General Laboratory
21%of exam
Clinical Chemistry
18%of exam
Hematology
15%of exam
Coagulation + Hemostasis
5%of exam
Immunology + Serology
3%of exam
Immunohematology
11%of exam
Blood Banking + Transfusion
8%of exam
Microbiology
12%of exam
Urinalysis + Body Fluids
7%of exam
Quick Facts
- Exam
- AMT MLS
- Items
- 210 MCQ
- Time
- 3.5 hours
- Pass
- 70 (0-100 scale)
- Areas
- 9 content areas
- Fee
- $245
- Pass rate
- 61% (2025)
- Retake
- 45-day wait
Order of Draw
Blue, Red, Green, Lavender, Gray
Blue: citrate (coag)Red: serumGreen: heparinLavender: EDTA (CBC)Gray: fluoride (glucose)
Accuracy vs Precision
Accuracy
- Close to true
- Systematic error
- Fixed by calibration
Precision
- Reproducible results
- Random error
- Measured by SD
Trueness vs reproducibility
Westgard QC Action
- One control >3SD→Reject run(random)
- 2-2s violated→Reject run(systematic)
- R-4s violated→Reject run(random)
- 4-1s violated→Reject run(bias)
- 10-x violated→Reject run(shift)
- Only 1-2s→Warning, inspect(no reject alone)
- All within 2SD→Accept run
Westgard QC Rules
- 1-3s
- Reject, random errorREJECT
- 1-2s
- Warning onlyWARN
- 2-2s
- Reject, systematic error
- R-4s
- Reject, random error
- 4-1s
- Reject, systematic bias
- 10-x
- Reject, systematic shift
- Levey-Jennings
- QC plotted over time
- SD
- Spread around mean
Serum vs Plasma
Serum
- No anticoagulant
- Clotted then spun
- No fibrinogen
Plasma
- Anticoagulant tube
- Not clotted
- Has fibrinogen
Clotted vs anticoagulated
Safety + Regulation
- CLIA '88
- Federal lab regulation
- CAP
- Lab accreditation body
- BSL-2
- Standard clinical labs
- BSL-3
- TB, systemic fungi
- Class II BSC
- Biosafety cabinet
- Standard precautions
- Treat all as infectious
- SDS
- Chemical safety sheet
- Chemical hygiene plan
- OSHA required
Chemistry Reference Values
- Glucose (fasting)
- 70-99 mg/dL
- Sodium
- 136-145 mmol/L
- Potassium
- 3.5-5.1 mmol/L
- Calcium
- 8.5-10.5 mg/dL
- BUN
- 7-20 mg/dL
- Creatinine
- 0.6-1.2 mg/dL
- Total protein
- 6.4-8.3 g/dL
- Albumin
- 3.5-5.0 g/dL
Enzymes + Cardiac Markers
- ALT
- Liver-specific enzyme
- AST
- Liver + muscle
- AST/ALT >2
- Alcoholic pattern
- ALP
- Liver, bone
- GGT
- Confirms biliary ALP
- Lipase
- Pancreatitis marker
- Troponin
- Cardiac injury marker
- Friedewald
- LDL = TC-HDL-TG/5
Iron Deficiency vs ACD
Iron deficiency
- Low ferritin
- High TIBC
- Microcytic
Chronic disease
- Normal/high ferritin
- Low TIBC
- Normo/microcytic
Ferritin + TIBC differ
CBC + Indices
- MCV
- Average RBC size
- MCH
- Average Hb per cell
- MCHC
- Hb concentration
- RDW
- Size variation
- Retic count
- Marrow response
- Hgb (male)
- 13.5-17.5 g/dL
- Hgb (female)
- 12.0-16.0 g/dL
- Platelets
- 150-400 x10^9/L
Anemia + Morphology
- Microcytic
- Iron def, thalassemia
- Macrocytic
- B12/folate deficiency
- Target cells
- Liver, thalassemia
- Schistocytes
- MAHA, DIC
- Sickle cells
- Hb SS disease
- Spherocytes
- Hereditary, immune hemolysis
- Howell-Jolly
- Post-splenectomy
- Auer rods
- Acute myeloid leukemia
Coag Pathways
PT = extrinsic; PTT = intrinsic
PT: 3 + 7PTT: 8, 9, 11, 12Common: 1, 2, 5, 10INR standardizes PT
PT vs PTT
PT
- Extrinsic + common
- Monitors warfarin
- Factors VII, X
PTT
- Intrinsic + common
- Monitors heparin
- Factors VIII, IX
Warfarin PT, heparin PTT
Coagulation Tests
- PT
- Extrinsic + common
- PTT
- Intrinsic + common
- INR
- Standardized PT
- PT monitors
- Warfarin therapy
- PTT monitors
- Heparin therapy
- D-dimer
- Fibrin degradation
- Fibrinogen
- Factor I
- Thrombin time
- Fibrinogen to fibrin
Immunology + Serology
- IgM
- Acute infection
- IgG
- Past / memory
- ANA
- Autoimmune screen
- RF
- Rheumatoid arthritis
- ASO
- Strep antibody
- RPR/VDRL
- Syphilis screen
- Prozone
- False-negative, excess antibody
- ELISA
- Antigen/antibody assay
Forward vs Reverse Type
Forward
- Tests patient cells
- Anti-A/anti-B reagents
- Antigen detection
Reverse
- Tests patient serum
- A1/B reagent cells
- Antibody detection
Cells vs serum
Blood Groups + Antibodies
- Type O
- Universal RBC donor
- Type AB
- Universal plasma donor
- Anti-A,B
- In group O serum
- DAT
- In-vivo coating
- IAT
- In-vitro detection
- Anti-Kell
- Significant IgG antibody
- Anti-Lewis
- Usually insignificant IgM
- AHG (Coombs)
- Detects IgG / C3
RhIg Dose
One vial = 300 µg = 15 mL RBCs
300 µg standard doseCovers 15 mL RBCs= 30 mL whole bloodKB test if large bleed
Acute vs Delayed Hemolytic
Acute
- ABO mismatch
- Intravascular
- Minutes, clerical error
Delayed
- Anamnestic antibody
- Extravascular
- Days later
Now vs days later
Transfusion Reaction Picker
- Fever, chills only→Febrile (FNHTR)(leukoreduce)
- Hives, itching→Allergic(antihistamine)
- Back pain, hemoglobinuria→Acute hemolytic(ABO error)
- Dyspnea, hypertension→TACO(volume overload)
- Dyspnea, hypotension→TRALI(anti-HLA)
- Shock, no fever→Anaphylactic(IgA deficiency)
- Fever days later→Delayed hemolytic(anamnestic)
Component Storage
- PRBC
- 1-6°C, 42 days
- Platelets
- 20-24°C, 5 days
- FFP
- Frozen, 1 year
- Thawed FFP
- 1-6°C, 24 hours
- Cryoprecipitate
- Fibrinogen, factor VIII
- Platelet storage
- Continuous agitation
- Irradiated
- Prevents TA-GVHD
- Leukoreduced
- Fewer febrile reactions
Strep Grouping
A = Bacitracin S; B = CAMP positive
Group A: bacitracin SGroup B: CAMP +Pneumo: optochin SViridans: optochin R
Gram-Positive Cocci ID
- Gram+ cocci clusters→Catalase test(Staph vs Strep)
- Catalase positive→Coagulase test(aureus?)
- Coagulase positive→S. aureus
- Catalase negative→Strep / Enterococcus
- Beta, bacitracin S→Group A (pyogenes)
- Beta, CAMP positive→Group B (agalactiae)
- Alpha, optochin S→S. pneumoniae
- Alpha, optochin R→Viridans strep
Gram-Positive ID
- Catalase +
- Staphylococcus
- Coagulase +
- S. aureus
- Novobiocin R
- S. saprophyticus
- Bacitracin S
- Group A Strep
- CAMP +
- Group B Strep
- Optochin S
- S. pneumoniae
- Bile esculin +
- Enterococcus / Group D
- PYR +
- Group A, Enterococcus
Gram-Negative + Others
- Oxidase +
- Pseudomonas, Neisseria
- Lactose fermenter
- E. coli, Klebsiella
- TSI A/A
- Ferments all sugars
- Urease +
- Proteus, H. pylori
- MacConkey
- Selects gram-negatives
- Acid-fast
- Mycobacteria
- Germ tube +
- Candida albicans
- India ink
- Cryptococcus capsule
Transudate vs Exudate
Transudate
- Low protein
- Systemic cause
- CHF, cirrhosis
Exudate
- High protein
- Inflammation/infection
- High LDH
Systemic vs inflammatory
Urinalysis + Body Fluids
- Specific gravity
- 1.003-1.030 range
- Nitrite +
- Gram-negative bacteria
- Leukocyte esterase
- WBCs, UTI
- Glucose +
- Exceeds renal threshold
- Ketones
- DKA, starvation
- RBC casts
- Glomerulonephritis
- WBC casts
- Pyelonephritis
- Waxy casts
- Chronic renal failure
Common Traps
PT/INR vs PTT
PT/INR tracks warfarin ≠ PTT tracks heparin
Forward vs reverse type
Forward tests cells ≠ Reverse tests serum
Accuracy vs precision
Accuracy is trueness ≠ Precision is reproducibility
Optochin S vs R
Optochin S = pneumoniae ≠ Optochin R = viridans
1-2s vs 1-3s
1-2s only warns ≠ 1-3s rejects run
Serum vs plasma
Serum has no fibrinogen ≠ Plasma keeps fibrinogen
TACO vs TRALI
TACO is volume overload ≠ TRALI is anti-HLA
Last Minute
- 1.General Laboratory is largest area (21%)
- 2.1-3s rejects; 1-2s only warns
- 3.PT = warfarin; PTT = heparin
- 4.Type O = universal RBC donor
- 5.Type AB = universal plasma donor
- 6.PRBC 42 days; platelets 5 days
- 7.Acute hemolytic = ABO clerical error
- 8.Coagulase + = Staph aureus
- 9.Optochin S = S. pneumoniae
- 10.Friedewald invalid if TG >400
- 11.RhIg: 300 µg covers 15 mL
- 12.Reference ranges vary by lab/method
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