Name: Travis Kaneshiro

Chapter 3: Blood Specimen Collection

1 Describe the application of standard precautions to the collection of blood specimens. Level
1
The application of standard precautions in blood collection is to protect whoever is
involved in specimen collection. Such precautions involve using the correct PPE
(gloves, lab coat, shoes) and to assume that all specimens collected are pathogenic
and have the potential to transmit an infection.

2 List collection equipment used for venipuncture and skin puncture. Level 1
Venipuncture

Tourniquet
Alcohol swab
Band-Aid
Collection tubes
Additives in collection tubes
Needles
Needle holder

Skin Puncture

Lancet
Capillary tubes
Microcollection tubes
Alcohol swab
Band aid

3 Correlate tube stopper color with additive, if any, and explain the purpose of the additive and
use of that tube type for laboratory tests. Level 1
Gold: clot activator and gel serum separation, used in chemistry for screening
and diagnostic testing of serum for infectious diseases
Red: clot activator: serum determinations in chemistry, blood donor screening
and diagnostic testing of serum for infectious diseases
Orange: thrombin based clot activator: for stat serum determinations in
chemistry
Royal Blue: clot activator (EDTA), used for trace element, toxicology and
nutritional chemistry determinations.
Green: Sodium heparin , used for plasma determinations in chemistry
Gray: potassium oxalate, sodium fluoride, for glucose determinations, oxalate
and EDTA anticoagulants will give plasma samples
Yellow: sodium polyaethol sulfonate, for blood culture specimen collection in
microbiology
 Lavender: liquid EDTA, whole blood hematology determinations, prevents
blood clotting
White: EDTA and gel for plasma separation , use for molecular diagnostic test
methods i.e. PCR
Pink: spray coated EDTA, may be used for routine immunohematology
testing.
Light blue: buffered sodium citrate, coagulation determinations
Clear/red light gray: No additives, use a secondary specimen tube.

4 Explain reasons for selection of certain veins for venipuncture and name the veins of choice
in the antecubital fossa in order of preference. Level 1
The selection of preference rates from median cubital vein, cephalic vein and the
basilic vein. The basilica vein is considered the last choice because of an increased
risk to injury to the median nerve and possible accidental puncture of the brachial
artery, both in close proximity to the basilica vein.

5 Describe the steps recommended by the Clinical and Laboratory Standards Institute for
venipuncture, including the recommended order of draw for tubes with additives. Level 1
Order of Draw

Yellow
Light Blue
Red
Green
Lavender
Gray

Venipuncture procedure

Prepare the test request order

Greet patient, state name and confirm with ID number, and DOB
Sanitize hands
Verify dietary restrictions (fasting)
Assemble supplies
Locate vein
Apply tourniquet (no longer than 1 min)
Put on gloves
Cleanse site with 70% isopropyl alcohol with concentric circles
Perform venipuncture
Release and remove tourniquet as soon as blood flow is established
Ensure patients hand is open
Place gauze lightly over puncture site wihout pressing down
Activate safety on needle
 Apply direct pressure to puncture site
Bandage
Dispose in biohazard waste
Label tube with correct information
Send materials to lab

6 Describe complications encountered in blood collection and the proper response of the
phlebotomist. Level 1
Common complications include:

Ecchymosis (bruising): prevent by applying pressure with gauze pad

Hematoma: remove needle immediately and apply pressure with gauze bad
for at least 2 min
Fainting: if patient faints, move and discard needle immediately, apply
pressure to site with gauze pad and lower patients head, loosen any
constrictive clothing. Also notify designated first aid providers at facility.
Hemoconcentration: concentration of cells from water imbalance. Results
from leaving tourniquet on patients arm too long
Hemolysis: do not use too small of a needle, pull blood through existing
hematoma, pull back too quickly on plunger of a syringe, force blood into a
tube from a syringe , mix a tube too vigorously.
Petechiae: small red spots indicating blood in the skin. Hemostasis
abnomarmaility
Allergies: ask patient if allergic to any skin antiseptic substances and
adhesive bandages or tape
Nerve damage: select the appropriate vein and do not blindly probe with the
neelde.
Seizure: remove and discard needle, and notify first aid providers
Vomiting : provide appropriate container and tisues, notify first aid provider

7 Describe the steps recommended by the Clinical and Laboratory Standards Institute for skin
puncture, including collection sites for infants, children, and adults, and the order of draw for
tubes with additives. Level 1
Skin puncture for infants under 1 year: later or medial or plantar surface of
heel
Children older than 1 and in adults: palmar surface of distal portion of the
third or fourth finger on the nondominant hand
Puncture must be perpendicular to fingerprint lines

8 Describe components of quality assurance in specimen collection. Level 1

The components of quality insurance in specimen collection involves ensuring that
all of the equipment used in collection are up to date and not expired i.e. collection
tubes that contain vacuum pressure and specific additives may fail and cause
inaccurate readings due to expiration.
 Technical competence
Correct collecting procedures
Patients must be properly ID, prepared for draw, collected in the right order,
correct anticoagulants.

9 List reasons for specimen rejection. Level 1

Test order and requisition and tube ID do not match
Tube is unlabeled or labeling including patient ID do not match
Specimen is hemolyzed
Specimen was collected at the wrong time
Specimen was collected in the wrong tube
Specimen was clotted, and the test requires whole blood or plasma
Specimen was contaminated with IV fluid
Specimen is lipemic.

10 Given the description of a specimen and its collection, determine specimen acceptability.
Level 2
(description?)
Acceptability is based on the correct matching of patient ID with requisition and
specimen samples that follow the correct order of draw without negatively
influencing the quality of the sample.

11 Recognize deviations from the recommended venipuncture practice in a written scenario and
describe corrective procedures. Level 2
The correct venipuncture procedure

Prepare the test request order

Greet patient, state name and confirm with ID number, and DOB
Sanitize hands
Verify dietary restrictions (fasting)
Assemble supplies
Locate vein
Apply tourniquet (no longer than 1 min)
Put on gloves
Cleanse site with 70% isopropyl alcohol with concentric circles
Perform venipuncture
Release and remove tourniquet as soon as blood flow is established
Ensure patients hand is open
Place gauze lightly over puncture site wihout pressing down
Activate safety on needle
Apply direct pressure to puncture site
Bandage
Dispose in biohazard waste
Label tube with correct information
 Send materials to lab

12 State the most important step in the phlebotomy procedure. Level 1

The most important step in the phlebotomy procedure is to ID the patient.

13 List reasons for inability to obtain a blood specimen. Level 1

Missing vein
Insufficient vacuum
Patient refusal
Missing patient

14 Summarize legal issues that need to be considered in blood specimen collection and
handling. Level 1
Breach of patient confidentiality and patient misidentifications are two areas of
particular concern. The phlebotomist must take careful precautions to ensure that
each is done correctly.

Chapter 7: Hematopoiesis

1 Define hematopoiesis. Level 1

Hematapoiesis is the development of RBC into functional cells that are eventually
released into circulation. Sites of RBC development can vary from fetal development
to adult hood and progress from the yolk-sack, liver, and bone marrow.

2 Describe the evolution and formation of blood cells from embryo to fetus to adult, including
anatomic sites and cells produced. Level 1
The development of blood cells from embryo to adult begins in the yolk sac and
then moves into the aorta gonad mesonephros region, which is the start of the
mesoblastic phase. At around 5-7 gestational weeks the hepatic phase begins where
the liver produces most of the blood. By the end of 24 weeks gestation the bone
marrow becomes the primary site of hematopoiesis at which begins the medullary
phase.
Cells produced
Mesoblastic Phase: primitive erythroblasts important to produce hemoglobin (gower-
1, gower-2, Portland.
AGM (aorta gonad mesonephros: give rise to hematopoietic stem cells for
definitive/permanent adult hematopoiesis
Hepatic phase: developing erythroblasts, granulocytes, monocytes that colonize the
fetal liver, thymus, spleen, placenta, and bone marrow space in the medullary
phase.
Medullary phase: measurable levels of EPO, G-CSF, GM-CSF, Hb F, Hb A.
3 Predict the likelihood of encountering active marrow from biopsy sites when given the
patients age. Level 2
Tiba and femur stop becoming a site of hematopoiesis by 25
From age 10-50 the vertabra, sternum, and ribs have a sharp decline in their
activity but level out
Lymph nodes remain constant

(graph on page 94 of text)

4 Relate normal and abnormal hematopoiesis to the various organs involved in the
hematopoietic process. Level 2
Normal hematopoiesis involves: Bone marrow, spleen, lymph nodes but during
abnormal hematopoiesis the spleen can become enlarged and cause anemia and
leukopenia (hyperspleenism). Cirrhosis of the liver may also cause abnormal
hematopoietic processes.

5 Explain the stem cell theory of hematopoiesis, including the characteristics of hematopoietic
stem cells, the names of various progenitor cells, and their lineage associations. Level 1
The stem cell theory of hematopoiesis involves morphologically unrecognizable
hematopoietic progenitor cells that can become either noncommitted and
committed progenitor cells that can give rise to all mature blood cells.
The lineage specific progenitor cells are the common lymphoid progenitor, which
can differentiate into T, B and NK lymphocyte and the common myeloid progenitor
which can differentiate into individual granulocytic, erythrocytic, monocytic, and
megakaryocytic lineages

6 Discuss the roles of various cytokines and hematopoietic growth factors in differentiation and
maturation of hematopoietic progenitor cells, including nonspecific and lineage-specific
factors. Level 2
The hematopeitic growth factors and cytokines regulate the proliferation,
differentiation and maturation of the various hematopoietic precursor cells
(includes: interleukins, lymphokines, monokines, interferons, chemokines, and
CFSs). Cytokines play a key role in the development in precursor cells because they
can inhibit apoptosis by stimulating them to divide and help regulate cell
differentiation into the various lineages.
Lineage specific Hematopoiesis:
The CFU-GEMM (colony forming unit granulocyte, erythrocyte, monocyte,
megakaryocyte) forms the burst forming unit-erythroid (BFU-E). under the influence
of Il-3, GM-CSF, TPO and KIT BFU-E develop into colony forming unit- erythroid (CFU-
E) requires EPO.
EPO is a very important differentiation factor that causes the CFU-E to turn into
pronomoblasts which is the precursor to erythrocytes in the bone marrow. EPO can
also recruit CFU-E, prevents apoptosis of erythroid progenitors, and induces
hemoglobin synthesis.

7 Describe general morphologic changes that occur during blood cell maturation. Level 1
Proerythroblast: first stem cell type dedicated to becoming RBC
a Early erythroblast
i Ribosome synthesis occurs
b Late erythroblast
i Hemoglobin synthesis becomes main priority
Normoblast: producing hemoglobin for 4 days,
c Begins to look like normal RBC
d Still contains nucleus but can be ejected
Reticulocyte:
e Contains ribosomes and RNA visible in nuclear area.
Erythrocytes
f Carry oxygen around in circulation for 120 days
g No nucleus

8 Define apoptosis and discuss the relationship between apoptosis, growth factors, and
hematopoietic stem cell differentiation. Level 1/ Level 2
Apoptosis refers to programmed cell death that has the capability to remove
unwanted cells that can potentially cause damage if they are abnormal, old or
harmful etc. this process usually occurs when cells do not obtain specific cytokines
needed for regulation.
The relationship between apoptosis and growth factors and stem cell differentiation
is that hematopoietic stem cells can be directed into one of three areas: self
renewal, differentiation, or apoptosis. Growth factors i.e. CSFs can influence the
progenitor cell to differentiate into various lineages and without the stimulation of
these factors a progenitor cell will not continue to develop and will die via apoptosis.

9 Discuss therapeutic applications of cytokines and hematopoietic growth factors. Level 2

Cytokines have provided treatment for hematologic malignancies and solid growth
tumors. They can also be sued to increase the amount of hematopoietic stem cells
when removing plasma for transplantation protocols.
(apheresis)

Chapter 1

What is the average volume of blood in humans?

 5 liters

What are four major functions of blood?

What term is used to describe the liquid (noncellular) portion of blood in the body?

What are the three basic cellular elements in blood? (State their common and scientific names.)

Briefly describe both the structure and the function of RBCs.

What is the microscopic appearance of RBCs when stained with a Romanowsky stain?

What aspects of RBCs are described when their morphology is described?

What is the meaning of the term anemia?

What is the meaning of the term polycythemia?

What saline concentration provides the ideal osmolality for the study of RBCs?

What is a hemocytometer? Describe how this device is used in hematology.

What is the name of the key reagent used to measure hemoglobin? What is its composition?

Briefly describe the hand procedure to measure hemoglobin in anticoagulated whole blood

specimens using Drabkin reagent?

What is an alternate term for hematocrit?

Packed cell volume

Briefly describe the procedure to measure hematocrits on anticoagulated whole blood specimens.

What phenomenon does the term buffy coat describe?

Packed WBC and platelets found in a thin layer between RBC and plasma after

hematocrit.

What phrases are represented by each of the following abbreviations: MCV, MCH, MCHC, and

RDW?

What characteristic of the RBC population is described by the MCV?

What characteristic of the RBC population is described by the MCHC?

What characteristic of the RBC populations is described by the RDW?

What is an approximate normal range for the WBC count?

What abnormal condition is represented by the term leukopenia?

What abnormal condition is represented by the term leukocytosis?

What term is often used to represent PMNs?

What is the most fundamental physiologic function of platelets?

What are the key morphologic features of thrombocytes on Wright-stained blood smears?

Chapter 2

What are four important examples of occupational hazards in the clinical laboratory

environment?

Why is fire a particularly dangerous hazard in the clinical laboratory?

What are some key fire safety rules that should be included in the protocols of all clinical

laboratories?

What are the four major classes of fire extinguishers? For what type of fire should each be used?

What information should be included on the labels of all containers of chemicals?

How should alcohol and other flammable chemicals be stored?

What are some examples of personal protective equipment appropriate for handling noxious

chemicals?

Under what circumstances should bottle carriers be used?

What types of chemical information are provided by Safety Data Sheets (SDSs)?
What procedures help ensure that SDSs are always available to laboratory personnel?

What are several examples of safety rules used to minimize electrical hazards within the clinical

laboratory?

When are clinical laboratory professionals most at risk of needle puncture?

What are some laboratory supplies other than needles that are prone to cause puncture wounds or

lacerations?

What activity is the most frequent cause of puncture from a sharp object within the clinical

laboratory?

What is the actual name of the government agency represented by the initials OSHA?

What is the most basic axiom of standard precautions?

What are some examples of body fluids, in addition to blood, that standard precautions apply?

What are three examples of common, potentially lethal, bloodborne viruses?

Chapter 8

Which one of the three RBC precursor nomenclatures is used most often in the United States?

Which one of the three RBC precursor nomenclatures is used most often in Europe?

What characteristics of RBC precursors are used to identify their maturation stage?

What changes are observed in the size and N:C ratio of RBC precursors during maturation?

What changes are observed in the nuclear chromatin pattern of RBC precursors during

maturation?

What are some of the key identifying features of pronormoblasts?

What are some of the key identifying features of basophilic normoblasts?

What are some of the key identifying features of polychromatophilic normoblasts?

What are some of the key identifying features of orthochromic normoblast?

How does the term erythron compare with the term RBC mass?

What is the expected life span of a mature, circulating RBC?

What is considered to be the foremost advantage of the biconcave disk shape of mature RBCs?