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Clin DX- Labs

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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

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