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Clinical Pathology Exam 1 > Lecture 1 - Introduction to CP > Flashcards

Lecture 1 - Introduction to CP Flashcards

1
Q

What 3 general things determine the quality of laboratory results

A
  1. preanalytic factors (sample quality) - patietn prep, collection tech, container, volume, handling, labeling
  2. Analytic factors (analysis quality) - method, quality of equipment, quality control
  3. post analytic factors (lab and patient record quality) - Min transcriptional errors, data presentation
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2
Q

What area do 90% of mistakes occur regarding lab tests

A

preanalytic! mostly technical issues not patient issue
usually issues with patient prep, sample collection, container used, volume given, how sample is handled, and improper labeling

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3
Q

__ phase involves all steps from test selection and sample collection to analysis.

A

pre-analytic, most errors occur here!

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4
Q

What are 5 technical/non-biological factors that occur in the pre-analytic phase can cause error

A
  1. test selection
  2. sample tube and fill
  3. sample collection
  4. sample ID
  5. sample handling and delayed processing

“HIT SC”

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5
Q

What physicological/biological factor is in the pre-analytic phase that can be means for an error

A
  1. patient preparation
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6
Q

__ can clot bc clotting factors are removed where the __ will not clot bc there are clotting factors present in it.

A

serum, plasma

clotting factors are proteins

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7
Q

purple top tube (chemical, sample, test)

A

chemical: EDTA
Sample: whole blood or plasma (has clotting factors)
test: CBC

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8
Q

green top tube (chemical, sample, test)

A

chemical: lithium heparin
sample: whole blood or plasma (has clotting factors)
test: plasma chemistry, ammonia, CBC

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9
Q

blue top tube (chemical, sample, test)

A

chemical: citrate
sample: whole blood or plasma (has clotting factors)
test: coagulation testing

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10
Q

serum tubes (with (tiger top) or without (red top) separator) used for

A

biochemical tests and most endocrinology tests

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11
Q

most labs reference samples are based on __

A

serum samples

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12
Q

The most common mistake is ___ contamination when putting samples into tubes

A

EDTA

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13
Q

With EDTA contamination __ will be artifactually increased to suprephysiologic levels

A

potassium

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14
Q

EDTA contamination artifactually decreases __ and __

A

Ca and Mg

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15
Q

EDTA ___ causing a decrease in Ca and Mg

A

chelates divalent cations

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16
Q

EDTA contamination effects which enzyme reactions that use Ca and Mg causing decrease in these enzymes

A

ALP, CK, glucose, amylase, lipase

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17
Q

EDTA contamination can appear like acidosis due to __ decrease

A

bicarbonate (EDTA is an acid! ethylene diamineteraacetic ACID)

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18
Q

overall EDTA contamination can cause artifactual increase in __, decrease in __, __, __ and __

A

increased: potassium
decreased: Ca, Mg, enzymes and bicarbonate

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19
Q

Best way to collect blood is by

A

vacutainer

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20
Q

3 direct access routes for blood sample collection

A
  1. needle, syringe
  2. butterfly or extension set
  3. vacutainer adapter
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21
Q

__ access should be avoided to collect blood because the sample can be contaminated by IV fluids/meds and need to account for deadspace

A

assisted (catheter, port, etc)

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22
Q

If a sample was taken via assisted access using a catheter where the patient was receiving fluid containing dextrose what might you see in the lab findings

A

electrolytes will be diluted/low (Na, K, Cl)

glucose will be very high!

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23
Q

Sample handling: samples should be kept __ to minimize cell changes and in indirect contact with ice to prevent __ and __ of cells

A

cool, freezing, lysis

24
Q

old blood samples will see

A

lysis, RBC swelling (MCV, MCHC, PCV), crenation, and platelet activation (MPV, platelet count)

25
Q

platelet clumps are machine counted as __ and the __ will decrease __

A

leukocytes, MPV (mean platelet volume)

26
Q

in old samples, cells clump and clot causing

A

decrease in all cell types, MCV/MCHC/HCT/PVT

27
Q

RBC lysis with storage will deacrease RBC count and HCT leading to falsely high __

A

MCHC (Mean cell hemoglobin concentration)

28
Q

RBC swell with storage causing a falsely increase __ and __ and decreased __

A

MCV (mean cell volume), HCT, MCHC (mean cell hemoglobin concentration)

29
Q

platelet clumping decreases __ and increases __ since small clumps of platelets are seen as one and large clumps are not counted at all

A

platelet count, MPV (mean platelet volume)

30
Q

Aged samples result in neutrophil swelling causing a falsely interpreted

A

left shift/inflammatory leukogram

31
Q

prolonged sample storage may decrease __ as glycolysis continues in vitro

A

glucose

32
Q

prolonged sample storage may increase __ as it leaks from RBC in certain species such as __

A

potassium
species with K rich RBCs: horses, Japanese dogs (Akita, shiba), camelids, pigs, sheep, some cattle.
Most other dogs and cats do not show this.

33
Q

sample exposure to light degrades __

A

bilirubin

34
Q

Evaporation and freezing (sublimation = evaporation during freezing) causes falsely increased __

A

electrolytes

35
Q

When applicable, in monogastrics especially, there should be pre-analytic fasting to prevent post-prandial (after meal) __

A

lipemia. but can’t fast all p (young animals, horses, cattle)

36
Q

To rule out analytic factor errors __ should always be evaluated as quality control

A

blood films

37
Q

If the analyzer gives results of thrombocytopenia, leukopenia, anemia what should you do?

A

check blood film for cell clumping (clumped cells are not read appropriately by the analyzer)

38
Q

What analyzer value should you NEVER trust when running feline blood

A

automated platelet count!!!

39
Q

__ can be counted as leukocytes by manual and some automated cell counters, need to correct leukocyte count!

A

nRBCs (metarubricytes and rubricytes) - these can be normal in low numbers for healthy dogs/cats

40
Q

NRBC are seen in what dz states

A

regenerative anemia, lead toxicity, marrow injury/dz, other inflammatory dz

41
Q

If more than __ nRBC/ 100 WBC are counted, the total WBC count will need to be corrected

A

5

42
Q

A dog has 50nRBC/100WBC with a measured WBC count of 9,000/mL. What is the corrected WBC count?

A

(measured WBC count x 100) DIVIDE (100WBC + nRBC)

(9000 x 100) / (100 + 50) = 6,000/mL

43
Q

How do you differentiate between a nRBC and a lymphocyte?

A 
nRBC = complete rim of cytoplasm, more eosinophilic cytoplasm
lymphocyte = scant cytoplasm
44
Q

__ is a method of absorptive photometry where reagents are added to produce a color change for biochemistry machine to observe the analytes present (lipemia, hemolysis, icterus, Ca, protein, ALP, Mg, etc)

A

spectrophotometry “wet chemistry”

45
Q

__ uses reflective photometry

A

dry chemistry

46
Q

Dry chemistry results are affected by

A

hemolysis, icterus, lipemia, hyperproteinemia, drugs

47
Q

__ can prevent correct assay results by color interference with spectrophotometric assays

A

hemolysis

48
Q

horses, cattle, some dogs have high K with RBCs so hemolysis can cause false increase in

A

K

49
Q

__ can be caused by turbidity of sample, if animal has recently eaten, or with hyperlipidemic syndromes

A

lipemia

50
Q

lipeamia can interfere with spectrophotometric assays by diluting out substances like __ resulting in falsely decreased concentrations

A

electrolytes (K, Na, Cl) = ion exclusion effect

51
Q

__ in blood due to cancer or dz effect the analytic factors by binding analytes causing hyperphosphatemia in dogs

A

paraproteins

52
Q

medications like potassium bromide can alter analytic factors causing very very high __ that is not compatible with life and negative anion gap (shouldn’t be negative)

A

chloride. Actually measuring the bromide with the chloride value

53
Q

reference intervals define “normal” test results based on a median of ___ of a healthy population

A

95% +/- 2.5%

54
Q

There is a __ % chance when measuring analytes that healthy animal will return an “abnormal” test result

A

5%. Can be normal but outside of the ref interval.

55
Q

__% chance that 1 test result will be outside the reference interval when 20 analytes are measured

A

64%

Clinical Pathology Exam 1 (12 decks)

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