CHAPTER I DISCUSSION

A.

Venous Blood

Venous blood is deoxygenated blood which travels from the peripheral vessels, through the venous system into the right atrium. Deoxygenated blood is then pumped by the right ventricle to lungs via the pulmonary artery which is divided in two branches, left and right to the left and right lungs respectively. Blood is oxygenated in lungs and returns to the left atrium through pulmonary veins. Venous blood is typically colder than arterial blood, and has a lower oxygen content and pH. It also has lower concentrations of glucose and other nutrients, and has higher concentrations of urea and other waste products. The difference in the oxygen content of the blood between the arterial blood and the venous blood is known as the arteriovenous oxygen difference. Most medical laboratory test are conducted on venous blood, with the exception of arterial blood gas tests. It is obtained for lab work by venipuncture (also called phlebotomy), or by finger prick for small quantities. Color Human blood is red, ranging from bright red when oxygenated to dark red when not. It owes its color to hemoglobin, to which oxygen binds, deoxygenated blood is darker due to the difference in color between deoxyhemoglobin and oxyhemoglobin. There exists a popular misconception that deoxygenated blood is blue and that blood only becomes red when it comes into contact with oxygen. Blood is never blue, but veins appear blue because light is diffused by skin. Moreover, the blood inside is dark red and exhibits poor light reflection. Blood also changes color due to the amount of oxygen in it The blue appearance of surface veins is caused mostly by the scattering of blue light away from the outside of venous tissue if the vein is at 0.5 mm deep or more. Veins and arteries appear similar when skin is removed and are seen directly.

Usage Venous blood is used mainly for blood transfusion. Commonly only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets are used. It is one of the three sources of stem cells, which are extracted previously through pheresis.

How to venous blood sampling

venous blood sampling
venous blood was obtained by venous function. Needles are used to pierce the venous should be large enough, while the edges should be pointed, sharp and straight. It is advisable to use a needle and syringe that dispossible; that kind syringes are usually made of a kind of plastic. Both syringes and needles should be discarded after use, do not be sterilized again for repeated use. Syringe used for hematological examination is having volume 2 and 5 ml. Also recommended using a "sterile needles" (Vacutainer, Venoject) the needles are equipped with vacuum glass tube; perform functions at a vein, blood was sucked into the tube. This tool can be used only once. Needles - this tube is no additional benefit for the blood that is obtained in a state is not contaminated.

venous blood sampling

Objective : To obtain venous blood with puncture path. Principle : When will the venous blood vessels, blood will enter the syringe tip, followed by pulling the piston / holder until the desired blood volume. Tools and Reagensia: Needle and syringe The needle should be large enough, the tip pointed, sharp and straight and should be discarded after use (dispossible). Tourniquet When no tourniquet can use pads from tensimeter or soft rubber hose (width 5 cm) Bottles blood reservoir

Dry and covered, for the purposes of microbiology should be sterile. The volume is not too large for the amount of blood will be collected and labeled. Clean Cotton 70% alcohol as a disinfectant Bearing A wedge or support hand (if needed) Localization : Venous are enough large and located superficial. Adults Children and infants : difosa cubital venous :

externa jugular venous (width) venous femoral (thigh) superior sagittal sinus venous (head) Working Procedure: 1. Prepared the necessary tools. 2. Examined the patient, the patient quiet sought versa officer (phlebotomis). 3. Determined to be punctured venous observed closely for the presence of inflammation, dermatitis or scarring, as it affects the results of the examination. 4. Pricking place disinfected with 70% alcohol and let dry. 5. Tourniquet placed on the upper arm (the arm proximal part) 6-7 cm from multiple hands. 6. Enforce the skin over the venous with the fingers of your left hand so 7. that venous is not moving. 8. With pinhole facing up, skin pierced with an angle of 45-60 until the end of the needle enters venous lumen is characterized by reduced blood pressure and the entry to the end of the syringe. 9. Holder withdrawn slowly until the desired blood volume. 10. Tourniquet is released. 11. Cotton placed on the needle and pressed slightly with the left finger, then the needle is withdrawn. 12. Patients were instructed to press the cotton for 1-2 minutes.

13. Needle is then removed from sempritnya closed, blood is inserted into the container through the wall of the bottle slowly. When using anticoagualant, immediately gently mixed.

B.

EDTA Blood Sampling

Anticoagulant
Anticoagulant is a substance that is used to prevent blood clotting. In order for blood to be examined not to clot can be worn a variety of anticoagulant. Not all kinds of anticoagulant can be used because there is too much influence on the shape of erythrocytes or leukocytes which will be examined morphology. Anticoagulants are often used in hematology is one EDTA (Ethylene diamine Tetra Acetic Acid). EDTA (Ethylene Diamine Tetra Acetic Acid), which is used here is the potassium salt and sodium, but that is often used is potassium and sodium salts, but that is often used is the potassium salt (dipotassium EDTA) as the solubility in water is approximately 15 times more larger than the sodium salt. How it works with the potassium salt (K2.EDTA) that can alter Calcium ions from the blood to form ions form compounds that are not soluble complexes based compounds Chelat bond formation. Advantage: Prevent platelet clumping. Can be used a variety of hematologic examination. And does not affect the shape of the erythrocytes and leukocytes. Disadvantage: Slowly dissolve because it is often used in dried form that must be shaken container containing EDTA blood for 1-2 minutes. How to manufacture: 1. Take a clean and dry bottle. 2. Pipette EDTA 10% as much as 0.02 ml with Sahli pipette. 3. Put it in a bottle and dry. With the amount of EDTA 10% as much as 0.02 ml can prevent blood freezing as much as 2 ml or 1 mg of EDTA in 1 ml.

Routine Blood Examination

Deposition Rate Blood
It is precipitated erythrocytes of a blood sample is checked in a specific tool that is expressed in mm / hr. Principle : Venous blood with certain anticoagulant tubes put in the time specified and recorded precipitation of erythrocytes. Objective : To determine abnormal erythrocyte sedimentation rate in the blood of a person with a certain time.

How to Westergreen
Tools and Reagensia: 1. Tubing / pipette Westergreen - Length 300 mm - Midline in 2.5 - Division of the scale of 0-200 mm - Fill pipette 1.0 ml - Open pipette tip 2. Rack tube Westergreen - To get the tube to be in a state of vertical Westergreen. - Bottom there is a rubber tube to seal the hole. - At the top there is a spring to push the tube down. 3. Paper filter 4. Self-timer 5. Anticoagulants EDTA powder 6. NaCl 0.9% Material Inspection : Venous blood with EDTA Anticoagulants powder. Techniques working with EDTA Anticoagulants 1. Pipetted 0.9% NaCl with 50 pipette westergreen to sign, put in a test tube. 2. Pipetted blood with a pipette westergreen had to sign 200, inserted in tubes containing 0.9% NaCl before, mixed. 3. Anticoagulants EDTA blood was sucked right with zero mark Westergreen tube, cleaned the outside of the pipette with filter paper or tissue. 4. The top hole of the pipette closed with a finger and then placed on a shelf in a state Westergreen be precise vertical tube. Westergreen

5. High read from top plasma layer on the top surface of the erythrocyte column is read after one hour and two hours.

Normal Value Westergreen

Male : 0-10 mm / hour

Female : 0-15 mm / hour