Lab MT 1 Review Flashcards
An anticoagulated tube of blood is drawn on a patient. What type of blood specimen would be found in the upper portion of the tube after centrifugation?
plasma
When performing venipuncture, some patients may have difficult veins to locate and access. This increases the risk for a compromised blood specimen as pictured here in the attached image. In this image, specimen 1 is normal and can be compared to increasing amounts of ____ seen in specimens 2,3, and 4.
hemolysis
- ruptured RBCs release hemoglobin (red/pink appearance of plasma/serum)
- releases K+ and LDH
A 5 y.o. female child is brought to a walk in Urgent Care clinic at 2:00 am by her parents. They say she has been running a fever for the past two days, fluctuating between 100.0 - 101.5 degrees. Their child woke up crying in the night and her fever was up to 103.2 degrees. They could not console her and felt it best that they immediately bring her in for medical care. Blood work is obtained and the results of the CBC are attached.
What clinical term applies to the total WBC count?
^WBC = leukocytosis
_WBC = leukopenia
A 5 y.o. female child is brought to a walk in Urgent Care clinic at 2:00 am by her parents. They say she has been running a fever for the past two days, fluctuating between 100.0 - 101.5 degrees. Their child woke up crying in the night and her fever was up to 103.2 degrees. They could not console her and felt it best that they immediately bring her in for medical care. Blood work is obtained and the results of the CBC are attached.
Based on this child’s presentation & CBC findings, what is your best possible diagnosis at this time?
Acute bacterial infection
When drawing multiple tubes of blood on a patient, careful consideration is necessary to draw the required tubes in the appropriate order. Why is it necessary to always consider the order of the draw?
to prevent additive carryover as tubes come off and on the apparatus
What can a phlebotomist do to help prevent the patient’s vein from rolling away from the needle?
Use tissue pull/traction vein downward
Certain blood tests in certain clinical situations may be obtained by performing a dermal puncture. This may be done as a finger prick on an adult or a heel stick on a baby. What type of blood specimen is obtained with a dermal puncture?
capillary blood
Name two types of PPEs (personal protective equipment) used when performing phlebotomy.
- gloves
- masks
- lab coat (protective clothing)
- protective eyewear
A venipuncture is performed and a tube without anticoagulant is obtained on the patient. The blood is allowed to clot and is centrifuged as seen in the attached image. What type of blood specimen would be available for laboratory testing in the upper part of the tube?
serum
A 56 y.o. male patient arrives by medevac at a trauma center after being involved in a serious car accident. His injuries are severe and he has lost a very significant amount of blood. A blood transfusion of packed red blood cells is immediately started. What other component/product will be administrated to help bring up his blood volume as quickly as possible?
Fresh frozen plasma
A patient did not comply with fasting directions before having their blood tests drawn. In the attached image, the resulting tube is shown above with a normal blood specimen shown below for comparison. What clinical term refers to the change in appearance of this patient’s specimen which may compromise the reliability of their laboratory tests?
lipemia
A 68 y.o. female patient is being readied for open heart surgery. The blood bank receives orders to type and crossmatch 4 units of blood for the patient. The patient types as B positive.
List any ABO and Rh antigens present on the patient’s red blood cells.
ABO antigens: B
Rh antigens: D
A 68 y.o. female patient is being readied for open heart surgery. The blood bank receives orders to type and crossmatch 4 units of blood for the patient. The patient types as B positive.
List any ABO and Rh antibody that would currently be in her plasma.
ABO antibodies: anti-A
Rh antibodies: none
Fill in the blanks (1) and (2) for the following statement using either the word antigens OR antibodies.
When the blood bank performs the type and crossmatch to find four compatible units of blood for this patient, the donor’s ____ (1) must be compatible with the patient’s ____(2)
(1) antigens
(2) antibodies
The antibodies associated with the ABO system are unique in that they are referred to as “naturally occurring”. Please briefly describe what this means. (In other words, how do these antibodies differ from the immune antibodies associated with the Rh system)
ABO = born with
Rh = immunity only produced after contact/exposure with antigen
The CBC report on a patient’s initial blood work evidences anemia. Patient and family history gives concern for a possible hemoglobinopathy or thalassemia as the underlying cause. What further test would be ordered as the definitive evidence for diagnosis?
Hemoglobin electrophoresis
Observe the CBC report attached here. Classify the anemia using the appropriate clinical terms which apply to the RBC indices.
- _MCV
- _MCH/C
Iron deficiency anemia
= microcytic + hypochromic
Observe the CBC report attached here. Classify the anemia using the appropriate clinical terms which apply to the RBC indices.
- ^MCV
megaloblastic anemia
= macrocytic
Observe the CBC report attached here. Classify the anemia using the appropriate clinical terms which apply to the RBC indices.
- N MCV
- N MCH/C
anemia of chronic disease
= normocytic + normochromic
What specific parameter (test) from the CBC indicates the degree of uniformity of the patient’s RBC size (and shape)? (see attached CBC report)
RDW = red cell distribution width
Observe the comments added by the technologist who performed the peripheral blood smear. What does the term poikilocytosis mean? AND What does the term anisocytosis mean? (CBC report attached)
poikilocytosis = variations in RBC shape
anisocytosis = variations in RBC size
During the patient interview, a 38 year old female patient complains of fatigue. In order to rule in/out anemia, her DC orders some blood work. The micro hematocrit tube is shown in the attached image both before and after centrifugation.
Using the formula B/A x 100% what number should be used for A in the formula AND what number should be used for B?
B = RBC height (mm)
A = total height (mm) of sample (plasma & RBCs)
(B/A x100 = hematocrit)
During the patient interview, a 38 year old female patient complains of fatigue. In order to rule in/out anemia, her DC orders some blood work. The micro hematocrit tube is shown in the attached image both before and after centrifugation.
What other 2 lab tests from a CBC can be used to assess for anemia in this patient?
hemoglobin
RBC count (indices)
When performing a venipuncture a tourniquet is very helpful in finding and selecting the best vein to access on a patient, but care must be taken not to leave the tourniquet on for too long. What is the time limit to keep in mind for proper tourniquet use?
1 minute
What is the standard needle gauge AND length used when performing a venipuncture on an adult patient?
21 gage
1.5 inches
Universal precautions should always be followed whenever working with blood and bodily fluids to prevent the spread of pathogens. What is the most common bloodborne pathogen in the United States?
HCV (Hepatitis C)
(MC in world is HBV/Hep B)
A 14 year old male with Hemophilia A needs to receive Factor VIII. What type of blood product/component can be administered as part of the treatment plan
cryoprecipitate
Identify the type of blood specimen shown in the attached image.
- whole blood = EDTA (lavender) tube, well-mixed
- serum = red/gray tube, cells on bottom, serum (fluid) on top
- plasma = centrifuged whole blood (lavender top), cells on bottom, plasma on top
What blood type is considered the universal donor, as it can be given to any patient regardless of their blood type in the ABO and Rh type?
O-
When performing a standard venipuncture, the patient’s arm is cleaned with isopropyl alcohol. This will create a clean, not sterile site. Certain blood draws require additional care to use iodine or chlorhexidine to achieve a sterile site for a draw. Name a blood test (or circumstance) which requires a sterile draw.
blood culture
A 28 y.o. pregnant woman presents to her OBGYN for prenatal care. Preliminary blood work performed indicates she is Rh neg.
What disease process/pathology does her health care practitioner need to be aware of as part of her prenatal care?
Erythroblastosis fetalis
A 28 y.o. pregnant woman presents to her OBGYN for prenatal care. Preliminary blood work performed indicates she is Rh neg.
Because this patient is Rh negative, what antibody do we need to prevent her immune system from making her own?
anti-D
A 28 y.o. pregnant woman presents to her OBGYN for prenatal care. Preliminary blood work performed indicates she is Rh neg.
What drug will be administered to this patient at 28 weeks gestation, and potentially again when the baby is born (based on results from the cord blood)?
Rhogam
(anti-D)
A 53 y.o. female patient, previously in good health, presents to her family doctor for her yearly physical. She states she is feeling tired recently and “worn out”. A CBC is ordered as part of her yearly blood work up and the report is attached.
Let’s start by observing findings associated with the WBC’s. What is the clinical term that applies to the WBC differential showing lymphocyte numbers higher than the neutrophils?
inverted diff
A 53 y.o. female patient, previously in good health, presents to her family doctor for her yearly physical. She states she is feeling tired recently and “worn out”. A CBC is ordered as part of her yearly blood work up and the report is attached.
The CBC report states that 8 of the 49 lymphocytes observed were determined to be “atypical” lymphocytes. Please answer both parts to this question:
1. Are atypical lymphocytes typically associated with a reactive or neoplastic process?
2. What specific type (or subset) of lymphocytes are atypical lymphocytes?
- reactive
- MHC1
A 53 y.o. female patient, previously in good health, presents to her family doctor for her yearly physical. She states she is feeling tired recently and “worn out”. A CBC is ordered as part of her yearly blood work up and the report is attached.
Still concentrating on the WBC findings, what diagnosis is most likely associated with the WBC differential findings?
viral infection (if lymphocytes > PMNs)
(if 30K+ lymphocytes, think leukemia)
An ESR (erythrocyte sedimentation rate) is ordered on a 45 y.o. male patient. The ESR normal reference range for males is 0-15 mm/hr.
Observe the attached image which shows the ESR from this patient. What is the clinical significance of this result?
if over 15 = non-specific indicator of inflammation
The principle behind the ESR test is based upon the impact on the negative charge of the red blood cells in certain clinical conditions. What is the term that refers to the negative charge found on all red blood cells?
zeta potential
When the negative charge on the RBCs is diminished, RBCs can move closer to each other more readily. During inflammation, the RBCs tend to stack up like coins. What is the clinical term that applies to the stacking up of the RBCs?
Rouleaux formation
A patient’s blood tests require the following tubes to be drawn: a lavender top tube for a CBC and a red-gray top tube for a chemistry panel. Which tube should be drawn first? AND please explain why.
- Red = no anticoagulant (won’t affect next tube)
- lavender = anticoagulant
Keeping a tourniquet on a patient for too long may lead to inaccurate results as the concentration of many waste products may be altered due to ____?
hemoconcentration
