Question

1. A phlebotomist receives a request to collect a specimen for a PT and D – dimer on a patient. The phlebotomist remembers drawing the patient in the ER when he was complaining of leg pain. Because the patient was a difficult draw, the phlebotomist wanted to draw from an ankle vein, but the physician would not give permission. The patient was subsequently diagnosed DVT.

When the phlebotomist received the next request on this patient, he still couldn't find a good vein in the AC area, but he noticed that the patient had a large vein on the underside of the wrist. Before he could collect from the wrist area, he was called to a stat in ER.

• Should the phlebotomist draw from the vein on the underside of the wrist? Why or why not? (3 points)

• If you are going to explain it to a non – medical person, how are you going to explain or describe DVT? (3 points)

• What is PT? What is a D – dimer test? Explain the significance of these tests with the diagnosis. (4 points)

• What body process is being evaluated by the requested tests? (3 points)  What type of specimen is required? Why? (2 points)

Answer 1

ANSWER: NO, Phlebotomist should not draw the blood from vein on the underside of wrist because:

• There will be possibility of cause injury to radial or ulnar nerve.
• hitting radial and ulnar nerve can cause paralysis of hand movement or impair hand functioning.
• it is no draw area, where drawing blood is not allowed. Phlebotomist can choose for basilic vein which is considered as last and final alternative.

ANSWER : DVT is deep vein thrombosis, which can be described or explained to nonmedical person as blood clot is accumulated or stick in blood vessels which cause impaired blood circulation. Usually, it occurs due to poor mobility, after surgery, or postpartum period. Sign and symptoms could be :

• leg pain
• swelling
• redness of calf area
• warmth feeling

It can be life-threatening when the clot dislogde and reaches to lungs and cause pulmonary embolism.

ANSWER : D -DIMER TEST

It has two dimer of fibrins that are joined by cross linking, it is used to determine the thrombosis in body, pulmonary embolism and DIC.

In this through puncturing the vessel blood is collected in tube and send for further investigations.If its value is high or positive D- dimer test this means you have DVT and need further investigations.

PT - PT/ INR is checked to know the status of warfarin therapy, warfin is anticoagulant which prevent the coagulation of blood in body. PT normal value is 11 - 13.5 seconds. It is mainly done to check if patient is on higher risk of bleeding or not. DVT needs anticoagulant therapy, before initiating therapy, PT is necessary to do.

ANSWER: PT:

Clotting process is being evaluated by PT test, it is test to check whether clotting is done properly or not, is there chances of uncontrolled bleeding.

BLOOD / PLATELET FREE PLASMA is required for this test. As blood contains clotting factors.

d - dimer test:

This test used to rule out the blood in vessels, D dimer is protein which is mainly present when there is blood clot, it makes when blood clot is break or dissolve. If its value is less than 0.50 then it is normal, if it is more then 0.50 than positive test.

PLATELET FREE PLASMA is collected for this specimen, in blue coloured vaccutainer. platelet free plasma rule out the number of d dimer in blood.