KEIZZY MARIE P.

YRAUDA

CHAPTER 9 : HANDLING AND PROCESSING OF BLOOD SPECIMENS DOR LABORATORY TESTING

The result test is compromised when the proper collection procedures, processing and transporting
protocol are not followed in the pre-analytical phase.

Routine handling

Phlebotomist should have knowledge and skills to perform routine venipuncture, be careful in handling
specimens, and be mindful to time limits set for delivery of specimen to the laboratory.

 Mixing tunes by inversion- some specimens require gentle inversion to evenly distribute the
additives.
 Transporting specimens – rough/ improper handling can lead to undesirable condition which
might damage the specimen.

Special handling

A special care to the specimen to protect its condition and quality.

 Body temperature- the specimen must have a temperature of a normal body (37°C)
 Chilled specimen – specimen must be chilled to slow the metabolic process.
 Light- sensitive Specimen – some specimens must be wrapped that it cannot be exposed to
light.

Blood specimen processing and specimen rejection

The collected specimen will be transported to the central processing where they are:

1. Identified
2. Logged
3. Sorted by department and type
4. Evaluated foe specimen sustainability

Specimens will be rejected for the following reasons:

7. Specimen is not Identified properly 1. Contaminated specimen

8. Inadequate volume 2. Insufficient specimen
9. There is hemolysis 3. Incorrect collection time
10. Wrong tube 4. Specimen is exposed to light
11. Tube is outdated 5. Procedure did not follow testing time limits
12. Improper handling 6. There’s a delay or error in processing
KEIZZY MARIE P. YRAUDA

DELIVERY TIME LIMITS AND EXCEPTIONS FOR DELIVERY AND PROCESSING SPECIMENS

Delivery time limits – routine blood specimen must reach the laboratory within 45 minutes

Time limit exceptions – specimen that is marked with “STAT” or “Emergency ” takes priority.

1. Blood smear from EDTA specimen – prepared 1 hour from collection

2. EDTA specimen for CBC
3. EDTA Specimen for erythrocyte sedimentation rate (ESR) – tested 4 hours in room temperature;
12 hours refrigerated.
4. EDTA specimen for reticulocyte counts – 6 hours at room temperature; 73 hours refrigerated.
5. Glucose test in sodium fluoride tubes – 24 hours at room temperature; 48 hours when
refrigerated at 2°C – 8° C
6. Prothrombin time (PT) – stable for 24 hours and partial thromboplastin time (PTT) should be
analyzed within 4 hours

Centrifugation

 A centrifuge is an apparatus that is used to separate cells, plasma, or serum of blood specimens
by spinning
 Plasma specimen collected in tubes with anticoagulants should be centrifuged immediately and
without delay
 The serum specimen needs to be completely clotted prior to centrifugation that takes around 30
to 60 minutes at room temperature

Aliquot Preparation

1. An aliquot specimen refers to a portion of a sample specimen taken for chemical analysis.
2. It is prepared on multiple test are ordered on a single specimen.

OSHA Act (RA 11058)- Required Protective Equipment Worn When Processing Specimen

Healthcare institutions should comply with the appropriate protective equipment set by the
Occupational Safety and Health Standards Act including gloves, lab gowns, and masks because
Healthcare workers are exposed to potentially infections material.
KEIZZY MARIE P. YRAUDA

CHAPTER 10: HANDLING AND PROCESSING OF NON-BLOOD SPECIMENS FOR LABORATORY TESTING

Non-blood specimen for laboratory

Urine

Urine analysis helps in monitoring wellness, diagnosing and treating urinary track infections detecting
and monitoring the progress of treatment in metabolic diseases, and identifying the effectiveness of an
administered therapy.

Common Urine test

 Routine Urinalysis – forms part of the physical examination procedure and does not only cover
physical analysis but also chemical analysis
 Urine Culture and Sensitivity (C&S) – it is requested if the patient has symptoms of UTI. Urine is
cultured on a special nutrient medium for 18-24 hours.
 Urine Cytology Studies – used to detect cancer, cytomegalovirus, and other viral and
inflammatory diseases in the urinary system.
 Urine drug testing – this test is done to detect : illicit use of recreational drugs, use of anabolic
steroids, unwarranted use of prescription drugs. It also monitors therapeutic drug use.
 Urine Glucose and Ketone Testing – it is performed to screen diabetes and to determine the
level for patients who are diabetic.
 Urine Pregnancy Testing – used to confirm pregnancy which can be detected 8-10 days after
conception.
 Other urine tests – chemistry tests of urine including electrophoresis, heavy metals, myoglobin
clearance, creatinine clearance, and porphyrins.

Types of urine samples:

 Random – collected at any time

 First morning/ 8-hour urine specimen- collected after waking up from 8 hours of sleep
 Fasting – a second specimen voided after fasting.
 Timed – collected at specific times
a. Tolerance test – fasting, ½ hour, hour, etc.
b. 2 hour postprandial – 2 hours after meal.
c. 24 hour – collection and pooling of urine that is voided in 24 hours (collect urine prior to
bowel movement)
d. Double voided - waiting time of approximately 30 minutes after emptying the bladder

Urine collection methods

 Regular voided the patient voids or urinates into a clean container

 Midstream the patient of voids or urinates into the toilet first interrupts the urination for a while
and then restarts into the container read the last urine flow voided in the toilet
 Midstream clean – catch special cleaning is performed on the genital area of the patient before
collection
 Catheterized – urine of patient is collected from a sterile catheter inserted through the urethra
into the bladder
KEIZZY MARIE P. YRAUDA

 Suprapubic – aspiration urine of patient is collected by inserting needle directly into bladder
 Pediatric – when the patient is a child who is not potty trained urine is collected in a plastic bag
and check every 15 minutes until the required volume is collected

Amniotic fluid

Amniotic fluid is a clear colorless the pale yellow liquid contained in the amniotic sac. It is collected by
the physician using transabdominal amniocentesis preferably 15 weeks after gestation

Cerebrospinal Fluid

Refers to the liquid that surrounds the brain and spinal cord. It is clear and colorless and is obtained by
the physician using a lumbar puncture or spinal tap. It is used to diagnose meningitis and other
disorders.

Gastric fluid/ Gastric Analysis

The gastric analysis is performed to check the contents of the stomach for abnormal substances and
overweight the production of acid.

Nasopharyngeal Secretions

These specimens are collected and cultured to determine the presence of bacteria that can cause
diphtheria, meningitis, pertussis and pneumonia .

Saliva

Saliva is the fluid secreted by the glands inside the mouth, is used to track the hormone levels and to
determine alcohol and drug or substance abuse.

Semen

Analysis of semen is done to evaluate the fertility and assess the effectiveness of sterilization after a
vasectomy procedure, but it is also ordered for forensic or legal reasons such as criminal investigations
involving sexual assault.

Serous fluid

This serum light fluid is pale yellow in color and watery and its main function is to allow the membranes
to pass through each other with minimal friction. An effusion or increase and volume indicates
inflammation, infection, or decrease in the serum protein level.

Sputum (mucous/phlegm)

Sputum specimens are used to diagnose and/ or monitor lower respiratory tract infections like
tuberculosis.

Sweat

Sweat is used to analyze the chloride content of patients under the age of 20 with symptoms of cystic
fibrosis. It can also be used to determine illegal use of drugs by placing patches on the skin for an
extended period of time which is further confirmed by subsequent drug testing.
KEIZZY MARIE P. YRAUDA

Synovial Fluid

It is a viscous fluid that lubricates movable joints and is tested to determine conditions such as
arthritis,gout, and other inflammatory conditions. The fluid is collected in three tubes:

 EDTA/ Heparin – cell counts, ID of crystals, smear preparation

 Sterile – culture and sensitivity
 Non-additive – macroscopic appearance, chemistry, immunology tests, and observing clot
formation

Buccal ( Cheek) Swabs

The buccal swab is used to obtain loose cells inside the cheek for purposes of DNA analysis.

Bone marrow

Used to examine to identify blood diseases

Breath samples

 C-urea breath test checks for the presence of helicobacter pylori which is a type of
bacteria that damages the stomach lining.
 Hydrogen breath test helps in detection of carbohydrate digestion problem. It also helps
detect bacterial overgrowth the small intestine and is thought as the most accurate
tolerance test.

Feces (Stool)

The specimen is collected to determine gastrointestinal disorder, to analyze for the presence of
intestinal ova and parasites, to be cultured examined for the presence of pathogenic bacteria and
viruses, to check fat and urobilinogen content, or to test for the presence of occult blood.

Hair

The sample can be used to analyze for trace and heavy metals, and can also be used to detect chronic
drug abuse where hair is the preferred specimen.

Throat Swabs

Throat Swabs are mostly collected to aid in streptococal (strep) infection detection.

Tissue specimen

The tissue specimen is usually collected using biopsy through which the tissue sample is removed for
examination.