ASCP MLS

Blood reaction grades; 1+, 2+, 3+ and 4+

1+: reaction has numerous small clumps and cloudy red supernatant 2+: has many medium-sized clumps and clear supernatant 3+: has several large clumps and clear supernatant 4+: has one solid clump, no free cells, and clear supernatant

Leukemoid Reaction Lab Results:

A high white blood cell count, usually 50-100 x109/L with a left shift is a common finding in leukemoid reactions. In addition, a key feature of a leukemoid reaction is a high LAP score

Define: Congestive heart failure

A left ventricular dysfunction resulting from aging, hypertension, atherosclerosis or muscle damage from an AMI or repeated AMIs.

Alpha thalassemia Major:

AKA as Hydrops Fetalis, is exhibited when all four alpha chain gene loci are deleted or non-functional. The alpha chain is crucial to the formation of hemoglobin variants that can conduct normal oxygen transport and gas exchange. The genetic code --/-- is incompatible with life.

t(8,21)

AML (M2)

Which two of the following tests are helpful for documenting previous Streptococcal throat and skin infections:

ASO titer and Anti-DNase B

Seriological marker for: Rheumatic fever Wegener's granulomatosis CREST syndrome Primary biliary cirrhosis

Antimyocardial antibodies Antineutrophili antibodies Anticentromere antibodies Antimitochondrial antibodies

Distinguishing characteristics of Mycobacterium fortuitum:

Mycobacterium fortuitum is positive for iron uptake, nitrate, arysulfatase, and growth on MacConkey agar without crystal violet in five days.

M4

Myeloblast and monoblast

M2

Myeloblast with maturation

M1

Myeloblast with minimal maturation

M0

Myeloblast without differentiation

Lysine reaction for all Citrobacter:

Negative

Which of the following is a characteristic of Factor XII deficiency?

Negative bleeding history Patients with a deficiency of factor XII tend to have thrombotic complications. The do not have bleeding problems most likely due to the lack of activation of fibrin lysis, also due to pathway activation of IX by VIIa/TF complex as well as the activation of Factor XI by thrombin

Patients at risk for developing TA-GVHD:

Neonates less than 4 months old, fetuses, recipients with a congenital of acquired immunodeficiency, such as bone marrow or stem cell recipients and patients receiving chemotherapy and recipients of donor units from a blood relative

NASBA

Nucleic acid sequence based amplification (NASBA) is a method in molecular biology which is used to amplify RNA sequences Used to monitor viral load in HIV paitents

How much does 1 unit of red blood cells raise the hemoglobin?

One unit of RBCs increases the hemoglobin level by approximately 1g/dL in an adult who is not actively bleeding and has no other predisposing factors that would shorten the survival of the transfused blood cells

Low LAP score:

Paroxysmal Nocturnal Hemoglobinuria, CML

Causes of Vitamin B12 deficiency:

Pericious anemia in relapse, Patients on chronic hemodialysis and hodgkin disease

Which of the following Rh antigens is found the highest frequency in the Caucasian population: A. C B. E C. c D. e

D. e

Nephrotic syndrome:

Damage to the electrical charges of the glomerular membrane, allowing the passage of high molecular weight proteins and lipids occurs in nephrotic syndrome. This results in markedly increased urine protein levels, and the appearance of fatty casts and oval fat bodies that are characteristic of nephrotic syndrome.

Thalassemias are characterized by:

Decreased rate of globin synthesis

Christmas Disease:

Deficiency in Factor IX

Heinz bodies are:

Denatured hemoglobin inclusions that are readily removed by the spleen.

The function of the major lipid components of the very low-density lipoproteins (VLDL) is to transport:

Endogenous triglycerides

Species that are Lysine (+), arginine (=) and ornithine (+):

Enterobacter aerogenes, Edwardsiella species and most Serratia species

M6

Erythrocytic series (erythroleukemia)

Which of the following combinations is useful for confirming the presence of extended spectrum beta-lactamases in E coli?

Extended spectrum beta lactamases (ESBL) are inhibited by clavulanic acid. Confirmatory tests of the presence of ESBL are based on the enhanced activity of a beta-lactam antibiotic, usually cefotaxime or ceftazidime, when it is tested with clavulanic acid compared to the activity of the betalactam tested alone.

Hemophilia B or Christmas disease is the results of a hereditary deficiency in which coagulation factor:

Factor IX

Which condition will show an increased PT with a normal aPTT?

Factor VII deficiency

Which factors is involved in the initial contact phase of the intrinsic pathway:

Factor XII, fitzgerald factor (HMWK), and fletcher factor prekallikrein

Sudan II will confirm the presence of:

Fat

Which part of the immunoglobulin molecule is responsible for activating complement?

Fc

Which of the following will give the best overall picture of a patient's iron stores:

Ferritin (storage form of iron)

Define Galactosemia:

Galactosemia is an inherited metabolic disorder that affects an individual's ability to metabolize the sugar galactose effectively. Infants affected by galactosemia typically present with symptoms of lethargy, vomiting, diarrhea, failure to thrive, and jaundice. The presence of galactose in the urine sample is not picked up by the glucose pad on the urine test strip, however, the clinitest result is positive since it can detect different sugars in the urine, including galactose. True lactose intolerance will usually not become symptomatic in children until they are at least 3 years old (usually after age 7). Also, lactose intolerance is associated with diarrhea, but not closely associated with vomiting.

A patient experiences a mild allergic reaction to a transfusion, including urticaria, erythema (skin redness), and itching. What is the most likely source of the allergen?

Plasma proteins Mild allergic reactions result from a patient's hypersensitivity to soluble allergens in the plasma of the donor unit. The blood recipient forms antibodies to these allergens that are bound to IgE on mast cells and cause the release of histamines. Allergen substances may be drugs or food consumed by the blood donor.

Intrinsic Pathway:

Prekallikrein, heavy molecular weight kinogen, XII, XI, X, IX, VIII, V, II and I Measured by APTT

M3

Promyelocyte

A hapten is only antigenic when it is coupled with which of the following:

Proteins

The prozone effect ( when performing a screening titer) is most likely to result in:

Prozone effect (due to antibody excess) will result in an initial false negative in spite of the large amount of antibody in the serum, followed by a positive result as the specimen is diluted.

Distingush between Pappenheimer bodies an Howell-Jolly bodies:

Prussian blue stain would help differentiate between the two. Prussian blue stains iron. Pappenheimer bodies, which contain iron, will stain blue. Howell-Jolly bodies will not stain with Prussian blue because they do no contain iron. Both Howell-Jolly bodies and Pappenheimer bodies will stain with Wright-Giemsa stain.

The sickling phenomenon observed in erythrocytes containing hemoglobin S may be induced by which of the following?

Reducing agents actually induce the sickling phenomenon in RBCs when they contain hemoglobin S.

Patients with antibody to the following antigen are immune to Hepatitis B:

Surface antigen (HbSAg)

Key characteristics of Micrococcus:

Susceptible to bacitracin ("A") and resistant to furazolidone; gram positive cocci in tetras, bacteria cells of micrococcus luteus are larger than those of the staphylococci and can arrange in tetras

Which T cell expresses the CD8 marker and acts specifially to kill tumor or virally infected cells?

T cytotoxic

Contact dermatitis is mediated by:

T lymphocytes

Distinguishing between T lymphs and B lymphs:

T lymphocytes are larger and have more vacuoles than B lymphocytes.

TdT:

TdT will stain lymphoblasts psitive and myeloblasts negative

IgG Index:

The IgG index is used to determine if increased IgG in CSF is due to increased production in the CNS or contamination from a breach to the blood-brain barrier.

What feature is most often found with patients with a splenectomy on a Wright's stained blood smear?

Howell-Jolly bodies

The primary mechanism responsible for glomerular filtration is:

Hydrostatic differential in glomerular tufts

In an adult where does hematopoiesis occurs?

Vertebrae, skull, proximal ends of long bones, ribs and pelvis in adults

What does washing red cells do:

Washing not only reduces the number of leukocytes and platelets that are often responsible for febrile reaction, but also eliminates anticoagulants, ammonia, lactic acid and potassium.

Nephrotic Syndrome Symptoms

Increased proteinuria, decreased serum albumina nd edema are all expected findings. Nephrotic syndrome develops when the kidney glomeruli are damaged, which allow proteins in the blood, especially albumin, to leak into the urine.

If a bacteria produces the enzyme tryptophanase to break down the amino acid tryptophan, which of the following tests will be positive with Kovacs reagent?

Indole test

Urobilinogen is formed in the:

Intestine

Adiponectin:

Is aprotective cytokine. This cytokine is anti-inflammatory and increases insulin sensitivity. Adiponectin is usually decreased in obesity

Myelomonocytic leukemia

Is associated with an increase in myeloid and monocytic cell precursors, but not red blood cell precursors

Le(a+b-) Le(a-b+) Le(a-b-)

Le sese Le Se lele sese or Se

Term that means varying degree of leukocytosis with a shift to the left and occasional nucleated red cell in the peripheral blood:

Leukoerythroblastosis

Which of the following would most likely occur as the result of hemodilution:

Low serum electrolyte values

In familial hypercholesterolemia, the hallmark finding is an elevation of:

Low-density lipoproteins

Hereditary deficiency of early complement components (C1, C4 and C2) is associated with:

Lupus erythematosus like syndrome

CD5 antigen is normally found on which of the following lymphocyte populations?

Mature T cells

M7

Megakaryocytic (megakaryocytic leukemia)

Purpose of a bi-chromatic analyzer with dual wavelengths is:

Minimize the effect of interference

In mass spectrometry, the "appearance potential" is defined as the:

Minimum energy required for the appearance of a particular fragment ion in mass spectrum

Alder-Reilly inclusions:

Mucopolysaccarids

A mojor action of angiotensin II is:

increased vasocontriction

Lab values of Wilson's Disease:

low values of plasma ceruloplasmin, increased urine copper and increased serum copper

m5

monoblast

Approximately what percent of the overall population is Rh negative:

15%

Criteria for blood donation (Age, hematocrit, blood pressure, pulse and temperature):

17, 35%, no greater than 180/100, 50-100 beats per minutes and not greater than 99.5 degrees

Granulocyte concentrates MUST be administered within _____ of collection:

24 hours

If an autologous blood donor weighs 35 kg, how much blood can be collected for later transfusion?

315 mL Volume to draw = (Donor's weight in kilograms / 50 kg (minimum weight requirement) x 450 mL (volume of unit to be donated) In this case, Volume to draw = (35 kg / 50 kg) x 450 mL = 315 mL

What percentage of dietary iron is normally absorbed daily?

5% to 15%

What is generally accepted as the lower threshold value for semen pH from fertile males?

7.2

Average life span of platelets (in the body):

9.5 days

What is the glomerular filtration rate for a patient with a serum creatinine of 2 mg/dL, if the urine creatinine was 124 mg/dL and the urine volume was 2.2 L/24 hrs?

95 mL/min One method of calculating a glomerular filtration rate is using creatinine and urine volume to determine creatinine clearance. The equation is as follows: Creatinine Clearance = (urine creatinine X urine flow rate) / plasma creatinine; where urine flow rate = volume in mL /24 hours x h/60 min) In this case = creatinine clearance = 124 X (2200/24 x hour/60) / 2 = 94.7 or 95 ml/min

Myelodysplastic syndromes can Best be described as:

A qualitative disorder of erythroid, myeloid and/ or megakaryoctic cell series

Diagnosis of Diabetes:

A random glucose concentration greater than 200 mg/dL, with classical signs and symptoms of diabetes A fasting glucose concentration greater than 126 mg/dL on more than one occasion. An abnormal oral glucose tolerance test (OGTT), in which the glucose concentration is greater than 200 mg/dL 2 hours after a standard carbohydrate load.

Tay-Sachs Disease:

A rare inherited disorder characterized by the near-total deficiency of the enzyme N-acetylbetahexosaminidase A.

Dolichos biflorus:

Anti-A1 lectin is extracted from the seeds of Dolichos biflorus. This reagent will agglutinate A1 cells, but not A2 cells

The accuracy of an immunoassay is its ability to discriminate between results that are true positives and results that are true negatives. Two parameters of test accuracy are specificity and sensitivity. Which of these statements apply to an immunoassay with high specificity, but low sensitivity?

Accurately identifies the absence of disease and has few false-positives A test with high specificity accurately detects the absence of disease. The more specific a test is, the fewer false-positive results will occur. A test with high sensitivity accurately identifies the presence of disease. The more sensitive a test, the fewer false-negative results it produces. In the case stated in this question, the immunoassay has high specificity, so it has few false-positives and will accurately detect those individuals who do not have the disease or condition that is being tested for. However, the test has low sensitivity, so it may not identify all individuals who actually have the disease; it may produce many false-negative results.

Sodium nitroprusside on a urine reagent strip reacts with:

Acetoacetic (diacetic) acid- ketones

What conditions increases the risk of HbS polymerization?

Acid pH dehydration, increased level of 2,3-DPG

Amorphous urates is found in:

Acidic pH urine

FAB M3:

Acute Promyelocytic leukemia

Symptomes of Acute leukemia:

Acute leukemia is associated with bone pain, hepatosplenomegaly, and swollen lymph nodes. In addition, infections (causing fevers) and bleeding are common. A high white blood cell count with man blasts in the peripheral blood and bone marrow, along with a low platelet and rbc count are also highly associated with this condition.

FAB M5:

Acute monoblastic leukemia

FAB M1:

Acute myeloblastic leukemia without maturaation

Which leukemia is characterized by immature cells that are Sudan black B positive with discrete fin granules, peroxidase negative, PAS variable, strongly alpha naphthyl acetate esterase positive and muramidase positive?

Acute myelomonoctic (AML)

FAB M4:

Acute myelomonocytic leukemia

Which adipokine is decreased in obesity, is anti-inflammatory, and increases insulin sensitivity?

Adiponectin is a protective cytokine. This cytokine is anti-inflammatory and increases insulin sensitivity. Adiponectin is usually decreased in obesity.

Respiratory Acidosis Metabolic Acidosis

All values except pH increased (HCO3, CO2 and pCO2) All values decreased (pH, HCO3, CO2 and pCO2)

Erythroleukemia:

Also known as Acute Myelogenous Leukemia type M6. This type is associated with either the presence of both erythroid and myeloid precursors OR strictly erythroid precursors.

Amorphous phosphate crystals are found in:

Amorphous phosphate, triple phosphate (ammonium magnesium phosphate), calcium phosphate, and ammonium urate crystals are frequently found in alkaline urine specimens

Define infarction:

An area of tissue death that occurs due to lack of oxygen.

Coulometry:

An automated method for measuring chloride which generates silver ions in the reaction

Dubin-Johnson Syndrome:

An autosomal recessive disorder that causes an increase of conjugated bilirubin without elevation of liver enzymes (ALT, AST)

Define: Ischemia

An inadequate blood supply that decreases availability of oxygen.

What characteristics are often associated with alpha thalassemia intermedia?

Anemia, splenomagaly

The incidence fo hemolytic disease of the fetus and newborn due to anti-D would be expected to be rarest in which population?

Asians

Crigler-Najjar syndrome:

Associated with increased levelss of bilirubin in the blood as teh disorder affect the etabolism of bilirubin

The mediator cells that bind MOST to IgE antibodies are:

Basophiles

CD34

Best associated with stem cells, present on undifferentiated pluipotential hemopoietic stem cell. CD34 is a cell surface glycoprotein and functions as a cell-cell adhesion factor

Estrogen and progesterone markers are most commonly used to provide prognostic information about:

Breast cancer

Which of the following blood components contains the most Factor VIII concentration relative to volume?

Cryoprecipitated AHF

In HbSS blood, an increased amount of which surfact antiens on young sickle cells (reticulocytes) many allow paltelets to forma bridge between the reticulocytes and endothelial cells, ultimately leading to vaso-occlusion?

CD36

Markedly elevated 5-hydroxyindole acetic acid (5-HIAA) determination is presumptive evidence for:

Carcinoid tumor

Nephrotic Syndrome:

Caused by damage to the kidneys, especially the basement membrane of the glomerulus; which causes abnormal excretion of protein and red blood cells in the urine. Fats are also present in the urine in most cases. A foamy appearance of the urine is a key characteristic of this condition. Clinical symptoms include: Swelling Weight gain from fluid retention Poor appetite High blood pressure

Gilbert's syndrome:

Causes an otherwise harmless jaundice, which does not require treatment, caused by hyperbilirubinemia

Diseases associated with dysfunctions of polymorphonuclear neutrophils (PMNs)

Chediak-Higashi syndrome (CH), Chronic granulomatous disease (CGD), Myeloperoxidase deficiency (MPO)

Define: Angina

Chest pain caused by inadequate supply of oxygen to heart myocardium.

Increased numbers of basophils are often seen in:

Chronic myelocytic leukemia

T lymphocytes that possess the CD8 surface marker mediate which of the following T-cell functions?

Cytotoxic T cells, which are capable of destroying targets such as tumor cells and virus-infected cells, bear the CD8 surface marker, while the other cell types listed ( delayed type hypersensitivity, regulatory and helper) are positive for the CD4 surface marker

Differentiate between group D streptococcus, Group D enterococcus, Group B strep and Group A:

Group D streptococcus (bile esculin +, 6.5% NaCl -, PYR -) Group D enterococcus (bile esculin +, 6.5% NaCl +, PYR +) Group B strep (bile esculin -, 6.5% NaCl variable, PYR -) Group A strep is beta hemolytic

HLA antibodies are:

HLA antibodies are formed in response to pregnancy, transfusion or transplantation and are therefore not naturally occurring. They are associated with febrile nonhemolytic transfusion reactions and TRALI. They are directed against antigens found on granulocytes and other cells such as platelets.

The part of the molecule responsible for difference among immunoglobulin classes is:

Heavy chains

B lymphocytes and T lymphocytes are derived from:

Hematopoietic stem cells

Which of the following antigen groups is closely related to the ABO antigens on the red cell membrane?

I and i antigens are related biochemically and spatially to the ABH and Lewis antigens on the red cell membrane. Anti-I is usually an autoantibody. It is common as a benign cold autoagglutinin. Strong anti-I is associated with Mycoplasma pneumonia infection, where it may be associated with cold autoimmune hemolytic anemia. Anti-I is characterized by its failure to react with cord red cells. Anti-i generally occurs as a cold reactive IgM antibody in the setting of infectious mononucleosis.

Patients with Waldenstrom's macroglobulinemia demonstrate excessively increased concentrations of which of the following?

IgM

Metabolic syndrome:

Includes high blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol levels

Deta-beta thalassemia minor:

Increase in Hb F and decrease in both Hb A and Hb A2

Oval fat bodies are:

Renal tubular epithelial cells that contain lipids

Low HCO3:

Represents acidosis

Low PCO2:

Represents alkalosis

What test can be used to evaluate the adequacy of fibrinogen in heparinized patients?

Reptilase time

Distinguishing characteristics of Micrococcus luteus:

Resistance to furazolidone is one of the key characteristics by which members of the genus Micrococcus (resistant) can be separated from members of the genus Staphylococcus (susceptible). Micrococcus species also are susceptible to novobiocin and to bacitracin, although the zone of inhibition to the "A" disk is often small (as shown in this photograph).

Prozone effect:

Results in a false positive reaction; is the result of antibody excess and dilution of antibody can help prevent its occurrence

For which determination is the Brilliant cresyl blue used MOST often?

Reticulocytes Immature erythrocytes, or reticulocytes, contain nuclear remnants of RNA. To detect the presence of this RNA, the red cells must be stained while they are still living, in a process called supravital staining. With supravital staining, the RNA appears as a reticulum within the red cell.

Nephelometers measure light:

Scattered at a right angle to the light path

ANA

See 2 quiz #27

Distinguishing characteristics of Shigella species:

Shigella species generally do not usually exhibit motility. Shigella spp. are gram-negative rods which is known to cause Shigellosis. This is an infectious disease caused by Shigella which is associated with diarrhea, fever and stomach cramps.

Which method is the gold standard for ANA detection:

Slide-based immunofluorescent assay (IFA) or colorzyme

Key Biochemical reactions for Enterobacteriaceae:

The key biochemical reactions by which the family Enterobacteriaceae can be identified include fermentation of carbohydrates, reduction of nitrates to nitrites and the absence of cytochrome oxidase activity.

Gaucher's disease

The most common lysosomal storage disease caused by insufficient activity of the lysosomal enzyme glucocerebrosidase that leads to the deposition of glucocerebroside in cells of the macrophage-monocyte system.

Chylomicrons are primarily composed of:

Triglycerides

LIpemia in a serum smaple is most likely caused by an increase in serum levels of:

Triglycerides

Which organism is MOST likely responsible for septic reactions associated with Red Blood Cell transfusions?

Yersina entercolitica is most likely responsible for septic reactions in transfusions of Red Blood Cells. This organism is usually acquired by ingestion of contaminated food and causes mild symptoms of abdominal pain and diarrhea. Growth of Y. entercolitica is enhanced in iron-rich environments such as red cell components.

A biomarker with a high specificity:

accurately detects the absence of disease and has few false-positives

A biomarker with high sensitivity:

accurately identifies the presence of disease and hos few false-negatives

The anemia of chronic infection is characterized by:

decreased serum iron levels; serum Fe levels low due to sequestration in macrophages and hepatocytes

In patients with suspected primary hypothyroidism associated with Hashimoto's thyroiditis, one would eexpect the following laboratory test results: T4___? TSH___? and TRH stimulation______?

decreased, increased, increased

Vitamin K Factors:

factors II (prothrombin), VII, IX and X. Anticoagulation proteins: proteins C, S

Multiple ring forms are most frequently seen in which Plasmodium?

falciparum Multiple ring forms are most frequently seen in Plasmodium falciparum. The trophozoite develops into a schizont made up of multiple ring forms (also known as merozoites) via schizogony, or asexual replication. The schizont then matures which causes the rupture of the erythrocytes- releasing merozoites into the circulation which in turn infect other erythrocytes

Key identifying characteristic for Pantoa (Enterobacter) agglomerans:

negative reactions for the three decarboxylases commonly tested ( Lysine, arginine and ornithine)

Respiratory Alkalosis Metabolic Alkalosis

pH increased, all others decreased (HCO3, pCO2 and CO2) All values increased (pH, HCO3, CO2 and pCO2)

Blood Gas Reference Ranges:

pH: 7.35-7.45 pCO2: 35-45 mm Hg HCO3: 22-26 mM/L pO2: 85-105 mmHg

The most frequent genotype among Rho (D)- negative persons is:

rr

Glucose levels whole blood, serum and CSF:

serum>whole blood>CSF

Define Oliguria:

the production of abnormally small amounts of urine Correlated with acute glomerulonephritis