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IMMUNOLOGY Clinical Immunology and Serology A Laboratory Perspective, 4th Edition Christine Dorresteyn Stevens, EdD, MLS(ASCP) Linda E. Miller, PhD, MP(ASCP)SI

A classic text now enhanced with full color!

WHAT MAKES EXCEPTIONAL

This practical introduction to clinical immunology covers the essential theoretical principles and the serology techniques most commonly used in the laboratory. NEW! Chapters on Innate Immunity, Adaptive, Immunity, and Immunizations and Vaccines.

MEDICAL LABORATORY SCIENTISTS AND MEDICAL LABORATORY TECHNICIANS? Professionals in this field are in high demand. Help your students excel by choosing resources that will build their knowledge base and help them thrive. Our visually rich and engaging texts provide vibrant, step-by-step photographs, easy-to-understand discussions, and real-world case studies to sharpen your students’ skills and build critical thinking.

NEW! Boxes highlighting Connections, Clinical Correlations, and In the Laboratory. MORE! Full-color photographs of assay results and patients with immune-related diseases. 576 pages | 197 illustrations Soft cover | 2017 $89.95 (US) | $128.95 (CAN) ISBN-13: 978-0-8036-4466-3

UPDATED & EXPANDED! Coverage of the external defenses and inflammation, human microbe relationships, bacterial virulence factors, the role of the B and T cells in the adaptive immune response, the immune mechanisms involved in humoral antibody production and cell-mediated immunity, and tumor markers and immune mechanisms.

A. Pro-B Cell

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Instructor §§ eBook §§ PowerPoint Presentations §§ Instructor’s Guide §§ Image Bank §§ Lab Exercises §§ Branching Cases §§ Test Bank

B. Pre-B Cell

Stem cell

NEW! Photos and line drawings now in full color.

C-kit

C. Immature B Cell

mu chains in cytoplasm Bone marrow stromal cell

mu and surrogate light chains

Self-antigens give negative signals

Apoptosis

IgM

Spleen

Lymph nodes

CD1

Self-antigen

Student/Premium §§ Branching Cases §§ Lab Exercises

IgD IgM

IgM

D. Marginal zone B cells

WHAT’S INSIDE Immunology..........................................................3 Phlebotomy..........................................................4

Microbiology.........................................................9 Molecular Diagnostics........................................10

Course Review & Exam Prep................................6

Urinalysis.............................................................10

Hematology..........................................................7

General References............................................11

Immunohematology.............................................8

Medical Terminology..........................................12

Math......................................................................8

CONTENTS

II. Basic Immunological Procedures 8. Safety and Quality Assessment 9. Principles of Serological Testing

2 Questions? Contact your F.A. Davis Educational Consultant at 800.323.3555 (US) | 800.665.1148 (CAN) | [email protected]

D. Follicular B cells

Remain in spleen

I. Nature of the Immune System 1. Introduction to Immunity and the Immune System 2. Nature of Antigens and the Major Histocompatibility Complex 3. Innate Immunity 4. Adaptive Immunity 5. Antibody Structure and Function 6. Cytokines 7. Complement System

CD23

Enter circulation

Author

ISBN #

Stevens

10. Precipitation and Agglutination Reactions 11. Labeled Immunoassays 12. Molecular Diagnostic Techniques 13. Flow Cytometry and Laboratory Automation III. Immune Disorders 14. Hypersensitivity 15. Autoimmunity 16. Transplantation Immunology 17. Tumor Immunology 18. Immunoproliferative Diseases 19. Immunodeficiency Diseases

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04/24/16 IV. Serological and Molecular Diagnosis AR X of Infectious Disease 35p4Molecular x 33p5 20. Serological and Detection of Bacterial Infections 21. Spirochete Diseases 22. Serological and Molecular Diagnosis of Parasitic and Fungal Infections 23. Serology and Molecular Detection of Viral Infections 24. Laboratory Diagnosis of HIV Infection 25. Immunization and Vaccines Glossary, Answer Key, References Artist

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4/C

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ISBN #

Stevens

4466 Document name

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PHLEBOTOMY

PHLEBOTOMY

Blood Collection

The Phlebotomy Textbook

A Short Course, 3rd Edition

3rd Edition

Marjorie Schaub Di Lorenzo, MT(ASCP)SH | Susan King Strasinger, DA, MT(ASCP)

Susan King Strasinger, DA, MT(ASCP) Marjorie Schaub Di Lorenzo, MT(ASCP)SH

Perfect for a short module on phlebotomy.

Whys & hows to safely obtain quality samples.

Here’s “to the point” instruction on blood collection techniques. Case Studies throughout the text challenge students to apply knowledge to realistic patient situations.

This full color text makes important concepts easy to understand with a friendly, narrative writing style, over 300 images, and clinical situations to encourage critical thinking.

Complies with the standards set by OSHA, The Joint Commission, and the National Committee for Clinical and Laboratory Standards.

4607_Ch03_045-086 08/02/16 9:52 AM Page 70

Emphasizes the clinical importance of proper technique.

70

CHAPTER 3

■

PROCEDURE 3-2

240 pages | 157 illustrations Soft cover | 2016 $46.95 (US) | $67.50 (CAN) ISBN-13: 978-0-8036-4607-0

Instructor §§ eBook §§ Instructor’s Guide §§ Test Bank §§ PowerPoint Presentations §§ Videos §§ Animations

For a list of resources visit

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Venipuncture Techniques

Venipuncture Using an Evacuated Tube System (Continued)

Step 13. Remove the plastic needle cap and examine the needle for defects such as nonpointed or barbed ends.

Step 15. Grasp the assembled needle and tube holder using your dominant hand with the thumb on the top near the hub and your other fingers beneath. Smoothly insert the needle into the vein at a 15- to 30-degree angle with the bevel up until you feel a lessening of resistance. Brace the fingers against the arm to prevent movement of the needle when changing tubes.

Step 14. Anchor the vein by placing the thumb of the nondominant hand 1 to 2 inches below the site and pulling the skin taut.

Step 16. Using the thumb, advance the tube on to the evacuated tube needle, while the index and middle fingers grasp the flared ends of the holder.

Student/Premium §§ eBook §§ Videos §§ Animations

504 pages | 350 illustrations Soft cover text + CD| 2011 $69.95 (US) | $100.50 (CAN) ISBN-13: 978-0-8036-2057-5

Evaluation checklists show your students how they will be assessed. Student CD with interactive exercises for each chapter and more than 30 minutes of video clips that demonstrate proper techniques.

ENHANCED! Photographs and line drawings now in full color.

Illustrated procedures, pre-examination considerations, technical tips, and phlebotomist alerts make learning easy.

Phlebotomy Notes

CONTENTS

Introduction to Blood Collection Venipuncture Equipment Venipuncture Techniques Pre-examination Variables and Venipuncture Complications 5. Special Blood Collection 6. Dermal Puncture 7. Point-of-Care Testing 8. Blood Collection from Vascular Access Devices Appendices A. Laboratory Tests and the Required Types of Anticoagulants and Volume of Blood Required B. Clinical Correlations of Blood Tests Related to Body Systems C. Answer Key D. Laboratory Abbreviations Commonly Used

A review of equipment and safety requirements, such as safety needle devices and disposal systems, mandated by OSHA.

Pocket Guide to Blood Collection

1. 2. 3. 4.

Susan King Strasinger, DA, MT(ASCP) Marjorie Schaub Di Lorenzo, MT(ASCP)SH

Adheres to CLSI & OSHA Guidelines. Rely on the perfect guide for collecting, transporting, and processing quality blood specimens for laboratory testing. NEW! Videos online at DavisPlus.com demonstrate proper techniques for venipuncture, dermal puncture, use of a winged blood collection set, donning and doffing PPE, handwashing.

4 Questions? Contact your F.A. Davis Educational Consultant at 800.323.3555 (US) | 800.665.1148 (CAN) | [email protected]

31 CLSI Recommended Order of Draw Fill tubes in the following order to prevent invalid test results caused by contamination of the specimen by microorganisms, tissue thromboplastin, and additive carryover. Order

Tube Color

1 2

Yellow Light blue Red plastic

3

No additive Gel separator tube with clot activator

Gold SST

Gel separator tube with clot activator

Light green PST Green Royal blue Lavender Pink

Step by step techniques for venipuncture, dermal puncture, and arterial puncture At-a-glance tables summarize labs, specimen type, and collection, special requirements 220 pages | 25 illustrations Soft cover, spiral bound | 2013 $34.95 (US) | $50.50 (CAN) ISBN-13: 978-0-8036-2594-5

Clot activator

Red and gray SST

Royal blue

5

Sodium citrate

Red glass

Orange RST

4

Additive SPS Sterile media bottles

Tan Royal blue White PPT

6

Gray

VENI PUNCT

Patient Identification

Gel separator tube Two forms of identification are recommended for the ALERT: withidentifi thrombin cation of all patients. Clot activator

For a Hospitalized Patient

1. Verbally Gel separator tube identify the patient by asking the patient to state his or her full name. with heparin

2. Check that the information on the patient’s ID band matches the information on the requisition form, including:

Heparin

Heparin ■ Patient’s name. ■ ■

EDTA

Hospital identification number. Date of birth.

EDTA ■ Physician.

EDTAALERT: Verify any discrepancies between the patient’s ID

band and the requisition form before performing venipuncture. EDTA Gel separator with EDTA Potassium oxalate Sodium fluoride

EQUIP

CLSI recommended Order of Draw and ‘Red Alerts’ are presented for quick access in any setting.

For an Outpatient

■ Verbally identify the patient by asking the patient to state his or her full name, address, birth date, or unique identification number. ■ Compare the response to the requisition form. ■ Check the patient’s photo identification, if required. ■ Check the patient’s ID band or patient ID card, if available.

ALERT: Verify any discrepancies between the patient’s ID and the requisition form before performing venipuncture.

42

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COURSE REVIEW & EXAM PREP

HEMATOLOGY Hematology In Practice, 2nd Edition

Quick Review Cards for Medical Laboratory Science, 2nd Edition

Betty Ciesla, MS, MLS(ASCP)SHCM

2956_Ch03_135-286 29/01/14 12:17 PM Page 187

Valerie Dietz Polansky, MEd, MLS(ASCP)CM

Diarrheagenic Escherichia coli

A complete, portable study guide!

More than 500 cards review the entire MLS curriculum for class, certification, and licensure exam success. Contents mirror the Board of Certification’s outline.

CRYSTAL

TRANSMISSION

DISEASE MECHANISM

GRAM STAIN OF STOOL

Diarrhea, hemorrhagic colitis, hemolytic uremic syndrome (HUS). Most common cause of renal failure in children in U.S. May be fatal, especially in young or elderly

Undercooked meat, raw milk, apple cider

Toxins (vertoxins or Shiga toxins)

RBCs but usually no polys

No polys or RBCs

Depictions of normal and common abnormal serum protein electrophoresis patterns, structures of urine crystals, diagnostic stages of parasites, and more.

E. coli O157:H7 is most common isolate of group & pathogen most often isolated from bloody stools. Non-O157 STEC also causes disease. DNA probes can ID genes that code for toxins. Report to public health.

(ETEC)

diarrhea in infants

Contaminated food or water

Toxins

Enteroinvasive (EIEC)

Bloody diarrhea. Dysentery-like. Usually

Contaminated food or water

Invasiveness Urinalysis Polys, RBCs,and mucusBody

areas of poor sanitation. DESCRIPTION

A unique visual language simplifies practical laboratory principles and procedures into easy-to-follow, manageable sections.

OTHER

Case studies illustrating the key principles of each major concept. End-of-chapter summaries and review questions

Profuse, watery stool. DNA probes to detect toxins or toxin genes.

Special “Troubleshooting: What do you do when…” sections.

Fluids Review 505

SIGNIFICANCE

COMMENTS

Yellow, oily-looking spheres. Radial & concentric striations.

Severe liver disease

Often seen with tyrosine.

Tyrosine

Fine yellow needles in sheaves or rosettes.

Severe liver disease

Often seen with leucine.

Cystine

Hexagonal (6-sided).

Cystinuria

Must differentiate from uric acid. Doesn’t polarize light. Confirm by cyanide-nitroprusside test.

Leucine

Mnemonics to make memorizing important information easier.

$57.95 (US) | $82.95 (CAN) ISBN-13: 978-0-8036-2956-1

PATHOGENICITY

Enterohemorrhagic (EHEC). Also known as Shiga toxin– producing (STEC) or verotoxinproducing (VTEC)

Abnormal Crystalsin*young children in

Large metal ring to loop through hole-punched cards.

618 cards | 75 illustrations Soft cover | 2014

GROUP

2956_Ch07_485-522 29/01/14 12:23 PM diarrhea, Page 505 Enterotoxigenic Traveler’s

Basic principles of hematology made memorable.

Clinical Microbiology Review 187

384 pages | 238 illustrations | Hard cover | 2012

continued...


$89.95 (US) | $128.95 (CAN) ISBN-13: 978-0-8036-2561-7

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Clinical Hematology and Fundamentals of Hemostasis,

From Strasinger SK, Di Lorenzo MS. Urinalysis and Body Fluids, 5th ed. Philadelphia: FA Davis; 2008:117.

continued...

5th Edition Denise Harmening, PhD, MLS(ASCP), CLS (NCA)

2828_Ch01_001-040 09/08/12 4:10 PM Page 39

Medical Laboratory Science Review, 4th Edition

1.8 | Hematology Problem Solving 15. Refer to the following scatterplot, histograms, and

automated values on a 28-year-old woman who had preoperative laboratory testing. A manual WBC differential was requested by her physician. The WBC differential was not significantly different from the automated five-part differential; however, the technologist noted 3+ elliptocytes/ovalocytes while reviewing the RBC morphology. What is the most likely diagnosis for this patient?

Robert R. Harr, MS, MLS(ASCP)

The perfect review for MLT and MLS success! Build the theoretical and practical knowledge your students need to succeed on classroom tests and certification and licensure exams. Includes over 270 full-color photomicrographs. More than 3,200 multiple-choice questions at taxonomy levels 1, 2, and 3, each with detailed rationales.

$67.95 (US) | $97.50 (CAN) ISBN-13: 978-0-8036-2828-1

Explore body fluids, quality control, flow cytometry, molecular diagnosis, red & white blood cells, hemostasis, and thrombosis, and more.

symptoms of jaundice, acute cholecystitis, and an enlarged spleen. On investigation, numerous gallstones were discovered. Review the following CBC results: WBCs = 11.1 × 109/L RBCs = 3.33 × 1012/L Hgb = 11.5 g/dL Hct = 31.6 mL/dL

MCV = 100 fL MCH = 34.5 pg MCHC = 37.5% PLT = 448 × 109/L

Case histories and study questions with answers enhance critical thinking.

WBC differential: 13 band neutrophils; 65 segmented neutrophils; 15 lymphocytes; 6 monocytes; 1 eosinophil RBC morphology: 3+ spherocytes, 1+ polychromasia

2828_Ch01_001-040 09/08/12 4:10 PM Page 39

608 pages | 74 illustrations Soft cover text + CD | 2013

A full-color text, lab manual, & atlas—all in one!

39

16. A 25-year-old woman saw her physician with

Each question has a rationale and is classified by subject category, task, and taxonomy level.

What follow-up laboratory test would provide valuable information for this patient? A. Osmotic fragility B. Hgb electrophoresis C. G6PD assay D. Methemoglobin reduction test Hematology/Evaluate laboratory data to recognize health and disease states/2

Laboratory methods on routine hematology methods, automated differential analysis, cytochemistry, and more.

Answers to Questions 15–16 15. B The finding of ovalocytes as the predominant RBC morphology in peripheral blood is consistent with the diagnosis of hereditary elliptocytosis (HE), or ovalocytosis. This disorder is relatively common and can range in severity from an asymptomatic carrier to homozygous HE with severe hemolysis. The most common clinical subtype is associated with no or minimal hemolysis. Therefore, HE is usually associated with a normal RBC histogram and cell indices and will go unnoticed without microscopic evaluation of the peripheral smear.

15. Refer to the following scatterplot, histograms, and

automated values on a 28-year-old woman who had preoperative laboratory testing. A manual WBC The osmotic fragility test is indicated as a differential was requested 16.byA her physician. confirmatory test for the presenceThe of numerous A. Disseminated intravascular coagulation (DIC) spherocytes, and individuals with hereditary B. Hereditary (ovalocytosis) was not significantly WBCelliptocytosis differential spherocytosis (HS) havedifferent an increased osmotic fragility. C. Cirrhosis The MCHC is elevated in more than 50% of patients D. Hgb C disease spherocytosis, and this parameter can be used from the automated five-part with differential; however, Hematology/Evaluate laboratory data to recognize as a clue to the presence of HS. Spherocytes have a health and disease states/2 decreased surface-to-volume ratio, probably resulting the technologist noted 3+ elliptocytes/ovalocytes from mild cellular dehydration. while reviewing the RBC morphology. What is the most likely diagnosis for this patient?

1.8 | Hematology Problem Solving

39


16. A 25-year-old woman saw her physician with

symptoms of jaundice,www.DavisPlus.com acute cholecystitis, and an enlarged spleen. On investigation, numerous gallstones were discovered. Review the following CBC results: WBCs = 11.1 × 109/L RBCs = 3.33 × 1012/L Hgb = 11.5 g/dL Hct = 31.6 mL/dL

MCV = 100 fL MCH = 34.5 pg MCHC = 37.5% PLT = 448 × 109/L

WBC differential: 13 band neutrophils; 65 segmented neutrophils; 15 lymphocytes; 6 monocytes; 1 eosinophil RBC morphology: 3+ spherocytes, 1+ polychromasia

CD includes 1,000 additional questions in the form of: Comprehensive Exam, MLT Exam, Problem-Solving Exam, Photomicrograph Exam, and a Customizable Test Bank.

What follow-up laboratory test would provide valuable information for this patient? A. Osmotic fragility B. Hgb electrophoresis C. G6PD assay D. Methemoglobin reduction test Hematology/Evaluate laboratory data to recognize health and disease states/2 Answers to Questions 15–16

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Plus codes in select, new print books unlock a A. Disseminated intravascular coagulation (DIC) wealth of Premium online resources B. Hereditary elliptocytosis (ovalocytosis)for your C. Cirrhosis students. Access can also be purchased. D. Hgb C disease Hematology/Evaluate laboratory data to recognize Free to adopters. Visit health and diseasewww.DavisPlus.com. states/2

15. B The finding of ovalocytes as the predominant RBC morphology in peripheral blood is consistent with the diagnosis of hereditary elliptocytosis (HE), or ovalocytosis. This disorder is relatively common and can range in severity from an asymptomatic carrier to homozygous HE with severe hemolysis. The most common clinical subtype is associated with no or minimal hemolysis. Therefore, HE is usually associated with a normal RBC histogram and cell indices and will go unnoticed without microscopic of the 226 pages |evaluation 283 illustrations peripheral smear.

Soft cover, spiral bound | 2013

16. A The osmotic fragility test is indicated as a confirmatory test for$36.95 the presence of numerous (US) | $52.95 (CAN) spherocytes, and individuals with hereditary ISBN-13: 978-0-8036-1902-9 spherocytosis (HS) have an increased osmotic fragility. The MCHC is elevated in more than 50% of patients with spherocytosis, and this parameter can be used as a clue to the presence of HS. Spherocytes have a decreased surface-to-volume ratio, probably resulting from mild cellular dehydration.

1,032 pages | 600 illustrations | Hard cover | 2009 $154.00 (US) | $220.50 (CAN) ISBN-13: 978-0-8036-1732-2

1902_Tab02_035-053 20/03/13 10:51 AM Page 44

Heme Notes A Pocket Atlas of Cell Morphology

ERYTHROPOESIS

Basophilic Normoblast Versus Polychromatic Normoblast

Denise M. Harmening, PhD, MLS (ASCP), CLS(NCA) Kathleen Finnegan, MS, MLS(ASCP)SH

1902_Tab03_054-081 20/03/13 10:52 AM Page 80

LEUKOPOESIS

Nucleus

Cell morphology at your fingertips. Here’s the ideal quick reference for morphology of normal and abnormal peripheral blood and bone marrow cells. Includes more than 280 full-color photographs!

Basophilic Normoblast Round 6:1–4:1 Basophilic Usually none Central Larger granularity

Polychromatic Compare and Contrast: Thrombopoiesis Normoblast Round Megakaryocyte Versus Osteoclast 4:1–2:1 Dark blue None Central to eccentric Increased clumped chromatin, cartwheel appearance: regular pattern of dark (chromatin) and white (parachromatin)

Color:

Basophilic

Amount:

Small

Polychromatophilic blue-gray to pink Nucleus Moderate Shape:

Shape: N:C ratio: Color: Nucleoli: Position: Chromatin:

Cytoplasm

N:C ratio: Color: Nucleoli: Position: Chromatin:

44

Osteoclast Multinucleated (2–5 of uniform size) Red-purple Present Central Coarse, clumped with visible parachromatin

Cytoplasm Color: Amount: Granules:

Side-by-side comparisons demonstrate the differences between commonly confused cells.

Megakaryocyte Multilobulated (2 or more lobes) 1:1–1:2 Blue-purple None Eccentric Granular

Megakaryocyte Pink to pink-blue Abundant Numerous, fine, azurophilic

Osteoclast Blue-purple Moderate to large Blue-red granules lysosomal granules

HINTS ■ Megakaryocyte is multilobed, and platelets may be shedding off the cytoplasm; the osteoclast is multinucleated with separate nuclei and has basophilic granular cytoplasm.

80

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IMMUNOHEMATOLOGY

MICROBIOLOGY

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Modern Blood Banking & Transfusion Practices,

Medical Parasitology

Denise M. Harmening, PhD, MLS(ASCP), CLS(NCA)

A Self-Instructional Text, 6th Edition Ruth Leventhal, PhD, MBA, MLS(ASCP) Russell F. Cheadle, MS, MLS(ASCP)

The perfect balance of theory & practice.

Building from a review of the basic sciences to the how and why of clinical practice, this popular text continues to set the standard for developing a comprehensive understanding of modern routine blood banking and transfusion practices.

An engaging, systematic introduction.

An extensive series of full-color photographs, line drawings, and plates help your students recognize parasitic diseases and build a solid understanding of the fundamentals of diagnosis and treatment.

Case studies with questions and answers emphasizes practical application that links science to the patient. Discussions of the legal and ethical aspects of providing *URXS$ *URXS$ blood$JJOXWLQDWLRQZLWK$QWL$ collection and transfusion. $JJOXWLQDWLRQZLWK$QWL$ $JJOXWLQDWLRQZLWK$QWL% *URXS$ $JJOXWLQDWLRQZLWK$QWL$ $JJOXWLQDWLRQZLWK$QWL%


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264 pages | 286 illustrations Soft cover | 2012

672 pages | 229 illustrations | Hard cover | 2012

$69.95 (US) | $100.50 (CAN) ISBN-13: 978-0-8036-2543-3

$117.00 (US) | $167.50 (CAN) ISBN-13: 978-0-8036-2682-9

Full-color photographs showing ABO forward and reverse blood grouping, as well as 500 illustrations, tables, & boxes, make complex concepts easy to master.

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Case studies enhance critical thinking. Review questions and post-tests in each chapter

Medical Mycology

Diagnostic Bacteriology

Kathleen S. Blevins, PhD, MLS(ASCP), CLS(NCA) Martha E. Kern, MD, DA, MLS(ASCP), CLS(NCA

A Self-Instructional Text, 2nd Edition

A Study Guide



Table on the inside front cover compares the diagnostic stages of various parasites.

Teach proper lab practice.

Margaret A. Bartelt, PhD, Diplomate, ABMM, MLS(ASCP)SM


Outlines, activities, 75 color plates, and self-study exams ensure your students grasp the biology and physiology of fungi, the epidemiology of fungal infections, and fungal disease states.

A concise, outline format.

Show your students the microbiology lab procedures needed for diagnosing and treating diseases. Line drawings and color plates help your students visualize key points.

MATH For a list of resources visit

Fundamental Laboratory Mathematics 1R$JJOXWLQDWLRQZLWK$QWL$RU$QWL%

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*URXS2 *URXS2 Required Calculations for the Medical Laboratory Professional

Lela Buckingham, PhD, MB, DLM (ASCP)

242 pages | 243 illustrations Soft cover | 1997

Chapter study questions and a 100-question comprehensive exam test their knowledge.

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500 pages | Soft cover | 2000 $50.95 (US) | $72.95 (CAN) ISBN-13: 978-0-8036-0301-1

Nearly 600 practice problems with answers show them the required calculations needed in the clinical laboratory for enzyme chemistry, hematology, urinalysis, molecular biology, and molecular diagnostics. Problem sets in each chapter show all the work performed in each calculation. ‘Application Problems’ ask your students to apply math in a clinical context. Caution boxes highlight common sources of error in calculations or procedures.

4607_Ch05_103-128 08/02/16 9:49 AM Page 104

4607_Ch05_103-128 08/02/16 9:49 AM Page 103

104

5

Diurnal Variation Normal changes in blood constituent levels at different times of the day

Special Blood Collection

eBook

eBooks

$57.95 (US) | $82.95 (CAN) ISBN-13: 978-0-8036-2949-3

Turnaround Time Amount of time between the request for a test and the reporting of results

Define the various test collection priorities.

5.2

Explain the requirements for oral glucose tolerance tests (OGTTs).

5.3

Discuss diurnal variation of blood constituents and list three substances that would be affected.

5.4

Differentiate between a trough and a peak level in therapeutic drug monitoring and state the importance for collecting the sample at the prescribed time.

5.5

Discuss the timing sequences for the collection of blood cultures, the reasons for selecting a particular timing sequence, and the number of samples collected.

5.6

Describe the equipment, procedure, and precautions associated with arterial puncture.

5.7

Explain the effects of sample handling and transport on test results.

5.8

Describe the procedure for collecting samples for cold agglutinins and cryoglobulins.

5.9

List eight tests for which samples must be chilled immediately after collection.

TECHNICAL TIP 5-1 Drinking water is encouraged to avoid dehydration in the patient, which can affect laboratory results.

TECHNICAL TIP 5-2 A specimen that appears lipemic is an indication that the patient was not fasting and the lipemia may interfere with laboratory testing.

INTRODUCTION Certain laboratory tests require the use of techniques that are not part of the routine venipuncture procedure. These procedures may involve patient preparation, timing of sample collection, blood collection techniques, sample handling, and sample transport. The blood collector must know when these techniques are required, how to perform them, and how sample integrity is affected when they are not performed correctly.

COLLECTION PRIORITIES Test orders are designated as routine, STAT, or timed. Turnaround times (TATs) are based on these designations. Routine tests are ordered by the health-care provider to diagnose and monitor a patient’s condition. STAT tests have the highest priority. Timed tests must be collected at a specific time. The samples must be delivered to the laboratory promptly and the laboratory personnel notified.

Test results most critically affected in a nonfasting patient are those for glucose, cholesterol, triglycerides, or lipid profiles. If the patient has not fasted, it must be noted on the requisition form. Prolonged fasting increases bilirubin and triglyceride results and markedly decreases glucose levels.

TIMED SAMPLES Blood collections are frequently requested for specific times, and the timing of sample collection must be strictly followed for accurate test results. Reasons for timed samples are shown in Box 5-1. Collecting a sample early could yield a falsely elevated result, whereas collecting the sample late could yield a falsely normal result. Misinterpretation of test results can cause improper treatment for the patient. The most frequently encountered timed samples are discussed in this chapter.

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Ask your Educational Consultant for details on pricing and packaging options. 8

Septicemia The presence of pathogenic microorganisms in the blood

Trough Level Sample collected when a serum drug level is lowest

Upon completion of this chapter, the reader will be able to: 5.1

FASTING SAMPLES Assessment of patient preparation is necessary before blood collection for laboratory tests that require the patient to be fasting or in a basal state. Fasting differs from a basal state condition in that the patient must only have refrained from eating and drinking (except water) for 12 hours, whereas in the basal state the patient also must have refrained from exercise. It is the responsibility of the blood collector to verify that the patient is in the fasting or basal state when required.

Peak Level Sample collected when a serum drug level is highest

Steady State A 20- to 30-minute period of controlled stable oxygen consumption and no physical exercise

LEARNING OBJECTIVES

103

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Special Blood Collection

Chain of Custody Documentation of the collection and handling of forensic samples

5.11 Define chain of custody and state three tests that may require it.


■

Aseptic Free of contamination by microorganisms

5.10 List five tests for which the results are affected by exposure of the sample to light.

352 pages | 30 illustrations | Soft cover | 2014

CHAPTER 5

KEY TERMS Arteriospasm Spontaneous constriction of an artery

Select core textbooks also include the eBook for FREE when your students buy new, print books. 9

MOLECULAR DIAGNOSTICS

GENERAL REFERENCES

Molecular Diagnostics Fundamentals, Methods & Clinical Applications, 2nd Edition

Effectively introduce your students to fundamentals of nucleic acid biochemistry and the advanced concepts integral to diagnostic testing in today’s laboratories. Show them how to apply molecular techniques in clinical laboratory practice, including microbiology, virology, genetics, oncology, and human identification. Case Studies provide real-world insight into what to expect when working in the lab. 2677_Ch15_419-446.qxd

11/2/11

5:03 PM

www.DavisPlus.com 576 pages | 371 illustrations Soft cover | 2012

‘Advanced Concept’ boxes throughout the text present more complex concepts to expand your knowledge. Section III

428

Lymphocyte Antibodies

Antigen

Complement

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Essentials of Medical Laboratory Practice

Introduction to Health Care in a Flash!

Dead cell

Constance L. Lieseke, CMA (AAMA), MLT, PBT(ASCP) Elizabeth A. Zeibig, PhD, MLS(ASCP)CM

An Interactive, Flash-Card Approach Positive reaction to antibody

Marilyn Turner, RN, CMA (AAMA), MA

Leukocytes and platelets

Line drawings, flowcharts, and photographs enhance comprehension and retention.

Arlene M. Muller, BA

Help your students see which career might be the right one for them.

+

Plasma

Retention and Career Placement Guide


Techniques in the Clinical Laboratory

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Working Together to Provide Quality Care

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Page 428

Problem-based study questions and troubleshooting tips throughout. For a list of resources visit

How to Survive and Maybe Even Love Health Professions School

Patricia Lockamy Royal, EdD, MSW

Lela Buckingham, PhD, MB, DLM(ASCP)

Clinical Application of Molecular Concepts.

Today’s Health Professions

Teach with the most common laboratory techniques, tests, and procedures performed in a physician’s office.

Erythrocytes

+ Blood

For a list of resources visit Negative reaction to antibody

■ Figure 15-5 Crossmatching to known antibodies is performed on buffy coat (leukocytes and platelets, left) in a 96-well plate format where each well contains different known antibodies. If the antibody matches the cellular antigen (positive reaction, top), complement-dependent cytotoxicity will occur, and the dead cell will take up stain (green). If the antibody does not match the cellular antigen, there is no cytotoxicity.

URINALYSIS

(reading >6) in a well of the plate indicates that the cells of antibodies against known HLA types. These antibodbeing tested have cell surface antigens matching the ies are prepared from cell lines or from donors or known known antibody in that well. As reading is somewhat HLA types. Plates preloaded with antibodies (typing subjective, it is recommended that trays should be read trays) are commercially available, or laboratories may by at least two technologists independently. An example construct their own antibody panels. The collection of anof partial results from a CDC test is shown in Table 15.5. tibodies may be modified to represent ethnic populations antigens of high prevalence in particular geographical Susanor King Strasinger, DA, MT(ASCP) | Marjorie Schaub Di Lorenzo, MT(ASCP)SH areas. The repeated use of antibody preparations facilitates the recognition and recording of the antigen binding characteristics of the various antibodies. Experienced technologists have detailed documentation of antibody panels, students including which antibodies bind antigen wellpractical and Give your the theoretical and knowledge they antibodies bind less strongly. need which toToconfidently handle and analyze non-blood body fluids, and to begin the typing procedure, different antibodies are in each well of a their typing tray (a plastic plate withfrom infectious agents. keep placed themselves and laboratory safe shallow wells). Donor or recipient lymphocytes to be Case studies and clinical situations promote typed are distributed to the wells. Cross-reactivity is assessed by the uptakeand of trypan blue or eosin red dye in problem-solving critical-thinking skills. cells that have been permeabilized due to reaction with the antibody and with complement is activated by emulate Study questions atthethe end ofthat each chapter the antigen-antibody complexes (Fig. 15-6). Cytotoxicity questions onthethe national ASCP examination. is scored by estimated percentage of cells in a well that have taken up the dye. The American Society for Histocompatibility and Immunogenetics (ASHI) has ■ Figure 15-6 Cells stained for cytotoxicity. Dead cells take 336 pages | 374 illustrations Soft cover | 2014 of the developed guidelines for|numerical description up dye, and live cells remain transparent. (Photo courtesy of Dr. Andres Jaramillo, Rush University Medical Center.) observed cytotoxicity (Table 15.4). High cytotoxicity


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Take a multimedia approach to understanding the world of health care—from the office to clinical settings.



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Davis’s Comprehensive Handbook of Laboratory & Diagnostic Tests with Nursing Implications, 7th Edition

Urinalysis and Body Fluids, 6th Edition

Colorful, comprehensive, & carefully structured.


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$69.95 (US) | $100.50 (CAN) ISBN-13: 978-0-8036-3920-1

MA Notes

Anne M. Van Leeuwen, MA, BS, MT (ASCP) Mickey L. Bladh RN, BSN, MSN With full Canadian content online co-authored by Beth Swart, RN, MES

Medical Assistant’s Pocket Guide, 3rd Edition Cindi Brassington, MS, CMA (AAMA) Cheri Goretti, MA, MT(ASCP), CMA (AAMA)


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Quickly access normal lab values, common medical abbreviations, dosage calculations, triage questions, and more.

This comprehensive and incredibly organized handbook will help your students understand how laboratory and diagnostic tests work, know how to interpret their results, and provide safe, quality patient care— pre-test, intra-test, and post-test.

240 pages | 72 illustrations | Soft cover, spiral binding | 2016

1,792 pages | Soft cover | 2017

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