Lab CE

A patient event occurs that results in a "near miss" (an event that was averted but may have resulted in death or serious injury). The error was caught in time before the serious injury occurred. Which of the following is an appropriate response to improve the process involved and patient safety?

Perform a risk assessment which includes performing a root cause analysis, document investigation, and implement appropriate risk-reduction processes.

Which of the following tests would be most affected by microclots in an EDTA tube drawn for a CBC?

Platelet count

A patient has a history of repeated spontaneous abortion. Coagulation studies reveal an elevated APTT, normal PT, normal platelet function, and normal thrombin time. Schistocytes were seen on the peripheral blood smear. Which test should be performed to determine if the patient has lupus anticoagulant?

Platelet neutralization test

Which of the following laboratory results would be seen in a patient with acute Disseminated Intravascular Coagulation (DIC)?

Prolonged PT, decreased fibrinogen, decreased platelet count, increased FDP

A manual white blood cell count was performed by the hematology technologist. The cell counts for each of two sides was 38 and 42 respectively. All nine large squares were counted on each side. The dilution for this kit was pre-measured at 1:10. What should the technologist report as the white cell count?

0.44 x10/L

How many standard deviations (SD) above and below the mean is accepted as being an appropriate control limit range on a control chart utilizing the Westgard rules:

3 SD

Which morphologic term describes this slide?

Alder-reilly Neutrophils

Which of the following is a FALSE statement regarding using extension cords in a health care facility?

An extension cord used in a healthcare facility can be either a two-prong or three-prong cord.

The hematology analyzer reported an elevated white blood cell count and flagged for manual review due to the suspected presence of immature cells. What is the arrowed cell's identity, and what name is given to its inclusion?

Blast with Auer rod

Which tests will be abnormal in a patient with Fibrin Stabilizing factor deficiency?

Both 5 M urea clot solubility test and Factor XIII assay

Hemophilia A is associated with a deficiency of which of the following?

Factor VIII

Which of the following options best describes how hemophilia A differs from hemophilia B?

Factor VIII is deficient in hemophilia A and factor IX is deficient in hemophilia B.

The fibrin clot begins to form when fibrinogen is cleaved resulting in a fibrin monomer, fibrinopeptide A, and fibrinopeptide B fragments. The fibrin monmers sponaneously polymerize due to hydrogen bonding, and then are covalently linked into fibrin polymers by which factor?

Factor XIII

All of the following tests will be abnormal in a patient with Stuart-Prower Factor deficiency EXCEPT?

Fibrinogen

What does the abbreviation FTE stand for?

Fill-Time Equivalent

Which of the following methods for long-term diabetic monitoring is recommended for patients with sickle cell anemia?

Fructosamine

Hydrogen ion concentration (pH) in blood is usually determined by means of which of the following electrodes?

Glass

Which of the following non-HbS hemoglobins can also sickle and show a positive solubility test?

HbC Harlem

Fire requires what three elements?

Heat, fuel, and oxygen

Which of the following additives should be used for the collection of a sample for blood gas analysis?

Heparin

What may prevent the detection of lupus anticoagulant in a plasma sample if the blood used for testing is not centrifuged for a sufficient time?

Increased platelets in the plasma sample

What is the most significant cause of decreased haptoglobin levels?

Intravascular Hemolysis

If a patient has a white blood count of 40,000/µL, what would be the MOST useful staining procedure to distinguish between bacterial infection and chronic myelogenous leukemia (CML)?

Leukocyte alkaline phosphatase (LAP)

Nephelometry and turbidimetry measure different properties of:

Light transmission and scatter by particles in suspension

A patient initially has a prolonged PT. After reviewing the patient's case and laboratory findings, the physician administers intravenous vitamin K. The repeat PT results are normal after 24 hours of vitamin K therapy. What clinical condition is MOST likely to produce these results?

Liver disease

Identify the nucleated blood cell that is indicated by the arrow:

Lymphocyte

A patient is admitted to the emergency room with lethargy and pallor. The CBC results are as follows: RBC = 4.1 x 1012/L Hemoglobin = 7.9 g/dL Hematocrit = 29% How would you classify this anemia?

Microcytic, Hypochromic

How many 1 mm x 1 mm squares is the Neubauer hemacytometer counting grid composed of?

Nine per side

This smear shows:

No abnormality

A patient's coagulation mixing study results are shown below after an initially prolonged aPTT result. Initial aPTT Immediate aPTT mixing study Incubated aPTT mixing study 63 sec. (normal range 21-34 seconds) 26 sec. 65 sec. Has the aPTT been corrected by the mix? Is a factor deficiency or a coagulation inhibitor the more likely cause of the patient's prolonged aPTT?

Not Corrected, Coagulation Inhibitor

Warfarin-based (coumarin derivative) oral anti-coagulant therapy is commonly monitored with :

PT/INR

Eosinophilia is commonly found in which of the following disorder?

Parasitic Infections

Which of the following cells are of lymphoid lineage?

Plasma cell

Which of the following describes the Westgard multirule 22s?

Two consecutive data points fall outside +2SD or fall outside -2SD.

When performing your mixing study, you aliquot your sample plasma and the pooled normal plasma to create your "mix." You then place the sample in a water bath to incubate for 90 minutes before running your new mixed sample. What is the problem with the steps involved in the procedure above?

You have not run a PT or aPTT on the new mix before incubating.

In the in vitro coagulation scheme, factor V is primarily involved in the:

common pathway

The dissolution of a clot with 5M urea indicates which one of the following factor deficiencies?

factor XIII

How would one prepare 3 mL of a 5% albumin working solution from a stock 30% albumin solution?

0.5 mL stock 30% albumin + 2.5 mL diluent

After experiencing extreme jaundice, abdominal pain, and vomiting from extensive hepatocellular damage, a patient's hepatic function panel is analyzed in the laboratory. The result of the ALT is too high for the instrument to read. Since the instrument does not perform automatic dilutions for ALT, the laboratorian performs a dilution using 100 microliters of patient sample to 400 microliters of diluent. The result now reads 369 U/L. How should the laboratorian report this patient's ALT result?

1,845 U/L738 U/L

The wavelength of the light measured by a spectrophotometer is generally designated in nanometers. A nanometer is equal in meters to:

10 -9 meters

What is the ratio of patient plasma to pooled normal plasma (PNP) that is usually used in the performance of a mixing study?

1:1

A technologist pipetted 200 microliters of serum in a test tube and added 5 milliliters of saline to the tube. What is the dilution ratio of serum to the total volume in the tube?

1:26

A sample of cerebrospinal fluid is diluted 1:100; the standard 9 squares of a hemocytometer were counted on each side for a total of 18 large squares. Side 1- 186 cells counted Side 2- 184 cells counted total cells = 370 What is the cell count per microliter?

2.06 x10

What transferrin saturation level would be indicative to investigate further for hereditary hemochromatosis (HH)?

45%

A technologist has 500 µL of serum and needs to make a 1/2 dilution for a glucose determination. How should he/she do it?

500 µL of serum plus 0.5 mL of saline

Convert 800 microliters to milliliters.

0.80 mL

The preparation of a Levey-Jennings quality control chart for any constituent of serum requires:

A minimum of 20-30 analyses of control serum over a period of 20-30 days

A standard is used to check the __________ of a method or instrument.

Accuracy

An assayed glucose control produces the following results in 10 runs: 99, 99, 99, 98, 98, 98, 98, 97, 97, 97. The established range for this control is 90-92. Where does the problem lie with this control?

Accuracy

Toxic granulation is seen most frequently in:

Bacterial Infections

Which of the following mutations is most commonly found in hereditary hemochromatosis (HH)?

C282Y

A hemoglobin F concentration of 100% may be seen in which beta thalassemia?

Delta-beta thalassemia major (dß0/dß0)

When performing controls for the morning run in coagulation, the normal control is within acceptable limits for both the PT and APTT, but the abnormal control is out of range for both procedures. Which of the following would be an appropriate action to take?

Document QC, repeat the abnormal control, troubleshoot if necessary; report patient results only when both controls are within acceptable ranges

What is the correct procedure when using a winged collection device (butterfly) to draw a light-blue top tube intended for a coagulation test if this is the first tube that will be collected in the draw?

Draw and discard a waste light-blue top tube before the tube that will be used for coagulation studies.

Which of the following red blood cell morphologies are frequently artifactual?

Echinocytes, stomatocytes

Which coagulation pathway is factor VII part of?

Extrinsic

The prothrombin time test will detect deficiencies in which pathways?

Extrinsic and Common Pathways

Which of the following factors is Vitamin K-dependent?

Factor IX

Which type of electrophoresis is used to separate larger DNA fragments (>50 kb)?

Pulsed field electrophoresis

Semi-automated and automated urine chemical reagent strip readers:

Remove subjectivity allowing for better reproducibility

You have just performed stat PT and aPTT tests on your coagulation instrument. Your results are as follows: PT = 12 seconds (normal range 10-13 seconds) aPTT = 24 seconds (normal range 21-34 seconds) What would be your next step?

Report the results

A spill of a chemical listed as a potential carcinogen has occurred in the laboratory. What document should the laboratory personnel use to find information on how to handle the spill?

Safety Manual

Which of the following cells is characterized by a thin rim of cytoplasm around the nucleus?

Small Lymphocyte

The fibrinolytic system may be activated by which one of the following?

Streptokinase

What is the primary target of HIV (human immunodeficiency virus)?

T Helper cells

What are the two general categories of nucleic acid amplification (NAA) techniques?

Target amplification and signal amplification

What is internal quality control?

Testing commercial materials in-house to quickly verify test validity.

What is the definition of a waived laboratory test or procedure?

Tests that are cleared by the FDA for home use

Which of the following conditions/findings is most likely associated with the peripheral blood picture in the photomicrograph?

Transfusion dimorphism

The following results were obtained on an SPE scan. What can you infer about the specimen from these results?

There is an interfering substance present in the specimen such as hemoglobin due to hemolysis

The federal government has categorized critical biological agents into three groups: A, B, and C. Why are the agents in category A classified as the highest-priority?

These organisms can be easily disseminated or transmitted person-to-person

The pI of a protein is 9.2. This protein is placed in an electrical field where a buffer sets the pH at 10.0. Select the correct statement regarding the electrophoretic migration of this protein.

This protein will have a net negative charge and will migrate toward the anode, the positively charged electrode

A 3-year old girl was brought to the ER with a temperature of 103ºF, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed: WBC: 4,500/µL Differential: 88% neutrophilsGlucose: 15 mg/dL 12% lymphocytesProtein: 140 mg/dLGram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider?

Bacterial Meningitis

What may cause the following mixing studies results? Initial aPTT = 133 seconds 1:1 Mix aPTT pre-incubation = 33 seconds 1:1 Mix aPTT post-incubation = 124 seconds

a slow acting coagulation inhibitor

The value that occurs most frequently in a set of results or values would be termed:

mode

All of the terms below are a measure of central tendency, EXCEPT:

molarity