PMLS2 - CASE STUDIES

2 Semester, S.Y. 2019-2020

nd

INSTRUCTIONS:
1. Based on your readings, answer the following case studies.
2. In answering, do not copy the case studies anymore. Just copy the questions
provided after each case study.
3. Answers must be hand-written.
4. Use short bondpaper.
5. Margins must be 1-inch for left side and 0.5 inch for all sides.

CASE STUDY NO. 01:

Jenny works with several other phlebotomists in a busy outpatient lab. This day
has been particularly hectic, with many patients filling the waiting room. Jenny is
working as fast as she can. Toward the end of the day, after Jenny has finished
drawing blood from what seems like the millionth patient, she mentions to a coworker
how extra busy it has been. The coworker says, “Yes it has, but it looks like there is
only one patient left.” Jenny grabs the paperwork and heads for the door of the waiting
room. As her coworker has said, there is only one patient, an elderly woman, sitting
there reading a book. The paperwork is for a patient named Jane Rogers. “You must be
Jane,” she says, glancing at the name on the paperwork. The patient looks up and
smiles. “Have you been waiting long?” Jenny asks. The patient replies, “Not really,” and
Jenny escorts her to a drawing chair. The patient is a difficult draw, and Jenny makes
two attempts to collect the specimen. The second one is successful. Jenny places the
labels on the tubes, dates and initials them, bandages the patient, and sends her on her
way. About 5 minutes later a somewhat younger woman appears at the reception
window and says, “My name is Jane Rogers. I just stepped outside to make a phone
call and was wondering if you called my name while I was gone.” The receptionist
notices that the patient’s name is checked off the registration log. The receptionist
turns around and asks if anyone had called a patient named Jane Rogers. “I already
drew her,” Jenny says as she walks over to the receptionist window. The woman at the
window is not the one Jenny just drew; however, her information matches information
on the requisition used to draw that patient.
QUESTIONS:
1. What error did Jenny make in identifying the patient?
2. What assumptions did Jenny make that contributed to her drawing blood from the
wrong patient?
3. Who might the other patient from whom Jenny mistakenly drew blood have been?
4. How can the error be corrected?
CASE STUDY NO 02:
Two phlebotomists went to a pediatric ward to collect a blood specimen from a
young boy they had drawn many times before. The child told them to go away and that
he was not supposed to have any more blood tests. The boy’s parents were not
present, but in the past they had always given permission for blood draws over the
child’s objections. The phlebotomists ignored the child, and one of them collected the
specimen while the other restrained him. It was later determined that the boy’s parents
had earlier fi led a written request that the child was to have no more blood drawn.

QUESTIONS:
1. What error did the phlebotomists make in drawing blood from the child?
2. What assumptions were made in deciding to draw blood from the child over his
objections?
3. What might be the consequences of the phlebotomists’ actions?

CASE STUDY NO. 03:

Jake, a phlebotomist, is sent to the ER to collect an EDTA specimen for a stat
type and crossmatch on an accident victim. He properly identifies the patient and is in
the process of filling the lavender-top tube when an ER nurse tells him that the patient’s
physician wants to add a stat set of electrolytes to the test order. Jake acknowledges
her request. He finishes filling the lavender top and grabs a green top. After completing
the draw, he takes the specimens straight to the laboratory to be processed
immediately.

QUESTIONS
1. One of the specimens that Jake drew is compromised. Which one is it?
2. Why is the specimen compromised and how may test results be affected?
3. How could Jake have avoided the problem without drawing blood from the patient
twice?

CASE STUDY NO. 04:

Charles is a phlebotomist who works in a physician’s office laboratory. One
morning shortly after the drawing station opens he is asked to collect blood specimens
for a CBC and a glucose test from a very heavy set woman who appears quite ill. The
patient tells Charles that she vomited all night and was unable to eat or drink anything.
She also mentions that she has had a mastectomy on the left side and the last time she
had blood collected she was stuck numerous times before the phlebotomist was able to
collect the specimen.

QUESTIONS:

1. What physiological variables may be associated with the collection of this specimen
and how should they be dealt with?
2. What complications might Charles expect and how should he prepare for them?
3. How should Charles go about selecting the blood collection site?
4. What options does Charles have if he is unable to select a proper venipuncture site?

CASE STUDY NO. 05:

A phlebotomist is sent to collect a CBC specimen on a 5-year-old pediatric
patient. The patient has an IV in the left forearm. The right arm has no palpable veins
so the phlebotomist decides to perform capillary puncture on the middle finger of the
right hand. This is the phlebotomist’s first job and, although he is quite good at routine
venipuncture, he has not performed very many capillary punctures. The child is
uncooperative and the mother tries to help steady the child’s hand during the
procedure. The phlebotomist is able to puncture the site, but the child pulls the hand
away. Blood runs down the finger. The phlebotomist grabs the child’s finger and tries to
fill the collection device with the blood as it runs down the finger. The child continues to
try to wriggle the finger free. The phlebotomist finally fills the container to the minimum
level. When the specimen is tested, the platelet count is abnormally low. A slide is made
and platelet clumping is observed. A new specimen is requested. Hemolysis is later
observed in the specimen.

QUESTIONS:
1. How might the circumstances of collection have contributed to the platelet clumping
in the specimen?
2. What most likely caused the hemolysis?
3. What factors may have contributed to the specimen collection difficulties?
 PMLS2 - LABORATORY ACTIVITIES
2nd Semester, S.Y. 2019-2020

INSTRUCTIONS:
1. Answers must be hand-written.
2. Use short bondpaper.
3. Margins must be 1-inch for left side and 0.5 inch for all sides.

LABORATORY ACTIVITY NO. 03: PHLEBOTOMY-RELATED VASCULAR ANATOMY

A. Illustrate and label the 2 basic patterns of the antecubital fossa veins
B. Illustrate and identify the different types of blood specimens
C. Discuss the difference of veins, arteries, and capillaries

LABORATORY ACTIVITY NO. 04: VENIPUNCTURE PROCEDURES

A. Illustrate and label the following:
1. Assembled Syringe System
2. Assembled Evacuated Tube System
3. Assembled Butterfly Set System
B. Tabulate the different color-coded evacuated tubes, the additive/s present, and
their uses
C. Define and discuss the significance of the following terms in performing
venipuncture:
1. Antiseptics
2. Needle gauges
3. Tube additives
4. Order of draw
5. Additive carry over

LABORATORY ACTIVITY NO. 05: PRE-ANALYTICAL CONSIDERATIONS IN

PHLEBOTOMY

A. Identify laboratory tests associated with the following conditions. Discuss the
effects of these conditions on the laboratory test results:
1. Dehydration
2. Hemolysis
 3. Tobacco smoking
4. Prolonged tourniquet application
5. Emotional stress
6. Mild to moderate exercise
7. Chronic consumption of alcohol
8. Increased ingestion of carbohydrates
B. Identify the different procedural error risks and discuss ways of how to reduce
the occurrence of risks
C. Define the following specimen quality concerns:
1. Hemoconcentration
2. Hemolysis
3. Partially-filled tubes
4. Specimen contamination
5. Wrong or expired collection tubes

LABORATORY ACTIVITY NO. 06: CAPILLARY PUNCTURE

A. List the indications for performing capillary puncture
B. Identify and discuss the rationale of the order of draw for collecting capillary
specimens
C. Illustrate the different puncture sites
D. Explain the importance of the following in obtaining capillary specimens:
1. puncturing perpendicular to the grooves of the fingerprints
2. warming the puncture site
3. wiping the first drop of blood