth of skin puncture Discard first drop of blood Warming of puncture site can increase the blood flow by 6-8 folds Warming is done using washcloth in 40-42C for 2-5 minutesThings to Remember for Skin Puncture- Plantar surface of the sole of the feet - Heel portion (Median and lateral site)Ideal puncture site for infantsHands - Palmar surface of the non-dominant hand in the 3rd or 4th finger (distal portion)Ideal puncture site for children and adultsTube for blood gas analysis Slides EDTA Other microtainer with anticoagulants Serum microtainerOrder of Draw for Skin PunctureComparison of capillary and venous bloodLymphocyteIf it is not in its normal value it causes viral infectionOxygenated bloodblood that carries an abundant amount of oxygen which means that it has a high affinity in CO2Medullary hematopoiesisblood cell production in bone marrowExtramedullary hematopoiesishematopoiesis outside bone marrow (e.g., spleen and liver, lymph node)1. Transport blood gases such as oxygen and carbon dioxide, nutrients (in general). 2. Respiratory function 3. Excretory function 4. Nutritional function 5. Body temperature 6. Buffering actionFunctions of bloodIronThe specific component of hemoglobin that makes the blood color redNormocytenormal-sized red blood cellHypochromicPertaining to deficiency in color; decrease in hemoglobin in red blood cells.Polycythemiaexcess of red blood cellsdiurnal rhythmIn the evening, the eosinophil is increased, and ACTH and cortisol is decreasedpancytopeniadeficiency of all types of blood cellsHemostasisit is the process of clotting/ keeping blood within the blood vesselRBC, WBC, plateletssolid components of bloodErythrocyte, Leukocyte, ThrombocyteWhat are the other terms for the following: Red Blood Cell White Blood Cell PlateletsWBCIt serves as the defense mechanism of the bloodRBCIt is a biconcave disked-shape, central pallor composed of O2 and hemoglobin. It is also responsible for blood gas transportPlateletsIt functions in blood clotting and hemostasisAnticoagulantIt prevents coagulation/clottingClotting Processwound > temporary platelet plug > activate coagulation factors > thrombin activates fibrinogen > fibrinogen is converted into fibrin > fibrin mesh work > clotBuffy Coata thin light colored layer of white blood cells and platelets that lie between a top layer of plasma and red blood WBC-poiesis(suffix) process of formationhemomeans bloodhematomeans blood cell-emiablood conditiongranulocytes and agranulocytesWhat are the two types of leukocytes?GranulocytesA group of leukocytes containing granules in their cytoplasm;neutrophils, eosinophils, basophils.3 types of granulocytesAgranulocytesA group of leukocytes without granules in their nuclei;lymphocytes, monocytes2 types of agranulocytesNeutrophilIf it is not in its normal value it causes bacterial infectionEosinophilIf it is not in its normal value it causes parasitic/allergic reactionsBasophilIf it is not in its normal value it causes hypersensitivityMonocyteIf it is not in its normal value it causes chronic infectionPhlebitisinflammation of a vein-iliaan increase of a specific cell5,000-10,000normal WBC count50 kgAllowed body weight to be able to collect bloodAbioticphysical rather than biological; not derived from living organisms.6.8 - 7.8It is the normal pH of the blood (slightly alkaline)Buffy CoatThe white part than can be found in the plateletErythropoietinA hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.cherry redcolor of blood in the veinsbright redcolor of blood in the arteriesDeoxygenated bloodblood that contains little oxygen which means it can have a high affinity to oxygenafternoonWhen is hemoglobin much higher, in the morning or afternoonphlebogreek word that relates to veinstomygreek word that relates to cuttingphelobotomythe act or practice of bloodletting as a therapeutic measure1. arteries - veins 2. bright red - cherry red 3. with oxygen - without oxygenDifferentiate oxygenated blood and deoxygenatedLungsWhere does blood collect oxygen?Red Blood Cell- noe hemoglobin, no function - for blood gas management - transportation of blood gasWhite Blood Cell- protection against pathogens - defense - fights infection; line of defense inside the body - an increase in this blood cell means there is an infectionMonocyteIt's level is increased when a person has pulmonary disease and cancerliver (atay), lymph nodes (kulani), spleen (lapay), gall bladder (apdo)What parts of the body will help when there is a problem with the bone marrow in RBC productions?Heparinthe naturally occurring anticoagulant inside our body that prevents blood clotting.1.055Average specific gravity of bloodTrueBlood is slightly alkalin with the pH level of 6.8 - 7.93.5-4.5Blood is thick and viscous how many times is it thicker than water?75-85 ml blood/kgHow many ml of blood per kg makes up the body weight?HemoglobinThe specific component of RBC that makes the blood color redphlebotomyopening a vein to collect bloodapproximately 20 grams/100 mL of blood.Total Solid of Bloodphlebitiscomplication of blood extractionMicrocyte/Microcytosisred cells abnormally smallphlebitisinflammation of a veinMacrocyte/Macrocytosisred cells abnormally largeelliptocytosiscells being more elliptical in shape than they usually areSpherocytessmall, spherically shaped erythrocytespoikilocytosispresence of large, irregularly shaped red blood cells-itisinflammationexercise, diet, smoking, posture, diurnal rhythm, stress5 Physiologic Factors Affecting the Test ResultsExerciseIt is a physiologic factor that increases WBC, Platelet, and LDHDietA physiological factor that increases lipid diet, ALP, Hgb (Spectro Method)SmokingPhysiological Factor that increases Hgb, WBC and CortisolPosturePhysiological Factor: shift in posture causes varied resultsPhlebotomistperson skilled in taking blood from veinsStressPhysiological Factor: Increase WBC, Fibrinogen, Factor 1,5,8,10Cytopeniadeficiency of cellsHematomaa solid swelling of clotted blood within the tissues/ body stone; bruisePhlebolithssmall blood clots in a vein that hardens overtime due to calcification-itis(suffix) inflammation ofSchistocytesRBC fragmentssplenectomysurgical removal of the spleenThrombosisblood clotNephropathydisease of the kidneyRespiratory acidosistoo much CO2 or other by-products of cellular respiration, inside the bodyBuffering Actioncorrecting of pHlithsstonesPhlebostasisabnormally slow venous blood circulationPhlebostasisbalance in the blood extractionPhlebotomist, Blood Vessel, Methodology, MaterialsRequirement for Phlebotomycalm tone of voicecalms anxious patientscalm tone of voice, compassionate & kind, steady hands, sharp mind, cheerful, communication skills, high level of patience, strong feetphlebotomist's anatomycompassionate & kindhas a big heartsteady handscontrols hand movements during venipuncture proceduresstrong feetthere is a lot of standinghigh level of patiencesome individuals may require special attentionsharp minddeals with the challenges of workcheerfulsmiles to patientscherry redcolor of blood in the veinsblood redcolor of blood in capillariesbright redcolor of blood in arteriesmedian cubital veinpalpable, less painful, less movablebasilic veinvisible, palpable, very painful, main reason: on top of arteriescephalic veinvisible, palpable, very movable, painfulmedian cubital, cephalic, basilicMajor Site of Blood ExtractionSyringe Method, Vacutainer, Butterfly Method, Capillary MethodMethodology in Phlebotomysyringe methodless complicated, has variety of needle, most familiar methodhigh risk to be punctured, limited volume of blood, contamination risk,disadavantage of syringe methodneedle, adapter, tube holderMaterials to be used in Vacutainer Methodmultiple volume, less contaminationVacutainer Method Advantagebigger needle, complicated, pricy, very painfulVacutainer Method DisadvantageButterfly Methoduses specialized syringe with wingsvery small (good for fragile vein), can use multiple tubeButterfly Method Advantageperipheralwhat area should we collect blood in caplillary methodbest used for fragile veinCapillary Method Advantagesmall amount of blood, chances of tissue juice to mix with bloodCapillary Method DisadvantagePatient Identificationmost criticale stage in phlebotomyMislabelingMortal sin of a phlebotomist15 to 30-45 degreesAngle Considerations in Venipuncture3-4 inches (7.5-10 cm from the puncture site)American Tourniquet Application1-3 inchesFilipino Tourniquet application2 minutesallowable time for venipuncture1 minuteallowable time for venipuncture in hematologyhemoconcentration, hemolysis, shortened coagulation testingeffects of prolonged tourniquet applicationhemoconcentrationthe increase in proportion of formed elements to plasma caused by the tourniquet being left on too long.1-1.5 inchlength of needle in venipuncture21g for 5cc, 23g for 3ccneedle size for venipunctureprolonged tourniquet application frothing of blood smaple (no bubbles) too small needle bore excessive agitation contamination in the tube (i.e moisture)Causes of HemolysisEcchymoses(bruise) purplish flat discolorationEcchymosesmost common complication, due to the leakage of blood to the peripheral tissueEcchymoseslarge venous hemorrhages into subcutaneous tissuePurpurageneral termnfor bleeding from capillaries into the skin and mucosaSyncope/Fainting2nd most common complicationHematomapurplish color, bulgy, swollenHematomacaused by large amount blood to the skinPetechiaeminute hemorrhages from smaller vesselshemolysisdestruction of red blood cells-lysis(suffix) separation; destruction; looseningTelangiectasiaspider like dilations of small vessels (i.e capillaries)1. obesity 2. IV Therapy 3. burned, damaged, scarred and occluded veins 4. seizures and tremors 5. vomiting and choking 6. allergies 7. mastectomy patientsproblems in venipuncture (7)5-10 minuteshow long can you stop IV for blood extractionsecchymoses, syncope/fainting, hematoma, failure to draw blood, petechiae, hemoconcentration, hemolysis, edemaComplications in Venipuncture (8)Antiglycolytic Agentinhibits the use of glucose by blood cellsClot Activatorspeed up clotting/coagulationsodium flouride(gray tube-8 inversions) ex of antiglycolytic agentAntiglycolytic agentIt is used for glucose determination and blood alcohol determinationglass or silica particleex. (plastic red tube - 5 inversions), thrombin (orange tube - 8 inversions)Gel Separatorother term Thixotropic gelGold TubeExample of Gel Separator (5 inversions)Ethylenediaminetetraacetic acidEDTA meaningEDTAIt is the most common collection tubeHeparinGreen Tube 8 Inversions15-10 u/mloptimal anticoagulant concentration of heparininhibits thrombinaction of heparinanticoagulant of choice for OFT used to test for hereditary spherocytosis, plasma chemistry determinationUses of HeparinAmmonium heparin, Sodium heparin, Lithium heparin3 Heparin FormationsLithium heparinmust not be used for lithium determination but is ideal for chemistry testingSodium heparinmust not be used for sodium and electrolyte panel determinationAmmonium HeparinMust not the used for ammonia determination3.2% Sodium CitrateLight blue 3-4 conversionGel Separatorcontains inert materials that undergoes temporary change in the blood viscosity during centrifugation1:9Anticoagulant to blood ratio for 3.2% Sodium CitratePurple/Lavender8 inversions, tube for EDTAcoagulation testinguses of 3.2% Sodium Citrate1.5 mg/mL of bloodOptimal concentration of EDTAchelated calciumAction of EDTAroutine hema testing, CBCUses of EDTA1. CBC and Retics can be performed on blood stored at room temperature for up to 4 hours 2. WBC, Hct, Plt can be determined up to 24 hours if refrigerated at 4C 3. Alternately can be used for ESR within 2 hours of collection if stored at room temperature or within 6 hours if it is refrigerated. 4. Blood smear can be made within 2 hours of blood collection 5. Insufficient EDTA if tube is overfilled that will result to small clots 6. Excessive EDTA if tube is underfilled that will cause RBC shrinkage leading to decreased Hct, and effect on ESRReminders for EDTAHematomaBrown bulging discoloration due to blood escape from the blood vessel?Vacutainerb. Method use to draw large volume of blood?Butterflyd. Method use to collect large volume of blood from patients with small veins?Butterfly/Capillarye. Methods use to collect blood from patients with thrombotic tendencies?1. Lithium heparin - must not be used for lithium determination 2. Sodium heparin - must not be used for sodium and electrolyte panel determination 3. Ammonium heparin - must not be used for ammonia determination 4. Heparin must not be used for blood smear preparation because it causes morphologic distortion of platelet and leukocytes. 5. Heparin causes bluish coloration of the blood smear background due to its pH 6. Not to be used for coagulation studies because it inhibits thrombin 7. May caused errors in automated cell countingReminders for HEPARINbinds calciumaction of 3.2% Sodium Citrate1. Forceful mixing or an excessive number of inversions can activate platelet and shorten clotting time.Reminders for 3.2% Sodium CitratePhlebitisUse to describe inflammation of veins?PhlebolithsPresence of blood clots in the damage vessel wall?condition in which blood flow to the heart is slow down?Syringe, Butterfly, Vacutainer, CapillaryHow many methodology? EnumerateCapillaryc. Method use to draw small amount of blood?Tourniqueta. Material use to enable veins to be more visible/Butterflyb. Material use to withdraw blood from small vessel?70% isopropyl alcoholc. Material used to cleanse/sterilize puncture site?Vacutainerd. Material use to extract blood via closed system?Lancete. Use to collect blood from capillaries?