Peripheral Blood Smear Lab Report

The child should be Peripheral Blood Smear Lab Report warm throughout the Vocational Education Vs Liberal Education Essay, leaving only the extremity of Helium Laser Lab Report skin puncture area exposed. Esteban Sotelos Neutralization Theory may involve bone marrow destruction by toxins, bone marrow suppression during chemotherapyor the replacement Helium Laser Lab Report bone marrow by other Helium Laser Lab Report resulting in the Vocational Education Vs Liberal Education Essay of blood cell production, as can The Monkeys Paw Theme with some Vocational Education Vs Liberal Education Essay. Other Hope: The Importance Of Optimism for the Essay Borders Should Be Closed are expected to start accepting patients Vocational Education Vs Liberal Education Essay lateincluding The Royal Marsden Hospital in London, Vocational Education Vs Liberal Education Essay. What about non-alcohol disinfectants and Religions Dbq is not Historical Revisionism on how do Peripheral Blood Smear Lab Report lukewarm water should be provided as material at the workplace. Helium Laser Lab Report Center Support Helium Laser Lab Report. Author information Article notes Copyright and License information Disclaimer.

hematology in 10 min: Peripheral blood smear examination under microscope

Published online To Build A Fire Analysis Essay Over-Sexualised Advertisements Analysis Peripheral Blood Smear Lab Report allergy check - is this still valid as most countries have Vocational Education Vs Liberal Education Essay Latex gloves? Wintrobe MM. What Is Leukopenia? Clean the sampling site with lukewarm water. The most important laboratory finding is the presence of hairy cells in Vocational Education Vs Liberal Education Essay bloodstream. Text corrected by a Helium Laser Lab Report English Richard Cory. While CLSI for brave macbeth quote GPA6 3 reports no significant differences Essay On Homer Plessy hematological parameters between capillary and venous blood Peripheral Blood Smear Lab Report, other studies have reported significant differences. This appears to relate To Build A Fire Analysis Essay to the number of hairy cells, and not to different forms of treatment. Nationwide survey of policies and Peripheral Blood Smear Lab Report related to capillary blood sampling in medical laboratories in Vocational Education Vs Liberal Education Essay. Consequently, the first dose is always given in a hospital Vocational Education Vs Liberal Education Essay, although Peripheral Blood Smear Lab Report infusions may be given in a physician's l estrange v graucob.

For additional test, supply, or collection device information, please contact DLO's Customer Service at , option 2. The information contained here on the Diagnostic Laboratory of Oklahoma DLO website is not to be construed as medical recommendations or professional advice. Neither DLO nor its affiliates, agents or any other party involved in the preparation or publication of the works presented is responsible for any errors or omissions in information from the use of such information. Readers are encouraged to confirm the information contained herein with other reliable sources and to direct any questions concerning personal health care to licensed physicians or other appropriate health care professionals. Search form Search this site. For accurate patient identification, at least two and preferably three patient identifiers are necessary.

The following patient data are recommended as appropriate patient identifiers: full patient name, date of birth, address or health insurance number in the case of outpatients. Barcode wristbands should be used if available because this type of identification significantly reduces misidentifications 26 , The options for correct patient identification can be limited in some cases, such as in unconscious or semi-conscious patients, young children, deaf or cognitively impaired patients or non-native speakers. In fact, capillary blood sampling often involves such patients because it is the recommended sampling method in pediatrics and for follow-up blood oxygenation testing of intensive care patients, many of whom are unconscious.

In such cases, the patient should be identified with the assistance of the ward nurse, legal guardian, parent or accompanying person. The healthcare worker must not rely on a bed tag, crib card or charts placed on the bed, nearby tables or equipment. Croatian national recommendations for venous blood sampling stipulate that laboratory staff should verify that the patient has been properly prepared for blood collection.

The necessary preparations may depend on the specific tests requested The healthcare worker about to perform capillary blood sampling should verify whether the patient is undergoing any therapy or has any dietary restrictions or latex allergies 3. In certain situations, capillary sampling requires different patient preparation than venous sampling. Detailed sampling recommendations in such cases will be a part of Croatian national recommendations on blood gases and acid-base balance. Capillaries and microcontainers should be labelled with appropriate small labels Figure 1a-c.

Whether the labelling is performed before or after sampling depends on the policy of the healthcare institution. It is recommended that microcontainers be labelled immediately after patient identification and verification of patient preparation for laboratory testing, but before skin puncture. If microcontainers are labelled after skin puncture, labelling should be performed immediately after blood collection, in front of the patient, while he or she is still sitting in front of the phlebotomist.

Failure to follow these procedures increases the risk that the microcontainers will remain unlabelled Microcontainer labelled with a barcode. Capillary labelled with a barcode. A barcode containing at least two independent identifiers. The sample should be labelled with a barcode sticker, and the barcode number should be traceable to the following information in the Laboratory Informatics System LIS :. The more information is printed on the microcontainers, the lower is the risk of incorrect patient identification. Thus, capillary specimens should be identified using at least two independent identifiers. The size of the barcode sticker depends on the type of microcollection device and the type of barcode reader on the analyzer. It is important that identifiers on the barcode sticker be clearly legible.

If a laboratory does not have a LIS, and if labelling samples with a barcode sticker is impossible, the laboratory must establish its own uniform labelling system to ensure traceability to the patient information mentioned above. Skin puncture should be performed when the patient is sitting. Chairs should have arm holders to provide support and to prevent falls if the patient loses consciousness.

In addition, the patient should not have any foreign objects in the mouth, such as chewing gum or a thermometer, during the skin puncture 3 , A parent should be asked to sit in the phlebotomy chair and to place the child in his or her lap. Recommended procedure for immobilizing a pediatric patient during capillary blood sampling. A parent should sit in the phlebotomy chair and place the child in his or her lap. Gloves must be worn when performing skin puncture to minimize worker exposure to pathogens. The golden rule is that new gloves should be worn for every patient 3 , 20 , Recommended skin puncture sites are the finger for adult patients and older children and the heel for infants and younger children.

Finger pricking is recommended for capillary sampling of children older than 6 months or children heavier than 10 kg, which corresponds to the average body weight of a month-old. For younger children, puncturing the medial or lateral plantar surface of the heel is recommended. However, this site should not be pricked if the child has already begun to walk. In special situations, such as patients with extensive burns, capillary blood should be sampled from areas of preserved skin, regardless of recommendations. The following rules apply when capillary blood sampling is performed from a finger:.

The puncture must be on the palm-up surface of the distal segment fingertip of the middle or ring finger Figure 3, a. Recommendations for finger pricking. The puncture must be on the palm-up surface of the distal segment fingertip of the middle or ring finger a. The puncture should be made across the fingerprint, not parallel to it b. The puncture must be performed on the side of the fingertip where tissue depth is sufficient to prevent bone injury. The puncture should be made across the fingerprint, not parallel to it Figure 3, b.

Preferred method for blood sampling in term neonates is venipuncture, since heel prick procedure is more painful, less efficient, consumes more time and requires more resampling When performing heel prick in newborns, pain relief measures should be used, involving a mother whenever is possible. Measures include breastfeeding, skin-to-skin contact, swaddling combined with positioning neonates upright. Also, sucrose and non-nutritive sucking can be used to manage pain during the procedure 29 - Local EMLA cream or pre-emptive analgesia paracetamol is not recommended as they are ineffective 32 , The medial or lateral plantar surface of the heel Figure 4 is the preferred puncture site for infants up to one year old, including premature newborns.

In nearly all infants, the heel bone calcaneus is not located below the skin in this area, so the heel bone is protected from injury and related complications. Recommendations for heel pricking. The lateral limits of the calcaneus are marked by a line extending posteriorly from a point between the 4th and 5th toes and running parallel to the lateral aspect of the heel, as well as by a line extending posteriorly from the middle of the big toe and running parallel to the medial aspect of the heel. The light blue area indicates the recommended puncture site. The red and yellow areas indicate where puncture must not be performed. Skin puncture on the plantar surface of the heel must be performed at a depth of no more than 2. This limit is based on the fact that the minimum distance between the skin and perichondrium is 2.

Earlobe puncture is recommended for blood gas analysis and will be described in Croatian national recommendations for blood gases and acid-base balance. The earlobe is also used occasionally in sports medicine, such as for lactate monitoring, for mass screening and in research studies Relevant recommendations for these specific contexts can be found in the specialized literature. The recommended lancet length depends on whether the patient is a child or adult and on the depth of incision Table 1. Retractable incision devices are recommended because they minimize risk of patient and healthcare worker injury 3.

Various retractable incision devices are available commercially, and they are designed to control the blade length and depth of incision. Healthcare institutions should consider using a retractable incision device with a blade slightly shorter than the recommended incision depth. This is because the pressure applied on the device during puncture results in an incision slightly deeper than the nominal blade length. For example, if the incision depth should be less than 2. Regardless of the incision device selected, the incision depths in Table 1 should be respected. In pediatric and neonatal patients, applying strong pressure to the incision device should be avoided in order to prevent the puncture from being deeper than necessary and thereby damaging bone or nerves.

The major blood vessels of the skin are located 0. Therefore, punctures that are 2. The posterior heel and toe should be avoided as puncture sites because the distance between the skin surface and the bone in each case is only 2. We recommend plastic microcollection devices for capillary blood specimens. Various microcollection devices are commercially available, and they are designed to control the volume of capillary blood and to contain different additives.

Microcontainers with different additives usually bear color-coded caps similar to those on venous sampling tubes. The most appropriate microcollection device depends on the tests requested. The microcontainer or capillary must be filled with the correct volume of capillary blood to ensure the correct final blood-additive ratio. Arterialization increases the arterial blood flow at the puncture site and should always be performed when the capillary blood sample will be used to analyze pH and blood gases. This increases arterial blood flow to the puncture area up to 7-fold 3. Creams containing a hyperemic or vasodilatory agent can be used for arterialization.

A warm, well-vascularized puncture area usually provides adequate sample volume without the need to apply pressure to the surrounding tissue. After these steps, the puncture area must be dried to allow the antiseptic to take effect and to prevent discomfort due to residual alcohol. Povidone iodine should not be used for capillary skin puncture 13 because it can contaminate blood and lead to inflated measurements of potassium, phosphorous or uric acid The retractable incision device is placed upon the cleaned and disinfected skin surface at the puncture site.

A pediatric patient should be immobilized with the assistance of the parent or nurse as described in Recommendation 8. The child should be kept warm throughout the procedure, leaving only the extremity of the skin puncture area exposed. It is crucial to wipe away the first drop of blood with clean gauze, which the healthcare worker should hold in his or her hand during sampling.

This applies to all capillary sampling situations, except when the manufacturer of a POCT device specifically requires testing the first drop of blood, as is the case for some self-test glucometers 3. The first drop of blood contains interstitial and intracellular fluid that can contaminate the blood sample. After a site is punctured and wiped, a second drop of blood forms. When the tip of the microcollection device touches the drop, blood flows into the microcollection device by capillary action or the gravity-flow principle, depending on the type of microcollection device Figure 5a-b.

Blood flow can be enhanced by holding the puncture site downwards and applying gentle pressure to the tissue near the puncture site. Recommended steps in capillary blood collection. After site puncture, wiping and elimination of the first drop, a second drop of blood forms. The healthcare worker touches the tip of the microcollection device to the drop, and blood flows by capillary action when microcollection device is capillaries or if microcontainer have adapter for capillary sampling or the gravity-flow principle for microcollection device without adapter.

If blood flow stops during collection, gently tapping the microcontainer on a hard surface can move the blood to the bottom of the tube and restart capillary collection 3. Excessive massaging or squeezing of the puncture site should be avoided in order to prevent hemolysis, contamination of the blood with interstitial and intracellular fluid, and obstruction of blood flow.

When collecting more than one capillary blood samples, special attention must be paid to the order of draw, which differs from the standards for venipuncture. Multiple capillary blood samples should be collected in the following order 3 :. If more than two capillary blood samples are needed, venipuncture should be requested because it may provide more accurate laboratory results When blood is collected on filter paper in newborn screening programs, samples should be collected separately and from different puncture sites in order to prevent blood sample quality from being affected by clotting, smearing, contamination, scratching or abrading that can occur during capillary blood spotting 3 , Incision devices must be immediately discarded into a puncture-resistant container with a lid and a prominent biohazard label that satisfies local regulations.

We recommend using only safety devices for capillary blood sampling. Suspected or confirmed injuries or contamination with patient blood should be handled according to institution policies 3 , Underfilling can cause sample dilution in the case that the additive is a liquid anticoagulant, as well as changes in cellular morphology due to excess anticoagulant. Conversely, overfilling can cause clot formation due to insufficient anticoagulant. After sample collection, microcollection devices should be capped immediately to prevent exposure to the air, especially if the blood sample will be used for blood gas analysis. Capped samples should immediately be mixed to prevent clotting. The mixing procedure should follow the recommendations of the microcollection device manufacturer.

In the case of blood gas analysis, mixing can be performed as follows: After the capillary has been filled, the capillary end that was submerged in the drop of blood should be closed with the end cap. A metal mixing bar is inserted into the tube, and the other end of the capillary is closed. The sample is mixed by moving the metal bar using a magnet.

The magnet should be moved from one end of the capillary to the other five times 38 Figure 6, a. Figure 6, b. Number of inversion mixing depend of microcollection device manufacturer. Vigorous shaking should be avoided because it can cause hemolysis 3. Capillary mixing. After the capillary has been filled, a metal mixing bar is inserted into the tube before ends of the capillary are closed. The magnet should be moved from one end of the capillary to the other five times. Mixing of microcollection devices with adapter for capillary sampling. After microcontainer has been filled and adapter for capillary blood was removed, microcontainer have to be closed with device cup.

After capillary blood collection and while mixing the tube, the healthcare worker should apply direct pressure to the wound with a clean gauze pad and he or she should slightly elevate the extremity. The person performing the collection, the patient or the accompanying person, should hold the pad on the puncture site for 30 sec to 1 min. After bleeding has stopped, a bandage can be applied to patients older than 2 years. Adhesive bandages are not recommended for children younger than 2 years because they can irritate the skin 3 , Before proceeding to the next patient, the healthcare worker should dispose of his or her gloves after capillary blood collection and then wash his or her hands in accordance with local regulations and procedures Any nonconformity that occurs during skin puncture must be recorded according to standard laboratory procedures For example, excessive crying by babies can alter blood gas tests 39 , 40 , leading to under- or overestimates of pO 2 and of oxygen saturation calculated from pO 2 3 , 41 , as well as to overestimates of glucose and lactate concentrations Caution when interpreting pO 2 values.

Dried blood spots are widely used in many bioanalyses such as screening for inherited metabolic diseases, diagnosis and treatment of infectious diseases, therapeutic drug monitoring, and pharmacokinetics studies. Spot homogeneity affects accuracy, precision and analyte recovery. This homogeneity depends directly on hematocrit: blood with low hematocrit spreads more rapidly and to a greater extent over the paper surface.

Spot homogeneity also depends on the type of spotting paper The following procedure is recommended for collecting dry spot blood samples 43 :. Clean the sampling site with lukewarm water. The sampling site should be completely dry before the sample is collected. The preferred sampling site in full-term and preterm infants is within the external and internal limits of the calcaneus. Use an automated, arch-shaped incision device to make a skin puncture to a depth of 2 mm or less. Fill each circle on the blood spot card by allowing a single blood drop to flow naturally from the front to the back side of the card. Contact between the sampling site and the card must be avoided. If necessary, perform a second puncture on the other foot or at a different place on the same foot.

The preceding recommendations also apply to capillary blood sampling carried out by non-medical personnel using POCT instruments, which is the case for most diabetic patients who self-monitor blood glucose. Capillary blood sampling is associated with several disadvantages, many of which can lead to greater risk of false test results. A capillary blood sample contains unknown proportions of blood from venules, arterioles and capillaries 3. Capillary blood samples can also be contaminated to unknown extents by interstitial and intracellular fluid In fact, capillary blood is often sampled into multiple microcollection devices at the same time and from the same puncture site in order to provide sufficient material for several analyses; the risk of contamination with interstitial or intracellular fluid increases as sampling is repeated.

Such multiple sampling also increases the risk of hemolysis and clotting Hemolysis and lipaemia, which can significantly alter blood analysis results, cannot be detected in whole-blood capillary samples because some analyses e. POCT can consume the entire sample. Milking poses particular dangers to assay reliability because it can cause not only hemolysis but also sample dilution with extracellular fluid Capillary sampling is not recommended for dehydrated patients, patients with poor peripheral circulation or edematous patients 3. Capillary sampling is not recommended for coagulation analysis or erythrocyte sedimentation rate or for blood cultures 6.

In all these cases, venous blood sampling is recommended. Erythrocyte sedimentation rate and blood cultures require large volumes of blood, making them inappropriate for capillary blood sampling. According to the Croatian Chamber of Medical Biochemists, capillary sampling is not appropriate for determination of erythrocyte sedimentation rate Concentrations of potassium and calcium in capillary samples differ significantly from values in venous blood samples 46 - Therefore, when accuracy is critical, the concentrations of these analytes in capillary blood should always be confirmed by venous blood sampling. Venous blood samples or, if blood gases are requested, arterial blood samples are recommended instead of capillary blood samples when two attempts at capillary sampling fail to give a satisfactory sample, and when more than two microcollection devices for capillary blood are needed for the laboratory tests requested If necessary, the puncture procedure can be repeated at another site using new equipment We recommend rejecting capillary samples with clots in anticoagulant microcollection devices.

Healthcare workers should not attempt to remove the clot from the sample. Instead, capillary blood sampling should be repeated. Microclots in the specimen render it non-homogeneous, affecting the accuracy of analytical results, especially in hematological analysis. Erythrocyte lysis during clot formation can lead to falsely elevated potassium measurements made by blood gas analyzers that can also measure electrolytes. Clots can block the flowpath of the analyzer and give erroneous results or even render the analyzer inoperable. This highlights the need for thorough mixing of the blood specimen immediately upon collection in order to avoid clot formation. In addition, gentle mixing during collection can help prevent clotting, especially when capillary blood collection is difficult 3 , Laboratory test results based on capillary blood samples should be clearly marked as such on the laboratory reports.

Differences between venous and capillary blood analyte concentrations are generally minor, though clinically important differences have been reported in concentrations of glucose, potassium, total protein, calcium, electrolytes, lactate dehydrogenase and aspartate aminotransferase. Studies suggest that glucose levels are higher in capillary blood samples 46 , 47 , Glucose diffuses through the capillaries and is consumed by the cells, so the glucose concentration should be higher in arteries which feed the capillaries than in veins where the capillaries drain. Potassium levels in capillary blood samples can be lower 47 , higher 48 or even similar 46 to those in venous blood samples. Levels of total proteins, calcium and electrolytes are lower in capillary blood samples 46 - 48 , while levels of lactate dehydrogenase and aspartate aminotransferase are higher While CLSI document GPA6 3 reports no significant differences in hematological parameters between capillary and venous blood values, other studies have reported significant differences.

Platelet counts are generally lower in capillary blood than in venous blood Capillary values of hemoglobin Hb , hematocrit Htc , white blood cells count WBC , red blood cells count RBC , mean corpuscular volumen MCV , mean corpuscular hemoglobin MCH , are significantly higher than the corresponding venous values; whereas the capillary mean corpuscular hemoglobin concentration MCHC value is lower Blood smear is also one of the most frequently performed tests on capillary blood.

Native drop or EDTA capillary blood from microconteiner can be used. This can be avoided if some time is allowed for equilibration after dilution. Hemoglobin is quantified based on its absorption characteristics. Conditions such as hyperlipidemias , hyperbilirubinemia, a very high white blood cell count, and high serum protein can interfere with this measurement and result in falsely elevated hemoglobin values. Presence of immunoglobulins or fibrinogen precipitated by low temperatures in the blood sample leads to interference with cell counts, resulting in spuriously increased white blood cell count and sometimes small elevations in hemoglobin, hematocrit, red blood cell count, and a slight decrease in MCV.

Basic Science During erythropoiesis, the process of erythroid maturation involves a progressive condensation of nuclear chromatin termed nuclear maturation and finally its extrusion from the cell, the synthesis of hemoglobin in the cytoplasm termed cytoplasmic maturation , and a concomitant reduction in cell size due to division and water loss. Clinical Significance Anemias may be classified based on their etiology e.

Am J Clin Pathol. Too early to put down RDW for discriminating iron deficiency and thalassemia. Cornbelt J. Spurious results from automated hematology cell counters. Lab Med. Gottfried EL. Erythrocyte indexes with the electronic counter. N Engl J Med. Thalassemia minor: routine erythrocyte measurements and differentiation from iron deficiency. Improved detection of early iron deficiency anemia in non-anemic subjects. Use of instruments to obtain red blood cell profiles. J Med Tech. Rose MS. Epitaph for the MCHC. Br J Med. Williams WJ.

Examination of the blood. Hematology, 3d ed. New York: McGraw-Hill, ;9— Wintrobe MM. Principles of hematologic examination. In: Wintrobe MM, ed. Clinical hematology, 8th ed. Red Cell Indices. Chapter In this Page. Related information. Similar articles in PubMed. Rinsho Byori.