Blood Banking
17-22%of exam
Chemistry
17-22%of exam
Hematology
17-22%of exam
Microbiology
17-22%of exam
Urinalysis Fluids
5-10%of exam
DipstickSedimentCastsCSFCrystals
Immunology
5-10%of exam
AntibodiesComplementSerologyAutoimmuneTransplant
Lab Operations
5-10%of exam
Quick Facts
- Credential
- MLS(ASCP)
- Owner
- ASCP BOC
- Questions
- 100 multiple-choice
- Time
- 2 hours 30 minutes
- Format
- CAT
- Pass
- 400 scaled
- Scale
- 100-999
- Delivery
- Pearson VUE
- Calculator
- Onscreen
- Fee
- $260
Reaction Stop
Stop transfusion; keep line open
Clerical checkDATHemolysis checkNotify blood bank
DAT vs IAT
DAT
- Patient cells
- In vivo coating
- Transfusion reaction
IAT
- Patient serum
- In vitro reaction
- Antibody screen
Cells vs serum
Blood Bank Picker
- Need oxygen→RBCs(Anemia)
- Need platelets→Platelets(Bleeding risk)
- Need factors→Plasma(Coagulopathy)
- Need fibrinogen→Cryo(Low fibrinogen)
- Neonate candidate→Irradiated(TA-GVHD risk)
- IgA allergy→Washed(Less plasma)
Blood Products
- RBCs
- Oxygen capacity
- Platelets
- Primary hemostasis
- Plasma
- Coag factors
- Cryo
- Fibrinogen rich
- Irradiated
- Prevents TA-GVHD
- Leukoreduced
- Less febrile risk
- Washed
- Less plasma protein
- CMV-negative
- Reduced CMV risk
Plasma vs Cryo
Plasma
- Multiple factors
- Warfarin reversal
- Large volume
Cryo
- Fibrinogen rich
- Factor VIII
- Small volume
Broad factors vs fibrinogen
ABO Rh
- Group A
- Anti-B plasma
- Group B
- Anti-A plasma
- Group O
- Anti-A,B plasma
- Group AB
- No ABO antibody
- O RBC
- Emergency donor
- AB plasma
- Universal plasma
- Weak D
- D variant
- RhIG
- Prevents anti-D
Transfusion Workup
- Type
- ABO/Rh
- Screen
- Unexpected antibodies
- Panel
- Antibody ID
- DAT
- In vivo coating
- IAT
- Serum antibody test
- Autocontrol
- Autoantibody clue
- Elution
- Remove bound antibody
- Crossmatch
- Compatibility check
ABG Map
pH decides; CO2 breathes; HCO3 metabolizes
pH low acidpCO2 respiratoryHCO3 metabolic
Metabolic vs Respiratory
Metabolic
- HCO3 primary
- Kidney/lactate clue
- Anion gap useful
Respiratory
- pCO2 primary
- Ventilation clue
- Lung process
Bicarbonate vs carbon dioxide
Chem Picker
- Metabolic acidosis→Anion gap(Classify)
- Lipid risk→LDL(Friedewald)
- Renal clearance→CrCl(Timed urine)
- Toxic alcohol→Osm gap(Screen clue)
- Pigment urine→Heme test(Hb/myoglobin)
- Drug monitoring→Trough(Before dose)
Chem Formulas
- Anion gap
- Na-(Cl+HCO3)
- LDL
- TC-HDL-TG/5
- Non-HDL
- TC-HDL
- A/G ratio
- Albumin/globulin
- Globulin
- Protein-albumin
- CrCl
- UxV/P
- Osm gap
- Measured-calculated
- Beer law
- A=abc
Chem Reference
- Glucose
- 74-100 mg/dL
- BUN
- 6-20 mg/dL
- A1C normal
- <5.7%
- pH
- 7.35-7.45
- pCO2
- 35-44 mmHg
- HCO3
- 23-29 mmol/L
- pO2
- >80 mmHg
- O2 sat
- >95%
Chem Interference
- Hemolysis
- Raises potassium
- Lipemia
- Photometric turbidity
- Icterus
- Spectral interference
- EDTA tube
- Low calcium
- Delayed spin
- Low glucose
- Air bubble
- ABG error
- Clot
- CBC reject
- Short draw
- Coag reject
Coag Pathways
PT external; aPTT internal; both common
PT: VIIaPTT: VIII/IXBoth: X/V/II/I
PT vs aPTT
PT
- Extrinsic pathway
- Factor VII
- Warfarin monitor
aPTT
- Intrinsic pathway
- Factors VIII/IX
- Heparin monitor
Extrinsic vs intrinsic
Heme Picker
- Microcytosis→Iron studies(Ferritin first)
- Macrocytosis→B12/folate(Megaloblasts)
- Hemolysis→Retic/DAT(Classify)
- Bleeding history→PT/aPTT(Pathway clue)
- Prolonged aPTT→Mixing study(Inhibitor?)
- nRBCs high→Correct WBC(>10 nRBC)
CBC Indices
- RBC
- 4.00-6.00 x10^6/uL
- HGB
- 12.0-18.0 g/dL
- HCT
- 35-50%
- MCV
- 76-100 fL
- MCH
- 26-34 pg
- MCHC
- 32-36 g/dL
- RDW
- 11.5-14.5%
- Platelets
- 150-450 x10^3/uL
- WBC
- 3.6-10.6 x10^3/uL
Anemia Patterns
- Iron deficiency
- Low ferritin
- Thalassemia
- Target cells
- B12 deficiency
- Macro-ovalocytes
- Folate deficiency
- Macrocytic anemia
- Hemolysis
- High retics
- AIHA
- Positive DAT
- Sickle cell
- HbS
- Myelofibrosis
- Teardrops
Hemostasis
- PT
- Extrinsic/common
- aPTT
- Intrinsic/common
- INR
- Warfarin monitor
- Fibrinogen
- Common pathway substrate
- D-dimer
- Fibrin breakdown
- Mixing study
- Deficiency vs inhibitor
- vWF
- Platelet adhesion
- Lupus anticoagulant
- Phospholipid inhibitor
Gram Start
Gram, shape, catalase, oxidase, context
GPC: catalaseGNR: oxidaseSpecimen source matters
Micro Picker
- Gram positive cocci→Catalase(Staph/Strep)
- Staph suspected→Coagulase(S aureus)
- GNR enteric→Oxidase(Enterics negative)
- Meningitis CSF→Critical report(STAT)
- AFB suspected→Acid-fast stain(Mycobacteria)
- Yeast ID→Germ tube(C albicans)
Gram Logic
- Staph
- Catalase positive
- Strep
- Catalase negative
- S aureus
- Coagulase positive
- Enterococcus
- Bile esculin positive
- Neisseria
- Oxidase positive diplococci
- Enterics
- Oxidase negative rods
- Pseudomonas
- Oxidase positive rod
- Vibrio
- Curved oxidase positive
Micro ID
- E coli
- Indole positive
- Klebsiella
- Mucoid lactose fermenter
- Proteus
- Swarming urease positive
- Salmonella
- H2S motile
- Shigella
- Nonmotile NLF
- Listeria
- Tumbling motility
- Campylobacter
- Curved microaerophile
- Bacteroides
- Anaerobic GNR
AST Resistance
- MRSA
- mecA/PBP2a
- VRE
- vanA/vanB
- ESBL
- Cephalosporin resistance
- CRE
- Carbapenem resistance
- D-test
- Inducible clindamycin
- MIC
- Lowest inhibition
- S
- Likely effective
- R
- Likely ineffective
Transudate vs Exudate
Transudate
- Systemic pressure
- Low protein
- CHF/cirrhosis
Exudate
- Inflammation
- High protein
- Infection/malignancy
Pressure vs inflammation
Urine Sediment
- RBC cast
- Glomerular bleeding
- WBC cast
- Renal inflammation
- Granular cast
- Tubular injury
- Waxy cast
- Chronic renal disease
- Fatty cast
- Nephrotic syndrome
- Hyaline cast
- Nonspecific
- Nitrite
- Nitrate reducers
- LE
- WBC enzyme
Body Fluids
- CSF cells
- Process rapidly
- Bacterial CSF
- Low glucose
- Viral CSF
- Lymphocyte predominance
- Transudate
- Systemic imbalance
- Exudate
- Inflammation leak
- Urate
- Needle negative
- CPPD
- Rhomboid positive
- Oxalate
- Envelope crystals
Screen vs Confirm
Screen
- High sensitivity
- Initial result
- May false positive
Confirm
- Higher specificity
- Supplemental test
- Final interpretation
Catch vs verify
Immunology Serology
- IgG
- Placenta crossing
- IgM
- Primary response
- IgA
- Mucosal defense
- IgE
- Allergy parasite
- C3/C4 low
- Complement consumption
- ANA
- Sensitive nonspecific
- Anti-dsDNA
- SLE specific
- Anti-CCP
- RA specific
Infectious Serology
- HBsAg
- Current HBV
- Anti-HBs
- HBV immunity
- Anti-HBc IgM
- Acute HBV
- Anti-HBc total
- Natural exposure
- HIV screen
- Ag/Ab combo
- HIV confirm
- Differentiation assay
- RPR/VDRL
- Nontreponemal screen
- TP-PA
- Treponemal confirm
Core Four
BB, Chem, Heme, Micro carry weight
Each 17-22%Support domains 5-10%Review mixed cases
Sensitivity vs Specificity
Sensitivity
- Detects disease
- Fewer false negatives
- Screening strength
Specificity
- Detects absence
- Fewer false positives
- Confirmatory strength
Rule out vs rule in
Exam Model
- CAT
- Adaptive difficulty
- No skipping
- Answer each item
- Flagging
- Review if time
- Field tests
- Unscored hidden items
- Score
- Psychometric scale
- Pass
- 400 minimum
- Result
- Preliminary screen
- Official
- Within four business days
QC vs QA
QC
- Run-level control
- Analytic monitoring
- Accept/reject run
QA
- System process
- Continuous improvement
- Pre-to-postanalytic
Control run vs system
Domain Weights
- Blood bank
- 17-22%
- Chemistry
- 17-22%
- Hematology
- 17-22%
- Microbiology
- 17-22%
- Urinalysis
- 5-10%
- Immunology
- 5-10%
- Operations
- 5-10%
- Core four
- Largest domains
Operations Core
- Preanalytic
- Before testing
- Analytic
- During testing
- Postanalytic
- After testing
- QC
- Method monitoring
- QA
- System improvement
- PT
- External challenge
- SDS
- Chemical safety
- PPE
- Exposure control
Test Metrics
- Sensitivity
- TP/(TP+FN)
- Specificity
- TN/(TN+FP)
- PPV
- TP/(TP+FP)
- NPV
- TN/(TN+FN)
- CV
- SD/mean x100
- Mean
- Average
- Median
- Middle value
- Mode
- Most frequent
Common Traps
CAT score
400 is scaled ≠ Not forty percent
Question count
100 total items ≠ Field tests hidden
ABO emergency
O RBC emergency ≠ AB plasma emergency
DAT meaning
In vivo coating ≠ Not free serum antibody
Short citrate
High anticoagulant ratio ≠ Reject coag specimen
Hemolyzed potassium
False high possible ≠ Correlate specimen quality
Dipstick blood
Hb/myoglobin possible ≠ RBCs may be absent
ANA result
Sensitive screen ≠ Not SLE diagnosis
Culture interpretation
Source drives significance ≠ Colonizer possible
QC violation
Do not report ≠ Troubleshoot first
Last Minute
- 1.Core four: 17-22 each
- 2.Support domains: 5-10 each
- 3.CAT: no raw cutoff
- 4.Pass: 400 scaled
- 5.ABO first, Rh next
- 6.DAT means coated cells
- 7.Anion gap = Na-(Cl+HCO3)
- 8.PT external; aPTT internal
- 9.Sensitivity rules out disease
- 10.Specificity rules in disease
- 11.CSF cells process rapidly
- 12.QC failure stops reporting
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