ASCP BOC comprehensive guide

What is used for the aseptic technique of collecting blood?

Scrub site for at least 30 secs with providine-iodine scrub

What is the donor criteria for ALLOGENIC donation?

• >16 years old

• <99.5F temperatures

• 90-180/50-100 BP

• HGB >12.5

• HCT >38%

• Minimum 110 lbs

donor criteria for AUTOLOGOUS donation

• No age limit

• HGB >11 g/dL

• HCT >33%

• Collection >72 hours prior

Purpose of washed red cels

to prevent allergic response to plasma proteins (IgA deficient)

Purpose of leukocyte reduced red cells

prevents febrile nonhemolytic reactions, HLA alloimmunization and CMV transmission

What is important to know about FFP?

• must be ABO compatible

  • collected from males, female collection can result in TRALI

Glycolysis

Glucose breakdown for energy

Gluconeogenesis

Glucose synthesis from non-carb sources

Glycogenesis

glucose storage as glycogen

Insulin

• beta cells of islets of langerhens

• DECREASE glucose by stimulating glucose uptake

Glucagon

• alpha cells of pancreas

• INCREASE glucose by stimulating glycogenolysis

Type 1 Diabetes Mellitus

• Autoimmune destruction of pancreatic beta cells → Absolute insulin deficiency

• Auto antibodies present

• Juveniles

• DKA

Type 2 Diabetes Mellitus

• Insulin resistant with progressive beta-cell dysfunction

• Mild symptoms

• Late-onset

• HHNS

Common symptoms of DM

The 3 Ps

• Polyphagia

• Polyuria

• Polydipsia

Lab Findings in Uncontrolled DM

• Increased blood & urine glucose

• Increased urine specific gravity

• Increased Ketones, BUN, osmolality, cholesterol, triglycerides

• Decreased bicarbonate and blood pH

Diabetic ketoacidosis DKA

• Type 1 DM

• Rapid

• Fruity breath → increased ketones

• Metabolic acidosis → Kussmaul-Kien respirations

Hyperglycemic Hyperosmolar Nonketoic Syndrome HHNS

• Type 2 DM

• Gradual

• severe neurological symptoms

• NO ketones

• Severe dehydration and hyperosmolality

What is the only non-reducing sugar?

Sucrose

Measurement of ketones

• detects acetoacetate

• uses nitroprusside

Glycated hemoglobin (HbA1c)

• Reflects average blood glucose over 2-3 months

• measures percentage of hemoglobin binded to glucose

• can be falsely decreased due to RBC disorders (anemia, hemolysis, hemoglobinopathies)

Fructosamine

• Reflects average blood glucose over 2-3 weeks

• Measures glycated serum proteins (albumin)

Fasting Glucose Pre-Diabetes RI

100-125 mg/dL

DX of HbA1c for DM

>6.5%

Normal HbA1c RI

<5.7%

Chylomicrons

• Transport dietary (exogenous) triglycerides

  • Think OUTSIDE source

VLDL

• Transport endogenous triglycerides

  • Think INSIDE source

LDL

• Transport cholesterol to tissues

• “LOUSY” cholesterol

HDL

• Transport cholesterol out of tissues

• Healthy cholesterol

Apo-A

Major protein for HDL

Apo-B48

Major protein for Chylomicrons

Apo-B100

Major protein for VLDL & LDL

Measured using enzymatic methods

Total cholesterol and triglycerides

Hypercholesterolemia

Elevated total cholesterol & LDL-C

Hypertriglyceridemia

Elevated triglycerides

Mixed hyperlipidemia

Elevated cholesterol & triglycerides

Artherosclerosis

Buildup of plaque in the arteries

VLDL calculation

Triglycerides/5

LDL calculation

Total cholesterol - HDL - VLDL

Triglycerides must be less than 400

Pre-hepatic jaundice

• hemolytic anemia

• increased red cell destruction → increased unconjugated bilirubin → increased urine urobilinogen

• NORMAL liver function

Hepatic jaundice

• cirrhosis, viral hepatitis

• increased unconjugated bilirubin → increased urine urobilinogen

• increased conjugated bilirubin → increased urine bilirubin

• liver dysfunction

Post-hepatic jaundice

• obstructive jaundice causing conjugated & unconjugated bilirubin to not be metabolized properly (cholestasis)

• increased conjugated bilirubin → increased urine bilirubin

• decreased urine urobilinogen

• clay colored stool

Heme breakdown pathway

Heme → biliverdin → bilirubin → conj. bilirubin → urobilinogen → urobilin → stercobilin

Gilbert’s syndrome

• benign

• mutation in UGT1A1 gene

• mild increase in unconjugated bilirubin

Type 1 Crigler-Najjar syndrome

• More severe with ZERO function in UGT1A1 gene

• NO conjugated bilirubin

• kernicterus without treatment

Dubin Johnson syndrome

• defective in hepatic transport

• ABCC2 mutation → MRP2 deficiency

• increased conjugated bilirubin

• BLACK GRANULES ON LIVER

Rotor syndrome

• impaired retake of bilirubin

• SCLO1B1/B3 mutation → OATP1B1/B3 deficiency

• increased conjugated bilirubin

• NO BLACK GRANULES ON LIVER

Isoelectric point

pH at which net charge is zero

An amino acid is a zwitterion when….

pH = pI

What can happen if you use plasma samples instead of serum when looking at an SPE?

There is a fibrinogen peak migrating between gamma and beta fractions

Albumin

• Largest protein fraction

• Regulator of osmotic (oncotic) pressure and transport protein

Alpha-1 antitrypsin

• 90% of alpha-1 fraction

• DECREASE → absence of alpha-1 fraction due to SERPINA1 mutation

Alpha-1 fetoprotein

• Screens for fetal distress or abnormalities

• INCREASE → neural tube defects (spina bifida)

• DECREASE → down syndrome

Alpha-2 globulins

Haptoglobin

• binds free hemoglobin

• DECREASED → transfusion rxn & hemolysis

Ceruloplasmin

• transports copper

• DECREASED → wilson’s disease (Kayser-Fleishcer rings)

Active cirrhosis SPEP

Beta Gamma bridge

IgA BUILDS THE BRIDGE

Nephrotic Syndrome

DECREASED albumin

INCREASED alpha-2

ALBUMIN LEAKS, ALPHA 2 STAYS

Hypogammaglobulinemia

DECREASED gamma

Think any immune deficiency of gamma globulins (IgG,IgA,IgM)

Monoclonal gammopathy

large spike in GAMMA region

Associated with Multiple myeloma, lymphoma, CLL, etc

Basic metabolic panel

Sodium, Potassium, Chloride, CO2, Calcium, BUN, Creatinine, glucose

Comprehensive metabolic panel

Sodium, Potassium, Chloride, CO2, Calcium, BUN, Creatinine, Glucose, Albumin, ALP, AST, Total protein, bilirubin

Electrolyte panel

Sodium, Potassium, Chloride, CO2

Hepatic function panel

Albumin, ALT, AST, ALP, bilirubin, total protein

Lipid panel

Total cholesterol, LDL-C, HDL-C, triglycerides

Renal function panel

Sodium, Potassium, CO2, calcium, glucose, Creatinine, BUN, albumin, phosphate

The rate of migration in protein electrophoresis is dependent on…

Size, shape and charge of a molecule

Acute inflammation SPEP

INCREASE alpha-1 & alpha-2 fractions

Inflammation raises the Alphas

BUN RI

6-20 mg/dL

Urea

• major waste product of protein breakdown

• ammonia → urea

• eliminated via kidneys

Pre-Renal Azotemia

• BUN & Ratio INCREASED

• Excess protein/protein breakdown, dehydration, CHF

Renal Azotemia

• BUN & Creatinine INCREASED

• AKI, CKD, Glomerulonephritis

Post-Renal Azotemia

• BUN, Creatinine & Ratio INCREASED

• Urinary obstruction

Ammonia specimens

Put on ice and separate plasma ASAP

***Ammonia hates waiting****

AFP Tumor marker

Hepatocellular carcinoma (liver cancer)

CEA Tumor marker

Colorectal cancer

CA-125 Tumor marker

Ovarian cancer

CA 19-9 Tumor marker

Pancreatic cancer

PSA Tumor marker

Prostate cancer

Beta-hCG Tumor marker

Testicular cancer

CA 15-3

Breast cancer

Respiratory Acidosis

pH decrease, CO2 increased

COPD, hypoventilation

• Cant breathe CO2 out

Respiratory Alkalosis

pH increased, CO2 decreased

hyperventilation, anxiety, hypoxia

• Breathing too much

Metabolic acidosis

pH and HCO3- decrease

DKA, Diarrhea

• losing too much base/bicarbonate, increased ketoacids

Metabolic alkalosis

pH and HCO3- increase

Vomiting

• losing too much acid

Hyponatremia

• Vomiting/Diarrhea

• Excess water

Hypernatremia

• Dehydration

• Hyperaldosteronism (increases renal reabsorption)

• cushing’s syndrome

Major cation of intracellular fluid

Potassium (K+)

Major anion of extracellular fluid

Chloride (Cl-)

ANION → A negative ION

Major cation of extracellular fluid

Sodium (Na+)

Hyperkalemia

• Diabetic acidosis

• Hemolysis

  • Addison’s disease

Hypokalemia

• Vomiting/Diarrhea

Hypochloremia

• Vomiting/Diarrhea

Hyperchloremia

• Dehydration

  • Diarrhea

What test is used to diagnose cystic fibrosis?

Sweat chloride test

• Sweat collected by iontophoresis

Osmolality

measure of total concentration of dissolved particles in a solution

Calcium

• PTH & Vitamin D → increase absorption

• Calcitonin → inhibits reabsorption

Vitamin D deficiency

Rickets

Hyperosmolality

thirst sensation → increased ADH → DKA, HHNS, DI

Hypoosmolality

thirst suppression → decreased ADH → SIADH

Uncompensated blood gas

pH abnormal

One (pCO2 or HCO3) is abnormal

Partial compensation of blood gases

All components abnormal

Complete compensation of blood gases

Normal pH

Abnormal pCO2, HCO3-