Hanzely content for final Flashcards
Describe what happened regarding CLIA in 1967 and 1988
1) est. 1967: first US lab regulation law (because of high error rate in PAP smears)
2) 1988 Amendments:
-All labs require HHS certification (quality control and proficiency tests)
-Stratified requirements based on complexity of test
-Made to establish quality standards to have accurate and reliable results
Describe OSHA
1) Established in 1970 under Department of Labor
2) Ensures safe working conditions (provides training, education, and assistance)
3) Laboratory Safety Guidance (to deal with hazards):
Engineering controls (fume hoods)
Administrative controls (standard procedures)
Work practices (defining safe/proper tasks)
PPE
Hygiene plans
Bloodborne pathogen and needlestick injury policy
What does HIPAA do and what are its requirements for labs?
1) Regulates handling of identifiable health information
Individuals’ privacy rights to understand and control how their health info is used
2) Laboratory specific requirements:
Patients have right to access reports (does not need to be interpreted)
Complete record must be accessible (orders, provider info, billing, insurance)
30-day processing time (one extension of 30 days allowed if pt is provided with reasoning and expected day for providing access)
Provider can disclose reports for treatment purposes with reasonable safeguards without pt consent (consulting with other providers)
Define:
1) Reference range
2) Therapeutic range
3) Accuracy
4) Sensitivity
5) Specificity
1) Reference range: normal range (95% of health population)
2) Therapeutic range: dosage/concentration to achieve desired effect
3) Accuracy: “trueness” of a test
4) Sensitivity: true positive; ability of a test to correctly detect disease
Many false positives; few false negative
5) Specificity: true negative; ability of a test to identify people without disease
Many false negatives; few false positives
Define:
1) Precision
2) Prevalence
3) Incidence
Precision: reproducibility of a test
Prevalence: all cases in time period
Incidence: new cases in time period
Define vacutainer
Vacutainer: sterile tube with colored stopper to create vacuum seal to draw blood
Color of top indicates additives in tube (for stabilizing or preserving)
What are the functions of the kidneys?
Function: maintain fluid environment of cells by adjusting excretion of water, electrolytes, and waste
Also secrete hormones for hemodynamics, RBCs, and bone metabolism
Describe renal presentation of kidney disease vs extrarenal
1) Renal: hematuria, flank pain
2) Extrarenal: edema, hypertension
Degree of disease needs to be established using GFR and urinary sediment
What is GFR?
Glomerular filtration rate (GFR)
Measures kidney filtration rate/efficiency (sum off all filtration rates in all functioning nephrons)
Normal values vary among individuals
Describe the general trends surrounding GFR
Declining GFR indicates kidney dysfunction; improving GFR means improving kidney function
Stable GFR doesn’t imply stable disease and normal GFR doesn’t always mean there isn’t underlying renal disease
How is GFR measured?
Indirectly measured through filtration markers (freely filtered at glomerulus and not secreted or reabsorbed by tubules) like:
-Creatinine Clearance (CrCl) (not perfect)
-Blood Urea Nitrogen (BUN) (inferior to creatinine)
-BUN/Cr ratio
Kidney disease ________________ the concentrating power of the kidney
diminishes
Reference ranges for blood:
1) pH
2) Specific gravity
1) 4.6 – 8.0 (average 7.0)
2) 1.005 – 1.030 *
True or false: Negative nitrite doesn’t rule out UTI
True [only produced by G-s]
Sulfosalicylic acid test (SSA) detects what?
All urine proteins [sensitive]
Specify whether each has a positive or negative reference value in urine:
1) Protein
2) Glucose
3) Ketones
4) RBCs
5) Crystals
6) Urobilinogen
7) Bilirubin
1) Negative
[not diagnostic]
2) Negative
[positive result is uncontrolled DM or newly dx DM]
3) Negative
4) Negative
5) Negative
6) Positive
7) Negative
When does glucose spillover into urine begin?
180mg/dL
Produced by breakdown of bilirubin in intestines. Reabsorbed and excreted in urine.
Increased amt suggests liver disease or hemolysis
These describe what?
Urobilinogen
Describe the different types of casts
Granular casts: disintegration of cells into granular particles
Waxy casts: further disintegration due to diminished urine flow through tubule (more time to degenerate)
Fatty casts: fatty deposits with protein. May be associated with long bone fractures.
WBC casts: pyelonephritis
RBC casts: glomerulonephritis
Differentiate b/t specific gravity and osmolality of urine
1) SG = size
2) Osmolality = number
What should you generally do if something is positive on a urine test?
24 hour collection [but do C&S for UTI]
Why may protein be in urine?
Glomerular or tubular dysfunction
What is released by lysed neutrophils and macrophages?
Leukocyte Esterase
Give examples for reasons for ketones to be present in urine
Uncontrolled diabetes mellitus [insulin deficit], alcoholism, fasting, starvation, high protein diet, certain pediatric illnesses
How does ketoacidosis affect pH?
Lowers it
Hemolysis and gallstones could cause what to be in urine?
Bilirubin
Decreased levels of urobilogen can indicate what?
Gallstones
Crystals in the urine indicate what?
Renal calculi
What kind of casts will you see with cellular damage?
Waxy brown
Squamous cells in urine indicate what?
Contamination
Macrocytic anemia has many causes, but usually is __________ or _______________ deficiency
Vit B12 or folate
List what is included in a CBC
RBC
Hemoglobin
Hematocrit
Platelets
RBC indices
MCV, MCH, MCHC, RDW
WBC count and differential
(Blood smear-WBC, RBC, PLT)-not on CBC
Insufficient iron intake, increased need, insufficient absorption, or increased blood loss can all lead to what?
Microcytic anemia
Aplastic anemia is the most common cause of what?
Pancytopenia [deficiency in all blood cell types]
[Toxin exposure, hereditary, autoimmune disorder. Often idiopathic.]
Low (or even normal) retic count in patient with anemia indicates what?
inadequate bone marrow response to the anemia
What are the Hct [hematocrit] reference ranges for men and women?
42-52%; female: 37-47% /“crit”
Thrombocytopenia (decreased platlet count) can be caused by what?
Cancer, clotting disorder, bone marrow failure, DIC, etc etc
What are 2 terms for increased platelets?
thrombocytosis
thrombocythemia
Iron deficiency anemia and cancer can both lead to what?
thrombocytosis
thrombocythemia
[+ various hematologic conditions can also do this]
1) Increased MPV may indicate what?
2) What abt decreased?
1) Massive hemorrhage, leukemia
2) Chemotherapy, myelosuppression, aplastic anemia
[-Increased MCV (macrocytic): Megaloblastic anemias like B12 or folic acid deficiency
-Decreased MCV (microcytic): Iron deficiency anemia or thalassemia]
Red blood cell distribution width (RDW) is useful in classifying anemias, and is high when?
in hemorrhaging
1) Average concentration of Hgb in 1 RBC relative to volume of the cell is called what?
2) Average amount of hemoglobin in an RBC is called what?
1) MCHC [Mean corpuscular hemoglobin concentration]
2) MCH
Macrocytic cells have more Hgb than microcytic cells, so ___________ values are consistent with MCV
MCH
What blood component will be elevated in chronic bacterial or acute viral infections?
Lymphocytes
1) Basophilia on its own [w/o eosinophilia] might indicate what?
2) What might lymphocyte elevation on its own indicate?
3) What abt PMN elevation?
1) Leukemia
2) Chronic lymphocytic leukemia (CLL)
3) CML [on differential] or AML [on blood smear]
1) Oval inclusions in WBCs due to severe stress (like burns) causing improper maturation are called what?
2) What WBC inclusion may indicate AML?
3) Which is Highly sensitive and specific for megaloblastic anemias?
1) Dohle bodies
2) Auer rods
3) Hypersegmented neutrophils
ALL more pediatric ; _________ more geriatric
AML
Should you use a blood smear for acute or chronic leukemia?
Acute
What is marked by the presence of Reed-Sternberg cells on biopsy?
[Mutated B-cells with “moth-eaten” appearance]
Hodgkin’s lymphoma (HL) 10%
[has a better prognosis]
1) What is calculated from PT in order to assess risk of bleeding/coagulation?
2) What does PTT measure?
1) International normalized ratio (INR) [1.0-1.3 reference range]
2) Factors VIII IX XI XII (8, 9, 11, 12)
What is used to determine cardiac risk factors (elevated: 3xs increased risk MI)?
CRP
Decreased hematocrit may indicate what?
Anemia
What are retics?
Immature RBCs [platelets can also be reticulated]
Acute leukemia may cause __________ WBCs, RBCs, and platelets
less
1) Transferrin (TIBC) measures what?
2) Transferrin saturation measures what?
1) Proteins available for binding [high indicates iron deficiency]
2) Percent of bound proteins
A faster ESR would indicate what?
Inflammation
What’s the difference between ESR and CRP?
CRP goes away quicker
An increase in PT/INR would indicate what?
Hypocoaguable state
PT includes what factors?
Factor 7 [plus common factors, so Factors I II V VII X]
What produces D-dimer?
Clot degradation
