e.

21 ONE-STAGE FACTOR ASSAY: INTRINSIC COAGULATION SYSTEM

(Definition/Description):

Intrinsic coagulation system consists of the protein factors XII, XI, IX and VIII and
prekallikrein (PK) and high molecular weight kininogen (HK). The APTT assess the
coagulation proteins of the so-called intrinsic system and common pathways. This assay is
commonly referred to as the partial thromboplastin time (PTT) but it is really an “activated”
PTT in that its reagent contains a negatively charged surface that accelerates the rate of the
reaction

Purposes: ?
Indications: ?
Contraindication/Precautions and interfering factors: ?
Equipment/Patient’s preparation: ?
Normal Values: ?
Procedure: ?
For these procedures, obtain 7 mL of venous blood, using a light blue-top Vacutainer tube
(sodium citrate as anticoagulant) and mixing gently.
Implications of Abnormal results:

Important Nursing Responsibilities after the procedure:

 Evaluate outcomes and counsel the patient appropriately about the treatment
(adjustment of dosage).
 Assess for bleeding when the times are prolonged or increased.
 Examine skin for bruises on extremities and on parts of the body the patient cannot
easily see.
 Record bleeding from the venipuncture and injection sites, nose, or groin.

e.22 PLASMA THROMBIN TIME

(Definition/Description):

Thrombin is an enzyme that functions in the release of fibrin from fibrinogen in the final stage of
the clotting cascade. This test measures the clotting time of a sample of plasma to which
thrombin has been added. Thrombin time is longer than normal when abnormalities in the
conversion of fibrinogen into fibrin are present.

Purposes:
 To detect a fibrinogen deficiency or defect
 To help diagnose DIC and hepatic disease
  To monitor the effectiveness of heparin or thrombolytic agents
Indications:
 The test is used as a rapid screening device to detect profound fibrinogen deficiency.
 This test is not reliable to monitor heparin therapy in clients with DIC.
 This test will NOT differentiate primary fibrinolysis from DIC.

Contraindication/Precautions and interfering factors:

 Hemolyzed specimens invalidate the results.
 Failure to discard the first 1-2 mL of blood may result in specimen contamination with
tissue thromboplastin.
 Heparin therapy within 2 days before the test increases the results. Collecting a sample
from a heparinized line without discarding the first blood withdrawn can falsely prolong
results.
 A recent blood or plasma transfusion will invalidate the results.

Equipment/Patient’s preparation:
Tube: 2.7-mL blue topped or 4.5-mL blue topped tube and a control tube, and a waste tube or
syringe.

Normal Values:
Within 2 seconds of 9-second to 13-second control value; or within 5 seconds of 15-second to
20-second control value; or <1.5 times control value

Procedure:
1. Withdraw 2 mL of blood into a syringe or vacuum tube. Remove the syringe or tube,
leaving the needle in place. (From a heparinized line, discard an amount equal to the
volume of the tubing prime.) Attach a second syringe, and draw a blood sample volume
of 2.4 mL for a 2.7-mL tube and 4.0 mL for a 4.5-mL tube.
2. Gently tilt the tube five or six times to mix the sample.

Implications of Abnormal results:

Prolonged plasma thrombin time:
 Heparin therapy
 Hepatic disease
 DIC
 Hypofibrinogenemia
 Dysfibrinogenemia
 Acute leukemia
 Lymphoma
 Factor deficiency
 Shock
Important Nursing Responsibilities after the procedure:
1. Send the sample to the laboratory within 2 hours.
2. Refrigerate the sample. The plasma should be frozen if it is not tested promptly.

e.23 PLASMA FIBRINOGEN QUANTITATION

(Definition/Description):

Fibrinogen (factor I) is heat-stable, complex polypeptide that converts to the insoluble

polymer of fibrin after thrombin enzymatic action and combines with platelets to clot the
blood. Synthesized in the liver, fibrinogen increases in diseases associated with tissue
damage or inflammation. There is some evidence that it may be useful as a predictor of
arteriosclerotic disease. One performs this test by adding thrombin to the client’s
plasma and measuring the amount of time taken for clotting to occur at standard
dilutions. The amount of fibrin is then calculated based on the thrombin clotting time.

Purposes:
To evaluate fibrinolytic activity as well as identity congenital deficiency, disseminated
intravascular coagulation, and severe liver disease.

Indications:

Contraindication/Precautions and interfering factors:

Reject hemolyzed specimens or tubes partially filled with blood.

Equipment/Patient’s preparation:
Tube: 2.7- or 4.5-mL blue topped

Normal Values:
Quantitative is 200-400 mg/dL (2.04.0 g/L, SI units).
Lower values can occur in newborns.
Procedure:
Withdraw 2 mL of blood into a syringe or vacuum tube. Remove the syringe or tube,leaving
the needle in place. Attach a second syringe and draw two blood samples, one in a citrated
blue topped tube and the other in a control tube. The sample quantity should be 2.4mL for
a 2.7-mL tube and 4.0 mL for a 4.5-mL tube. Draw a 5-mL blood sample in a sodium citrate
anticoagulated blue topped tube.

Implications of Abnormal results:

High fibrinogen values may also be associated with:

 Infections and inflammation

 Cancer
 Rheumatoid arthritis
 Nephrotic syndrome
 Heart attack
 Stroke
 Pregnancy 
Low fibrinogen values may be associated with:

 Liver disease
 DIC
 Cancer
 Malnutrition
 Inherited or congenital blood clotting disorders
 Frequent blood transfusions

Important Nursing Responsibilities after the procedure:

 For clients with coagulopathy, hold pressure over sampling site for at least 5
minutes and observe site closely for development of a hematoma.
 Transport the specimens to the laboratory immediately for spinning. The specimens
are then stable for 3 days when refrigerated.
E.24 FIBRIN SPLIT PRODUCTS OR FIBRINOGEN DEGRADATION PRODUCTS (FDP)

(Definition/Description):

Fibrinogen degradation products is a test that directly measures the effectiveness of the clotting
process. There are four products (i.e., D, E, X, Y) that are form during the dissolving of clots.
These substances are indicative of recent clotting activity. If present in an increased amount,
they act as anticoagulants.

Purposes:
Indications:
 Elevated levels are found with blood transfusion reactions, thromboembolic states,
cancer, DVT, preeclampsia, sepsis, shock, sunstroke, and extensive tissue damage.
 Decreased level are not significant

Contraindication/Precautions and interfering factors:

Traumatic venipuncture; medications that alter results are barbiturates, heparin, urokinase,
and streptokinase.

Equipment/Patient’s preparation:
Blue-top tubes; needle and syringe or vacutainer; alcohol swab

Normal Values:
<10 mg/mL or <10mg/L (SI units)

Procedure:
1. Label the specimen tube. Correctly identifies the client and the test to be performed.
2. Obtain a 2mL blood sample.
3. Do not agitate the tube. Agitation may cause RBC hemolysis
4. Send tube to the laboratory.

Implications of Abnormal results:

Increased FDPs may be a sign of primary or secondary fibrinolysis (clot-dissolving activity)

due to a variety of causes, including:

 Blood clotting problems

 Burns
 Problem with the heart's structure and function that is present at birth (congenital
heart disease)
 Disseminated intravascular coagulation (DIC)
 Low level of oxygen in the blood
 Infections
 Leukemia
  Liver disease
 Problem during pregnancy such as preeclampsia, placenta abruptio, miscarriage

Important Nursing Responsibilities after the procedure:

 Apply pressure for prolonged time (5mins) to the venipuncture site.
 Explain that some bruising, discomfort, and swelling may appear at the site and that
warm, moist compresses can alleviate this.
 Monitor for signs of infection.

e.25 PLASMA PLASMINOGEN

(Definition/Description):

Plasminogen is a beta-globulin protein found in fibrin clots of blood vessels, soft tissue, and in
any body cavity lined with endothelial cells. When healing or cellular repair has occurred,
endothelial cells enzyme triggers the conversion of plasminogen to the fibrinolytic enzyme
plasmin, and lysis of the fibrin clot begins. Plasminogen has a biologic half-life of 2 days.
Plasminogen activity assays are used in the evaluation of fibrinolysis and increased fibrin-
fibrinogen degradation products and in the diagnosis of the source of hypofibrinogenemia.

Purposes:

Indications:

Contraindication/Precautions and interfering factors:

Reject hemolyzed or clotted specimens.

Equipment/Patient’s preparation:
 Clarify with the laboratory whether this test must be prescheduled for processing.
 Tube: blue topped; also obtain ice.
 Do not use plasma collected in the presence of fluoride, EDTA, or heparin.
 Specimens without lipidemia or hemolysis are preferred.
 Specimens MAY be drawn during hemodialysis.

Normal Values:
70%-100%
Procedure:
 1. Draw and discard a 2-mL blood sample and discard the syringe, leaving the needle in
place.
2. Perform venipuncture and withdraw 2 mL of blood into a syringe or vacuum tube.
Remove the syringe or tube, leaving the needle in place.
3. Attach a second syringe, and draw a sample quantity of 2.4 mL for a 2.7-mL tube and 4.0
mL for a 4.5-mL tube.
4. Immediately place the specimens in a container of ice.

Implications of Abnormal results:

Increased PLG levels are observed in the following clinical situations:

 Anabolic steroids treatment
 Hypothyroidism
 Hormonal contraceptives
 After liver/kidney transplantation
 Pregnancy

Inherited decreased PLG levels are observed in the following clinical situations:
 Type I: Both functional and immunological PLG level is decreased (hypoplasminogenemia).
 Type II: Only functional activity is decreased while protein concentration is normal
(dysplasminogenemia).

Acquired decreased PLG levels are observed in the following clinical situations:
 Disseminated intravascular coagulation
 Thrombolytic therapy
 Liver disease
 Hyperthyroidism
 L-asparaginase therapy
 Postoperative period

Important Nursing Responsibilities after the procedure:

 Write the collection time on the laboratory requisition.
 Send the specimens to the laboratory and refrigerate them if not processed within 8
hours.

E.26 PROTEIN C

(Definition/Description):

Activated protein C is a plasma, vitamin K–dependent glycoprotein anticoagulant that

inhibits factors V and XIII. Protein C was first identified in the early 1980s. Sixty percent of
protein C is bound to complement protein, and it is converted to an activated functional form by
active serine protease and its activity is enhanced by cofactor protein S. Protein C deficiency
may be congenital or acquired. Congenital protein C deficiency is an inherited, autosomal
dominant thrombophilia present in 3%-5% of clients with venous thrombosis. Congenital
deficiency may be exhibited either as reduced protein C levels or as resistance to protein C
despite normal levels. Clients with homozygous deficiencies usually die as a result of thrombosis
during their first year of life, which is often preceded by neonatal purpura fulminans. Those with
heterozygous deficiency often have venous thromboembolisms, such as deep vein thrombosis
or pulmonary embolism, at a young age. Acquired protein C deficiency is seen in acute
respiratory distress syndrome, disseminated intravascular coagulation, hemolytic uremic
syndrome, hepatic disease, infection, postoperative states, vitamin K deficiency, and clients
receiving warfarin sodium (Coumadin). Protein C deficiency is responsible for a much greater
proportion of venous thromboses than arterial thromboses. The factor V Leiden mutation,
newly identified in the 1990s, is a thrombotic molecular defect in factor V making it resistant to
anticoagulant activation by protein C. It is a significant cause of deep vein thrombosis, as the
mutation is thought to be present in 5% of the population. The Leiden mutation is identified by
performing an activated protein C resistance test (APTT with and without commercially available
activated protein C) and confirming an abnormal result with DNA evaluation for the Leiden
mutation.

Purposes:
Diagnose the cause of thrombosis. Protein C/protein S ratio is helpful in identifying carriers
of congenital protein C deficiency.

Indications:
Elevated levels are found with bacterial infections, active rheumatic fever, postoperative wound
infections, kidney or bone marrow transplant rejection, Chron’s disease, systemic lupus
erythematosus, active rheumatoid arthritis, TB, acute myocardial infarctions, and blood
transfusions

Contraindication/Precautions and interfering factors:

 Reject hemolyzed or clotted specimens, specimens not completely mixed, tubes
partially filled with blood, specimens not refrigerated, specimens diluted or
contaminated with heparin, or specimens received more than 2 hours after
collection.
 Specimen results are invalidated if client is receiving a recently adjusted (within
previous week) dose of warfarin. Oral anticoagulants decrease functional protein C
values.
 Falsely decreased functional protein C values occur in clients with abnormally high
levels of factor VIII.
 Falsely increased functional protein C values occur in clients receiving heparin.
Equipment/Patient’s preparation:
 Tube: 4.5-mL blue topped. Also obtain ice.
 Indicate on the laboratory requisition if the activated protein C resistance testing is
needed.
 For recurrent venous thrombosis, perform test at least 2 months after the last
event, and with anticoagulants held.
Normal Values:
Protein C Range
Critical value <50%
Heterozygous protein C 20%-74% deficiency
Homozygous protein C As low as 0% deficiency protein C

Procedure:
1. Withdraw 2 mL of blood into a syringe or vacuum tube. Remove the syringe or tube,
leaving the needle in place. Attach a second syringe, and draw a 2.4-mL sample in a 2.7-
mL tube or a 4.0-mL sample in a 4.5-mL tube. Place the specimens immediately into a
container of ice.
2. Gently tilt the tube five or six times to mix.

Implications of Abnormal results:

Increased:
 Diabetes, nephrotic syndrome, pregnancy.
 Drugs include oral contraceptives.
Decreased:
 Congenital protein C deficiency.
 Acquired protein C deficiency conditions such as disseminated intravascular
coagulation, hepatic disease, vitamin K deficiency.

Important Nursing Responsibilities after the procedure:

 Place the specimens on ice immediately.
 For clients with coagulopathy, hold pressure over the sampling site for at least 5
minutes and observe the site closely for development of a hematoma.
 Write the collection time on the laboratory requisition.
 Transport the specimens to the laboratory immediately, discard the ice, and
refrigerate the specimens.

e.27 EUGLOBULIN LYSIS TIME

(Definition/Description):
 Euglobulin lysis time measures the clotting activities by evaluating plasminogen and
plasminogen activator. These substances are proteins that prevent fibrin clot formations.
Fibrinolysis is essential to normal hemostasis and clotting/dissolution is constantly occurring.
When this system is dysfunctioning, a fibrin clot will dissolve immediately and result in bleeding
tendency. The effects of thrombolytic medications (e.g., streptokinase or urikinase) are assessed
by euglobulin testing. In this test, the lysis time is evaluated by adding the client’s plasma to a
blood clot and observed for 6-24 hour (labeled the euglobulin lysis time)

Purposes:
Standard screening test for hyperfibrinolysis

Indications:
 Elevated levels are found with cirrhosis, shock, DIC, incompatible drug transfusion,
malignancies, and thrombolytic medications.
 Decreased levels are found with prematurity and diabetes.

Contraindication/Precautions and interfering factors:

 Exercising within 1 hour of test.
 Venipuncture that is preceded by pumping the fist or massaging the vein
 Anticoagulants

Equipment/Patient’s preparation:
Three blue-top tubes; needle and syringe or vacutainer; alcohol swab; ice

Normal Values:
Lysis in 1.5-4 hr

Procedure:
1. Label the specimen tube. Correctly identifies the client and the test to be performed.
2. Obtain three 2.4 mL samples in three tubes
3. Do not agitate the tube. Agitation may cause RBC hemolysis
4. Send tube to the laboratory.
5. Keep specimen on ice. High temperature alter the results.

Implications of Abnormal results:

Longer-than-normal ELT time may be due to:

 Diabetes
 Prematurity
A shorter-than-normal ELT time may be due to:
  Blood vessel injury or surgery
 Cancer of the prostate
 Cirrhosis
 Fibrinogen deficiency
 Leukemia
 Pregnancy complications (for example, antepartum hemorrhage, hydatidiform
mole, amniotic embolism)
 Shock
 Thrombocytopenia purpura
The test may also be done to diagnose or rule out:
 Spontaneous abortion
 Primary thrombocythemia

Important Nursing Responsibilities after the procedure:

 Apply pressure to the venipuncture site. (Note: may need to leave pressure on 3-5
minutes if there is prolonged clotting time)
 Explain that some bruising, discomfort, and swelling may appear at the site and that
warm, moist compresses can alleviate this.
 Monitor for signs of infection.

H. MYOGLOBIN TEST

(Definition/Description):

Myoglobin (Mb, S-Mgb) is an oxyegen binding protein found in striated muscle. It releases
oxygen at very low tensions. Any injury to skeletal muscle will cause a release of myoglobin
into the blood. Because myoglobin rises and falls so rapidly, its use in diagnosing AMI is
limited

Purposes:
In combination with other tests, helps diagnose myocardial ischemia; serial values are used
to monitor for reinfarct, success of thrombolytic treatment and myocardial injury during
open-heart surgery.

Indications:

 Early evaluation of a patient with suspected acute myocardial infarction (MI).

 Disease or injury of skeletal muscle - used to assist in the diagnosis
Contraindication/Precautions and interfering factors:
• It has a very short half-life of 10 minutes in blood and is rapidly cleared by the kidneys. As
an index of myocardial infarct, myoglobin returns rapidly to baseline levels.
• It is known for its excellent clinical sensitivity early after MI but is not a widely used test
due to its lack of tissue specificity.
• Myoglobin levels may be increased after intramuscular injections and have been reported
after a high-voltage electrical accident.
Equipment/Patient’s preparation:
1. Tube: Red, green, lavender, or pink topped.
2. Clients should have no isotopes 7 days before testing.

Normal Values:
Males: 28–72 ng/mL
Females: 25–58 ng/mL

Procedure:
1. Draw a 2-mL blood sample.

Implications of Abnormal results:

Higher results may also be caused by:

 Kidney failure
 Shock
 Electrical shock
 Malignant hyperthermia, an inherited condition in which your body temperature rises
rapidly and your muscles contract when you have general anesthesia

Lower results may mean:

 Rheumatoid arthritis
 Myasthenia gravis
 Antibodies to myoglobin in your blood

Important Nursing Responsibilities after the procedure:

1. Specimens should be refrigerated.
2. Specimens may be frozen and stored for up to 2 years.
F. MCV/MCH/MCHC

(Definition/Description):

MCH is the content (weight) of hemoglobin (Hb) of the average red cell, or, in other words, a
reflection of hemoglobin mass in red cells. 

Mean corpuscular hemoglobin concentration (MCHC), is the average concentration of

hemoglobin in a given volume of packed red blood cells.

MCH, MCHC, and MCV are parts of red cell indices (parameters reflecting size and hemoglobin
content of red cells) that have traditionally been used to aid in the differential diagnosis of
anemia. 

Purposes:
 Useful in elucidating the etiology of anemia
 To classify anemia as microcytic, macrocytic and normocytic, hypochromic and
nomochronic
Indications:

Contraindication/Precautions and interfering factors:

MCHC
• High values may occur in newborns and infants.
• Presence of leukemia or cold agglutinins may increase levels. MCHC is falsely elevated with
a high blood concentration of heparin.
MCH
• Hyperlipidemia and high heparin concentrations falsely elevate MCH values.
• WBC counts greater than 50,000/mm3 falsely elevate Hgb and MCH values.

Equipment/Patient’s preparation:

Normal Values:
MCV 82–98 mm3 or 82–98 fL (femtoliters)
MCH 26–34 pg/cell or 0.40–0.53 fmol/cell (femtomoles)
MCHC 32–36 g/dL or 320–360 g/L
Procedure:
• Venous plasma (5–7 mL) with EDTA additive is obtained by venipuncture, using a purple-
top Vacutainer tube. The blood cannot have any clots present for the CBC to be valid.

Implications of Abnormal results:

• Mean corpuscular volume (MCV) changes in certain conditions. Microcytic RBCs and an
MCV less than 80 mm3 (80 fL) occur with iron deficiency, excessive iron requirements,
pyridoxineresponse anemia, thalassemia, lead poisoning, and chronic inflammation.
Normocytic RBCs and an MCV of 82 to 98 mm3 (82–98 fL) occur after hemorrhage,
hemolytic anemia, and anemias due to inadequate blood formation. Macrocytic RBCs, with a
MCV of more than 98 mm3 (98 fL), occur in some anemias: vitamin B12 deficiency,
pernicious anemia, folic acid deficiency in pregnancy and inflammation, fish and tapeworm
infestation, liver disease, alcohol intoxication, after total gastrectomy, and strict
vegetarianism.
• Mean corpuscular hemoglobin concentration (MCHC) decreases signify that RBCs contain
less hemoglobin than normal, as in iron deficiency microcytic anemias, chronic blood loss
anemia, pyridoxine-responsive anemia, and thalassemia. • MCHC increases indicate
spherocytosis.
• Mean corpuscular hemoglobin (MCH) decreases in microcytic anemia.

Important Nursing Responsibilities after the procedure:

G. Direct/Indirect Coomb’s test

(Definition/Description):

The Coombs’test shows the presence of antigen-antibody complexes. The direct

Coombs’ test detects antigen-antibody complexes on the RBC membrane and RBC sensitization.
The indirect Coombs’ test detects serum antibodies, reveals maternal anti-Rh antibodies during
pregnancy, and can detect incompatibilities not found by other methods.

Purposes:
To detect antibodies that act against the surface of red blood cell
Indications:
• Diagnose hemolytic disease of the newborn when the RBCs of the infant are sensitized.
• Diagnose acquired hemolytic anemia in adults (ie, autosensitization in vivo).
• Investigate transfusion reaction when the patient may have received incompatible blood
that sensitized his or her own red blood cells.
• Detect drug-induced hemolytic anemia.
Contraindication/Precautions and interfering factors:
 Reject hemolyzed specimens.
 Cord blood contaminated by Wharton’s jelly may yield unreliable results.
 Cold agglutinins may cause false-positive results.
 Drugs that may cause false-negative results in the presence of acquired hemolytic
anemia include heparin calcium and heparin sodium.

Equipment/Patient’s preparation:
Tube: Lavender topped, red topped, red/ gray topped, or gold topped.

Normal Values:
• Direct Coombs’test: No agglutination
• Indirect Coombs’test: No agglutination

Procedure:
• A 7-mL venous blood sample with added EDTA and 20 mL of clotted blood are studied.
• Notify the laboratory about the diagnosis, history of recent and past transfusions,
pregnancy, and any drug therapy.

Implications of Abnormal results:

• Direct Coombs’test is positive (1+to 4+) in the presence of transfusion reactions;
autoimmune hemolytic anemia (most cases); cephalothin therapy (75% of cases); drugs such
as alphamethyldopa (Aldomet), penicillin and insulin therapy; hemolytic disease of
newborn; paroxysmal cold hemoglobinuria (PCH); and cold agglutinin syndrome.
• Direct Coombs’test is negative in non-autoimmune hemolytic anemias.
• Indirect Coombs’test is positive (1+to 4+) in the presence of specific antibodies, usually
from a previous transfusion or pregnancy, and nonspecific antibodies, as in cold
agglutinants.

Important Nursing Responsibilities after the procedure:

• Interpret the test outcome and counsel the patient appropriately. Hemolytic disease of
newborn can occur when mother is Rh negative and the fetus is Rh positive. The diagnosis is
derived from the following information: The mother is Rh negative, the newborn is Rh
positive, and the direct Coombs’test is positive. Newborn jaundice results from Rh
incompatibility. More often, the jaundice results from an ABO incompatibility.
I. BLOOD TYPING

(Definition/Description):

Blood typing involves determining the four major blood types (A, B, AB, and O). Red blood
cells have A, B, AB, or no (O) surface antigens. These antigens are capable of producing
antibodies. These antigens are capable of producing antibodies. Genes determine the
presence or absence of A or B antigens on chromosome 9. Red blood cells that are known as
A have antibodies, while red blood cells B have anti-a antibodies, red cells A/B have neither
antibodies and type O have both, making AB the universal recipient and O the universal
donor. Most anti-A and anti-B antibodies reside in the IgM class of immunoglobulins and
some activity rest with IgG. Anti-A and anti-B antibodies are strong agglutinins causing rapid
complement mediated destruction of incompatible cells. This clumping may plug small
vessels and arterioles as well as accelerated red cell destruction and phagocytosis. With red
cell hemolysis there is a release of free hemoglobin into the bloodstream, which can
damage renal tubules and result in renal failure and death. ABO typing is an agglutination
test where red cells are mixed with anti-A and anti-B serum (forward grouping). The
antibody screen detects the antibodies in the serum of donors and recipients which may
lead to transfusion reaction and destruction of red blood cells.

Purposes:
Blood transfusion therapy, erythroblastosis fetalis, paternity determinations, pregnancy,
and preoperatively.

Indications:
Evaluates blood type in rape trauma investigations

Contraindication/Precautions and interfering factors:

Previous administration of incompatible blood; hemolysis of specimen; type and cross-
match not done in a timely fashion (must be done within 48 hour of blood draw);
medications that alter results are dextran, blood or blood products, and IV contrast
materials; hemodialysis; improper identification of client or blood specimen

Equipment/Patient’s preparation:
 Red-top tube or lavender-top tube or plasma separator tube; needle and syringe or
vacutainer; alcohol swab; blood bank arm band; labeling material
 Note the client’s age, medications, past transfusions of blood products, and number of
pregnancies on the laboratory requisition.
  Consult institutional protocol for any additional requirements.
 Do NOT draw specimens during hemodialysis.

Normal Values:
Determination of correct blood type

Procedure:
1. Identify the client by name, social security number, and hospital number.
Correctly identifies the client and the test to be performed.
2. Obtain a 20-mL blood sample and place 10-mL in red-top tube and 10mL in lavender-top
tube.
3. Label specimen with client’s name, social security number, and hospital number and
assign a blood bank number and place a blood bank wrist band on the client with the
same information. Ensures correct identification of the client.
4. Do not agitate the tube. Agitation may cause RBC hemolysis.
5. Send tube to the laboratory.

Implications of Abnormal results:

Important Nursing Responsibilities after the procedure:

 Apply pressure to the venipuncture site
 Explain that some bruising, discomfort, and swelling may appear at the site and that
warm, moist compresses can alleviate this.
 Monitor for signs of infection.
 Inform client of blood type when known.

J. RH FACTOR BLOOD TEST

(Definition/Description):

Rh testing measures the Rh factor, which is a system of blood typing that identifies
protein on the surface of the red blood cell. If a person’s blood has an Rh antigen, the
blood is Rh positive. If there are no Rh antigens, the blood is Rh negative. The Rh testing
can also determine if the Rh-negative client has been sensitized to Rh-positive antigen.
The most common way for the mother to be sensitized to Rh-positive antigens is during
labor and delivery of her first Rh-positive child (Note: It is possible for her to be
sensitized after miscarriage, ectopic pregnancy, induced abortion, amniocentesis, or
 receiving a blood transfusion with Rh antigens). If the pregnant mother is Rh-negative
and is carrying an Rh-positive baby, it is possible for the mother to make antibodies that
would recognize the baby’s blood as foreign, which would initiate an immune response

Purposes:
To determine whether an individual is Rh positive or Rh negative

Indications:
 Rh testing is routinely done on pregnant women or women who wish to become
pregnant and their partners.
 Monitors Rh antibodies, which may be done in the Rh-sensitized pregnant mother.
 Evaluates potential for an Rh problem after a blood transfusion reaction

Contraindication/Precautions and interfering factors:

 Hemolyzed specimen invalidates results.
 Specimen drawn from extremity into which blood or dextran is infusing invalidates
results. 3. Drugs causing a false-positive Rh test include levodopa, methyldopa, and
methyldopate hydrochloride.
 Abnormal plasma proteins, cold autoagglutinins, positive direct antiglobulin
 test, and in some cases, bacteremia may interfere with results.

Equipment/Patient’s preparation:
Lavender-top tube; needle and syringe or vacutainer

Normal Values:
Rh-positive or Rh-negative. The results are informational regarding blood type.
Note: if a pregnant mother is Rh-negative and the fetus she is carrying is Rh-positive, the
fetus is at risk of developing Rh disease.

Procedure:
1. Label the specimen tube. Correctly identifies the client and the test to be performed.
2. Obtain a 5mL blood sample.
3. Gently invert tubes several times, but do not agitate the tube. Mix the
anticoagulant, but agitation may cause RBC hemolysis.
4. Send tube to the laboratory.
5. If obtaining other tube of for blood testing, have a separate lavender-top tube solely
for the Rh testing. This may mean two or more lavender-top tubes. The Rh sample is
sent to the blood bank and the other tubes may be processed in a different
laboratory. In addition, when drawing multiple samples, draw the lavender-top
tubes last. Prevents contamination of preservatives in the other tubes.
Implications of Abnormal results:
• The significance of Rh antigens is based on their capacity to immunize the patient as a
result of receiving a transfusion or becoming pregnant.
• Antibodies for Rh2(C) are frequently found, together with antiRh1(D) antibodies, in
the Rh-negative, pregnant woman whose fetus or child is type Rh positive and possesses
both antigens.
• With exceedingly rare exceptions, Rh antibodies do not form unless preceded by
antigenic stimulation, as occurs with pregnancy and abortions; blood transfusions; and
deliberate immunization, most commonly of repeated IV injections of blood for the
purpose of harvesting a given Rh antibody.

Important Nursing Responsibilities after the procedure:

 Apply pressure to the venipuncture site
 Explain that some bruising, discomfort, and swelling may appear at the site and that
warm, moist compresses can alleviate this.
 Monitor for signs of infection.
 Counsel the client and her partner regarding the risk of Rh disease to the baby.
 Explain that RhoGAM, or RhIg, can be given by injection at 2 weeks gestation and
again within 72 hours after delivery.