PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

Alinsunurin, Nitzi C. March 8-10, 2022

BSMT1-A Prof. Michael Aguilar
PART I:
1. List, describe, and explain the purpose of the equipment and supplies needed to
collect blood specimens by venipuncture. (refer to your venipuncture kit).
ANSWER:
• SYRINGES (1cc, 3cc, 5cc) – It is used to withdraw blood from a patient. It is
also limited to single use only.
• TOURNIQUET – It is used to tie around a patient’s arm to apply pressure to
the arm in order to control the blood flow, and to also facilitate the findings of
vein in the patient. The placement of tourniquet should not exceed one minute
because when is exceeded, the patient is more likely to suffer from
hemoconcentration, which is vein clotting.
• RED TOP TUBE – It is the tube that contains no additives or anticoagulants.
• PURPLE TOP TUBE – The anticoagulant EDTA is present in this tube, which is
the most common anticoagulant. This tube is also the most commonly used to
collect for hematology tests.
• COTTON BALLS – It is used after venipuncture to apply pressure to the
venipuncture site in order to stop bleeding.
• ALCOHOL – to cleanse the venipuncture site.
• MARKER – to label the tubes.

2. List and describe evacuated tube system (ETS) and syringe system components,
explain how each system works, and tell how to determine which system and
components to use.
ANSWER:
The evacuated tube system (ETS) is used to collect blood directly into the evacuated
tube, to eliminate the transfer of blood from the syringe. It also allows for the collection of
multiple tubes in just a single venipuncture.
EVACUATED TUBE SYSTEM COMPONENTS:
• Multisample needles
• Tube Holder
• Color-coded evacuated tubes
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

Here in the Philippines, the syringe system is mostly used in the hospitals. Syringe
system is the process of collecting blood specimen from a patient with a syringe and then
transferring it into evacuated tubes. It is also used for patients who have small veins.
SYRINGE SYSTEM COMPONENTS:
• Plunger
• Bevel
• Shaft
• Hub
• Protective Cover
• Barrel

3. Demonstrate knowledge of the types of blood collection additives by making an

illustration, identify the chemical composition of the specific additives within each
type, and describe how each additive works.
ANSWER:
BLOOD COLLECTION ADDITIVES CHEMICAL HOW ADDITIVE
COMPOSITION WORKS
ETHYLENEDIAMINETETRAACETIC C10H16N2O8 EDTA binds to
ACID (EDTA) chelation to form
1,2-diaminoethane insoluble salts,
(ethylene diamine),
which prevents
formaldehyde,
blood clotting.
water and sodium
cyanide
SODIUM CITRATE Na3C6H5O7 This type of additive
is used to prevent
coagulation by
binding calcium, it’s
also using the
reagent
thromboplastin.
LITHIUM HEPARIN C14H25NO20S3 This additive
activates
antithrombin, which
inhibits coagulation
factors. It generates
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

whole blood or
plasma.
SODIUM FLUORIDE NaF It has antiglycolytic
properties, which
prevents glycolysis
by the Red Blood
Cells.
POTASSIUM OXALATE K2C2O4 By precipitating
calcium, oxalates
prevent clotting.
THROMBIN C12H10CIN3S The role of thrombin
is to maintain blood
coagulation and
regulates
hemostasis.
SODIUM POLYANETHOL C10H12NaO4S It is a microbiology
SULFONATE (SPS) additive because it
reduces the activity
of complement
system, which is a
group of plasma
proteins that acts as
a defense against
pathogens.
ACID-CITRATE DEXTROSE (ACD) Citric Acid, It is commonly used
Monohydrate 0.8 g, for blood storage as
Dextrose an anticoagulant for
Monohydrate 2.45 whole blood and
g, sodium Citrate Red Blood Cells
Dihydrate 2.2 g, and survival.
Water for injection

4. Describe ETS tube stopper color coding used to identify the presence or absence of
an additive either by illustration, diagram, flow scheme or plain textual explanation,
connect additives and stopper colors with laboratory departments and tests, and list
the order of draw and explain its importance.
ANSWER:
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

ETS TUBE STOPPER ADDITIVES LABORATORY

DEPARTMENTS AND TESTS
PURPLE EDTA HEMATOLOGY
PINK EDTA BLOOD BANK
LIGHT BLUE SODIUM CITRATE COAGULATION
RED GLASS TUBE NO ADDITIVE CHEMISTRY, BLOOD BANK,
SEROLOGY/IMMUNOLOGY
RED PLASTIC TUBE CLOT ACTIVATOR CHEMISTRY
RED/LIGHT GRAY CLEAR NO ADDITIVE DISCARD TUBE ONLY
RED/BLACK (TIGER) GOLD CLOT ACTIVATOR AND GEL CHEMISTRY
SEPARATOR
GREEN/GRAY LITHIUM HEPARIN AND CHEMISTRY
GEL SEPARATOR
LIGHT GREEN
GREEN LITHIUM HEPARIN CHEMISTRY
GREEN SODIUM HEPARIN CHEMISTRY
GRAY SODIUM FLUORIDE AND CHEMISTRY
POTASSIUM OXALATE
GRAY SODIUM FLUORIDE AND CHEMISTRY
EDTA
GRAY SODIUM FLUORIDE CHEMISTRY
ORANGE THROMBIN CHEMISTRY
GRAY/YELLOW THROMBIN CHEMISTRY
ROYAL BLUE NO ADDITIVE CHEMISTRY
ROYAL BLUE EDTA CHEMISTRY
ROYAL BLUE SODIUM HEPARIN CHEMISTRY
TAN EDTA CHEMISTRY
YELLOW SODIUM POLYANETHOL MICROBIOLOGY
SULFONATE (SPS)
YELLOW ACID-CITRATE DEXTROSE BLOOD BANK AND
IMMUNOLOGY
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

ORDER OF DRAW IMPORTANCE

BLOOD CULTURES This is the first in the order of draw
because it is sterile collection, to reduces
microbial contamination. Alcohol-Iodine-
Alcohol are the only three changes that are
exclusive here.
COAGULATION TUBES When blood cultures are not required, the
order of draw begins here. This is the first
because all additives have the potential
interfere with coagulation tests.
GLASS NONADDITIVE TUBES It is in the order of draw because it has a
chance to obtain blood without any
additives. It also protects against
contamination from additives in other
tubes.
PLASTIC CLOT ACTIVATOR TUBES It is the next because silica particles
activate clotting which causes coagulation.
Get serum with or without additives.
SERUM SEPARATOR TUBES
(SSTs)
PLASMA SEPARATOR TUBES (PSTs) Heparin interferes with serum specimen
collection and it affects in coagulation tests.
HEPARIN TUBES
EDTA TUBES This is the end of the order of draw
because it is responsible for many
PLASMA PREPARATION TUBES (PPTs) carryover problems, unlike other additives.
Because when it comes before other
additives, the process may repeat again
from the beginning.
OXALATE/FLUORIDE TUBES It is not commonly or widely used. Oxalates
damages cell membranes and causes Red
Blood Cells’ (RBCs) morphology, these
tubes are filled after hematology tubes.
Also, oxalates disrupt enzyme reaction and
by precipitating calcium, oxalates prevent
clotting.
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

PART II:
Define the following:
ACD – Acid-citrate dextrose is the anticoagulant of the stopper color yellow. It is use in
blood bank, because acid-citrate dextrose is commonly used in DNA testing, human
leukocyte antigen phenotyping or tissue human typing, and for paternity testing.

additive – Additives contains anticoagulants or clot activators, or maybe both, except for
the red top tube glass because it has no additives but the red top tube plastic it contains
silica particles. All of the evacuated tubes contain different type of additive for each type
of evacuated tubes.

Anticoagulants – Are used to prevent blood from clotting, but when there are more
anticoagulants present the clotting factor performs slowly. The anticoagulant works in
two ways: first is chelation, which is calcium binding, which means the additive attaches
itself to the calcium, and second is the precipitation.

antiglycolytic agent – It is a type of substance that prevents glucose from breaking

down.

Antiseptics – The microorganism can be prevented, but not necessary killed. Used to
clean wounds and the skin. For instance, a medical technologist, must clean the
venipuncture site before performing the venipuncture. We also used povidone-iodine
(betadine) to clean the wounds.

Bevel – It is a slanted part of the needle. During venipuncture, it should be bevel up, and
bevel down during blood donation.

Biocide – It is a type of chemical that can either kill or prevent the growth of
microorganism.

blood collection sets – This is the process for collecting a blood sample in order to
diagnose and monitor diseases.

carryover/cross-contamination – As a phlebotomist, we have an order of draw that we

must follow to avoid cross-contamination of the specimen. Cross-contamination occurs,
for instance, when a phlebotomist transfers blood from EDTA tubes to other tubes that
has different additive or anticoagulant. Therefore, it is transfer of additive from one tube
to another.

clear/discard tube – It is a new tube that does not contain any additives.

clot activator – It activates clotting factor, and the sample type result for all specimens
from the tube containing clot activators is serum. It is also a clot enhancer with or without
gel separators. Even with clot activator, the specimen is still mixed.
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

CPD – The primary anticoagulant used for whole blood preservation is the Citrate-
phosphate dextrose. It’s also a dextrose that can be buffered. And, phosphate is used in
the histopathology department. A type of additive that is commonly used for blood
donation specimens.

disinfectants – It is a liquid containing chemicals that kill and prevented the growth of
bacteria. It is not suitable for human skin.

EDTA – It is the most common type of anticoagulant, and can not go to the chemistry. The
mechanism of EDTA is chelation, which EDTA binds chelation to form insoluble salts.
EDTA is the type of additive that causes most carryover problems than any other
additives. Moreover, EDTA is the best because it preserve cellular morphology of blood
cells. Furthermore, Dipotassium EDTA is the most preferred EDTA because it is sprayed
coated, which allows to dilute the blood quickly because the spray contains EDTA salts.
These salts are a type of compound formed by ionic compounds, which have a high
solubility, that’s why it dissolves quickly. The other is Tripotassium EDTA, which contains
a liquid that is prone to specimen dilution. And, when Tripotassium EDTA is used in
hematology, the hemoglobin, hematocrit, RBC, WBC, and platelet count, and others can
decrease.

ETS – The evacuated tube system is a method of collecting blood from a patient in which
blood is flows through a needle inserted into the patient’s vein and directly into the
evacuated tube. It also enables the collection of multiple tubes in a single venipuncture,
and it is the safe method of collecting blood.

evacuated tubes – Are a tube used to collect and store a blood specimen of a patient that
is obtained through venipuncture that has vacuum and is color-coded to indicate the
additive inside.

gauge – It is the needle’s measurement. The gauge is also color-coded. Each color of the
gauge has a specific measurement depend on the color of the gauge. The needle decreases
as the gauge rises. The standard gauge for adults is 21g, and the standard gauge for pedia
and seniors are 23g.

glycolysis – It is the breakdown of glucose by blood cells in order to produce energy.

heparin – It prevents the thrombin enzyme. The human body produces its own heparin
through liver, lungs, and other tissues. Heparin is also produced by basophils which
contains anticoagulant heparin.

hypodermic needle- It is a syringe needle with a hinged disposable plastic sheath

attached. “Hypo” means ‘under’ and “dermic” means ‘skin.’ Also, it is the type of needle
that is used with the syringe system.

lumen- It is the hollow or hole portion of the needle.

 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

multisample needles – It is a type of needle used with an evacuated tube system.

order of draw – It is the sequence in which certain tubes can be used in blood collection
to minimize additive carryover in tubes. As a result, we should not be able to make
mistakes when filling tubes because this can cause interference in testing due to additive
carryover.

potassium oxalate – The stopper color is gray. When the specimen here is underfilled,
the Red Blood Cells (RBCs) explode. Furthermore, it always binds with calcium. It is also
combined with sodium fluoride.

PPTs – Plasma Preparation Tubes are a plastic evacuated tube that is used to collect
blood for the preparation of undiluted plasma.

PSTs – Plasma separator tubes are tubes that contains clot activators, but does not
contain anticoagulants. This tube is used to collect serum for certain laboratory tests.

RST – Rapid Serum Tube is a tube that delivers or provides serum in five to six minutes
because it contains thrombin as a clot activator, so that’s why serum production is rapid.

SESIP – Sharp with Engineered Sharps Injury Protection is a safety feature that
reduces the risk of accidental exposure to sharp materials such as needles.

sharps containers – As medical health-allied, we must be aware of how to properly

dispose wastes such as needles, lancets, and other sharp medical instruments in order to
avoid causing harm to others.

sodium citrate – It is the additive or anticoagulant in a stopper color light blue. This
additive is used to prevent coagulation; as an anticoagulant, it binds to calcium and uses
the reagent thromboplastin. Prothrombin time (PT) and Activated Partial
Thromboplastin Time (aPTT) are the most common coagulation tests; these tests are
only performed when a blood clot is detected.

sodium fluoride – It is the additive or anticoagulant in a gray top tube. It does not act as
an anticoagulant to prevent blood clotting, but it acts as a glucose preservative. It may
also be combined with EDTA.

SPS – Sodium polyanethol sulfonate it is only used in microbiology; it reduces the

activity of the complement system which works against bacteria; and it is a group of
plasma proteins that acts as a defense against pathogens. The concept complement
system is attached to the cell walls, so there will be a hole, sodium will enter to the hole
and followed by liquid, causing the cell wall to explode. Furthermore, in microbiology,
when collecting blood, the bacteria must live and survive until the actual testing because
the bacteria must be cultured or grown. Also, by binding calcium, it prevents the blood
clotting.
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

SSTs – Serum separator tube produces serum in 15 minutes, as opposed to the Rapid
serum tube (RST), which produces serum in 5-6 minutes.

syringe transfer device – It allows the blood to be safely transferred into evacuated
tubes without the use of a syringe needle.

thixotropic gel – The gel is not a clot activator; it is simply a gel. A thixotropic gel is a gel
that serves as a barrier between serum or plasma and the blood cells. It also prevents
contamination and facilitates separation.

trace element-free tubes – Trace elements are present in the human body but it’s only
few. The trace elements that can be found n the human body are Carbon, Hydrogen,
Oxygen, Nitrogen, Phosphorus, and Sulfur. Royal blue stopper is used for trace elements,
it does not contain additive but it has EDTA and heparin. Moreover, when measuring
trace elements, it is necessary to consider where the tube is made, whether it is made of
glass or plastic, and also the stopper.

winged infusion set – It is commonly referred to as “butterfly” set, and it is intended for
infants and seniors. This type of needle is also used for patients whose veins are difficult
to reach with a straight needle.

PART III:
Compared and contrast.
1. M pattern veinage from H pattern.
ANSWER: It is known as the M pattern because it resembles the most prominent
veins in humans, which are the median, median cephalic, and median basilic. The H
pattern is the most common in human veins.

2. Venipuncture from arterial puncture.

ANSWER: Venipuncture is used to collect blood from veins, whereas arterial
puncture is used to collect blood from arteries. Arterial puncture is only used when
no blood vessel is visible.

3. Anticoagulant from clot activator.

ANSWER: Anticoagulant is the type of additives that is used to prevent blood clotting
while clot activator is the type of additives that is used to promote blood clotting; it
has a gel that helps the serum to separate from the cell.

4. Serum from plasma.

ANSWER: The serum is produced by the red top tube, and the plasma is produced by
the purple top tube. Serum is the liquid component of the blood that remains after
coagulation process and serum doesn’t contain fibrinogen, whereas plasma is a fluid
component of the blood that contains fibrinogen and has been mixed with an
anticoagulant.
 PRELIMINARY TERM EXAMINATION PMLS 2 (PHLEBOTOMY FUNDAMENTALS)

5. ETS from needle and syringe.

ANSWER: Evacuated tube system is a method of collecting blood, but this system
allows blood to flow through a needle inserted into a patient’s arm and then directly
into an evacuated tube without exposure to air and other contaminants, whereas
needle and syringe is a method of collecting blood sample to the patient where blood
goes to the syringe and then phlebotomist transfer it into the evacuated tube hence,
needle and syringe has exposure to air and to contamination.