MLS final comprehensive

methods to measure osmolality

osmometer→ freezing point (urine and serum)

LD measurements

• LDH-1 

  • Dangerous in the LDH flip - seen in cardiac necrosis 

• LDH-2 

  • Major fraction in healthy adults

• LDH-3

  • Elevated in pulmonary damage and carcinomas 

• LDH-4 and LDH-5

  • Seen in liver and skeletal muscle

• LDH-6

  • Alcohol dehydrogenase 

  • Sign of arteriosclerosis cardiovascular failure 

  • Sign of impending death 

Other than viability and abnormal forms, what else do we analyze semen for

Liquefaction, Volume, Motility, Viability, Count, Morphology, pH, acid phosphatase,

fructose (ACID PHOSPHATASE IN RAPE CASES)

semen collection

Collect in sterile container, without

condom, after 3-day abstinence. Keep at

room temperature and deliver to lab

within 1 hour of collection. Keep

specimen at 37 C

Viability of sperm eosin stain

red is dead

Chemistry tests most affected by hemolysis

Potassium and LDH

Electrophoresis protein flow

Albumin, A1 (A1-antitrypsin, alpha-fetoprotein), A2 (haptoglobin, ceruloplasmin), Beta, Gamma

How does electrophoresis flow

cathode to anode

Acid Base reference ranges

pH 7.35-7.45

CO2 45-35

HCO3 22-26

respiratory acidosis

CO2 excess

respiratory alkalosis

CO2 deficient

metabolic acidosis

HCO3 deficit. diabetic ketoacidosis- hyperventilation for compensation

metabolic alkalosis

HCO3 excess. hypoventilation for compensation

how do you screen for cushings disease

cortisol levels, 24 hour urine cortisol, cushings is increased cortisol without normal diurnal variation of cortisol

blood draw times for peak and trough drug levels

peaks drawn 1-2 hours after administration (depends on IV or IM or oral). troughs drawn right before next dose administered.

voided urine

first morning (ideal)

what urine sediments polerize

uric acid and cholesterol

what test can we do to differentiate urine from amniotic fluid

creatinine

transferase enzymes

transaminase, phosphotransferase, hexokinase

lead screening

lead measurement on whole blood, observation of basophilic stippling

method for measuring drugs of abuse

screen by immunoassay, confirm by GCMS or LCMSMS

what is hemoglobin A1C

glycosylated hemoglobin test for diabetes. normal = 5.7-6.4 prediabetes= >6.5

how does lab measure glucose

glucose oxidase→ converts glucose into gluconic acid and H2O2

hexokinase→ reference method

blood gasses hemolyzed

increase potassium and LDH

blood gasses exposed to air

decreased CO2, increased pH, increased O2

what tests are affected if the blood is not spun for hours

glucose, liver function, renal function, serum electrophoresis

prealbumin

transthyretin, appears as faint band on serum electrophoresis used to assess nutritional status

alpha fetoprotein tumor marker

liver, ovaries, and testes

carcinoembryonic antigen (CEA)

colon, breast, lung

CA 15-1, BR 27-29

breast

CA 125

ovaries

CA 19-9

pancreas

estrogen and progesterone receptors tumor marker

breast

prostate specific antigen (PSA)

prostate

human chorionic gonadotropin (HCG) tumor marker

testicular

beta-2-microglobulin tumor marker

multiple myeloma, CLL

what contributes to specific gravity but not osmolality

protein

what protein forms a hyaline cast

tamm horsfall

what antibodies cause intravascular hemolysis

igM

what antibody causes extravascular hemolysis

IgG, Rh, Kell, Duffy, MNS (anti-Ss more than anti-MN)

HDFN ABO

increase spherocytes, weakly positive DAT, delayed jaundice, 1st pregnancy (O mother with A baby typically)

HDFN Rh

increase reticulocytes, strong positive DAT, immediate jaundice, usually not 1st pregnancy (D negative mother D positive baby)

intrauterine transfusions

irradiated, O negative, compatible with mother’s plasma, negative for sickle cell, <7 days old, CMV negative

MUST BE COMPATIBLE WITH MOTHER (antigen negative for corresponding antibody)

Calculation for KB

#cells counted/2000 × 5000 =mL of bleed (/30 to calculate vials)

→ 1 vial even if none seen for procautions

→ round up

Acceptable donors

• 17 years or older

• 35.7 or 99.5 temp

• systolic 90-180

• diastolic 50-100

• >12.5 hgb

• >38 hct

• >110lb

permanent deferrals

Hep B positive, HIV, T. cruzi present or past, drug use, creutzfeldt jakob, babesias

3 year deferral

malaria lived in malaria endemic country

1 year deferral

hep immunoglobulin, tattoo, needle stick exposure, blood exposure, completion of therapy for syphilis or gonorrhea, >72 hours in a correctional facility

tests for a transfusion reaction

DAT, post AB screen, type and screen

acute hemolytic transfusion (intravascular)

immediate- 24 hr, hemolysis, ABO system error, fever, pain at transfusion site and lower back pain

delayed hemolytic transfusion reaction (extravascular)

24 hours- 2 weeks after transfusion, no indication, positive DAT, often due to KIDD

transfusion related acute lung injury

pulmonary edema without cardiac failure, chills, fever, hypotension, caused by antibodies in the plasma to neutrophils or HLA antibodies

GIVE FFP FROM MALE DONOR

febrile reaction

1 degree temperature increase, fever, chills, recipient performed leukocyte antibodies to lymphocyte, granulocytes, and platelets

GIVE LEUKOREDUCED RBC

transfusion associated circulatory overload

pulmonary edema with hypertension

SLOW TRANSFUSION RATE

allergic transfusion reaction

recipient preformed IgE antibodies to donor soluble plasma proteins, mild, rash or hives with itching

GIVE WASH PACKED RBC

anaphylactic transfusion

hypotension, shock, IgA deficient patient with anti-IgA reacting with IgA donor plasma

GIVE IGA DEFICIENT BLOOD PRODUCTS OR DEGLYCERIZED RBC

Antibodies enhanced by enzymes

Kidd, rh, lewis, I, P1

antibodies destroyed by enzymes

Duffy, Kell, MNS

Genotype vs phenotype

genotype→ the observed alleles for an individual at a genetic locus (AA, AO, BB, BO, AB, OO)

phenotype→ observable characteristics (Group A, Group B, Group O, Group AB)

Fisher race

R0 Dce

R1 DCe

R2 DcE

Rz DCE

r dce

r’ dCe

r” dcE

ry dCE

Bombay phenotype (anti-H)

hh, no H antigen

IgM antibodies

pentamer, better at agglutination, cold/body temps, can’t cross placenta

IgG antibodies

monomer, not as good at agglutination as IgM, AHG, can cross placenta

IS AB

anti-… I, M, N, H, Lea, Leb, P1

37 AB

anti-… Rh, D, C, E, c, e

AHG AB

anti-… D, C, E, c, e, Kell, Duffy, Kidd, M, Lea, Leb

HLA system (DR/Bg)

Bg→ class I antibodies, anti-Bgb is an antibody directed against HLA antigens on red cells

Dr→ present peptide antigens, potentially foreign in origin, to the immune system for the purpose of eliciting or suppressing T (helper) cell response that eventually lead to production of antibodies against the same peptide antigen

absorption for patients with WAA

patients own serum and cells, auto absorb the antibody to uncover the alloantibody

IAT vs DAT

DAT→ invivo, what happening on patients red cells

IAT→ in vitro, antibody screen

ABO discrepancies aquired B phenomenon

from bacterial infection

ABO discrepancy subgroups of A

LISS

lowers zeta potential, enhances antibody uptake

PEG

removes water, lowers zeta potential

Lewis neutralization

saliva

P neutralization

hydatid cyst fluid, pigeon egg white

sda neutralization

urine

chido/rodgers neutralization

complement

Anti-I

adult, absent or weak, anti-I is cold reacting, and can mask a clinically significant antibody

anti-i

infant, in cord cells

antibody screening using group O cells

IAT, use group O cells as there are no A or B antigens present

minor crossmatch

patient red cells and donor plasma

major crossmatch

patient plasma and donor red cells

what blood product do we give for chronic granulomatous disease

granulocytes

what blood products do we give for IgA antibodies

IgA deficient blood products

what blood products do you give for anemia

red cells packed

storage conditions blood

1-6 c, frozen >-65 c

FFP conditions

>-18 c

platelet storage

22-24c with constant agitation

expiration date on blood

frozen 10 years, 24 hours after alterations

expiration on FFP

1 year

expiration on platelets

5 days

expiration on cryo

1 year if frozen 24 hr thaw

P antigen associated with

paroxysmal cold hemoglobinuria

duffy antigen associated with

malaria resistance

A suagr

N-acetylgalactosamine

B sugar

D-galactose

O sugar

fructose

dolichos biflorus

anti-A

ulex europaeus

Anti-D/O

Lab tests to measure platelet function

platelet function assay