SOME BASIC CONCEPTS OF BIOCHEMISTRY (Lesson - 6: Anticoagulants used for blood collection, venous blood collection procedure) FOR DMLT FIRST YEAR STUDENTS (U. P. State Medical Faculty syllabus) in ENGLISH & HINGLISH

Types of blood samples, anticoagulants used for blood sample collection, EDTA, citrate, heparin, oxalate, fluoride, venous blood collection procedure for diagnostic tests, phlebotomy, phlebotomist, correct order of draw, some DOs & DON'Ts, dead space of syringe, one hand scoop technique, preanalytical errors, hemolysis

1. 1
SOMEBASICCONCEPTSOFBIOCHEMISTRYFORDMLTFIRSTYEARSTUDENTS(U.P.
StateMedicalFacultysyllabus)inEnglish&Hinglish
LESSON6
[Anticoagulantsusedforbloodcollection,venousbloodcollectionprocedure]
INENGLISH
BLOOD&ANTICOAGULANTS
BLOOD
Bloodisactuallyatissuemadeofplasma(about55%ofbloodfluid)and3maintypesofblood
cellscirculatingwiththeplasmaviz.platelets(thrombocytes),whitebloodcells(leukocytes)and
redbloodcells(erythrocytes).Plasmacontains92%waterandtherest8%consistsofglucose,
fats,variousproteins,hormones,vitamins,mineralsetc.
Bloodcirculatesinthreetypesofbloodvessels-arteries,veinsandcapillariesandtherefore,
bloodcirculatinginthemiscalledarterialblood,venousbloodandcapillarybloodrespectively.
Arterialblood(oxygenatedblood)ispumpedandcirculatedinthepulmonaryvein,theleft
chambersoftheheart,andinthearteriesthroughoutthebody.Itisbrightredincolour.
Venousblood(deoxygenatedblood)flowsfromtinycapillarybloodvesselswithinthetissues
intoprogressivelylargerveinstotherightsideoftheheart.Itisdarkredincolour.
CapillaryBloodisobtainedfromcapillarybedsthatconsistofthesmallestveins(venules)and
arteries(arterioles)ofthecirculatorysystem.Thevenulesandarteriolesjointogetherincapillary
bedsformingamixtureofvenousandarterialblood.Capillarybloodisoftenthespecimenof
choiceforinfants,veryyoungchildren,elderlypatientswithfragileveins,andseverelyburned
patients.

2. 2
ANTICOAGULANTSUSEDINDIAGNOSTICLABORATORYFORBLOODCOLLECTION
Threetypesofbloodsamplesusedindiagnosticlaboratoriesare-wholeblood,plasmaand
serum.Theanticoagulantsareusedforwholebloodandplasmasamplecollection.The
purposeofananticoagulantistopreventbloodfromclottingandtomaintaintheintegrityof
bloodcells.
Differenttypesofanticoagulants:
1.EDTA(Ethylenediaminetetraaceticacid)-isusedforbloodsamplecollectionfor
hematologicalparameterssuchascellcount,hematocrit,hemoglobinestimation,andthecell
differentialcount.
Mechanismofaction-EDTAisachelatingagentthatbindsthecalciumions,whichisneeded
forcoagulation.Thusthecoagulationofbloodisprevented.
●Itisusedasdisodium,ordipotassium,ortripotassiumsalt.
●PotassiumEDTA(K2orK3)ismorepreferred,ratherthanSodiumEDTA,because
SodiumEDTAislesssolubleinwater.
●TheamountofEDTAusedforbloodcollectionis1.2to2.0mg/mlblood(4.1to6.8
mmol/lblood)basedonanhydroussalt.Morethan2mg/mlbloodconcentrationcauses
shrinkageofthecells.
●TheadvantageofEDTAbloodisthatEDTApreservesthemorphologyofthebloodcell
structure(ifcollectedincorrectratio)andhaslittleeffectonthevarioustests.
●ThedisadvantageisthatEDTAinhibitsalkalinephosphatase,creatinekinase,and
leucineaminopeptidaseactivitiesandEDTAbloodisnotsuitableforCalciumandiron
estimation.
2.Citrate(Trisodiumcitrate)-isusedforcollectionofbloodsampleforcoagulationparameters
suchasPT,aPTT,INRandESRbyWestergrenmethod.
Mechanismofaction-Itpreventscoagulationbybindingionizedcalcium,whichisrequiredin
clotformation.However,unlikeEDTA,thebindingofcalciumisreversible—socalciumcanbe
addedbacktostudycoagulationundercontrolledconditions.
●3.2-3.8g/dltrisodiumcitratesolutionisusedintheratioof1partcitratesolutionand9
partsofbloodforPT,aPTTandINRbutforESRtheratiois1partcitrateand4parts
blood.
●Theratioofcitratetobloodshouldbeaccurateforreliabletestresults.
3.Heparin-isusedasananticoagulantforcollectingbloodsamplesfortheestimationofpH,
bloodgases,electrolytes,ionizedcalciumetc.
Mechanismofaction-Heparininhibitstheformationofthrombinfromprothrombinandthereby
inhibitsbloodcoagulation.
●Thoughheparinizedbloodcanbeusedformanybiochemicaltestsbutitisnotsuitable
forperipheralbloodsmear,coagulation,hematologicalandsomebiochemical
parameters.
●Usedaslithiumsaltorsodiumsalt
●Lithiumsaltisusedforelectrolytestestingwhereassodiumsaltisusedforbloodtobe
testedforlithium
●Itisusedataconcentrationof2mgor20-50Upermlofblood.Excessofheparinmay
underestimateionizedcalciumduetothecalciumbindingeffectofheparinandmayalso

3. 3
affectpHandbloodgasparameters.Likewise,alesserthantherequiredamountof
heparinmayresultinclots/microclots.
4.Oxalate-Thepotassiumandammoniumsaltsofoxalicacidarethemostcommonlyused
oxalatesasanticoagulants.Itformsaninsolublecomplexwithcalciumions(precipitatingthe
calcium).
●Potassiumoxalatebeingthemostsolubleisthemostcommonlyusedoxalateata
concentrationof2-3mgpermlblood.
●Thecombinationofammoniumoxalateandpotassiumoxalatepreventstheshrinkageof
RBCsafterbloodcollection.
●Higherconcentrationofoxalatemaycausehemolysisandreductionofhematocrit.
5.SodiumFluoride-isaweakanticoagulantbutbeinganantiglycolytic,usedforcollectionof
bloodforglucoseestimation.
Mechanismofaction-Itinhibitsredcellmetabolismandbacterialactionbyinhibitingthe
enzymeenolaseofglycolyticpathwaytherebypreventingthedeteriorationofbloodglucose.
●Itismixedwithpotassiumoxalate(3partsto1partofsodiumfluoride)orwithEDTA(1
partofdisodiumEDTAto2partsofsodiumfluoride)tomakeitabetteranticoagulant
and3mgofthismixturepermlbloodisused.
●Itisnotgoodforotherclinicalchemistrytests.
VENOUSBLOODSAMPLECOLLECTION
[Phlebotomy-istheprocessoftakingblooddirectlyfromtheveinusinganeedle]
[Phlebotomist-Aphlebotomistisamedicalprofessionalwhoistrainedtoperformblooddraws
onchildrenandadults]
Bloodiscollectedforanalysisofitsextracellular(plasma/serum)andcellularcomponents.Itis
veryimportantthatthesecomponentsremainunchangedafterbloodcollectiontogetvalid
laboratorytestresults.Thechancesoferrorsaremaximumduringpreanalyticalphase(which
includestestrequest,patientandspecimenidentification,specimencollection,transportand
sortinginthelab)especiallyinbloodcollection.Therefore,itisveryimportanttoknowhowto
collectbloodcorrectly:
I.PREPARATION
1.Washyourhandswithsoapandwater.Followallthehandhygieneprotocolsprovidedby
yourhealthcarecentre.
2.Gatherthematerialsrequired-Assemblethefollowingitemsinatraybeforegoingtothe
patient-
●Bloodrequisitionform
●Disposalsyringes/Vacuumextractionsystemaccessories(with21-22gaugeneedles;check
expirydate)

4. 4
[Thedeadspaceordeadvolumeofasyringeisthevolumeofliquidremaininginthe
hubandtheneedleaftercompletelyemptyingthesyringe.Itvarieswiththesizeofthe
syringeandtheneedleandthematerialusedforthesyringe.Normallythedeadvolume
/spaceof1mlto10mlsyringesis0.08-0.25ml]
●Bloodcollectiontubes(Vacutainers/non-vacuum)-checktheexpirydateandarrangethemin
arackinthecorrectorderofdraw(takesomeextratubes)
●Tourniquet(preferablysingleuse)
●70%alcohol(ethylalcoholorisopropylalcohol),2%chlorhexidinein70%isopropylalcoholor
povidone-iodineswab,forskindisinfection
●Cleananddrygauzepadsorcottonwoolballs

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●Non-sterilegloves(sterileglovesforbloodculturesample)
●Markerpen(withwaterproofink)
●Apuncture-resistantsharpcontainer
Materialrequiredforvenipuncture
3.Checkpatientdetails-Askthepatient'snameandage(talktothepatientpolitelywithasmile
onyourface;thiswouldmakethepatientcomfortable)tomatchwiththenameandagegivenin
therequisitionformtoensurethebloodcollectionofthedesiredpatient.
4.Preparethepatientmentallyandphysically.Tellthepatientabouttheteststobedone,make
himcomfortableandstress-freeandobtainhis/herverbalconsentforbloodcollection(the
patienthastherighttorefusethebloodcollection).
5.Confirmthefastingstatus.Ifatestrequiresafastingbloodsample,confirmthe12-hour
fastingstatusofthepatient.

6. 6
6.Inthecaseoftherapeuticdrugmonitoring(TDM)followthespecificinstructionsforthe
exacttimeofbloodcollectionfromtheorderingphysician.
7.Bloodsamplesforanalyteswithdiurnalvariationssuchascortisol,TSHshouldbe
collectedatthetimesspecifiedbythelaboratory.
8.Locatethevein.Findavisibleandstraightveinintheantecubitalfossaorforearm.The
patientcanberequestedtoclenchhis/herfist(nottopumprepeatedly)tomaketheveins
clearlyvisible.
II.BLOODCOLLECTION
1.Putonnon-sterilegloves(sterileglovesforbloodculturesample).
2.Cleansethevenepuncturesite.Usea70%alcoholswabandletitdry(ifnotdrythen
venepuncturemaycauseitchingandmayalsohemolyzethebloodsample).Thevenepuncture
sitecanbecleanedintwoways-
A.Withonewipe(ifanotherwipeisrequiredthenuseanotherswab)
B.Startwipingfromthecentreofthevenepuncturesiteandworkdownwardandoutwardsto
coveranareaof2cmormore.
3.Applyatourniquetabout4-5fingerswidthabovetheintendedvenepuncturesite.
4.Performvenepunctureusingvacuumextractionaccessoriesorthesyringe(withneedlebevel
faceup).Oncethebloodbeginstoflow,loosenthetourniquetandrequestthepatienttoopen
thefistifitwasclenched.
5.Fillthevacutainertubesinthecorrect'orderofdraw'orfillthesyringewiththerequired
amountofblood.Mixthebloodbygentleinversionofvacutainersfortherequirednumberof
times(redcappedserumtubecontainingclotactivatorsisalsoinverted5timestomixtheblood
withclotactivators).

7. 7
Recommended'orderofdraw'
6.Removethetourniquetandplaceacleangaugepiece(preferably)oradrycottonwoolballat
thepiercingsiteandpulltheneedlegently.Requestthepatienttoholdthegauge
piece/cottonwoolballwithpressurefor2-10minutes(donotbendthearmasthismayresultin
hematoma).Anadhesivetapecanbeplacedonthegauzepiece.
Hematoma
7.Ifbloodcollectedisinasyringe-Transfertherequiredamountofblood(asmentionedinthe
tubelabel)directlyintothevacutainerhelduprightintuberack(inthecorrectorderofdraw)by
piercingtherubbercap(don'tremovethecap)orbyusingabloodtransferdevice.
8.Transferringthebloodtonon-vacuumtubes-
●Recaptheneedlebyone-hand-scooptechniquebeforeitsremovaltoavoidneedlestick.
●Removetheneedleofthesyringecarefullyusingplierorarteryforceps.
●Pourthebloodafterremovingthecapofthetubesonebyone(toavoidinterchangeof
caps)anddon'texertexcessivepressureonthepistonofthesyringe(toavoidhemolysis)
9.Mixthebloodtubesbygentleinversionandfortherequirednumberoftimes.Mixingis
requiredtoavoidmicroclotsintubeswithanticoagulants.
10.Labelthetubeswithpatient'sinformation.Writethepatient'sname,age,bednumber,
date/timeofcollection,fasting/nonfastingstatusandthenameofthephlebotomist.
11.Discardalluseditemsincludingthegaugepiece/cottonwoolballheldbythepatient(ensure
thebleedingisstopped).Removetheglovesanddiscardthem.
12.Thankthepatient.
13.Sendthebloodsamplestothelaboratoryassoonaspossible.Forlight-sensitive
parameterssuchasvitaminA,E,B1,B6,B12andbilirubinetc.coverthebloodtubeswithfoil.
14.Washyourhands.

8. 8
SOMEDOsandDON'Ts:
DOs:
●Followhandhygienebeforearrangingbloodcollectionaccessoriesinthetray.
●Checktheexpirydatesofsyringes(expiredsyringesdon'tguaranteetheirsterility)andblood
collectiontubes(expiredtubesmayhavedecreasedvacuumandchemicaldeteriorationof
additives).
●Useafreshpairofglovesforeachpatienttoavoidthespreadofinfection.Disinfecttheskinat
thevenepuncturesiteandletitdrybeforevenepuncture.
●Usethesyringewiththecorrectgauge(21-22G).Atoofineneedlemayhemolyzetheblood.
●Thoughthereuseofabloodtubeholderisnotrecommended,itisbetterto
decontaminateitbystandardsterilizationprocedurebeforereuse.
●Followthecorrectorderofdraw(toavoidcross-contaminationwithtubeadditives)while
collecting/transferringbloodintobloodcollectiontubei.e.bloodculturetube→citratetube→
plaintubewithclotactivator(withorwithoutgelforserumseparation)→heparintube→EDTA
tube→fluoridetube(sugar)→othertubes.
●Whileremovingtheneedleofthesyringerecaptheneedleby‘onehandscoop’techniqueand
removetheneedleusingplierorarteryforcepsbeforepouringbloodintonon-vacuumtubes.
●Placethebloodcollectiontubesinthetuberackbeforeinjectingbloodintothetubesandin
thecorrectorderofdraw.
●Fillthetubeswiththecorrectamountofblood(underfillingandoverfillingmaygiveerroneous
resultsofhaematologicalandcoagulationparameters).
●Mixthebloodintubesbygentleinversionandfortherequirednumberofinversions.
●Discardtheuseddevicesintodesignatedcontainers.
DON'Ts:
●Don'tforgettocleanyourhandsbeforeandafterbloodcollection.
●Avoidpre-labellingthebloodcollectiontubeswithpatient'sinformation.Labeltheminthe
presenceofthepatient(topreventthechancesoftubesbeingleftunlabelled).
●Don'tcollectbloodfromanindwellingcathetertoavoidcontamination/dilutionofthe
bloodsamplefromthefluidpresentinthecatheter[ifthereisnochoicethenfirststop
theinfusionfortwominutes,collect5mlbloodanddiscardthebloodandthesyringe.
Thencollecttherequiredamountofbloodusinganewsyringe].
●AvoidcollectingbloodfromafreshlyinsertedIVcannula(Viggo);notevenbeforeanyinfusion
isdone.
●Don'tcollectbloodfromtheveinoreventhearmreceivinganyinfusion.
●Don'ttiethetourniquetformorethan1minuteanddon'taskthepatienttoclenchthefistand
pumpitrepeatedlyduringbloodcollectiontoavoidhemoconcentrationresultinginfalse
elevationofproteinsandpotassium.
●Ifvenepunctureisnotsuccessfulinthefirstattemptthenavoidtomanipulateit.Makeanother
venepunctureatadifferentsiteusinganewsyringe(don'tusethesyringeused
inthepreviousprickevenifthereisnovisiblebloodinit)toavoidhemolysis.
●Don'trecapaneedleusingbothhandstoavoidneedlestickinjury(useonehandscoop
technique).

9. 9
●Don'tpourbloodintobloodcollectiontubeswithgreatpressureonthepistontoavoid
hemolysis.
●Don'topenthecapsofvacutainerstopourblood(transferthebloodfromthesyringeintothe
tubebypiercingtherubbercaporbyusingbloodtransferdevice).
●Don'tshakethebloodtubevigorouslyafterpouringthebloodintoittoavoidhemolysis.Mixby
gentleinversionsandfortherequirednumberoftimes.
●Don'ttransferthebloodofonetubetoothertubestoavoidcross-contaminationoftube
additive.
●Don'tkeepthebloodsamplesintherefrigerator(asthismaycausefalselyhigh
potassiumandlowsodium)orfreezer(asthisresultsinhemolysis).Keeptheblood
samplesatroomtemperatureandsendthemtothelaboratoryassoonaspossible.
Howtopreventhemolysisinbloodsamples:
Haemolysisisaverycommonerrorofpreanalyticalphaseandtheresultsofsomeofthetests
maybeaffectedduetoreleaseofthecontentsoftheerythrocytesintoserum/plasmaasaresult
ofhemolysis.Theredcolorofserum/plasmaduetohemolysisalsointerferesindifferenttests.
Butthishemolysiscanbepreventedbythefollowingways:
●Usethecorrectsizeneedle(20-22G)forbloodcollection.
●Letthevenipuncturesitedryaftercleaningitwithdisinfectantbeforevenipuncture.
●Keepthebloodsample(collectedintubeswithoutanticoagulant)tubeinatesttube
standfor15-30minutesatroomtemperaturetoclotthebloodcompletelyandthen
centrifugeitforserumseparation(Donotcentrifugeitimmediatelyaftercollection).
●Pulltheplungerofthesyringeslowly(notforcefully)whilecollectingtheblood.
●Donottiethetourniquetformorethan1minute.
●DonotcollectthebloodfromIVcatheter.
●Donotkeepserumorplasmaforlongtimeincontactwithbloodcells.
●Donotshakethebloodvial/tubecontainingbloodvigorously.
●Ifthevenipuncturefailsinthefirstattemptthentryanewvenipunctureatadifferentsite
usinganewneedleandanewsyringe.
INHINGLISH
BLOOD
Bloodवास्तवमेंएकप्रकारकाऊतक(tissue)हैजोplasma(bloodfluidकालगभग55%)औरतीनमुख्य
प्रकारकीbloodcells(plateletsयाthrombocytes,whitebloodcellsयाleukocytesऔरredblood
cellsयाerythrocytes,जोbloodमेंcirculateकरतीहैं,सेबनाहोताहैIPlasmaमेंलगभग92%water
और8%अन्यअवयवजैसे-glucose,fats,विभिन्नproteins,vitamins,hormones,mineralsआदिहोते
हैंI

10. 10
Bloodतीनप्रकारकीरक्तवाहिकाओं(bloodvessels)मेंcirculateकरताहै,जोहैं-arteries,veinsऔर
capillaries,इसीलिएइनमेंपरिसंचरित(circulating)bloodकोक्रमशःarterialblood,venousbloodऔर
capillarybloodकहतेहैंI
Arterialblood(oxygenatedblood)pulmonaryvein,heartकेleftchamberऔरपूरेशरीरकी
धमनियों(arteries)मेंpumpedऔरपरिसंचरित(circulate)होताहैIयहचमकदारलाल(brightred)रंगका
होताहैIArterialbloodsampleसामान्यतौरपरbloodgasanalysisऔरacid-basebalanceanalysis
हेतुलियाजाताहैI
Venousblood(deoxygenatedblood)tissuesकेअंदरtinycapillarybloodvesselsसेlargerveins
मेंजाताहैऔरफिरrightsideoftheheartमेंजाताहैIयहगहरेलाल(darkred)रंगकाहोताहैIVenous
bloodsampleलगभगसभीdiagnostictestsलियाजाताहैI
CapillaryBloodcapillarybeds,जोcirculatorysystemकीsmallestveins(venules)andarteries
(arterioles)होतीहैं,सेप्राप्तहोताहैIvenulesऔरarteriolescapillarybedsमेंआपसमेंमिलकरvenous
andarterialbloodकाएकmixtureबनातीहैंICapillarybloodअक्सरशिशुओं,बच्चों,बुज़ुर्गोँऔरबुरीतरह
जलेहुएमरीज़ोंमेंएकspecimenofchoiceहोताहैICapillarybloodमेंसामान्यतौरपरcellcounts,
clottingtime,parasitedetection,bloodglucose,bloodgroupआदिकीजाँचकेलिएउपयोगहोताहैI
ANTICOAGULANTSUSEDINDIAGNOSTICLABORATORYFORBLOODSAMPLE
COLLECTION
Diagnosticlaboratoriesमेंतीनप्रकारकेbloodsamplesइस्तेमालहोतेहैं-wholeblood,plasmaand
serum.Anticoagulantsकाइस्तेमालwholebloodऔरplasmasamplecollectionमेंहोताहैI
Anticoagulantsकाइस्तेमालbloodकोclotहोनेसेरोकनेऔरbloodcellsकीअखंडता(integrity)कोबनाए
रखनेकेलिएकियाजाताहैI
Differenttypesofanticoagulants:
1.EDTA(Ethylenediaminetetraaceticacid)-काइस्तेमालhematologicalparametersजैसे-cell
count,hematocrit,hemoglobinestimationऔरcelldifferentialcountआदिकेलिएbloodsample
collectionमेंहोताहैI
Mechanismofaction-EDTAएकchelatingagentहैजोcalciumions(जोbloodclottingकेलिए
आवश्यकहोताहै)कोbindकरलेताहैIइसप्रकारcalciumionsकेअभावमेंbloodcoagulation(clotting)
रुकजाताहैI
●EDTAकेdisodiumयाdipotassiumयाtripotassiumsaltsकाइस्तेमालकियाजाताहैI

11. 11
●PotassiumEDTA(K2orK3)कोSodiumEDTAकीअपेक्षाप्राथमिकतादीजातीहैक्योंकि
SodiumEDTAपानीमेंकमघुलनशीलहैI
●BloodcollectionकेलिएEDTA(anhydroussalt)को1.2से2.0mg/mlblood(4.1to6.8
mmol/lblood)केहिसाबसेइस्तेमालकियाजाताहैI2mg/mlbloodconcentrationसेअधिक
EDTAइस्तेमालकरनेसेbloodcellsसिकुड़(shrink)सकतीहैंऔरइससेकमEDTAहोनेपरblood
clottingपूरीतरहनहींरुकपातीI
●EDTAbloodकाफायदायहहोताहैकियहbloodcellsकीmorphologyकोसुरक्षितरखताहै(यदि
सहीअनुपातमेंलियाजाए)औरbloodकेविभिन्नजाँचोंपरइसकाबहुतकमप्रभावपड़ताहैI
●EDTAकानुकसानयहहोताहैकियहalkalinephosphatase,creatinekinase,औरleucine
aminopeptidaseenzymesकीactivitiesकोinhibitकरताहैऔरEDTAbloodकोCalciumऔर
ironestimationकेलिएइस्तेमालनहींकरसकतेI
2.Citrate(Trisodiumcitrate)-काइस्तेमालcoagulationparametersजैसे-PT,aPTT,INRऔर
ESR(Westergrenmethod)केलिएbloodsamplecollectionमेंहोताहैI
Mechanismofaction-Citratecalciumकोbindकरलेताहैजिससेbloodclotनहींहोताक्योंकिclotting
केलिएcalciumकीआवश्यकताहोतीहैIहालांकि,EDTAकेविपरीतcalciumकीcitrateसेbinding
reversibleहोतीहै,इसलियेcalciumकोनियंत्रितस्थितियों(controlledconditions)मेंडालकर
coagulationकाअध्ययनकरसकतेहैंI
●Bloodcollectionकेलिए3.2-3.8g/dltrisodiumcitratesolutionके1भागमें9भागbloodmix
कियाजाताहै(PT,aPTTandINRकेलिए)लेकिनESR(Westergren)केलिएcitratesolution
के1भागमें4भागbloodmixकरतेहैंI
●Citrateऔरbloodकाअनुपातबिलकुलaccurateहोनाचाहिए,तभीtestकेसहीपरिणामआतेहैंI
3.Heparin-यहएकnaturalanticoagulantहैक्योंकियहहमारेशरीरमेंस्वाभाविकरूपसेपायाजाताहैI
Heparinकाanticoagulantकेरूपमेंइस्तेमालbloodमेंpH,bloodgases,electrolytes,औरionized
calciumआदिकीजाँचकेलिएहोताहैI
Mechanismofaction-Heparinbloodcoagulationकेलिएआवश्यकprothrombinसेthrombinबनने
कीप्रक्रियाकोरोकदेताहैजिससेbloodclottingनहींहोतीI
●यद्यपिheparinizedbloodकोकईbiochemicaltestsकेलिएइस्तेमालकरसकतेहैंकिन्तुयह
peripheralbloodsmear,coagulation,hematologicalऔरकुछbiochemicalparametersके
लिएउपयुक्तनहींहोताहैI
●Heparinकेlithiumsaltयाsodiumsaltकाइस्तेमालकरतेहैंI
●Lithiumsaltकाइस्तेमालelectrolytestestingमेंऔरsodiumsaltकाइस्तेमालlithiumtestके
bloodcollectionकेलिएकरतेहैंI
●Heparinको2mgor20-50Upermlofbloodकेहिसाबसेइस्तेमालकरतेहैंIज़रुरतसेअधिक
heparinहोनेपरionizedcalciumकाunderestimationहोसकताहैक्योंकिअधिकheparin
calciumकोbindकरसकताहैIअधिकheparinbloodकेpHऔरgasparametersकोभी
प्रभावितकरसकताहैIइसीतरहआवश्यकतासेकमheparinहोनेपरbloodclotकरसकताहैI
4.Oxalate-Oxalicacidकेpotassiumऔरammoniumsaltsकोanticoagulantकेरूपमेंइस्तेमाल
कियाजाताहैIयहcalciumionsकेसाथएकअघुलनशीलcomplexबनाताहैऔरइसतरहcalciumको
precipitateकरकेbloodclottingकोरोकताहैI2mgpotassiumoxalateऔर3mgammoniumoxalate
केमिश्रणको2mgpermlकेहिसाबसेइस्तेमालकरतेहैंI
●Potassiumoxalateकेअत्यधिकघुलनशीलहोनेकेकारणइसकाइस्तेमालअधिकहोताहैऔरइसे
2-3mgpermlbloodकेहिसाबसेइस्तेमालकरतेहैंI
●ammoniumoxalateऔरpotassiumoxalateकेmixtureकोइस्तेमालकरनेसेbloodcollection
केबादRBCsमेंshrinkageनहींहोताI

12. 12
●आवश्यकतासेअधिकoxalateconcentrationइस्तेमालकरनेसेhemolysisहोनेऔरhematocrit
केकमहोनेकाखतरारहताहैI
5.SodiumFluoride-एकweakanticoagulant(calciumbindingद्वारा)हैलेकिनantiglycolyticहोनेके
कारणइसकाइस्तेमालbloodglucoseestimationकेलिएbloodsampleलेनेमेंकियाजाताहैI
Mechanismofaction-यहRBCsकीmetabolismऔरbacterialactionकोरोकताहैIऐसाइसलिएहोता
हैक्योंकिfluorideglycolyticpathwayकेenzymeEnolaseकोinhibitकरताहैजिससेglucoseकाह्रास
(deterioration)रुकजाताहैI
●इसेएकबेहतरanticoagulantबनानेहेतुpotassiumoxalateके3भागकोsodiumfluorideके1
भागयाdisodiumEDTAके1भागकोsodiumfluorideके2भागकेसाथमिश्रितकरतेहैंऔरइस
मिश्रणके3mgpermlbloodकेहिसाबसेइस्तेमालकरतेहैं
●Fluoridebloodsample,glucoseestimationकेअतिरिक्तकिसीअन्यclinicalchemistrytestके
लिएउपयोगीनहींहोताहैI
VENOUSBLOODSAMPLECOLLECTION
[Phlebotomy-किसीveinसेसीधेएकneedleकीमददसेbloodलेनेकीप्रक्रियाकोphlebotomyकहतेहैं
औरजोइसप्रक्रियाकोसंपन्नकरताहैउसेphlebotomistकहतेहैं]
Bloodकोइसकेextracellular(plasma/serum)andcellularcomponentsकीanalysisकेलिएcollect
कियाजाताहैIऔरयहबहुतमहत्वपूर्णहैकिbloodकेइनcomponentsमेंbloodcollectionकेबादभीकोई
परिवर्तननहींहोताकिइनकीजाँचकरनेपरहमेंसहीresultsप्राप्तहोंIत्रुटियोंकीसर्वाधिकसंभावना
preanalyticalphase(जिसमेंशामिलहैtestrequest,patientऔरspecimenकीपहचान,sample
collection,transportandsortinginthelab.)में,खासतौरपरbloodcollectionकेसमय,होतीहैI
इसलियेयहजाननाआवश्यकहैकिसहीतरीकेसेbloodकैसेनिकलाजाएI
I.तैयारी(PREPARATION):
1.हाथोंकोसाबुनऔरपानीसेअच्छीतरहधोयेंIअपनेhealthcarecentreकेhandhygieneprotocolका
पालनकरेंI
2.ज़रुरतकासामानएकत्रकरें-मरीज़केपासजानेसेपहलेनिम्नसामानएकtrayमेंएकत्रकरें:
●Bloodrequisitionform
●Disposalsyringes/Vacuumbloodcollectionsystemaccessories(with21-22gaugeneedles);
checkexpirydates
[SyringeकाDeadspaceordeadvolume-किसीsyringeसेliquidकोपूरीतरहनिकालनेकेबाद
भीजोथोड़ासाliquidsyringeकेhubऔरneedleकेअंदररहजाताहैउसamountकोsyringeका
deadspaceयाdeadvolumeकहतेहैंIआमतौरपर1mlसे10mlकीsyringeकाdead
space/volume0.08-0.25mlहोताहैक्योंकियहsyringeकेsizeऔरउसकेmaterial(जिससे
syringeबनीहै)परनिर्भरकरताहै]

13. 13
●Bloodcollectiontubes(Vacutainers/non-vacuumcollectiontubes)-expirydatecheckकरेंऔर
एकrackमें'correctorderofdraw'मेंarrangeकरें(कुछextratubesभीरखें),
●Tourniquet(preferablysingleuse),टूनिकेट/टूनिके
●70%alcoholswabskinकोdisinfectकरनेकेलिए
●Cleananddrygauzepadsorcottonwoolballs
●Non-sterilegloves(sterileglovesforbloodculturesample),

14. 14
●Markerpen(waterproofinkवाला),
●एकpuncture-resistantsharpcontainer
Materialrequiredforvenipuncture
3.patientdetailscheckकरें-मरीज़कानामऔरउम्रपूछें(मरीज़सेमुस्करातेहुएबातकरेंताकिवो
comfortableमहसूसकरे)औरउसेrequisitionformसेमिलाकरयहसुनिश्चितकरेंकिवांछितमरीज़काही
bloodलियाजाएI
4.मरीज़कोbloodदेनेकेलिएमानसिकऔरशारीरिकरूपसेतैयारकरेंIउसेtestsकेबारेमेंजानकारीदेंऔर
उसेcomfortableऔरstressfreeकरनेकीकोशिशकरेंIफिरbloodलेनेकेलिएउसकीरज़ामंदीलें(मरीज़
कोपूराअधिकारहोताहैकिवहbloodनिकलवानेसेमनाकरदे)I
5.मरीज़केfastingstatusकोसुनिश्चितकरें-यदिकिसीtestकेलिएfastingbloodsampleकी
आवश्यकताहोतोमरीज़के12-hourfastingstatusकोसुनिश्चितकरेंI
6.यदिbloodtherapeuticdrugmonitoring(TDM)केलिएलेनाहोतोphysicianद्वाराbloodcollection
केexacttimeकेबारेमेंदिएगएनिर्देशोंकापालनकरेंI
7.यदिbloodsamplesकिसीऐसेanalyte(जैसे-cortisol,TSH)केलिएलेनाहोजिसमेंdiurnal
variationsहोतेहोंतोbloodलैबद्वारानिर्दिष्टसमयपरलेनाचाहिएI
8.Locatethevein-सबसेपहलेantecubitalfossaयाforearmमेंएकस्पष्टऔरसीधीveinदेखतेहैंIयदि
veinस्पष्टनहींहोतोमरीज़कोअपनीमुट्ठीकोकसकेबंदकरनेकोकहतेहैं(लेकिनबार-बारखोलनेबंदकरने
कोनहीं)ताकिveinसाफदिखेI

15. 15
II.BLOODCOLLECTकरना-
1.non-sterileglovesपहनलें(bloodculturesampleकेलिएsterileglovesपहनें)I
2.venepuncturesiteको70%alcoholswabसेपोछेऔरalcoholकोसूखनेदें(अगरबिनासुखाए
venepunctureकरेंगेतोमरीज़कोअल्कोहलकेकारणजलनहोसकतीहैऔरbloodsamplehemolyzeभी
होसकताहै)Ivenepuncturesiteकोदोतरहसेसाफकरसकतेहैं-
A.एकबारपोंछकर(Withonewipe);अगरदोबारापोछनापड़ेतोदूसरेswabकाइस्तेमालकरेंI
B.चुनीहुईvenepuncturesiteकेकेंद्रसेपोछनाशुरूकरकेनीचेकीओरऔरफिरबाहरकीतरफजातेहुए
लगभग2cmयाअधिककाक्षेत्रसाफकरतेहैंI
3.अभीष्ट(intended)venepuncturesiteके4-5उँगलियोंकीचौड़ाईकेबराबरऊपरएकtourniquetबांधदेते
हैंI
4.vacuumextractionaccessoriesयाsyringeसेvenepunctureकरें(withneedlebevelfaceup)I
जैसेहीbloodआनाशुरूहोवैसेहीtourniquetकोढीलाकरदेंऔरमरीज़कोमुट्ठीखोलनेकोकहें,यदिमुट्ठी
बंदहोI
5.सभीvacutainertubesकोcorrectorderofdrawमेंभरेंयाफिरsyringeसेbloodकीrequired
amountcollectकरलेंIसभीvacutainersकोआहिस्तासेनिर्धारितबारinvertकरकेbloodकोअच्छीतरह
mixकरलें(serumtubeसहितजिसमेंclotactivatorsहों)I

16. 16
Recommended'orderofdraw'
6.tourniquetकोहटादेंऔरएकसाफgaugepieceयाएकसुखीcottonwoolballकोpiercingsiteपर
रखेंऔरneedleकोधीरेसेनिकाललेंIमरीज़कोकहेंकिवोgaugepiece/cottonwoolballकोpressure
केसाथ2-10minutesतकदबायेरखे(हाथकोमोड़ेनहींक्योंकिइससेhematomaबननेकाखतराहोताहै)I
gauzepieceपरएकadhesivetapeलगासकतेहैंI
Hematoma
7.अगरbloodएकsyringeमेंcollectकियाहैतोbloodकीआवश्यकमात्रा(जैसाtubelabelमेंलिखाहो)
सही'orderofdraw'मेंvacutainers(जोएकrackमेंसीधीखड़ीलगीहों)मेंउनकेrubbercapमेंछेदकरते
हुएडालें(capकोनिकालेंनहीं)याएकbloodtransferdeviceकाइस्तेमालकरेंI
8.non-vacuumtubesमेंsyringeसेbloodtransferकरना-
●needleकोsyringeसेहटानेकेपहलेsyringeकीneedleपरउसकाcapलगाएं(one-hand-scoop
तकनीकद्वारा)ताकिneedleहाथमेंनचुभेI
●syringeकीneedleकोएकplierयाarteryforcepsकीमददसेसावधानीपूर्वकहटाएँI
●अबप्रत्येकtubeमेंएकएककरकेcapहटाकर(जिससेtubesकेcapsinterchangeनहों)syringeसे
bloodबिनाअधिकpressureडाले(ताकिhemolysisनहो)tubeमेंडालेंऔरcapलगातेजाएंI

17. 17
9.प्रत्येकtubeकोआहिस्तासेनिर्धारितबारinvertकरकेbloodकोmixकरेंIbloodकोmixकरना
अतिआवश्यकहोताहैताकिtubeमेंपड़ाanticoagulantअच्छीतरहbloodमेंmixहोजाएऔरbloodclot
नहींहो(redcapवालीserumtubeकेbloodकोभी5बारinvertकरनाचाहिएताकिbloodtubeकेclot
activatorसेmixहोजाए)I
10.सभीtubesकेlabelपरमरीज़कानाम,उम्र,bednumber,bloodcollectionकीdate/time,
fasting/nonfastingऔरbloodcollectकरनेवालेकानामलिखेंI
11.इस्तेमालकियेगयेसामान,gaugepiece/cottonwoolballसहित,कोनिस्तारितकरेंIमरीज़काgauge
piece/cottonहटानेसेपूर्वसुनिश्चितकरेंकिbleedingबंदहोगईहोIglovesभीउतारकरनिस्तारितकरेंI
12.मरीज़कोधन्यवाददेंI
13.bloodsamplesकोlaboratoryमेंजल्दीसेजल्दीभेजदेंIlight-sensitiveparametersजैसेvitaminA,
E,B1,B6,B12औरbilirubinआदिकेलिएsamplesकोfoilसेढकदेंI
14.अपनेहाथोंकोधोलेंI
SOMEDOsandDON'Ts:
DOs:
●bloodcollectionaccessoriesकोtrayमेंarrangeकरनेकेपूर्वhandhygieneकापालनकरेंI
●syringesऔरbloodcollectiontubesकीexpirydatescheckकरेंक्योंकिexpiredsyringeमेंउनकी
sterilityकीguaranteeनहींहोतीऔरexpiredvacutainersमेंvacuumकमहोसकताहैऔरउसमेंपड़े
additiveकीरसायनिकक्षमताभीकमहोसकतीI
●प्रत्येकमरीज़काbloodलेनेकेपूर्वglovesबदललेनेचाहिएताकिएकमरीज़काinfectionदूसरेमरीज़कोन
लगेI
●venepuncturesiteको70%alcoholसेdisinfectकरेंऔरbloodनिकलनेसेपहलेइसेसूखनेदेंI
●syringeकीneedle21-22Gकीहोनीचाहिएक्योंकिअधिकमहीनneedleसेbloodhemolyzeहोसकता
हैI
●हालांकि,bloodtube(vacutainers)holderकोreuseकरनाrecommendedनहींहैकिन्तुयदिreuse
करनाहैतोइसेपहलेstandardsterilizationprocedureद्वाराdecontaminateकरनाचाहिएI
●vacutainersमेंbloodcollectकरतेसमययाsyringeसेnonvacuumtubeमेंडालतेसमयसही'order
ofdraw'कापालनकरनाचाहिएजिससेtubeadditiveकाcross-contaminationनहींहोIसही'orderof
draw'है-bloodculturetube→citratetube→plaintubewithclotactivator(withorwithoutgelfor
serumseparation)→
heparintube→EDTAtube→fluoridetube(forsugar)→othertubes.
●nonvacuumtubeमेंbloodडालनेकेलिएneedleकोsyringeसेहटानेकेपहलेsyringeकीneedleपर
उसकाcap'onehandscooptechnique'द्वारालगाएंऔरफिरsyringeकीneedleकोएकplierया
arteryforcepsकीमददसेसावधानीपूर्वकहटाएँI
●bloodcollectiontubesमेंbloodinjectकरनेकेलिएपहलेtubesकोएकtuberackमेंसहीorderof
drawमेंarrangeकरलेनाचाहिएI
●tubesमेंbloodकीनिर्धारितमात्राडालनीचाहिएक्योंकिनिर्धारितमात्रासेकमयाअधिकमात्रामेंblood
डालनेसेhaematologicalऔरcoagulationparametersकेresultsगलतहोसकतेहैंI
●bloodtubesकोbloodडालनेकेबादआहिस्तासेऔरनिर्धारितबारinvertकरकेहीmixकरनाचाहिएI
●इस्तेमालकिएगएसामानकोनिर्दिष्टcontainersमेंहीनिस्तारितकरनाचाहिएI
DON'Ts:
●bloodcollectionकेपहलेऔरबादमेंहाथधोनानहींभूलेंI
●bloodcollectiontubesपरमरीज़कीinformationपहलेसेlabelनहींकरें,बल्किbloodलेनेकेबादमरीज़
केसामनेहीlabellingकरेंताकिकिसीtubeकेबिनाlabelरहनेकीगुंजाईशनहींरहेI

18. 18
●एकindwellingcatheterसेbloodcollectनहींकरेंक्योंकिइससेcatheterमेंउपस्थितfluidसेblood
diluteहोसकताहैऔरcontaminateभीहोसकताहैIअगरकिसीपरिस्थितिमेंcatheterसेbloodलेना
मजबूरीहोतोसर्वप्रथमinfusionको2मिनटकेलिएरोकदें,फिरsyringeसे5mlbloodलेकरइसblood
औरsyringeकोफ़ेंकदेंIअबएकनईsyringeसेवांछितमात्रामेंbloodनिकाललेंI
●किसीमरीज़मेंलगाएगएनएIVcannula(viggo)सेbloodनहींलें,चाहेउससेकोईinfusionनभीदिया
गयाहोक्योंकिइससेbloodकेhemolyzeहोनेकाखतरारहताहैI
●उसveinयाउसहाथसेbloodनहींलेंजिसमेंकोईinfusionदियाजारहाहोI
●bloodलेतेसमयtourniquetको1minuteसेअधिकसमयकेलिएtightनहींरखनाचाहिएऔरमरीज़को
मुट्ठीकसकरबार-बारखोलने-बंदकरनेकोनहींबोलनाचाहिएक्योंकिऐसाकरनेसेhemoconcentrationके
कारणbloodमेंglucose,proteinsऔरpotassiumआदिकईरिपोर्टगलततरीकेसेबढ़ीहुईआसकतीहैI
●अगरपहलेप्रयासमेंvenepunctureसफलनहींहोतोकोईजोड़-तोड़नहींकरें,बल्किएकनईsyringeसे
दूसरीजगहप्रयासकरें(पहलेप्रयासमेंइस्तेमालकीगईsyringeकाइस्तेमालदूसरेप्रयासमेंबिल्कुलनहींकरें,
चाहेपहलेप्रयासमेंउसsyringeमेंकोईbloodनहींआयाहोतोभी,ताकिhemolysisकाखतरानहो)I
●syringeकीneedleपरcapलगानेकेलिएदोनोंहाथोंकाइस्तेमालनहींकरें,बल्किइसकेलिए'onehand
scooptechnique'काइस्तेमालकरेंI
●bloodcollectiontubesमेंsyringeसेbloodडालतेसमयsyringeकेpistonपरअधिकदबावनहींडालना
चाहिएताकिhemolysisनहींहोI
●vacutainerमेंbloodडालनेकेलिएउसकाcapहटानेकीबजाएसीधेsyringeसेneedleद्वाराrubber
capमेंछेदकरकेडालनाचाहिएयाएकbloodtransferdeviceकाइस्तेमालकरनाचाहिएI
●tubesमेंbloodडालनेकेबादtubeकोज़ोरसेनहींहिलानाचाहिएक्योंकिइससेhemolysisहोसकतीहैI
tubesकोआहिस्तासेनिर्धारितबारinvertकरकेmixकरनाचाहिएI
●एकtubeकेbloodकोदूसरीtubeमेंकभीनहींडालनाचाहिएक्योंकिइससेtubeadditiveकाbloodमें
contaminationहोसकताहैI
●bloodsamplesकोतुरंतrefrigeratorयाfreezerमेंनहींरखेंक्योंकिrefrigeratorमेंरखनेसेfalselyhigh
potassiumऔरfalselylowsodiumresultsआसकतेहैंतथाfreezerमेंरखनेसेbloodhemolyzeहो
सकताहैIइसलियेbloodsamplescollectकरनेकेबादउन्हेलैबमेंजल्दीसेजल्दीभेजदेनाचाहिएI
Howtopreventhemolysisinbloodsamples:
Haemolysispreanalyticalphaseकीएकcommonerrorहैऔरerythrocytesकेcontentsका
haemolysisकेकारणserum/plasmaमेंreleaseहोनेकेकारणकईtestresultsप्रभावितहोसकतेहैंI
इसकेअतिरिक्तhemolysisकेकारणserum/plasmaकाredcolourविभिन्नtestsमेंinterferenceपैदा
करसकताहैIकिन्तुइसhemolysisकोनिम्नप्रयासोंद्वारारोकाजासकताहै:
●bloodcollectionहेतुcorrectsize(20-22gauge)कीneedleकाइस्तेमालकरकेI
●venipunctureकीsiteपरलगाएगएdisinfectantकोvenipunctureकेपूर्वपूरीतरफसूखनेदेकरI
●Serumपृथक्करणहेतुएकत्रितकियेगयेbloodtubesकोcentrifugeकरनेसेपूर्वtubesकोएक
testtubeस्टैंडपरसीधाखड़ारखकरroomtemperatureपर15-30मिनटतकरखकर,ताकि
bloodपूरीतरहclotहोजाएI
●bloodलेतेसमयsyringeकेplungerकोforcefullyखींचनेकीबजायेआहिस्तासेखींचकरI
●tourniquetको1मिनटसेअधिकसमयकेलिएनहींबांधकरI
●IVcatheterसेbloodनहींcollectकरकेI
●serumयाplasmaकोलम्बेसमयतकcellsकेसम्पर्कमेंनहींरखकरI
●bloodvial/tubeकेbloodकोअत्यधिकज़ोरसेनहींहिलाकर(आहिस्तासेहिलानाचाहिए)I
●यदिपहलेप्रयासमेंvenipunctureअसफलहोजायेतोनएvenipunctureहेतुदूसरीsiteपरनई
needleऔरनईsyringeकाप्रयोगकरकेI

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Somepracticequestions
Q.1.Completethetablegivenbelow:
VacutainercolourcodeAnticoagulant no.ofinversionsForwhichtests
Gray a-? b-? c-?
Green d-? e-? f-?
Red g-? h-? i-?
Blue j-? k-? l-?
Yellow m-? n-? o-?
Purple p-? q-? r-?
Ans.a-sodiumfluoride,b-8-10,c-glucose,d-heparin,e-8-10,f-pH,bloodgases,
electrolytes,ionizedcalciumetc.,g-plain(noanticoagulant),h-5,i-bloodbiochemistry,
Serologytests,Therapeuticdrugmonitoring,j-sodiumcitrate,k-3-4,l-PT,aPTT,fibrinogen
andotherbloodCoagulationtests,m-noanticoagulant(serumseparatorgel),n-5,o-blood
biochemistryandserologicaltests,p-EDTA,q-8-10,r-hematologicalparameters
Q.2.Whatwillhappen(क्याहोगा):
(a)अगरएकexpiredsyringeऔरexpiredbloodcollectiontubeकाइस्तेमालbloodcollectionकेलिए
कियाजाए?
(b)अगरहम'correctorderofdraw'कापालननहींकरेंगे?
(c)अगरहमएकindwellingcatheterयाऐसीveinसेbloodcollectकरेंजिससेमरीज़कोकुछinfusion,
जैसे-कोईदवायाfluid,दियाजारहाहो?
(d)Ifwepourbloodinanon-vacuumtubethroughtheneedle?
(e)यदिbloodcollectकरनेकेतुरंतबादहीsampleकोrefrigeratorयाfreezerमेंरखदें?
(f)अगरटूनिकेटको1मिनटसेअधिकदेरतकबांधकरveinसेbloodcollectकरें?
(g)अगरsyringeकीneedleपरcapलगानेहेतु'onehandscooptechnique'कीबजायेदोनोंहाथोंका
इस्तेमालकरें?
(h)यदिbloodcollectionकेबादvacutainerकोबहुतज़ोरोंसेshakeकियाजाए?
(i)अगरvacutainersकेलेबलपरजितनेmlbloodलेनेकोलिखाहोउससेकमयाज़्यादाbloodउसमेंलेलें?)
(j)यदिbloodcollectionकेलिएबहुतमहीनneedleकाप्रयोगकियाजाए?
Ans.
(a)होसकताहैकिExpiredsyringesterileनरहगईहो,इसलिएइसsyringeसेbloodcollectकरना
patientकेलिएख़तरनाकहोसकताहैIऔरऐसीsyringeसेbloodcultureहेतुbloodलेनेपरbloodculture
कीजाँचगलतहोसकतीहैIExpiredvacutainerकाvacuumकमहोसकताहैजिससेउसvacutainerमें
वांछितमात्रासेकमbloodआएगाऔरइसप्रकारunderfillingकेकारणtestsकेपरिणामगलतआसकतेहैंI
Expiredvacutainerमेंपड़ाadditiveभीdegradedहोसकताहैजिससेउसमेँbloodpartiallyclotभीहो
सकताहैI
(b)'correctorderofdraw'कापालननहींकरनेपरएकvacutainerमेंपड़ेadditive(chemical)कादूसरे
vacutainerमेंcross-contaminationहोसकताहैजिससेtestsकेपरिणामप्रभावितहोसकतेहैंI
(c)ऐसाकरनेपरbloodsampleमेंcatheterमेंउपस्थितfluidद्वाराcontamination/dilutionहोसकताहै
जिससेtestsकेपरिणामगलतहोसकतेहैंI
(d)ऐसाकरनेपरbloodमेंhemolysisहोसकतीहैजिसकाकारणहोताहैsyringeकेpistonपरअत्यधिक
दबावकेसाथbloodडालना,विशेषतौरपरयदिneedleबहुतमहीनहोI
(e)Bloodsampleकोतुरंतrefrigeratorरखनेपरpotassiumकेपरिणामगलतरूपसेबढ़ेऔरsodiumके
कमआसकतेहैंऔरfreezerमेंरखनेसेhemolysisहोसकतीहैIइसकेअतिरिक्तbloodसेserumपृथक
करनेकेलिएbloodकोRTपर15-30मिनटरखनाआवश्यकहोताहैI

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(f)इससेproteinsऔरpotassiumकेजाँचपरिणामगलतरूपसेबढ़ेहुएआसकतेहैंजिसकाकारणहैअधिक
देरतकtourniquetकेबंधेहोनेपरhemoconcentrationकाहोनाI
(g)इससेneedleकेहाथमेंचुभसकतीहैI
(h)ऐसाकरनेसेhemolysisहोनेकाखतराहोताहैजिसकाकारणहोताहैcellsकाआपसमेंरगड़खाकरटूटना
I
(i)Vacutainerमेंलिखीमात्रासेकमयाअधिकbloodलेनेपरhematologicalऔरcoagulation
parametersकेजाँचपरिणामगलतहोसकतेहैंI
(j)बहुतमहीनneedleसेbloodcollectकरनेपरbloodमेंhemolysisहोसकतीहैजिसकाकारणहोताहै
cellsकाआपसमेंरगड़खाकरटूटनाI
Q.3.Fillintheblanks-
(i)Thedifferencebetweenplasmaandserumisthattheplasmacontains__________but
serumcontainsno_________.
(ii)Theliquidportionofaclottedbloodspecimeniscalled_______
(iii)Theliquidportionofaunclottedbloodspecimeniscalled_______
(iv)Thetwoanticoagulantsusedinliquidformforbloodcollectionare______and_____.
(v)Theanticoagulantwhichchelatescalciumis_________.
(vi)Sodiumfluorideinhibitstheenzyme_______.
(vii)Nametheveins(1,2,3)inthediagramgivenbelow:
Ans.(i)fibrinogen,fibrinogen,(ii)serum,(iii)plasma,(iv)sodiumcitrate,heparin,(v)EDTA,(vi)
enolase,(vii)1-cephalic,2-basilic,3-mediancubital
REFERENCES
1.PracticalClinicalBiochemistry.VarleyH,GowenlockAH,BellM.Fifthedition,1991.
2.Manualofbasictechniquesforahealthlaboratory,WorldHealthOrganization,Geneva,
Secondedition,2003.
3.UseofAnticoagulantsinDiagnosticLaboratory-WHO|WorldHealthOrganization,
2002,https://apps.who.int
4.NigamP.K.Howtoavoid/minimizepreanalyticalerrorsinvenousbloodcollectionfor
routinebloodtests.IndJNursStudies2020;11(02):63-66.
Disclaimer:ThepicturesgiveninthetexthavebeendownloadedfromGoogleimagesandI
amthankfultothepersonswhohaveuploadedthesepictures.
Dr.P.K.Nigam
Ph.D.(RetiredBiochemist)

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