 Okay. Good morning, everybody. So for today, we'll be discussing and we'll be continuing our discussion on the different specimen collection and handling requirements and procedures for clinical chemistry one. So again, good morning to everybody. So if you haven't, I hope you're already finished with the patient preparation, which will be included in your quiz next meeting, which is on, which will be the second meeting for this week. Okay. So for our next meeting for this particular week, you'll be having your quiz in this particular topic and also in your patient preparation. So please do prepare for that. Okay. Please do prepare for that. So for today's discussion, I just want to give you a rough overview of the things that we're going to discuss. So first and foremost, we will be discussing about the different types of specimen or the different types of samples in clinical chemistry. So we're just going to have a brief discussion about this. At the same time, we're also going to talk about your method of collection. So some of these are actually very much familiar to you. We're actually just reviewing some of the topics. So I hope most of you will be able to tune in and really listen properly for all our discussion. And the third part will be the collection tubes and devices and the different additives and the different anticoagulants that are found in your test tubes or evacuated tubes. And finally, we'll be having a review on the protocol of specimen collection, handling, processing, and transport, which will be a second part of this video, which will be given to you next meeting. Okay. Which will be given to you next meeting together with the chain of questions. Okay. So let's get started and discuss about the first one because our review for today will be quite long. But again, I hope that all of you will be able to catch up because most of the things that we're going to discuss today are just reiteration review from your PMLSP-2 subject. Okay. So of course, when we talk about your samples, okay, there are different types of samples in the clinical chemistry laboratory. Do we have your blood, your urine, your cerebrospinal fluid, your parasynthesis fluid, and also your amniotic fluid. So all of these things can be measured in the clinical chemistry section, although among these five samples, the one very much common to the clinical laboratory and the clinical chemistry section is your blood in the form of your serum. So your urine, your CSF, your parasynthesis fluid, and even your amniotic fluid, those will be discussed further in your analysis of urine and other body fluids. But for this particular morning, we're just going to have some discussion about the samples which are also vital when it comes to their function and uses in the clinical chemistry section. So let's get started with the first one and we're going to talk about your blood. When we say blood, there are actually three forms that we can use in the laboratory. It can be your cool blood, your plasma, and also your serum. So we're going to talk about them one by one. So when we say cool blood, okay, when you say cool blood, we use both the liquid portion and the cellular components of the blood. So your cool blood is composed of two, okay, your plasma and the cellular components of your plasma, which contains now your red blood cells, your white blood cells, and also your thrombocytes or your platelet. So please do remember that this particular sample does require blood collection into a vessel or into a test tube that contains your anticoagulant. So when we say anticoagulant, please remember this because I actually noticed that some of you are still having a hard time or are confused when it comes to the function of your anticoagulant. Remember that when you put an anticoagulant in a test tube or in a container, the specimen that you will have there will either be your cool blood and if you centrifuge that, okay, dahil meron na siya anticoagulant because that particular tube contains your anticoagulant, when you centrifuge that specimen, you will get your plasma, which will be discussed in a short while. So again, remember when we say cool blood, remember when we say cool blood, it is not clotted, it is not clotted, you use your anticoagulant with this one, so your cool blood in the clinical chemistry section is usually being used for HPA1C or glycated hemoglobin, which is used in the monitoring of diabetes. So please do take note that when it comes to your cool blood, again, we use both the liquid portion, which is your plasma, and also your cellular component composed of your white blood cells, red blood cells, and also your thrombocytes or your platelets. Again, remember that when it comes to cool blood, we use your anticoagulant, anticoagulant that prevents the clotting or the formation of fibrin, okay, the formation of your fibrin, it prevents the clotting through different mechanisms, which will also be discussed towards the end of this discussion. Now moving forward, aside from your cool blood, of course, we also have your plasma. So your plasma, okay, your plasma is actually the yellow or the clear or the pale yellow liquid that you would see on top of your background cell if you centrifuge your cool blood. So again, let's have that in mind that your plasma was yielded from your cool blood. So if you have your cool blood, it does have your anticoagulant preventing the clotting. So walang pangumuwanang dugo, there is no clotting that happened. If you centrifuge that, you will get your plasma. So your plasma again is normally a clear to slightly hazy pale yellow fluid or liquid that is separated from the cells when a blood in an anticoagulant tube was centrifuged. Please do remember that your plasma still contains your fibrinogen. Sir, what is fibrinogen? Fibrinogen is one coagulation factor, okay, fibrinogen is one coagulation factor that is the substrate for your thrombin. Your thrombin is the one that will convert or the one that will activate your fibrinogen into becoming your fibrin. And if there is fibrin formation, there will be clotting. Merong pangumuwanang dugo. Pero, but if you use your anticoagulant, the formation of your fibrin will be prevented and various mechanisms. For most of your anticoagulant, their mode of action is by chillating your calcium. So this will be the action of your EDTA, your sodium citrate, your potassium oxalate. So most of your anticoagulant, okay, most of your anticoagulant, why do we call them anti-coagulant? Because they prevent, they are anti what? Anti or they prevent coagulation or the formation or the solidification of your blood through the formation of your fibrin. So they prevent coagulation, okay, they prevent coagulation by chillating your calcium, okay, by chillating your calcium. And secondly, most specifically for your heparin, okay, your heparin prevents coagulation, your heparin is anti-coagulant by inhibiting the action of your thrombin, okay, by inhibiting the action of your thrombin. So to cut the long story short, if we centrifuge your cool blood and it does contain your anticoagulant whether that is an EDTA, a sodium citrate, a potassium oxalate or a sodium or lithium heparin, okay, when you centrifuge that you will get your plasma. Then one protein, okay, one protein unique to plasma that cannot be found in your serum is your fibrinogen, okay, again that is your fibrinogen. If we're going to talk about your coagulation factor, your fibrinogen is actually your coagulation factor one. Again, your fibrinogen is your coagulation factor one. So for most of our clinical chemistry measurement, as you all know, we use your serum. But sir, where are we talking about plasma din? Because plasma is used for STAT or other tests that requires fast turnaround time. To take for example, your doctor requested for your electrolyte and it is STAT, they need to look immediately. So instead of waiting for five minutes if you're using your thrombin, instead of waiting for 15 to 30 if you're using a red plastic tube, or instead of using 30 to 60 minutes before the blood clot, if you are using your red glass tube, you can simply use your green top tube. Take note that only your green top tube so that you can use that and you can yield, okay, you can get your plasma and measure that and you can simply measure the electrolytes immediately without waiting for the complete clotting of your sample, okay, for the complete clotting of your sample. So that's one thing that is very good when it comes to your plasma, okay. That's one thing that is very good when it comes to your plasma because, okay, within your plasma because, okay, because your sample doesn't need to wait for it to clot. We don't need to wait for the blood to complete clot before we can run the sample in the laboratory. So that's the second sample that we are using in the laboratory, your plasma. Now finally, okay, the one that is very much common and very much widely used in the clinical chemistry section will be now your serum. So let's describe your serum first. So your serum is the liquid portion now of your clotted blood. Take for example, you collected your blood using a serum tube, using your red top, your orange top or your gold top tube. If you centrifuge them, when you separate it, when your blood separate it, you have on the upper most layer, you have your serum and then you have your boffy coat containing your WBC and your platelets and then below you have your pack red set. Remember, okay, remember that when it comes to your serum, it is also a clear pale yellow fluid, especially if your patients are fasting, although if your patient did not fast, it might appear hazy or cloudy due to the presence of lipids, specifically your triglyceride in your sample. So the major difference between your plasma and your serum is that your serum does not contain your fibrinogen. Again, your serum does not contain your fibrinogen. Unlike your plasma, that's one of their main differences. Number one is that your plasma contains fibrinogen, serum do not have your fibrinogen. Bakit wala na siyang fibrinogen? Why is it that your serum doesn't have your fibrinogen anymore? Again, because this particular sample is clotted. So your fibrinogen was converted to fibrin, hence the formation of your clot in your blood. So your serum samples must be allowed to completely clot approximately 30 minutes to 60 minutes if you are using your red glass tube, 15 to 30 if you're using your red plastic and 5 minutes if you're using your orange top that contains your thrombine. Remember everybody that when it comes to complete clotting time, you need to allow the blood to clot completely to prevent the formation of your latent fibrin clot. So what's the synanigan that's related to your latent fibrin clot? Remember that your latent fibrin clot can cause, again remember that your latent fibrin clot can cause interferences when it comes to your measurement. Why? Because your latent fibrin clot can clog your pipetors, your machine that can cause erroneous results in your samples. So those are the different blood specimen that we can use. You can have your whole blood, your plasma in your serum. So as for the information of everybody, what is the most commonly used sample among those three? It is your serum. But please take note that for most of the machines now, and for most of our agents now, we can use your plasma, you can use your serum. But again, the million dollar question is sir, what would be the deciding factor unto when I can use my serum and when can I use my plasma? Simple. Remember that in the establishment of your reference interval, we need to standardize the processing, the collection, and even the measurement of your sample. So if the reference value or if the reference interval you have in the laboratory was established using your serum, then it is best for your laboratory to use your serum. If you use your plasma, then it is best for your laboratory to use your plasma. If you use both, you use your serum or your plasma in establishing. When you are establishing your reference interval, you use both your serum and you also use your plasma. Then you can use either the either specimen when it comes to your laboratory. Ganan lang sya ka simple. Always remember that it will always depend upon how you establish your reference interval, including your fasting. I think I was able to mention that our last meeting in the patient preparation part. So when it comes to patient preparation, again, you can use, again when it comes to patient preparation, you can use either the fasting requirement that you use for in establishing the one that you use when you establish your reference interval. So those are the blood specimen, are the blood samples that we are using in the clinical chemistry section. Of course, quick sideline discussion will also use your urine. So remember that your urine is an ultrafiltrate of your plasma and it does consist of your urea and other organic and inorganic chemical dissolved in your water or dissolved in your urine. So it is the second most common fluid of determination in the laboratory, second to blood, second to your blood. So your urine will give you an idea of how your body is properly excreting your waste materials or your waste, your byproducts of the different processes inside our body. So remember that there are different types of urine. You have your first morning urine, you have your random urine, you also have your suprapubic urine and other, your midstream catch. There are different types of urine in the laboratory but for most of it, we are actually using in clinical chemistry. For most of our measurement, we are either using your midstream catch or your random if it is just a simple measurement of your creatinine or your microalbumine. But if we are measuring, like take for example electrolytes, other components of your urine, we're usually using your 24 hour urine. Again, in clinical chemistry, we usually use your 24 hour urine. So please take note of that for our urine. So aside from urine, we also have your cerebrospinal fluid or your CSF. So your cerebrospinal fluid is also an ultrafiltrate of your plasma and will ordinarily reflect the value seen in your plasma. So if you are now on the CSF part in your AUBF, you will be able to notice that some of the measurement of your plasma is being mirrored in your CSF. So remember that when it comes to the collection of your CSF, we usually collect it on the fourth and fifth lumbar vertebrae between the fourth and fifth or fifth and sixth lumbar vertebrae of your patient. So remember that on a usual basis, if you are able to collect your CSF properly, you can get three or more samples from your patient. So if it is irregular or a normal collection and you are able to get three test tubes, so this will be the order of draw. So the first tube will be for clinical chemistry or serology. The second is for your microbiology and the last one will be for your hematology. Again, the last one will be for your hematology. Now here's the thing. What if you're only able to collect one tube of cerebrospinal fluid and all of your sections will be sharing with that one specimen? What will be the order of draw? So remember that the order of draw for your, rather the order of processing, not order of draw anymore. The order of processing, if you only have one CSF tube, the first section that needs to get their hand into your CSF will be your microbiology. Because they need the specimen sterile, so the first one that will be processing the specimen will be your microbiology, followed by your hematology. And the last one will be your, the last section to use your specimen will be your clinical chemistry section. Sir, why clinical chemistry section will be the last? Because they will simply centrifuge that and all cellular components, they will not be using that in the measurement, only the liquid portion of your CSF. And then in hematology, they need the entire specimen including the cellular components. In microbiology, the reason why it is the first section to use your CSF tube, it's because they need a sterile procedure. Again, please take note that that order only happens, okay? Again, that order only happens if you only collected one tube of CSF. Kapag isa lang yung nakolik mo na CSF tube dahil na short ka o wala ng CSF na nilalabas yung patient, okay? If there is not enough sample and you only collected one CSF tube, then the order of processing will be from micro, hema, and then plentim, sero for the last one, okay? That is your CSF, okay? Your CSF, your seru cross-binal fluid. Now, second to the last, we also have your serous fluid. Serous fluid can be in the form of your pleural fluid, pericardial fluid, and peritoneal fluid. So remember, your serous fluid is the fluid that lines the inner cavity of our body to prevent friction and abrasion between your organs. So let's take, for example, right now, I'm breathing. But why is it that my lungs is not having friction with my heart? It is because of your serous fluid. So there are three types of serous fluid. We have your pleural fluid. Pleural fluid is the one that lines your lungs, okay? It is the liquid that is surrounding your lungs. Also the reason why most in Filipino term, we have this thing called tubig sabaga. This is actually the one that they are pertaining to, okay? When your pleural fluid is in excess, okay? That is what they term in tagalog as tubig sabaga, okay? That is your pleural fluid. Your pericardial fluid is the fluid that lines or surrounds your heart, preventing the friction of your heart from other body organs inside our body, okay? So that is your pericardial fluid. And finally, the one that lines your gastrointestinal tract and other organs, okay? In that particular cavity are your peritonal fluid, okay? Those are now your peritonal fluid. So remember, you have your pleural fluid, the one that lines your lung, your pericardial, the one that lines your heart, and your peritonal fluid, the one that lines your gastrointestinal tract, your liver, your splint, and all the other organs in your gastrointestinal cavity, okay? So this one is your peritonal. The one that covers your heart is your pericardial. The one that covers or lines your lungs, these are your pleural fluid. Sir, what do we, what do you mean by Torah synthesis, pericardial synthesis, and parasyntesis? This is the process of the, this is the collection process of your pleural fluid. So the pleural fluid is collected through Torah synthesis, your pericardial fluid is collected through pericardial synthesis, and your peritonal fluid is collected by your doctors and your medical, medical technologists through parasyntesis, okay? Through parasyntesis. Again, Torah synthesis, pericardial synthesis, and parasyntesis. So you need to take note of those three. How are this serious fluid collected and in which particular cavity can we find this particular serious fluid, okay? So in excess, okay, in excess, this will be detrimental and these are associated with different diseases on the body, which will be discussed further in your AUBF. Now finally, we also have your amniotic fluid. Your amniotic fluid on the other hand is the fluid or the liquid that lines, okay, that lines that is within your amniotic sac, okay? That is within your amniotic sac. So as you can see, you have the fetus within your amniotic sac and the liquid that they have within that is your amniotic fluid. So what is the use of your amniotic fluid? So your amniotic fluid is a product of a fetal metabolism and the constituent that are present in the fluid can provide information about first the metabolic processes that took place within your fetus and also aside from your metabolic, aside from metabolic byproducts, you can also determine, okay, you can also determine the fetal maturation of your fetus through the help of your amniotic fluid and finally, then you know that aside from that, your amniotic fluid can also serve as an early specimen for molecular testing for your infant or for your fetus. So if you wanted to know the chromosomal analysis of your fetus, you may do so by using your amniotic fluid, okay? By using your amniotic fluid. Now finally, okay, those are the different specimens that is being used in the clinical chemistry section. So you have your blood, your urine, your CSF, your parasyntesis fluid are in general your serous fluid, okay? Your serous fluid and finally, we also have your amniotic fluid, okay? Your amniotic fluid. So hopefully everything was clear and you're able to understand all the things that I've been saying all this time regarding the different types of samples in the clinical chemistry section. Now let's move forward to the next part of our discussion which will now talk about the different collection method in the laboratory. Although some of these will be, will just be a review, I will be going through this particular discussion quickly. Okay, number one because some of these were already discussed in your hematology, specifically your capillary puncture. And then in our laboratory part, we're already finished discussing about your vene puncture. So I'll be showing to you some of the slide and I think I will be able to, you'll be able naman din, you'll be able to take a screenshot of the procedure. And then I'll give you some tips on how you should study this particular part, okay? When it comes to method of collection, there are actually four types, okay? Four systems or four collection methods that are being used. We have your arterial puncture, we have your skin puncture, also known as your capillary puncture, also known as your heel puncture. You also have your central venus access device, okay? Or your CVAD method of collection. And you also have your vene puncture. When it comes to your vene puncture, we have your syringe system, your ETS, your evacuated tube system. And we also have your wing infusion set or your butterfly method, okay? So let's go first with your arterial puncture. So first with your arterial puncture, that syringe are being used instead of evacuated tube. So why are we using syringe? Because there is already a pressure exerted by your artery. So when we do your arterial puncture, we do not pull the plunger, it will just move on its own. Why? Because of the pressure in your artery, okay? The pressure in your artery will be enough to move the plunger and then fill now your barrel. Again, we do not use your evacuated tube. Why? Because they already contain your negative vacuum. They already contain your negative pressure, a vacuum that will suck the blood. And we do not need that. We do not want that for arterial puncture. Why? Because there's already a pressure that will be exerted by your artery. So the common arterial site puncture inside our body are your radial artery, your brachial artery and your femoral artery. Radial artery, look for your thumb. This is your thumb, okay? You just go on your wrist. So this part, this one is your radial artery. So if you can feel the pulsation, okay? If you can feel your pulse through your radial artery, that is your radial artery people. Next is your brachial artery. Your brachial artery is the artery nearest to your basilic vein, okay? The reason why we do not usually use your basilic vein is because we might tend to, we might accidentally heat your brachial artery. And of course, we have your femoral artery. That I cannot show because, of course, that is already the femoral artery, but I can give you your picture. So you have your radial artery in your wrist, your brachial artery found in your anti-cubital fossa. And of course, your femoral artery that are found in your groin. So remember that your arterial puncture are usually used for your arterial blood gas analysis or in general for blood gas analysis. Your blood gas analysis made through two specimens, your arterial blood or your capillary blood. Remember, in the order of draw for your microcollection tube, the first tube to be collected is for your capillary blood gas, okay? Capillary blood gas. But if you're going to choose between the two, which one will be the most ideal or the most accurate specimen to be used in the laboratory? It will be your arterial blood, okay? It will be your arterial blood. So remember when it comes to your arterial puncture, remember this people, we do not use your tourniquet. Again, we do not use your tourniquet when it comes to arterial puncture. Why? Because, okay, so I guess I was able to put this on your quiz, on your previous, that we do not use your tourniquet in collecting your arterial blood or in doing your arterial puncture because it already had, it already have its own pressure, okay? So remember this, ladies and gentlemen, that before you perform, that before you perform your arterial puncture, you need to do your modified allen test first, okay? Your modified allen test needs to be performed first. So for your modified allen test, you can actually read that on your Henry's. So please take note to read and review the process of, the process of modified allen test. But in general, I'll just give you an idea what is modified allen test, no? Your modified allen test is being performed in the laboratory so that, okay? Your modified allen test is being performed in the laboratory so that we can determine if the artery can be punctured, okay? Why? If we puncture your radial artery, it will no longer be able to supply oxygen, oxygenated blood into your hands. That's why you need to verify if your ulnar artery, ulnar artery, from your pinky going down, this one is your ulnar artery. Ulnar artery thumb is your radial artery. So if you're going to puncture your radial artery, we need to make sure that the ulnar artery will be sufficient enough to supply blood into your hands. Why? Because if not, that will be a big problem for you and your patients. Okay, so you need to check the perfusion of your hand, okay? And how do we check the perfusion of your hand? When you say perfusion, if your blood vessel are properly distributing blood through your hand. This is not just in your hand but perfusion is a general term. If your blood vessel can deliver the blood through your organs or other parts of your body. So again, to check the perfusion, you need to perform your modified allen test. Again, that is your modified allen test. In tagalog, your modified allen test binagawa natin to para makita, mag-check kung sapat ba ang ulnar artery na iiwan mo para patuloy na dumalo yung dogo dun sa kamay mo. Kasi kung hindi, you cannot perform, okay? If your modified allen test is negative, if your modified allen test is negative, you cannot perform your arterial puncture. You cannot perform your arterial puncture. Now moving forward before I proceed to your skin puncture quickly, please do remember that when it comes to your arterial puncture, we use a different angle, okay? We use different angle. Remember that when it comes to your veni puncture, the ideal angle will be 15 to 30 degrees, okay? 15 to 30 degrees for veni puncture, but for arterial puncture, it can range from 30 degrees to 90 degrees Celsius. Not 90 degrees Celsius, 90 degree angle, okay? So 30 to 90 degree angle depending on the side, okay? Depending on the side. If you are, okay? If you are collecting through your radial artery, the angle should be 30 to 45 degrees. 30 to 45 degrees. Although for most of the time, we use the 45 degree angle for your radial artery. For your brachial, okay? For your brachial and your femoral, we use as your 90 degree angle. So perpendicular. So take for example, this is your, I know this is your arm, you just simply puncture that this way, okay? I guess you can see my, so yeah, so 90 degree angle for femoral and brachial, 45 degree angle for your radial artery, okay? So that's all the things that I want you guys to remember when it comes to arterial puncture. Number one, in arterial puncture, we collect your arterial blood. We do not use your evacuated tube. These are the particulars site of collection that we can utilize for arterial puncture. We do not use your tourniquet. We need to perform modified alentas before performing your arterial puncture. And finally, your arterial puncture is used for your arterial blood gas analysis, which is important in clinical chemistry specifically when you are determining acid-base balance disorders, okay? Acid-base balance disorders. Now finally, aside from arterial puncture, we also have your skin puncture, also known as your heel puncture, also known as your capillary puncture in the laboratory. Okay. So, apologies if you cannot see the, you know, I'll stop my sharing quickly, okay, just so that you guys can see, okay? So remember that when it comes to your arterial, when it comes to your skin puncture, okay, when it comes to your skin puncture, it's very important for us to remember to wipe the first drop of blood with a clean dry cloth. Again, I'm not going to discuss na further the procedure when it comes to your skin puncture. Please do review. Again, I will not be discussing it thoroughly because it's already done in hematology lab and even in the, eventually in the lecture, so please review that. So you need to wipe the first drop of blood with a dry clean, dry cotton or gos. So always remember to cut or to puncture the site, perpendicular or across the fingerprint, 90-degree angle or perpendicular dapat. Do not milk the site because it will cause hemolysis and excess tissue fluid. Remember that the lanset, the needle of your lanset is measured 1.75 millimeter and the depth of incision for your infant should be less than 2.0 millimeter and for your adults, okay, 2 to 3 millimeter na depth incision. So please do remember the common site of collection for your skin puncture. For adult and for older children, you can use the third or fourth finger of their non-dominant hand. You can also use your ear lobe. You can also, of course, use your heel for your infants, most specifically the lateral side of the plant, the lateral side of the plantar surface of the heel. Okay, the lateral side of the plantar surface of the heel, which is this one. So remember, I always reiterate this that it is best to use the lateral side of the infant's heel because in the medial or in the median part, you have your posterior tibial artery that might be accidentally punctured during your capillary puncture. So remember, when it comes to your fingerprint, you need to puncture across or perpendicular to your, perpendicular to your, what do you call this? It should be perpendicular to your fingerprints. It should be perpendicular to your fingerprint. Of course, please do remember the things that are also important in your skin puncture like the use of COVID and iodine because it can increase your bilirubin, your uric acid, your potassium and your phosphorus. Aside from that, you need to use your warming device. Warming device that should be less than 40 degrees Celsius. This time, Celsius na talaga. It should be less than 40 degrees Celsius to warm the site so that it can, you can increase the blood flow in that particular area where you will be collecting your blood. Now, in addition to that, we also have, of course, your central venus access device, your CVAD, okay, it can provide a ready access to patient circulation, eliminating multiple phlebotomy. So, these are usually for patients that are actually chemo patients that where or dialysis patient in which their veins are being preserved for therapy or for dialysis. So instead of being used for phlebotomy purposes, we can simply use your CVAD so that we will avoid multiple phlebotomy to our patient or multiple collection or extraction from our patient. So, how can we do that? So, we can use your central venus access device. So, it will eliminate multiple phlebotomy and most especially useful for critical care and even in surgical situation. So, the sites usually are your cephalic vein, okay, your cephalic vein in your anti-cubital fossa or your internal jugular vein dito, sa leg, if you have watch night bird, okay, merong siyong subclavian na CVAD, okay, right across her chest, okay, and you also have of course, you can also have your CVAD on the femoral area, okay, on the femoral area. But on the femoral area and in addition to that, your central venus device okay, your central venus device needs to be when you are collecting blood central venus access devices. It's important for you to take note of your discard tube. Your discard tube hopefully is familiar to you because we also use your discard tube if we are collecting blood from a patient with IV fluid inserted to them. Take for example both hand has IV fluid inserted so meaning to say ideally you cannot use their veins in there to collect your blood but of course there's no other site for you to collect your blood so you need to collect your blood through the arm with your CVAD or your intravenous fluid or there's an intravenous insertion so what you need to do is to have your discard tube. Your discard tube usually we collect a minimum of 2 ml and a maximum of 5 ml. 2 to 5 ml of blood we collect that first. Take for example you're gonna collect for coagulation and then chemistry and you are collecting through a central venus access device so the first thing that you need to do is to collect blood through a discard tube. Discard tube because obviously you will be discarding this blood because it is contaminated by intravenous fluid or it is contaminated because it will be passing through the line of your CVAD so the first thing that you need to do is to collect sufficient blood 2 to 5 ml to be drawn in a clear and in a clear test tube or a clear test tube a plain test tube or a simple red test tube okay just to clear out the line okay to avoid any contamination from your patient again ha we need to collect a discard discard we need to collect blood for your discard tube 2 to 5 ml and then after collecting the discard tube okay after collecting the discard tube that's the time now that you can collect your samples so if it is your light blue your yellow if red top heparin your lavender so you can collect them na after collecting your discard tube okay again your discard tube will not be used for any test in the lab because it is contaminated okay it is contaminated um it is it will really just be discarded but take note you don't need to inform your patient na okay again you don't need to inform your patient na mom hi tatapon ko dito taran no okay we're not going to mention that to your patient okay so that is your central venous access device again because usually um done and useful useful for critical care patient surgical situation including those who will undergo dialysis and chemotherapy okay so moving forward um eto lang um a quick um a quick reminder on the order of draw in your category lines this is found or taken from your henry's so again you need to draw uh in some textbook in makol take for example 2 to 5 but in henry's 3 to 5 siya okay 3 to 5 so 3 to 5 ml in a sya range or a discard tube and then you can now collect your um your tube for blood culture your antico anticoagulated tube and then for your clotting uh for your clot tubes your red top and then other serum tubes okay other serum tubes but again one thing that i want always you guys to remember is to first collect your discard tube okay your discard tube so if if you guys could see note like um there are um there are procedures that needs to be performed before arterial puncture that is modified alentis for skin puncture warming the the side for CVAD naman collecting a discard tube first okay now finally this one is very much common to you this is your veni puncture so when we say veni puncture this is um blood collected from a patient's vein which also what we term as phlebotomy so what we collect here are the oxygenated blood because it is the one that passes through your uh that passes through your vein um and the common uh common the commonly used vein for veni puncture are located in your anticubital fossa so of course um you guys are very much familiar so the best vein for veni puncture is your median cubital vein second choice is your cephalic vein and the third one that the least the least preferred vein is your bacillic vein okay so again this is the order your median cubital your cephalic vein and your bacillic vein if we're asked what is the most preferred vein you answer your median cubital vein but if you are asked guys what is the most preferred site the answer to that is your anti anti or anti-cubital fossa but of course there are patients um that were already underwent mastectomy um there are other complications like take for example hematoma rash or other bruising on that particular on the anti-cubital fossa what would be your alternative site of course you can use um when the anti-cubital fossa or the anti-cubital veins are not accessible you can actually um collect your blood through your dorsal venus arc or your metacarpal plexus your metacarpal this one on your on your race or you can collect through your dorsal your dorsal venus arc okay on your um what do you call this pa um on your hands okay so you will be collecting through your iam you will be collecting through your hand sure have you experienced collecting blood um other than the anti-cubital fossa yes i've collected blood ven i've already collected blood through your hands and even through your feet okay there was a time that our patient um doesn't have um any accessible um vein on their anti-cubital fossa i cannot shut down naman the IV fluid because um the patient's the patient's um situation at the time is was critical so they need to have the IV fluid running so our only choice left was their foot okay so i collected uh blood through the foot of your patient but remember if you're gonna do that in the future the one thing that you need to remember okay before collecting is that you need to confirm if your patient are diabetic or not if your patient are diabetic your foot the feet of your patient are no no you cannot collect blood or you can yeah you cannot collect blood through your feet um if your patient are diabetic but if they are normal naman then you can do so okay you may do so again sir bakit hindi po kong pwede pag diabetic because remember their um their uh what do you call this their wounds don't heal normal as normal as um us na walang diabetes okay now walang diabetes okay so please do remember that okay please do remember that so for the procedure here is your procedure i'll be giving you um five seconds for each slide so five four three two one zero so remember the things that you need to review here of course the procedure the purpose of the procedure which is actually on your laboratory manual laboratory exercise number two okay and then yeah next slide five four three two one okay let's move forward diwan parang nga go online shopping na hawa na tayong in sir mark so last slide okay please take a photo okay ma'am sir pa take pa pa take na pa ka ng screenshot five four three two one and zero so please review the procedure of your vene puncture um the distance how to do your cleansing of course your antiseptic technique i already have discussed in the previous discussion in the pre um and in the patient preparation the alternatives and the different and the different antiseptics that you need we need to use okay now moving forward of course um i hope all of you are still okay there um this one will be quite long um discussion but again these are actually just to review na okay um these are actually just to review of your phlebotomy so of course we're gonna now discuss the different devices for blood collection so of course you have here your 30k your blood collection system either syringe evacuated in your wing infusion set your land set and your micro collection tubes together with your evacuated tubes okay so for your 30k remember that your 30k is made up of a pliable rubber usually latex or a strip of velcro so ayan this is surely um usually you we are using your latex but this one this is a type of a velcro na sample a velcro 30k so remember that we use your 30k to aid us to help us locate your patient's vein so much of my discussion about 30k was already discussed in the pre uh analytical patient patient preparation but again let me reiterate to everybody that you need to apply uh you need to apply your 30k at your patient's arm during venipuncture and once blood flow was established you can already remove your 30k so that's one thing no if you're reading your books and even in most of the webinar seminars and conferences we've been na um once your your blood flow is established you can already release your 30k again once your blood flow was established kapag meron ng kumasok na dugo sa hub you can already release your 30k so aside from that um remember that it should not be left um um on your patient's arm longer than one minute and if you're going to reapply your your 30k you need to wait for two minutes before reapplication please to remember the distance of your 30k application from the site it should be three to four inches away from the phlebotomy site or ten centimeter if we're going up if we're talking about your metric system aside from that in case that you don't have your 30k or you have patient obese patient that um uh obese patient and we cannot use the 30k to them kasingan na grow old or hindi kasha okay hindi kasha yung 30k we can actually use your blood pressure cuff just remember that when you're using your blood pressure cuff the blood the pressure that you need to exert should be below the diastolic pressure of your patient or in general it should be less than 40 millimeter mercury okay again an alternative for your 30k if you don't have your latex or your velcro 30k you can use your blood pressure cuff but remember to apply the pressure lower than your diastolic um diastolic pressure or just to give you an idea now it should be less it should be um less than or equal to 40 millimeter mercury okay less than or equal to 40 millimeter mercury if you're using your blood pressure cuff again what's the what are the instance that you are using your blood pressure cuff number one if there is no available 30k in the laboratory and secondly if your patients are obese and the 30k does not fit them okay and the 30k does not fit them now aside from your 30k of course we'll also have different blood collection system that are being used in the laboratory the first one are your syringe so your syringe um the usual syringe that we are using the most common gauge of your syringe is 21 gauge okay for your um normal patient for your your patient that has normal veins we are using your 21 gauge so remember by the way that your your gauge and your bore are inversely proportional or indirectly proportional the higher the gauge okay the higher the gauge the smaller the bore the high the lower the gauge the larger the bore okay the larger the bore or the when you say bore yung butas okay the the bore or the hole in your needle okay the usual length of this the usual length of the the needle is 1 to 1.5 inches in length okay the needle is 1 to 1.5 inches and then of course please do remember that your 21 gauge is most common for your uh is the most common gauge for your syringe okay for your blood collection if we are collecting from fragile vein fragile geriatric elderly um or pediatric the infants or the chill uh or the kids we are using your 23 gauge okay so if your vein are fragile if you have um patients um if you have elderly or children na patient we need to use your 23 gauge you also use your 25 gauge if you are collecting blood through the scalp okay scalp yeah scalp okay if you're using if you're collecting through your scalp you use your 25 gauge so again please remember the different parts of your syringe we have your bevel it should always be bevel up your the shaft of your needle that is uh the needle is 1 to 1.5 inches in length you have your hub and then you have your graduated barrel you have your plunger and this is completely assembled syringe system um in addition to your syringe system if we're using your syringe system of course we need to transfer the blood um that we collected so usually we use your syringe transfer yeah we use your syringe transfer device so in your syringe transfer device uh we transfer your blood okay so that uh we could prevent the hemolysis of your blood of course aside from your ETS we also have your evacuated tube system your ETS which is the most common and the most efficient system and is the preferred um collection tube uh collection system by the CLSI for um collection collecting your blood so it is a closed system preventing exposure um to air contaminants um and to air and other contaminants in the environment okay again this is the most common and these are the different parts or the different components of your evacuated tube system so you have your multi sample needle so it is a two-way needle okay you have your tube holder or your adapter and of course you have your evacuated tube evacuated tube that has different colors and those different color signifies different uses or different additives within them okay so those are your evacuated tube system so please take note of them so again these are the components your multi sample needle okay that will allow you to collect multiple tube of um multiple tubes of blood unlike your your syringe that is a single vene puncture so if you use your syringe 5 ml you will only be collecting at most 7 ml but if you use your ETS like for example last time I collected blood from a patient I collected 12 uh test tubes from a patient okay so that's very important for you to remember okay so for your evacuated tube remember that there's a vacuum present already negative pressure that's why upon inserting your evacuated tube the blood will already be flushing into the tube okay or will be collected into your tube okay so that is it for your ETS so aside from that we also have your wing infusion set or your butterfly so it is an indispensable tool for collecting blood for small difficult vene such as hand vene if you're using your dorsal plexus um veins of your elderly patients pediatric patients and most specifically also helpful if your patients are um cancer patient because they're they we will really have a hard time or difficult time collecting blood from them okay so aside from that of course um please do remember that the the needle of your wing infusion set or your butterfly is usually one half or three fourth inch okay and it's connected to a five to twelve inches long tubing so this one um you have your your needle okay your needle around one half to three fourths inch and then you have a five to twelve inches long na tubing okay five to um twelve inches long na tubing and here you can insert either your um you can insert here your syringe or sometimes you can simply insert here your adapter and then you can collect through your evacuated tube system okay again remember that when you're using your butterfly or your wing infusion set you need to have a discard too why because um the first few drops of blood or the first few ml of blood are contaminated with air because um it needs to fill in the tubings first okay so aside from that other devices for your blood collection specifically for your skin puncture um and for your skin puncture are your landscapes so of course you already know this you have your your capillary tubes your red capillary tubes contains your heparin okay your your your heparin your blue uh your blue hematocrit tubes does not have your anticoagilan okay wala sya anticoagilan of course ayan these are your um um micro hematocrit tubes remember that they hold around 50 to 70 micro liter of blood so this is your hematocrit tube which will be discussed further in hematology so we're just discussing and reviewing it briefly here in clinkem and finally you also have here your um bullets or your micro collection tubes again for the order of draw for your micro collection tube the first tube should be collected for your capillary blood gas again i want you guys to be particular when it comes to this because um there's arterial blood gas and there's also capillary blood gas and then followed by edta and then other tubes with additives and then your non additive tube will be the last one okay so that is for your micro collection tube but now what about your um what about your evacuated tube of course we also have okay also have your uh we also have your evacuated tube system okay we also have your evacuated tube system and we also uh will be using okay we will also be using your we will also be using your we'll also be using your order of draw for your evacuated tube system and for everybody I want yun na, na by this time, I want everybody to review and memorize this table, okay? So the different color, stopper color, the different stopper colors, the different anti-coagulant and additives that they contain, the different type of specimen and their use and of course the mechanism of action. When you say mechanism of action, the action of the anti-coagulant or the additive found on your tube, okay? So for the order of draw, okay? For the order of draw, okay? Again, I'll give you five seconds, five, four, three, two, one to screenshot this. You can also find this at table three dash four of your Henry's. So please again, this is one table that you need to memorize, that you really need to take into heart from this day on, okay? From this day on. So please take note of that and finally this is the order of draw for your, this is the order of draw for your, for your samples or for your evacuated tube, for your evacuated tube. So the first one is of course your yellow. Again, when it comes to order of draw, we refer to them by color rather than by additive. Why? Because yung na, when we say color, we go by the color of the stopper or the colored top tube, okay? So have your yellow, your light blue followed by your serum tubes. Your serum tubes can be your gold top tube or your speckled red or your tiger red, your red top, either red plastic or red glass and you also have your orange top tube and then you have your light blue, okay? Your light blue, your light green and then your green top tube that contains your heparin, your lavender or your purple that contains your EDTA, your white that contains your K2 EDTA with gel separator and of course your gray top tube that contains your fluoride. And then just for the information of everybody, the black top tube should be collected after your gray top, okay? Your black top tube is to be collected after your gray top. So this is the order of draw and then the other tubes will be collected after your gray top na. Again, after your gray top. Example of that yung, take for example, your black, so after sila. They are being used after your gray top. Again, please remember the inversion. So again, like what I mentioned, the magic number is eight except for your gold top. You need to mix them for five times, your red plastic five times and then your light blue top, okay? That contains your sodium citrate. You need to mix them for three to four times. So again, why is there an order of draw in the laboratory? Why do we need to perform and why do we need to follow the order of draw? Simple, ladies and gentlemen, because your order of draw, okay? Because your order of draw now refers to the order in which tubes are to be collected during your multiple tube draw or are filled from a syringe. So your CLSI recommend the order of draw following this order, okay? So you perform your sterile tube first and then your blue top and then your serong tube and then your heparin tubes and then your EDTA tube and then your glycolytic inhibitor tubes. Again, please refer to them according to color. And now the ultimate purpose of this is to prevent first the carryover or cross-contamination of anticoagulants and at the same time to cross contaminants of blood then from one tissue from the other. At hand from that is this also to prevent tissue, trombo-plastin contamination and also to prevent microbial contamination, okay? To prevent microbial contamination in our patients, okay? So please remember this is the purpose, the sole purpose of your order of draw. Hindi dito dahil trip ko lang parang mas mag- parang it is of better colors, Kim or whatsoever, no? It is because we are preventing cross-contamination or carryover. There is what we call your anticoagulant reflux, okay? What do you mean by anticoagulant reflux? Sometimes the anticoagulant within your tube enters your blood vessel. So we also need to prevent that from happening because if that happened you will be contaminating the succeeding tubes that you will be collecting, okay? That you will be collecting. So that is the order of draw. Again, please remember it's very important for you guys to take note and to, I really want you not to memorize this because this will get you very, very far, okay? So if there's one thing that I want you guys to take from Glen Kim, okay? As I, of course, from all the other topics that we discussed. When asked of the different anticoagulants, you know now what are those. So I also want you guys to remember which one will give you your plasma and which one will yield you your serum because a lot of you are still confused with that, okay? So remember, if your test tube contains anticoagulant, you will get your full blood and if you centrifuge that, you'll get your plasma. If it does not have your anticoagulant, then if you centrifuge that, you'll get your serum. Again, ladies and gentlemen, I want you guys to remember that inside your test tube, it's not always anticoagulant, okay? para sa mga Filipino students namin. Ang test tubes mo hindi pala, again, anticoagulant ang laman. That's why we call them additives because there are different additives within your test tube, okay? It can be your tixotropic gel, it can be your SPS, it can be your anticoagulant, your antiglycolytic agent, or it can even be your clot activator. So hindi lahat ng laman ng test tube, not all component of your test tube are anticoagulant. Some of them are clot activators or some of them perform different purposes that are vital in our collection. So with that being said, we'll be discussing the different tubes briefly. So I'll be discussing them and highlighting some of the things that I need you guys to remember. So let's start off with your yellow SPS. I call it yellow SPS because there is another yellow top tube which will be discussed in the special tube that contains your acid citrate dextrose. So your yellow SPS contains your sodium polyanethylsulfonate and I want you guys to be specific because if you only answer sodium polyanethylsulfonate, that's wrong because the correct answer is the 0.025% of your sodium polyanethylsulfonate. Again, we are using your 0.025% sodium polyanethylsulfonate in the laboratory. So what is the purpose of your 0.025 sodium polyanethylsulfonate in the laboratory? So it aids in the bacterial recovery by inhibiting your complement. It inhibits your complement, it inhibits your phagocyte and it can also inhibit certain antibiotics. So your yellow SPS are usually for your microbiological test or your microbiological culture in the obviously in the bacteriology section. So please do remember that your sodium polyanethylsulfonate is also, A is also an anticoagulant. So your SPS, the action of your SPS is by inhibiting rather by chelating. They are able to inhibit your complement, your phagocyte and other antibiotics in the laboratory. And more specifically, it is able or capable of inhibiting your complement and at the same time, preventing coagulation by chelating your calcium. Again, here, your yellow, it inhibits your complement, it inhibits your phagocyte by binding to your calcium. That is your 0.025% sodium polyanethylsulfonate. Again, yellow SPS for bacteriology and it should be stare it. Second, after your yellow SPS, we collect now your light blue top. Your light blue top can either contain your 0.105 molar or 0.129 molar of your sodium citrate. We have two formulation for your sodium citrate. It can be your 3.2% or 3.8% sodium citrate. Remember that your light blue top is best for coagulation test specifically your protrombin time and your activated partial thromboclastin time. That is what you mean by PT. Protrombin time with international normalized ratio. That important for now. But again, remember, your PT and PTT is what we call collectively as your coagulation test. What are coagulation test? We are determining if your body has enough coagulation factor that will aid or will help in the formation of clot or in the formation of your fibrin. So your PT is your protrombin time. Your PTT is your activated partial thromboclastin time. So remember when it comes to your light blue top, it preserves your labile coagulation factor. So there are coagulation factors. These are proteins as well. So there are a list of coagulation factor but do not worry that will be part of your hematology to next semester. So again, when it comes to your light blue top, it contains your sodium citrate. And it is very important for you to remember the blood to anticoagulant ratio which is 9 is to 1. 9 is to 1. Again, the correct blood to anticoagulant ratio is 9 is to 1. 9 is to 1. Blood to anticoagulant. Please take note of that. Because most of the students when we switch that, what is the anticoagulant to blood ratio? They will still answer 9 is to 1. But the correct answer now will be 1 is to 9. So remember that when it comes to your light blue top, this one is very sensitive when it comes to volume. So you have a triangle here. So the ideal one will be in the middle of the triangle that is the correct volume, the correct fill volume for your light blue top. The upper part of the triangle that will be the maximum will still be accepted in the laboratory. And then the lower part of the triangle, okay, the lower point of the triangle that is the minimum. So if you reach the minimum, we can accept the specimen. If you reach the maximum, we can reach the specimen. If it exceeds the maximum or it was short, or it was short, or you had a short draw, okay, the collected blood was short, okay, below the minimum that will be rejected, okay. Underfilled, overfilled light blue top will be rejected. Again, underfilled and overfilled light blue top will be rejected. Again, because we are maintaining and we are making sure that the blood to anticoagulatration should be 9S21, okay. 9S21. So aside from your light blue top, let's go now to your serum tubes. Okay, so when we call, when we say serum tubes collectively, these are group of tubes that when centrifuge, when you centrifuge the specimen, you will get your serum. And generally we can divide your serum tubes into two. We have your serum separator tubes and we have your simple serum tubes. When we say serum separator tubes, these are the one that contains your tixotropic gel, okay. Again, these are the one that contains your tixotropic gel. Ladies and gentlemen, I will not be accepting answers like inert gel because you need to be specific. These are tixotropic gel, okay. So your red gray top tube is an example. These are tiger or speckled red top tube, okay. Red top tube, when you say speckled, there are speckled of gray or black colors on their stopper. So these are usually being used for clinical chemistry, okay. You will get your serum, okay. Out of it. So you need to mix it for five times, okay. Five inversion. So again, your red gray top tube, does contain your tixotropic gel clotting time within 15 to 30 minutes, okay. So aside from your gray top, your red gray top tube, red and gray top tube or your tiger red tubes, of course you have your gold top tube. Your gold top tube is the most commonly used in the laboratory. Although in the Philippine setting, you will still see a lot of red top tube. Remember that your gold top tube, it does contain your tixotropic gel. Okay, your tixotropic gel and it is being used for clinical chemistry section. Again, please take note of the table that I have given you in Henry's. You need to memorize and familiarize yourself with that. Now, aside from your gold top tube, okay. Your gold top tube and your red gray or your speckled red or tiger red tube, those are your serum separator tube. Why do we call them serum separator tube because they do have a barrier, a physical barrier that will separate your serum from the cellular component of your blood and that is through the help of your tixotropic gel, okay. That is through the help of your tixotropic gel. Please do remember that there are certain tests in the clinical chemistry section that discourages the use of your serum separator tube because some of the analytes, some of your, for example, therapeutic drugs and some of your trace elements of metal, they tend to adhere on the gel. That's why we do not use your serum separator tube. So if we cannot use your serum separator tube, then that's the time that we can use your serum tubes, okay. Your serum tubes. Your red top tube, your plastic contains your silica particle. You need to invert it for five times. It is usually being used in chemistry, immunology and blood backing. Highlight on immunology. Similarly in clinical chem, it's specifically in trace element, therapeutic drug, heavy metals. We do not use your serum separator tube because of the gel. In immunology, we also discourage the use of your gold top or any tube that contains your gel. Why? Because your antibodies, okay, your antibodies tend also to adhere to your gel. So if your antibody adhere to your gel, you will not be able to measure them in the laboratory that will lead to a falsely reactive, falsely non-reactive or a false negative result. As for your serum tube, your red top tube, again, it contains your silica particle. Aside from your silica particle, it can also have your glass particle or your coaline or your cellite. So those are the other components of your plastic. You need to invert them for five times. So the reason we converted to your plastic tubes because glass tubes are somehow hazards in the laboratory. But again, there are times that we cannot go away. Go away apart from your your red, your glass test tubes. Again, because glass test tubes are nonporous, okay, meaning to say they can preserve the anticoagulant within them. Unlike in your plastic tubes, okay? So aside from your red top tubes, read your red plastic. We also have your red glass. It doesn't have any additive. So it does not have any gel and your no clot activator. So it doesn't need any inversion. Again, when you centrifuge your sample, your blood that are collected through your red top glass, you'll be having your serum. Okay. So the usual coagulation time or clotting time, rather, for your red top tubes, your red glass, okay, is 30 minutes to 60 minutes or one hour. Okay. So aside from your red, your red glass, you also have your orange top tubes. Your orange top tube contains your thrombin. Okay. It contains your thrombin. The clotting time is usually five minutes and it is being used for clinical chemistry and other stat samples. So before, as you heard me mention kanina, in stat samples for clinical chem, we usually use your plasma, specifically the one that are collected in your green top tube. But now we can use your orange top tube because it contains your thrombin. Your thrombin will readily convert your fibrin agent to fibrin. It will clot within five minutes only. Okay. But of course, there are certain limitation when it comes to your orange top tube. Specifically if your patient has thrombocytosis or increased platelets, it is still best to you. It is best to use your green top tube in case of stat electrolytes. Okay. Specifically for your electrolytes. So aside from orange top tube, of course we have your light green. Your light green contains either your lithium heparine or your sodium heparine. But this one, light green denotes the presence of your gel. So these are plasma separator tubes. Bakit plasma separator tube? Because it doesn't simply separate your plasma from the pack red cell, but it uses a physical barrier in the form of your tixotropic gel. So your light green contains your sodium or your lithium heparine together with a gel separator. In this case, your tixotropic gel as well. So this is also being used for chemistry section. And for your plasma, for your plasma tube, let's start off with your green top tubes. Okay. Your green top it only contains your lithium or your sodium heparine without, that is without gel. Okay. So please correct that without gel. Okay. Without gel. Also used for chemistry. Now, aside from your, aside from that, remember that your lithium heparine and your sodium heparine are your anticoagulant. Anticoagulant in your light green and your green top tube and their action is to inhibit your thrombine. They inhibit your thrombine. So please remember that because for most of your anticoagulant, most of their action is by preventing your or by reacting or acting by binding to your calcium. Your green top is the only one that your green top is the only one that contains your heparine and it is the only one that inhibits your thrombine. Now, aside from that, of course, we have your plasma tubes, your lavender top or your purple top that contains your ethylene diamine tetraacetic acid or your EDTA. There are two formulation of your EDTA, your dipotashong and your tripotashong EDTA and it is being used in hematological, most hematological processes or procedures but in clinical chem, we are using it in measuring your glycated hemoglobin or your HBA1C and I think that I need you guys to remember when it comes to your lavender top is that the most common formulation that is being used in the laboratory is your K2 or your dipotashong EDTA. In our quizzes, abbreviation will not be accepted. So please remember ethylene diamine tetraacetic acid without spaces in between except for acid. So aside from your lavender, again the last tube to be collected will be now your great top tube that would contain two components. There are two additives that are found in your great top tube your sodium fluoride and your potashong oxalate. Your sodium fluoride is an anti-coagulant. Rather, your sodium fluoride is your anti-glycolytic agent that prevents the that prevents your glycolysis and then you also have your potashong oxalate which is your anti-coagulant. So in clinical chemistry we can use your great top tube in the collection of sample for glucose, lactate and also alcohol or your ethanol. So remember that when it comes to your sodium fluoride it inhibits your it inhibits or it binds directly to your magnesium okay? Bind to your magnesium inhibiting your enzymes okay? That will inhibiting your enzymes that are essential in your glycolysis. So we prevent the degradation of your your glucose by your red blood cells. Okay? By your red blood cell. So kunare you'll be traveling the blood you don't have your centrifuge yet. So your great top tube is a best alternative to that. If you don't have your gel separator. Okay? So because it will be preventing your glycolysis. Other special tubes okay? So those are the routine tubes that you can see in the laboratory. Okay? So you have your yellow okay? Your yellow SPS your light blue your serum tube your plasma tube your green your purple and then also your great top. There are also other special tubes that I want to discuss briefly. So the first special tube your pink top tube is it actually contains your K2 EDTA your K2 EDTA is a sprayed dried EDTA okay? Sprayed dried EDTA and it is usually used for blood banking and molecular diagnostic pink top tube pink top tube. So sir it does contain K2 EDTA so what is the difference between my pink top and my lavender? Your pink top tube contains a special labeling okay? Special labeling special label that is allotted for your blood bank so that is for your pink top again for blood banking and molecular diagnostic it contains your sprayed dried K2 EDTA I guess I was not able to mention no? Your K2 EDTA can be of two form your K2 EDTA is sprayed dried your K3 EDTA is in liquid form okay? in liquid form so aside from that I was able to mention this na kanina we have your white top tube your white top tube contains your EDTA and your gel usually for molecular testing white blood white top tube for molecular diagnostic and next we also have your royal blue top your royal blue top can be of two form actually it can contain K2 EDTA or sodium heparin and in some royal blue color top they also contain silica particle so when you're using your royal blue you can actually collect serum if it contains your silica particle if it contains your K2 EDTA or sodium heparin it you will be able to collect your plasma okay? so these are usually for toxicology for your trace element and your heavy metas so please do remember that your royal blue top even though there are some there are other tube that already contain your K2 EDTA and your sodium heparin your royal blue denote that it is for toxicology now finally last three tubes we have now your yellow top tube this one contains your acid citrate dextrose okay? your acid citrate dextrose is for your your yellow top tube is for your blood banking but most specifically this is for your HLA phenotyping or paternity testing so DNA testing HLA phenotyping these are these are also molecular techniques but not PCR okay? HLA phenotyping and paternity testing what are we going to use your yellow top tube but not the yellow top tube that contains 0.025% sodium polyanethol sulfonate but the one that contains your ice acid citrate dextrose or known as your ACD okay? that is your yellow top tube I will not be discussing your acid citrate dextrose as an anticoagilan for blood bank muna because that is different okay? here the purpose of your again, I want to be clear the purpose of your acid citrate dextrose in a test tube is to preserve your WBC okay? more importantly to preserve your WBC that will be used for HLA phenotyping and paternity testing I need to specify ACD in the test tube because there is an ACD your acid citrate dextrose that can be found in your blood bags okay? and they have a different purpose okay? so that is for your yellow top tube now we also have your what? we also have your tantop tubes okay? your tantop tubes okay? if it is a glass tantop tube the anticoagilan or the additive is heparin if it is a plastic tantop tube it contains your K2 EDTA K2 EDTA is again a spray-dried type of EDTA so your tantop tubes are usually used for lead testing or lead determination so unlike your royal blue your royal blue that is for your trace element which actually lead belongs to but we are not using the royal blue for lead instead we are using your tantop tube that is to denote that this particular sample collected in your tantop tube is exclusively for lead testing okay? for lead testing now finally last tube for today your block top tube your block top tube contains your buffered citrate dextrose buffered citrate dextrose that is that is already a in another world okay? your block top tubes contain your buffered sodium citrate rather your buffered sodium citrate is used for Westergren ESR I need to be specific it is only for Westergren ESR okay? Westergren ESR we use your block top tube and unlike the other citrate your light blue top which has a blood to anticoagulant ratio of nine is to one the blood to anticoagulant ratio for block top tube is four is to one four parts blood one part anticoagulant that is for your block top tube again blood to anticoagulant ratio is four is to one and this is exclusively for your Westergren ESR ESR which means your erythrocyte sedimentation rate okay? much of your ESR this week in your hematology laboratory but please remember for your block top tube we are using that for your Westergren ESR with a blood to anticoagulant ratio of four is to one with that that ends now our discussion for today so thank you so much for listening okay? thank you so much for listening so if you have any questions or clarification feel free to send me a message by the end of this meeting so thank you so much for listening and please do prepare for your quiz next meeting for your specimen collection and also patient preparation so with that thank you so much for listening have a nice and great day ahead of you a great week ahead of you thank you so much for listening and I'll see you on our next class bye