UAMS MLT-MLS Comprehensive Exam

Which antibody is most associated with delayed hemolytic transfusion reactions?

Anti-Jka

What is most associated with Anti-I?

Mycoplasma pneumonia

IgG antibodies cause ______ hemolysis from sequestration by spleen.

Meaning of sequestration- removal or separation; banishment or exile.

Extravascular

T/F: Enzyme panels will react with Duffy Antibodies (Fya or Fyb).

False

T/F: RhIG at 28 weeks can cause a mom to have a low titer anti-D.

True

What type of blood should be given if from mom to child?

Irradiated

Room temp crossmatch detects _____ errors.

ABO

Why do premature infants typically need transfusions?

Blood loss from lab tests

When phenotyping, use a positive control that is _______ positive.

Heterozygously

Why is cryoprecipitate normally used?

To replace fibrinogen

What can make an auto control positive? (Distinguish by warming, looking under scope or saline replacement)

Rouleaux and Cold auto

Cold auto will react with _____ AHG and ___ Monospecific AHG.

Polyspecific; C3

What kind of plasma can an AB= patient be transfused with?

AB (+ or =)

_____ transfusion must be fresh, CMV =, radiated and collected with CPDA

Intrauterine

How should intrauterine transfusions be handled?

Radiated and collected with CPDA

When is FFP used?

When PT and PTT are prolonged

Fresh frozen plasma (FFP) is used for patients with a coagulopathy who are bleeding or at risk of bleeding, and where a specific therapy or factor concentrate is not appropriate or unavailable.

At what temperature do Lewis antibodies react?

RT and sometimes 37 and cause invitrio hemolysis

What type of hemolysis do Lewis antibodies cause?

In Vitro

How long are sexual partners of IV drug users differed from donating?

1 year

+DAT can make the Rh control ___ when doing weak D test

Positive

Storage: Whole Blood

1-6 C; 35 days

Storage: RBCs (Red cells, Packed RBCs, RBCs)

1-6 C (CPDA- 35 days; ADSOL- 42 days)

Storage: Leukocyte- Reduced RBCs

1-6 C (CPDA- 35 days; ADSOL- 42 days)

Storage: Washed Red Cells

1-6 C; 24 hours

Storage: Irradiated Blood to prevent GVHD

1-6 C; 28 days

Storage: Frozen/ Deglycerolized RBCs

-70 C for 10 years; 1-6 C for 24 hours after prepared

Storage: Random Platelets

20-24 C; 5 days with agitation and temp check every 4 hours (4 hours after pooling)

Storage: Platelets, Apheresis (single-donor)

20-24 C with agitation; 5 days

Storage: Granulocytes, Apheresis

20-24 C; 24 hours

Storage: FFP, frozen

-18 C; 1 year

Storage: FFP, thawed

1-6 C; 24 hours

Storage: Frozen Cryoprecipitated AHF

-18 C; 1 year

Storage: Thawed Cryoprecipitated AHF

RT if used for Factor VIII; 1-6 if used for fibrinogen

Storage: Pooled Cryoprecipitated AHF

20-24 C; 4 hours

What are whole blood transfusions used for?

Cells and volume

What are packed RBC transfusions used for?

Anemia

What are Washed RBC transfusions used for?

Allergy to plasma proteins in IgA deficiencies

What are Leuko-depleted RBC transfusions used for?

Febrile from HLA or CMV risk

What are Frozen, deglycerolized RBC transfusions used for?

Rare or autologous

What must be done to issue red cell products?

ABO, Rh and screening compatible

ABO discrepancies

occurs when ABO phenotyping of red cells does not agree with expected serum testing results for the particular ABO phenotype

See print out

How are PLTs and WBCs stored?

RT (20-25 C)

Always perform forward and reverse expect when?

Exception is babies under 6 months -do not do reverse because they have no antibodies yet

What are Leuko-reduced PLT or WBC transfusions used for?

Prevent febrile from HLA and prevent CMV

What are granulocyte transfusions used for?

Severe neutropenia

What are FFP transfusions used for?

Coag disorders (type compatible)

What are cryo transfusions used for?

Factor VIII and IX concentrate- Virus inactivated and lyophilized

What does PT monitor?

Coumadin

DIC Disseminated intravascular coagulation (Consumption coagulopathy)

Etiology

Inappropriate, uncontrolled fibrin formation throughout the body from damage to endothelial cells

DIC Disseminated intravascular coagulation (Consumption coagulopathy)

Tests to Diagnose

↑ PT, PTT, TT, FSP

↓ Fibrinogen,

Platelet count + D-dimer

DIC Disseminated intravascular coagulation (Consumption coagulopathy)

blood smear?

Schistocytes on blood smears

DIC Disseminated intravascular coagulation (Consumption coagulopathy)

Clinical & Special Features

Life-threatening thrombosis and bleeding

Associated with sepsis, obstetrical complications, trauma, malignancies Treat with support therapy, heparin, fibrinolysis inhibitors and cryo to restore fibrinogen

What will a cold agglutinin not affect on the cell counter?

Hemoglobin

What does Protein C deficiency cause?

Thrombosis (Thrombosis occurs when blood clots block your blood vessels.)

What does Factor XII deficiency cause?

Thrombosis instead of bleeding

How does old blood affect the RBCs and WBCs?

Crenate RBCs and cause vacuoles in WBCs.

What happens when you mix patient plasma (with a high PTT) with normal plasma?

Corrects Factor Deficiency

(Not correct lupus anticoagulant)

Sickle cells and spherocytes will ____ a sed rate.

Lower

Young children, present with bruising

Platelets very low, anemia

Positive TdT and CALLA

Positive PAS

WBC can be high, low or normal

Mostly blasts with one nucleolus and scanty cytoplasm

Best chance for survival for acute leukemia

All (L1 - L3

Dry tap

Positive for TRAP

Hairy cell leukemia

Myelomonocytic (Naegli)

o Cells have features of monocytes and immature granulocytes

o Myeloblasts and monoblasts are present

o Specific and non-specific esterase are positive

o Positive lysozyme in urine and blood

M4

Very high WBC, extreme left shift, Philadelphia chromosome, few blasts,

baso & eos,

LAP (distinguish CML from leukomoid reaction)

CML (how to calculate LAP)

Myeloblasts without maturation

Pos for Sudan, peroxidase and specific esterase

Auer rods

M1

Teardrops

Left Shift; NRBC

Variable; ↑ fibrosis; Dry tap

+ reticulin, silver stain

Myelofibrosis

Malignant plasma cells with high serum Ig

Older adults, bone lesions

High calcium and protein, especially immunoglobulins

Peripheral pancytopenia with rouleaux and maybe plasma cells BM - abnormal plasma cells - flame, mott, grape

Multiple Myeloma

Patient with polycythemia needs to have anticoagulant adjusted for ___ or ____

PT or PTT

90% of the hemoglobin is Hgb C and the rest A2 and F on electrophoresis.

Hgb C disease

Bence Jones protein will be detected as a monoclonal spike when present in urine

Normocytic, normochromic anemia o Pancytopenia in more advanced stages

Decreased platelet, RBC and WBC

o Rouleaux formation of RBC is a common finding Due to increased immunoglobulins

Stacks of coins

Usually see more than 30% plasma cells in a 300-1000 cell count

Laboratory Evaluation of Multiple Myeloma

Osmotic fragility test

Diagnostic test for hereditary spherocytosis.

Cells are placed in graded hypotonic salt (saline) solutions

Water enters cell, cell swells, and burst Increased in HS

RBC can swell less than normal cells and lyse at higher concentration of salt than do normal cells

Normal = 0.45; HS = 0.65

Hemocytometer

Each grid is 9 mm 2 and the depth is 0.1 mm

o Area X depth = volume (mm3)

o 9 X 0.1 = 0.9 mm3 (volume)o Each "big" square is 1X1 mm or 1 sq mm and .1 mm deep for a total volume of .1 mm3

o Results are reported in μL or mm

Hemacytometer Counts

Counts are always performed in duplicate and averaged

o Calculation Total count = cells counted X dilution factor X depth factor area counted based on 1 large square (mm2) Total count is reported in (mm)(cells/mm3)

Dilution factor = reciprocal of the dilution EX: 1:20 = 20 dilution factor

Depth factor = depth of chamber (.1) or 1/10 = 10 depth factor

Comparison of Hemophilia A and von willebrand's Disease

Normal BT ( bleeding time) IN Hem A

Associated with hyper-segmented neutrophils, pancytopenia and macrocytes.

Megaloblastic anemia

What are Howell-jolly bodies made up of?

DNA fragments

When are Howell-Jolly Bodies seen?

Non-function spleen & accelerated or abnormal erythropoiesis

What is basophilic stippling made up of?

Denatured RNA

When is basophilic stippling seen?

Lead poisoning & thalassemia

What are pappenheimer bodies (Siderocytes) made up of?

mitochondria and ribosomes that contain iron

When are pappenheimer bodies (Siderocytes) seen?

Sideroblastic anemia, thalassemia, splenectomy

When are Heinz bodies seen?

G6PD deficiency, unstable hemoglobin causing iron to be unprotected, oxidizing drugs, alpha thalassemia

What are Heinz bodies made up of?

Denatured hemoglobin

When are Cabot rings seen?

Severe anemias, pernicious anemia, dyserythropoiesis

What are Cabot rings made up of?

arginine-rich histone and non-hemoglobin iron (remnants of spindle fibers)

When are hemoglobin c crystals seen?

Hemoglobin C disease

What are hemoglobin C crystals made up of?

Abnormal hemoglobin crystallizes

When are Dohle Bodies seen?

May Hegglin Anomaly

DIC lab tests

^PT, PTT, TT, FSP; low Fibrinogen & PLT count; + D-dimer; schistocytes

What are Dohle Bodies made of?

Strands of endoplasmic reticulum RNA

Lab tests for Multiple Myeloma

Protein electrophoresis (M-spike), N/N anemia, pancytopenia (low PLT, RBC & WBC); rouleaux; BM biopsy >30% plasma cells

How do you distinguish Hemophilia A from VWD?

Normal BT

How does lipemia affect the results of the automated CBC?

Falsely elevated Hgb. Correct by replacing lipemic plasma with saline.

Copper reduction test

Copper Reduction Test▪Clinitest (Benedict's Reaction) ▪Reducing sugarsconvertcopper sulfate to cuprous oxide in the presence of heat and alkali

▪Positive for allreducing sugars but not as sensitiveas the dipstick

dipstick neg but clinistest postive?

Other reducing sugars*Galactose-congenital enzyme defect;failure to thrive, retardation;screen kids

4+ Glucose dipstick BUT CLINTEST NEG?

Interferenceortesting error

transudates or exudates

Systemic disorders that disrupt filtration:

•CHF

•Nephrotic syndrome

•Liver disease

•Electrolyte/protein imbalancesDiseases outsidethe cavity

Clear, pale yellow

No clots

WBC count Generally

Transudates

Conditions directly involving the membrane:•Malignancy•InfectionDiseases insidethe cavity

Cloudy, purulent, or bloody

May clot, use EDTA

wbc >1000/uL

SG >1.015

Exudates

Osmotic fragility results with hereditary spherocytosis

Increased; cells are Hyperchromic and easily lyse

Lysed RBC- hypotonic; diluted; can cause false neg

Ghost cell

WBC in a hypotonic urine

Glitter cell

Hypertonic; can cause false negative

Crenated RBC