tep 20: Review Practice Exercise 16-3

Review the answers to the Practice Exercise and use this as a study tool when preparing for your quiz.

1. Capillary blood is usually taken from the d. heel in infants.

2. This is a heavy glass slide used to count blood cells. b. Hemocytometer

3. Wright’s stain is placed on blood smears because each different type of cell will c. show up in a different color.

4. A normal hemoglobin value for a 10-month-old infant is c. 12 to 14.5 g/dL.

5. This is the ratio of the volume of packed RBCs in relation to the whole blood specimen. b. Hematocrit

6. These don’t have granules and consist of lymphocytes and monocytes. d. Agranulocytes

7. A bee stung Kylee, and she had an allergic reaction. c. Detoxification

8. An amoeba eats a bacterium. a. Phagocytosis

9. David sprained his ankle playing soccer; it’s now swollen and red. 

Step 18: Blood Safety Guidelines

Each facility establishes guidelines for blood safety. Usually, these will be based on government regulations such as the Bloodborne Pathogens Standard. Blood safety is a primary concern for healthcare workers because of their frequent contact with blood samples and infected patients.

Diseases that can be transmitted through blood include HIV/AIDS, hepatitis B and hepatitis C. AIDS is caused by HIV, human immunodeficiency virus, which acts by destroying the white blood cells that provide immunity to the body, called T cells. HIV is carried in the blood, all other body fluids and the mucous membranes.

Like HIV, viral hepatitis is transmitted through direct contact with infected blood or fluid. Hepatitis is classified as Hepatitis A (HAV), Hepatitis B (HBV), Hepatitis C (HCV), Hepatitis D (HDV) and Hepatitis E (HEV). The three most common of these are HAV, HBV and HCV.

Healthcare employers are required to provide immunization for HBV to their personnel. Both HBV and HCV are progressive diseases carried in the blood and may become chronic. The virus may or may not result in any symptoms, although infected individuals can carry the virus and transmit it to others for a lifetime without knowing they have it. HCV causes liver damage, cirrhosis and liver failure. HBV also damages the liver and has been linked to liver cancer. Symptoms of HBV include fatigue, nausea, headache, fever and jaundice, a yellow discoloration of the skin. HBV can remain asymptomatic (have no symptoms) for years while it is causing damage. There is no vaccine for HCV; however, it has been treated with antiviral drugs with limited success.

Here are the most common ways that viral diseases are transmitted in the medical setting:

• Blood specimens during venipuncture
• Open wounds or lesions
• Nosebleeds

Step 17: Erythrocyte Sedimentation Rate

Erythrocyte sedimentation rate (ESR) is the measurement of the rate that RBCs will settle toward the bottom of a vertical tube if the sample is well mixed and the blood is anticoagulated. The ESR is used for diagnosis and treatment of diseases because it is easy to perform, accurate and fairly inexpensive. The ESR is often referred to as the sed rate.

When the body has a disease, the plasma protein (fibrinogen) will be altered which will affect the sedimentation rate. Similarly, the surface of the RBC can be altered by disease and will affect the sedimentation rate.

The sed rate is taken in two ways, by using either the Wintrobe method or the Westergren method.

Wintrobe Method

In order to conduct an ESR test using the Wintrobe method, a venous blood sample is mixed well with an anticoagulant and transferred to a Wintrobe tube. A Wintrobe tube is a thick-walled glass tube with a flat bottom and millimeter marks from 0 to 105.4.

Step 15: Hematologic Tests

Hematologic tests, which include laboratory assessment of blood formation and blood disorders, are used to make a diagnosis, evaluate a patient’s progress and regulate treatment. The complete blood count (CBC) is the most common laboratory test in hospitals. The phlebotomist collects blood in the tube with the lavender top for a complete blood count.

Step 13: Glucose Monitoring

Glucose is the principal carbohydrate found in blood and serves as an energy source. Glucose is also found in urine, cerebrospinal fluid and semen.

The glucose test screens for glucose disorders such as liver dysfunction and hypoglycemia—a low blood glucose level. Another glucose disorder is hyperglycemia, which is a high blood glucose level. Hyperglycemia may indicate diabetes mellitus, Cushing’s syndrome or an acute response to stress.

There are many portable glucose analyzers designed for both personal use and the medical office.

There are a variety of testing methods to diagnose, evaluate and monitor glucose. Let’s discuss a few of these.

Fasting Blood Glucose

Examining a patient’s fasting blood glucose (FBG) levels can screen for diabetes mellitus. A normal fasting serum value is less than 100 deciliters (dL). According to the American Diabetes Association, the prediabetes range is between 100 mg/dL and 125 mg/dL. Diabetes is diagnosed at fasting blood sugar of greater than or equal to 126 mg/dL.3

Diabetes mellitus is a chronic syndrome of