How Much Blood Does A Microtainer Hold

[Saurabh Cloudas]

Anyhospital can practice bloodless medicine, as this area of medicine does not always need to involve advanced techniques, expensive equipment, or esoteric methods of patient care. In many cases, optimization of bloodless medicine patient care can be managed with a careful review of current medical practices. Laboratory testing is a great example of this: we order labs on most hospitalized adult patients each day as a routine, but this practice has been associated with increased needs for transfusion in some patient populations.1 Hospital-acquired anemia, which can occur as a consequence of daily routine blood draws, is associated with increases in-hospital mortality and resource utilization.2 In the bloodless medicine subset of patients, daily phlebotomy may cause excessive and unnecessary blood loss which may be harmful.

It is important to remember that the bloodless medicine patient can remain alive without receiving blood. Although it may seem impossible to many of us, patients do survive without receiving blood transfusions for acute blood loss anemia with hemoglobin concentrations as low as 3-4 mg/dL. We learn early in our training that acutely anemic patients should receive blood transfusions, but we do not learn how to manage patients who cannot receive such transfusions.

When blood transfusion is unable to be performed on a patient due to medical or religious reasons, members of the medical team may react with frustration or anger. In some cases, the focus on the perceived need for transfusion may distract the medical team from ordering other consultations or procedures that could be performed to control active bleeding. There are many simple interventions that can be implemented as soon as the patient arrives at the hospital, to reduce the indications for blood transfusion and optimize care of the bloodless medicine patient.

We suggest that Emergency Departments consider implementation of both focused phlebotomy techniques and use of pediatric microtainer tubes or point-of-care testing, in the bloodless medicine population.

Along with the volume of blood drawn, the frequency of blood draw attempts can also contribute to iatrogenic acute blood loss. Computerized entry sets for laboratory orders often default to a daily frequency for blood draws, but daily labs are not often needed in every patient. For the bloodless medicine population, a simple change in the frequency of blood draws from every day to every other day can result in a reduction in blood loss that can be potentially life-saving. We must think about why we are ordering labs, and not just what we are ordering. For many bloodless medicine patients, especially those who are admitted due to complications of acute anemia, checking a daily complete blood count will not change the treatment plan since transfusion is not an option. Thus, it is completely reasonable to check labs every 2-3 days, or even less frequently, in this patient population.

For a patient, the description of noncompliance may, in turn, lead to impairments in the relationship between the patient and the other members of the medical team, further breakdowns in communication, and marginalization of the patient and his/her needs.

If a physician, for whatever reason, is not able to care for a patient without the use of blood transfusion, the patient should be referred or transferred immediately to a physician or hospital willing and able to provide appropriate care. Failure to act promptly may result in harm to the patient.

We know that severely anemic patients can survive without receiving blood transfusions; simple recognition and acceptance of this fact allows us, as treating physicians, to consider other currently available options to minimize blood loss and augment erythropoiesis. Basic interventions, such as limiting unnecessary blood draws and understanding which laboratory assays are most relevant for a particular patient population, can greatly enhance our ability to care for those for whom blood transfusion is not an option.

These same techniques can also be applied to our daily medical practice for all patients, and can result in reductions in hospital-acquired anemia, avoidance of transfusion-related complications, and optimized outcomes for all of our patients.

Depending on how many hormones and biomarkers are being tested, your kit will include one, two or three sample collection microtainers. Each microtainer holds 10 to 15 drops of blood. With a simple finger prick using the lancet provided, you can get this small amount of blood into the microtainer.

Once you collect the sample, send it to the lab in the pre-paid envelope provided. Results for hormonal tests will be within your email usually in 48 hours. More complex tests, like chromosomal tests can take up to 21 days.

Yes, we work with many clinics to provide testing and assessment for their patients. You will have access to your results in the Enhanced Fertility app and also be able to download a PDF that you can share with your doctor.

Yes, the fertility test kit is UKCA and CE marked and our labs partner participates in National External Quality Assessment Schemes. These schemes are subscribed to by NHS and private laboratories and results are subjected to strict internal and external quality control. This means your results are as reliable as a standard blood test at a clinic.

Newborn: Obtain a minimum of 3.0 mL of newborn whole blood via venipuncture into a lavender top vacutainer (EDTA) tube. A microtainer tube does not hold a sufficient amount of blood. Cord blood and heel stick specimens cannot be used and are NOT approved for testing.

Blood for hematologic testing must be collected into an anticoagulant, preferably EDTA (purple top tube). Blood smears should be made at the time of collection to minimize storage-associated changes, which invariably occur. Venipuncture should be minimally traumatic to minimize platelet activation and should be done using a minimum of a 23G needle (21-22G is ideal for small animals and 18-20G is ideal for large animals) and 3-5 mL syringe (depending on the desired volume). Vacutainers can be used for sample collection, as can short butterfly catheters. For very small or pediatric patients, samples can be placed into microtainer tubes. Regardless of the tube used for sample collection, the blood must be adequately mixed with the anticoagulant during and after collection to prevent clotting. This is done by gentle inversion of the tube (tubes should never be shaken).

All samples should be kept cool (at refrigerated temperatures, but not frozen) during storage and shipping to minimize changes in cells that can occur with storage. The sample should be wrapped in paper towels to prevent direct contact of the tube with ice, which will result in freezing and lysis of red and white blood cells within the tube. Also, blood smears should be made from freshly collected blood and submitted along with the tubes to help facilitate blood smear examination and ensure provision of the most accurate results. The blood in the tube should be kept cold, however slides should be stored and shipped at room temperature. Both tubes and slides should be placed in break-proof containers for shipping.

Artifacts in blood samples for hematologic testing stem mainly from either sample collection, aging of sample, or poor maintenance of the staining solutions (stain precipitate and water artifact). See also a summary of some of these artifacts.

Artifacts of specimen handling and preparation can significantly impair examination of blood cells, but are easily avoided. If a delay in analysis is anticipated (e.g., lab closed or when sending a sample to a reference lab), smears should be made and sent along with the EDTA tube. Air-dried unfixed smears hold up very well unless subjected to flies or moisture.

In vitro aging of blood cells in the specimen tube causes changes in the appearance of the cells on stained blood films. Eventually, cells will break down altogether, rendering the specimen useless for analysis. Shown on the right is a smear from a sample which had been in EDTA for 48 hours at room temperature. Extreme crenation of the erythrocytes is evident, which could easily mask or render suspect significant pathologic shape abnormalities. The leukocyte nucleus has undergone pyknosis and karyorrhexis, making certain identification impossible.

48 hr old blood sample with extreme RBC crenationStain artifactsDiff-Quik, Hemacolor, and other commonly used quick stains for hematology and cytology can provide good staining quality if properly used and maintained:

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Specimens collected in tubes other than lavender microtainer (K2EDTA). Specimens transported in tubes other than trace element-free transport tubes or lavender microtainer (K2EDTA) tubes. Heparin anticoagulant. Clotted specimens.

Venous whole blood, refer to Lead, Blood (Venous) (ARUP test code 0020098).

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