PATIENT PREPARATION
EXERCISE |
- increased in lactate, fatty acid, ammonia, ALT, AST, CPK, LD
- increased in growth hormone, prolactin, testosterone, leutenizing hormone.
- elevated levels of proteins in urine (proteinuria)
- vigorous hand exercise (fist clenching) increases potassium, lactate and phosphate. |
FASTING |
- 8-16 hrs is required for glucose, lipids and LPP.
- Serum bilirubin may increase after 48 hrs of fasting
- Plasma triglyceride increases after 72 hrs of fasting
Basal state collection — glucose, cholesterol, triglyceride and electrolytes. |
DIET |
- metabolic products of food can increase in venous blood (High CHON diet — increases urea)
- Serotonin = will increase the urinary excretion of 5-hydroxyindole acetic acid
- Caffeine = increases the concentration of glucose, releases catecholamines from adrenal medulla and brain tissue.
- Increases turbidity or lactescence = triglyceride levels exceed 400 mg/dL
-Contributes to degree of ictericia (bilirubin) — 25.2 mg/L
-Icteric samples interfere with albumin, cholesterol, glucose and total protein tests. |
POSTURE |
- patient should be seated/supine for at least 20 min before blood collection to prevent hemodilution or hemoconcentration.
- changing from supine to sitting or standing position causes constriction of blood vessels and reduction of plasma volume — inc levels of albumin, enzymes and calcium.
- changing from sitting to supine causes shifting of water and electrolytes into tissue causing hemoconcentration — inc levels of proteins, lipids, BUN, iron and calcium.
- changing from standing to supine causes extravascular water to transfer to the vascular system and dilutes nondiffusable plasma constituents — decreased levels of cholesterol triglycerides and LPP. |
TOURNIQUET APPLICATION |
- 1 minute application is recommended
- prolonged tourniquet application results to:
hemoconcentration (venous stasis)
anaerobiosis
- the pressure from the tourniquet causes biological analytes to leak from the tissue cells into the blood.
Increased levels: proteins, enzymes, lactate, cholesterol, potassium and ammonia |
TOBACCO SMOKING |
- inc in plasma non-esterified fatty acid (NEFA) concentration.
- inc in plasma catecholamines and serum cortisol
- inc in glucose, growth hormone, cholesterol, triglyceride and urea. |
ALCOHOL INGESTION |
- inc plasma concentration of urate and triglyceride
- inc GCT concentration
- it causes hypoglycemia (chronic alcoholism) |
STRESS (anxiety) |
- affects adrenal hormone secretion
- also associated with inc levels of albumin, glucose, insulin, lactate and cholesterol |
DRUGS |
- TDM specimen collection should be schedule according to the last time of the last dose.
- medications affecting plasma volume can affect protein, BUN, iron and calcium concentrations.
- hepatotoxic drugs can elevate liver function enzymes
- diuretics can decrease plasma sodium and potassium levels. |
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