Introduction to Blood

By
Hiba Akram
Blood

 Blood is a body fluid in humans and other

animals that delivers necessary
substances such as nutrients and oxygen
to the cells and transports metabolic waste
products away from those same cells
Haematology

  haematology, is the branch of medicine

concerned with the study of the cause,
prognosis, treatment, and prevention of
diseases related to blood.
 Formed elements include: 
Erythrocytes (red blood cells, RBCs)

Platelets (cellular fragments)

Leukocytes (white blood cells, WBCs)

Granulocytes
Neutrophils
Eosinophils
Basophils
Agranulocytes
Lymphocytes
Monocytes
 Hematocrit
RBCs as percent of total blood
volume

100%

- Female: 37%-48%
- male: 45%-52%
Erythrocytes (Red Blood Cells, RBCs)

Appearance:

- biconcave disc shape,

which is suited for gas
exchange. The shape is
flexible so that RBCs can pass
though the smallest blood
vessels, i.e., capillaries.
Erythrocytes (Red Blood Cells, RBCs)

Structure:
-Primary cell
content is
hemoglobin,
the protein
that binds
oxygen and
carbon
dioxide.
- no nucleus
nor
mitochondria
 General Properties of Whole Blood (continued)

Hemoglobin
Female: 12-16 g/100 ml
male: 13-18 g/100 ml

Mean RBC count

Female: 4.8 million/l
male: 5.4 million/l
Platelet counts 130,000-360,000/l
Total WBC counts 4,000-11,000/l
Plasma
 Composition of Plasma
Water 92% by weight

Proteins Total 6-9 g/100 ml

Albumin 60% of total plasma protein

Globulin 36% of total plasma protein

Fibrinogen 4% of total plasma protein

Enzymes of diagnostic value trace

Glucose (dextrose) 70-110 mg/100 ml

Amino acid 33-51 mg/100 ml

Lactic acid 6-16 mg/100 ml

Composition of Plasma (continued)

Total lipid 450-850 mg/100 ml

Cholesterol 120-220 mg/100 ml

Fatty acids 190-420 mg/100 ml

High-density lipoprotein (HDL) 30-80 mg/100 ml

Low-density lipoprotein (LDL) 62-185 mg/100 ml

Neutral Fats (triglycerides) 40-150 mg/100 ml

Phospholipids 6-12 mg/100 ml

Composition of Plasma (continued)
Iron 50-150 g/100 ml

Vitamins (A, B, C, D, E, K) Trace

amount

Electrolytes
Sodium 135-145 mEq/L

Potassium 3.5-5.0 mEq/L

Magnesium 1.3-2.1 mEq/L
Calcium 9.2-10.4 mEq/L
Chloride 90-106 mEq/L
Bicarbonate 23.1-26.7 mEq/L
Phosphate 1.4-2.7 mEq/L
Sulfate 0.6-1.2 mEq/L
 Composition of Plasma (continued)

Nitrogenous Wastes
Ammonia 0.02-0.09 mg/100 ml

Urea 8-25 mg/100 ml

Creatine 0.2-0.8 mg/100 ml

Creatinine 0.6-1.5 mg/100 ml

Uric acid 1.5-8.0 mg/100 ml

Bilirubin 0-1.0 mg/100 ml

Respiratory gases (O2, CO2, and N2)

plasma serum

clotting proteins
(fibrin)
Main functions of the blood

 Transportation and distribution

o Oxygen
o Nutrients
o Hormones
o Waste products
  
1) Transportation  

- Deliver life-supporting materials, i.e., O2, glucose,

amino acid, fatty acids, vitamins, minerals, etc.

- Deliver regulating signals, i.e., hormones to tissue

cells

- Collect waste products from tissue cells and

deliver to special organs (kidney, lung) for disposal

- Distribute heat throughout the body

 Regulatory
o Buffer
o Proteins systems
o Temprature
 Protective
o Immune system
o Hemostasis
Primary Functions of the Circulatory System
 
2) Protection
- Special components of the blood patrol the whole
body and fight against invaded microorganisms and
cancerous cells.
Phlebotomy
Theory and Practice of Phlebotomy
What is phlebotomy

 The term phlebotomy refers to the ancient

practice of bloodletting
 (from the Greek words phlebo-, meaning
"pertaining to a blood vessel", and -tomia,
meaning "cutting of").
 Now the term phlebotomy is used for the
withdrawal of blood from a vein, artery, or
the capillary bed for lab analysis or blood
transfusion.
Who is a phlebotomist

 Collects blood and other specimens

 Prepares specimens for testing

 Interacts with patients & health care

professionals
 plays a vital role in any health care system
Who is a phlebotomist

 Other medical professionals, including

doctors, nurses, technologists, and
medical assistants must also be trained to
collect blood specimens.
Professionalism
Confidentiality

 All employees are responsible for

maintaining confidentiality of medical
information
Attitude

 Tone of voice and facial expression will

determine how patients respond to you.
 Always be polite, friendly, calm, and
considerate.
Appearance

 Your personal appearance will also affect

the impression you make.
 Comply with your facility’s dress code and
personal appearance policies.
Safety
Blood-Borne Pathogens
 Infectious micro-organisms which live in
the bloodstream.
 You can be exposed to bloodborne
pathogens if you are injured with a
contaminated needle.
 You can also be exposed if your mucous
membranes, including eyes, mouth, or the
inside of your nose come into contact with
contaminated body fluids.
 Occupational Health and Safety
Administration of the federal government
has mandated bloodborne pathogen
training for all workers who are at risk of
exposure.
OSHA Training

 Standard Precautions
 Personal Protective Equipment
 Hand Washing
 Hazardous waste disposal
 Needle sticks and prevention act
Standard Precautions

 Standard Precautions means treating all

body fluids and substances as if they were
infectious.
Standard Precautions

 Potentially infectious body fluids include:

Blood, Semen, Vaginal Secretion,
Peritoneal, pericardial and pleural fluids,
and Saliva
 Sweat and tears are not generally
considered infectious.
Personal Protective Equipment
Personal Protective Equipment

 lab coat
 Gloves
 Face masks ( certain types of isolation)
Hand Washing

 Hand washing is the single most important

infection control measure.
 Wash hands thoroughly before, after, and
between all patient contacts.
 Be sure to turn off faucets using a paper
towel to avoid contamination.
Hand washing
 Remove rings
 Stand by the sink but do not touch it
 Apply soap and rub hands together
 Both sides of the hand, between fingers,
around knuckles, under fingernails
 Rinse hands in a downward motion
 Dry hands with a clean paper towel
 Turn off water with another paper towel
Hazardous waste disposal
 All needles & other
sharps must be
disposed of in
approved sharps
disposal containers.
 Other contaminated
waste must be
discarded in an
appropriate
biohazard bag or
waste receptacle.
Needlestick
Needle sticks and prevention act

 Safety Devices should always be

encouraged
Equipment
Trays
 Trays should be
sanitized daily using
appropriate disinfectant

 Kept Organized and

well-stocked.
Blood Collection tubes
 glass or plastic tube
with a rubber stopper.
 It has a vacuum so
that blood will flow
into the tube.
 anticoagulants and/or
other chemical
additives.
Blood collection tubes
 Rubber stoppers of
blood collection tubes
are color coded.
 Each type of stopper
indicates a different
additive or a different
tube type.
LAVENDER
 EDTA to prevent
clotting
 hematology studies.
 Should be completely
filled
 Must be inverted after
filling
LIGHT BLUE
 sodium citrate.
 coagulation (clotting)
studies.
 must be completely
filled
 must be inverted
immediately after
filling
GREEN
 sodium or lithium
heparin
 for tests requiring
whole blood or
plasma such as
ammonia
RED
 No additives
 Blood bank tests,
toxicology, serology
 Must not be inverted
after filing
Yellow
GRAY
 Inhibitor for glycolysis
+ anticoagulant
 Sodium Fluride
+potassium oxalate.
 glucose levels.
YELLOW
 Acid citrate dextrose
 Inactivates
complements
 DNA studies,
paternity testing
ROYAL BLUE
 heparin or Na EDTA
anticoagulants
 Tube is designed to
contain no contaminating
metals
 Trace element and
toxicology studies
Blood Culture Bottles
 Different blood culture
bottles are used for
aerobic, anaerobic,
and pediatric
collections.
Blood collection tubes: Safety
 The rubber stopper is
positioned inside the
plastic shield
Expiration Dates
Holders
 A plastic holder must
be used with the
evacuated tube
system.
Needles

 Different sizes.
 size =gauge.
 The larger the needle, the smaller the
gauge number.
 22 or 23 gauge needle is mostly used.
Needle Components
Single Draw Needle
 Single draw needles
are of the type that fit
on a syringe, and can
be used only to fill the
syringe to which they
are connected.
Multiple Draw Needle
 Used with vacuum
collection tubes.
 They have a
retractable sheath
over the portion of the
needle that
penetrates the blood
tube.
Butterfly Needle
 Winged infusion set
 Difficult venipunctures
including pediatric
draws
 with a syringe or a
holder and vacuum
collection tube
system.
 24, or 25 gauge.
Butterflies with built-in safety features

 number-one cause of needlestick

injuries, so proper use of their safety
devices is critical.
Butterflies with built-in safety features
Lancets
 Lancets are used for
difficult
venipunctures,
including pediatric
draws.
Tourniquets
 Vein easier to SEE,
FEEL, and
PUNCTURE
Sterilization
Bandaging Material
Gloves
 Gloves must be worn
for all procedures
requiring vascular
access.
 Non-powdered latex
gloves are most
commonly used;
Sharp Disposal Container
Marking Pen
Collecting Blood
Greeting
 Always greet patient in a professional,
friendly manner.
 A good initial impression will earn the
patients trust, and make it easier and more
pleasant to draw a good specimen.
 Knock on the patient’s door before
entering.
 Identify yourself by name and department.
 Explain the reason for your presence.
Technical Tip
 The more relaxed and trusting your
patient, the greater chance of a successful
atraumatic venipuncture.
Technical Tip
 Good verbal, listening, and nonverbal
skills are very important for patient
reassurance
Patient Identification

 Make sure the name, medical record

number, and date of birth on your
order/requisition match those on the
patient’s armband.
 Verify the patient’s identity by politely
asking them to state their full name.
Patient Identification

 Properly identifying patients and

specimens is probably the single most
critical part of your job.
 The consequences of misidentifying a
specimen can be life threatening.
Patient Identification

 Never rely on the patient name on the

door or above the bed. Patients are
frequently moved from room to room.
Technical Tip
 A hospitalized patient must always be
correctly identified by an ID band that is
attached to the patient.
Wash hands
Apply gloves
Technical Tip
 Patients are often reassured that proper
safety measures are being followed when
gloves are put on in their presence.
Position the Patient

 Comfortable position
 Turn the arm so that the wrist and palm
face upward, and the antecubital area is
accessible
Technical Tip
 When supporting the patient’s arm, do not
hyperextend the elbow. This may make
vein palpation difficult.
Applying the tourniquet

 Tie the tourniquet just above the elbow.

 The tourniquet should be tight enough to
stop venous blood flow in the superficial
arm veins.
 The tourniquet should be applied a
maximum of 1 – 2 minutes.
Applying the tourniquet
Applying the tourniquet
 After applying the
tourniquet, you may
ask the patient to
make a fist to further
distend the arm veins.
Technical Tip
 Patients often think they are helping by
pumping their fists
 This is an acceptable practice when
donating blood, but not in sample
collection as this can lead to
hemoconcentration
Choose a site

 The median cubital vein

 If not accessible: Cephalic vein, or the
Basilic vein.
 If not accessible: veins on the back of the
hand.
 Use a much smaller needle for these hand
veins.
Technical Tip
 Using the nondominant hand routinely for
palpation may be helpful when additional
palpation is required immediately before
performing the puncture.
 Often, a patient has veins that are more
prominent in the dominant arm.
 Avoid performing a venipuncture on
1. Arm on side of mastectomy. If drawn here, the test results
could be inaccurate because of lymph edema.

2. Scarred or burned areas. Performing a venipuncture at

these sites is more difficult due to the scar tissue.

3. Arm in which blood is being transfusion / IV cannula.

The fluid in the IV could dilute the specimen.

1 2 3
4. A hematoma (A hematoma is an abnormal collection of
blood outside of a blood vessel. It occurs because the wall of
a blood vessel wall, artery, vein, or capillary, has been
damaged and blood has leaked into tissues )  If drawn here,
could cause incorrect test results.

5. Edematous (Edema is swelling caused by fluid retention)

 should be avoid because the accumulated fluid could alter
test results.
Cleansing the site

 Isopropyl alcohol swab

 Outward expanding spiral starting with the
actual venipuncture site.
 Allow the alcohol to dry:-
1-disinfect the site
2-prevent a burning sensation
Cleansing the site
Technical Tip
 Patients are quick to complain about a
painful venipuncture. The stinging
sensation caused by undry alcohol is a
frequent, yet easily avoided, cause of
complaints.
Insert needle

the needle bevel up

Push tube into holder
 Gently push the tube
onto the needle
holder so that the
catheter inside the
needle holder
penetrates the tube.
 Blood flow should be
visible at this point.
Technical Tip
 Allow tubes to fill until the vacuum is
exhausted to ensure the correct blood to
anticoagulant ratio.
Blood won’t flow
 If you do not see blood flow, the tip of the
needle:

1. May not yet be within the vein.

2. May have already passed through the
vein.
3. May have missed the vein entirely.
4. May be pushed up against the inside wall
of the vein.
TROUBLESHOOTING
Incomplete collection or no blood is
obtained:
 Change the position of the needle. Move it
forward (it may not be in the lumen)
Incomplete collection or no blood is
obtained:
 or move it backward (it may have
penetrated too far).
Incomplete collection or no blood is
obtained:
 Adjust the angle (the bevel may be against
the vein wall).
Incomplete collection or no blood is
obtained:
 Loosen the tourniquet. It may be
obstructing blood flow.
 Try another tube. There may be no
vacuum in the one being used.
 Re-anchor the vein. Veins sometimes roll
away from the point of the needle and
puncture site.
Other Problems

 A hematoma forms under the skin

adjacent to the puncture site - release the
tourniquet immediately and withdraw the
needle. Apply firm pressure.
Order of draw
Removing the Needle

 Gently release the tourniquet before the

last tube of blood is filled
 Remove the last tube from the needle
 Withdraw the needle in a single quick
movement
Apply Pressure

 Quickly place clean gauze over the site,

and apply pressure.
 You may ask the patient to continue
applying pressure until bleeding stops.
Apply Adhesive bandage
Technical Tip
 The practice of quickly applying tape over
the gauze without checking the puncture
site frequently produces a hematoma
Needle disposal

 Remove the needle from the holder if

appropriate, and properly discard it in an
approved sharps disposal container.
 Discard all waste and gloves in the
appropriate biohazardous waste container.
 Wash hands.
Specimen Labeling

 Label specimens at the bedside according

to your institution’s standard procedures,
or apply preprinted labels.
 Proper labeling is the single most critical
task you are asked to perform.
Proper labeling generally includes:

 Patient’s first and last name

 Hospital identification number
 Date & time
 Phlebotomist initials
 Your institution may provide bar coded
computer generated labels that contain
this information.
Finger stick-Specimen collection
 A safety Lancet,
which controls the
depth of incision
 Finger-sticks should
not be performed on
children under one
year of age.
Finger stick
 If possible, use the fourth
(ring) finger or the middle
finger.
 Many patients prefer that
you use fingers on their
nondominant hand.
 Choose a puncture site
near the right or left edge
of the finger tip.
 Clean the site as you
would for routine
venipuncture.
Finger stick
 Select a safety lancet
appropriate for the size of
the patient’s finger.
 You may warm the finger
prior to puncture to
increase blood flow.
 Make the puncture
perpendicular, rather than
parallel, to the finger
print.
Finger stick
 Wipe away the first
drop of blood using
gauze to remove
tissue fluid
contamination.
Finger stick
 Collect blood into an
appropriate tube.
 Label specimens
appropriately.
 Make sure bleeding
has stopped. Apply
an adhesive bandage
if necessary.
 Discard sharps
appropriately.
Fainting

 Rarely, patients will faint during

venipuncture.  
 It is therefore important that patients are
properly seated or lying in such a way
during venipuncture so that if they do faint,
they won’t hurt themselves.
 self-limited
Fainting; what to do?
 Gently remove the tourniquet and needle from
the patients arm, apply gauze and pressure to
the skin puncture site. 
 Call for help. 
 If the patient is seated, place his head between
his knees. 
 A cold compress on the back of the neck may
help to revive the patient more quickly.
 
Unsatisfactory Specimens
 They can cause misleading laboratory results
 Must be rejected by the laboratory.
 The patient must then undergo another
venipuncture to get a better specimen. 
 It costs time & money to redraw the specimen.
 The credibility of the laboratory is reduced if too
many unsatisfactory specimens are drawn.
Causes of Unsatisfactory Specimens
Hemolysis
Hemolysis

 Hemolysis means the breakup of fragile

red blood cells within the specimen, and
the release of their hemoglobin and other
substances, into the plasma.
 A hemolyzed specimen can be recognized
after it is centrifuged by the red color of the
plasma.
Causes of Hemolysis

 Using a too small needle for a relatively

bigger vein
 Pulling a syringe plunger too rapidly
 Expelling blood vigorously into a tube,
 Shaking a tube of blood too hard.
Hemolysis

 Hemolysis can cause falsely increased

potassium, magnesium, iron, and
ammonia, AST, LDH levels, and other
aberrant lab results.
Clots
Clots

 Blood clots when the coagulation factors

within the plasma are activated.
 Blood starts to clot almost immediately
after it is drawn unless it is exposed to an
anticoagulant.
 Clots within the blood specimen, even if
not visible to the naked eye, will yield
inaccurate results.
Causes of Clots

 Inadequate mixing of blood and

anticoagulant
 Delay in expelling blood within a syringe
into a collection tube
Insufficient volume
Insufficient volume
 short draws will result in an incorrect ratio
of blood to anticoagulant, and yield
incorrect test results.
 Short draws can be caused by:
 A vein collapsing during phlebotomy.
 The needle coming out of the vein before
the collection tube is full.
 Loss of collection tube vacuum before the
tube is full.
Labeling Errorrs

 Labeling errors are the most common

cause of incorrect laboratory results.
 If detected, the incorrectly labeled
specimen will be rejected.
 If undetected, it will produce incorrect
results which might adversely affect your
patient’s care.
Causes

 Failure to follow proper patient identification

procedure.
 Failure to label the specimen completely
and immediately after collection.
THE END