Blood test specimens are divided into whole blood, plasma, serum, etc. Whole blood samples are mainly used for clinical hematological examination, such as blood cell count and classification, morphological examination, etc. Plasma samples are suitable for endocrine hormones, thrombosis and hemostasis, while serum samples are mostly suitable for clinical chemistry and immunology. The following is the knowledge I brought to you about the collection method of blood samples. Welcome to reading.
First, venous blood collection methods, matters needing attention and the safe disposal of materials used to collect samples.
1, tourniquet or pulse compressor: When collecting venous blood, the time for tourniquet to compress the vein should not be too long, and should not exceed 40 seconds.
Otherwise, it will easily lead to congestion and venous dilatation, which will affect the inspection results of some indicators, such as the increase of lactic acid, the decrease of pH value, the increase of K+, Ca 2+ and creatine kinase.
2. Time and place of blood collection: Most laboratory tests require venous blood collection on an empty stomach in the morning, and try to avoid blood collection while infusion. Transfusion not only dilutes blood, but also seriously interferes with test results, especially blood sugar and electrolytes.
3. Avoid hemolysis and impurity pollution: Blood collection instruments must be sterile, dry and clean. Avoid particularly hard inhalation, injection and avoidance.
Avoid hemolysis caused by chemical pollution and bacterial pollution. Because some components of red blood cells are different from serum (plasma), hemolysis will make the sample
Some components of red blood cells will be released, which will affect the results of laboratory tests.
4. Collecting blood samples: It is required to collect blood samples at the same time every day, and the ideal time is 7:00-8:00 in the morning. Especially for monitoring, it is necessary to ensure the unification of sample collection time. The last intake of food and liquid should be in.
6:00-7:00 a day (except for emergency examination). Blood samples should be collected during non-drug treatment, such as before taking medicine in the morning. When collecting blood samples, the patient should lie on his back, and the blood collection point should be in the same vein area, usually the arm vein.
5. Samples should be sent for inspection immediately after collection, and too long storage time will affect the test results. When blood collection is not smooth, avoid repeating it in the same place.
Puncture can easily lead to hemolysis or small clots, which will affect the test results.
6. When collecting blood culture specimens, the anaerobic bottle should be injected first to minimize the time of exposure to the air.
7. Syringes used for trace element determination and containers for collecting samples cannot contain free metals.
8. Safe disposal of materials used to collect samples: sharp objects such as used blood collection needles and syringe needles should be directly placed in impenetrable sharp weapon boxes or die breakers for safe disposal. It is forbidden to re-cap the used disposable needles, and it is forbidden to directly contact sharp objects such as used needles and blades with your hands; Syringes, cotton swabs and other medical wastes are put into yellow medical waste bags, and medical wastes and domestic garbage are collected and stored separately. Disinfected and disfigured medical waste must be handed over to the designated medical waste treatment plant and shall not be discarded without authorization.
Second, clinical chemistry/immune test specimens
Non-anticoagulant samples are mostly used for clinical chemical/immunological detection, and it is best to use vacuum negative pressure blood collection tubes.
The key points for attention in specimen collection are:
1, most chemical projects need to take venous blood on an empty stomach, and test-tube blood can generally be taken when multiple single chemical testing projects are merged;
2. The amount of blood collected varies according to the number of examination items, generally 4.0 ~ 5 .0ml.
3, multiple combined test items at the same time blood sampling should be carried out in the following order:
Adding tube for blood culture without adding tube coagulates blood vessels.
The order of test tubes with additives is citrate test tube, heparin test tube, EDTA test tube and oxalate/sodium fluoride test tube.
4. Regardless of anticoagulation or non-anticoagulation, in order to shorten the contact time between serum or plasma and blood cells, serum or plasma should be separated from whole blood as soon as possible after blood sample collection, so as not to affect the accuracy of test results. Whole blood must be treated as serum or plasma within 2 hours from the collection of blood samples.
1) serum (non-anticoagulant): after blood collection, the specimen can spontaneously (spontaneously) completely coagulate at 22 ~ 25℃ (room temperature) 15 ~ 30 min, and it is forbidden to peel off clots such as wooden sticks and glass sticks; The agglutination of samples in cold storage is slow, and the agglutination is accelerated after adding coagulant.
2) Plasma (anticoagulant): Take blood with an anticoagulant tube, mix it upside down for 5 ~ 10 times immediately after blood collection, and it can be done within a few minutes after blood collection.
Centrifuge plasma.
3) Frozen samples: used to stabilize temperature-dependent components in blood (inhibit cell metabolism). The specimen should be refrigerated at 2 ~ 8℃ (the specimen should be put into the refrigerator immediately after collection, and the refrigeration must be sufficient); The items to be tested in the cold storage include catecholamine, gastrin, parathyroid hormone, PH/ blood gas, NH3, lactic acid and pyruvate. Whole blood samples are generally not refrigerated, and blood potassium determination samples should not be refrigerated >: 2h. Whole blood samples should not be frozen.
4) Application of metabolic inhibitors and preservatives: used to inhibit cell metabolism. After adding sodium fluoride to the blood sample, the blood cells did not
Glu in blood samples was stable at 22 ~ 25℃ for 24 hours and at 8℃ for 48 hours. Sodium fluoride is not suitable for the determination of Glu in newborns and children (because of the high PCV in children, cell glycolysis is difficult to control); Sodium fluoride-thymol mixture is not suitable for enzymatic detection (because sodium fluoride-thymol mixture inhibits enzyme activity); Potassium formaldehyde oxalate anticoagulant preservative is not suitable for blood sugar determination.
Three, erythrocyte sedimentation rate test specimens
Intravenous collection of sodium citrate (109mmol/L, that is, 32.06g/L) anticoagulation (sodium citrate anticoagulation tube blood collection), black hat tube.
Precautions for blood collection:
1, respectively collect 1 tube of blood, and prepare to collect blood to 2 ml scale line (anticoagulant: whole blood =1:4);
2. Immediately after blood collection, mix upside down for 5~ 10 times;
3. After blood collection, it should be submitted for inspection as soon as possible (it must be tested within 2h).
Four, blood routine (whole blood cell analysis) test specimens
Generally, EDTA 1.5 ~ 2.2 mg/ml is used for anticoagulation (EDTA anticoagulant blood vessel-purple cap tube).
Precautions for blood collection:
1, immediately after blood collection, mix backwards, 5 ~ 10 times. Don't shake hard;
2, should according to the scale of anticoagulant blood to 2ml, don't need an empty stomach;
3, should be submitted as soon as possible after blood collection (need to observe the shape of the specimen after blood collection should be fixed in time, because more than 2.
WBC morphology will change in a few hours);
4. Blood type and blood routine can be 1 tube blood.
Verb (abbreviation of verb) 75g glucose tolerance test (OGTT )/ insulin release test /C peptide release test
1, patient preparation: 3 days before the trial, the daily carbohydrate intake was not less than 250-300g, and maintained at a normal level.
Drugs (such as caffeine, oral contraceptives, salicylates, etc. ) Frequent activities that affect the test should be stopped 3 days ago.
Patients should not eat 10 ~ 16 hours before the test.
2. Specimen collection: The common clinical method is to take 75g glucose orally after fasting blood in the morning, and then give sugar.
0.5, 1, 2, 3 hours, 2 ml blood/1 time (*** 5 times).
3. Specimen preservation: After blood collection, separate the serum within 1 hour, and send it for inspection in time, or collect it with a special anticoagulant tube for blood sugar.
Blood, stored at 2 ~ 8℃.
4. Precautions: The determination of insulin is greatly affected by hemolysis, so hemolysis should be avoided when taking blood.
Six, hypertension series test specimens
1, hypertension (renin, angiotensin I, angiotensin II)
1) patient preparation:-blockers, vasodilators, diuretics, steroid hormones, licorice, etc. Affect the level of renin in the body. Generally, renin activity (PRA) should be measured 2 weeks after drug withdrawal, and drugs with slow metabolism such as reserpine should be measured 3 weeks after drug withdrawal. Patients who should not stop taking drugs should take antihypertensive drugs such as guanethidine, which has little effect on PRA. Sodium intake affects the level of PRA in the body, so patients should reduce their salt intake properly 3 days before PRA measurement, and it is best to measure urine sodium content 24 hours before blood collection for reference in analyzing PRA results.
2) Specimen collection: take 4 ~ 5ml of blood from vein, unplug the needle, slowly inject it into the special anticoagulant tube, cover the plug and put it on.
Invert for 5 times, mix at 2500 rpm, centrifuge for 5 ~ 10 minutes, separate plasma, put it into a special plasma tube, and send it for inspection at low temperature. If it cannot be sent for inspection immediately, it needs to be frozen as soon as possible (-15℃). Hemolytic samples cannot be detected;
3) Specimen type and quantity: use special anticoagulant tube to collect blood, separate plasma, and take 2ml for inspection;
4) Specimen preservation: it can be preserved for 2 months at low temperature (below-15℃);
5) Precautions: The application form should indicate the position when taking blood (lying position: the patient takes venous blood before getting up at 6-8 am; Standing position: the patient moves for 3 hours after getting up and takes venous blood. ) and diet (general diet, low sodium diet); Failure to separate plasma in time, repeated freezing and thawing, hemolysis, improper storage and the use of expired anticoagulation tubes can all affect the results.
2. Aldosterone
1) patient preparation: before sampling, stop using diuretics for at least 3 weeks and stop using antihypertensive drugs 1 week;
2) specimen collection: heparin should be used for anticoagulation in plasma aldosterone determination, and the plasma should be separated immediately after collection and stored at -20℃
To be tested; Urine samples were collected for 24 hours and stored with 10 ~ 15 ml concentrated hydrochloric acid.
3) Remarks on the application form: body position (lying position, standing position) and diet (general diet, low sodium diet) during blood drawing;
Urine samples should accurately record the 24-hour urine volume.
Seven, cortisol specimen collection and matters needing attention
Cortisol secretion in normal people has a circadian rhythm. Usually, blood is collected at eight o'clock in the morning or four o'clock in the afternoon. Please be sure to indicate the time of blood collection on the application form when submitting for inspection.
Eight, flow cytometry detection project specimen collection and matters needing attention
1, lymphocyte subsets series
Specimen requirements: 2ml of whole blood anticoagulated with EDTA or heparin (EDTA is recommended).
Note: The reference value of cell number of this series of items is different at different ages, so please be sure to send it for inspection.
The age of the patient is indicated on the application form.
2. Immunotyping of leukemia
Specimen requirements: 2ml heparin anticoagulated bone marrow or whole blood.
Note: Please use the special application form for leukemia immunophenotyping.
3. Detection of human leukocyte antigen B27/ paroxysmal nocturnal hemoglobinuria
Specimen inspection requirements: EDTA or heparin anticoagulated whole blood 2ml Note: Make sure the specimen is fresh, and the flow cytometry inspection items should be sent for inspection within 24 hours;
Nine, trace element detection sample collection requirements
1, all blood sampling personnel should undergo strict training, be familiar with the blood sampling process, and understand the operation technology of trace elements (especially
Lead and zinc).
2, blood sampling personnel should wear latex or polyethylene gloves, if gloves are coated with powder, need to use vein blood skin cleaning method to deal with gloves.
After the operation.
3. When taking blood for blood lead test, clean the skin in the blood collection area with 0.2% nitric acid, pure water, iodine and alcohol to prevent environmental pollution.
Detection of blood lead pollution.
4. The rubber plug is polluted by zinc, so the common blood collection tube cannot be used. Please use the special tube provided by this center.
5. Collection method: Collect 0.5- 1.0mL of venous blood, mix it gently upside down immediately after collection, stick a barcode on it, and put it in.
Self-sealing bag for inspection.
6. If it cannot be sent for inspection in time, it should be kept in the refrigerator at 2-8℃.
7, specimen solidification or contains clots, can't test.
Ten, genetic testing specimen collection requirements
1. Specimen collection: peripheral blood samples can be collected by heparin anticoagulation tubes (for genetic use only) and blood collection needles issued by the center. Immediately after collection, gently invert the test tube and mix it evenly to avoid solidification; Open the heparin anticoagulant tube cover distributed in the center, inject cord blood or bone marrow into the collection tube, immediately invert the tube and mix it evenly to avoid coagulation, and then successfully puncture cord blood samples and bone marrow samples. Please pay attention to aseptic operation and don't pollute the tube cover. Please avoid injecting the sample directly into the collection tube after using a syringe to avoid hemolysis. Do not use anticoagulant tubes (such as EDTA) to collect samples.
2. Specimen size: 4ml of peripheral blood, cord blood and bone marrow.
3. Specimens for inspection: Qualified specimens must be sent to the genetic laboratory on the same day after blood collection. Please inform Ai in time after specimen collection.
The deacon receives the specimen; Specimens with hemolysis and coagulation are also regarded as unqualified specimens. Bone marrow specimens should be sent as soon as possible.
Go to the lab
4. Specimen preservation: after collection, the specimen should be preserved at 18 ~ 25℃, and it is not allowed to be frozen or placed in high temperature environment.
5. Fill in the application form: Please fill in the application form completely, especially the time of specimen collection, gender, medical history and clinical diagnosis.
XI。 Collection requirements of genetic test samples
1, all samples used for gene diagnosis must be kept in sterile test tubes or containers, heparin anticoagulation tubes are strictly prohibited, and collection standards are adopted.
Pay attention to aseptic operation at this time.
2. In order to avoid pollution, the genetic diagnosis specimens submitted for inspection need to be single, single and single tube.
3. Acquisition method:
1) blood sample
Take the patient's venous blood, put it in a sterile test tube and naturally coagulate at room temperature or separate the heart at 2000 rpm, and take the separated EDTA anticoagulant plasma/serum for inspection;
2) Female secretion specimen
(1) Secretion specimens should be collected during non-menstrual period; Do not use drugs or rinse vagina within 3 days before sampling; You should not have sex within 24 hours;
(2) When collecting, gently wipe off excessive secretions at the cervix or urethra with a cotton swab, replace the cotton swab, insert the cotton swab into the cervix, and rotate it for 3-5 weeks to ensure that more columnar epithelial samples are obtained. For patients suspected of human papillomavirus infection, collecting samples from the affected area as much as possible can improve the detection rate of human papillomavirus. Put the sampling cotton swab into the matching hose and tighten the tube cover;
(3) First, clean the urethral orifice of the male secretion specimen, insert the cotton swab into the male urethra 1cm, rotate it for 3-5 times to obtain the specimen, put the sampling cotton swab into the matching hose, and tighten the tube cover;
(4) Herpes fluid or wart specimen: For those who have wart hyperplasia around genitals or anus and are suspected to be condyloma acuminatum, it is advisable to directly collect wart tissue and put it into a specimen tube for examination. Remarks: When making wart specimens, what should I write in the column of specimen type in the application form? Warts? .
4. Specimen preservation: Specimens whose target nucleic acid is DNA can be preserved at 2 ~ 8℃ for 3 days; The detection target nucleic acid is RNA.
Specimens should be kept at -20℃.
Twelve, bone marrow examination requirements and matters needing attention
1, smear requirements: 2 blood slides, 6 bone marrow slides and 8 suspected leukemia bone marrow slides. Notes on bone marrow blood slides? b？ , bone marrow film shows? m？ , to show the difference.
2. Matters needing attention in the application form:
1) case summary: it should be filled in comprehensively, especially the symptoms related to blood diseases such as liver, spleen, lymph nodes and bleeding status, as well as the application of drugs;
2) Test results: Blood routine results are definitely indispensable. If possible, you should also fill in MCV, maternal and child health care, maternal and child health care and classification;
3) Bone marrow should also be filled. If the bone marrow is not smooth, it should be pumped again to avoid delaying the patient;
4) Write the contact information of the attending doctor, such as the telephone number and mobile phone number of the department (in order to keep close contact with the clinic).
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