956-1050 Flashcards
- STAT for the Latin word statim meaning immediately. Tests that fall into this category include:
Glucose in diabetic ketoacidosis
Some drug levels such as theophylline
Amylase in suspected pancreatitis
CK in suspected MI
Hematocrit
Blood gases
Potassium
- CRITICAL VALUES or PANIC VALUES: list of analytes that truly do have the potential to be lethal if unchecked for a short period.
- SCHILLING TEST: Laboratory determination of vitamin B12 absorption
- Hemostatic mechanisms comprise four (4) main systems: the vascular system, platelets, coagulation system and fibrinolytic system.
- OSMOLALITY
Osmolality = 2Na + ( Glucose/20 ) + ( BUN/3 )
Osmolality = 1.86Na + ( Glucose/18 ) + ( BUN/2.8 ) + 9
- ANION GAP (AG)
AG = Na - (Cl + HCO3)
AG = (Na + K) – (Cl + HCO3)
NORMAL URINARY CRYSTALS
962. Uric acid is alkali soluble
963. Amorphous urates - soluble in alkali and heat
964. CaOx - soluble in dilute HCl
965. Amorphous phosphates - soluble in dilute acetic acid
- Calcium phosphate - soluble in dilute acetic acid
- Triple phosphate - soluble in dilute acetic acid
- Ammonium biurate - soluble in acetic acid with heat
- Calcium carbonate - forms gas from acetic acid
ABNORMAL URINARY CRYSTALS
970. Cystine is soluble in ammonia, dilute HCl
971. Cholesterol is soluble in chloroform
972. Leucine is soluble in hot alkali or alcohol
973. Tyrosine is soluble in alkali or heat
- Bilirubin is soluble in acetic acid, HCl, NaOH, ether and chloroform
- Sulfonamides soluble in acetone
- Radiographic dye soluble in 10% NaOH
- Ampicillin crystals form bundles when refrigerated
- F. tularensis is a very small, strictly aerobic, coccoid to pleomorphic rod-shaped, gram-negative bacillus that requires CYSTINE or CYSTEINE for growth
- Legionella spp. may be isolated on BCYE agar supplemented with growth factors, including L-CYSTINE, FERRIC SALT, AND Α-KETOGLUTARATE.
- Bordetella spp. are strictly aerobic, nonfermentative, catalase-positive, minute coccobacilli requiring NICOTINIC ACID, CYSTEINE, and usually METHIONINE for growth.
- MEDICAL MALPRACTICE is misconduct or lack of skill by a health-care professional that results in injury to the patient.
- NEGLIGENCE, which is defined as failure to give reasonable care by the health-care provider, must be proven in a malpractice suit.
- SERUM or PLASMA is the specimen of choice for the determination of circulating concentrations of most drugs. THERAPEUTIC DRUGS, BISHOP
- Analysis for the presence of ABUSED SUBSTANCES has focused primarily on the use of URINE as the test sample of choice. The urine specimen represents the net load of the drug over a long period, whereas the blood sample provides only a quick picture of the drug level at a specific time. DRUGS OF ABUSE, CALBREATH
- CHAIN OF CUSTODY
Processing steps for such specimens—initial collection, transportation, storage, and analytical testing— must be documented by careful record keeping. Documentation ensures that there has been no tampering with the specimen by any interested parties, that the specimen has been collected from the appropriate person, and that the results reported are accurate.
Each step of the COLLECTION, HANDLING, PROCESSING, TESTING, AND REPORTING PROCESSES must be documented; this is called the chain of custody.
- RICE BODIES are fragments of degenerating proliferative synovial cells or microinfarcted synovium.
- OCHRONOTIC SHARDS, ground pepper appearance from pigmented cartilage fragments may be the result of a metabolic disorder (i.e., ochronosis).
- PROBLEMS: RBCs appear gray, WBCs are too dark, eosinophil granules are gray, not orange.
CAUSES: Stain or buffer too alkaline (most common), inadequate rinsing, prolonged staining, heparinized blood sample. - PROBLEMS: RBCs are too pale or are RED, WBCs are barely visible.
CAUSES: Stain or buffer too acidic (most common), underbuffering (too short), over-rinsing.
- HBeAg indicates HIGH INFECTIVITY.
- CORDOCENTESIS, or percutaneous umbilical blood sampling (PUBS).
SPECIAL URINE PRESERVATIVES
992. Formaldehyde – for Addis count
993. HCl – for epinephrine, norepinephrine, catecholamines, vanillylmandelic acid
994. Glacial acetic acid pH 4.5 – for aldosterone
995. Sodium carbonate – for porphyrins and urobilinogen (to ensure alkalinity)
- Glacial acetic acid pH 2.0 – for serotonin
- Conc. HCl – for steroids, ammonia, urea, total nitrogen
- Chloroform – for aldosterone
- Sulfuric acid – preserves calcium and other inorganic constituents
- Sodium fluoride or benzoic acid – ideal for glucose analysis, prevents glycolysis
- DILUTION is an INDICATION OF RELATIVE CONCENTRATION
- RATIO is an expression of one amount relative to another amount (AMOUNT/AMOUNT)
- CONCENTRATION is the amount of one substance relative to the amounts of other substances in the solution (AMOUNT/SOLUTION)
- MOLARITY is the gram-molecular mass (or weight) of a compound per liter of solution
- SODIUM is the most abundant extracellular cation. It contributes to the osmolality of extracellular fluid and maintains the volume of ECF and cell size and shape. Sodium is essential for transmitting nerve impulses.(Hubbard)
- POTASSIUM is the major intracellular cation that regulates activity at the neuromuscular junction, as well as cardiac muscle contraction and pH. (Hubbard)
- POTASSIUM is an INTEGRAL PART OF NERVE IMPULSE TRANSMISSION. (Calbreath)
- CHLORIDE is the major extracellular anion that acts to maintain osmotic pressure, keeps the body hydrated, and maintains electric neutrality via interaction with sodium or carbon dioxide.
- BICARBONATE is the second most abundant anion in the extracellular fluid. It is a major component of the blood buffering system, accounts for 90% of total blood carbon dioxide, and maintains charge neutrality in the cell.
- Assays for bicarbonate (carbon dioxide)
Assay as carbon dioxide (1) measure carbon dioxide with ion-selective electrode and (2) diffuse carbon dioxide into solution containing PHENOLPHTHALEIN indicator.
Enzymatic assay for bicarbonate.
- Regulation of aldosterone secretion via the renin/angiotensin system is achieved as follows:
Decreased blood volume or blood pressure induces the release of kidney renin, which induces the production of angiotensin I and II.
Angiotensin II affects release of aldosterone from the adrenal gland, which ultimately causes the kidney distal tubule to RETAIN SODIUM, thereby raising blood volume and blood pressure.
- CHYLOMICRONS are large molecules that contain mostly triglyceride.
- VLDLs are smaller than chylomicrons. They contain mostly endogenous triglyceride, are made in the liver, contain equal amounts of phospholipids and cholesterol, and degrade to LDLs in the circulation.
- LDLs contain mostly cholesterol, with equal amounts of phospholipid and protein and some triglyceride.
- HDLs contain mostly protein, some cholesterol, and a little triglyceride.
- Sterile normal saline, containing 9 grams of salt per liter or 1000 mL (0.90% NaCl).
- Pulmonary secretions may be obtained by any of the following methods:
Spontaneously produced or induced sputum, gastric lavage, transtracheal aspiration, bronchoscopy, and laryngeal swabbing.
Most specimens submitted for examination are sputum, aerosol-induced sputum, bronchoscopic aspirations, or gastric lavage samples.
Spontaneously produced sputum is the specimen of choice. (Bailey)
- Induced Sputum: Aerosol-induced specimens are collected by allowing patients to breathe aerosolized droplets of a solution containing 15% sodium chloride and 10% glycerin for approximately 10 minutes or until a strong cough reflex is initiated.
- Aerosol-induced sputum are collected by allowing the patient to breathe aerosolized droplets, using an ultrasonic nebulizer containing 10% 0.85% NaCl or until a strong cough reflex is initiated.
- ASCARIS EGGS: In the soil, it takes about two to three weeks for eggs to develop into the infective stage (embryonation) under favorable conditions with suitable temperature, moisture and humidity. The embryonated eggs can survive in moist shaded soil for a few months to about two years in tropical and subtropical areas, but for much longer in temperate regions. (Belizario)
- The mode of transmission of Fasciola hepatica and F. gigantica is by ingestion of metacercaria encysted on edible aquatic plants or by drinking water with floating metacercariae.
- FASCIOLA GIGANTICA is the dominant species in the PHILIPPINES, affecting CATTLESand water buffaloes. There are only few human cases reported locally.
- Human infection with F. hepatica also called the sheep liver fluke is now considered a global zoonosis. In countries like Bolivia, Ecuador, Islamic Republic of Iran and Yemen, human fascioliasis usually parallel the prevalence of infection in SHEEP and other ruminants like GOATS, CATTLE, BUFFALOES and HORSES.
- PULMONARY PARAGONIMIASIS may coexist with other infections, particularly PTB.
Definitive diagnosis is based on the detection of eggs in sputum, stool or in aspirated material from abscess and pleural effusions.
An equal amount of 3% NaOH is added to the sputum, and this is followed by standing and centrifugation.
- Diphyllobothrium latum egg: OVA are usually yellowish brown, with a moderately thick shell and an inconspicuous operculum. Opposite the operculum is a small knob-like thickening (aboperculum).
- LIFE CYCLE OF ECHINOCOCCUS GRANULOSUS: The adult E. granulosus resides in the small bowel of the definitive hosts, dogs or other canids. Gravid proglottids release eggs that are passed in the feces. After ingestion by a suitable intermediate host (under natural conditions: sheep, goat, swine, cattle, horses, camel), the egg hatches in the small bowel and releases an oncosphere that penetrates the intestinal wall and migrates through the circulatory system into various organs, especially the liver and lungs. In these organs, the oncosphere develops into a cyst that enlarges gradually, producing protoscolices and daughter cysts that fill the cyst interior. The definitive host becomes infected by ingesting the cyst-containing organs of the infected intermediate host. After ingestion, the protoscolices evaginate, attach to the intestinal mucosa, and develop into adult stages. (CDC)
Definitive host: DOGS (infective stage to DH, hydatid cyst)
Intermediate host: SHEEP (Infective stage to IH, eggs)
Accidental intermediate host: MAN
Found in the IH: HYDATID CYST
- PYURIA: presence of pus (leukocytes) in the urine; indicates a possible urinary tract infection.
- When an accident involving electrical shock occurs, the electrical source must be removed immediately. TURNING OFF THE CIRCUIT BREAKER, UNPLUGGING THE EQUIPMENT, or moving the equipment using a nonconductive glass or wood object are safe procedures to follow. (Strasinger)
- Before REPAIR OR ADJUSTMENT of electrical equipment is attempted, the following should be done (a) unplug the equipment, (2) make sure the hands are dry, and (3) remove jewelry. (Rodak)
- Increased casts in ATHLETIC PSEUDONEPHRITIS and in some diuretic therapies.
- ANAEROBES usually cannot grow in the presence of O2, and the atmosphere in anaerobe jars, bags, or chambers is composed of 5% to 10% hydrogen (H2), 5% to 10% CO2, 80% to 90% nitrogen (N2), and 0% O2
- Venipuncture (Bishop/Rodak)
Veins at the antecubital region: MEDIAN CUBITAL VEIN - preferred vein, cephalic vein-second choice, and basilic vein - third choice.
Three alternate sites (RODAK) If a vein cannot be located in either arm, it may be necessary to examine the veins on the dorsal side of the wrist and hand (1st and 2nd alternate sites). The veins in the feet (3rd alternate site) should not be used without physician permission. The policy in some institutions is to request that a second phlebotomist attempt to locate a vein in the arm before a vein in one of these three alternate sites is used.
Drawing blood from an arm with an intravenous catheter should be avoided if possible. The arm opposite the arm with the intravenous line should be used. If there is no alternative, blood should be drawn below the catheter with the tourniquet placed below the catheter site. It is preferable to have the nurse stop the infusion for 2 minutes before the specimen is drawn. The CLSI recommends that 5 mL of blood be drawn for discard before samples to be used for testing are obtained. It is important to note on the requisition and the tube that the specimen was obtained from an arm into which an intravenous solution was running.
- WEDGE SMEAR: Keep the spreader slide at a 30 to 40 degree angle and the edge of the slide firmly against the horizontal slide, push the spreader slide rapidly over the entire length of the slide. (push spreader slide RAPIDLY). The tail of the film should be SMOOTH. Barbara Brown
- RBC indices are used to define the size and hemoglobin content of RBCs. They consists of MCV, MCH and MCHC. The indices are commonly used as an aid in diagnosing and differentiating anemias. (Brown)
- The MCH is much less valuable to the clinician than the MCV and MCHC.
- Although CYTOKINES are produced by many cell populations (endothelial cells, fibroblasts, epithelial cells, and others), they are MAINLY THE PRODUCTS OF HELPER T CELLS (TH) AND MACROPHAGES. (Henry)
- CHEMOKINES are a family of cytokines that enhance motility and promote migration of many types of white blood cells toward the source of the chemokine (chemotaxis).
- Since the cloning in 1990 of the complementary DNA corresponding to messenger RNA transcribed at the blood group ABO locus, more than 200 ABO alleles have been identified by molecular investigation. The SEVEN (7) common ABO alleles include A1, A1variant (A1v), A2, B1, O1, O1variant (O1v), and O2. (SEVEN common ABO alleles/Harmening 6th ed)
- Concentration of ALCOHOL as fixatives: It must be used in concentrations ranging from 70 to 100% because less concentrated solutions will produce lysis of cells.
Ethyl alcohol 70 to 100%
Methyl alcohol 100%
Isopropyl alcohol 95%
- Carnoy’s fluid (alcoholic fixative) preserves nucleoproteins and nucleic acids.
- ABSCESSES are localized collections of purulent inflammatory tissue caused by suppuration buried in a tissue, an organ, or a confined space. Abscesses have a central region that appears as a mass of necrotic leukocytes and tissue cells. There is usually a zone of preserved neutrophils around this necrotic focus, and outside this region vascular dilation and parenchymal and fibroblastic proliferation occur, indicating chronic inflammation and repair.
- ULCER is a local defect, or excavation, of the surface of an organ or tissue that is produced by the sloughing (shedding) of inflamed necrotic tissue.
- GRANULOMA is a focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells.
- LANGHAN’S GIANT CELLS in tuberculosis.
- CROHN’S DISEASE: inflammatory bowel disease. Immune reaction against intestinal bacteria.
- CHED Memo Order No. 14 s2006: Policies, Standards and Guideline for MT Education
- CHED Memo Order No.6 s2008: All tertiary clinical laboratories licensed by DOH thru BHFS shall apply for accreditation with CHED as training laboratories for interns. (unless stated that according to RA 5527, BRL)
- EXECUTIVE ORDER NO. 266: Institutionalization of the Continuing Professional Education (CPE) Programs of the various Professional Regulatory Boards (PRBs) under the Supervision of PRC
- License to operate (LTO) a clinical laboratory must be displayed at all times at a PROMINENT PLACE WITHIN THE LABORATORY PREMISES. AO 2007-27: Revised Rules and Regulations Governing the Licensure and Regulation of Clinical Laboratories in the Philippines.
- Classification of Blood Service Facilities (BSF) according to Service Capability:
a. Blood Station (BS):
Advocacy and promotion of voluntary blood donation and healthy lifestyle
Provision of whole blood and packed red cells
Storage, issuance, transport and distribution of whole blood and packed red cells
Compatibility testing of red cell units, if hospital based.
b. Blood Collection Unit (BCU):
Advocacy and promotion of voluntary blood donation and healthy lifestyle
Recruitment, retention, and care of voluntary blood donors; screening and selection of voluntary blood donors
Conduct health education and counseling services
Collection of blood (mobile or facility-based) from qualified voluntary blood donors
Transport of blood to BC for testing and processing; compatibility testing of red cell units, if hospital based.
c. Blood Bank (BB):
Advocacy and promotion of voluntary blood donation and healthy life
Storage and issuance of whole blood and blood components obtained from a BC
The following services shall also be provided:
Compatibility testing of red cell units
Direct Coomb’s test
Red cell antibody screening
Investigation of transfusion reactions and assist the Hospital Blood Transfusion Committee (HBTC) in the conduct of post-transfusion surveillance (hemovigilance)
d. Blood Center (BC):
Advocacy and promotion of voluntary blood donation and healthy lifestyle
Recruitment, retention, and care of voluntary blood donors; collection of blood (mobile or facility-based) from qualified voluntary blood donors
Conduct health education and counseling
Testing of units of blood for transfusion-transmitted infections (TTIs)
Processing and provision of blood components; storage, issuance, transport and distribution of units of whole blood and/or blood products to hospitals and other health facilities
