Blood Banking
15-20%of exam
Chemistry
20-25%of exam
Hematology
20-25%of exam
Microbiology
15-20%of exam
Gram StainCultureBiochemicalsASTSpecimens
Urinalysis + Fluids
5-10%of exam
DipstickSedimentCastsCSFSynovial
Immunology
5-10%of exam
ANAHBVHIVSyphilisComplement
Laboratory Operations
5-10%of exam
QCSafetySpecimensInstrumentationCompliance
Quick Facts
- Exam
- MLT(ASCP)
- Questions
- 100 MCQ
- Time
- 2 hr 30 min
- Format
- CAT
- Pass
- 400 scaled
- Scale
- 100-999
- Fee
- $235
- Delivery
- Pearson VUE
ABO Memory
Plasma logic reverses RBC logic
O RBCAB plasmaForward antigenReverse antibody
RBC vs Plasma Compatibility
RBC
- Avoid donor antigens
- O is broad
Plasma
- Avoid donor antibodies
- AB is broad
Antigens vs antibodies
Blood Bank Picker
- Forward/reverse agree→Report ABO
- ABO discrepancy→Resolve first
- Positive screen→Antibody panel
- Known antibody→Antigen-negative RBC
- No antibody history→Electronic XM
- Transfusion reaction→Clerical check
ABO/Rh
- Forward type
- Patient RBC antigens
- Reverse type
- Patient plasma antibodies
- Group O RBC
- Universal emergency RBC
- Group AB plasma
- Universal donor plasma
- Weak D donor
- Report Rh positive
- Weak D patient
- Policy dependent
Screen vs Panel
Screen
- Detects unexpected antibody
- Few reagent cells
Panel
- Identifies specificity
- Many reagent cells
Find vs name
Compatibility
- Antibody screen
- Unexpected antibodies
- Panel
- Identify specificity
- Major crossmatch
- Recipient plasma donor RBC
- Electronic XM
- Validated negative screen
- History antibody
- Honor forever
- DAT
- In-vivo coating
Components + Reactions
- RBC
- Oxygen capacity
- Platelets
- Thrombocytopenia support
- FFP
- Multiple factor replacement
- Cryo
- Fibrinogen source
- AHTR
- Clerical mismatch first
- TRALI
- Acute respiratory distress
Chemistry QC
QC before patients, delta before panic
QC firstCheck specimenCheck identityHold results
Direct vs Indirect ISE
Direct ISE
- Undiluted sample
- Less lipemia effect
Indirect ISE
- Diluted sample
- Pseudohyponatremia risk
Undiluted vs diluted
Chemistry Picker
- High potassium→Check hemolysis
- Low sodium lipemic→Direct ISE
- Metabolic acidosis→Anion gap
- TDM ordered→Timing trough
- Delta failed→Verify identity
- QC shifted→Hold results
Chemistry Panels
- Glucose
- Carbohydrate status
- BUN
- Renal nitrogen
- Creatinine
- Renal filtration marker
- Bilirubin
- Heme breakdown
- ALT
- Hepatocellular injury
- ALP
- Cholestasis or bone
- Troponin
- Myocardial injury
Chemistry Calculations
- Anion gap
- Na - Cl - CO2
- Osmolality
- Solute concentration
- Delta check
- Prior-result comparison
- Dilution factor
- Final over sample
- Creatinine clearance
- Timed urine estimate
- Corrected calcium
- Albumin-adjusted calcium
Interferences
- Hemolysis
- False potassium high
- Lipemia
- Photometric turbidity
- Icterus
- Bilirubin interference
- EDTA contamination
- Calcium falsely low
- Direct ISE
- Lipemia resistant
- Indirect ISE
- Pseudohyponatremia risk
Coag Screen
PT warfarin, aPTT heparin
PT extrinsicaPTT intrinsicINR warfarin
PT vs aPTT
PT
- Extrinsic/common
- Warfarin screen
aPTT
- Intrinsic/common
- Heparin screen
Seven vs twelve
Hematology Picker
- Microcytic anemia→Iron studies
- Macrocytic anemia→B12/folate
- Schistocytes present→Hemolysis workup
- Platelet clumps→Recollect citrate
- Prolonged PT→Extrinsic pathway
- Prolonged aPTT→Intrinsic pathway
CBC + Indices
- MCV
- Cell size
- MCHC
- Hemoglobin concentration
- RDW
- Size variation
- Reticulocyte
- Marrow response
- Left shift
- Immature neutrophils
- Pancytopenia
- All lines low
Microcytic vs Macrocytic
Microcytic
- Low MCV
- Iron/thalassemia
Macrocytic
- High MCV
- B12/folate
Small vs large
Morphology
- Spherocytes
- Membrane loss
- Schistocytes
- Fragmentation hemolysis
- Target cells
- Liver or thalassemia
- Teardrops
- Marrow infiltration
- Sickle cells
- HbS disease
- Auer rods
- Myeloid blasts
Coagulation
- PT
- Extrinsic pathway
- aPTT
- Intrinsic pathway
- INR
- Warfarin monitoring
- D-dimer
- Fibrin breakdown
- Fibrinogen
- Clot substrate
- Mixing study
- Deficiency or inhibitor
Cocci Split
Clusters catalase, chains strep
Staph clustersStrep chainsCatalase split
Gram Positive vs Negative
Gram positive
- Purple
- Thick peptidoglycan
Gram negative
- Pink
- Outer membrane
Purple vs pink
Micro Picker
- Clusters cocci→Catalase
- Chains cocci→Strep workup
- Oxidase negative rod→Enteric ID
- Oxidase positive rod→Nonfermenter ID
- Positive blood culture→Gram stain
- AST invalid QC→Do not report
Gram ID
- Staphylococcus
- Gram-positive clusters
- Streptococcus
- Gram-positive chains
- Enterococcus
- Bile esculin positive
- Enterobacterales
- Oxidase negative rods
- Pseudomonas
- Oxidase positive rod
- Neisseria
- Gram-negative diplococci
Culture + AST
- Blood culture
- Critical positive
- Urine culture
- Quantify growth
- Throat culture
- Group A strep
- Chocolate agar
- Fastidious organisms
- Kirby-Bauer
- Disk diffusion AST
- MIC
- Lowest inhibitory level
Urine Casts
Casts localize damage to tubules
RBC glomerularWBC inflammationWaxy chronic
Transudate vs Exudate
Transudate
- Pressure imbalance
- Lower protein
Exudate
- Inflammation
- Higher protein
Pressure vs inflammation
Urinalysis
- Specific gravity
- Concentration estimate
- Nitrite
- Nitrate reducers
- Leukocyte esterase
- WBC enzyme
- Blood pad
- Heme pigment
- RBC casts
- Glomerular bleeding
- Waxy casts
- Chronic renal stasis
Body Fluids
- CSF
- Process immediately
- Bacterial CSF
- Neutrophils high protein
- Light criteria
- Exudate classification
- Urate crystals
- Needle negative
- CPPD crystals
- Rhomboid positive
- Amniotic fluid
- Fetal lung testing
HBV Markers
Surface antigen means current infection
HBsAg currentAnti-HBs immuneIgM acute
Treponemal vs Nontreponemal
Treponemal
- Specific confirmation
- Often stays reactive
Nontreponemal
- Screen/monitor
- Titer follows therapy
Confirm vs monitor
Immunology Serology
- ANA
- Sensitive nonspecific screen
- Anti-dsDNA
- SLE association
- Anti-CCP
- RA specificity
- HBsAg
- Current HBV infection
- Anti-HBs
- HBV immunity
- RPR/VDRL
- Nontreponemal monitoring
- IgM
- Primary response
- IgG
- Placental transfer
Random vs Systematic Error
Random
- Imprecision
- Isolated event
Systematic
- Bias
- Shift or trend
Scatter vs bias
Operations Picker
- Unlabeled specimen→Reject
- QC out→Troubleshoot first
- Critical verified→Notify provider
- Needlestick occurs→Wash/report
- Chemical spill→SDS procedure
- Corrected result→Document correction
Quality + Safety
- Preanalytical
- Before analysis
- Analytical
- During measurement
- Postanalytical
- After analysis
- Random error
- Imprecision event
- Systematic error
- Bias or shift
- PT testing
- Patient-like handling
- SDS
- Chemical safety
- Critical value
- Notify and document
Common Traps
Scaled Score
400 is scaled ≠ 400 is not 40%
CAT Pacing
Answer every question ≠ No skipping ahead
Historical Antibodies
Honor history ≠ Do not ignore screen
Failed QC
Hold patient results ≠ Do not annotate later
Hemolyzed Potassium
Check specimen integrity ≠ Do not overdiagnose hyperkalemia
Positive ANA
Sensitive screen ≠ Not diagnostic alone
Dipstick Blood
Heme pigment test ≠ Not always RBCs
PT Sharing
Test like patients ≠ Never discuss answers
Last Minute
- 1.Chemistry and hematology dominate
- 2.Blood bank: resolve discrepancies first
- 3.History antibodies require antigen-negative RBCs
- 4.QC failure means hold results
- 5.Hemolysis raises potassium falsely
- 6.PT extrinsic; aPTT intrinsic
- 7.Gram stain guides workup
- 8.CSF cells deteriorate quickly
- 9.HBsAg means current HBV
- 10.RPR monitors; treponemal confirms
- 11.Critical values need documentation
- 12.400 scaled is not percent
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