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MEDICAL

LABORATORY

SCIENCE

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IMMUNOLOGY

WHAT MAKES EXCEPTIONAL MEDICAL LABORATORY SCIENTISTS AND MEDICAL LABORATORY TECHNICIANS?

WHAT’S INSIDE

Immunology .........................................................3

Phlebotomy .........................................................4

Course Review & Exam Prep ...............................6

Hematology .........................................................7

Immunohematology ............................................8

Math .....................................................................8

Microbiology ........................................................9

Molecular Diagnostics .......................................10

Urinalysis ............................................................10

General References ...........................................11

Medical Terminology .........................................12

Clinical Immunology and Serology A Laboratory Perspective, 4th EditionChristine Dorresteyn Stevens, EdD, MLS(ASCP)Linda E. Miller, PhD, MP(ASCP)SI

A classic text now enhanced with full color! This practical introduction to clinical immunology covers the essential theoretical principles and the serology techniques most commonly used in the laboratory.

� NEW! Chapters on Innate Immunity, Adaptive, Immunity, and Immunizations and Vaccines.

� NEW! Boxes highlighting Connections, Clinical Correlations, and In the Laboratory. � MORE! Full-color photographs of assay results and patients with immune-related diseases.

� UPDATED & EXPANDED! Coverage of the external defenses and inflammation, human microbe relationships, bacterial virulence factors, the role of the B and T cells in the adaptive immune response, the immune mechanisms involved in humoral antibody production and cell-mediated immunity, and tumor markers and immune mechanisms.

576 pages | 197 illustrations Soft cover | 2017

$89.95 (US) | $128.95 (CAN) ISBN-13: 978-0-8036-4466-3

Instructor � eBook � PowerPoint Presentations � Instructor’s Guide � Image Bank � Lab Exercises � Branching Cases � Test Bank

Student/Premium � Branching Cases � Lab Exercises

I. Nature of the Immune System 1. Introduction to Immunity

and the Immune System 2. Nature of Antigens and the Major

Histocompatibility Complex 3. Innate Immunity 4. Adaptive Immunity 5. Antibody Structure and Function 6. Cytokines 7. Complement System

II. Basic Immunological Procedures 8. Safety and Quality Assessment 9. Principles of Serological Testing

10. Precipitation and Agglutination Reactions

11. Labeled Immunoassays 12. Molecular Diagnostic Techniques 13. Flow Cytometry and Laboratory

Automation

III. Immune Disorders 14. Hypersensitivity 15. Autoimmunity 16. Transplantation Immunology 17. Tumor Immunology 18. Immunoproliferative Diseases 19. Immunodeficiency Diseases

IV. Serological and Molecular Diagnosis of Infectious Disease 20. Serological and Molecular Detection

of Bacterial Infections 21. Spirochete Diseases 22. Serological and Molecular Diagnosis

of Parasitic and Fungal Infections 23. Serology and Molecular Detection

of Viral Infections 24. Laboratory Diagnosis of HIV Infection 25. Immunization and Vaccines

Glossary, Answer Key, References

CONTENTS

NEW! Photos and line drawings now in full color.

IgM

Stem cell

A. Pro-B Cell

C-kit

Bone marrowstromal cell

mu chains incytoplasm

Apoptosis

Self-antigen

IgM

IgMIgD

mu and surrogatelight chains

CD1 CD23

B. Pre-B Cell

D. Marginal zoneB cells

D. Follicular B cells

C. Immature B Cell

�

�

�

�

�

��

�

Self-antigensgive negative

signals

Remainin spleen

Entercirculation

Spleen Lymphnodes

Author Author's review(if needed)

InitialsDate

OK Correx

ISBN #

Fig. #

Artist

B / W 4/C 2/C

Document name

Date

Check if revision

Stevens 4466

Figure-4-7 4466_Figure-4-7.eps

AR

Final Size (Width X Depth in Picas)

35p4 x 33p5

04/24/16Editor's review

InitialsDate

OK Correx2nd color PMSX

Author Author's review(if needed)

InitialsDate

OK Correx

ISBN #

Fig. #

Artist

B / W 4/C 2/C

Document name

Date

Check if revision

Stevens 4466

Figure-4-1 4466_Figure-4-1.eps

MEL

Final Size (Width X Depth in Picas)

20p6 x 15p4

04/21/16Editor's review

InitialsDate

OK Correx2nd color PMSX

Professionals in this field are in high demand. Help your students excel by choosing resources that will build their knowledge base and help them thrive. Our visually rich and engaging texts provide vibrant, step-by-step photographs, easy-to-understand discussions, and real-world case studies to sharpen your students’ skills and build critical thinking.

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70 CHAPTER 3 ■ Venipuncture Techniques

Step 13. Remove the plastic needle cap and ex-amine the needle for defects such as nonpointedor barbed ends.

Step 15. Grasp the assembled needle and tubeholder using your dominant hand with the thumbon the top near the hub and your other fingersbeneath. Smoothly insert the needle into the veinat a 15- to 30-degree angle with the bevel up untilyou feel a lessening of resistance. Brace the fin-gers against the arm to prevent movement of theneedle when changing tubes.

Step 14. Anchor the vein by placing the thumbof the nondominant hand 1 to 2 inches belowthe site and pulling the skin taut.

Step 16. Using the thumb, advance the tube onto the evacuated tube needle, while the indexand middle fingers grasp the flared ends of theholder.

PROCEDURE 3-2 Venipuncture Using an Evacuated Tube System (Continued)

4607_Ch03_045-086 08/02/16 9:52 AM Page 70

PHLEBOTOMY PHLEBOTOMY

220 pages | 25 illustrations Soft cover, spiral bound | 2013

$34.95 (US) | $50.50 (CAN) ISBN-13: 978-0-8036-2594-5

31

EQUIP

CLSI Recommended Order of Draw

Fill tubes in the following order to prevent invalid test results caused by contamination of the specimen by microorganisms, tissue thromboplastin, and additive carryover.

Sodium fluoride

SPSSterile media bottles

Light blue Sodium citrate

Red plastic

Red glass

Red andgray SST

Gold SST

Orange RST

Royal blue

Clot activator

No additive

Gel separator tubewith clot activator

Gel separator tubewith clot activator

Gel separator tubewith thrombin

Clot activator

Light greenPST

Green

Royal blue

with heparin

Heparin

Heparin

Lavender

Pink

Tan

Royal blue

White PPT

EDTA

EDTA

EDTA

EDTA

Gel separatorwith EDTA

Gray Potassium oxalate

1

Order Additive

Yellow

2

3

4

5

6

Gel separator tube

Tube Color

42

VENI PUNCT

Patient Identifi cation

ALERT: Two forms of identifi cation are recommended for the identifi cation of all patients.

For a Hospitalized Patient1. Verbally identify the patient by asking the patient to state

his or her full name.2. Check that the information on the patient’s ID band matches

the information on the requisition form, including:■ Patient’s name.■ Hospital identifi cation number.■ Date of birth.■ Physician. ALERT: Verify any discrepancies between the patient’s ID

band and the requisition form before performing venipuncture.

For an Outpatient■ Verbally identify the patient by asking the patient to state his

or her full name, address, birth date, or unique identifi cation number.

■ Compare the response to the requisition form.■ Check the patient’s photo identifi cation, if required.■ Check the patient’s ID band or patient ID card, if available.

ALERT: Verify any discrepancies between the patient’s ID and the requisition form before performing venipuncture.

Phlebotomy NotesPocket Guide to Blood CollectionSusan King Strasinger, DA, MT(ASCP) Marjorie Schaub Di Lorenzo, MT(ASCP)SH

Adheres to CLSI & OSHA Guidelines.Rely on the perfect guide for collecting, transporting, and processing quality blood specimens for laboratory testing.

� Step by step techniques for venipuncture, dermal puncture, and arterial puncture

� At-a-glance tables summarize labs, specimen type, and collection, special requirements

The Phlebotomy Textbook3rd EditionSusan King Strasinger, DA, MT(ASCP) Marjorie Schaub Di Lorenzo, MT(ASCP)SH

Whys & hows to safely obtain quality samples. This full color text makes important concepts easy to understand with a friendly, narrative writing style, over 300 images, and clinical situations to encourage critical thinking.

� A review of equipment and safety requirements, such as safety needle devices and disposal systems, mandated by OSHA.

� Evaluation checklists show your students how they will be assessed.

� Student CD with interactive exercises for each chapter and more than 30 minutes of video clips that demonstrate proper techniques.

Blood Collection A Short Course, 3rd EditionMarjorie Schaub Di Lorenzo, MT(ASCP)SH | Susan King Strasinger, DA, MT(ASCP)

Perfect for a short module on phlebotomy. Here’s “to the point” instruction on blood collection techniques.

� Case Studies throughout the text challenge students to apply knowledge to realistic patient situations.

� Complies with the standards set by OSHA, The Joint Commission, and the National Committee for Clinical and Laboratory Standards.

� Emphasizes the clinical importance of proper technique.


$46.95 (US) | $67.50 (CAN) ISBN-13: 978-0-8036-4607-0

Instructor � eBook � Instructor’s Guide � Test Bank � PowerPoint Presentations � Videos � Animations

Student/Premium � eBook � Videos � Animations

CONTENTS1. Introduction to Blood Collection2. Venipuncture Equipment3. Venipuncture Techniques4. Pre-examination Variables and

Venipuncture Complications5. Special Blood Collection6. Dermal Puncture7. Point-of-Care Testing8. Blood Collection from Vascular

Access DevicesAppendicesA. Laboratory Tests and the Required

Types of Anticoagulants and Volume of Blood Required

B. Clinical Correlations of Blood Tests Related to Body Systems

C. Answer KeyD. Laboratory Abbreviations

Commonly Used

ENHANCED! Photographs and line drawings now in full color.

NEW! Videos online at DavisPlus.com demonstrate proper techniques for venipuncture, dermal puncture, use of a winged blood collection set, donning and doffing PPE, handwashing.

504 pages | 350 illustrations Soft cover text + CD| 2011

$69.95 (US) | $100.50 (CAN) ISBN-13: 978-0-8036-2057-5

Illustrated procedures, pre-examination considerations, technical tips, and phlebotomist alerts make learning easy.

CLSI recommended Order of Draw and ‘Red Alerts’ are presented for quick access in any setting.

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COURSE REVIEW & EXAM PREP HEMATOLOGY

Quick Review Cards for Medical Laboratory Science, 2nd Edition

Medical Laboratory Science Review, 4th Edition

Robert R. Harr, MS, MLS(ASCP)

The perfect review for MLT and MLS success! Build the theoretical and practical knowledge your students need to succeed on classroom tests and certification and licensure exams. Includes over 270 full-color photomicrographs.

� More than 3,200 multiple-choice questions at taxonomy levels 1, 2, and 3, each with detailed rationales.

� Each question has a rationale and is classified by subject category, task, and taxonomy level.

� CD includes 1,000 additional questions in the form of: Comprehensive Exam, MLT Exam, Problem-Solving Exam, Photomicrograph Exam, and a Customizable Test Bank.

618 cards | 75 illustrations Soft cover | 2014

$57.95 (US) | $82.95 (CAN) ISBN-13: 978-0-8036-2956-1

608 pages | 74 illustrations Soft cover text + CD | 2013

$67.95 (US) | $97.50 (CAN) ISBN-13: 978-0-8036-2828-1

Clinical Hematology and Fundamentals of Hemostasis, 5th Edition

Denise Harmening, PhD, MLS(ASCP), CLS (NCA)

A full-color text, lab manual, & atlas—all in one!Explore body fluids, quality control, flow cytometry, molecular diagnosis, red & white blood cells, hemostasis, and thrombosis, and more.

� Case histories and study questions with answers enhance critical thinking. � Laboratory methods on routine hematology methods, automated differential analysis, cytochemistry, and more.

1,032 pages | 600 illustrations | Hard cover | 2009

$154.00 (US) | $220.50 (CAN) ISBN-13: 978-0-8036-1732-2

Hematology In Practice, 2nd Edition

Betty Ciesla, MS, MLS(ASCP)SHCM

Basic principles of hematology made memorable.A unique visual language simplifies practical laboratory principles and procedures into easy-to-follow, manageable sections.

� Case studies illustrating the key principles of each major concept. � End-of-chapter summaries and review questions � Special “Troubleshooting: What do you do when…” sections.

384 pages | 238 illustrations | Hard cover | 2012

$89.95 (US) | $128.95 (CAN) ISBN-13: 978-0-8036-2561-7

226 pages | 283 illustrations Soft cover, spiral bound | 2013

$36.95 (US) | $52.95 (CAN) ISBN-13: 978-0-8036-1902-9

Heme Notes A Pocket Atlas of Cell Morphology

Denise M. Harmening, PhD, MLS (ASCP), CLS(NCA) Kathleen Finnegan, MS, MLS(ASCP)SH

Cell morphology at your fingertips.

Here’s the ideal quick reference for morphology of normal and abnormal peripheral blood and bone marrow cells. Includes more than 280 full-color photographs!

Side-by-side comparisons demonstrate the differences between commonly confused cells.

6

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Valerie Dietz Polansky, MEd, MLS(ASCP)CM

A complete, portable study guide! More than 500 cards review the entire MLS curriculum for class, certification, and licensure exam success. Contents mirror the Board of Certification’s outline.

� Large metal ring to loop through hole-punched cards.

� Mnemonics to make memorizing important information easier.

� Depictions of normal and common abnormal serum protein electrophoresis patterns, structures of urine crystals, diagnostic stages of parasites, and more.

Diarrheagenic Escherichia coli Clinical Microbiology Review 187

DISEASE GRAM STAIN GROUP PATHOGENICITY TRANSMISSION MECHANISM OF STOOL OTHER

Enterohemorrhagic (EHEC). Also known as Shiga toxin–producing (STEC) or verotoxin-producing (VTEC)

Enterotoxigenic (ETEC)

Enteroinvasive (EIEC)

E. coli O157:H7 is mostcommon isolate ofgroup & pathogen most often isolatedfrom bloody stools.Non-O157 STEC alsocauses disease. DNAprobes can ID genesthat code for toxins. Report to public health.

Profuse, watery stool.DNA probes to detecttoxins or toxin genes.

Undercookedmeat, raw milk,apple cider

Contaminatedfood or water

Contaminatedfood or water

Diarrhea, hemorrhagiccolitis, hemolytic uremicsyndrome (HUS). Mostcommon cause of renalfailure in children in U.S.May be fatal, especiallyin young or elderly

Traveler’s diarrhea, diarrhea in infants

Bloody diarrhea. Dysentery-like. Usually in young children inareas of poor sanitation.

Toxins (vertox-ins or Shigatoxins)

Toxins

Invasiveness

RBCs but usuallyno polys

No polys or RBCs

Polys, RBCs, mucus

continued...

2956_Ch03_135-286 29/01/14 12:17 PM Page 187

Abnormal Crystals*Urinalysis and Body

Fluids Review 505

CRYSTAL DESCRIPTION SIGNIFICANCE COMMENTS

Leucine

Tyrosine

Cystine

Often seen with tyrosine.

Often seen with leucine.

Must differentiate from uric acid.Doesn’t polarize light. Confirm bycyanide-nitroprusside test.

Yellow, oily-looking spheres.Radial & concentric striations.

Fine yellow needles in sheavesor rosettes.

Hexagonal (6-sided).

Severe liver disease

Severe liver disease

Cystinuria

From Strasinger SK, Di Lorenzo MS. Urinalysis and Body Fluids, 5th ed. Philadelphia: FA Davis; 2008:117.

continued...

2956_Ch07_485-522 29/01/14 12:23 PM Page 505

A. Disseminated intravascular coagulation (DIC)B. Hereditary elliptocytosis (ovalocytosis)C. CirrhosisD. Hgb C diseaseHematology/Evaluate laboratory data to recognizehealth and disease states/2

1.8 | Hematology Problem Solving 39

15. Refer to the following scatterplot, histograms, andautomated values on a 28-year-old woman who hadpreoperative laboratory testing. A manual WBCdifferential was requested by her physician. TheWBC differential was not significantly differentfrom the automated five-part differential; however,the technologist noted 3+ elliptocytes/ovalocyteswhile reviewing the RBC morphology. What is themost likely diagnosis for this patient?

Answers to Questions 15–16

15. B The finding of ovalocytes as the predominant RBCmorphology in peripheral blood is consistent withthe diagnosis of hereditary elliptocytosis (HE), orovalocytosis. This disorder is relatively common andcan range in severity from an asymptomatic carrier tohomozygous HE with severe hemolysis. The mostcommon clinical subtype is associated with no orminimal hemolysis. Therefore, HE is usually associatedwith a normal RBC histogram and cell indices and willgo unnoticed without microscopic evaluation of theperipheral smear.

16. A The osmotic fragility test is indicated as aconfirmatory test for the presence of numerousspherocytes, and individuals with hereditaryspherocytosis (HS) have an increased osmotic fragility.The MCHC is elevated in more than 50% of patientswith spherocytosis, and this parameter can be usedas a clue to the presence of HS. Spherocytes have adecreased surface-to-volume ratio, probably resultingfrom mild cellular dehydration.

16. A 25-year-old woman saw her physician withsymptoms of jaundice, acute cholecystitis, and anenlarged spleen. On investigation, numerousgallstones were discovered. Review the followingCBC results:WBCs = 11.1 × 109/L MCV = 100 fLRBCs = 3.33 × 1012/L MCH = 34.5 pgHgb = 11.5 g/dL MCHC = 37.5%Hct = 31.6 mL/dL PLT = 448 × 109/LWBC differential: 13 band neutrophils; 65 segmented neutrophils; 15 lymphocytes; 6 monocytes; 1 eosinophil RBC morphology: 3+ spherocytes, 1+ polychromasia

What follow-up laboratory test would providevaluable information for this patient?A. Osmotic fragilityB. Hgb electrophoresisC. G6PD assayD. Methemoglobin reduction testHematology/Evaluate laboratory data to recognizehealth and disease states/2

2828_Ch01_001-040 09/08/12 4:10 PM Page 39

A. Disseminated intravascular coagulation (DIC)B. Hereditary elliptocytosis (ovalocytosis)C. CirrhosisD. Hgb C diseaseHematology/Evaluate laboratory data to recognizehealth and disease states/2

1.8 | Hematology Problem Solving 39

15. Refer to the following scatterplot, histograms, andautomated values on a 28-year-old woman who hadpreoperative laboratory testing. A manual WBCdifferential was requested by her physician. TheWBC differential was not significantly differentfrom the automated five-part differential; however,the technologist noted 3+ elliptocytes/ovalocyteswhile reviewing the RBC morphology. What is themost likely diagnosis for this patient?

Answers to Questions 15–16

15. B The finding of ovalocytes as the predominant RBCmorphology in peripheral blood is consistent withthe diagnosis of hereditary elliptocytosis (HE), orovalocytosis. This disorder is relatively common andcan range in severity from an asymptomatic carrier tohomozygous HE with severe hemolysis. The mostcommon clinical subtype is associated with no orminimal hemolysis. Therefore, HE is usually associatedwith a normal RBC histogram and cell indices and willgo unnoticed without microscopic evaluation of theperipheral smear.

16. A The osmotic fragility test is indicated as aconfirmatory test for the presence of numerousspherocytes, and individuals with hereditaryspherocytosis (HS) have an increased osmotic fragility.The MCHC is elevated in more than 50% of patientswith spherocytosis, and this parameter can be usedas a clue to the presence of HS. Spherocytes have adecreased surface-to-volume ratio, probably resultingfrom mild cellular dehydration.

16. A 25-year-old woman saw her physician withsymptoms of jaundice, acute cholecystitis, and anenlarged spleen. On investigation, numerousgallstones were discovered. Review the followingCBC results:WBCs = 11.1 × 109/L MCV = 100 fLRBCs = 3.33 × 1012/L MCH = 34.5 pgHgb = 11.5 g/dL MCHC = 37.5%Hct = 31.6 mL/dL PLT = 448 × 109/LWBC differential: 13 band neutrophils; 65 segmented neutrophils; 15 lymphocytes; 6 monocytes; 1 eosinophil RBC morphology: 3+ spherocytes, 1+ polychromasia

What follow-up laboratory test would providevaluable information for this patient?A. Osmotic fragilityB. Hgb electrophoresisC. G6PD assayD. Methemoglobin reduction testHematology/Evaluate laboratory data to recognizehealth and disease states/2

2828_Ch01_001-040 09/08/12 4:10 PM Page 39


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44

ERYTHRO-POESIS

Basophilic Normoblast Versus Polychromatic Normoblast

NucleusBasophilic Polychromatic Normoblast Normoblast

Shape: Round RoundN:C ratio: 6:1–4:1 4:1–2:1Color: Basophilic Dark blueNucleoli: Usually none NonePosition: Central Central to eccentricChromatin: Larger granularity Increased clumped chromatin,

cartwheel appearance: regularpattern of dark (chromatin) andwhite (parachromatin)

CytoplasmColor: Basophilic Polychromatophilic blue-gray

to pinkAmount: Small Moderate

1902_Tab02_035-053 20/03/13 10:51 AM Page 44

LEUKO -POESIS

80

Compare and Contrast: Thrombopoiesis

Megakaryocyte Versus Osteoclast

NucleusMegakaryocyte Osteoclast

Shape: Multilobulated Multinucleated(2 or more lobes) (2–5 of uniform size)

N:C ratio: 1:1–1:2Color: Blue-purple Red-purpleNucleoli: None PresentPosition: Eccentric CentralChromatin: Granular Coarse, clumped with visible

parachromatin

CytoplasmMegakaryocyte Osteoclast

Color: Pink to pink-blue Blue-purpleAmount: Abundant Moderate to largeGranules: Numerous, fine, Blue-red granules

azurophilic lysosomal granules

HINTS

■ Megakaryocyte is multilobed, and platelets may be shedding off thecytoplasm; the osteoclast is multinucleated with separate nuclei andhas basophilic granular cytoplasm.

1902_Tab03_054-081 20/03/13 10:52 AM Page 80

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IMMUNOHEMATOLOGY MICROBIOLOGY

MATH

Modern Blood Banking & Transfusion Practices, 6th Edition

Denise M. Harmening, PhD, MLS(ASCP), CLS(NCA)

The perfect balance of theory & practice. Building from a review of the basic sciences to the how and why of clinical practice, this popular text continues to set the standard for developing a comprehensive understanding of modern routine blood banking and transfusion practices.

� Case studies with questions and answers emphasizes practical application that links science to the patient.

� Discussions of the legal and ethical aspects of providing blood collection and transfusion.

Fundamental Laboratory Mathematics Required Calculations for the Medical Laboratory Professional

Lela Buckingham, PhD, MB, DLM (ASCP)

Are your students confident calculating lab math? Nearly 600 practice problems with answers show them the required calculations needed in the clinical laboratory for enzyme chemistry, hematology, urinalysis, molecular biology, and molecular diagnostics.

� Problem sets in each chapter show all the work performed in each calculation. � ‘Application Problems’ ask your students to apply math in a clinical context. � Caution boxes highlight common sources of error in calculations or procedures.

672 pages | 229 illustrations | Hard cover | 2012

$117.00 (US) | $167.50 (CAN) ISBN-13: 978-0-8036-2682-9

352 pages | 30 illustrations | Soft cover | 2014

$57.95 (US) | $82.95 (CAN) ISBN-13: 978-0-8036-2949-3

Full-color photographs showing ABO forward and reverse blood grouping, as well as 500 illustrations, tables, & boxes, make complex concepts easy to master.

Medical Parasitology A Self-Instructional Text, 6th Edition

Ruth Leventhal, PhD, MBA, MLS(ASCP) Russell F. Cheadle, MS, MLS(ASCP)

An engaging, systematic introduction.An extensive series of full-color photographs, line drawings, and plates help your students recognize parasitic diseases and build a solid understanding of the fundamentals of diagnosis and treatment.

� Table on the inside front cover compares the diagnostic stages of various parasites.

� Case studies enhance critical thinking. � Review questions and post-tests in each chapter

Diagnostic Bacteriology A Study Guide

Margaret A. Bartelt, PhD, Diplomate, ABMM, MLS(ASCP)SM

A concise, outline format. Show your students the microbiology lab procedures needed for diagnosing and treating diseases.

� Line drawings and color plates help your students visualize key points.

� Chapter study questions and a 100-question comprehensive exam test their knowledge.

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103

LEARNING OBJECTIVES

Upon completion of this chapter, the reader will be able to:

5.1 Define the various test collection priorities.

5.2 Explain the requirements for oral glucose tolerance tests (OGTTs).

5.3 Discuss diurnal variation of blood constituents and list three substances that would be affected.

5.4 Differentiate between a trough and a peak level in therapeutic drug monitoring and state theimportance for collecting the sample at the prescribed time.

5.5 Discuss the timing sequences for the collection of blood cultures, the reasons for selecting aparticular timing sequence, and the number of samples collected.

5.6 Describe the equipment, procedure, and precautions associated with arterial puncture.

5.7 Explain the effects of sample handling and transport on test results.

5.8 Describe the procedure for collecting samples for cold agglutinins and cryoglobulins.

5.9 List eight tests for which samples must be chilled immediately after collection.

5.10 List five tests for which the results are affected by exposure of the sample to light.

5.11 Define chain of custody and state three tests that may require it.

5Special Blood Collection

4607_Ch05_103-128 08/02/16 9:49 AM Page 103

FASTING SAMPLES

Assessment of patient preparation is necessary beforeblood collection for laboratory tests that require the patient to be fasting or in a basal state. Fasting differsfrom a basal state condition in that the patient mustonly have refrained from eating and drinking (exceptwater) for 12 hours, whereas in the basal state the patientalso must have refrained from exercise. It is the respon-sibility of the blood collector to verify that the patientis in the fasting or basal state when required.

Test results most critically affected in a nonfasting pa-tient are those for glucose, cholesterol, triglycerides, orlipid profiles. If the patient has not fasted, it must benoted on the requisition form. Prolonged fasting in-creases bilirubin and triglyceride results and markedlydecreases glucose levels.

TIMED SAMPLES

Blood collections are frequently requested for specifictimes, and the timing of sample collection must bestrictly followed for accurate test results. Reasons fortimed samples are shown in Box 5-1.

Collecting a sample early could yield a falsely ele-vated result, whereas collecting the sample late couldyield a falsely normal result. Misinterpretation of test re-sults can cause improper treatment for the patient. Themost frequently encountered timed samples are dis-cussed in this chapter.

104 CHAPTER 5 ■ Special Blood Collection

KEY TERMS

Arteriospasm Spontaneous constriction of an artery

Aseptic Free of contamination by microorganisms

Chain of Custody Documentation of the collec-tion and handling of forensic samples

Diurnal Variation Normal changes in blood con-stituent levels at different times of the day

Peak Level Sample collected when a serum druglevel is highest

Septicemia The presence of pathogenic microor-ganisms in the blood

Steady State A 20- to 30-minute period of con-trolled stable oxygen consumption and no physicalexercise

Trough Level Sample collected when a serumdrug level is lowest

Turnaround Time Amount of time between therequest for a test and the reporting of results

INTRODUCTION

Certain laboratory tests require the use of techniquesthat are not part of the routine venipuncture proce-dure. These procedures may involve patient prepara-tion, timing of sample collection, blood collectiontechniques, sample handling, and sample transport.The blood collector must know when these tech-niques are required, how to perform them, and howsample integrity is affected when they are not per-formed correctly.

COLLECTION PRIORITIES

Test orders are designated as routine, STAT, or timed.Turnaround times (TATs) are based on these designa-tions. Routine tests are ordered by the health-careprovider to diagnose and monitor a patient’s condition.STAT tests have the highest priority. Timed tests mustbe collected at a specific time. The samples must be de-livered to the laboratory promptly and the laboratorypersonnel notified.

TECHNICAL TIP 5-1

Drinking water is encouraged to avoid dehydrationin the patient, which can affect laboratory results.

TECHNICAL TIP 5-2

A specimen that appears lipemic is an indicationthat the patient was not fasting and the lipemia mayinterfere with laboratory testing.

4607_Ch05_103-128 08/02/16 9:49 AM Page 104

Medical Mycology A Self-Instructional Text, 2nd Edition

Kathleen S. Blevins, PhD, MLS(ASCP), CLS(NCA) Martha E. Kern, MD, DA, MLS(ASCP), CLS(NCA

Teach proper lab practice. � Outlines, activities, 75 color plates, and self-study exams ensure your students grasp the biology and physiology of fungi, the epidemiology of fungal infections, and fungal disease states.


$58.95 (US) | $84.50 (CAN) ISBN-13: 978-0-8036-0036-2


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$69.95 (US) | $100.50 (CAN) ISBN-13: 978-0-8036-2543-3

500 pages | Soft cover | 2000

$50.95 (US) | $72.95 (CAN) ISBN-13: 978-0-8036-0301-1

How to Survive and Maybe Even Love Health Professions School Retention and Career Placement Guide

Arlene M. Muller, BA

Practical advice, true stories, & activities keep your students on track for graduation and landing that first job.


$38.95 (US) | $55.95 (CAN) ISBN-13: 978-0-8036-2365-1

Essentials of Medical Laboratory PracticeConstance L. Lieseke, CMA (AAMA), MLT, PBT(ASCP)Elizabeth A. Zeibig, PhD, MLS(ASCP)CM

Teach with the most common laboratory techniques, tests, and procedures performed in a physician’s office.


$69.95 (US) | $100.50 (CAN) ISBN-13: 978-0-8036-1899-2

10 11

MOLECULAR DIAGNOSTICS GENERAL REFERENCES

URINALYSIS

Molecular DiagnosticsFundamentals, Methods & Clinical Applications, 2nd EditionLela Buckingham, PhD, MB, DLM(ASCP)

Clinical Application of Molecular Concepts. Effectively introduce your students to fundamentals of nucleic acid biochemistry and the advanced concepts integral to diagnostic testing in today’s laboratories. Show them how to apply molecular techniques in clinical laboratory practice, including microbiology, virology, genetics, oncology, and human identification.

� Case Studies provide real-world insight into what to expect when working in the lab. � Problem-based study questions and troubleshooting tips throughout. � ‘Advanced Concept’ boxes throughout the text present more complex concepts to expand your knowledge.


$77.95 (US) | $111.50 (CAN) ISBN-13: 978-0-8036-2677-5

Line drawings, flowcharts, and photographs enhance comprehension and retention.

Urinalysis and Body Fluids, 6th Edition

Susan King Strasinger, DA, MT(ASCP) | Marjorie Schaub Di Lorenzo, MT(ASCP)SH

Colorful, comprehensive, & carefully structured. Give your students the theoretical and practical knowledge they need to confidently handle and analyze non-blood body fluids, and to keep themselves and their laboratory safe from infectious agents.

� Case studies and clinical situations promote problem-solving and critical-thinking skills.

� Study questions at the end of each chapter emulate questions on the national ASCP examination.


$69.95 (US) | $100.50 (CAN) ISBN-13: 978-0-8036-3920-1

of antibodies against known HLA types. These antibod-ies are prepared from cell lines or from donors or knownHLA types. Plates preloaded with antibodies (typingtrays) are commercially available, or laboratories mayconstruct their own antibody panels. The collection of an-tibodies may be modified to represent ethnic populationsor antigens of high prevalence in particular geographicalareas. The repeated use of antibody preparations facili-tates the recognition and recording of the antigen bindingcharacteristics of the various antibodies. Experiencedtechnologists have detailed documentation of antibodypanels, including which antibodies bind antigen well andwhich antibodies bind less strongly.

To begin the typing procedure, different antibodies areplaced in each well of a typing tray (a plastic plate withshallow wells). Donor or recipient lymphocytes to betyped are distributed to the wells. Cross-reactivity is as-sessed by the uptake of trypan blue or eosin red dye incells that have been permeabilized due to reaction withthe antibody and with the complement that is activated bythe antigen-antibody complexes (Fig. 15-6). Cytotoxicityis scored by the estimated percentage of cells in a wellthat have taken up the dye. The American Society forHistocompatibility and Immunogenetics (ASHI) has developed guidelines for numerical description of the observed cytotoxicity (Table 15.4). High cytotoxicity

(reading >6) in a well of the plate indicates that the cellsbeing tested have cell surface antigens matching theknown antibody in that well. As reading is somewhatsubjective, it is recommended that trays should be readby at least two technologists independently. An exampleof partial results from a CDC test is shown in Table 15.5.

428 Section III Techniques in the Clinical Laboratory

Plasma

Erythrocytes

Leukocytesand platelets

+

+

LymphocyteAntigen

Antibodies

Positive reactionto antibody

Negative reactionto antibody

Dead cellComplement

Blood

■ Figure 15-5 Crossmatching to known antibodies is performed on buffy coat (leukocytes andplatelets, left) in a 96-well plate format where each well contains different known antibodies. If theantibody matches the cellular antigen (positive reaction, top), complement-dependent cytotoxic-ity will occur, and the dead cell will take up stain (green). If the antibody does not match the cellular antigen, there is no cytotoxicity.

■ Figure 15-6 Cells stained for cytotoxicity. Dead cells takeup dye, and live cells remain transparent. (Photo courtesy ofDr. Andres Jaramillo, Rush University Medical Center.)

2677_Ch15_419-446.qxd 11/2/11 5:03 PM Page 428


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Today’s Health Professions Working Together to Provide Quality Care

Patricia Lockamy Royal, EdD, MSW

Help your students see which career might be the right one for them.


$99.95 (US) | $142.95 (CAN) ISBN-13: 978-0-8036-4465-6

Introduction to Health Care in a Flash! An Interactive, Flash-Card Approach

Marilyn Turner, RN, CMA (AAMA), MA

Take a multimedia approach to understanding the world of health care—from the office to clinical settings.


$64.95 (US) | $92.95 (CAN) ISBN-13: 978-0-8036-2586-0

MA Notes Medical Assistant’s Pocket Guide, 3rd Edition

Cindi Brassington, MS, CMA (AAMA) Cheri Goretti, MA, MT(ASCP), CMA (AAMA)

Quickly access normal lab values, common medical abbreviations, dosage calculations, triage questions, and more.240 pages | 72 illustrations | Soft cover, spiral binding | 2016

$34.95 (US) | $44.95 (CAN) ISBN-13: 978-0-8036-4561-5

Davis’s Comprehensive Handbook of Laboratory & Diagnostic Tests with Nursing Implications, 7th Edition

Anne M. Van Leeuwen, MA, BS, MT (ASCP)Mickey L. Bladh RN, BSN, MSNWith full Canadian content online co-authored by Beth Swart, RN, MES

This comprehensive and incredibly organized handbook will help your students understand how laboratory and diagnostic tests work, know how to interpret their results, and provide safe, quality patient care—pre-test, intra-test, and post-test.

1,792 pages | Soft cover | 2017

$56.95 | $81.50 (CAN) ISBN-13: 978-0-8036-5943-8


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