1. Collecting, Processing, and Testing Blood Specimens
Chapter 48
Collecting, Processing, and Testing Blood Specimens
PowerPoint® presentation to accompany:
Medical Assisting
Third Edition
Booth, Whicker, Wyman, Pugh, Thompson

2. Learning Outcomes 48.1 Discuss the composition and function of blood.
48.2 Describe the process for collecting a blood specimen.
48.3 Explain the importance of confirming patients’ identities and correctly identifying blood samples.
48.4 Describe how to perform venipuncture and capillary puncture procedures.

3. Learning Outcomes (cont.)
48.5 Identify the equipment and supplies required for blood-drawing procedures.
48.6 Discuss the correct procedures for disposing of waste generated during blood-drawing procedures.
48.7 Discuss common fears and concerns of patients and how to ease these fears.

4. Learning Outcomes (cont.)
48.8 Develop techniques for helping patients with special needs, including children, the elderly, patients at risk for uncontrolled bleeding, and difficult patients.
48.9 Identify common blood tests and explain their purposes.
48.10 Perform certain blood tests.

5. Introduction Medical assistant Collects blood specimens
Performs waived testing
Knowledge needed
Understand circulatory system and function of blood
Appropriate supplies and equipment
How to perform and screen common blood tests

6. Role of the Medical Assistant
Phlebotomy – insertion of a needle or cannula into a vein to withdraw blood
Put the patient at ease during procedure
Process specimens and conduct testing
Complete necessary paperwork and make sure specimens are handled properly

7. Functions and Composition of Blood
Circulatory system transports blood
Heart pumps 8–12 pints of blood through 70,000 miles of vessels / day
Hematology – the study of blood

8. Functions and Composition of Blood (cont.)
Functions of blood
Distributes oxygen, nutrients, and hormones
Eliminates waste products
Attacks infecting pathogens
Maintains acid-base balance
Regulates body temperature

9. Functions and Composition of Blood (cont.)
Red blood cells – erythrocytes
Internal respiration
Transport oxygen to cells
Hemoglobin – 98%
Dissolved in plasma – 2 to 3 %
Hemoglobin
Main component of RBCs
Protein containing iron

10. Functions and Composition of Blood (cont.)
White blood cells – leukocytes
Protect against infection
Granular
Basophils
Eosinophils
Neutrophils
Agranular
T and B lymphocytes
monocytes

11. Functions and Composition of Blood (cont.)
Platelets – thrombocytes
Fragments of cytoplasm
Essential for clot formation
Plasma
Clear, yellow liquid
Contains formed elements of blood
90% water
Serum
Clear, yellow liquid remaining after clot formation

12. Functions and Composition of Blood (cont.)
Blood types or groups
Presence of antigens A and B determines type
Blood also carries antibodies
Transfusions require careful matching to prevent hemolysis

13. Apply Your Knowledge Very Good!
What is the role of the medical assistant related to collecting blood samples?
ANSWER: The medical assistant will put the patient at ease during the procedure, process specimens, conduct testing, complete necessary paperwork, and make sure specimens are handled properly.
Very Good!

14. Apply Your Knowledge Very Good! What are three functions of blood?
ANSWER: Functions of the blood are: (list any 3)
Distributes oxygen, nutrients, and hormones
Eliminates waste products
Attacks infecting pathogens
Maintains acid-base balance
Regulates body temperature
Very Good!

15. Collecting Blood Specimens
Reading and interpreting the test order
Review order
Assemble equipment and supplies
Preparing the patient
Greet and identify the patient
Confirm pretest preparation
Explain the procedure and safety precautions
Establish chain of custody

16. Collecting Blood Specimens (cont.)
Use Standard Precautions and PPE as needed
Handling exposure incident
Needlestick or other exposure to blood / blood products
Report to appropriate person immediately
Wash area and apply bandage
Document date, time, people involved, type of exposure

17. Collecting Blood Specimens: Drawing Blood
Not all states permit medical assistants to draw blood
Venipuncture
Puncture of a vein
Most common sites are in the anticubital fossa and forearm
Common Sites for Venipuncture

18. Collecting Blood Specimens (cont.)
Venipuncture complications
Hematoma
Hold needle still
Hold pressure on site after removal of needle
Latex allergy
Ask patient
Use non-latex gloves, tourniquet, and bandages
Nerve injury
Know anatomy
Infections
Rare
Clean site prior to venipuncture
May not be evident for several days

19. Collecting Blood Specimens (cont.)
Equipment
Evacuation systems – use special double-pointed needle, needle holder
Needle and syringe systems
Butterfly system – winged infusion set and syringe
Collection tubes
Sealed to create a vacuum
Color-coded to identify appropriate additive

20. Collecting Blood Specimens (cont.)
Engineered safety devices
Reduce the possibility of needlestick injuries
Types
Retracting needles
Hinged or sliding shields
Self-blunting needles
Retractable lancets

21. Collecting Blood Specimens (cont.)
Capillary puncture
Superficial puncture of skin with sharp point
Lancets / automatic puncturing devices
Micropipettes – small calibrated glass tubes that hold a small, precise volume of fluid
Reagent products
Chemically treated paper or dipstick
Smear slides

22. Apply Your Knowledge excellent!
What precautions should you take when collecting a blood specimen?
ANSWER: You should use Standard Precautions and appropriate personal protective equipment.
excellent!

23. Responding to Patient Needs
Respond with sensitivity and competence
Fears and concerns
Pain
Bruises or scars
Serious diagnosis
Contracting a disease from the procedure

24. Responding to Patient Needs: Special Considerations
Children
Talk with parent or caregiver first
Address child directly
Speak in a calm, soothing voice
Explain the procedure briefly in terms they can understand
Keep child informed of status during the procedure

25. Responding to Patient Needs: Special Considerations (cont.)
Elderly
Prone to bruising
Difficult to obtain an adequate sample
Speak clearly in a low-pitched voice
Allow adequate time for patient to respond to questions

26. Responding to Patient Needs: Special Considerations (cont.)
Risk of bleeding
Hemophilia or taking blood-thinning medication
Hold site for at least 5 minutes
Contact physician if bleeding does not stop

27. Responding to Patient Needs: Special Considerations (cont.)
Difficult patients
Difficult venipuncture – do not stick more than twice
Fainting patients –
Reaction to blood draw
Position to avoid injury
Angry or violent patients
Explain need for testing
Avoid arguing
Do not force patient
Document behavior and if patient refuses

28. Correct! Apply Your Knowledge
What is one precaution you can take when drawing blood from a patient who is taking anticoagulants?
ANSWER: After drawing blood on a patient taking anticoagulants, you should hold a cotton ball over the puncture site for at least 5 minutes, monitor the site carefully, and notify the physician if bleeding does not stop.
Correct!

29. Performing Common Blood Tests
Results aid in diagnosis
POLs often only perform waived tests
Know office policy

30. Performing Common Blood Tests (cont.)
Chemicals in lab
Anticoagulants – keep blood in uncoagulated state
Serum separators – form a gel-like barrier between serum and clot in coagulated sample
Stains – color particular cells

31. Performing Common Blood Tests: Hematologic Tests
Blood counts
RBC count
White blood cells
Differential white blood cell
Platelet
Hematocrit
Hemoglobin
Centrifuged Capillary Sample

32. Performing Common Blood Tests: Hematologic Tests (cont.)
Morphologic studies
Morphology – study of shape and form of objects
Requires special training
Coagulation tests
Identification of potential bleeding problems
Monitor therapeutic drug levels for anticoagulants
PT and PTT

33. Performing Common Blood Tests: Hematologic Tests (cont.)
Erythrocyte sedimentation rate
Measures rate of RBCs falling to the bottom of the blood sample
Must be performed on a fresh sample
Tube must contain an anticoagulant
Read after one hour
Recorded as mm/hr

34. Performing Common Blood Tests: Chemical Tests
Rarely performed in the POL
Waived tests
Blood glucose monitoring
Hemaglobin A1c
Cholesterol tests

35. Performing Common Blood Tests: Serologic Tests
Introduction of an antigen or antibody into a specimen and detection of a reaction to it
Immunoassays
Western blot
Radioimmunoassay (RIA)
Enzyme-linked immunosorbent assay (ELISA)
Immunofloruescent antibody (IFA) test
Rapid screening tests
Infectious mononucleosis
HIV
Helicobactor pylori

36. Super! Apply Your Knowledge Matching: ___ Hemoglobin A1c A. ESR
___ Lysing RBCs / evaluating the color B. Serology test
___ Shape or form of objects C. Coagulation tests
___ Identify bleeding problems D. Chemical test
___ Rate at which RBCs fall E. Differential
___ Percentage of each type of WBC F. Morphology
___ ELISA G. Hemoglobin
ANSWER: D G F C A E
Super! B

37. In Summary Phlebotomy procedures require Medical assistant
Technical skills
Interpersonal communication skills
Medical assistant
Patient instructions
Completion of testing procedures

38. Blood will tell, but often it tells too much.
End of Chapter
End of Chapter 48
Blood will tell, but often it tells too much.
~ Don Marquis