Clin DX- Labs
Terms
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- Fasting time for a Lipid panel
- 12 hrs
- Fasting time for a fasting glucose
- 8 hrs
- Fasting timeS for glucose tolerance
- 30 min, 1 hr, 2 hr, 3 hr
- You are asked to draw blood but not told what tubes. Which tubes should you automatically get?
-
-red
-blue
-purple - What is the difference btwn plasma and serum?
- -plasma contains clotting components and serum does not
- Red top tube
-
-no anticoag
-serum
-added clotting factors so will clot - Blue top tube
-
-uses sodium citrate as anticoag so that clotting factors will be perseved
-evaluates for the ability of the blood to clot
-used for PT, INR, PTT - Purple top tube
-
-contains anticoag EDTA
-perserves the cells
-used for CBC - EDTA
-
-anticoagulating agent
-blocks the binding of Ca2+ - T/F: You can use a purple top tube for coagulation studies
- False: Ca2+ is a coagulation factor and you are blocking it with EDTA
- Tiger top tube
-
-aka serum separator
-contains a gel that forms a barrier btwn the serum and cells - Gray top tube
-
-contains NaF oxidase
-prevents glycolysis
-used for glucose tolerance testing - Yellow top tube
-
-used for blood culture
-use aerobic or anaerobic bottles - Green top tube
-
-contains heparin, prevents clotting
-provides plasma-ammonia & carboxyhemoglobin testing
-can order a platelet count - 45% of the blood is...
- -RBCs, WBCs, and platelets
- 55% of the blood is...
- -Plasma (which is 90% water)
- 10% of the blood is...
- -proteins, salts, enzymes, lipids
- Hematology
- -study of the formed elements in the blood
- Blood collected w/o an anticoag produces...
- -serum
- Blood collected w/ an anticoag produces...
- -plasma
- Buffy coatq
-
-middle layer after centrifuge
-contains WBCs and platelets - With high sensitivity, people with the disease will test...
- -positive (there are few false negatives)
- With high specificity tests, people will test...
-
-negative (few false positives)
-used to confirm dx - As cells mature, the nucleus gets ____ and the cytoplasm gets _____
-
-nucleus gets smaller
-cytoplasm gets larger - Granulocytes
-
-neutrophils
-eosinophils
-basophils
-possess a multilobed nucleus - Agranular, mononuclear cells
- -lymphocytes
- Neutrophils aka...
-
-polys
-segs
-PMN - WBCs are highest at...
- -birth
- Hb highest at...
- -birth
- Panic values of Hb
-
<8
>20 - Hct
-
-usually 3x the Hb
-panic: <24% - MCV
-
-ave vol of red cells
MCV = (Hct x 10) / RBC - MCH
-
-wt of Hb of the ave RBC
MCH= (Hb x 10) /RBC - MCHC
-
-ave conc of Hb in a give vol of red cells
MCHC = (Hb x 100)/ Hct - RDW
-
-red cell distribution width
-measures anisocytosis
-helps in distinguishing Thalessemia from Fe def.
-NL = 11.5-14.5 - Critical values of platelets
-
<50,000
> 1 million - The more mature the neutrophil, the more lobulations of the...
- -nucleus
- mature neutorphils are called...
- segs
- immature neutrophils are called...
- bands
- Left shift of neutrophils
-
-less mature forms are released
-seen in inflammation and hemorrhage - right shift of neutrophils
-
-release of hypersegmented ones
-seeen in megablastic anemias and liver disease - What do eosinophils respond to?
-
-NAACP
-counts are lower in the morning - What do basophils contain?
-
-heparin
-histamine
-serotonin - neutrophilia
- -increase in absolute number in response to invading organisms or tumor cells
- neutropenia
- -may be due to decreased production, excess stored in blood vessel margin,
- eosinophilia
- -NACCP and PIE
- eosinopenia
- -steriods, drugs, prostaglandins, stress, burns
- Monocytosis
- -recovery state of acute infection, TB, subacute endocarditis
- monocytopenia
- -prednisone treatment, RA, hairy cell leukemia
- Lymphocytosis
- -inverted or reversed diff, ALL, CLL, viral
- Lymphopenia
- -chemo, radiation
- Thrombocytosis
- -sudden exercise, post trauma, post-surgical esp. after splenectomy
- Thrombocytopenia
- -ITP, TTP, DIC, burns, snakes and insect bites, marrow suppressants
- Anisocytosis
-
-variation in size of RBC
-normocytic
-microcytic
-macrocytic - Ex of microcytic anemias
-
-Thalassemia
-Fe def - Ex of macrocytic anemia
- -folate def
- Poikilocytosis
-
-variation in shape of RBC
-spherocyte
-ovalocyte
-target cells
-schistocytes
-acanthocytes
-stomatocytes
-hemet cells - basophilic stippling
-
- numerous dark purple dots throughout the RBC
-Lead or heavy metal poisoning, thalassemia - Howell-Jolly Bodies
-
- small dark purple dot near RBC periphery, represent a DNA remnant
-post splenectomy - Pappenheimer bodies
-
-aka siderocytes
- bluish, purple dots in small groups in the RBC, represent iron particles - Heinz Bodies
-
-denatured or precipitated protein
-G6PD Deficiency, drug-induced hemolytic anemia - Rouleaux Formation
-
- stack of coins, due to abnormal proteins
-multiple myeloma - Reticulocytes
-
-last stage of development prior to becoming a mature RBC
-have remenant of RNA - reticulocyte count
- -measures the ability of the bone marrow to react to anemia and make RBCs
- Why do a Sed rate?
-
-Inflammation and necrotic processes cause an alteration in blood proteins resulting in the aggregation of red cells
-Sed rates should not be performed on blood older than 12 (4) hours. - Major systems involved for maintaining hemostasis
-
-vascular
-platelets
-coagulation
-finbrinolosis - bleeding from aterioles produce...
- -petechia
- bleeding from venules produce...
- -ecchymosis
- all coagulation factors are produced in the liver except...
- -factor VIII
- What is the end stage of both intrinsic and extrinsic coagulation?
- -fibrinogen
- PTT tests for all factors but...
- -III and VII
- PT tests for...
- -I, II, V, VII, and X
- PT tests for which coagulation system?
- -extrinsic
- PTT tests for which coagulation system
- -intrinsic
- Coag factor III is
-
-tissue factor
-aka thromboplastin - Coag factor VII
- -stable factor
- Coag factor IV
- -Ca 2+
- Coag factor VIII
- -antihemophilic factor
- what is an antidote to Vit K
- -warfarin
- What interfers with PT
-
-ETOH
-high fat diets or green veggies
-drugs - INR
-
-International Normalized Ratio
- standardizes the results from lab to lab - What is bleeding time an indicator of?
- -platelet function
- Heparin
-
-accelerates the binding of antithrombin III to thrombin
-antidote: protamine sulfate - Fibrin D-dimers are increased where?
- -DIC, PE, and DVT
- What is thrombin time used for?
- -Used to detect presence of heparin, decreased fibrinogen, aids in evaluation of prolonged PTT.
- What labs should you order with bleeding disorders?
- -CBC with diff, platelet count, bleeding time, PT, PTT, TT
- Myelopoesis
-
-production of neutrophils, eosinophils, basophils, and monocytes
-maturation process takes 7-10 days - components of a CBC
-
-total WBC
-total RBC
-Hb
-Hct - Hb consists of...
- -globin, protoporphyrin, and iron
- Hct is increased in...
- -polycythemia vera, smokers, high altitudes, dehydration
- Hct is decreased in...
- -folate def anemia, blood loss, drug or alcohol addiction, Fe def or sickle cell anemia, pregnancy
- How do you differentiate btwn Thalassemia and Fe def anemia?
-
-use the RDW
-Thalessemia: NL RDW
-Fe def: high RDW - T/F: Eosinophils are bacterial-cidal
- False: are phagocytic, but only Ag-Ab complexes
- Basophilia
- - CML, Hodgkin’s disease
- Basopenia
- -hyperthyroidism, acute phase of infection, stress
- The largest cell of NL blood...
- -the monocyte
- What is the monocyte's job?
-
-to remove dead cells from circulation
-NL 2-6% - When monocytes go to the tissues they are...
- -macrophages
- B cell lymphos
- -involved with ab response to ag
- T cell lymphos
- -involved in cell mediated immunity
- Amt of lymphos in circultion
- -20-40%
- Atypical lymphocytes found in...
- -infectious mono, CMV infection, viral hepatitis, toxoplasmosis
- Erythropoesis
-
-red blood cell production in the bone marrow
-Cells develop through four stages of mitosis
-taking 4-5 days - Ave lifespan of erythrocytes?
- -120 days
- spherocyte
-
-no central area of pallor
-osmotic fragility (can burst)
-hemolytic anemia, ABO transfusion reactions - ovalocytes
-
-oval shaped with white centers
-sickle cell, Fe def, thalessemia, megaloblastic anemia - target cells
-
-small clump of Hb in center surrounded by pallor
-Liver disease, thalessemias, hemoglobinopathies, post-splenectomy - schistocytes
-
-fragmented cells
-prosthetic heart valves - Burr cells
-
-rounded projections
-Severe liver disease, uremia, DIC, TTP, carcinoma - acanthocytes
-
-thorny projections
-anorexia, severe burns and hypothroidism - tear drop cells
- -fibrotic bone marrow, ineffective erythropoesis
- stomatocytes
-
-smiley cells bc of the slit-like area of pallor
-liver disease, artifact, lupus - Helmet cells
-
-Pac man
-G6PD crisis, DIC, pulmonary emboli - What disease would a Sed rate be useful?
-
-polymyalgia rheumatica
-temporal arteritis - Sed rate is increased in...
- -infection, inflammation, multiple myeloma, macrocytic disorders, acute MI
- Sed rate is decreased in...
- -microcytic disorders, polycythemia vera, hereditary spherocytosis, sickle cell anemia, hemoglobin C disease
- Sed rate is NL in...
- -allergies, viral infections, cirrhosis, malaria
- Green pee
- -pseudomonas
- Red pee
- -ingestion of beets
- orange pee
- -pyridium
- brown pee
- -macrodantin
- intense yellow pee
- -riboflavin
- pee that smells aromatic
- -NL
- pee that smells like acetone
- diabetics
- pee that has a foul odor
- UTI
- pee that has a fecal odor
- fistula
- NL pH of pee
- 4.6-8
- NL specific gravity of pee
-
-1.005-1.030
-Measures the concentration of particles in urine
-Reflects renal ability to concentrate urine and hydration status - Leukocyte esterase
- -Purple (+) for presence of leukocytes, 90% accurate
- nitrite
- -If pink(+), indirectly suggests presence of bacteria
- Blood-Hemoglobin/myoglobin
-
-always be sure to correlate with microscopic.
-If (+) consider infection, nehprolithiasis, menses, exercise regimen - Protein
- -normally NOT in urine, present if glomerular membrane is damaged-check
- glucose
- -blood glucose > 180 it will exceed renal threshold and spill into urine
- ketones
- --(+) in uncontrolled DM, alcoholism, fasting/starvation states, High protein diets, acute febrile illness
- Bilirubin
- -(+) may be seen in liver disease, gallstones, drug toxicity
- urobilinogen
- -If(+) consider hemolysis
- For casts to form...
-
-pH must be acidic and urine must be concentrated
-proteinuria - T/F: all areas above the urethra are sterile
- true
- If you see a UTI in a younger male, you should consider...
- STD
- How many organisms would you find on a contaminated plate?
- three or more
- What will appear in urine 10 days after conception?
- -B-HCG
- aspermia
- -no sperm seen
- oligospermia
- -count is <20 million
- asthenospermia
- -poor mvmt
- tetarozoospermia
- -abn morphology
- In the Gram stain, you first fix with...
- methanol
- The second stain you use in the Gram stain is...
- -crystal violet
- The third fixing agent in the Gram stain is...
- -iodine
- The counterstain in the Gram stain process is...
- -safranin
- gram + cocci in clusters
- staph
- gram + cocci in chains
- strep
- gram + diplococci
- strep pneumonae
- gram - diplococci
- neisseria
- gram - coccobacillary
- haemophillus
- Giemsa stain
- -used to identify intracellular organisms such as Chlamydia, malaria, parasites
- Acid-fast stain
-
-carbolfuschin
-acid ETOH
-brillant green
acid fast- dark red to pink
non- green - enriched agar
- -most commonly used for primary culture
- selective agar
-
-selects for certain organisms while inhibiting others
-ex: MacConkey, Martin-Lewis, CNA - differential agar
-
-colonies of one organism are distinct from colonies of another
-ex: MacConkey, Hektoin - What org is catalase +?
- -staph
- What org is catalast -?
- strep
- What org is coagulase +?
- -staph
- When using a P disc, a 14mm inhibition zone is indicative of what?
- -strep
- MIC
- -lowest concentration of antimicrobial agent that will inhibit bacterial growth
- MBC
- -lowest concentration of antimicrobial agent needed to yield a 99.9% reduction in colony
- serum cidal level
-
-Lowest dilution of a patient’s serum that kills a standard of inoculum of an organism
-monitors endocarditis, osteomyelitis, etc - Pathogens associated with prosthetic joints
-
-Staph epidermidis
-Staph aureus
-Cornybacterium sp.
-Propionibacterium sp - septicemia
- -Septicemia-the multiplication of bacteria in blood, bacteria or their products that cause damage to the host
- lumbar puncture showing PMNs, low glucose, high protein
- bacterial
- lumbar puncture showing lymphocytes, normal glucose, and normal to moderately elevated protein
- viral
- lumbar puncture showing low glucose and elevated protein
- fungal