UNIVERSITAS SRIWIJAYA

FAKULTAS KEDOKTERAN

SPECIMEN HANDLING

Kemas Yakub Rahadiyanto

Clinical Pathologist
kemasyakub@gmail.com
2014
Silahkan dicicipi !!
 Tujuan Instruksional Umum
Peserta didik mengetahui dan memahami
proses pengambilan bahan pemeriksaan
Peserta didik mengetahui dan memahami
jenis bahan pemeriksaan
Peserta didik mengetahui dan memahami
faktor-faktor yang mempengaruhi hasil
pemeriksaan
 Diagnostic Testing
1. Basic screening (frequently used with wellness groups
and case finding)
2. Establishing (initial) diagnoses
3. Differential diagnosis
4. Evaluating current medical case management and
outcomes
5. Evaluating disease severity
6. Monitoring course of illness and response to treatment
7. Group and panel testing
8. Regularly scheduled screening tests as part of ongoing
care
9. Testing related to specific events, certain signs and
symptoms, or other exceptional situations
Fischbach, FT., Manual of Laboratory & Diagnostic Tests, 7th Ed, 2004 Lippincott Williams & Wilkins
 Interfering Factors
Minimize test outcome deviations by following proper test
protocols. Make certain the patient and his or her
significant others know what is expected of them. Written
instructions are very helpful.
Reasons for deviations may include the following:
Incorrect specimen collection, handling, storage, or
labeling
Wrong preservative or lack of preservative
Delayed specimen delivery
Incorrect or incomplete patient preparation
Hemolyzed blood samples
Incomplete sample collection, especially of timed samples
Old or deteriorating specimens
 Patient factors that can alter test results
may include the following:
Incorrect pretest diet
Current drug therapy
Type of illness
Dehydration
Position or activity at time of specimen collection
Postprandial status (ie, time patient last ate)
Time of day
Pregnancy
Level of patient knowledge and understanding of testing process
Stress
Nonadherence or noncompliance with instructions and pretest
preparation
Undisclosed drug or alcohol use
Age and gender
 Pre Analysis
Errors and variables in the pre-analysis stage can affect test results.
Patient variables include physical activity, diet, age, sex, circadian
variations, posture, stress, obesity, smoking and medication.
Strict adherence to proper technique and site selection can minimize
collection variables such as hemolysis, hemoconcentration, clots and
other causes for sample rejection or erroneous results.
Blood collection containers are color-coded based on additive or
preservative and each is only suitable for specific tests. Failure to use
the proper tubes or filling tubes in the wrong sequence can produce
erroneous results.
Blood collection staff must be adequately trained in safety and
confidentiality issues.
Blood, urine and other body fluid constituents can change during
transport and storage. The extent of these changes varies by analyte.

Miller, H., Lifshitz, MS., Henry's Clinical Diagnosis and Management by

Laboratory; McPherson & PincusMethods, 21st ed. 2006, WB Saunder Co
 Table 3-1 -- Ten Common
Errors in Specimen Collection
1. Misidentification of patient
2. Mislabeling of specimen
3. Short draws/wrong anticoagulant to blood ratio
4. Mixing problems/clots
5. Wrong tubes/wrong anticoagulant
6. Hemolysis/lipemia
7. Hemoconcentration
8. Exposure to light/extreme temperatures
9. Improperly timed specimens/delayed delivery to
laboratory
10. Processing errors: incomplete centrifugation,
incorrect log-in, improper storage
Proses Diagnosis dan Sintesis
Data
KUMPULAN DATA

1
5
Masalah /
Diagnosis
1 Keluhan
Utama
Pemeriksaan
Fisik
0
Riwayat Pemeriksaan
Penyakit Tambahan

9
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SPECIMEN COLLECTION

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 INTRODUCTION
The laboratory examination has an important
role as a diagnostic tools

The accuracy of any laboratory result begins

at the beginning, with proper laboratory
specimen collection

The foundation of reliable and valid

laboratory results starts with the specimen
collection and the way in which it was
obtained
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 The nature of the test dictates the
manner in which the specimen is
collected

Some specimen collections are

complicated and require specially
trained technical personal

Most specimen collections are not

complicated

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 Proper collection depends on giving
clear and concise instruction to the
patient

Patient instruction is the responsibility

of clinical laboratorians

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 THE TEST REQUEST

The specimen testing initiated by physician

who request the certain test be performed on
a patient

The request form usually contains all relevant

information regarding the patient identity

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 DOCUMENTATION
The variety of biologic specimens, the
multitude of analytes and the various
methods of specimen and transport all
provide opportunities where inaccuracies and
errors may be introduced into the test
procedure

The laboratory requires that documentation

of specimen collection procedure are
available.

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 PROCEDURE MANUAL
Name of the test
Specimen type and quantity
Method of collection
Patient preparation
Labeling information
Special handling
Criteria of rejection
Stability and time constrains

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 TRANSPORTATION
For transportation all special requirements
necessary to preserve the specimen must be
followed

Every specimens needs the proper condition,

e.g refrigerated, iced, preservatives

Some specimens collections involves test that

are very personal and highly confidential

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 URINE SPECIMEN
Random urine specimen
the specimen obtained at any time during the
day

Fasting /First morning urine specimen

the specimen collected before a patient has
eaten in the morning

Midstream urine specimen

the specimen which the patient collects only
the middle portion of the urine flow
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 URINE SPECIMEN
Timed urine specimen
the specimen obtained at certain time , for
example urine collected post prandial (after
eating) is tested for glucose

Twenty four hour urine specimen

the specimen which contain all the urine
produced by the patient in a twenty four hour
period

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URINE SPECIMEN CONTAINER

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INTERFERENCE FACTOR
Drugs
Detergent
Sodium Chloride
Blood
Excessive exercise

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 BLOOD SPECIMEN
Capillary blood:
Collection bloodspecimen from the
capillaries
The commonly used sites:
- the ring or middle finger on adults
- the great toe on infants
- the medial and lateral plantar
surface of the foot of newborns
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CAPILLARY BLOOD COLLECTION SITES

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THE CORRECT DIRECTION OF
CAPILLARY PUNCTURE

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THE PROPER POSITION FOR PATIENTS
HANDS DURING CAPILLARY PUNCTURE

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BLOOD SPECIMEN
Venous blood:
Collection blood specimen from
the superficial vein (phlebotomy)
The commonly used sites:
- the median cubital vein
- the cephalic vein of the forearm

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PALPATING A VEIN and PERFORMING
VENIPUNCTURE

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PERFORMING VENIPUNCTURE

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BLOOD SPECIMEN TUBES

Lavender :EDTA

Red : none

Light blue: citrate

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 INTERFERENCE FACTOR

Capillary blood
- DILUTED with the tissue fluid , caused
by squeeze the finger excessively
- CONTAMINATED by the alcohol swab

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 INTERFEENCE FACTOR
Venous blood
- Hemolyze
- Improper anticoagulant
- Hemoconcentration: stress,
excessive exercise, applied the
torniquet to tight

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STOOL SPECIMEN:

No special preparation
The stool must be freshly collected (
2-4 hours) directly into a disposable
container

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STOOL CONTAINER

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INTERFRENCE FACTOR

Certain food
Drugs
Contaminated with urine
Contaminated with blood from
menstruation

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CEREBROSPINAL FLUID SPECIMEN
Specimen divided in 3 tubes:
Fist tube: chemical and serological
test
Second tube: microbiological study
Third tube: Cytologic study

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Interference factors
Traumatic collection procedure
Contamination
Drugs

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Sites of cerebrospinal fluid
collection

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SPUTUM SPECIMEN
Sputum must be deliberately
coughed up from the lungs and
lower bronchial tree
The patient must be gargle prior to
collection to reduce the number of
normal flora

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Sputum specimen container

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MICROBIAL SPECIMENS

1. Blood
2. Urine
3. Stooll
4. Throat and nasopharynx
5. Sputum
6. Vaginal discharge/urethral
discharge
8. Wound and abcess specimens
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Integrasi Hasil Pemeriksaan
Riwayat Pemeriksaan Pemeriksaan
Penyakit Fisik Tambahan
(Lab, Ro, dsb)

Data Nominal
Data Ordinal Data Metris
Data Metris

Kriteria Diagnostik

Masalah / Diagnosis 68