SKIN PUNCTURE

Dermal Puncture/ Microtechnique/ Micropuncture

Capillary blood= Arterial + Venous + Tissue juices
Sites for Dermal Puncture:
o
o
o
o

Adults: Middle/ring finger

Heel
Big toe
Earlobe

Preferred when:
-

Patient is infant
Good vein is not found
Small child (uncooperative/ no good
vein found)
Test requires a few drops of blood
Unsuccessful repeated venipuncture
Severe burns
Thrombotic tendencies
Veins reserved for IV lines
Fragile superficial veins

Not appropriate when Patient is:

-

Severely dehydrated
In shock
Extremely cold
With chronic poor circulation

Order of Draw:

EDTA tube
Heparin tube
Serum tube

**Wipe first drop (tissue juices)

Failure to wipe 1st drop= Kcell count, Hgb, Hct
Depth: less than 2mm

Phlebos: vein
Tome: to cut
Veins at the Antecubital fossa:

A.

Thin Smear: for observation of blood cell

morphology
**Length of smear: 2/3 the glass slide
Angle of spreader: 33-450
Shape: Bullet w/ feathery edge, no bubbles
Ideal blood: Freshly drawn blood w/
anticoagulant

B.

Thick Smear

Rapid diagnosis of presences of blood

parasites
Malaria
Filaria
Trypanosomes

Increases the chances of detecting light

parasitic blood infections

Decreases time needed for reliable

diagnosis

Contains 16-30x more blood

Median Cubital
Basilic
Cephalic

Torniquet: to make veins more prominent (3-4

inches), not more than 1 min (hemoconcentration:
K)
Clench fist: make the veins easier to feel & prevents
vein from rolling
Cleansing w/ alcohol pad: center to periphery
Air Dry: prevents hemolysis & stinging sensation
Anchoring the vein: 1-2 inches below the site
Needle:15-300, -1 cm

STAINING OF BLOOD SMEARS

Gauze: 2 minutes

Romanowsky Group of Stains (polychromic)

Order of Draw:

Yellow (Sodium Polyanethol Sulfonate)

Light blue (Sodium Citrate)
Serum Tube (none)
Green (Heparin)
Lavender (EDTA)
Gray (K oxalate, NaF: preservative)

Adverse effect of Venipuncture:

Syncope
Hematoma
Bruising
Petichiae
Vomiting
Advantages of Vacutainer over syringe method:

VENIPUNCTURE

THIN AND THICK BLOOD SMEAR

Multiple draw
Less prone to contamination (closed system)
Easier to perform

Wrights stain
Leishmans stain
Giemsa Stain
Jenner-Giemsa Stain
May-Grunwald-Giemsa Stain

Components:

Methylene blue
Eosin (B or Y)

Powder Form: dissolved in GLYCERINE and mixed w/

acetone-free-methyl alcohol
Methyl Alcohol: fixative
Phosphate Buffer: sets desired pH

Blood, BM: 6.8

Malarial Parasites: 7.2

Well Stained Smear:

Pink to purple
RBC: orange to salmon pink
Leukocyte nuclei: purple to blue
Neutrophil granules: violet/lilac in a pink to
tan cytoplasm

Eosinophil granules: bright orange or

reddish orange

Steps:

Acanthocytes
(thorn/ spur)

Irregularly
spiculated

Abetalipoproteine
mia

Echinocytes
(crenated RBC)

Regularly
speculated
(rounded at tip)

Artifactual drying
Bile acid
abnormalities
Effectsof
barbiturates and
salicylates

methanol (5)
Eosin (5)
Methylene Blue (25)

Ovalocytes
(elliptocytes,
cigar cells)

Phosphate Buffer
NORMAL RBC MORPHOLOGY AND RBC ANOMALIES
A.

B.

ANISOCYTES (size)
1. Microcytic: thalassemia, anemia
2. Macrocytic: liver disease, megaloblastic
anemia
POIKILOCYTES (shape)

Spherocytes

Stomatocytes
(Mouth cell)

Spherical
Lacks central
pallor
MCHC
Elongated
slit like cp

Hereditary
spherocytosis
Rh Null Syndrome
Alcoholism
Hereditary
stomatocytosis
Sev. Liver disease

Dacryocytes
(teardrop)
Schistocytes

Sickle Cells
(depranocytes)
C.

Normal: 5-10%
Congenital
elliptocytosis:
90%
Pear shaped

Fragmented
RBC

Crecsent
shaped

Myelofibrosis
Myeloid
Metaplasia
Microangiopathic
HA
Uremia
Severe burns
DIC
SCA

ANISOCHROMIC CELLS (color)

Target Cells
(Leptocyte)
(Platycyte)

Bulls eye
appearance

Liver disease
Hemoglobinopat
hies (SCA,HbCC)

(Codocyte)
(Mexican hat
cell)
Hypochromic
cells
Hyperchromic
cells
Polychromatophi
lic
Pessary cells
(ghost cells)
(anulocytes)

hb conc
Larger CP
Falsely hb
content
Lacks CP
RBC not fully
hemoglobinized
w/ large clear CP
Very thin
peripheral Hb

RBC INCLUSION BODIES

WBC MORPHOLOGY

IDA
Hookworm
infection
Spherocytes

Reticulocytosis
IDA