S P EC IM EN

C O LLEC TIO N A N D
H A N D LIN G

TYPES O F SPECIM EN

Blood
Urine
CSF
Other body fluids

Proper

patient
Identification is the first
step in sample collection

Patient Identifi
cation Procedure

Conscious Inpatients/

Hospitalized patients
Sleeping patients
Unconscious, mentally
incompetent patients
Infants and children
Outpatient/Ambulatory

BLO O D

Human body contains 5

quarts (4.73L) whole blood
MALE 5-6L WB
FEMALE 4-5L WB
WB 60% plasma
40% cells

 SERUM
1.Some substance are

cleared (LPL)
2.Clearer than plasma
3.Anticoagulants produce
potential interferences

Tim ing ofSpecim en Collection

Fasting
Random
24-Hour
Post-prandial

Factors contributing to the variation

ofresults

EXERCISE

A. Transient or immediate
effect (w/in 1hr)
a. Elevated lactate
b. Elevated alanine
c. Elevated fatty acids

B. Long-lasting effect
- increase activity of
muscle enzymes
AST, CPK, LDH, ALD (Iso
A)

C. Long-term effect
- Elevated concentration of
sex hormones
a. Testsoterone
b. LH
c. Sex hormone binding
globulin

 FASTING
8-12hrs
Elevated glucose, K, Lipids
Prolonged elevated

Bilirubin, TG, glycerol, FFA

and decrease glucose

 DIET
Increase K and TG
2-4hrs - ALP
High protein -

urea,ammonia, urates
Serotonin - urine 5-HIAA
Caffeine - plasma NEFA

Turbidity and lactescence

(4.6mmol/L)
Determinations affected
- BCG method (albumin)
- O-cresophtalein
complexone method
(calcium)

- Acid-ammonium Molybdate
procedure (Inorganic
Phosphorus)
- decrease activity of AMS,
CPK, urease and uricase
- decrease levels of bilirubin
- increase levels of TP

 POSTURE OR POSITION
Preferably supine or

upright sitting position

 TORNIQUET

APPLICATION
One minute application
Prolonged application
hemoconcentration,
anaerobiosis

Chronic effects
- increase WBC count
- increase Hgb
(carboxyHgb)
- increase MCV

 TOBACCO SMOKE

Acute effects
- increase NEFA
- cathecolamines & cortisol
- increase nuetrophil and
mono
- decrease eosinophil

 ALCOHOL INGESTION

- increase lactate, urate,

acetate, and acetaldehyde
-increase GGT and MEV

 STRESS
Affects hormone

secretion
Hyperventilation
Increase lactate
Increase FFA

 DRUGS

- Affects the liver

G eneralm ethod in blood collection

CAPILLARY PUNCTURE (SKIN

PUNCTURE)
1.75mm lancet
<2.0 mm for infants
2-3mm for adults
1.5-2.4mm distance of skin to
bone

 the Cut should be oriented

across the fingerprints to

generate large drop of blood
using single deliberate motion
do not milk to prevent
hemolysis and excess tissue
fluid

Sites
1.Lateral plantar heel
2.Palmar surface of fingers
3.Plantar surface of big toe
4.earlobes

Sites to avoid
1.Edematous areas
2.Cyanotic areas
3.Scarred areas
4.Traumatized areas
5.Heavily calloused areas

 ARTERIAL PUNCTURE
Arterial blood oxygenated

blood w/ bright red color

Preferred for blood gas
analysis and pH measurement
Arterial bleeding is hardest to
control

Sites
1. Radial artery
2. Femoral artery
3. Brachial artery
4. Scalp artery
5. Umbilical artery

 VENIPUNCTURE
Venous blood

deoxygenated
Median cubital best
site and best anchored
vein

Sites
1. Anticubital fossa
2. Wrist
3. Ankle
4. Dorsal aspect of
hands

Sites to be avoided
1. Intravenous lines
2. Burned or scarred areas
3. Areas w/ hematoma
4. Thrombosed veins
5. Edematous arms

6. Partial/radical
mastectomy on one/
both arms
7. Arms w/ fistula
8. Cast(s) on arm(s)

N otes to Rem em ber

Tourniquet application

60mmHg if Bpcuff is used

Disinfection
- No traces of alcohol should
remain to avoid hemolysis and
contamination in glucose
testing

- for ethanol testing,

benzalkonium chloride
soln (zephiran chloride
1:750) should be used

 Needle specifications and

bevel position
21G-22G ideal for blood
collection
23G children
21G,23G,25G - butterfly

 1 or 1.5 inch (1/2 to

inches butterfly
needle)
Color coding for needles
indicates gauge

 Other significant information

Torniquet is applied to

obstruct the returns of

venous blood to the heart
and distend the veins
Cephalic vein is 2nd choice
Median basilic is 3rd

 Ankle and veins is used only

when arm veins are unstable

Sites adjusted to IV therapy
should be avoided
Increased in glucose,
electrolytes, decrease urea and
creatinine IV contamination

- Renin blood level is

collected after 3-day
diet from peripheral vein

Com plications ofVenipuncture

Immediate Local Complications
a. Hemoconcentration
b. Failure of blood to enter the
syringe or vacutainer tube
- excessive pull of the plunger
- piercing the other pole of
the vein

- transfixation of vein
- incorrect bevel
positioning
- absence of vacuum
c. Syncope or fainting

Late Local Complication

a. Thrombosis
b. Thrombophlebitis
c. hematomas

Late General
Complications
a. Serum Hepatitis
b. AIDS

 ARTERIALIZED CAPILLARY

BLOOD
Indwelling umbilical artery
best site for blood gas
analysis
Earlobe is best preferred
site

a.Vascularity
b.Low metabolic

requirements
c. Ease with which it can
be arterialized

 Procedures

1. Warm the earlobe w/

paper towel saturated w/
warm water, 39-42C
2. Flick the earlobe w/
index finger

3. Cleansed the area w/ 70%

alcohol
4. Two heparinized tubes are
placed in the center of the
next drop of blood and
filled to capacity w/o air
bubbles

5. Both ends are sealed in

clay after the insertion
of flea
6. Blood is stirred using a
magnet

Reason for rapid separation of

blood
To prevent glycolysis

2mg NaF/mL of blood - prevents

glycolytic enzyme enolase)
To prevent lipolysis
Certain subs. are very unstable
Prevent shift of electrolytes
Prevent hemolysis
Prevent blood gas exchange

hem olysis
1.Increase enzymes (ACP, ALT,

AST, LD) & inhibits lipase

2.Increase electrolytes (Mg,
Phosphorus, K)
3.Increase TP, Alb and iron
4.Interferes w/ color reaction
5.Affects bilirubin levels

N otes to rem em ber

1000-2000 rcf for 10min

Electrolytes are affected by

evaporation of specimen prior

to testing
LDH 4&5 iso (decrease) and
ALP (increase) affected by
low temp

 Specimens that require chilling

ammonia, blood gases,

cathecolamines, gastrin, lactic

acid, renin, PTH, and pyruvate
Photosensitive analytes
bilirubin, beta-carotene,
folate,porphyrins and Vit. A & B6

Anticoagulants

Oxalate
Combines w/ Ca to form an
insoluble salt
Interferes w/ Na, K and
BUN
Concentration: 1-2mg/mL

Citrate
Combines w/ Ca in a
non-ionized form
Concentration: 3.2-3.8
g/dL in a ratio of 1 part
to 9 parts of blood

EDTA
Combines w/ Ca in a
process called chelation
Concentration: 1-2mg/mL
Uses: CEA and lead testing

Flouride
Formimg weakly
dissociated Ca
components
Interferes w/ Na, K, BUN
Concentration: 10mg/mL

Heparin (mucoitin polysulfuric

acid)
Acts as antithrombin and
antithromboplastin; anti-Factor
X; ideal universal anticoagulant
Available as Na, Lithium, K and
ammonium salts

 concentration; 0.2mg/mL
Uses: NH3,

carboxy/methemoglobin, plasma
hemoglobin, pH and blood gas,
cytogenic studies (sterile tubes)
Lithium heparin glucose, BUN,
ionized Ca, elec and crea

10 com m on Errors in Specim en Collection

1. Misidentification of patients
2. Mislabeling
3. Short draws/wrong

anticoagulant to blood ratio

4. Mixing problems/clots
5. Wrong tubes/anticoagulant

6. Hemolysis/Lipemia
7. Hemoconcentration
8. Exposure to light
9. Improperly timed specimen
10. Processing errors: incomplete
centrifugation, incorrect log-in,
improper storage

Reasons for specim en

rejection
1.Hemolysis
2.Clots
3.Non-fasting specimen
4.Short draws
5.Improper transport
6.Errors between labelling and
test request

7. Unlabeled
8. Contaminated
specimen