Steps Involved in Processing and Handling

Different Types of Specimens

• The accuracy of a test results depends on the proper collection
procedures, storage, processing and transporting protocols
(pre-analytical phase).
• Studies show that approximately 46-68% of errors prior to
analysis.
• It is the responsibility of the phlebotomist to follow all the
PMLS 2
appropriate steps required for each test that they are scheduled
to perform.
Instructor: Cindy Calimlim

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Routine Handling Mixing Tubes by Inversion

• Phlebotomistshould have the knowledge and skills to • Some test require gentle inversion
perform routine venipuncture. of the specimen tube to evenly
• Theyshould be careful in mixing tubes and preparing distribute the additive.
specimens for transport in the laboratory.
• The number of inversions depend
• They should adhere to time limits set for delivery of on the type of additive, but is
specimen to the laboratory except for cases such as usually between 3 to 10 gentle
emergency specimen or other conditions mentioned inversions.
in the time limit exceptions.
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Transporting Specimens
• Handling specimens for transport to the laboratory
Blood culture- SPS 8-10 times
should be done properly because rough handling
Citrate 3-4 times can lead to undesirable conditions which might
Serum tube/ Gel Separator 5 times hemolyze the specimens, activate platelets, and
even break the glass tube.
Heparin 8-10 times

EDTA 8-10 times

Fluoride 8-10 times

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• The specimen tube should be transported
with the stopper to:
Avoid contact between contents and the
stopper. Special Handling
Minimize agitation of the specimen,
Aid clot formation for tubes. • Specialcare is needed when handling blood specimens
to protects its condition and quality
• The tubes are placed in a liquid-tight closure
plastic bags with a visible biohazard logo
and a slip pocket for the appropriate
paperwork or documentation.

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Body Temperature Chilled Specimens

• The specimenwill precipitate or agglutinate if allowed to
cool below body temperature; it should be transported at • Chilling
slows the metabolic process, which could affect
near body temperature of 37⁰C. the result for some specimens.
• The tubes should also be pre-warmed at 37 ⁰C and • Thespecimen tube should be completely submerged in
portable heat blocks are used during transport which could crushed ice and water during transport and
hold the temperature for 15 minutes from removal from immediately tested or refrigerated, if necessary.
the incubator.
• Examples: ACTH, ACE, ammonia, catecholamines, free
• A heelwarmer can be used for specimens that can fatty acids, gastrin, glucagon, homocysteine, lactic acid,
withstand a temperature slightly higher than 37 ⁰C. PTH, pH/blood gas (if indicated), pyruvate, renin.
• Example: Cold agglutinin, cryofibrinogen and cryoglobulins. 9 10

Blood Specimen Processing and

Light-sensitive Specimens Reasons for Specimen Rejections
• Exposure
to light can affect the result of some • The collectedspecimens are transported to the central
specimens, like bilirubin. processing or triage for screening and prioritizing.
• The phlebotomist should wrap the tube with • They are
aluminum foil or use light-blocking or amber- 1. Identified
colored container. 2. Logged or Accessioned
• Examples:Bilirubin, carotene, red cell folate, 3. Sorted by department and type of processing, and
serum folate, Vitamin B2, Vitamin B6, Vitamin 4. Evaluated for specimen suitability which is necessary to get
B12, Vitamin C, Urine porphyrins, and Urine accurate results.
porphobilinogen.
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Any specimen will be rejected for the following
reasons: 7. The specimen is contaminated.
8. Specimen is insufficient or “quality not sufficient”
1. Specimen is not identified properly. (QNS).
2. It has inadequate volume to complete the test. 9. Collection time is incorrect.
3. There is hemolysis. 10. Specimen is exposed to light.
4. Wrong tube for collection is used. 11. Procedure did not follow testing time limits.
5. Tube used is outdated. 12. There is a delay or error in processing.
6. There is improper handling (or improper mixing).
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Delivery Time Limits

• The specimenshould be transported to the laboratory
Delivery Time Limits and Exceptions immediately after collection.
for Delivery and Processing • Routineblood specimen is expected to reach the
Specimens laboratory within 45 minutes.
• Centrifugation needed by the specimen should be done
in 1 hour.
• However, hematology specimens with EDTA, which are
placed in tubes with lavender or purple stopper, should
not be centrifuged.
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Other exceptions to the time limit rule:

Time Limit Exceptions
1. Blood smear from EDTA specimens- prepared 1 hour from
collection.
• The deliverytime limit has some
2. EDTA specimens for CBC- analyzed within 6 hours but is
exceptions. For instance, a specimen stable for 24 hours from collection if stored at room
that is marked “STAT” or temperature.
“emergency” takes priority over all 3. EDTA specimens for ESR determination.
other specimens in terms of 4. Glucose test drawn in Sodium Fluoride tubes.
transportation, processing and
5. Prothrombin time stable for 24 hours
testing.
6. Partial Thromboplastin Time (PTT) should be analyzed
within 4hours from collection.
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 Centrifugation • Itis important to leave the stoppers on the tube before
and during centrifugation to avoid
• A centrifugeis an apparatus that is used  CONTAMINATION
to separate cells, plasma, or serum of  EVAPORATION
blood specimens.  AEROSOL FORMATION
 pH CHANGE
• Centrifugation is achieved by spinning
the blood tubes inside the vessel at a • Tubes should be BALANCED in a centrifuge:
high speed such that the centrifugal  SAME SIZE AND VOLUME of specimen should be placed
opposite one another.
force will cause the separation of the
specimens. • The process of centrifugation should not be repeated.

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• Plasma specimen- centrifuged immediately. Aliquot Preparation

• Serum specimen- Needs to be completely • Analiquot specimen refers to a portion of sample
clotted (30-60 minutes) prior to specimen taken for chemical analysis or testing.
centrifugation.
• It
is prepared when multiple tests are ordered on a single
• A face
shield or splash shield should be used specimen.
during specimen processing.
• The preparation is done by transferring a portion of the
• A gauze or tissue is used to cover the stopper specimen into one or more tubes that are labeled with
to catch drops of blood that may leak or to the same specimen into one or more tubes that are
prevent the aerosol that may be released labeled with the same information as the original
during the process. specimen tube using a disposable transfer pipette.
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• Specimens with different anticoagulants

should not be put in the same aliquot OSHA Act (RA 11058)
tube. Required Protective Equipment Worn When
• The phlebotomist must see to it that the Processing Specimen
tube is covered as soon as it is filled. • When processing specimens in the laboratory,
healthcare institutions/workers should comply with
the appropriate protective equipment set by the
Occupational Safety and Health Standards Act (RA
11058).

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• The protectiveequipment
includes
gloves,
laboratory gowns/coats,
Face shields and
Masks

References:
 Learning Guide for Principles of
Medical Laboratory Science 2 by
Ebuen et.al.
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