Phleb Study Guide
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| Phlebotomist job opportunities can be in | Physician office, Reference Labs, Urgent Care Ctrs, Nursing homes & Wellness clinics
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| Function of the circulatory system | Deliver O2, nutrients, hormones & enzymes to cells; transport cellular waste (CO2), Urea to lungs, kidney to be expelled from body.
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| More circulatory function | A transport system where blood is the vehicle; the blood vessels, the tubes, and the heart work as the pump
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| Heart has how many pumps | Two - Right and Left
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| What are the two heart circulations | Pulmonary and Systemic
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| Function of Pulmonary circulation | Carries deoxygenated blood from the right ventricle to lungs and returns oxygenated blood from the lungs to the left atrium
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| Oxygenation of blood occurs in: | The Alveoli
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| Function of the Systemic circulation | Carries oxygenated blood from the left ventricle throughout the body
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| What are the chambers of the heart? | Two chambers:- the Atrium and the Ventricle
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| What the valves of the right heart? | Tricuspid and Pulmonic
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| What kind is the Tricuspid valve | Atrioventricular valve
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| What kind is the Pulmonic valve | Semi lunar valve
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| What is the location of the Tricuspid | Between the right atrium and right ventricle
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| What is the location of the Pulmonic | Between the right ventricle and the pulmonary artery
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| What are the valves of the left heart? | Mitral (Bicuspid) and Aortic valves
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| What kind of a valve is the Mitral? | Atrioventricular
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| What kind of valve is the Aortic? | Semilunar
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| What is the location of the Mitral valve? | Between the left atrium and left ventricle
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| What is the location of Aortic valve | Between the left ventricle and the Aorta
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| Heart has how many layers | Three
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| What are the three layers of the heart? | Endocardium, Myocardium & Epicardium
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| What is the Endocardium? | Endothelial inner layer lining of the heart
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| Myocardium? | Muscular middle layer. Contractile element of the heart
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| Epicardium? | Fibrous outer layer. Coronary arteries which supply blood to the heart are located here.
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| Name the blood vessels | Aorta, arteries, arterioles, capillaries, venules, veins, superior & inferior vena cavae
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| Except the capillaries, blood vessels are composed of three layers | Tunica adventitia (Outer), tunica media (Middle) & tunica intima (Inner)
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| What vessels carry oxygenated blood from the heart? | Aorta, arteries, and arterioles
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| What vessels carry deoxygenated blood back to the heart | Venules, veins and the Superior & Inferior vena cavae
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| Capillaries are composed of: | Endothelial cells
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| What connects the arterioles & venules? | Capillaries
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| Capillary blood is a mixture of? | Arterial and venous blood
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| Average adult has how many liters of blood? | 5-6 liters
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| What is the liquid portion of blood? | Plasma
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| What is the cellular portion of blood? | Formed elements
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| Plasma is comprised of 55% of? | Blood, proteins, amino acids, gases, electrolytes, sugars, hormones, minerals vitamin and 92% water and urea
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| Formed elements constitute 45% of blood | Erythrocytes, leukocytes, and thrombocytes
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| Blood cells originate from? | Stem cells in the bone marrow
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| Erythrocytes contain? | Hemoglobin (O2 carrying protein)
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| What is a reticulocyte? | An immature erythrocyte
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| How many RBCs are in a microliter of blood? | 4.2 - 6.2 million
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| What is the normal life span of an RBC? | 120 days
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| What are leukocytes? | White blood cells
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| What is the function of leukocytes? | Protects body from infection
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| What is normal WBC per microliter? | 5 - 10 thousand
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| What is leukocytosis? | An increase in WBCs in cases of infection
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| What is leukopenia | Decrease of WBCs in cases of viral infection of chemo
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| How many types of WBCs are there? | Five
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| What are the types of WBCs? | Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils.
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| Function of Neutrophils? | They are phagocytes that eat bacteria. First to arrive at infection site. They Fights infection. Increase in a bacterial infection. Most numerous.
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| Lymphocytes | Fights Immunity. Second most numerous. Increase in cases of viral infection
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| Monocytes | Fight intracellar infections. Largest WBCs. Monocytes in blood, but macrophages in tissues and become phagocytes. Increase with infections and tuberculosis
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| Eosinophils | Fights allergies (antibody-labeled foregin molecules). Increase in allergies, skin and parasitic infections
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| Basophils | Carry histamine which is released in allergic reactions
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| What are thrombocytes? | Are platelets - small irregularly shaped packets of cytoplasm formed in the bone marrow. Essential for blood coagulation. Average number 140 - 440 thousand microliter.
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| What is the life span of thrombocytes? | 9 - 12 days
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| What is HEMOSTASIS? | Process by which blood vessels are repaired after an injury.
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| Hemostasis has how many stages? | Four
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| Name the four stages of Hemostasis | Vascular, Platelet, Coagulation & Fibrinolysis
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| What is the vascular phase? | Injury to a blood vessel causes it to constrict slowing the flow of blood
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| Platelet phase? | Forms a temporary platelet plug to an injury
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| What is aggregation? | Process where additional platelets stick to injured site forming a plug
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| What are the primary phases of hemostasis? | Vascular and Platelet phases
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| Coagulation phase? | Coagulation factors form a temporary platelet plug to a stable fibrin clot. It involves the intrinsic and extrinsic pathways.
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| What is the intrinsic pathway? | a sequence of reactions leading to fibrin formation, beginning with the contact activation of factor XII, and resulting in the activation of factor X to initiate coagulation
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| What is the extrinsic pathway? | the mechanism that produces fibrin following tissue injury, beginning with formation of an activated complex between tissue factor and factor VII and leading to activation of factor X, inducing the reactions of coagulation.
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| Activated partial thromboplastin time (APTT) | Test used to evaluate the intrinsic pathway. Monitors heparin therapy
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| Prothrombin time (PT) | Test used to evaluate the extrinsic pathway. Monitors coumadin therapy
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| Fibrinolysis | Breakdown and removal of a clot
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| Fibrin degradation products (FDPs) | Measurement used to monitor the rate of fibrinolysis
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| What is the preferred venipuncture site? | Antecubital fossa of upper extremities
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| Name major veins in the antecubital area: | Median cubital vein, Cephalic vein, & Basilic ven
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| Median cubital vein | Vein of choice. Large and does not move when needle is inserted
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| Cephalic vein | Second vein choice. Usually difficult to locate and has tendency to move. Often best used for obese patient
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| Basilic vein | Third choice. Least firmly anchored. Located near brachial artery. Usually painful.
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| Unsuitable venipuncture veins are: | Sclerosed, Thrombotic & Tortuous veins
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| 70% Isopropyl alcohol pads | Commonly used to clean site.
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| Winged infusion (butterfly) sets are used: | On small veins, elderly and ped patients
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| Sterile syringes and needles | 10-20ml syringe is when the vacutainer method cannot be used
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| Most common size of a butterfly needle | Is 23gauge, 1/2 to 3/4 inch long
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| Needle sizes differ in: | Length and gauge. 1" and 1.5" long are routinely used
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| What is a gauge? | Diameter of the bore of a needle
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| The smaller the gauge? | The bigger the diameter of the needle - e.g., 23gauge (small needle)
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| The larger the bore? | The smaller the diameter of needle - e.g., 16 gauge (large needle)
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| Needles smaller than 23 gauge not used in drawing blood because | They can cause hemolysis
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| What is hemolysis | Breakdown or destruction of RBCs
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| Hematoma | Blood accumulation in the tissue surrounding vein
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| Hemoconcentration | Increase in propostion of formed elements to plasma due to tourniquet left for too long (more that 1min
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| Phlebitis | Inflammation of vein due to repeated venipuncture
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| Petechiae | Tiny non-raised red spots on skin from rupturing of capillaries due to tourniquet left too long or too tight
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| Thrombus | Blood clot due to insufficient pressure applied after needle withdrawal
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| Thrombophlebitis | Inflammation of a vein with clot formation
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| Septicemia | Systemic infection due to presence of pathogenic organism during venipuncture
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| Trauma | Injury to underlying tissues caused by probing of needle
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| Factors to consider before performing venipuncture | Fasting, Edema & Fistulas
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| Fasting | Required for glucose, cholesteral, triglycerides tests. Patient abstain from eating for at least 12hrs
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| Edema | Accumulation of fluid in the tissues
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| Fistula | Permanent surgical connection between an artery and a vein. Used for dialysis procedures
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| Analytical errors before collection | Patient misidentification, Improper time of collection, Wrong tube, Inadequate fast, Exercise, Patient posture, Poor coordination with other treatments, improper site preparation, medication inteference
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| Analytical errors during collection | Extended tourniquet time, Hemolysis, Wrong order of draw, Failure to invert tubes, Faulty technique, under filling tubes
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| Analytical errors after collection | Failure to separate serum from cell, Improper use of serum separator, processing delays, exposure to light, improper storage conditions, rimming clots
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| Fasting speciments | Require collection when patient is in the basal state (fasted for 12hrs)
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| Timed specimens | Used to monitor level of specific substances or condition in patient - e.g. cortisol hormone, digoxin and hemoglobin levels
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| Two-hour Postprandial Test | Used to evaluate diabetes mellitus. Compared with the level 2hrs after eating
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| Oral Glucose Tolerance Test (OGTT) | Used to diagnose diabetes and evaluate pts with frequest low blood sugar.
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| 3-hour OGTT | Used to test hyperglycemia
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| 5-hour OGTT | Used to evaluate hypoglycemia
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| Therapeutic Drug Monitoring | Used to monitor blood levels of certain meds to ensure pt safety and maintain plasma level.
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| Trough (Lowest blood level) | Blood collected 30min before scheduled dose for therapeutic drug monitoring
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| Peak (highest blood level) | Collection depend on medication, patient's metabolism and routine of administration
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| Blood Cultures (BC) | Ordered to detect presence of microorganisms in pt's blood. BCs are usually STAT or timed
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| PKU | Ordered for infants to detect phenylketonuria.
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| Cold Agglutinins | Are antibodies produced in response to Mycoplasma pneumoniae infection. Specimen must be kept warm until serum is separated from the cells. Blood is collected in red-topped tubes pre-warmed at 37 degrees C
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| Chilled specimens | Require chilled immediately after collection in crushed ice or ice and water mixture.
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| Chilled specimens examples | Arterial blood gases, ammonia, lactic acid, pyruvate, ACTH, gastrin, and parathyroid hormone
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| Light-sensitive specimens | Are protected from light by wrapping the tubes in aluminium foil immediately after they are drawn. Test are Bilirubin, beta-carotene, Vitamins A & B6 and porphyrins
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| Dermal punctures | Microcapillary collection
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| Lancets are used for | Dermal punctures which delivers a depth of from 0.85mm for infants and 3.0 for adults
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| Infants dermal puncture site | Medial and lateral areas of the plantar surface of foot. Medially from middle of great toe to heal and laterally from middle of fourth and fifth toes to heel
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| Older children and adult dermal puncture sites | Distal segment of the third or fourth finger of non-dominant hand.
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| Order of draw for capillary speciments | a) Lavender tube
b)Tubes with other additives
c) Tubes without additives
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| Order of draw for all other specimens | Because - Blood cultures
Better - Blue top (sodium citrate)
Specimens - Serum tubes (red tops)
Generate - Green (heparin)
Perfect - Purple (EDTA)lavender tops
Goals - (gray tops)- oxalate/fluoride tubes
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| Lavender (purple) top tube | Contains ethylenediaminetetraacetic Acid (EDTA)
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| EDTA anticoagulant | Binds to calcium. Tubes must be filled at least 2/3 full and inverted eight times
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| Common tests: CBC | Includes RBC, WBC and Platelet counts; WBC differential, hemoglobin and hematocrit, ESR (Erythrocyte Sedimentation Rate, Sickle cell Screening
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| Light-Blue top tube | Contains anticoagulant Sodium Citrate which also binds to Calcium. Tube must be filled completely and inverted three to four times
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| Common Tests: Coagulation Studies | Prothrombin Time (PT); Activated Partial Thromboplastin Time (APTT, PTT); Fibrinogen Degradation Products (FDP)Thrombin Time (TT); Factor assays, Bleeding Time (BT)
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| APTT | Evaluates the intrinsic system of the coagulation cascade and monitors Heparin therapy
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| PT | Evaluates the extrinsic system of coagulation cascade and monitors Coumadin therapy
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| Green Top tube | Contain anticoagulant Heparin combined with sodium, lithium or ammonium ion.
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| Heparin | Inhibits thrombin in the coagulation cascade. Not used for hematology Tube should be inverted eight times
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| Common Tests: Chemistry tests | Performed on plasma such as Ammonia carboxyhemoglobin & STAT electrolytes
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| Gray top tube | Contains additives and anticoagulants. Contain glucose preservative agent - sodium fluoride. Tube should be inverted eight times
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| Common Tests: Gray tubes | Fasting blood sugar (FBS); Glucose tolerance Test (GTT); Blood alcohol levels; Lactic acid measurement
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| Red/Gray (speckled) top tube | Also called Tiger-top and serum separator tubes (SST). Contain clot activators, e.g., thixotropic gel. Tubes must be inverted five times
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| Red/Gray Common tests | Most chemistry tests
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| Red top tube | Also known as plain vacuum tube and contains no additive or anticoagulant. Collected blood clots by normal coagulation process in 30min.
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| Red top Common tests | Serum chemistry tests; Serology tests; Blood bank
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| Yellow top tube (Sterile) | Contains anticoagulant sodium polyanetholesulfonate (SPS). Used to test microorganisms. Tubes should be inverted eight times
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