Common reasons a lab rejects a blood specimen and quality assurance steps that prevent them, tested on phlebotomy certification exams.
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- What causes hemolysis in a blood specimen?
- Improper technique (excessive tourniquet time, difficult draw), rough handling, temperature extremes, or prolonged storage at room temperature.
- Name the correct order of blood tube collection.
- Culture bottles, serum (red), coagulation (light blue), EDTA (purple), glycolysis inhibitor (gray).
- What is hemolysis?
- Rupture of red blood cells that releases hemoglobin into serum or plasma, contaminating the specimen.
- What happens when an EDTA tube is not inverted after collection?
- The anticoagulant does not mix properly, allowing blood to clot and the specimen to be rejected.
- What is the ideal storage temperature for most serum specimens?
- 2 to 8 degrees Celsius (refrigerated).
- What rejection criterion applies to a specimen without proper labeling?
- Patient identification missing or incorrect, the specimen cannot be accepted.
- How long should a tourniquet be applied during collection?
- No more than 1 minute to prevent hemoconcentration and hemolysis.
- Why is blood collection from a running IV line problematic?
- Risk of specimen dilution with IV fluid and contamination of results.
- What causes lipemia in a specimen?
- High fat content in blood, usually from a non-fasting state or recent fatty meal.
- What is the standard needle gauge for adult venipuncture?
- 20 or 21 gauge.
- What happens if an anticoagulant tube is under-filled?
- The blood-to-anticoagulant ratio is incorrect and the specimen must be rejected.
- Why must blood be collected in a specific tube order?
- To prevent cross-contamination of additives that would interfere with test results.
- What does clotting in an EDTA tube indicate?
- Improper mixing, tube expiration, or loss of anticoagulant effectiveness.
- At what angle should capillary tubes be held during collection?
- 45 to 50 degrees to maintain steady flow and prevent air bubbles.
- What rejection reason applies if blood is collected from an IV line without clearing it first?
- Contamination, unless 5 mL of waste was drawn first to clear the line.
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