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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?
What is the difference btwn plasma and serum?
-plasma contains clotting components and serum does not
Red top tube
-no anticoag
-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
-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
-study of the formed elements in the blood
Blood collected w/o an anticoag produces...
Blood collected w/ an anticoag produces...
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
-possess a multilobed nucleus
Agranular, mononuclear cells
Neutrophils aka...
WBCs are highest at...
Hb highest at...
Panic values of Hb
-usually 3x the Hb
-panic: <24%
-ave vol of red cells
MCV = (Hct x 10) / RBC
-wt of Hb of the ave RBC
MCH= (Hb x 10) /RBC
-ave conc of Hb in a give vol of red cells
MCHC = (Hb x 100)/ Hct
-red cell distribution width
-measures anisocytosis
-helps in distinguishing Thalessemia from Fe def.
-NL = 11.5-14.5
Critical values of platelets
> 1 million
The more mature the neutrophil, the more lobulations of the...
mature neutorphils are called...
immature neutrophils are called...
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?
-counts are lower in the morning
What do basophils contain?
-increase in absolute number in response to invading organisms or tumor cells
-may be due to decreased production, excess stored in blood vessel margin,
-steriods, drugs, prostaglandins, stress, burns
-recovery state of acute infection, TB, subacute endocarditis
-prednisone treatment, RA, hairy cell leukemia
-inverted or reversed diff, ALL, CLL, viral
-chemo, radiation
-sudden exercise, post trauma, post-surgical esp. after splenectomy
-ITP, TTP, DIC, burns, snakes and insect bites, marrow suppressants
-variation in size of RBC
Ex of microcytic anemias
-Fe def
Ex of macrocytic anemia
-folate def
-variation in shape of RBC
-target cells
-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
-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
bleeding from aterioles produce...
bleeding from venules produce...
all coagulation factors are produced in the liver except...
-factor VIII
What is the end stage of both intrinsic and extrinsic coagulation?
PTT tests for all factors but...
-III and VII
PT tests for...
-I, II, V, VII, and X
PT tests for which coagulation system?
PTT tests for which coagulation system
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
What interfers with PT
-high fat diets or green veggies
-International Normalized Ratio
- standardizes the results from lab to lab
What is bleeding time an indicator of?
-platelet function
-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
-production of neutrophils, eosinophils, basophils, and monocytes
-maturation process takes 7-10 days
components of a CBC
-total WBC
-total RBC
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
- CML, Hodgkin’s disease
-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...
B cell lymphos
-involved with ab response to ag
T cell lymphos
-involved in cell mediated immunity
Amt of lymphos in circultion
Atypical lymphocytes found in...
-infectious mono, CMV infection, viral hepatitis, toxoplasmosis
-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
-no central area of pallor
-osmotic fragility (can burst)
-hemolytic anemia, ABO transfusion reactions
-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
-fragmented cells
-prosthetic heart valves
Burr cells
-rounded projections
-Severe liver disease, uremia, DIC, TTP, carcinoma
-thorny projections
-anorexia, severe burns and hypothroidism
tear drop cells
-fibrotic bone marrow, ineffective erythropoesis
-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
Red pee
-ingestion of beets
orange pee
brown pee
intense yellow pee
pee that smells aromatic
pee that smells like acetone
pee that has a foul odor
pee that has a fecal odor
NL pH of pee
NL specific gravity of pee
-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
-If pink(+), indirectly suggests presence of bacteria
-always be sure to correlate with microscopic.
-If (+) consider infection, nehprolithiasis, menses, exercise regimen
-normally NOT in urine, present if glomerular membrane is damaged-check
-blood glucose > 180 it will exceed renal threshold and spill into urine
--(+) in uncontrolled DM, alcoholism, fasting/starvation states, High protein diets, acute febrile illness
-(+) may be seen in liver disease, gallstones, drug toxicity
-If(+) consider hemolysis
For casts to form...
-pH must be acidic and urine must be concentrated
T/F: all areas above the urethra are sterile
If you see a UTI in a younger male, you should consider...
How many organisms would you find on a contaminated plate?
three or more
What will appear in urine 10 days after conception?
-no sperm seen
-count is <20 million
-poor mvmt
-abn morphology
In the Gram stain, you first fix with...
The second stain you use in the Gram stain is...
-crystal violet
The third fixing agent in the Gram stain is...
The counterstain in the Gram stain process is...
gram + cocci in clusters
gram + cocci in chains
gram + diplococci
strep pneumonae
gram - diplococci
gram - coccobacillary
Giemsa stain
-used to identify intracellular organisms such as Chlamydia, malaria, parasites
Acid-fast stain
-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 +?
What org is catalast -?
What org is coagulase +?
When using a P disc, a 14mm inhibition zone is indicative of what?
-lowest concentration of antimicrobial agent that will inhibit bacterial growth
-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-the multiplication of bacteria in blood, bacteria or their products that cause damage to the host
lumbar puncture showing PMNs, low glucose, high protein
lumbar puncture showing lymphocytes, normal glucose, and normal to moderately elevated protein
lumbar puncture showing low glucose and elevated protein

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