Phlebotomy 5 - Laboratory, Order Of Draw, "Test Tubes, Additives And Tests"

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Phlebotomy 5 - Laboratory, Order Of Draw, "Test Tubes, Additives And Tests"

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The process by which blood vessels are repaired after an injury. It starts from vascular contraction as an initial reaction to injury, then to clot formation, and finally removal of the clot when the repair to injury is done. 
Four stages of Hemostatis
1. Vascular phase2. Platelet phase3. Coagulation phase4. Fibrinolysis
Stage one of hemostatis
Injury to a blood vessel causes it to constrict, slowing the flow of blood
Stage two of hemostatis
Injury to the endothelial lining causes platelets to adhere to it.Additional platelets stick to the site, forming a temporary platelet plug in a process called 'aggregation.'Vascular phase and platelet phase comprise the primary hemostatis. Bleeding time test is used to evaluate primary hemostatis.
Stage three - coagulation phase
Involves a cascade of interactions of coagulation factors that converts the temporary platelet plug to a stable fibrin clot. The coagulation cascade involves an intrinsic system and extrinsic system, which ultimately come together in a common pathway.
Activated partial thromboplastin time (APTT) - test used to evaluate the intrinsic pathway. This is also used to monitor heparin therapy.
Prothrombin time (PT) - test used to evaluate the extrinsic pathway. This is also used to monitor coumadin therapy.
Stage four - Fibrinolysis
This is the breakdown and removal of the clot. As tissue repair starts, plasmin (an enzyme) starts breaking down the fibrin in clot. Fibrin degradation products (FDPs) measurement is used to monitor the rate fibrinolysis. 
Warmed Specimen
Some tests require that the specimen collected be kept warm until the serum is separated from the cells. 
Blood is collected in tubes pre-warmed in the incubator (or Chemical hand warmer) for 30 minutes.
Chilled Specimens
Some test require that the specimen collected be chilled immediately after collection in an ice and water mixture. The specimen then must be immediately transported to the lab for processing.
Light-sensitive specimens
wrap in aluminum foild immediately after they are drawn.
Exposure to light coudl alter the test results for: Bilrubin, beta-carotene, Vitamins A and B6, and porphyrins.
Cold Agglutinins
C.A. are antibodies produced in response to Mycoplasma pneumoniae infection (atypical pneumonia). The antibodies formed may attach to red blood cells at temperatures below body temperature, and as such, the specimen must be kept warm until the serum is separated from the cells. Blood is collected in red-topped tubes pre-warmed in the incubator at 37 degrees Celsius for 30 minutes.
Chilled specimens
Some tests require that the specimen collected be chilled immediately after collection in crushed ice or ice and water mixture. Likewise, the specimen must be immediately transported to the laboratory for processing. Some of the tests that require chilled specimen are: arterial gases, ammonia, lactic acid, pyruvate, ACTH
Specimens that require Chilling
- ammonia- Arterial Blood Gases (also determine PH)- Gastrin - Glucagon- Lactic Acid- Parathyroid Hormone- Partial Thromboplastin Time- Prothrombin Time
Specimens that require protection from Light
- Bilirubin-Carotene-Red Cell Folate- Serum Folate- Urine Porphyrins- Vitamin B12
Specimens requiring 37 degree Celsius Collection and transportation
- Cold agglutinin- Cryofibrinogen- Cryoglobulin (Cryoprotein)
Order of draw recommended by National Healthcareer Association
1. blood culture or vials2. sodium citrate tubes (e.g. blue tops)3. Serum tubes with or without clot activator or gel (e.g. red tops)4. Heparin tubes (e.g. green tops)5. EDTA tubes (e.g. lavender tops)6. Oxalate/fluoride tubes (e.g. gray tops)
what should you do if a light blue is the only tube to be drawn
draw a red top tube first to eliminate potential contamination from the skin or needle.
This is done to prevent thromboplastin released by the venipuncture from entering the light-blue tube and interfering with the coagulation studies. 
Color Tube for EDTA
Lavender top
Color tube for heparin
Green top
color for Serum tube with or without clot activator or gel
red top
Color for sodium citrate tube
blue top
Color for oxalate/fluoride tube
Gray top
Lavender top tube 
ADDITIVES- contains EDTA, which inhibits coagulation by binding to calcium present in the specimen.- K3 EDTA- Freeze-dried Na2
GENERAL-for whole blood hematology determinations. - Tube inversions prevent clotting.
- must be filled at least two-thirds - inverted eight times.
COMMON TESTS- CBC (complete blood count)- Complete blood count with auto diff.- RBC count, WBC count, Platelet count, WBC differential count- Hemoglobin and Hematocrtit determinations- ESR (Erythrocyte Sedimentation Rate)-Sickle Cell Screening- Cylcosporin- Lupus erythematosus (LE) prep-Reticulocyte Count
Light-blue top tube
ADDITIVE- Contains the anticoagulant Sodium Citrate, which also prevents coagulation by binding calcium in the specimen- Different ratios
GENERAL- coagulation is also a part of hematology- used for coagulation studies and determinations because it preserves the coagulation factors.- must be filled completely to maintain the ratio of nine parts blood to one part sodium citrate, and- should be inverted three or four times. prevents clotting. -Note: certain tests require chilled specimens
COMMON TESTS: - Prothrombin time (PT) - evaluates the extrinsic system of teh coagulation cascade and monitors Coumadin therapy.- Partial Thromboplastin Time - (PTT) - Evaluates the intrinsic system of the coagulation cascade and monitors Heparin therapy.- Activated partial thromboplastin time (APTT)-Thrombin time (TT)- Prothrombin time (PT)- Bleeding time (BT)
Green top tube
ADDITIVE- sodium heparin- lithium heparin- ammonium heparin

GENERAL- for plasma determinations in chemistry- tube inversions prevent clotting.- needs to be inverted 8 times
COMMON TESTS- Chemistry tests: performed on plasma such an Ammonia, carboxyhemoglobin and STAT electrolytes
Gray top tube
ADDITIVE- Potassium oxalate (prevents clotting by binding calcium)- Sodium fluoride (preserves glucose for 3 days)- Lithium iodoacetate (preserves glucose for 24 hours)- Lithium iodoacetate/lithium heparin
GENERAL- contains glucose preservative (antiglycolytic agent)- Tube should be inverted 8 times- Glycolytic inhibitors stabilize glucose values for up to 24 hours at room temperature with iodoacetate, for at least 3 days with fluoride.- Tube inversions ensure proper mixing or additive with blood- Oxalate and heparin, anticoagulants, will give plasma samples
COMMON TESTS- Fasting blood sugar (FBS)- Glucose tolerance test (GTT)- Blood alcohol levels- Lactic acid measurement 
Red/gray (speckled) top tube
ADDITIVE- Clot activator (glass particles, silica and celite which hastens clot formation - 15 minutes)-thixotropic gel, a serum separator. when centrifuged, it forms a barrier between the serum and the cells preventing contamination of the serum with cellular elements.
GENERAL- also called 'tiger-top," 'serum separator," "SST", "Marble Top", "Gel"- invert 5 times- SST tube for serum determinations in chemistry- Tube inversions ensure mixing of clot activator with blood and clotting within 30 minutes
COMMON TESTS- Most chemistry tests- Albumin- Aldosterone- Alk Phosphatease - ALk PhosAlanine Amino Transferase - ALTAmylaseAndrostendoioneAspartate Amino Transferase - ASTBasic Metabolic PanelBilirubin- DirectBilirubin - TotalBlood Urean Nitrogen - BUNCancer Antigen - 125 - CA -125CalciumCarcinoEmbryonic AntigenChlorideCholesterolCreatinine Kinase - CKCK-MBCO2 - Carbon dioxideComp. Metab. PanelCortisol - AMCortisol - PM- Epstein Barr Virus- EstradiolEstrogens- TotalFerretinFolic Acid - SErumFree T4 - Free ThyroxineFollicle Stimulating Hormone - FSHGamma-Glutamyl Transpeptidase GGTHCG QUalitativeHCG QuantitativeHepatic Function PanelIron Lactate Dehydrogenase - LDHLeutinizing Hormone - LHLipid Panel- Magnesium- Phosphorus- Potassium- Progesterone- Prolactin- Protein- Prostate Specific Antigen - PSA- SodiumT3 UptakeT4 thyroxineTestosterone serumtheophyllinethyroid paneltotal iron binding capacity - TIBCtotal T3TriglyceridesThyroid Stimulating Hormone - TSHURic acidVitamin B12
Red top
ADDITIVE- none - additive or anticoagulant
GENERAL- plain vaccum tube- no inversions- collected blood clots by normal coagulation process in 30 minutes- used for serum determinations in chemistry, serology and blood banking- Also frequently used as a discard tube
COMMON TESTS- Serum chemistry tests- serology tests- blood bankAnti nuclear antibodiesDigoxinDilantinDirect CoombsH. PyloriHBsAg - Hepatitis B surface AntigenHIVInfectious MonoPhenobarbitol LithiumRheumatoid FactorRotavirusSyphillis Serology - RPRTegretol TheophyllineValporic AcidVancomycin
Pink top
ADDITIVES- contains potassium EDTA
GENERAL- used by Blood Banks for molecular and testing of viral loads
Royal Blue
ADDITIVES- Sodium heparin (8 inversions)- Na2 EDTA (8 inversions)- NONE
COMMON TESTS- for trace element (lead)- toxicology determinations-Special stopper formulation offer lowest verified levels of trace elements available.
Brown test tube
ADDITIVE- Sodium heparin (8 inversions)
COMMON TESTS- For lead determinations.- certified to contain less than .01 ug/ml (ppm) lead
Yellow tube
ADDITIVE- Sodium polyanetholesulfonate (8 inversions)
GENERAL - For blood culture specimen collections in microbiolog