Shobanjo Ibrahim Showunmi Felix Onayemi Oluwaseye Introduction Classification

Shobanjo Ibrahim Showunmi Felix Onayemi Oluwaseye

� Introduction � Classification � Types and international colour coding of laboratory bottles � Uses of laboratory bottles � Precautions while using laboratory bottles

�Classification of intravenous fluids �Composition of intravenous fluids �Indications for intravenous fluids �Contraindications for intravenous fluids �Conclusion

� Hematology Ethylene diamine tetra acetic bottle Plain bottles � Chemical pathology Lithium heparin bottle Fluoride oxalate bottle � Microbiology Sterile universal bottle � Histopathology Containers with fixatives

The following are various types of laboratory bottles and their functions; � FLOURIDE OXALATE BOTTLE � LITHIUM HEPARIN BOTTLE � EDTA [Ethylenediamine tetraacetic acid] BOTTLE � PLAIN SPECIMEN BOTTLE � STERILE UNIVERSAL BOTTLE

COLOUR- GREY Mechanism of action Flouride inhibit enolase enzyme in glycolytic pathway preventing red blood cell utilization and thus further depletion of glucose in the sample. Oxalate chelates calcium.

� To collect sample or specimen for sugar analysis example a]. Blood sample for fasting and random blood sugar estimation in conditions like diabetes mellitus , protein energy malnutrition, severe malaria, IDM, neonatal seizure, neonatal hypoglycaemia, post term and LGA neonates, childhood poisoning. b]. In meningitis for interpretation of csf sugar c]. suspected inborn errors of metabolism d]. serous fluid like pleural effusion, pericardial effusion, ascitic fluid.

� COLOUR- GREEN Mechanism of action Anticoagulant is lithium salt of heparin. Heparin acts by potentiating effect of antithrombin III that inhibits factors IX, X, XI and XII and protein C and S. Heparin is the best anticoagulant because it does not produce any change in composition of blood.

To collect sample for the following analysis; a]. Electrolyte analysis such as chloride, sodium b]. Urea and creatinine measurement c]. Total protein and albumin estimation d]. Uric acid measurement e]. Hormonal assays f]. Csf proteins and ions

COLOUR- PURPLE OR LAVENDER Mechanism of action Anticoagulant is sodium or potassium salt of EDTA chelates calcium making it unavailable to participate in coagulation reactions

For haematological investigations like; a]. Full blood count b]. Packed cell volume c]. Erythrocyte sedimentation rate d]. Blood film for malaria parasite e]. Reticulocyte count f]. peripheral blood smear g]. clotting profile h]. Hb electrophoresis(HB genotype)

COLOUR- WHITE Mechanism of action Contains no anticoagulant, serum obtained from blood in it after 2 -7 minutes

To collect blood sample for; a]. Blood grouping and cross matching b]. Coomb’s test c]. serum protein electrophoresis d]. Bilirubin (Total and conjugated bilirubin in neonatal jaundice) e]. Antibody assay(immunoglobin assay) f]. Enzymes assay example aspartate transaminase, alanine transaminase

COLOUR- RED Contains no anticoagulant

To collect sample for microbiological investigations; a]. Blood for veneral disease research laboratory test, filarial worms, flukes, hepatitis B surface antigen b]. Urine for microscopy culture and sensitivity (MCS) c]. Stool for MCS d]. CSF for MCS e]. Gastric washout for AAFB f]. Pus and vesicular fluid for MCS g]. Serous fluid example pleural aspirate, ascetic fluid etc for MCS.

� seek the consent of the patient or parent/guardian if patient is a minor � proper introduction of yourself to the patient � explain the procedure to the patient � identify the patient prior to sample collection � This is done by ascertaining the name , date of birth of patient, hospital number and test required. � do not collect any specimen unless two positive identifications can be made.

� note that all specimens are regarded as potentially hazardous and infectious hence strict universal precautions should be adhered to. � Make sure both hands are gloved properly � Make sure materials are ready before venepuncture in order to prevent blood spilling. � Patient should be assured and stabilized before venepuncture. However, if confronted with a noncompliant patient , he/she should be held still before the procedure

� Use the appropriate sized syringe depending on the volume of specimen needed � As soon as procedure is done place a swab on the site of puncture while pressure is applied, do not leave patient to bleed about. � Test requisition must include o Patient’s name o Hospital number o Hospital unit o Name and signature of authorized provider requesting the test o The test or procedure being ordered o Date and time of specimen collection o Diagnosis

� Always check out the colour of the bottle or name of additive[i. e anticoagulant] before use � The right or specific specimen should be taken � Fasting blood specimen for fasting blood sugar � Postprandial blood specimen for postprandial sugar � Early morning gastric washout for acid, alcohol fast bacillus[AAFB] � Avoid contamination of collected specimen � Specimen should be tighly sealed in a leak proof container.

� Crystalloids -0. 9% sodium chloride -Ringer’s lactate -Hypertonic saline 3% � Colloids -5% human serum albumin in 0. 9% Na. Cl -6% hydroxylethyl starch in 0. 9% Na. Cl -10% dextran 40 in 5% dextrosein water -fresh frozen plasma -Whole blood

�Ringer’s -Na+ -K+ -Ca+ -Cl- lactate : 150 mmol/l 4 mmol/l 3 mmol/l 109 mmol/l

�Half strength darrow solution -Na+ 61 mmol/l - K+ 18 mmol/l - Cl- 52 mmol/l - HCO 3 27 mmol/l

�Normal Na+ Cl� 4. 3% saline: 154 mmol/l dextrose in 0. 18%[1/5] saline Na+ 30 mmol/l Cl 50 mmol/l dextrose 286 mmol/l

NORMAL SALINE/0. 9% SALINE/ISOTONIC SALINE a]Fluid resuscitation in severe dehydration or shock (note that ringer’s lactate is the fluid of choice but not readily available). b]. Rehydration fluid in sickle cell vasoocclusive crisis c]. Initial fluid resuscitation in burns. d]. partial exchange transfusion. e]. Initial resuscitation in diabetic ketoacidosis f]. Administration of some intravenous drugs example

2 Types namely 1]. Half strength 2]. full strenght Note; Full strenght darrow’s is not used in paediatrics because of its light potassium content.

� Mainly for potassium replacement (Note that potassium chloride and potassium phosphate are preferred to darrow’s solution because potassium deficit is replaced faster) in conditions like; Diarrhea diseases, hypertrophic pyloric stenosis, drug induced hypokalaemia example thiazide and loop diuretics, paralytic ileus.

� Indications include a]. To increase glucose concentration of other fluids such as in preparation of D 10 and D 12. 5 in latter, 75 ml (instead of 50 ml in former )of 50% dextrose is added to a bag of 4. 3% dextrose from which equal volume of fluid has been withdrawn. b]. In the management of hyperkalaemia as glucose potassium insulin c]. Correction of hypoglycaemia (0. 4 ml/kg of solution)

�Certain fluids are contraindicated in some health conditions. These are; �Normal saline: contraindicated when there is metabolic acidosis because it can cause acidosis itself.

�These are mainly contraindications to potassium replacement. They include; �Severe dehydration or shock �Acute renal failure �Burns �Immediate post operative period �Severe crush injury[rhabdomyolysis]

� Patient on hyperkaemia inducing drugs � Potassium sparing diuretics e. g spirinolactone , amiloride � Angiostensin converting enzyme inhibitors e. g captopril , enalapril , lysinopril � Angiostensin receptor blockers e. g valsertan, candesertan � Beta blockers e. g propanolol, timolol , pindolol � Suxamethonium � Cytotoxic drugs e. g cyclophosphomide , � Patient who has hypoaldosteronism.

Patient at risk of increased intracranial pressure �Patient with acute neurological dysfunction. �Patient at risk of third space fluid shift �Elevated blood glucose. �

Contraindicated in; �Cases of metabolic alkalosis �Severe hypernatraemia

It is contraindicated in; �Severe Anaemia �Acute renal failure…. dextran 70 �Bleeding diathesis…. dextran 70, dextran 40. �Pulmonary edema �Congestive cardiac failure �Reactions to colloids

� en. wikipedia. com � Introduction to clinical laboratory techniques; Akinyinka A. Oyekola. 2011. � The Guide; MSSN UITH ILORIN. � Principles and practice of surgery in the tropics, 2 nd Ed. ; Badoe et al. �

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