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Handling and Processing of Blood Specimens For Laboratory Testing

This document discusses guidelines for properly handling and processing blood specimens for laboratory testing. It emphasizes that strict adherence to collection, storage, transport and testing protocols is important to avoid errors. The key steps covered include routine handling procedures, mixing tubes, transport requirements, special handling for certain specimens, reasons for rejection, time limits for delivery and processing, centrifugation, aliquot preparation, and required protective equipment. Following these procedures is vital for obtaining accurate laboratory results.

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Najibah A. Casim
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160 views

Handling and Processing of Blood Specimens For Laboratory Testing

This document discusses guidelines for properly handling and processing blood specimens for laboratory testing. It emphasizes that strict adherence to collection, storage, transport and testing protocols is important to avoid errors. The key steps covered include routine handling procedures, mixing tubes, transport requirements, special handling for certain specimens, reasons for rejection, time limits for delivery and processing, centrifugation, aliquot preparation, and required protective equipment. Following these procedures is vital for obtaining accurate laboratory results.

Uploaded by

Najibah A. Casim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Handling and Processing of

Blood Specimens for


Laboratory Testing
Lesson 9
• The result of a test is compromised when the proper collection
procedures, storage, processing and transporting protocol are not
followed in the pre-analytical phase

• Studies show that approximately 46 to 68% of laboratory errors occur


prior to analysis
Steps Involved in Processing and
Handling Different Types of Specimens
Routine Handling

• Knowledge and skills to perform routine venipuncture

• Careful in mixing tubes and preparing specimen for transport to the


laboratory.

• They should adhere to time limits set for delivery of specimen to the
laboratory except for cases such as emergency specimen or other
conditions mentioned in the time limit exceptions
Mixing Tubes by Inversion

• Number of inversion depends on the type of additive – usually


between 3 to 10 gentle inversions
Transporting Specimens

• Rough handling can lead to undesirable conditions –


• hemolyze the specimens

• activate platelets

• affect coagulation

• even break the glass tube


Special Handling
Special care is needed when handling blood specimen to protect its
condition and quality
Body Temperature

• 37°C

• Body temperature

• Transport of specimen

• Specimen will precipitate or agglutinate if allowed to cool below body temperature

• Tubes are pre-warmed

• Portable heat blocks are used during transport, which could hold the temperature
for 15 minutes from removal from the incubator
Body Temperature

• Heel warmer
• Used for specimens that can withstand a temperature slightly higher than
37°C

• Examples: Cold agglutinin, cyrofibrinogen and cyroglobulins


Chilled Specimen

• Chilling
• slows metabolic process which could affect the results for some specimens
• Specimen tube should be completely submerged in crushed ice and water slurry
during transport and immediately tested or refrigerated, if necessary

• Examples: Adrenocorticotropic hormone (ACTH), acetone, angiotensin-converting enzyme


(ACE), ammonia, catecholamines, free fatty acids, gastrin, glucagon, homocysteine, lactic
acid, parathyroid hormone (PTH), ph/blood gas (if indicated), pyruvate, and renin
Light-sensitive Specimen

• There are cases when exposure to light can affect the result of a
specimen, like bilirubin

• Wrap the tube with aluminum foil or use light-blocking, amber-


colored container
• Examples: bilirubin, carotene, red cell folate, serum folate, vitamin B2, vitamin B6,
vitamin B12, Vitamin C, urine porphyrins, and urine porphobilinogen
Blood Specimen Processing and Reasons for
Specimen Rejection
The collected specimen are transported to the central processing or
triage for screening and prioritizing.

1. Identified

2. Logged or accessioned

3. Sorted by department and type of processing

4. Evaluated for specimen suitability which is necessary to get accurate


results
Any specimen will be rejected for the following reasons:

1. Specimen is not identified properly

2. It has inadequate volume to complete the test

3. There is hemolysis

4. Wrong tube for collection is used

5. Tube used is outdated

6. There is improper handling (improper mixing)


Any specimen will be rejected for the following reasons:

7. The specimen is contaminated

8. Specimen is insufficient or “quality not sufficient” (QNS)

9. Collection time is incorrect

10. Specimen is exposed to light

11. Procedure did not follow testing time limits

12. There is a delay or error in processing


Delivery Time Limits and Exceptions for
Delivery and Processing Specimens
Delivery Time Limits

• The specimen should be transported to the laboratory immediately


after collection

• Within 45 minutes – routine blood specimen is expected to reach the


laboratory
Delivery Time Limits

• 1 hour – centrifugation of the specimen

• However, hematology specimens with EDTA, which are placed in


tubes with lavender or purple stopper, should not be centrifuged.
Time Limit Exceptions

• The delivery time limit has some exceptions. For instance, a specimen

that is marked as “STAT” or “EMERGENCY” takes priority over all the

other specimens in terms of transportation, processing, and testing.


Time Limit Exceptions

1. Blood Smear from EDTA specimen


• Prepared 1 hour from collection

2. EDTA specimen for CBC


• Analyzed within 6 hours but is stable 24 hours from collection if stored at room
temperature

3. EDTA specimen for erythrocyte sedimentation rate (ESR) determination


• Tested 4 hours (room temperature) and 12 hours (refrigerated)
Time Limit Exceptions

4. EDTA specimen for reticulocyte counts


• Stable for 6 hours (room temperature) and 72 hours (refrigerated)

5. Glucose test drawn in sodium fluoride tubes


• Stable for 24 hours (room temperature) but stable up to 48 hours (refrigerated
at 2°C to 8°C)

6. Prothrombin time (PT)


• Stable for 24 hours and partial thromboplastin time (PTT) should be analyzed
within 4 hours from collection
Centrifugation

• Centrifuge
• apparatus used to separate cells, plasma, or serum of blood specimens
• achieved by spinning the blood tubes inside the vessel at high speed such
that centrifugal force will cause the separation of the specimens
Centrifugation

• It is important to leave the stoppers on the tube before and during


centrifugation to avoid contamination, evaporation, aerosol
formation, and pH changes, which will affect the accuracy of results

• Tubes should be balanced in a centrifuge; tubes of the same size and


volume of specimen should be placed opposite on another
Centrifugation

• Plasma specimen collected in tubes with anticoagulants


• should be centrifuged immediately and without delay

• Serum specimen
• Needs to be completely clotted prior to centrifugation

• Complete clotting: 30 – 60 minutes (room temperature)


Centrifugation

• Although there are machines that test sample specimens directly


through the stopper, most of the processes require the stopper to be
removed to obtain the serum or plasma

• Removal can be done using devices or robotics, but if there is a need


to remove the stopper manually, a face shield or splash shield should
be used to protect the technician from any risk of contamination
Centrifugation

• A gauze or tissue is used to cover the stopper to catch drops of blood


that may leak or to prevent the aerosol that may be released during
the process

• The tube should be removed by pulling it straight up and off the tube
Aliquot Preparation

• Aliquot of specimen – portion of a sample specimen taken for


chemical analysis or testing

• Prepared when multiple tests are ordered on a single specimen


Aliquot Preparation

• Done by transferring a portion of the specimen into one or more tubes that
are labelled with the same information as the original specimen tube using a
disposable transfer pipette

• Specimens of different anticoagulants should not be put in the same aliquot


tube

• The phlebotomist must see to it that the tube is covered as soon as it is filled
OSHA Act (RA 11058)- Requried Protective
Equipment Worn When Processing Specimen
• When processing specimens in the laboratory the health worker is exposed to
blood and other potentially infectious materials

• For this reason, healthcare institutions should comply with the appropriate
protective equipment set by the Occupational Safety and Health Standards
Act (RA 11058)

• The protective equipment includes gloves, laboratory gowns/coats, and


masks

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