A patient with influenza would be placed in:
Which area of the laboratory is responsible for blood coagulation studies that test for the patient's ability to clot their blood?
The coagulation department tests samples for:
A zone of inhibition is the area around an antibiotic-infused paper disk that does not show any bacterial growth. The antibiotic impregnated on the disk will diffuse into the agar in the area surrounding the disk. If the bacteria are sensitive to the antibiotic, they cannot grow near the disk. The size of the zone is proportional to how sensitive the organism is. If the organism is resistant to the antibiotic, it will grow very closely to the disk.
The size of the zone of suppressed growth on a sensitivity plate using sensitivity disks is referred to as the zone of:
HCG levels rise rapidly during the first trimester, then the levels start to decline around week 16. The hCG levels slowly decrease and can level off during the remainder of the pregnancy.
The following BEST describes serum hCG levels during pregnancy:
Lipids tend to form a "maltese cross" pattern when viewed in polarized light, which helps to differentiate them from other urine microscopic components.
Substances found in urinary sediment that are more easily distinguished by use of polarized microscope are:
The most likely causes of delayed hemolytic reactions are Kidd system antibodies. Both jka and jkb are often responsible for delayed hemolytic transfusion reactions.
Blood Bank
Delayed hemolytic transfusion reactions are usually caused by antibodies directed against what blood group system?
Unconjugated bilirubin is a byproduct of RBC breakdown, or hemolysis. It would be expected to see an increase in unconjugated bilirubin when hemolysis is occuring at an increased rate. The liver enzymes would not remain at normal levels if there were a viral infection of the liver, chemical damage to the liver, or obstruction of bile ducts.
Chemistry
A patient presents with an elevation of unconjugated bilirubin, normal serum alkaline phosphatase, normal liver enzymes, and no bilirubin in the urine. This combination would suggest:
The intended response is Vitamin B12 and folate deficiencies. Each of these conditions lead to a megaloblastic production of the red blood cells in the bone marrow. Since vitamin B12 and folate are needed in order to produce a synchronous development of the nucleus with the cytoplasm in hematologic cells, oval-macrocytosis often occurs if these nutrients are not in adequate supply within the body. This can also affect neutrophils, allowing for the characteristic hypersegmented nucleus.
The photographic field contains several oval-macrocytes and a hypersegmented neutrophil with greater than 5 nuclear segments. Oval macrocytes are most commonly associated with pernicious anemia and malabsorption syndromes leading to vitamin B12 and folic acid deficiencies.
Clinical information relating to chronic infection, aplastic anemia, and other hematologic maligancies provide the context for the presence of the oval macrocyte.
Macrocytic erythrocytes and hypersegmented neutrophils are not present in thalassemias or in Pelger-Huet anomaly (hyposegmented neutrophils).
Conditions suggested by the macrocytes and the neutrophil in the photograph to the right include which of the following?
The correct answer which best fits the characteristics in this question is Mycobacterium kansasii.
The remaining Mycobacterium strains can be elimated as:
Mycobacterium marinum is considered a fast-grower.
Mycobacterium scrofulaceum produce deep-yellow to orange pigmented colonies when grown in the either the light or dark.
Mycobacterium avium grows colonies which are nonpigmented in the light and dark which do not intensify after light exposure.
What is the MOST likely identification of an acid-fast bacillus that demonstrates the following characteristics?
slow growth
cream to tan colored colonies when grown in the dark
development of yellow pigment upon exposure to light
Rapid vascular constriction, not dilation, immediately occurs when there is vascular injury in order to constrict the amount of blood that escapes the vessels; ultimately preventing massive loss of blood.
Primary hemostatic processes resulting from vascular damage include all of the following EXCEPT:
Abrupt change in temperature is one of the risk factors in which a sickling event may occur.
Dehydration, hypoxia, and physical exertion, rather than excessive intake of fluids, inhaling oxygen, and sedentary lifestyle, are all additional risk factors in which sickling events may occur.
Which of these could cause a sickling event?
The results of this PT and aPTT are in normal range. These results can be reported and are not indicative of the need to: order a mixing study or request a redraw.
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?
Gram positive organisms resist decolorization by ethyl alcohol. The large crystal violet-iodine complex is not able to penetrate the peptidoglycan layer, and is trapped within the cell in gram-positive organisms. Conversely, the outer membrane of gram-negative organisms is degraded and the thinner peptidoglycan layer of gram-negative cells is unable to retain the crystal violet-iodine complex and the color is lost.
What is the purpose of using ethyl alcohol or acetone in the gram stain procedure:
Valine substitutes for glutamic acid in the Beta 6 position to produce HbS.
To produce hemoglobin S, glutamic acid that is normally present in the sixth position on the beta globin chain is substituted with which of the following?
Which of these advancements in the clinical laboratory has led to concerns about patient privacy
Monoclonal antibodies are monospecific antibodies that are the same because they are made by one type of immune cell which are all clones of a unique parent cell, also called a hybrid cell line, which usually arise from a hybridoma. The fusion of a specific antibody-producing lymphocyte with a myeloma cell will multiply to become a source of pure monoclonal antibody. This is often used in the manufacturing process for monoclonal antibody reagents.
Monoclonal antibodies are usually manufactured in vitro by using:
In sickle cell anemia, rapid hemoglobin turnover may be present. HbA1C and other glycated hemoglobin assays are not valid in rapid hemoglobin turnover and in abnormal hemoglobin conditions. Fructosamine measurements can be used because of shorter half life of albumin.
HbA1C measurements are NOT ordinarily used to monitor long-term diabetic control in a diabetic with sickle cell anemia.
Report the isolate as coagulase negative Staphylococcus is the correct answer because this is an isolate from a urine specimen with a coagulase negative Staphylococcus susceptible to novobiocin. Staphylococcus saprophyticus is resistant to novobiocin. Further testing is required to speciate coagulase negative Staphylococci but only if the specimen is from a sterile body site, not urine.
Gram positive cocci isolated from a catheterized urine culture on a 76-year-old male gave the following reactions:
Blood agar- creamy, white, opaque colonies
Catalase- positive
Slide coagulase- negative
Tube coagulase- negative
Novobiocin- susceptible
The next action the MLS should take is:
Blood bank
Once the seal on a unit of packed red cells is broken, how long can the unit be stored refrigerated prior to administration:
FFP that has been thawed at 30 - 37oC and maintained at 1 - 6oC must be transfused within 24 hours. In contrast, "Thawed Plasma" can be used for up to 5 days as a replacement therapy for patients requiring stable clotting factors. Keep in mind that these are two different component types and you are asked about FFP.
Blood Bank
FFP that has been thawed at 30 - 37oC and maintained at 1 - 6oC must be transfused within ___________ after it has been thawed.
Diagnosis of malaria may require thick smears as well as conventional thin blood smears.
A definitive diagnosis of malaria can be made by:
The structures involved in the production of semen include the prostate, the seminal vesicles, and the bulbourethral gland, along with the testes and epididymis.
Semen is produced as a combination of secretions from the different regions of the male reproductive tract. Each fraction differs in chemical composition and function.
Spermatozoa are produced in the testes. They mature in the epididymis. The testes also produce testosterone and inhibin.
Fluid from the seminal vesicles accounts for approximately 70% of semen volume. The seminal vesicles are the source of fructose in semen. Fructose is used by the spermatozoa as an energy source.
The prostate gland supplies about 20% of the volume of semen. Its fluids include acid phosphatase and proteolytic enzymes that lead to coagulation and subsequent liquefaction of semen. The prostate also contains most of the IgA found in semen.
The bulbourethral gland produces mucoproteins that make up about 5% of the volume of semen.
The pituitary gland is not directly involved in the production of semen; instead hormones are released which stimulate the production of sperm. The urethra is not involved in the production of semen.
Which of the following are directly involved in the production of semen?
Though it may not be required, TDM should still be used to confirm adequate dosing. Genotyping does not make TDM redundant.
A PM will metabolize the drug more slowly and therefore will need lower doses. CYP2D6 metabolizes many different drugs; it is not associated with just one class of drugs. Anytime a drug is taken that competes for the same metabolizing enzyme as another drug, there is potential for the concentrations of both drugs to be increased.
A patient has been characterized as a CYP2D6 poor metabolizer (PM) after genotyping. Which of the following statements is not true?
The activities conducted in a laboratory with a certificate of waiver include:
HbsAg is positive in acute and chronic Hepatitis B infections, since the antigen is found on the actual surface of the virus. HbeAg is present in the blood when the hepatitis B viruses are replicating, indicating an active infection. Anti-Hbc IgM is present due to the immune response to the presence of the hepatitis core antigen and indicates an acute infection. Anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection, according to the CDC.
Given the following results, what is the immune status of the patient?
HbsAg: positive
HbeAg: positive
Anti-HBc IgM: positive
Anti-HBs: negative
All of the following tubes contain separation gel except:
Question options:
Chemistry
Estrogen and progesterone markers are most commonly used to provide prognostic information about:
Which area of the laboratory can analyze a patient sample and be able to predict their risk of developing a disease?
Provide the equivalent measurement for one pint.
Charcot-Leyden crystals in stool are thought to be created from damaged eosinophil byproducts. These crystals have a strong association, although they are rare, with parasitic infections or allergic reactions.
Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of:
Infection early in the pregnancy is the most dangerous time period for the manifestation of anomalies due to rubella. In fact, defects are rare when infection occurs after 20 weeks gestation.
Immunology
The greatest risk for the manifestation of anomalies in maternal rubella infection during gestation is the:
Hypochromia can best be described as:
Troponin is a very specific biomarker that is released during cardiac injury or stress. CK is found not only in cardiac tissue, but also in muscle and brain tissue. LD levels can be elevated in cardiac events, tissue breakdown, and hemolysis. Myoglobin is elevated when muscle tissue is damaged and is not specific for the heart muscle.
Chemistry
Which one of the following is the MOST specific biochemical marker of myocardial infarction?
Spirochetes such as Borrelia and Treponemes are best visualized using darkfield microscopy. Borrelia, which causes Relapsing fever, can be visualized under darkfield microscopy of wet preps of peripheral blood. Treponema can be visualized by darkfield microscopy of early primary lesions, and aspirates of affected lymph nodes.
Which of the following organisms is best visualized by use of a darkfield microscope:
The image shown in this question is depicting a rosette formation. Here the red blood cells are surrounding and adhering to the outside of the white blood cell.
What is the best description of the phenomenon seen in this illustration?
Howell-Jolly bodies are composed of DNA, usually left from the nucleus, that appears as a round, dark-staining inclusion in the cytoplasm of red blood cells. Howell-Jolly bodies can be found in various conditions including splenectomy and anemia.
Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called:
The colonies seen growing on the bird seed agar appear smooth and have a distinct reddish-brown pigmentation. The active ingredient in bird seed (Guizotia abyssinica) agar is caffeic acid, which is extracted and placed in an agar containing 1% glucose. Of the cryptococci, and other species of yeasts, Cryptococcus neoformans selectively produces the enzyme phenoloxidase, which oxidizes the caffeic acid in the medium to melanin, producing the red-brown pigmentation.
The other yeast species included in this exercise do not possess phenoloxidase activity and therefore remain non-pigmented when grown on bird seed agar.
The colonies shown in this photograph were grown on Guizotia abyssinica (bird seed) agar at 30°C for 72 hours. The most likely identification is:
An international, nonprofit organization that establishes standards of best current practice for clinical laboratories is
Convert the following temperature from Fahrenheit to Celsius
102 degrees F
AHG must be added to the cells immediately following washing. Antibodies may elute from the cells if the cells are allowed to sit in saline without the addition of AHG.
Which one of the following may cause a FALSE-NEGATIVE result with antiglobulin techniques?
In an evacuated tube, blood flow into the tube depends on:
Question options:
Acute hemolytic transfusion reactions are most commonly due to ABO-incompatible blood being transfused to a recipient with naturally occurring ABO alloantibodies (anti-A, anti-B, anti A,B).
Acute intravascular hemolysis as the result of a blood transfusion is most often associated with which of the following causes?
Personal protective equipment (PPE) should be put on in the following order:
A key laboratory characteristic by which Mycobacterium bovis can be separated from Mycobacterium tuberculosis is:
Following an accidental needlestick, the person should be tested for all of the following except:
Standard precautions should be followed:
During primary hypothyroidism, where a defect in the thryoid gland is producing low levels of T3 and T4, the TSH level is increased. TSH is released in elevated quantities in an attempt to stimulate the thryoid to produce more T3 and T4 as part of a feedback mechanism.
Serum TSH levels five-times the upper limit of normal in the presence of a low T4 and low T3 uptake could mean which of the following:
The most common specimen analyzed in the hematology section is:
This patient is most likely suffering from sickle cell anemia. This cell, which is sickle-shaped, is indicative of the presence of hemoglobin S. Polychromasia is also commonly observed in sickle cell anemia.
After experiencing crippling pain in her chest, Elizabeth's mother rushes her to the Emergency Room. After a complete blood count and differential are ordered, the hematology technologist views many peripheral cells similar in appearance to those found in the image below. Which condition is most likely present?
Elevation in conjugated bilirubin is most likely to be found in which of the following conditions:
All the following characteristics are accurate for the influence of Health Insurance Portability and Accountability Act (HIPAA) except
The deposition of plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries is the defintion of atherosclerosis.
Arteriosclerosis is a more general term that describes a thickening and loss of elasticity of the walls of the arteries (hardening of the arteries). Atherosclerosis is a type of arteriosclerosis but is not synonymous with it.
Atherosclerosis is not the most common outcome for risk marker studies because it can be hard to measure. Infarcts, cardiac procedures, death, and 'events' are more common. Most humans have visible or measureable atherosclerosis by early middle age.
Chemistry
Which of the following is true concerning atherosclerosis?
Measuring the turnaround times of troponin tests from the emergency department would provide valuable information. This data represents circumstances in which patient safety may be compromised if results are delayed and treatment is not started as soon as possible.
A laboratory manager wants to evaluate the timeliness of patient services in order to prevent medical errors caused by delay in treatment. Measuring the turnaround time for which of these analytes would provide the most valuable information?
Insulin is the hormone that is mainly responsible for the entry of glucose into the cell for energy production
Glucagon and epinephrine promote glycogenolysis, conversion of glycogen to glucose, which increases plasma glucose. Cortisol, along with glucagon, increases gluconeogenesis, formation of glucose from noncarbohydrates, which also raises plasma glucose concentration.
Chemistry
Which of the following hormones is mainly responsible for the entry of glucose into the cell for energy production?
The presence of a clot is acceptable in:
Root cause analysis (RCA) is a structured study that determines the underlying causes of adverse events. RCA focuses on systems, processes, and common causes that were involved in the adverse event. It then determines ways to prevent recurrence by identifying potential improvements in systems and processes that should decrease the likelihood of repeating the event.
Failure mode and effect analysis (FMEA) is used to evaluate a process prior to its implementation. Its purpose is to identify ways in which a process might possibly fail with the goal being to eliminate or reduce the likelihood of such a failure.
Monitoring quality indicators is important in the maintenance of quality health care. Quality indicators should be identified to prevent medical errors from occurring or to prevent the recurrence of a quality issue. However, it is not the method that is used to evaluate an adverse event after it has occurred.
A medical record audit may be a part of a root cause analysis.
A medical event occurs that results in serious injury to a patient. All systems, processes, and common causes that were involved in the adverse event should be evaluated. A method that can be implemented to effectively study the underlying causes is known as:
Blood bank
Which of the following is the most common subgroup of A?
When an antigen comes in contact with the skin, the antigen is processed by cells in the epidermis and come in contact with T lymphocytes. T lymphocytes recognize the antigen as foreign and circulate through the bloodstream back to the epidermis and produce an inflammatory response to eliminate the antigen, but this immune response can produce a characteristic rash in the skin called contact dermititis.
Contact dermatitis is mediated by:
In healthy individuals, procalcitonin is only synthesized by the thyroid C cells. In bacterial infections, PCT is synthesized in various extrathyroidal neuroendocrine tissues.
In healthy individuals, procalcitonin is synthesized by which cells in the body?
In this case, with the pre-incubation aPTT mixing study result "corrected" and the post-incubation aPTT mixing study result "not corrected", a coagulation inhibitor should be suspected. Both anti-factor VIII and lupus anticoagulant have been known to be slow-acting and can exhibit this result pattern. If a factor deficiency was present, we should not see a post-incubation prolongation.
Hematology
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
Serum amylase and lipase levels may be slightly elevated in chronic pancreatitis, but not diagnostic enough to predict chronic pancreatitis; wheras high levels are found only during acute pancreatitis episodes. In the later stages of chronic pancreatitis, normal to decreased levels of amylase and lipase are caused by the gradual inability of the pancreas to secrete the enzyme
All of the statements below regarding amylase and lipase in pancreatitis are TRUE EXCEPT:
The document designed to protect phlebotomists from contacting hepatitis is the:
What two glycoproteins are expressed on the surface of influenza A viruses and are used for subtyping of the viruses?
Type I hyperlipoproteinemia is a form of hyperlipoproteinemia associated with deficiencies of lipoprotein lipase. Hyperlipoproteinemia type II is the most common form and is classified into type IIa and type IIb, depending on whether there is elevation in the triglyceride level in addition to LDL cholesterol. Hyperlipoproteinemia type III is associated with high chylomicrons and IDL. Hyperlipoproteinemia type IV is assoicated with high triglycerides. It is also known as hypertriglyceridemia. Hyperlipoproteinemia type V is similar to type I, but with high VLDL in addition to chylomicrons.
An obese adult with premature arteriosclerosis is seen in the clinic. When her serum is tested no chylomicrons are present, LDL are normal and VLDL are increased. There is an increase in triglycerides and slight increase in cholesterol. Lipoprotein electrophoresis reveals a heavy pre-beta band. She has no skin rash and uric acid is increased. This patient has a hyperlipoproteinemia with the MOST likely type of:
No HLA matching is performed for corneal tissue transplants as the cornea occupies a privileged site not usually seen by the immune system. This term has been coined "immune privileged".
Corneal tissue may be transplanted successfully from one patient to another because:
Thrombocytes, or platelets, are of course involved with hemostasis, not immunity.
Immunology
Which of the following would not be considered a part of the body's cellular immune system:
The approximate volume of CSF in an adult is 90-150 mL.
What is the approximate volume of spinal fluid in an adult?
The correct set of patient data would be: Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0%
Patients with sickle cell trait commonly have Hgb A values between 40 and 60%, Hgb S values between 20 and 40% and Hgb A2 values between 2 and 3%.
A known sickle cell trait patient has a hemoglobin electrophoresis test performed. Which of the following hemoglobin percentage sets would most closely match this patient's diagnostic state?
Osteoblasts are generally seen in clusters while plasma cells are often more diffusely distributed. Osteoblasts have delicate cytoplasm, whereas plasma cells have dense basophilic cytoplasm with a perinuclear halo.
Hematology
The large cell shown in the illustration to the right is occasionally seen in the bone marrow and can be mistaken for a plasma cell - what is this cell called:
Gating sets up boundaries around a subset of data points to segregate those events for analysis.
Gating the proper cell population is crucial for flow cytometric analysis. The CD marker information presented on the histogram data is only representative of the cells inside the gate.
When analyzing the raw data of a sample on the flow cytometer, CD marker information on the histograms represents data inside the _____ population.
Transfusion of red cells of any ABO type other than O to a group O patient is of course likely to cause a hemolytic transfusion reaction.
Which of the following types of packed RBCs could be transfused to a group O patient:
In combined fiscal years 2005 through 2009, transfusion-related acute lung injury (TRALI) caused the higest number of reported fatalities (48%), followed by hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%) incompatibilities. Complications of microbial infection, transfusion-associated circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller number of reported fatalities.
Match each of the descriptions with the appropriate magnification:
1. Color, Rouleau, Overall Slide Quality, Cell Distribution
2. Platelet estimates RBC-platelet-WBC morphology WBC differential RBC inclusions
3. Select area to examine, WBC estimate
Antidiuretic hormone, or ADH, has the important role of conserving body water by reducing the loss of water in urine by changing the water permeability of the distal tubule and collecting duct. An increase in ADH causes a concentrated urine since the water is retained and absorbed through the permeable membrane. An decrease in ADH causes the collecting ducts to retain very little water, instead it is excreted as urine.
Chemistry
Which of the following action describes the MAJOR property of antidiuretic hormone?
Serum calcitonin is normally produced by the C cells of the thyroid. It functions to reduce serum calcium by inhibiting release of calcium from bone. It is a peptide with a molecular weight of 3400, and has a half life of approximately 12 minutes. It is characteristically elevated in medullary carcinoma of the thyroid. Since medullary carcinoma often occurs as an autosomal disorder, family members of patients with this condition should be screened for serum calcitonin.
Serum calcitonin is typically elevated in which of the following conditions:
The intended response is "transfusion dimorphism". The microcytic, hypochromic erythrocytes suggests iron deficiency anemia. Interspersed among these cells are normocytic, normochromic erythrocytes suggesting two populations of red cells following transfusion. This was a case of severe iron deficiency treated with red cell transfusions and iron supplement.
The condition most likely associated with the peripheral blood picture in the photograph is:
Medical ethics
The cell depicted with the arrow in this image is an atypical (reactive) lymphocyte. These cells are common found in certain viral infections, especially infectious mononucleosis. Notice the larger size and abundant cytoplasm present in this lymphocyte. There is also apparent vacuoliation which is a key feature of atypical lymphocytes. The chromatin pattern of this cell as well as the overall shape, color and size rules out the monocyte, macrophage, and mesothelial cell choices.
A patient with an infectious mononucleosis infection presents in the emergency room. Physicians order a spinal tap which is immediately sent to the laboratory for review. Please identify the cell in the image below from this patient's cerebrospinal fluid sample.
The lecithin-sphingomyelin ratio is a test for assessing fetal lung maturity that is useful in determining risk of an infant born with respiratory distress syndrome.
The Lecithin/Sphingomyelin ratio determination of amniotic fluid is useful in assessing the probability of:
L/S ratio <2.0 indicates an increased risk of respiratory distress syndrome (RDS) at delivery. L/S ratio <1.5 indicates a very high risk of developing RDS.
Which of the following statements regarding the L/S ratio is TRUE?
The correct answer is highlighted below
A ratio of 2:1 or greater usually indicates adequate pulmonary surfactant to prevent respiratory distress syndrome (RDS)
A ratio of 1.5:1 indicates fetal lung maturity in pregnancies associated with diabetes mellitus.
Sphingomyelin levels increase during the 3rd trimester causing the L/S ratio to fall slightly during the last two weeks of gestation.
A phosphatidylglycerol (PG) spot indicates the presence of meconium in the amniotic fluid
Lecithin is in direct ratio with sphingomyelin
Heparin contamination is characterized by an elevation in the aPTT test and can also cause an increased PT test as well. Reptilase time tests are used to elimate the effects of heparin contamination as the reagents and method are resistant to the effects of antithrombin III, unlike the PT and aPTT tests. Therefore, it would be expected that a patient sample containing pre-analytical heparin contamination will show an increased aPTT (and sometimes PT as well) while showing a normal reptilase time.
A specimen drawn from an indwelling catheter that was contaminated by heparin would be indicated by:
The recommended disinfectant for blood and body fluid contamination is:
These are tyrosine crystals
Urinalysis & Other Body Fluids
True or false? Cystine crystals are present on this slide.
The antiglobulin test may be omitted from the serological crossmatch if the patient's antibody screen is negative and there is no history of detection of unexpected antibodies.
Blood Bank
What must be true for the antiglobulin phase of the serologic crossmatch to be omitted (i.e., immediate spin crossmatch is done)? Please select all correct answers
Anything that can cause significant turbidity in a blood sample, such as high leukocyte count or lipemia can potentially interfere with the accuracy of a spectrophotometric hemoglobin assay.
Hematology
Which of the following may interfere with the accurate measurement of hemoglobin: