RECALLS

 Troponin T normal, LD abnormal: MI

 Picture of Monoclonal Gammopathy in electrophoresis
 Beta HCG marker of malignancy
 Anion Gap
 TCBS – V. cholera (sucrose fermenter)
 Positive control has weak result, Neg control has negative result, patient result is
positive, what to do? – My answer: Perform titer on positive control to identify
values
 Result of haptoglobin in hemolytic anemia: Decreased
 Effect of blood sample exposure to air: dec CO2 inc pH
 P. vulgaris- indole pos; P. mirabilis- indole neg
 Cystic Fibrosis associated with: Bulkholderia, Staphylococcus, Pseudomonas
 Picture of normocyte in Di Guglielmo’s Syndrome
 Cell seen in myelofibrosis: Teardrop cell (Dacryocyte)
 Hemoglobin electrophoresis
 Many blast cells present in bone marrow: AML?
 Anti-thrombin III: Heparin co-factor; deficiencies assoc. with thrombosis
 I got 2 blood panels
 Rhogam
 Anti-I: Cold agglutinin disease
 Question about Kidd antibody
 Know cold and warm antibodies
 FFP after thawing: 6 hours expiry at 4 degree C.
 Cryoprecipitate after pooling: 4 hours expiry
 Autoantibodies
 Ouchterlony technique
 Presence of anti-HBc only, what will be the problem? My answer: repeat HBsAg
 Addition of Bromthymol blue, which substance will become positive? My answer:
Reducing sugars
 Use of caffeine benzoate/methanol in bilirubin: Accelerator
 Increased anion gap due to: Metabolic acidosis
 ABO discrepancy
 RIST: total IgE; RAST: specific IgE
 Study about fluorescence
 Birefringent crystal in synovial fluid causes what: Pseudogout (Calcium
pyrophosphate)
 What to add to check mucin clot in synovial fluid: Glacial acetic acid
 May CSF infection, sensitive naman daw sa antibiotic (I forgot what antibiotic), pero
bakit hindi daw gumagaling? My answer: low MIC
 Best method to diagnose Rickettsia infection
 Mucor: No rhizoids
 Fungus that resembles chandelier- T. schoenleinii
 Bacteria present after jaw surgery: Veilonella
 Description of Nocardia- musty odor
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 Principle of fluorometry
 Meaning of coefficient of variation
 Sperms attached to each other, either head to head, head to tail, etc. What
discrepancy?
 Collection of blood gas sample
 Difference between Citrobacter and Salmonella
 Hemoglobinuria will only be seen if: Haptoglobin is depleted
 Contact lens parasite: Acanthamoeba
 Consistent SG in urine of 1.010: Diabetes Insipidus
 SG of 1.050 presence of: Abnormal solutes
 Proteins nearest to cathode: Gamma and Beta
 Clinical findings of patient with Lactic Acidosis
 How to resolve if RBCs are stained blue in Wright’s Stain?
 Parasite that causes autoinfection in an immunocompromised patient: S.
strercoralis
 RBC morphology of Hookworm infection
 CSF with increased Neutro: Bacterial
 Tap water bacillus: M. gordonae
 Biochemical reaction of Aeromonas hydrophilia
 Decreased Iron and decreased TIBC but normal iron stores? My Answer: Anemia of
chronic disease
 Alpha Thalassemia may consist of what: Bart’s HgB
 Cofactor of more than 300 enzymes: Magnesium and Zinc (if both present, answer
Mg)
 Zinc protoporphyrin is never tested in children on lead poisoning, why? My answer:
low sensitivity
 Meaning of creatinine clearance
 Parameters for accurate monitoring of Phenytoin

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"ESKAPE"

ESKAPE pathogens : a group of pathogens (Enterococcus faecium, Staphylococcus

aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa,
and Enterobacter species) with a high rate of "antibiotic resistance" that are
responsible for the majority of nosocomial infections.

Enterococcus faecium:

Vancomycin-resistant E. faecium is often referred to as VRE.

Staphylococcus aureus:

Today, S. aureus has become resistant to many commonly used antibiotics.

β-lactamase-resistant penicillins, MRSA, VRSA, and much more...

Klebsiella:

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Klebsiella species with the ability to produce extended-spectrum beta-lactamases
(ESBL).

Acinetobacter baumannii:

Multidrug-resistant A. baumannii has spread to civilian hospitals in part due to the

transport of infected soldiers through multiple medical facilities. Due to the
prevalence of infections and outbreaks caused by multidrug-resistant A. baumannii,
few antibiotics are effective for treating infections caused by this pathogen.

Pseudomonas aeruginosa

One of the most worrisome characteristics of P. aeruginosa is its low antibiotic

susceptibility, which is attributable to a concerted action of multidrug "efflux pumps"
with chromosomally encoded antibiotic resistance genes.

Enterobacter spp (Two clinically important species from this genus are E. aerogenes
and E. cloacae.

E. aerogenes:

The majority are sensitive to most antibiotics designed for this bacteria class, but this
is complicated by their inducible resistance mechanisms, particularly "lactamase",
which means that they quickly become resistant to standard antibiotics during
treatment.

E. cloacae:

Resistance to Beta-lactams, Aminoglycosides: Aminoglycoside, Fluoroquinolones,

Trimethoprim-sulfamethoxazole (TMP-SMZ).
____________________________________________________________________________________

1. CO2 electrode measures--- HCO3

2. postprandial lipemia increases--- lipoprotein (triglycerides is not in the choices)

3. lupus anticoagulant – increases APTT

4. a person has fasting glucose of 140 and OGTT of 180. What further testing is
needed to confirm diabetes mellitus.

- no further testing needed

5. creatinine clearance….pls memorize the formula (U/P) x (v/1440) x (1.73/A).

6. CML ---t (9:22)

7. potassium permanganate- quenching agent

8. primidone toxicity --- phenobarbital level assay

9. picture of stomatocytes- liver disease

10. cell counting problem– memorize the formula

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11. I only got one blood panel---- choices are just the description of the antibodies.
The antibodies I detected are the Lewis antigen. So the answer I chose is “
antibodies adsorbed onto the surface of the erythrocyte”

12. What are secreted by type A, Le (a-b+) -------- A, H, Lea, Leb

13. picture of blood smear with schistocytes ----- choices led me to choose DIC.

14. What to do if accidently splashed with chemical on eyes ------ flush with water for
15 minutes

15. what increases in hemolytic anemia ---- elevated unconjugated bilirubin, elevated
urobilinogen.

16. normal control 3SD and abnormal control within 2SD… What is the cause. Control
left at room temperature for a long time.

17. picture of Burr cells. ---- what is the condition of the patient. – Uremia

18. inscription on the volumetric pipette reads 1 +/- 0.006 mL……. What does this
mean?

a. reproducibility b. precision c. accuracy d. calibration…. I just guessed for my

answer.

19. prolonged APTT, prolonged PT, Prolonged TT, elevated fibrinogen ------- DIC

20. I was given lab result with glucose having abnormal value, the rest are
normal…..what other test needed. ----- A1C.

21. glucose --- positive ; Clinitest ---- negative------ What does the test mean? Urine
contains glucose.

22. which of the following conditions would have a urine pH of 4.5?

a. ketoacidosis b. vomiting c. hyperventilation d. salicylate intake. ----

23. For the micro part, you need to be familiar with the TSI of enterobacteriaceae.
Micro chart from wordsology is helpful. However, Maricel’s notes are GOLD.

24. A girl with severe normocytic, normochromic anemia but with normal WBC and
platelet counts...... Red cell aplasia

25. gram positive bacteria that is bile positive and NaCl negative---- Strep bovis

26. What is the best test that detects syphilis.. Test that detects syphilis at all phases.

27. Gout; Monosodium Urate; Negative Birefringent (Yellow when parallel. Needle
shape).

Pseudogout; Calcium Pyrophosphate; Positive Birefringence (Blue when parallel.

Rhomboid shape).

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28. Pos control for anti c = C+c+
Neg control for anti fya = fya- fyb+

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*what poikilocyte can be seen in moth ball ingestion?

*what leukemia has the PML/RARA oncogene?
*russel viper test is for?
*coagulation graphs
microbiology
*ATCC S. agalactiae
*cause of Streptococcal Glumerolunephritis
clinical chemistry
*correlation of liver enzymes
blood banking
*I got a more or less 5 panels..
*lectins
*ABO descrepancies
microscopy
*memorize urinary crystals, either acidic/alkaline
serology/immunology
* serial dilutions <---the only calculation I got

1. Magnesium is monitored in case of? pre-eclampsia

2. In Auramine-Rhodamine staining, KMNO4 acts as? quenching agent
3. HbA1c is dependent with? RBC lifespan
4. Anti-smooth muscle Ab is seen in? Chronic Active Hepatitis
5. What is the next thing to do when retics are seen in smear? Stain to detect Heinz
Bodies
6. Which chemistry panel is fit for Hemolytic Anemia? Increase B1, 7. Normal urine
bilirubin, Increase urine urobilinogen
8. Cushing Syndrome causes? Hyperglycemia
9. Which disease has low level of EPO? Polycythemia vera
10. Burr cell = uremia
11. SIADH? Low sodium
12. D-TEST? Inducible resistance to clindamycin
13. [Link] ferments mannitol
14. What is in the saliva of a Le(a+b-) individual?
15. Pic of stomatocytes = liver disease
16. Pic of cholesterol crystal in urine
17. Latex test for [Link] = Protein A and Clumping Factor
18. Prostate removed then positive for PSA = disease recurred
19. Autoinfection - Stongyloides
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20. Cant remember the question but the answer was PURE RED CELL APLASIA
21. Pic of ANA = Centromere
22. menstrual period-decrease in ferritin
23. heparin/histamine = Basophil/mast cell
24. Lewis Blood group = easily destroyed
25. Mother donating rbc to son , what do you do… Wash, irradiate ect…
26. Where heme c and s found… Extrinsic , intrinsic, warfarin, heparin
27. Pseudomonas aeroginosa vs putida
28. Hepatitis marker
29. High Hct in coag sample. What should you do? Report the result
30. What can cause increase ESR? Choices were diseases
31. Virus shipment? Lyophilized
32. Picture of rouleaux; the cause of this can be prom the proliferation of (plasma
cells-multiplemyeloma)
33. 1 malaria question. which among them has no schizonts. I answered P. oval (not
sure)
34. What is increased with mumps = Amylase
35. what does the hair test confirm ( I believe it was T. rubrum / T menta but I am not
sure )
36. spikey cells = slides not dry yet
37. Renal shutdown for diabetic patient. what would be screened first? Choices were:
crea, bun, micro albumin, 24h protein. I don't know the answer. I answered micro
albumin lol
38. Double zone bacteria how to confirmation positive reverse CAMP
39. Alpha thalassemia-hgb Bart and Hgb htest.
40. Patient comes in with lesions on arm, given description of what is seen in culture.
– I guessed, but I’m pretty sure it was Sporothrix schenkii
41. specimen for legionella? not so sure about the question but the answer was
NASOPHARYNGEAL SWAB
42. What is the second, irreversible step in platelet aggregation studies? Or something
like that. – I had no idea, guessed change in platelet shape. Upon googling, it seems
‘release of nucleotides’ or something related would be correct.
43. know PTH effects on Ca+
44. a couple of thrombin/ antithrombin questions
45. a really crappy grainy picuture of what looks like rbc
agglutination/flocculation/some other crap … that sais what should you do next – I
chose heinz body stain (actually got this exact pic twice)
46. absolutely no parasitology
47. know (sensitivity = TP/TP +FN) and those others (SPECificity = TN/TN+TP)
(PRECISION = TP/TP+FP)

____________________________________________________________________________________

1-EIA method for HBsAg gives you

Cutoff number: 0.7
HBsAg:0.7

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Negative, Positive, indeterminate, I choose Positive but I am not sure.
2- Cold agglutinin picture twice one for cold antibody reaction second one for
Mycoplasma Pneumonia
3- The best sensitive method for syphilis
Detect almost all reactions
Detect all false negative
Detect syphilis in all phases
I Choose to detect almost all reactions
4-UA strips detect Blood but you can’t see any blood under the microscope
Alkaline and dilute urine
Ascorbic acid
Outdated UA strips
I choose alkaline and dilute
5- Big Urinary case has 3-4 granular casts and about 25 renal tubular cells
Pyelonephritis
Glomerulonephritis
Acute tubular necrosis (my choice)
6- Anti-smooth muscle antibody - Chronic hepatitis
7- Picture for ANA (has some red circles around the green phosphoric pattern) - I
choose nuclear pattern
9 – Give you Ferritin value, Fe serum value, and UIBC value, and you need to calculate
the Transferrin saturation percentage - I ignore the Ferritin value and use the equation
%= Fe/TIBC
10-Hemolytic anemia and unconjugated & conjugated bili, urobilinogen question
11- SIDAH – low serum Na
12- Fasting glucose 120mg/dl, NonFasting glucose 165 mg/dl
Diabetes Mellitus
Impaired fasting
No hyperglycemia (mu choice I am not sure)
13- High Cortisol and ACTH levels - adrenal Cushing’s
14 – This question comes from this group, what can give urine of 4.5 Ph
High protein diet (my choice), salicylic toxicity, vomiting
15. Grave’s - antibodies directed against TSH receptors
16- Primidone – Phenobarbital
17- CO2 electrode measure - PH
18- Antigen is not stable in storage? MN
19- Le(a+b-) – only Lea
20- Mixed field forwarded group - Blood O transfusion
21- Rouleaux is undetectable at what phase – AHG
23- PCR problems – Nucleotides interference
24- Something about D control and Du control
25- Catheter – heparin contamination
26-what indicate not successful streptokinase therapy?
PT of 12 (my choice)
PT of 25
PPT pf 120
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D-Dimer positive
27- What is the right position for safety biological cabinet - I choose randomly
28- What cause decrease ESR – vibration of the disk
29- PPT out of control – change the CaCl reagent
30- Normocytic normochromic anemia. Retics is 0.01. – Pure red cell aplasia
31-The second step in platelet aggregation studies – I got two release ADP and
something else
32- Big viruses’ case gives you results for EBV, CMV, and Toxoplasmosis. I found IgG
and IgM values in every case so I choose coinfection
33-HbAc1 decrease with – hemolytic anemia
36- Histamine/Heparin? Basophil, Mast cell
37- EPO is decreased in
Polycythemia due to brain something
Polycythemia due to something
Polycythemia vera (my choice)
38- Picture of target cell and hemoglobin C crystals both OMG, after changing the
lysing agent what give false high WBC. I chose target cell I know it resists lysing agent
I am not sure.
39- Hair [Link] and T-manta
40- S. pneumonia identification
41- Aeromonas - Oxidase positive
42- Salmonella subtypes (do not produce H2S) what you do next-type with salmonella
group
43- Leuconostoc identification catalase – but not Enterococcus or [Link]
44- What to do if you have EDTA tube for ABO typing- draw another sample
45-Fletcher’s media- Leptospira

____________________________________________________________________________________

1. On microscopic exam, wbc were seen but urinary nitrite was negative. What could
be the explanation?
A. Wbcs were lymphocytes
B. Bacteria reduced nitrite to nitrogen
*C. Presence of ascorbic acid
D. Diluted urine
2. Picture of burr cells: uremia
3. 2 pictures of rbcs with tear drop cell, hypersegmented neutro and erythrocytes with
cytoplasmic inclusion (acidophilic stained): I answered was g6pd and anti malarial
drug. Forgot the questions.
4. What to do with viscous synovial fluid for analysis of crystals?
A. Add hyaluronidase
B. Dilute with saline
C. Dilute with acetic acid
5. Seen in RA (not sure but I answered letter A)
A. IgG attacking Igm RF
B. IgG crystals

Page 8 of 312
6. Child who ingested moth balls? Heinz bodies
7. There was a picture comparison of 3 graphs on platelet aggregation.
Adp, epinephrine and something else. Choices were something like this:
A. Adp and 2 are correct, epi is wrong
B. Adp is correct, 2 and epi are wrong
C. All are correct
8. RBC count, 1:10 dilution and given 2 values.
9. Corrected wbc count. It was a little tricky for me because i didnt memorize the
formula and they only counted 50 wbc so i got confused. But this is the question.
50 wbc were counted manually in a patient with 0.5x10^3/L WBC, 88 NRBC were
counted. What is the corrected wbc count.
10. Picture of spike cell: slide not dry
11. Blood parameters given: aplastic anemia
12. Lupus anticoagulant
13. A problem with px having 35k wbc and lymph 35%, neutro 55%
A. Absolute lymphocytosis
B. Relative lymphocytosis
I answered relative [Link] not sure.
14. 2 questions about transferrin and TIBC. Just their definitions.
15. Blood comes positive for htlv 1 iea. What to do? Do confirmatory western blot
16. Individual with past infection but also present jn acute infection? Anti-HBcore
17. Confirm cmv : latex agglutination
18. Recurrent syphilis: vdrl
19. Pheochromocytoma: VMA
20 virus soecimen transport: lyophilized, -65
21. Specimen nasal/throat swab, no growth for h. Influeza: inactivated by sample
collector
22. Lewis blood group: easily destroyed
23. Pseudomonas aeruginosa vs putida:
24. Micro of aeromonas (given previously)
25. Increased in mumps: amylase
26. Hair test: t. Menta
27 alpha thalasemia: hgb bart and hemoglobin h
28. Cushing syndrome : hyperglycemia
29. Gram (-) anaerobe jaw surgery: veilonella
30. Zygomycota picture
31. Walking pneumonia given penicillin but with no relief: bacteria has no cell wall
32. Given TsI: salmonella
33. Proteus vulgaris: indole (+)
34. Erysipelothrix rhustopathiae: butcher somethinf
35. Picture of alternaria
36. Description of geothricium
[Link] species of malaria had no schizont and mature troph in peripheral blood?
38. Post prandial lipemia (choices: cholesterol, lipoprotein, fatty acids)
39. Crea clearance but the choices were something to do with BUN

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40. 1 antibody panel but not to identify antibody, it was to confirm JF and E and if they
were positive or negative.
41. A px with elevated ALP, unconjugated and total bili, urine bilurubin and urine
urobilinogen. All were elevated and the question, which of the following was out of the
picture ( which value should not be high?)
42. Anti Hbe given cut off 0.7 px value 0.3: negative for anti hbe
43. B-hcg 12 or 100 something like that then the question was Usual [Link] for b-hcg?
I answered 25.
44. Incidence of anti-k? A. 1<1% B. 10% c. 90% d. 100%
45. If you need 4 rbc which are anti fy and anti k (given fy+ individuals are % in
population, and k positive % population. How many do you need to be able to get a
crossmatch? (Forgot the choices but there was 17, 21)
46. How many units do you need to match 6 units of k (+) blood? Something like that.
Not sure. But i got 2 questions like this.
47. An osmolality of 300mOSm. Choices were CHF, kidney problem, etc i answered
Kidney problem, not sure.
48. Flurometry (given earlier)
49. Total bb: 3.2
Added caffeine total bb: 5.4
(The values are correct as i remmbered but i forgot how the question was asked.)
Choices: a. Unconj 3.2, con 5.4
B. Uncon 5.4, con 3.2
C. Uncon 2.2, con 3.2
D. Uncon 3.2, con 2.2
50. Got 2 questions about specificity and sensitivity. Like the one here were procedure
2 is more sensitive and specific.
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1. Least reaction with anti-H: A1

2. Burr cells : uremia
3. rotavirus specimen: stool
4. LDL calculation
5. Stomatocytes: liver disease
6. Releases histamine/heparin : basophil/mast cell
7. Tap water: M. gordonae
8. Autoinfection : Strongyloides
9. Bilirubin:450 nm
10. HTLV confirmatory test: western blot
11. Sezary syndrome: T cells
12. Ingestion of moth balls: heinz bodies
[Link] 1 hypersensitivity : IgE
14. WBC count calculation
15. Cat bite: Pasteurella
16. jaw surgery: veilonella
[Link] bet. vulgaris & mirabilis
18. Antibodies not enhanced by enzymes
Page 10 of 312
19. Cystic fibrosis- B. cepacia
[Link] permanganate- quenching agent
20. Decreased ESR
21. may hegglin- giant platelets
22. Chronic hepatitis- anti-smooth muscle
23. ANA pattern- centromere
[Link] agglutination for S aureus- protein A and clotting factor
25. Pregnant women- estriol
25. SIADH- dec sodium
26. malassezia furfur- olive oil
[Link]- amylase
28. Spikey cells : slides not dry
29. hepatitis marker
30. pic of bilirubin crystals

____________________________________________________________________________________

Chemistry/Urinalysis
Transudates
Abnormal urine colors
Cast dealing with strenuous exercise
Difference between traumatic tap; hemorrhage
The difference between primary and secondary thyroidism ---TSH
Know your enzymes –ALP AST, LD, etc [Wordsology’s high yield chemistry chart]
Know your Tumor markers --what cancer is associated with it. I got one with hCG—
testicular cancer –[Wordsology’s high yield chemistry chart]
Dilution question
Blood Gasses: Metabolic Acidosis/Respiratory Alkalosis etc. [know reference ranges;
clinical conditions]
Procainamide ---NAPA
Immunology
DiGeorge Syndrome- Regarding T-Cell deficiency—Absence of Thymus
CD4: is it a) inducer b) phagocytic c) cytotoxic d) don’t remember the other choice
ANA patterns
Hematology/Coag
Picture of a peripheral blood smear with Plasmodium falciparum
Howell Jolly inclusion picture –what is it composed of? DNA-
One with Pappenheimer Bodies – what do you stain it with? --Confirm with Prussian
Blue
Know what anemias are considered normochromic normocytic
Hemoglobin C disease---Target cells
Picture of a peripheral blood smear with Plasmodium falciparum
APTT; PT – Disseminated intravascular coagulation—Correlating the APTT: PT
FIBRINOGEN results [prolonged or not]
Know what factors are in the Intrinsic and Extrinsic Pathway, mixing studies

Page 11 of 312
Blood Bank
Felt like I had a lot of blood bank questions (my weakest subject) Know how to do
panels, DAT/ELUTION/ Subgroups of A
Criteria for Allogenic Donor Selection
CDPA-1 know its advantage
Microbiology/Mycology
Had a question deal with +/- controls for Bile Esculin; CAMP; NACL; Bacitracin [Used
Wordology's Gram Pos Cocci Chart]
picture of Kansassi
Sterilization – 15 lbs –121C
ESBL
TSI reactions for Enterobacteriaceae--Bottom Line Approach Yellow & Purple book
Ziehl-Neilson—hot stain
Rotavirus – stool
Histoplasma capsulatum –tuberculate macroconidia
Sporothrix schenckii—Cigar bodies
Laboratory management:
One question about quality assurance
____________________________________________________________________________________

potassium permanganate- quenching agent

primidone toxicity --- phenobarbital level assay
picture of stomatocytes- liver disease
picture of blood smear with schistocytes
what increases in hemolytic anemia ---- elevated unconjugated bilirubin, elevated
urobilinogen.
Which disease has low level of EPO?
Latex test for [Link] = Protein A and Clumping Factor
Autoinfection - Stongyloides
menstrual period-decrease in ferritin
Lewis Blood group = easily destroyed
What is increased with mumps = Amylase
what does the hair test confirm (T. rubrum / T menta )
specimen for legionella? Urine
High Cortisol and ACTH levels - adrenal Cushing’s
Antigen is not stable in storage? MN
Read on PCR, composed of?
What cause decrease ESR – vibration of the disk, not given. Choices where low, high
temp, microcycytes, rouleaux formation
The second phase and irreversible platelet aggregation occurs?– release ADP and
dense granules

Page 12 of 312
There was a picture comparison of 3 graphs on platelet aggregation.
Adp, epinephrine and Ca I think. Choices were something like this:
A. Adp and 2 are correct, epi is wrong
B. Adp is correct, 2 and epi are wrong
C. All are correct
Pheochromocytoma: VMA
Gram (-) anaerobe jaw surgery: veilonella
Zygomycota description
Kleb oxytoca: indole (+)
Erysipelothrix rhustopathiae: butcher somethinf
Picture of alternaria
1 antibody panel but not to identify antibody, it was to confirm JF and E and if they
were positive or negative.
Incidence of anti-k? A. 1<1% B. 10% c. 90% d. 100%
If you need 4 rbc which are anti fy and anti k (given fy+ individuals are % in
population, and k positive % population. How many do you need to be able to get a
crossmatch? (Forgot the choices but there was 17, 21)
How many units do you need to match 6 units of k (+) blood? Something like that.
Not sure. But i got 2 questions like this.
Got one question about specificity and sensitivity. Like the one here were procedure
2 is more sensitive and specific
Least reaction with anti-H: A1
rotavirus specimen: stool
Stomatocytes: liver disease
Releases histamine/heparin : basophil/mast cell
Tap water: M. gordonae
Autoinfection : Strongyloides
Bilirubin:450 nm
HTLV confirmatory test: western blot
Sezary syndrome: T cells
Ingestion of moth balls: heinz bodies
diff bet. vulgaris & mirabilis= indole + for [Link]
Antibodies not enhanced by enzymes
may hegglin- giant platelets
ANA pattern- centromere
Latex agglutination for S aureus- protein A and clotting factor
SIADH- dec sodium
malassezia furfur- olive oil

Page 13 of 312
Mumps- amylase
Spikey cells : slides not dry
hepatitis marker
pic of bilirubin crystals
Know the conditions relating to Increase and Decrease PT/APTT
NAPA- Procainamide
Renal Tubular Necrosis – UA result
Micrococcus – F
Nutreint for anaerobic agar
Valinomycin-K
Blood drawn was 369ml, used for? WB
HbAic lowers when RBC life span is shorten
CA 19-9 – Pancreas
In Rhabdomyolysis, breakdown of what component causes kidney damage? –
Myoglobin
CLL – B cell
Description of Blastoconidia
Caffeine benzoate- accelerator
____________________________________________________________________________________

A gram negative bacillus has been isolated from feces and the confirmed biochemical
reaction fit those of shigella. The organism does not agglutinate in Shigella antisera.
What should be done next:
- Test the organism with a new lot of antisera
- Rest with Vi antigen
- Repeat the biochemical test
- Boil the organism and retest with the antisera
can you help me how to solve this [Link] value of series hub controls found
12.5 and the SD was calculated at [Link] range is [Link] is the allowable
limits for control?
a.14.5-15.5
b.15-15.4
c.15.2-15.6
d.14.8-15.6

Wich test differentiates [Link] O157:H7:

- manitol
- sorbitol
- lactose
O157:H7 does not ferment sorbitol. It could be a differentiate test:

During the past month, Staphylococcus epidermis has been isolated from blood
cultures at 2-3 times the rate from the previous year. the most logical explanation for
the increase in theses isolates is that
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- the blood culture media are contemned with this organism
- the hospital ventilation system is contemned with S. epidermidis
- There has been a break in proper skin preparation before drawing blood
for culture
- a relatively virulent isolate is being spread from patient to patient

What is the effect of dextran why it is difficult to interpret in bloodbanking?

A. It inhibits anti a and anti b
B. It causes rouleaux
C. It destroys the D antigen on red cell surface
D. It has soluble like antigen

Patient that physically appears to be pregnant but the HCG is neg. U/A = decreased
SG, protein is trace. Why is d result negative?
A. Low SG
B. False neg. Bcos of d trace protein.
C. Theres no HCG detectable becos its produced 6-8days after conception.

Analyzer is set to delta check sodium at +/-7. Of these results, which would delta
check? (and yes, there were 2 that would “technically” delta check”)
Day 1: 137
Day 2: 141
Day 4: 132
Day 5: 137
Day 7: 136
Day 8: 142
Day 10: 134
A) Day 1
B) Day 4
C) Day 8
D) Day 10

whole blood collected at 9 am stored at 4C. At 1 pm platelet was prepared. according

to AABB, which is correct regarding about platelets:
- hard spin first
- centrifuge should be at 4-6C
- platelet cannot be prepared

In a random population 16% of the people are RH [Link] is the percentage of the
RH pos population in heterozygous for r?
A.36%
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B.48%
C.57%
D.66%

75x16/25= 48

Qualitative pcr something is useful in detecting?

A. Enterovirus
B. Rabies virus
C. Adenovirus

antacid poisoning,what will you test?

A ph
B. ammonia
CK

A urine was read using a refractometer with a specific gravity of 1.010 was read at
10C temp and the glucose was 1000 mg dl. What to do next?
A. Report the result
b. Correct the specific gravity dut to incorrect temp.
C. Correct the specific gravity due to high glucose
d. Correct temp due to high glucose

On CBC parameter MCV, RDW, RBC PLT, WBC was ok delta failure on HGB, due what
- Instrument malfunction
- tourniquet too tight
- wrong blood was tested

Whole blood donation stops at 390ml (low volume unit), what should be done.. still a
whole blood or PRBC?

Baby o+ from a mother of o- has an HDN and jaundiced. What will be the result?
A. False positive with anti D
b. False negative with anti D
c. False negative DAT
d. False positive dat

Tuberculin test is:

a. Initiated by t cells
b. Produces a granuloma
c. Initiated by antibody rxns

Why is it that serum bilirubin is preferably measured than amniotic fluid?

A. amniotic fluid exceeds linearity of the machine being used
B amniotic fluid is more difficult to extract
C amniotic fluid has different biological components

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blood from newborn had high PT, high PTT and TT, bleeding from cord is also a
reason..
a) afibriginogemia
b) lupus inhibitor
c) factor 8 deficiency
d) factor 10 deficiency

If a patient is type A with Lewis a+b- what substance will be on their red cells?
a) Lea
b) Lea+A
c) Lea+A+H
d) Lea+Leb

wright stain was too pink..what would you do…i

increase ph…
decrease ph…
add more wright stain

CSF has which band in protein electrophoresis?

Albumin
beta globuin
pre albumini
gamma globulin

What is measured in bilirubin before addition of caffeine and after?

Before addition of caffeine is conjugated and after addition of caffeine is

unconjugated

A patient had a random blood glucose 255 and his FPG > 126 what should we do
a Diabetic
b Repeat FPG
c OGTT

A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered
prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests (which is in
this case), you have diabetes.

For OGTT pregnant woman who had a FPG 249 mg/dl what is next
[Link] it
[Link] physician before proceeding
[Link] and retest
[Link] dose anyway

New expiration for pooled cryo?

6 hours if it is single unit or pooled in closed system ,4 hours if pooled in

open system

how to differentiate between E antigen and fya

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E antigen enhanced by enzymes treatment and Fya destroyed by enzymes
treatment.

A neonate whose cord blood type positive with negative DAT but the mother type AB
negative what you should do:
1-Heelstick 2- do antibody work 3- issue mom vial of rh IG

During a job interview an applicant has the right to refuse to answer if they ask
about..
a) address
b) reason why he/she left the previous job
c) provide photograph
d) availability during night shift or weekend

1).proficiency sample should be

A run as a sample
B run as a control
C run by a senior personal
D run in duplicate
2).TIBC- iron= UIBC
3).best anti coagulant fo chemistry
A EDTA
B Oxalate
C Citrate
D Heparin

Decontamination choice for Pseudomonas in AFB culture

A. Oxalic acid
B. NALC

result of lipase increased at normal amylase

- acute pancreatitis
- duodenal obstruction
Gram Positive Cocci from a brain abscess.... what would be the preferred agar....
A. Blood agar at 35 degrees(?)
B. MacConkey agar at room temp(?)
C. Chocolate agar at anaerobic environment
D. PEA agar

Hemolyzed blood sample causes HbA1c to?

Decrease

RBCs 3.9 ,, Hct 33% ,, Hb 12.5 what's the problem?

Lipemic

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Mother: Type O, Rh neg with Anti-D, anti-C, anti-I and anti-Lea
Child: Type A, Rh positive, DAT +
What blood type should be transfused to the baby?

Answer: Type O, Rh neg, without C, I and Le(a) antigen

Bilirubin results are high for 3 consecutive days in a new born baby. On the 4th day,
result became normal. What is the reason.
A. it is normal
B. because of hemolysis on the 1st 3 days.
C. hemolysis on the 4th day
D. baby has undergone phototherapy

How would you differentiate Micrococcus and Staphylococcus?

A. Coagulase
B Oxidase
C Novobiocin

Which organism commonly causes food poisoning by consumption of foods containing

excessive populations of organisms or preformed enterotoxin?

Salmonella enteritidis
Shigella sonnei
Bacillus cereus
Escherichia coli

An O positive patient has a known anti-K. Wich of the following is true:

93% of O blood will be compatible
7% of O blood will be compatible
93% of A blood will be compatible
3% of A blood will be compatible

Viral specimen in lab is shipped for 96 hours. What temp should the specimen be
kept?
A. ambient temp
B. loefflers serum slant and ref
C. Lyophilize in a serum
D. Ice pack

which test is best to do to check reactive syphilis after 10 years?

tropenemal test or (RPR) non treponemal?

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False positive for protein urine analysis test strip
radiographic dye Aka x-ray contrast dye
Glass membranes electrode measure:
Na or PH

Series of results of HGb result for 5 consecutive days , result in day 3 is high the
others are almost the same what is the reason
A machine malfunction
B collected too early
C specimen left standing too long

every other parameter on cbc was ok (mcv,rdw,rbcs,plt,wbc) delta faliure on hgb is

due to what
A instrument malfunction
B torniquet too tight
C wrong blood was tested

plasma cell surface markers?

plasma cells are identified through flow cytometry by their additional expression of
CD138, CD78, the Interleukin-6 receptor and lack of expression of CD45. CD27 is a
good marker for plasma cells

How would you differentiate Group A from Arcanobacterium?

A. PYR
B. Catalase
[Link]
D. Hemolysis studies

in obstructive liver diseases how would the rbc morphology look like?
a- macrocyte
b-microcyte
c-shictocyte
d-tear drop

Detection of malarial parasite is by?

(1): thick blood film.
(2): gram stain.
(3): protein precipitation.

Hormones produced from cholesterol are called ?

a: protein hormones
b: steroid hormones
c: nonsteroid hormones
d: peptide hormones

How much water should we add to 500ml of a solution of 10% of NAOH to bring it to
7.5%?
a. 666
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b. 250
c. 166
d. 300

what percentage of plasma is there in the blood

a. 45%
b. 65%
c. 55%
d. 35%

blood incompatibility transfusion can cause death by

a- ANAPHYLACTIC SHOCK
B- SEPTIC SHOCK
C- HYPOVOLAEMIC SHOCK

THE BEST SITE FOR BMA IS

A- FEMUR
B-STERNUM
C- ILIAC

the shape of a cell is maintained by which of the following

a. microtubules
b. spindle fibre
c. ribosomes
d. centrioles

Malaria infection transmitted by:

A. Male anopheles mosquito.
B. Female anopheles mosquito.
C. House fly.
D. Body contact.

The Main function of the Kidney is ?

a) To Control Blood Pressure

b) To Control Body Temperature
c) To Remove Waste Product from the Body
d) To Help in Digestion of Food

An antibody molecules that is some time called incomplete antibody????

1) IgE
2) IgM
3) IgG
4)IgA

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The definitive host is an animal?
(A) Entamoba histolytica.
(B) Trypnosoma cruzi.
(C) Toxoplasma gondii.
(D) [Link].

Indirect anti-antibody test is used to detect?

(A): sensitized RBCs in patient blood.
(B): IGg.
(C): IGm.
(D): sensitized antibodies in patient serum.

Red blood cells survive around.........days

A. 120
B. 240
C. 10
D. 360

Reticulocytes contain?
[Link] remnants
[Link]-Jolly bodies
[Link] granules
4. DNA remnants

nutritional anemia often occur due to lack of

a. sodium
b. iron
c. calcium
d. iodine

The most common cause of anemia in young female.?

A) B12 deficiency
B) Iron deficiency
C) Anemia of chronic disease
D) sideroblastic anemia.

Which component of the blood is responsible for transporting of oxygen

(A)Albumin
(B)fibrinogen
(C)Haemoglobin
(D)Thrombocyte

Pus cells or fat in urine would cause this color:

[Link]
[Link]-brown
[Link]-blue
[Link]-white
[Link]

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Red blood cells are enlarged in malaria infection with:
A)[Link]
B)[Link]
C)[Link]
D)[Link]

The second most abundant IG is

a. IgM
b. IgA
c. IgE
d. IgG

The valency of IgM is.

1) 2
2)4
3)6
4) None of them. (Pentamere)

The enzyme which is not usually assayed in a heart attack is:

[Link]
[Link]
[Link]
[Link]
[Link]

Which of the following disease is not transmitted through Air borne droplets???
1:Tuberculosis
2:Pneumonia
3:Aids
4:Chicken pox

One is not found (involve) in colorimetric?

A): cuvett.
B): light source.
C): photo sensor and analyzer.
D): fuel source.
E): filter.

YOU HAVE ONE GROUP O NEG BLOOD ALONG WITH 3 DEMANDS

A- HB 3.5 G/DL
B- RTA WITH BLEEDING
C- DIC IN LABOUR.
WHICH ONE YOU would CHOOSE.

Which test would not be performed on plasma or serum:

[Link] electrophoresis
[Link]
[Link]
Page 23 of 312
[Link] electrophoresis
[Link] profile

Fatty acid and glycerol are absorbed by____

a) blood
b) lacteal
c) imiuno system
d) none

The bacteria that ceases to chancroid is?

a) nisseria gonoria
b) salamonela thphi
c) Haemophilus ducreyi
d) hepatitis

What volume of alcohol can be used to prepare 500ml of 1% acid alcohol? 495ml
D/Water & 5ml Acid Alcohol

When agar plate is streaked correctly the final result is

A. Pure culture
B. Individual colonies
C. no growth pathogen
D. dense growth which cover plate

The hormone produces mother’s milk is:

A Progesterone
B Estrogen.
C Prolactin.
D Colostrum.

inscription on the volumetric pipette reads 1 +/- 0.006 mL... What does this mean?
a. reproducibility
b. precision
c. accuracy
d. calibration

EIA method for HBsAg gives you

Cutoff number: 0.7
HBsAg:0.7
A Negative,
B Positive,
C indeterminate

MI pt who was treated with streptokinase, which result suggests treatment didn't
work? PT 12, PT 25, PTT 200 or D-dimer +

which of the following conditions would have a urine pH of 4.5?

a. ketoacidosis

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b. vomiting
c. hyperventilation
d. salicylate intake.

No reaction on Is,37, ahg,cc and patient control. What is the possible cause?
A. Report thr results
b. Ahg defective
[Link] not added
d. Perform it again

____________________________________________________________________________________

- role of caffeine in analysis of bilirubin.

-increase of onion gap = respiratory alkalosis ( I'm not sure! )
-blood pressure and body temperature of an acceptable donor.
- ffp refrigerator must be auto defroster.
- patient who was positive for hepatitis B some months ago. Now, have:
- HBsAg:neg
- HBcAg:neg
- HBeAg: neg
- HBsAb:neg
- HBcAb: pos
- HbeAb: neg
What should be done?
- correction of WBC count and Retic.
-hemoglobins in alfa thalassemia major.
-Trait sickl cell anemia and reaction in screning.
-picture of plasma cells in CSF
- Refractometry for SG and radiologic materials. Use strip
- A normal spermogram.
- Chemical changes of CSF and viral/ bacterial/ fongal meningitis
- creatinin clearance and GF relationship.
- ALP and Obstructive jundis.
- Judg between 4 method based on computing correlation coefficient ( SD/Min×100)
-bacteria in a butcher's wound.
-M. Kanzasii is a photochromogen mycobacterium.
Biocahemical characteristics K. Oxitoka.
-Listeria Monocytogenes and neonatal meningitis.
- picture of over infection of P. Falciparum.

____________________________________________________________________________________

1. Post partum mom rh neg with baby dat pos - rhogam

2. A 4+ b 4 + d 0 c 0 reverse a 4 b 0 - work on a1
3. IS 4 + both tube 1 and 2 - cold agglutinin. Prewarm
4. Cold and warm antibodies
5. Donor 1 - and donor 2 pos antibody what should you do? Do dat
6. Bun - nad
Page 25 of 312
7 mrsa swab for hospital setting - prevent on spreading.
8. Stomatocytes images - liver disease
9. Glass membrane electrode measures - Na
10. Specimen of choice for legionella - urine ag
11. Rotavirus - stool
12. Free psa - higher result less risky
13. False a1c - lipemic
14. Life span of rbc - dec results
25. Secreter SeSe - Le (a+a-)
26. Urine images for lipids
27. Hemocytometer calculation. Take the average of the 2 wbc results and calculate
for corrected wbc.
28. Serum osmo. You're given chemistry results, know how to calculate it to come up
with a decision to report the test.
29. Nocordia - musty odor
30. Sezary syndrome - t cell
31. Aplastic anemia image
32. Pure red cell anemia - normal mcv, mch but low hgb.
33. esbl - negative orgnanism
34. Sicke cell - sodium dithimite
35. Bence jones protein
36 plasmodium vivax - duffy
37. Heavy menstral period - tibc normal
38. 2 BB panels. Know how to r/o and see neg results. Hetero or homo. Read the
question three or 4 times very confusing. Many info that they give but you only need a
few to answer it.
39. Hiv 1 reactive , hiv 2 non reactive - western blot
40. Pt high glucose - abs - fta
41. Olive oil - malazia fur fur
42. Sensitivity
43. Specificity
44. P falcipirum images
45. Heinz bodies images
46. Cushing syndrome - tsh, acth
49. Hashimoto
50. Mcv calc
51. Mch calc
52. Nephrotic syndrome - alpha 2
53. Cellolose ph 8.4 - hgb A S - D rides with it.
54. Fecal fat test - chromography
54. 1st specimen - 120 glu, 2nd 200 glu, - ogtt
55. Aptt - hemophilia 8
56. Pt going for heart surgery - 72 hrs deferment
57. AST - liver
58. MI - trop
59. Blastocomidia images
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60. Ldl
61. Differentiate between salmonella/ shigella
62. Differentiate proteus/ pseudomonas
63. Kliebsiela/e coli - indole test
64. 3 were non lactose fermenters 1 lactose ferm in tube 1 - 4. What is this lactose
fermenters? Kliebsiela
65. Strep pneumo gave new anti microbial that didnt know about
66. Staph coag/micrococcus - sensitivity
68. Megaloblastic anemia - mcv high , mchc normo
69. Iron def - microcytic, normo
70. CLL - B lymphocytes
71. ALL - young child
72. Antidiuretic hormone - due to dilution
73. Acute hepatitis - hbsab
74. Chronic hepatitis - hbcab
75. Micrococcus - furalzolridone resistant
76. Farmers cut but they used buthers - eripelothrix rhisiopathaie
77. Anion gap calculation
79. Corrected wbc calculation. The depth hematocytometer got changed from 0.1 to
0.5.
80. Olive oil - malazezia fur fur
81. Rbc smear monocyte - mycobacterium tuberculosis
82. Organism after the surgery was performed - veillomele
83. Tear drop smear - dna
84. Lab received a swab to culture bacteria and fungus. Something happenned. Its
asking what your are going to do? - i said culture both of them.
85 - 87. 3 more guestions on forward - reverse discrepancy. Simple task not too hard
of a question. Do not memorize. Understand it.
88. Images of of a fus - alternaria
89. What is transferrin?
90 - 92. Conjugated and inconjugated bilirubin - serum and urine chemistry results.
What is wrong with the reporting? Know what increased/dec under different situation.
90. Basic metabolic chemistry results with osmo level of 300. Gave conventional/SI
units result. Figure out what the problem. I recalculated osmolality and came out with
a different answer 230. - i picked something is wrong with the osmo reporting
91. Besides the mrsa antimicrobial they asked what other antimicrobial that a
conventional laboratory used - i didnt know the answer. Unfamiliar antimicrobial.
92. Rbc, hct, hgb results a situation where a pt had clinical problems. I checked rule of
3 - hct was the problem. i said not to report bec discrepancy.
93. Normal wbc, retic 0.1 - pure red cell
94. Urobilinogen. What makes the color. - i picked clear color.
95. ESR results - i picked table vibrating.
96. Cd 19 and cd 20 - B cell
97. Platelets aggredation - ADP
Released

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98. Le a antibody. - absorbed by plasma.
99. Anode with a ph 8.4. Cellular acetate. Know where A S travels - i picked D. Use
polansky material.
100. Exactly the last question asked about IFE
101. menstrual period... decrease in ferritin or decrease TIBC? decrease ferritin,
increased TIBC
____________________________________________________________________________________

Recall::
Important part to ID dermatophytes
1)macro india
2)chlymydospore
3)blastoconidia

____________________________________________________________________________________

unconjugated/conjugated and urobilinogen, tons of red cell morphology (gave me pics

of red cells) with CBC results and told me to identify the cause, study your
anemias!! like 5 or questions about direct and indirect fluorescence, immunoassays, a
couple on electrophoresis ph, probes for ph and co2, how blood gas sample is effected
if exposed to air, know your enzymes! (Like ALP, AST, CK, etc and where they are
located!) Which electrolytes are affected by hemolysis (all the intracellular ones),
Imvic reactions!, know your media (what they have in them and how they work and
how organisms react on them), antibodies effected by enzyme treatment, warm and
cold antibodies, LDL calculation, weight volume calculation (I think), Manual WBC
count formula, difference between histoplasma, urinalysis reagent strip questions
(what causes false pos/negs) rbc cell casts for glomerulonephritis, reference vales for
ferritin, iron, CBC results, ABO discrepancies and how to solve them, when you would
use elution/absorption, different between transudate and exudate, HDFN, beta
thalassemia lab values, factor 8 and what would be affected if it was decreased,
protein c question, a question about decreased thrombin levels.
____________________________________________________________________________________

Blood bank questions I remember:

I got a discrepancy with forward type A and reverse AB. I chose patient was not
producing strong antibodies.
Question on how much rhogam to give Rh- woman who was miscarrying at 9 weeks.
I got a chart of a donor information and to choose the reason for deferral (I chose
temp as it was 99.8)
I only had one antibody id panel
There was a few more that I can't remember right now. Will post in comments if I
recall any more.
Micro questions:
I got a picture of 4 TSI agars and had to choose which was fermenting lactose
I got a question on how to differentiate citrobacter.
One of them was like this: "gram stain of sputum specimen shows few gram positive
bacilli, moderate gram negative bacilli, and many gram positive diplicocci. Which
Page 28 of 312
organism would be the most prominent on culture?" I chose strep pneumo because of
"many" and "most prominent"
One was about which would need a modified Kirby Bauer and the options were e coli,
kleb, n gonorrhea, and something else. I chose gonorrhea but wasn't 100% sure. It
just seemed logical in my head.
One of the questions was how to store a stool specimen if it wasn't able to be cultured
right away. I chose anaerobic culturette but can't remember the other options.
Question on what to use loefflers for
I got thrown a ton of hematology questions and a ton of chemistry questions. I got
quite a few on thyroid disorders and lipid panels.
I got a question on how to check for rubella vaccination
I got a question on calculating LDL.
I got quite a few on the processes of the instrumentation for chemistry.
I got quite a few on thalassemias.
Got one on smudge cells.
I had one that asked what kind of anemia is microcytic, normochromic seen in.
I got quite a few CBC reports and had to answer questions related to them.
Most of them I can't exactly remember the exact questions and answer choices.
I only had about two coag questions, one was on D-Dimer, and one was component
selection for vWD.
The only urinalysis questions I had were about oval fat bodies and identification of
amorphous. Oh and one about what a granular cast degenerates into.

How long after whole blood donation should plasma be separated from rbc?
2) How long after whole blood donation should platelets be separated from RBCs?
3)Immunology: i had a question where it showed a picture of serum IFE and a gamma
band and a light chain, and told you that the urine light chain had that light chain as
well. Then asked what your next action could be: potential a)multiple myeloma,
b)redo it again because c)ULC and d)S-IFE were not the same.
4)effect of IV line on chemistry analytes, a) Diabetes, non-ketoacidosis coma b)
enzymes for liver c)enzymes to help ID muscle problems d)cardiac enzymes
5)Had a picture of a pinworm and needed to know its real name( Answer is Enterobius
vermicularis)
6)bilirubin- Absorbance 480nm
7)ISE -KSL
8)the blood glucose was given 390mg/dl, potassium 4.2mmol after insulim
administration glucose is 215 potassium is now? Note that this is kot the exact values
given
9)how to measure hdl. I chose thin-layer but I really dont know. Ultracentrifugation
was not on the choices.
10)A dilution in a tube 1:20 and then you took 2 mL of the dilution and add 3 mL of
water, if the result is 120 mg/dl, how many would be the original?
11)A staph like organism is isolated from a wound culture in is resistant to all GPC
Page 29 of 312
antibiotics and to Vancomycin, using the automated bichemical method.
what should the tech do.
a. do a gram stain
b. recallibrate the machine
c. report as not Susceptible?
12)a person overdoses on salicylate and goes to the ER. WHAT WOULD BE TESTED?
a) pH
B) Ammonia
c)creatinine
d) BUN
13)FTA, RPR,VDRL, which is for testing reinfection, late stage and early stage?
14)Which of the following condition is the most common cause of increase anion gap?
A)Metabolic alkalosis
B)Respiratory alkalosis
C)Metabolic acidosis
D)Respiratory acidosis
15)Which of the following analytes is cofactor for most of 300 enzymes?
A)Zinc
B)Magnesium
C)Calcium
D)Potassium
16)Which of the following cells releases histamine/heparin?
A)Neutrophil, Eosinophil
B)Eosinophil, Basophil
C)Basophil, Mastcell
D)Mastcell, Eosinophil
17)Which of the following causes decrease HbA1c?
A)IDA
B)Hemolytic Anemia
C)Sickle cell
18)Which of the following parasite cause autoinfection in immunocompromised px?
A)[Link]
B)[Link]
C)[Link]
D)[Link]
19)15)Where heme c and s found… A)Extrinsic B) intrinsic C)warfarin D)heparin
20)Viewing crystals or urine under microscope a) use 10x b) 40 more light c)less light
21)Alkali (that was the exact word )what happens a)co2 b) co3 c)ph
22)Abnormal cells in the bone marrow with a high nucleus to chromatin ratio with few
present nucleoli; choices were a) atypical lymphocytes b)monoblasts c)lymphoblasts
23)What is used to differentiate primary from secondary hypothyroidism; a) T3 b)free
T4c)TSH d)TBH
24)[Link] poisoning,what will you test?a) ph b) ammonia c)k?
25)ketone 1+,bili +1,occult [Link] one is the most pathogenic?
26) what is decrease in females who have their menstrual period?
A)transferrin
Page 30 of 312
B)alt
C)haptoglobin
D)GGt
27)3.8 yr old in er had a alkaline dark brown urine,what do you expect to see in his
urine?
[Link] cells and hyaline cast
[Link] cast and granular cast
C red cells and red cells
D white cells and white cells
28)How would you differentiate V parahaemolyticus from V cholerae?
A. Sucrose
B Glucose
C Some other sugar
D You can’t
29)10. Decontamination choice for Pseudomonas in AFB culture
A. Oxalic acid
B. NALC
30)8. How would you differentiate Group A from Arcanobacterium?
A. PYR
B. Catalase
[Link]
D. Hemolysis studies
31)Which is the agent of hand foot and mouth disease?
A. Herpes
B. Coronavirus
C. Coxsackie A
D. Reovirus
32)Which is an appropriate specimen to diagnose Dracunculus medinensis?
[Link]
B. Skin snipping
[Link]
33)Which of the following is most likely to penetrate through unbroken skin?
A. Necator americanus
B. Trichuris trichura
C. Enterobius vermicularis
34)2 This catalase positive, gram positive bacilli with diptheroid morphology is highly
resistant to many antibiotics and is associated with immunocompromised patients.
A.)C. diptheriae
B.)C. jeikeium
C.)L. monocytogenes
D.)E. rhusiopthiae
35)1(Picture of S. haematobium)
From which source are you most likely to see this parasite?
[Link]
[Link]
[Link]
Page 31 of 312
[Link]
36)What is the cv is the 80-100 mmol/L is within 2SDs (choices: a)5.5% b)10% c)20%)
37)What is the purpose of Protein C and S? (choices: a) act as natural anticoagulant,
b)activates protein coagulants.. etc..)
38)What is the specific gravity of the 3mL urine diluted with 3mL H2O? Specific
gravity is 1.024 before dilution. (choices: a)1.024, b)1.072 c)1.048 etc..)
39)Ran controls and PT was normal, PTT was abnormal. Replaced controls and got
same results. What should you do next?
A) Change out the Recombiplastin
B) Change out the CaCl
C) Rerun controls
D) Run patient tests

1)Someone who expresses immunity and acquired Hep B will have?

2)Blood EDTA given to the lab 6hrs after draw will most effect– I chose platelets?
3)Role of supervisor?
A) Democratic
B) Autocratic
C) laissez-faire
4What does it mean if the organism is resistant? (This is the sensitivity)
A too little organism
B too much organism in the innoclum
5) low serum ferritin, high tibc, low iron. What disorder?
6)Ionized cal was left to stand for a while. What would happen?
A) change in ph
B)Evaporation
7)Which org requires safety precaution? Choices: Aspergillus, Sporothrix schenckii
8)Blood from newborn had high PT, high PTT and TT, bleeding from cord also…
reason…is a) afibriginogemia b) lupus inhibitor c) factor 8 deficiency d) factor 10
deficiency
9)Every other parameter on CBC was ok, (MCV, RDW, RBC, PLT, WBC)..delta failure on
HGH is due to what a)instrument malfunction, b) tourniquet too tight c)wrong blood
was tested
10)Lactic acid specimen has to handled how…..a) chilled and separated from cells b)
heated c) room temp incubation d) request EDTA sample only
11)Protein electrophoresis in pH 8.6 what is close to cathode? Choices: a) albumin &
alpha b) 1, gamma & beta c) albumin & alpha 2..
12)Pt and ptt controls were abnormal qc repeated ptt was normal what will you do? –
a) replace thromboplastin b)replace activator
13)What process will you do for Weak D? choices: a)DAT b) IAT c) elution/adsorbtion
etc..
14First step in agglutination? Choices: a) flocculation b) sensitization c)lattice
formation
Page 32 of 312
15)2mL of blood was filled only for a 5 mL of anticoagulant tube; what would happen
for results of apt? A) decreased B) Increased? C)Normal

1. Cat scratch disease – bartonellahenslea

2. Microscopic agglutination caused by CAIHA: answers: presence of cold
antibodies & infection w/ Mycoplasmapneumoniae

3. Mycoplasmapneumo causes walking pneumonia

4. Latex agglutination staphaureus – clumping & protein A
5. False DECREASE ESR – delay 8 hrs in set up
6. Prolonged apnea – pseudocholinesterase
7. Specimen rotavirus – stool
8. Specimen legionella – urine antigen
9. Cushing’s syndrome – hyperglycemia
10. Increased Ca and normal PTH – metastatic carcinoma
11. Primedone – Phenobarbital
12. Low sodium – hyperglycemia
13. Low sodium – repeat ion selective electrode
14. Low erythropoietin – polycythemiavera
15. PT normal (patient for gall bladder surgery), PTT prolonged, TT normal – factor
XII assay
16. They give Ab panel and you identify (lewisAb) – adsorbed from plasma
17. Cbc result: about method 1, method 2 – lyse resistant in Hgb C
18. quantitative fecal fat test – weight & extraction
19. absenttrophozoite / merozoite – PLASMODIUM FALCIPARUM
20. lupus anticoagulant – thrombosis
21. UA results: 25 – 30 renal tubular epi cells  acute tubular necrosis
22. Bacteria LAP (-), bile esculin (+), NaCl (growth), PYR (-) Resistant to
vancomycin – leuconostoc
23. Carbon dioxide ion selective electrode measure – pCO 2
24. ANA patterned picture – (speckled or nuclear anti-SSA)
25. Monocytosis seen in tuberculosis
26. FBS:120, OGTT: 140 – impaired glucose
27. Patient with fasting blood glucose 155mg/dL & random 225 mg/dL - OGTT
28. Hair perforation test: trichophytonmentagropytes& T. rubrum
29. 18% retics – Heinz body stain
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30. 0.1% retics – pure red cell aplasia
31. streptokinase therapy does not work in myocardial infarction – D-dimer positive
32. lesion of arm, cigar bodies – sporothrixschoenkii
33. hct 33%, hct 33.5% in manual – lipemic
34. rbc in reagent strip, none seen in microscope: diluted ALKALINE urine
35. blastoconidia – mother & daughter cells
36. CSF storage in subsequent culture – incubate at 35C temp
37. TSI, A/A, oxidase positive – aeromonas
38. Pink colony on MAC agar, LOA -++: enterobacter cloacae
39. CA 19-9: pancreatic marker
40. Increased hemolytic anemia – increased UNCONJUGATED bili, increased
urobilinogen
41. EIA HTLA ½ reactive, what to do next? – western blot
42. False NEGATIVE ABO – red cells positive DAT
43. Anti-IgG NEGATIVE, anti C3D POSITIVE – prewarm saline solution
44. Echinocytes picture – faulty to dry the slide
45. No growth @ 6.5% NaCl – streptococcus bovis (group D), endocarditis&
colorectal cancer
46. Specific gravity 1.010 at 4C result glucose 1000mg/dL – correct the
temperature due to high glucose
47. What is the saliva Le(A+ B-) person? – Lea
48. Ph 4.5 in urine – high protein diet
49. Tap water: M. gordonae
50. Mutation of polycythemiavera: JAK
51. Pharyngitis, seen in renal biopsy: s. pyogenes
52. Differentiate p. aeruginosa from p. putida: 42C
53. Valinomycin: potassium
54. Image of crithidialucilae: double stranded, SLE
55. pH measurement needs: known buffer @ constant temp
56. butchers cut – e. rhusiopathiae
57. many tear drops(PBS), what deficiency? – DNA
58. favors growth of anaerobic GNR – vitamin K &hemin
59. rapid testing for CMV? - PCR DNA urine
60. rouleaux not seen in what phase? AHG
61. Burr cells – uremia
62. Newborn w/o thymus gland, normal B cells but no production of t cells –
DiGeorge syndrome
63. PT control out but APTT within normal range – change CaCl 2 reagent
64. Organism isolated in Hektoen: TSI K/A, H2S (+), PAD (-), lysine decarboxylase
(-), urea(+), citrate (+)  tech report as NORMAL FLORA
65. Instrument linearity something about comparing means – paired T-test
66. Postprandial lipemia? Triglycerides!!!
67. Whole blood donation stops at 390 mL: pRBC (low volume unit)
68. Le(a) Le(b) IS 37 AHG
0+1+00
0+1+00
Page 34 of 312
+ 0 0 + / - 2W + / - 2W
+ 0 0 +/ -2W +/-2W
glycolipid absorbed from plasma
69. Ab that deteriorates in storage: P1
70. Choose positive controls to test for anti-c and negative control to test anti-
Fy(a): C+c+ for positive control, Fy(a) for negative control
71. Detection of Ab where 11 tubes resulted NEGATIVE in AHG, but when
added CC 4 of them didn’t agglutinate – machine didn’t dispense correctly
the saline in the wash
72.
IS 37 AHG CC

SC1 0 0 0 2+

SC2 +/- +/- 0 2+

Answer: add 4 drops of serum

73. patient DAT (4+), IAT (+), did eluate and the results are DAT (2+) they
auto absorb serum and keeps reacting to SCI1 & SC2 in AHG, what should you
do? Panel cells (there was also enzyme panel cells, report DAT or make
another autoadsorption)
74.
Anti-A Anti-B Rh Du Control D

0 0 3+ + -

IS 37 AHG CC

SC1 0 0 0 2+

SC2 0 0 0 2+

Patient cells 0, 0, 2+ not tested  presents auto alloAb

75. calculate % of saturation – UIBC 185, Fe 125, TIBC = 185 + 125 = 310
%sat (125/310) * 100 = 40%
76. PT normal, PTT (56), mix 1: plasma (47)  factor VIII deficiency
77. Sample taken from indwelling catheter, patient isn’t on
anticoagulants yet PTT & TT are way elevated – HEPARIN CONTAMINATION
(from catheter)
78. In the second phase of platelet aggregation what is irreversible?
Fibrin formation
79. Control and patient’s PTT elevated, control & patient PT elevated:
thromboplastin was added by error
80.
Anti-A Anti-B A B

4+ 4+ 2+ 2+

What should tech do? First, perform Ab screen w/ autocontrol. If screen &autocontrol
= negative THEN Prewarmb/c cold agglutinins
Page 35 of 312
180.
Anti-A Anti-B A B

0 2+mf 4+ 0

Discrepancy due to Bx-subgroup

81. HgbA1C – what can be the trouble with the test???decreased life span
on RBCs (in the case of sickle cell)
82. Mycoplasma can’t be treated w/ penicillin = no cell wall
83. Effect of dextran as anticoagulant: destroy D antigen
84. Potassium permanganate: quenching agent
85. Common error in PCR: nucleic acid contamination
86. Low incidence Ag present in blood panel: Wra
87. Surfactant fetal lung maturity – phosphatidyl glycerol
88. Anti-microsomal – hashimoto’sthyroiditis
89. In multichannel analyzer, controls of enzymatic assays are lower than
expected values while non-enzymatic assay controls are within normal limits.
What is the probable cause? instrument temperature may be low
90. Speckled pattern – anti SBB, anti RNP, anti Sm
91. Patient has the results after collecting blood in an indwelling catheter.
Patient is not in heparin / anticoagulant therapy. APTT: abnormal, PT:
normal, fibrinogen: 150 mg/dL, what test should be ordered?  Factor XII assay
92. PREDOMINANTLY seen in acute phase of infection but rarely seen in
chronic infection? anti-HBc, IgM
93. Adrenal cushing syndrome – TSH decrease, cortisol increase
94. Deferred donor: Hepatitis Ig six months ago

RECALLS

 Parameters for accurate monitoring of Phenytoin. Measure Phenobarbital

 Gram negative bacilli, TSI (A/A), Oxidase + isaolated from wound: Aeromonas

This is the exact picture and it ask for its CD markers

Hairy cells Leukemia= B cells so I choose the one with CD 19, CD 20

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 Nucleolar ANA pattern –

 Multiple Sclerosis – increased IgG and Oligoclonal band

 Cat scratch disease – Bartonellahanselae


answers: presence of cold antibodies
infection w/ Mycoplasma pneumoniae

 Bile Esculin + Catalase - No growth @ 6.5% NaCl – Streptococcus bovis(group

D), endocarditis & colorectal cancer
 Specific gravity 1.010 using refractometer at 4C result glucose 1000mg/dL –
correct the specific gravity due to high glucose

 What is the saliva A, Le(A+ B-) person? – Lea

 Ph 4.5 in urine – high protein diet

 Pharyngitis, seen in renal biopsy: Streptococcus pyogenes

 Differentiate Pseudomonas aeruginosa from pseudomonas putida: growth at

42degC

 Burr cells – uremia

Page 37 of 312
 aPTT control out but PT within normal range – change CaCl2 reagent

Organism isolated in Hektoen Agar TSI K/A, H2S (+), PAD (-), lysine

decarboxylase (-), urea(+), citrate (+)  tech report as NORMAL FLORA
 Instrument linearity something about comparing means – paired T-test
 Postprandial lipemia: Lipoprotien
 Whole blood donation stops at 365 mL: pRBC(walanangnagsasalinnang WB)
 Le(a) Le(b) IS 37 AHG
0+1+00

0+1+00

+ 0 0 + / - 2W + / - 2W

+ 0 0 +/ -2W +/-2W

glycolipid absorbed from plasma

 Ab that deteriorates in storage: P1

 Choose positive controls to test for anti-c and negative control to test anti-Fy(a):
C+c+ for positive control, Fy(a) for negative control

 Detection of Ab where 11 tubes resulted NEGATIVE in AHG, but when added CC

4 of them didn’t agglutinate – machine didn’t dispense correctly the saline
in the wash

IS 37 AHG CC

SC1 0 0 0 2+

SC2 +/- +/- 0 2+

Answer: add 4 drops of serum

 patient DAT (4+), IAT (+), did eluate and the results are DAT (2+) they auto
absorb serum and keeps reacting to SCI1 &SC2 in AHG, what should you do?
make another autoadsorption)
25.

Anti-A Anti-B Rh Du Control D

0 0 3+ + -
Page 38 of 312
 IS 37 AHG CC

SC1 0 0 0 2+

SC2 0 0 0 2+

Patient cells 0, 0, 2+ not tested presents auto or allo Ab

26. calculate % of saturation – UIBC 185, Fe 125, TIBC = 185 + 125 = 310
%sat (125/310) * 100 = 40%
27. PT normal, PTT (56), mix 1:1 plasma (47)  factor VIII deficiency
28. Sample taken from indwelling catheter, patient isn’t on anticoagulants yet
PT PTT & TT are way elevated – DIC
29. In the second phase of platelet aggregation what is irreversible? ADP
release

30.
Anti-A Anti-B A B

4+ 4+ 2+ 2+

What should tech do? First, perform Ab screen w/ autocontrol. If screen &autocontrol
= negative: wash then retest(walangprewarmsa choices)

31.
Anti-A Anti-B A B

0 2+mf 4+ 0

Discrepancy due to Bx-subgroup

32. HgbA1C – what can be the trouble with the test??? decreased life
span on RBCs (in the case of sickle cell)
33. Mycoplasma can’t be treated w/ penicillin = no cell wall
34. Common error in PCR: nucleic acid contamination
35. Adrenalcushing syndrome – TSH increase, cortisol increase
36. Deferred donor: Hepatitis Immunoglobulin six months ago
37. In multichannel analyzer, controls of enzymatic assays are lower than
expected values while non-enzymatic assay controls are within normal limits.
What is the probable cause? instrument temperature may be low
38. Patient has the results after collecting blood in an indwelling catheter.
Patient is not in heparin / anticoagulant therapy. APTT: abnormal, PT:
normal, fibrinogen: 150 mg/dL, what test should be ordered?  Factor XII assay
39. Mycoplasma pneumoniae causes walking pneumonia:(no cell wall)
40. Latex agglutination staph aureus – clumping factor & protein A
41. False DECREASE ESR – delay 8 hrs in set up
42. Prolonged apnea – Pseudocholinesterase

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43. Specimen rotavirus – Stool
44. Specimen Legionella – Urine antigen
45. Cushing’s syndrome – Hyperglycemia
46. Increased Ca and normal PTH – Metastatic carcinoma
47. Primedone – Phenobarbital
48. Low sodium – Hyperglycemia
49. Low sodium normal other electrolytes – repeat ion selective electrode
50. Low erythropoietin – Polycythemia vera
51. PT normal (patient for gall bladder surgery), PTT prolonged, TT normal:
Factor XII assay
52. Cbc result: about method 1, method 2 – Lyse resistant in Hgb C
53. quantitative fecal fat test – Weight & Extraction
54. absent trophozoite / merozoite – PLASMODIUM FALCIPARUM
55. Lupus anticoagulant – causes Thrombosis
57. UA results: 25 – 30 renal tubular epi cells acute tubular necrosis
58. Bacteria gram + cocci Catalase - LAP (-), bile esculin (+), NaCl (growth),
PYR (-) Resistant to vancomycin – Leuconostoc
59. Carbon dioxide ion selective electrode measure – CO2 (pressure)
60. Monocytosis seen in tuberculosis
61. FBS:120, OGTT: 140 – Impaired glucose
62. Patient with fasting blood glucose 155mg/dL& after 2 hours 225 mg/dL -
DM
63. Hair perforation test differentiates: Trichophyton mentagropytes and
Trichophyton rubrum
64. 18.5 % retics – Heinz body stain
65. 0.1% retics normal RBC and PLT – Pure red cell aplasia
66. Streptokinase therapy does not work in myocardial infarction – D-dimer
positive
67. multiple lesion of arm, cigar bodies – Sporothrixschienkii
68. RBC: 3.6 HGB: 14 HCT: 33%, manual hct 33.5% in manual – Lipemic
(does not follow rule of 3)
69. Rbc in reagent strip, none seen in microscope: Diluted ALKALINE urine
70. Blastoconidia – mother & daughter cells budding
71. CSF storage in subsequent culture – incubate at 35C temp
72. Pink colony on MAC agar, LOA -++: Enterobacter cloacae
73. CA 19-9: pancreatic marker
74. Increased hemolytic anemia – increased UNCONJUGATED bili, Normal
Bilirubin increased urobilinogen
75. EIA HTLA ½ reactive, what to do next? – Western blot
76. False NEGATIVE ABO– incubation at 37 degcelcius (ABO Ab are IgM
it reacts at RT)other answers Positive DAT
77. Anti-IgG NEGATIVE, anti C3D POSITIVE – wash with warm saline
78. Echinocytes picture – faulty to dry the slide

Page 40 of 312
 hindiganitoyungitsurabastamakikitanyosyapagbinasanyoa
gadyung slides kahitbasasyaganunyungitsura.
79. Glucose reagent strip : + Clinitest : + : Expired Strip is my answer cause
if glucose is present it should also give positive Clinitest bec its also a reducing
agent. Other choices are Positive for Glucose, Patient has taken Ascorbic Acid
and presence of Galactose

BLOOD BANK

1. What are DAT applications?

2. What is RHOGAM, when are you going to give it and what will it do to the patient?

3. In an emergency, what blood type of blood would you give if the red cells are
needed or plasma is required and the blood type is unknown?

4. Would you phenotype a patient who had been transfused within the last 3 months?

CHEMISTRY

1. Potassium is high but the blood sample plasma is not hemolyzed, patient does not
show any symptoms, what do you think happened?

2. Control was high even after you have repeated it, what's the next step that you
would do?

3. Intepret a QC graph..you should know about trends, shifts, what would you do to
resolve the problem.

HEMATOLOGY

1. MCV was 85 yesterday, today it was 77, what do you think happened and how
would you solve the problem?

2. What causes high MCHC, explain step by step how you would solve the problem if
the MCHC is 380 ?
Page 41 of 312
3. What causes falsely low platelet count and what would you deal with it?

4. What causes false low WBC count, falsely low WBC count, how would you solve the
problem?

5. What causes false increase in hemoglobin, how would you solve the problem?

A postpartum female with a history of transfusions tests positive for Anti-D. What is
your next step?

A) report results and Anti-D

B) Screen for additional antibodies*

C) no further testing is required

D) assume the Anti-D is rhogam and report results

I couldn't remember the possible choices word for word on that one, but I do
remember that 3 of them you could rule out just by thinking about it.

A patient's serum is known to have anti-Jkb, but anti-K and anti-C can't be ruled out.
Specific antigen testing was performed on the patients cells and the results are as
follows.

Anti-K Anti-C

0 2+

What can be concluded from these results?

A) Anti-K is confirmed. Anti-C is excluded.

B) Anti-K is excluded. Anti-C is confirmed.

C) Anti-K is neither confirmed or excluded. Anti-C is excluded.*

D) Anti-K is excluded. Anti-C is neither confirmed or excluded.

The same antibody was found in 3 different patients. The results of testing is listed
below. Which antibody is most likely to be present?

IS 37 AHG

patient 1 0 2+ 0

patient 2 2+ 0 0

Page 42 of 312
patient 3 0 0 2+

A) Anti-Jkb

B) Anti-K

C) Anti-M

D) Anti-Leb*

Although I can't remember the wording or answers for another question, I do

remember that they showed results of screen cells 1 and 2 being negative for any
antibody, but then when doing a crossmatch, an antibody showed up. I said the
answer was that the patient has a low incidence antibody.

1. This is a platelet vessel wall interaction, bleeding time prolonged, platelet count
decrease and on peripheral smear the platelets are increase in size.

a. Von Willebrand Disease

b. Bernard- Soulier Disease (this is the answer)

c. Congenital afibrinogenemia

d. Glanzmann's thrombasthenia

[Link] hCG marker of malignancy:

a. Choriocarcinoma

b. Testicular Cancer

c. Pancreatic (answer)

d. Nonseminomatous

[Link] the protein elevation from B1B2 and gamma are to merge together, what
immunoglobulin would I indicate?

a. IgM

b. IgA (answer)- this starts to form alpha2 end gamma

c. IgD

d. IgE

Page 43 of 312
[Link] are DAT applications?

[Link] is RHOGAM, when are you going to give it and what will it do to the patient?

[Link] an emergency, what blood type of blood would you give if the red cells are
needed or plasma is required and the blood type is unknown?

[Link] you phenotype a patient who had been transfused within the last 3 months?

[Link] is high but the blood sample is not hemolyzed, patient does not show
symptoms what do you think happened?

[Link] was high even after you repeat it, what’s the next step that you would do?

I would re run calibration

[Link] is the isoagglutinations in type O?

[Link] product we should use when the patient has fever when transfusion the
blood?

a. WBC- reduce RBCs

b. Irradiated RBC

c. Wash RBC

[Link] else could cross placenta except Anti-D (IgG)?

Ans. Bilirubin, Drugs, gases, hormone…

[Link] culture in aerobic and an anaerobic bottle are negative, but in gram stain
smear shows gram positive bacteria. What should you do next?

[Link] 2 days of blood culture, technician found gram positive cocci, what should
you do next?

a. Report to doctor (answer)

b. Gram positive cocci culture

c. Maybe contaminated by skin when collecting specimen

Page 44 of 312
[Link] is the reason for Synovial Fluid Turbidly?

a. Crystals

b. Protein (answer)

c. immunoglobulin

[Link] Rh(-), but DAT(+) her baby is Rh (-). What is the reason for discrepancy?

Ans. DAT(+) – baby RBC is sensitized by antibody.

[Link] B Rh(-), Father AB Rh (+). Child 1 A Rh(-) Child 2 B Rh (+). Which is correct

a. Parental is rule out

b. Parental cannot rule out (answer)

c. Child 1 can rule out

d. Child 2 can rule out

[Link] #1 detected 50/100 true positive and 100/100 true negative. Produce 2#
detected 80/100 true positive and 70/100 true negative

a. Produce 1 is more sensitive

b. Produce 2 is more sensitive

c. Produce 1 is more sensitive and specific

d. Produce 2 is more sensitive and specific

[Link]/TP +FN =?

a. Sensitivity

b. Specificity

c. Precision

d. Variance

[Link] might the following indicate? Urine: RBCS, WBCs, nitrite, bacteria.
Page 45 of 312
a. Pyelonephritis- kidney infection caused by bacteria or virus

b. Glomerulonephritis- renal disease usually affects both kidneys. Blood or protein

in urine.

c. Nephrotic syndrome - Nephrotic syndrome is a group of symptoms that include

protein in the urine, low blood protein levels, high cholesterol levels, high triglyceride
levels, and swelling

d. renal calculi - A kidney stone is a solid mass made up of tiny crystals.

[Link] is albumin the first protein to be detected in tests for renal failure?

a. It’s molecular size is large

b. Its molecular size is smallest

c. It is very negatively charged.

Corr wbc count with 50 cells ( I changed it to wbc X 50 divided by (nRbcs + 100),

Blood bank discrepancies, panels, enzymes, what to do next, check freezer temp
every 4 hrs!

ANA patterns, abs, diseases

conj and unconj bili, urobilinogen,inc and dec

coag inc and dec ptt,pt

cocaine metabolite, moth ball intoxication ( i guessed basophilic stippling still cant
find it)

screw therap drugs and monitoring not useful

know which anemias are micro/macro/hypo/hyper, I calculated rbc indices to rule out
answers.

question on lyme disease i forgot what it asked.

how to measure HDL (precipitate out other lipoproteins)

apoliprotein A is in what lipoprotein.

density of proteins in decreasing to ascending order I dunno what IDL is but I put it in
between VLDL and LDL.

Normal total CK but increase in troponin in what? (got it down to unstable angina or
acute M.I)

urine from catheter rapid analysis only need to setup which two plates for micro?
Page 46 of 312
nitroprusside detects what?

gardn vag needs human blood

c-reactive protein

guy is coughing, pnemoniae ruled out= bordatella

ersipelothrix and butchers

Reactions for enterobactericiae: know the main differential ones

morganella vs providencia =citrate

mycobacterium in tap water? gordonae

what stain to see the cells in the cast? i said oil red o only one that made sense

no cell markers, only molecular was pcr steps eaaaaasy

A1, A2 and anti- H

picture of dysmorphic rbcs and asked why (got it down to oxidizing drugs or
antimalarial drug)

Listeria cold enrichment

c. dificile not reverse camp pos, its perfringens

one said strep b was neg on CAMP test w/ s. aureus, do what next (do biochem rxns
for b or run CAMP with beta lysin s. aureus I chose this)

inc in pmns in bact mening, lymphs in viral

small qc zones b/c 1.0 mcfarland standard used

alpha thal has hgb H disease and barts

at end of protein electro which is closest to the cathode (gamma and beta)

asked about a csf electrophoresis showing anodal band to albumin (picked normal
results)

lactic acidosis 2 questions, and how to measure it

know both diabetes and icto test more sensitive

after getting blood thru IV what do potass levels do? dec

which worm causes autoinfection

had 2 questions, one which increases/or falsley inc hgA1c and what decreased A1c (i
think Hgb S is one of the answers)

Page 47 of 312
high pH and something but what enzyme (Pagets was the answer b/c ALP (Alkaline
pH)

met acidosis= diabetic ketoacidosis

excess edta causes

what hepatis ag/ab will make sure vaccination has occured

which dermatophyte has antler like pseudohyphae (wtf??) got this wrong

mucor has no rhizoids

strep a in glomerularnephritis

disease with bite cells or blister cells

monitor antithrobin3 with monitoring what

Why is albumin the first protein to be detected?

burn patient w Pseudomonas aeruginosa accompany with ? another bac

morganella vs providencia

how many bag blood to prepare platelet apheresis

PCR

alpha thalassemia with what Hb?

moth ball intoxication will see what in RBC

small qc zones b/c 1.0 mcfarland standard used

diabetes and icto test

measure HDL?

baby w RH+ O mom w Rh- O baby need transfusion what blood should give?

muscle dystrophy what enzyme increase

teardrop RBC what disease

anion Gap increase indicate what disease

blood gas use what tube/synringe to transport

CNS smear what condition

Corr wbc count with 50 cells

Page 48 of 312
anaerobic bacteria

proteus,klebsiella rxn

I had a few that had to do with interpreting bili results and what is causing them

A question needing to interpret enzyme results

math calculation...something like, how many grams are needed to make a 3% solution
of NaCL.

Calculate LDL

What would cause a false positive for protein on a UA test strip

What do you do if you see your coworker ...gosh I can't remember what my coworker
was doing but it was a silly question. I chose tell my supervisor?

There were a few questions of interpreting lab results to determine which anemia

LDL is made up of mostly ?

which fat LDL, HDL, VLDL has the most cholesterol

glycosis has an end result of ?

1) HACEK group what belongs to.

2) PAS stain negative and sudden black stain positive what disease.

3) Yellow, Turbid urine what should be?

4) APTT, PT and TT all prolonged?

5) Patients with DIC, patient RBC decreased, Platelet decrease?

6) Rhogham , how many vials equal to blood?

7) ESR increase in what? Choices were A) Ammonia B) Platelet c) Fibrinogen.

8) What is standard practice. A) student read parasite slide that instructor gave them
B) student memorize coag cascade and gave exam C) student fix instrument after
reading operator manual.

9) Alk/acid butt question, citrate positive and something more.

10) Antibody panel I had 2 questions.

11) TP/TP+FN, but it was with wording and long sentence.

12) This spiral-form organism is seen in urine and cultured on Fletcher’s media.

Page 49 of 312
13) Synovial fluid collected in anticoagulant tube, what do you use to dilute the
specimen?

14) HBa1c levels control , but glucose levels high today why?

15) Respiratory acidosis/alkalosis, metabolic alkalosis/acidosis.16) ANA Picture

17) Rh- mother has increase titer of anti-D. After delivery, the DAT is strongly (+) but
the baby is Rh- a) inadequate washing b) added monoclonal anti-D sera instead of anti
globulin (or vise versa) c) or maternal antibodies blocking the antigenic site

18) 15 units of platelet requested for A - patientAvailable: A- =1unit A = 6units O- =

15 or something a) transfuse A unitsb) transfuse 15 O negativeC) find out need of 15
unit need or not.

19) Cryo = 80ul

20) Bhcg is negative and patient think she is pregnant, but all test are negative.

21) 17- ketosteriod

22) Disease associated with the following results? Elevated TSH; Elevated T3;
Elevated free T4

- Blood Bank Discrepancies. ALL TYPES!

- Sensitivity and Specificity (formulas and definitions)

- Hematology Stains and implications (PAS, LAP, Sudan Black etc.)

- What causes false positives and false negatives on urine reagent strip tests (protein,
blood etc).

- Indices/Clinical picture of Urinalysis Disease States (Glomerulonephritis, nephrotic

syndrome etc.)

- Platelet Aggregation Studies (be able to interpret graphs and determine disease
states)

- RBC inclusions (stains used for each, where each comes from, disease states
commonly seen in each)

- Know biochemical characteristics for ALL bacteria (to make it easier group them into
GNR, GNC, GPR, GPC, ANAEROBES, MYCOPLASMA)

- I didn't study mycology or parasitology, but there were 3 questions (pictures to

identify). If you know what it looks like you'll be okay. I didn't study it, I didn't know
the answers, I guessed, probably failed the questions, but passed the exam :-)

- Immunohematology: can you give incompatible Cryo? How long after thawing can
you administer platelets, plasma etc. How long after pooling?

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- RhIg (when do you administer? what does a positive anti-D postpartum mean? When
do you do weak D testing? Know EVERYTHING about RhIg)

- Serology: know Hepatitis B antigen AND antibodies. When does each appear? during
which clinical phase? (HBe, HBsAg, HBcAg etc).

I had mostly blood bank and coagulation. I had one panel that was asking in a
roundabout way about the antibodies properties( I think it was Le(b). Everything thing
else was a discrepancy(mother AB neg, Baby typed O pos), A2 subgroup, positive
Weak D control, Autoabsorption, neg DAT at room temp but was positive five minutes
later.

Coagulation was mostly lupus anticoagulant( ptt did not correct, patients form clots,
russell viper test to confirm). Also had a question about the indication of failure of
streptokinase. Best test to monitor heart surgery patients.

Microbiology: Salmonella biochemicals and TSI reactions. Enterobacter vs

Klebsiella( know species E. Cloacae, E. Aerogenes, K. oxytoca, K pneumoniae).
Enterococcus vs Streptococcus( Bile esculin, growth in salt, PYR). Salmonella species
was serotyped as so species of Salmonella but did not produce hydrogen sulfide and
was lysine negative, what would you do? Subacute endocarditis,

Parasitology: One question about ova( albumin covered) No mycology

Hematology: Calculate RBC indices, two questions with pictures of rbc

agglutination( M. pnuemoniae infection/ cold agglutinin disease). Picture of smear with
white blood cells and choosing appropriate stain( Sudan black vs esterase, nonspecific
esterase etc.) Conditions affecting ESR( false increase/decrease) Osmotic fragility
results(predict blood smear results). Two hematology analyzers with different lysing
agents had varying white cell counts( showed a smear with target cells and HGB C
crystals. Which one affects RBC lysing)

immunology: hepatisis results, two ANA patterns, principle of IFA, out of VDRL for CSF
and using RPR kit(What would you do?)

chemistry: diagnostic criteria for diabetes mellitus, primary vs secondary cushings,

finding concentration from asorbance reading, coefficient of variation and SD
interpretation, percent recovery, blood gas analyzer issues and measurements, BNP
for what conditio

Chemistry- interpret bilirubin results and tell what kind of disorder it is

Cushings- cortisol and Acth would be increased or decreased

Electrolytes are all decreased- whats wrong with the analyzer?

Patient has impaired fasting glucose and 2 hr- what would you do next?

Urobilinogen - gives urine its color

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Contraceptives have what effect on iron levels?

Hematology- calculate indicies and use that to classify the anemia

picture of myeloid cells- what stain is best?

Lots of coat questions- lupus anticoagulant, what does coumadin act on? Coag
controls are high, what can it

be contaminated with?

Types of hemoglobin and what they are composed of

Effect of lysing reagent on HGB C

Some fluid questions and questions about heme results associated with CHF

Moth ball intoxication looks like what?

Micro- A couple mycology questions with pictures, olive oil is needed to grow what
fungus, a lipid chain is added to culture to grow what? What is added to a plate that
you wish to grow gram negative rods. A salmonella question. Picture of TB with a
small description- which species? How are viruses transported? HbV results- what
stage? Gram neg anaerobic cocci is? Nocardia stain results- Role of potassium permag
in staining.

Blood bank- These were tricky, lots of "Dce/dCe"type questions about what
percentage would be ok for transfusing if a certain genotype was pos/neg. Lots of ABO
discrepancies, panel cells all positive, but neg check cells,

1.) be able to identify the antibody pattern for EBV on a graph

2.) be able to identify IGG/IGM and which is displayed graphically. The exact same
graph is in the Patsy Jarreau book.

3.) 120 lb malnourished man is seen in the ER. What would be indicative of his
condition? listed were BUN, OSMOS, CRP, HAPTOGLOBIN. they all had abnormal values
next to them, but i can't remember.

4.)ANA Patterns for RA and SLE

5.) I got A LOT of questions about iron deficiencies. be able to identify iron deficiency,
hemachromatosis, etc..

6.) This is seen in alpha thalssemia. choices- increased A2 and F, Barts and H disease,
persistence of F

7.) I got a question about "dry tap" - Mylefibrosis

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8.) CSF electrophoresis and multiple sclerosis. Choices- IgG Monoclonal, IgM
Monoclonal, IgG Oligcolonal, IgM Olicolonal

9.) Patient comes in on a sunday and AB screen neg and receives on unit, following
wednesday SC III is positive in the AHG phase. Choices- recollect, assume AB and ID
for AB, perform autoabsorbtion, re-test sample from sunday

10.)know about acquired B antigen

11.) you perform daily maintenance and you get the message "excessive shift" for K.
what do you do? Choices- Assay new control, replace membrane, recalibrate, clean
ISE.

12.) Patient has been coming in the past 5 days getting blood draw and on 3/19 his
hemoglobin suddenly drops. Why? Choices-lipemia, chronic anemia, iron deficiency,
wrong patient. Everything else matched just hemoglobin was significantly changed.

13. Automated hematocrit was 33.0 you perform a manual and you get 33.5. Choices-
report automated result, redraw specimen, report manual, etc.

14.) bacili is seen microscopically in urine, but nitrite portion of strip is neg why?

15.) know what causes spherocytes in blood

16.) Know what causes false positives on urine strip

17.) know what causes auto infection- strongyloides

18.) nematode egg that is transparent and bile colored

19.) know what enzymes are increased in biliary obstruction, hepatitis, cardiac etc.

20.) positive control for hcg is weakly pos and negative is neg. Patient result is
positive. choices- release results, rerun controls with new control batch, recollect
patient sample.

21.)be able to calculate half life for meds

22.) effects of sulfa drugs and what's seen on a smear

23.) know relative and absolute lymph

24.) storage requirements for Cryo

25.) know phenotyping

-infectious mononucleosis know everything about it

-biochemical reactions between BGN

-proteus,klebsiella,morganell,e coli,enterobacter specifics reactions

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-why RhIg at 28 weeks of pregnancy? what effect it does?

-supravital stain,

-Hiv confirmatory test

-discrepancy

-B acquired(forward was AB,reversed was A group,why?)

-crytococcus neoformans

-fungus

-ldl calcul

-cardiac markers

-ABO type

-coagulation facteurs and correction

-aptt prolonged after mixing [Link]?

-autoadsorption

-which tube for coagulation studies (ca?edta?....)

-falses resuts after 3 assays in the lab,what to do? they did well everything before the
lab test.

blood splited on the floor,what to do?clean by yourself? call the supervisor?call the
call the safety and ...... department to let them know?

-clerical error

I had 3 antibody panel 1 regarding exchange blood transfusion, 1 about AHG

reagent,1 about baby's antibody coated with mom's antibody, and 1 calculation with
how many units of blood be matched if there are 66% of anti K and 25% anti E.

Clini test, salmonella paratyphie serotyped biochemical reaction, fungus that requires
olive oil to grow, manual RBC count, RHG immunoglobin calculations, coccaine
metabolite, moth ball poisoning, serratia biochemical rxn discrapancy,abo
discrapancies, performing cold autoadsorbtion on Anti A1 patient RBC is forward is A
and reverse is O, Baby has toxoplasma; best to test mother or baby?, Hepatitis C all
antibodies increased,how many units to transfuse for Anti-Kell,one analyzer gives low
WBC count the other gives a high count,what to do next?,coefficient of variation
calculation,Synovial fluid yellow due to what?,Turbid synovial fluid due to what?,
Pheripheral blood picture with acanthocyte and tear drop cells Diagnosis?, alpha
thalessemia; what HB is increased,HBc is resistant to which diluent, prolonged PT and
APTT during surgical bleeding, all tests are normal, what will u do next?, coumarin

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therapy, corynebacterium sp beta hemolytic and motile, glucose fermentation of
veolena, peptstreptococcus, micrococcus. TIBC HUS, picture of gram negative bacilli
with gliding motility, treatment for syphilis reinfection other choices were antibody
tests, Antibody ID and report what to do next; had jka and k so had to do selective
panel. cryo thawed at 2pm requested at 3, what will you?issue or not?.

ABO and Rh incompatible platelet pheresis donor platelet range should be more than
250,350 or >500,000?. blood grouping of patient with Anti P antibody,m auto is pos?,
To make a good pos control,Anti E should be? DCE/dce?, mixing study not able to fix
PT and APTT due to what?? lupus anticoagulant or unknown [Link] low
platelet, PT + APTT normal? DIC??. Amylase low due to what? lipemia or decrease in
lipase as well?. howel jolly bodies picto, glomerulonephritis due to what? Efaecalis or
Strept, cardiobacterium grams staining, oral contraceptives on iron stores, TIBC and
loss of blood, known alcoholic with arrythemia, test for what HBA1C or GTT?
Toxoplasma gondii latexx test beads to ricketts. antibodies dealing with pregnancies.
mother rh negative, baby rh positive, hemolysis due to what? sodium decreased,
potassium normal, test for what next, magnesium? or could be due to kidney
disease?. woman with abdominal pain- pancreatitis or appendicitis? bunch of
biochemical rxns for shigella, proteus and serratia with discrapancy in reactions.
melassessia furfur, sprothrix schenkii, histoplasma capsulatum. transportation temp
for RBCs,best method for transporting viruses for culture

which factor does coumarin affect? blood picture if whole blood is left at room
temperature for 8 hours, what will be affected? bizzare wbc?creanetd rbc? HBc?. Is it
possible to test for glucose on from a lithium heparin tube after refridgeration and
separation from rbc? I answered yes to this one. Platelet graph aggregation with
epinephrine and 3 other hormones, had to select the correct graph. organism
innoculated on skin, after 3 days inflammation on the site of innoculation due to what?
monocyte, tcellm bcell?. spectrophotometer color of bulb orange and red,why??.
drugs measured using what, Nepho atomic spectro?..1 unit of whole blood transfused,
what is frst to increase? RBC,HB,retics, mcv??TIBC transferrin measure if HB is
decreased HB electophoresis questions. did not get any hepatic questions or ANA
[Link] anti ID panels, super easy to do. make sure you are really good in Blood
banking, they are worth the most points. i passed because of blood banking

[Link] bacteria will show positive and negative for the following. Bile esculin, 6.5na,
Camp, bacitracin. I choose [Link], S. Agalactia, enterococcus . Other option has
s. Virdian, S. Aureus...

2. I will bacteria when exposed to light change color m kansasii

3. Contained tap water [Link]

4. Anti body panel that had anti k. How would the panel show specific or sensitivity
can't remember. I choose run enzyme panel not sure is that correct.

5. Had to calculate LDL

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6. A questions who's had odd results for glucose, sodium, BUN. What would be
affected osmolslity 2na + glucose/20+!bun/3

7. Double zone bacteria how to confirmation positive reverse CAMP test.

8. Gram negative anaerobes jaw surgery veillonella

9. A panel that ha anti d and p1

10. Waxy cast or fatty cast I think dye suban o oil.

11. Aeromonas gran negative, bets hemolytic, oxidase positive

12. N meningitis OPNG negative

13. Picture of histoplasma, and one about fluid being drained from the lungs.

14. Picture of aspergillus

15. Zygomycota sporengium

16. Malasezzis furfural- oil or olive oil

17. Auto infection strangyloides

18. Chromogenic agar I think. It was a picture of a agar one side clear organism had
different color sheep blood agar all agate looks the same

19. K ISE- valinomycin

20. Person overdose on salicylate decrease ph- I chose metabolic acidosis

21. ALP ph 9.6- pagers

22. Cocaine metabolite- benzoylecgonine

23. Group A pod mother had and miss carriage d neg, weak d beg... Is the patient a
candidate for rhig

24. I have to calculate diagnose for rhig twice. Whole blood divide by 30. Rbc by 15

25. Hba1s affected by hemolytic anemia

26. Caffein for diazo rxn why?

27. Bilirubin- 450nm

28. Pituitary gland - increased TSH and T4

29. Increase bilirubin and urobilinogen

30. Release heparin/ histamine - basophils and mast cells

31. Cryo store at RT from 2pm pt scheduled to be transfused at 3pm what would you
do?

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32. Irradiated blood for pt receiving blood from mother

33. Positive RPR negative FTA for syphilis -false positive

34. Picture of a waxy cast

35. Alpha thalassemia-hgb Bart and Hgb h

36. Eosinophils in Urine/ intestinal nephritis

37. know the difference CML and AML

38. Questions about multiple myeloma

39. Increase platelet and wbc

40. Issoagglutinin of Type O- anti A, anti B, anti AB

41. Beta and gamma bridge

1.-Procainamide: NAPA
2.-ABO discrepancie I remember.A4+B0 O0 A0 B0 O0
3.- how differentiate Proteus Mirabilis and P Vulgaris.
4.-cloride shift-HCO3-Cl-
5.- A sample that was collected in gray tube for chemistry. what to expect.
6.- which anticoagulant should I use for coagulation studies.
7.- malaria in blood.
8.- peppenrhimer bodies
9.- Falciparum
10.-AFT as cancer marker
11.-what is increased in Hemolytic anemia? its as Unconjugated billirubin, iron, TIBC
12.-Gram + Bacili, Branching, CATALASE – partially acid fast— that was easy–
Nocardia
13.-Oxidase -, Catalase+ Indole – H2S+ i thought it was Salmonella
14.- difference between primary and secondary thyroidism —TSH
[Link] sydrome-cortisol increased
16.- ALP increased when
17.-it was a line with for pictures i have to pick if they were in acid or basic urine
there where also some from bilirubin, some parasites, but no calculations for me.
the infective form
the first thing I did was wrote down all the bacter charts just in case. and the
antibodies and ABO discrepancies because studied them from here. was easier to
remember.
I cannot remember more but if i do i will come back
Thank you for this web site, it really helped me i read every single post and question.

For Micro: I studied high yield notes micro here, then went through micro review
section bacteria from Harr book. Don’t forget to study all micro recalls from here.
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For Blood Bank: I studied high yield notes from here. Then reviewed all section of BB
from Harr. Some questions from BOC very helpful: 18, 20, 30, 175, 228, 231, 244,
246, 247, 248, 250, 252, 259, 272, 274, 283, 289, 293, 301, 306, 315.

For Chemistry: I studied high yield notes from here. all recalls from here. and studied
review section from a Bottom line approach.

Hematology and coagulation: I studied high yield notes from here and review section
from a Bottom line approach. All recalls from here.

Urinalysis, BF, immunology: I studies high yield notes, recalls from here. Bottom line
approach.

I had a lots of BB questions in my exam today.

Blood Bank:
1. a patient is group A Rh negative and anti-Le(a-b+), what antigen patient have:
A, H, Le(b+)

2. What cause of weak D? Missing Epitope

3. A picture of RBC agglutination: 2 questions:

1) what does it associated with: PCH
2) what is this indicate: Cold antibody reacting

4. Given table : anti-A anti-B Rh Weak D Control

0 0 0 3+ 0
IS 37 AHG CC
SC I 0 0 0 2+
SCII 0 0 0 2+
PT 0 0 2+ NT

What does patient has?

patient has auto and alloantibody

5. Given result: DAT poly = 0, DAT C3= 3+, what should the tech do?
Report DAT positive.

6. Given result of antibody ID, All 11 tubes AHG= Negative, then added Check cells, 4
tubes did not given agglutination.
What happened? the wash machine did not dispense correctly volume of saline.

7. What causes this donor defer?

He had HB immunoglobulin injection 6 week ago.

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[Link] rouleaux can’t detect at what phage? AHG phage.

9. ABO discrepancy:
anti-A anti-B A1 B
4+ a+ 1+ 1+
what should tech do? incubation at room temperature.

10. Given table results:

Screen I and II positive, DAT = 3+, after autocontrol = 4+, after do auto adsorption,
auto control = 2+, what should the tech do?
do enzyme treatment; report result; do another auto adsorption
or do panel selected cells. ( I chose do panel selected cells)

11. Whole blood donation stop at volume of 390ml:

What should we use for this?
a. do separated for platelet and plasma
b. use as packed red cell
c. use as whole blood cells ( I picked this one)
d. separated to plasma

12. Given panel: LeA LeB IS 37 AHG

0+000
0+000
+ 0 +/- 0 0
+ 0 +/- 0 0

this patient has what?

a. Glycolipid absorbed from plasma ( I picked this one)
b. patient has antibody.
c. do a panel
d. run auto control

13. Mother: O Negative has anti-D, anti-C, previously known has anti-LeA
Baby: A postive, DAT = 3+

What blood you chose to transfuse to infant?

a. Group A negative, D, C, LeA antigen negative
b. Group O negative, C antigen negative ( I picked this one)
c. Group A positive, D, C LeA antigen negative
d. Group O positive, D, C antigen negative

14. What cells antigen when storage will deteriorate?

a. Kidd
b. Kell

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c. C
d. P ( I picked this one)

15. Given table panel red cells: choose positive control for anti-c (little c) and negative
control for anti-FyA: C+c+ for positive control for anti-c, and FyA- FyB+ for negative
control for anti-FyA.

16. ABO discrepancy: anti-A anti-B A1 B

0 2+MF 4+ 0

what happened? Patient received group O transfusion.

For laboratory:

1. To calibration of blood gas analyzer, you need what?

two buffers with pH and constant temperature.
2. Compare method for control and patient, what method to used?
Paired- T test

For Micro: you must remember diagram of high yield notes, I have about 10 questions
and few they are not from high yield notes such as:
1. patient has cat scratch: GNB, low grade fever, enter ED.
a. Pasteurella multocida ( this for cat or dog bite)
b. Bartonella henselae ( I picked this one)
c. Steptobacillus moniliformes
d. toxaplasmo

2. Child suspected has “walking” pneumonia, doctor description penicillin, two weeks
later the child still sick, what happened?
the organism mycoplasma doesn’t have cell wall.

I have 4 questions of Mycology, 1 questions of Parasitology:

1. Test using on hair penetration to differentiate of what organisms?

T. mentagrophytes and T. rubrum

2. What dimorphy yeast have description branch like mother and daughter?
Blastomyces dermatitis

3. Description of dimorphy yeast have ” cigar – bodies”

Sporotrix schenkii

4. Description about Histoplasma capsulatum : Tuberculate, Macroconidia

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5. What Plasmodium doesn’t have stage of Schizont and Trophozoite in blood smear?
P. falciparum ( have ring and banana shape?)

Procainamide=NAPA
[Link] vs. P. putida = choices ; 1. pyoverdin, 2. growth @ 42C (answered #2
not sure)
Growth in olive oil = M. furfur
Picture of stomatocytes= liver disease
Whats in the saliva of Le (a+b-)= answered Lea( not sure) other choices include H and
A
Specimen of choice for whopping cough = nasopharangeal swab
Zygomycetes description
Creatinine clearance calculation
ABO typing discrepancies (5 items or more )
Before addition of caffeine bilirubin = 3.2 after addition of caffeine bili = 5.4 = what is
the conjugated and unconjugated bilirubin result
Abnormal acetaminophen result ( increased) what other relevant test mus be
performed
Choices are 1. bun 2. crea 3. salicylate
Cryoprecipitate storage after thawing
Will you preapare platelet concentrate from wholeblood stored in ref for 24hours?
Picture of hypersegmented neutrophil = condition associated with it
Picture of burr cells = condition associated with it
Antibody panels = identify the unit to be transfused
Patient for coagulation study has 67% hematocrit what would you do.
Choices include 1. recollect with reduced anticoagulant 2. proceed with test 3.
recollect with increased anticoagulant

Procainamide: NAPA
BHCG tumor marker for what? Not sure but I answered chorocarcinoma. Cos the three
choices were pancreatic, colon and lungs
MCV calculation
5HIAA carcinoid tumors
I had 5 bb panels (was thinking maybe this was the reason I failed. Although I did
understand but the questions were a bit confusing. Not sure with my answers)
Proteus vulgaris and mirabilis indole tests
Bb and Heme Case studies
Hydatid cyst fluid
Rh stuff
ABO descripancies
Antacid overdose? What lab test should you conduct?
Ouchterlony reading

-coagulation
-Prolonged PT, PTT, and thrombin after collecting from catheter= heparin

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contamination
– Question with mixing study that was performed with a prolonged PTT that couldn’t
be corrected=
DRVVT
-Another question with two pt’s ran in duplicate (PT and PTT). The PTT seemed to
always be prolonged but PT looked ok= I picked check the CaCl/phospholipid reagent
delivery
– Patient is on coumadin therapy, what will be affected= Decreased protein C
-Hematology-
-Lot’s of stomatocytes= liver disease
-Burr cells= uremia
-Picture of target cells with hemoglobin C crystals. The white count was high on
instrument 1, so a second instrument was used with a stronger lysing agent, and the
white count was corrected= I picked anti-lysing target cells are what increased the
white count.
-A sodium citrate tube was drawn for a HCT on a pt but the hematocrit was abnormal.
Options were recollect in heparin (what I picked), recollect with increased
anticoagulant, recollect with decreased anticoagulant, etc.
-Question that gives a red blood cells count, HGB, and HCT. I did the rule of 3 and
found that the HGB didn’t meet the rule of 3 because it was too high= I picked check
for lipemia (elevates HGB)
-Picture of PBS with an elevated reticulocyte count and howell jolly bodies in the
RBC’s.= I picked stain with prussian blue stain in order to see the retic nuclei
-what is composed of DNA?=howell jolly bodies
-what falsely decreases ESR=vibration
-ESR is increased, what is NOT a cause=I picked macrocytes because macrocytes
don’t rouleux. Other options were rouleux, increased globulins, inflammation, etc.
-Chemistry-
-Question about lactic acid collection=separate from serum and put on ice
-Question about coefficient of variation
-Carbon dioxide electrode measures what?= pH
-Question about patient that had a random glucose >200 and an FPG >126. What do
you do next?= I picked repeat the FPG. Other options were diagnose with diabetes
mellitus, perform OGTT, etc.
-Immunology-
-Man tested positive for syphilis 2 years ago but may have again, how would you test
him?-RPR
-Question with a graph with 3 peaks related to a bacterial infection= I picked that the
first peak was the antigen in the stool, the second peak was IgM (goes up and then
down quickly), and the third peak was IgG (goes up and levels off a little).
-Person tested positive for HIV-1 and HIV-2 but western blot was indeterminate. What
do you do?= I picked do CD4 count. Other options were repeat western blot, repeat
HIV-2, etc.
-Blood Bank- It felt like I had a lot of questions
– 1 small antibody ID panel. The antibodies that matched up were Lewis A Lewis B.
Question asked about the characteristics of the antibodies.= I picked that they are
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lipids absorbed onto RBC from plasma.
– There was a positive DAT on cord blood; mother is Rh pos, baby is Rh neg. What is
most likely coating the baby’s red cells?= I picked K (kell). Other options were A&B, D,
Lewis, etc.
-Picture of what looks like cold agglutinins (I got this picture 2 different times during
the test).= The first time I picked cold reacting antibody. The second time the options
were different so I went with Paroxysmal cold hemoglobinuria. Mycoplasma infection
was an option but there wasn’t a lot of WBC’s in the picture so I didn’t pick
Mycoplasma.
-What phase can rouleux not be detected in?= I picked AHG phase because a positive
37C, negative AHG, and positive auto=rouleux
-Picture of ABO type with mixed field reaction in the forward type= I picked that
patient was transfused with O blood
-Picture of AB in forward reaction, and weak reactions in back type= I picked incubate
at room temp because probably cold agglutinins
-Question about an adsorption that had been done twice, and antibody screen is
positive=I picked perform antibody ID panel
-If a patient is type A with Lewis a+b- what substance will be on their red cells= I
picked Lewis a but other options were (A, Lea), (H, A, Lea), (Lea,Leb), etc.
-Micro- no parasite questions, 2 mycology questions
– Only 1 micro picture. Bile esculin +, NaCl-, alpha hemolytic, looked like a
strep=Group D strep gallolyticus/bovis
-TSI slant K/A H2S+, PD-,= Salmonella antisera was only organism that fit
-Question with lactose fermenter, ODC+, lysine -, etc.=Enterobacter cloaca but I’m
not sure
-Rotavirus= stool
-CSF storage= incubate at 35C
-Hair perforation test= Trichophyton metagrophyte and T. rubrum
-Good way to detect Legionella infection=antigen detection in urine
-Question about a lesion on an arm= I picked sporothrix schenckii but I’m not sure.
Other options were cryptosporidium, microsporum, etc.
-Mycoplasma can’t be treated with penicillin= no cell wall

1. eosinophils in urine sediments indicates what ? interstitial nephritis

2 calculate creatinine clearance : (Urine creatinine X urine Volume/Plasma creatinine x
time in minutes)x (1.73/body surface area)
3. what is measured in procainamide ? NAPA
4. LEARN YOUR IMVIC REACTIONS YOU WILL AT LEAST 5 QUESTIONS AND TRY TO
TURN EACH SEGMENT INTO A SENTENCE; THIS REALLY HELPED
5. Glomerulonephritis is found linked to which microorganism? Strep pyogenes
6. disease correlations : basophilic stippling and high lead results. Is this correct
7. what happens to CO2, PCO2, and pH when blood is left around for an extended
period of time? low, low, and high
8 make a list of organisms that must be worked on under the hood

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1. Need to pipette .5ml of specimen, what do you use—Volumetric, Erlenmeyer, or
Serologic pipette. I picked serologic.
2. When to give Rhogam—Gave various types with moms Anti-X found. I picked
Mother Neg with baby pos mother has Anti-C
3. Cold antibody—Anti-I
4. Gave two more ABO discrepancies and how to resolve them—Rouleaux seen
microscopically use Saline replacement technique
(Recommend [Link]
5. ABO discovery: Landsteiner
6. According to Beers law- directly proportional to the amount of light absorbed, or
inversely proportional to transmitted light.
7. One question that kind of tripped me up was mom was type BO- and father was
OO- the results of the baby appeared AB+ asked what to do… Since this isn’t possible
I figured mom messed around and still chose to report it, instead of any type of
correction.
8. Dce/dce – R0/r
9. QC +/- of bacteria question- I picked oxidase- [Link] and pseudomonas
10. Cell line question with multiple listed, anisocytosis and ovalcytes stuck out to me –
anemias and myelofibrosis
11. Bile Eschulin and 6.5% NaCL pos– distinguishes Enterococcus species from the
group D strep
12. Strep pneumo hemolysis- Alpha
13. Picture of strep pneumo in respiratory found here
([Link]
14. ALP seen in—- Liver and Bone
15. Someone comes in after 4hours of MI symptoms gave results of CK CKMB and
troponin- I picked troponin it was most elevated.
16. PT elevated in—Gave various factors I choose VII
17. Intrinsic has which factor- I picked Von Wilebrand(VIII)
18. Enterobacteria broad question- can’t remember the question but I chose Ferments
Lactose
19. Someone who expresses immunity and acquired Hep B will have- HbsAg
20. Blood EDTA given to the lab 6hrs after draw will most effect– I chose platelets
21. What tube quantitates the determination of Calcium- Sodium heparin? (Red/Gold
was not avail)
22. Electrophoresis question
23. Description of immature cell no picture
24. Differentiation by description no picture of myelocyte and promyelocyte
25. When using a blutterfly for coag study – Discard a blue top then use 2nd blue
26. Description of Football shaped egg with hyaline plugs at each end- Trich Trich
27. 4 nuclei may have chromatoidal bars large, round glycogen vacuole.- E. Histolytica
28. Hypersegmented neutrophils seen in vitamin B12 or folate deficiencies
29. Picture of Triple phos in urine
30. ALP elevation seen in- Hepatic Carcinoma?
31. Colon tumor marker- CEA
Page 64 of 312
32. trough level is the lowest concentration in the patient’s bloodstream, therefore,
the specimen should be collected just prior to administration of the drug.
33. Peak Levels drawn 2-3hrs after drug is given
34. bacitracin test can also be used to differentiate the bacitracin-resistant
Staphylococcus from the bacitracin-susceptible Micrococcus.
35. Increased bili in urine will appear- Dark yellow color
36. WBC casts seen in pyelonephritis (kidney infection)
37. Waxy Cast- a higher refractive index
38. Metabolic acidosis- Vomiting

1. Role of a supervisor
A. Democratic
B. Autocratic
C. Laissez-faire
2. Colony stimulated factor is composed of?
3. Picture of histoplasma capsulatum
4. Hodgkins cell- I guessed reed stern berg
5. Giant platelets- since there was no Bernard, I chose the may hagglin.
6. What it means to have a high plt count-essential thrombocytopenia
7. Procainamide-NAPA
8. A histogram ?
9. What does it mean if the organism is resistant? (This is the sensitivity)
A. Too little agar
B. Too much organism in the innoculum.
10. Basket cells/smudge cells. Where do you see them in?
11. Low serum ferritin, high tibc, low iron. What disorder?
12. Picture of a tube that had white organism inside. (Thought ithat was the Kansasii
one but I was most likely wrong)
13. ABO discrepancies
14. Oligoclonal band-multiple sclerosis
15. Electrophoresis
16. Something about a chromosome. So I assumed t15:17
17. Rotavirus. If the EIA is positive, what do you do next?
18. picture of a cell
A. Dohle bodies
B. Auer rods
19. A graph with something on the left ( I forgot) and on the bottom is time. The
question is about enzyme.
A. Enzyme concentration
B. Substrate concentration
20. Another graph with plt, wbc, rbc. 3 different graphs but the question was about
the WBC.
21. A/A niacin postive
22. Ionized cal was left to stand for a while. What would happen?
A. Change in pH
B. Evaporation
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23. A line graph of glucose and time. Which line would be a normal glucose level.
24. Hepatobilliary test
A. Ast and ALT
B. GGT
25. What enzyme would go up first in myocardial infarction.
A. CK
B. Myoglobin
26. Picture of agglutinated blood. How to disperse the cells.
A. 22% albumin
B. Saline
C. Prewarm
27. Another colony stimulated factor question
28. Anti-Hcv positive, Anti-Hbs positive
A. Hep A
B. Hep B
C. Hep C
D. Hep D

After ingesting moth balls what you see in PBS? Heinz Bodies
AB Rh: POSITIVE patient has reaction on forward A 4+ and B 1+ Rh 4+. What will you
report? I answered AB Rh +
Gram negative cocci after a jaw surgey? Veilonella spp
QC on BhCG has weak positive in QC + and negative on QC neg what will you release?
Release as positive BhCG.
MCV day 1: 78, MCV day 2: 77 MCV day 3: 76 MCV day 4: 62, what is the probable
reason? Wrong patient.
Which leukemia + for Philadelphia?
High LAP score?
Low LAP score?
Smudge cells usually seen in? ALL
A picture of alternaria fungus.
A picture of Candida geothricum.
Olive oil for. [Link]
calculate precision.
Youre given a list of cv, which of them is best?
Given lab results, which one is suggestive of Lactic acidosis?
Calculate how many units of blood to be taken given the antibodies and their
percentages.
Calculate corrected WBC given the retics and WBC count. In this case the differential
was only 50. Im not sure but what i did is: WBC Uncorrected x 50 / nucleated RBC x
50. I did the 100 the answere is not on d choices, but when i calculated using 50 as
factor, the answer was on the choices.
Study antibodies of HAV.
RPR negative FTABS +? Release positive.
Cryoprecipitate and FFP allowable time of use if Ref. temp is 4 degree celcius. Based
on AABB standard.
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CK MB normal, Tn I is high? Myocardial infarct.
First to increase in MI? Myoglobin.
Study electrophoresis: Albumin, alpha 1, alpha2, beta, globulin.. Which is high given
the disease, or the other way around.
There was a fungal colony which is violet to purple in color on the plate. Im not sure, i
chose Fusarium.
Biochemicals of Salmonella typhimurium and Kleb. oxytoca
I had one simple BB panel. it was positive for Anti-Fya and anti-E.
Majority of lymphocytes. T Cells
Premature new born was transfused? why? I answered to compensate to the loss
blood becoz of frequent phlebotomy. Not sure though..
Pheochromocytoma : Metanephrines
coccaine metabolite? Benzoylecgonine..

1. Transudates are a. purulent b. has many bacteria c. usually noninflammatory

2. All about DAT and ABO discrepancies. I recommend you study all the discrepancies
the cause and solutions of each
3. difference between p. aeruginosa and p. putida – growth at 42’C
4. S. epidermidis in catheterized patients
5. Microccus
6. Pictures of ANA patterns and dse association
7. Picture of Curvularia
8. Geotrichum candidum
9. Levey-Jennings chart
10. Random and systematic error
11. aggregating substances
12. picture of poikilocytes
13. Hbnopathy assoc w naphthalene poisoning
14. Blood pictures and ds associations
[Link] question.
[Link]-1 expiry date
17. coagulation pathways and dse correlations
18. metabolic acidosis
19. pappenheimer bodies
20. CLL, leukemoid reaction
21. Mixing studies
22. graph abt asp, collagen, epinephrine
23. Donor deferrals
24 Hepatitis markers

child ate mothball accidentally: Heinz bodies

M. furfur: olive oil
gave 4 different equation with SD & mean; asked which would be more productive CV
(So know how to calculate)
something to do with LDL and HDL: heparin manganese solution
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5HIAA test: Carcinoid tumors
same effect as Procainamide:NAPA
Zygomycetes (from mycology) (Not sure what were the options or what I chose)
A picture of Histoplasma Capsulatum: identify
A picture of Blastomyces dermatitis: ( i think thats what it was; don’t know for sure)
Cryo was pooled; when is the new expiration?: 4 hrs
FFP was thawed at 11:15 am and left for the OR: came back to blood back at 11:40
and the temp was 11degC; what should the tech do? I chose accept and return to the
inventory as it was less than 30 minutes with improper temp
Lots of DAT and Elution question
Lots of panel (please please and super please listen to the ab identification lectures by
the BBGUY)
Something about dosage effect of antiE
Lots of ABO discrepancies asking why and what to do? (Please understand Sohal’s BB
high yield notes; it is beautifully categorized and explained)
Lots of diagrams with iron, ferritin, TIBC, bilirubin, urobilinogen and then asked what
type of disease?
KNOW IMVIC reactions: I have had 2 /3 question from there
K. pneumoniae vs K. Oxi….(See i don’t svn remember the whole name) (As soon as I
saw it, I knew indole pos)
How would you differentiate diid Yersinia species: chose motility
know the X factor and V factor H. influenza and how it correlates with S. Aureus.
sensitivity for all the gram (+) organisms ( asked bat Bacitracin, positive camp test,)
Lots of ANA questions(remember the numbers and the patterns)

CDPA-1 how many days?

Which Mycobaterium (pictured) incubated for weeks and exposed tolight become
yellow? picture of Kansassi (yellow colonies)

You received a nasopharyngal swab specimen for ROTAVIRUS, what to do? (I choose
call for clarification of the request)

Which org requires safety precaution? Choices: Aspergillus, Sporothrix schenckii

Picture of Howell Jolly bodies

Blood from newborn had high PT, high PTT and TT, bleeding from cord also…reason…
is a) afibriginogemia b) lupus inhibitor c) factor 8 deficiency d) factor 10 deficiency

FFP is thawed at 8am when is the expiration? Choices: 8pm, 8am etc..

Speckled Pattern is for? Choices: RA, SLE etc..

Question about what antibody causes HDFN when dad was O neg rr, and mom is A
pos, R1R1…choices were antibody…. D, c, A, or B
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Every other parameter on CBC was ok, (MCV, RDW, RBC, PLT, WBC)..delta failure on
HGH is due to what…instrument malfunction, tourniquet too tight, wrong blood was
tested….

Lactic acid specimen has to handled how…..a) chilled and separated from cells b)
heated c) room temp incubation d) request EDTA sample only

Picture of Strongyloides stercolaris

LDL computation

Picture of Western Blot for HIV, read and interpret the results

Series of results of HGB results for 5 consecutive days, results in Day 3 is high, the
others are almost the same. What is the reason? Choices: machine malfunction,
collected too early, specimen left standing too long..

S. aureus ferments what? choices: mannitol, sucrose, lactose, fructose

Protein electrophoresis in pH 8.6 what is close to cathode? Choices: albumin & alpha
1, gamma & beta, albumin & alpha 2..

A 70 year old man will donate, what will be the grounds of deferral given the following
screening tests: BP 140/90, Pulse 70, Temp 37 degrees the other choice is HBG of 120
or 125 I forget..
Donor will donate plasma. What will be the reason for deferring the donor; choices:
Donor received penicillin(I think?) for last week, confirmed Hep B infection last year I
forget the other choices..

Pt and ptt controls were abnormal qc repeated ptt was normal what will you do? –
replace thromboplastin or replace activator

What process will you do for Weak D? choices: DAT, IAT, elution/adsorbtion etc..

Choriocarcinoma

Picture of P. falciparum (identify)

Biochemical tests identifying Shigella (IMVIC, motility etc)

Question about immunodiffusion arcs: Ouchterlony (identity, partial, non-identity)

First step in agglutination? Choices: flocculation, sensitization, lattice formation

Graph of lag phase micro what are the IgG and IgM?
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Elizabethkingia meningoseptica – meningitis is premature NBs

A result of CBC: increase WBC, the rest are normal. Platelets is 20. What is the blood
picture? (choices ranged from the normal or abnormal status of the ff PT, PTT,
Fibrinogen, D-Dimer)

A picture of bone marrow smear. Is it normal or abnormal blood picture?

A LOT of antibody identification, discrepancies and resolution (3-7 questions)

2mL of blood was filled only for a 5 mL of anticoagulant tube; what would happen for
results of apt? (decreased? Increased? Normal?)

O positive man had a strong anti-e, he will be incompatible with what percent of what
blood Rh type? (choices; it’s something like: 97% of O positive? 25% of A positive? I
forgot the others)

If the PT controls were okay and the aptt controls were okay, what do you do next?
Choices were replace thrombin, replace activator, etc.

What is the cv is the 80-100 mmol/L is within 2SDs (choices: 5.5% , 10%, 20%)

What is the purpose of Protein C and S? (choices: act as natural anticoagulant,

activates protein coagulants.. etc..)

What bacteria will show positive and negative for the following. Bile esculin, 6.5na,
Camp, bacitracin. (choices: S. pyogenes, S. agalactiae, Viridians, Enterococcus)

Slight agglutination only on RPR test. What to do next? (choices: Repost as positive,
re-calibrate and re-test, replaced new lot number, repeat testing using same kit)

Effect of increased/decreased aldosterone on Na and K

What’s wrong with this stain? blood smear shows pink buff on rbcs (choices: acid
alcohol is too strong, carbolfuchsin is used instead of safranin etc.. I forgot the other
choices)

Know common markers for B and T lymphs (CD 19, 20/ CD 2,3,5,7, 4/8 mature

Graph of 650 nm?

What does ISE measures?

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How do you differentiate Yersinia enterocolitica vs Yersinia pestis? (I choose motility
but not sure)

What is the specific gravity of the 3mL urine diluted with 3mL H2O? Specific gravity is
1.024 before dilution. (choices: 1.024, 1.072, 1.048 etc..)

How do you know if the plasma used for PT has been contaminated with heparin?
(choices: test for PT, perform mixing studies.. etc.. I forgot the other choices)

Memorize mnemonics for IMVICs, TSIs, H2S producers, Oxidase and Urease producing
bacteria and others etc.

aHCG – Pacreatic CA or testicular?

Where does ALP is increased? (I choose the associated with bone disease; no Obj.
Jaundice in the choices)

Bernard Soulier syndrome – The question is long but the main differentiation that
caught my eye is “giant platelets”. The rest of the choices are not in sync with the
question. (No May-Hegglin in the choices so I choose Bernard S.)

What does 5HIAA in urine mean? (choices: renal disease, carcinoid tumors etc..)

Picture of Ascaris lubricoides ova (Identify)

Given: HDL was 34, Trig was 400, and cholesterol was 235. LDL was directly tested
and was 169. What to do next? (choices: repeat Trigly and recalculate LDL?, repeat
Chole and recalculated LDL? Recollect after 12 hours of fasting Etc.. I forgot the other
choices)

A control blood smear was made that covered 60% of the slide. The red cells stained
pink while white cells had their nuclei stain dark blue to light blue. The white cells
were clustered at the tail end.
A) Accept
B) Reject – white cells clustered at tail
C) Reject – Red cell color is incorrect

Ran controls and PT was normal, PTT was abnormal. Replaced controls and got same
results. What should you do next?
A) Change out the Recombiplastin
B) Change out the CaCl
C) Rerun controls
D) Run patient tests

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Chemistry/Urinalysis
Transudates
Abnormal urine colors
Cast dealing with strenuous exercise
Difference between traumatic tap; hemorrhage
The difference between primary and secondary thyroidism —TSH
Know your enzymes –ALP AST, LD, etc [Wordsology’s high yield chemistry chart]
Know your Tumor markers –what cancer is associated with it. I got one with hCG—
testicular cancer –[Wordsology’s high yield chemistry chart]
Dilution question
Blood Gasses: Metabolic Acidosis/Respiratory Alkalosis etc. [know reference ranges;
clinical conditions]
Procainamide and NAPA

Immunology
DiGeorge Syndrome- Regarding T-Cell deficiency—Absence of Thymus
CD4: is it a) inducer b) phagocytic c) cytotoxic d) don’t remember the other choice
ANA patterns

Hematology
Picture of a peripheral blood smear with Plasmodium falciparum
Howell Jolly inclusion picture –what is it composed of? DNA-
One with Pappenheimer Bodies – what do you stain it with? –Confirm with Prussian
Blue
Know what anemias are considered normochromic normocytic
Hemoglobin C disease—Target cells
Picture of a peripheral blood smear with Plasmodium falciparum
COAGULATION
APTT; PT – Disseminated intravascular coagulation—Correlating the APTT: PT
FIBRINOGEN results [prolonged or not]
Know what factors are in the Intrinsic and Extrinsic Pathway, mixing studies
Blood Bank:
Felt like I had a lot of blood bank questions (my weakest subject) Know how to do
panels, DAT/ELUTION/ Subgroups of A
Criteria for Allogenic Donor Selection
CDPA-1 know its advantage

Microbiology/Mycology
Wordsology’s Gram Positive Cocci Chart! Had a question deal with +/- controls for Bile
Esculin; CAMP; NACL; Bacitracin
picture of Kansassi
Sterilization – 15 lbs –121C
ESBL
TSI reactions for Enterobacteriaceae –Bottom Line Approach Yellow & Purple book
Ziehl-Neilson—hot stain

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Rotavirus – stool
Histoplasma capsulatum –tuberculate macroconidia
Sporothrix schenckii—Cigar bodies

Laboratory management:
One question about quality assurance

1) amniotic fluid cannot be tested for bilirubin on regular chemistry analyzer as serum
bilirubin because???A) they are demanding, B) they are biochemically different, or C)
it is just too turbid. I guessed B (not sure if correct).
2)picture of Aued rod
3) picture of sideroblasts.
4) iron deficiency anemia question.
5) I had many electrophoresis questions…HGB C disease picture.
6) Many panels, including enzyme panels, RT, 37 degree reactions,
7) lectins are used in blood bank to…a) find an antigen on rbc b) enhance reactions.
there were 2 more choices.
8) blood from newborn had high PT, high PTT and TT, bleeding from cord also…
reason…is a) afibriginogemia b) lupus inhibitor c) factor 8 deficiency d) factor 10
deficiency…..I guessed A (not sure if correct)
9) long slender gram neg rods from plueral fluid..tapered ends and long…I chose
bacteriodes fragelis (not sure if correct)
10) how would you differentiate morganella and providencia.
11) question about TIBC low, serum iron low…I chose anemia due to chronic
inflammation (not sure if correct)
12) question about a discrepancy (subgroup of A) another one about patient had
emergency transfusion in past..front type had mixed field reactions.
13) unusual band between gama and beta band on serum electrophoresis is due to
what….
14) Spike in gamma region on serum electrophereisis is due to what…
15) If plts are pooled just before transfusion in room temp in open system…when do
they expire
16)type I hypersensitivity reactions are due to ….
17) patient is diagnosed with hepatitis B 5 months ago…only thing positive is anti-
HBc..what will the med tech do….a) report it as is..b) repeat the negative HBsAG c)
report the anti-HBc as false positive d) suggest HCV testing.
18) Donor had anti-Lea, what is the best product for the blood inventory…a) rbc 2)
FFP..there were 2 more choices.
19) Myelofibrosis picture.
20) enzymes tests that are needed for muscle dystrophy.
21) ANA detects what…
22) what is chloride shift?
23) what disorder leads to hypertension…when Na is high and K is low…
24)teacher was exposed to Rubella 5 days ago…but she had IgG in her serum…was

Page 73 of 312
she immune ?
25) Gram neg coccobacilli grows on chocklate agar and grows around staph aureus
colonies on SBA as satellites…does it need a) X and V factor b) X only c) V only d)
doesnot need either.
26) presumptive id of Neisseria gonorrhea had be made when it is seen in a) male
urethral discharge b) female urine…. there were 2 more choices….
27) question about what method is it when light is emitted and expanded and
transmitted at different wavelength..
28)something about mycobacteria…and Kinyoun Stain….
29) wright stain was too pink..what would you do…increase ph…decrease ph…add
more wright stain..
30) cat bite wound culture grew gram neg…the choices were pastuerlla multocida,
toxoplasma and 2 other..
31) question about what antibody causes HDFN when dad was O neg rr, and mom is A
pos, R1R1…choices were antibody…. D, c, A, or B
32) High PT reason…very easy…factor 7
33) every other parameter on CBC was ok, (MCV, RDW, RBC, PLT, WBC)..delta failure
on HGH is due to what…instrument malfunction, tourniquet too tight, wrong blood was
tested….
34) for OGTT pregnant woman had a FPG of 250 mg/dl…what would you the best
thing to do…a) consult physician before proceeding b) redraw and retest c) report it d)
give oral glucose dose any way…
35) antigen frequencies were given… how many units would you screen…
36) anion gap values were given…calculate anion gap and choose an answer that
explains instrument malfunction.
37) eluate had sc one pos, SC two pos, SC theree negative…..you would do what…a)
repeat eluate b) do a panel on eluate c) do an autoabsorption d) do neautraliazation
38) A pos man had no platelet increase after 8 units RH negative were transfused…a)
irradiate a unit b) HLA matched unit c) RH pos platelets only d) ABO compatible only.
39) lactic acid specimen has to handled how…..a) chilled and separated from cells b)
heated c) room temp incubation d) request EDTA sample only .
40) If urine had many RBC and yeast…how would you add in the urine to differentiate
rbc from yeast…a) glacial acetic acid b) saline c) acetic acid…not sure what I chose or
what is correct…

Hema (pictures)/STAINS: 8 items mostly pbs

PBS: Burr cells-uremia
What deficiency Teardrop cells? DNA

Stomatocytes:liver disease

Picture of trichuris trichiura

BLOOD BANK
8 questions either interpret or what should you do next….

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Anti a Anti b Weak D Rh control A cells B cells
4+ 4+ 2+ 0 0 0

Anti-A Anti-B A cell B cell

4+ 4+ 2+ 2+

• About Micrococcus- (100 ug) Furazolidone resistant

• Favors growth of anaerobic gram negative bacilli- Vitamin K and hemin
• Purpose of potassium permanganate in auramine rhodamine-quenching agent to
enhance the color background
• A positive culture of sputum was stained. Carbolfucshin was added, washed,
decolorized and malachite blue was used as counter stain. Two entire field was
scanned and no acid fast bacilli were found. The most probably reason is: Inadequate
scanning of slide
• A patient has “whooping cough”, what specimen?- Nasopharyngeal swab
• RIST – Total IgE
• Graph of the platelet aggregation expressed in % transmittance for ADP, collagen
and epinephrine. Result was 0% transmittance ACE. abnormal ADP, Collagen, and
Epinephrine)

• Computation: SENSITIVITY AND SPECIFICITY

Positive (100) Negative (100)

Method 1 50 100
Method 2 60 88

• Formula of sensitivity Sensitivity = (TP/TP+FN) 100%

• Lewis Antibody – if Le and Se gene is inherited, one has Leb adsorbed unto RBC Le
(a-b+)

• Carbon dioxide ion selective electrode measure?pCO2

• Metabolic acidosis

• Result of lipase increased at Normal amylase (given reference value) saan daw
associated ?

Choices : acute AP, colon cancer, Duodenal obstruction etc.

• Why is it that serum bilirubin is preferably measured than amniotic fluid?

Choices: amniotic fluid exceeds linearity of the machine being used , amniotic fluid is
more difficult to extract, amniotic fluid has different biological components
• Characteristics of transudates at exudates
The question was clear yellowish peritoneal fluid with results
ofRBC,WBC(Lymphocytes 80%)Glucose,Lipase,Amylase,LDH,Potassium
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Choices: Viral transudate,Bacterial exudates etc etc etc (super detailed question and I
don’t know the answer )
• Hepatitis B marker
• Urolbilinogen :Colorless product of bilirubin metabolism
• HIV: repeat EIA
• Storage of virus: Lyophilized
• Sorage of CSF for culture
• Niacin pos w/ picture [Link]
• CML-diff count result
• Group O isoagglutinins
• Blood to be transfused to a GVHD pxmother to child -irradiated
• Dss association pseudo pelger huet anomaly
• Chronic heap-auto abs- anti smooth muscle
• Picture of teardrop cells:myelofibrosis of the newborn
• Partial D: structure protein altered
• Delta Check:comparison of present data with previous result
• Result increase potassium cause: tourniquet left for more than 10 mins
• Phase contrast microscope : living cells,ustained spx
• Diff morganella and providencia
• Acinetobacter
• Aeromnas
• Differentiate mature and immature blood cells: chromatin clumping
• Light hit, emit power: fluorometry
• Cloudy urine: hematuria
• Picture spherocytes:mild anemia
• Low in serum iron, low tibc, normal ferritin:anemia of chronic disease
• Homogenous pix: ssDNA
• Electrophoresis protein
• Thermistor
• Half life
• Encapsulated yeast seen in DM: C neoformans
• Haptoglobin
• Protein C and Protein S
• Causes thrombosis:C3
• S. aureus ferments: Mannitol
• Heparin-Manganese
• Specimen collection for uine
• Sperm collected for 2 hous-repeat collection
• Hgb electrophoresis
• MCV MCH MCHC
• BB Pannel
• Tap water bacilli- M. gordonae
• Kleihauer Betke Disk
• Ouchterlony

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Blood Bank:
-Discrepancies, study them. A useful mnemonic device I used for ABO discrepancies
was “EMMMA”:
Extra antigen
Missing antigen
Mixed field
Missign antibody
Additional antibody

– Lewis- secretors vs nonsecretors. Know everything about them

– Make sense of who can and can’t donate and why
-Weak D vs Partial D

Chem: I literally only had recall questions from here. A mnemonic I used was U C B U
“yoU C(see) Bulls**t”
U- unconjugated billirubin: Elevated in pre hepatic and post hepatic or billary
obstruction
C- conjugated billirubin: elevated in hepatic and post hepatic
B- billirubin: elevated in hepatic and post hepatic
U- urobillinogen: Elevated in pre-hep and hepatic. Decreased in billiary obstruction

Heme: Know your PT APTT ranges and MIXING STUDIES! and lupus anticoagulant.

Immunology: I had alot of HIV, just know that Wetern Blot is used for confirmation.

Urinalysis: know your dipsticks like everyone else said

Immunology: HIV, and ANAs

[Link] Interpretation, what to do next if it has 3+ on c3d only

[Link] shift reconstituted controls using water from the water purifier. Why? (Expired
reagents) and volumetric pipette results were bad – why? (Improper calibration of
pipette)
[Link] subgroup +mf on anti B
[Link] DISCREPANCIES and how to remedy them. Anti-a and Anti-b. Both 4+. A and B
cells both 2+. How to resolve this discrepancy? (Report? Prewarm? Wash the cells and
retype?)
[Link] performed AUTO ADSORPTION because of 4+ auto control But after
adsorption it has still 2+ what to do?
[Link] free PSA is associated with?
[Link] PIC associated with which of the following choices: were anti ssa anti dsdna
anti mitoch anti smooth muscle, the pic was speckled
[Link] of low NA? (Hypoproteinemia, Diabetes insipidus)
[Link] transfusion. Mother was AB NEG AND HAS ANTI D, C, I AND
LEWIS. BABY WAS O POS. What blood to be transfused on baby?
O RH NEG NEGATIVE FOR D C I ANTIGENS forgot other choices
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[Link] you are testing for MRSA, what to do? (Decrease the level of salt in the media
increase the methicillin conc of the disk, forgot other choices)
[Link] computation
[Link] of lack of agglutination after adding check cells on negative results
Two days old infant glucose strip positive. Clinitest negative. Cause? (Galactosuria,
Excess ascorbic acid, expired strip)

CA 19 9
Metabolite of PHENOBARBITAL
PROCAINAMIDE
SLEEP APNEA- Associated with pseudocholinesterase
Flurometer
Valinomycin- K
Cut off absorbance for HBEAG was 0.734 something. Specimen was 0.3. Interpret
result (Positive, Indetermine, Negative)
Stomatocytes associated with? (Burr cells)

[Link]-antibiotic use for potasium

[Link] gap calculation (2 question)
[Link] reaction of kidd,kell,duffy (3 question)
[Link] is interferon?
[Link] reaction in mannitol and how to report (2 question)
[Link] panel reaction (situational) 4 question
7. ABO discrepancy and DAT
[Link] media is for???
[Link] test is for??
[Link] acid test for ???
[Link] ESR increase/decrease 2 question
[Link] of biochemical reaction
13. how to identify Necator americanus?
[Link] media and identification?
[Link] plasma temp. after thawing? and how many hours should be use after
thawing (2 question)
16 .releaux formation,spherocytes and cells abnormality(3question)

Values of Cl, Na, Co2 and asked which one is not valid based on anion gap

RPR pos, FT-ABS neg, what does that mean?

primary, secondary, false positive

RPR is a good sensitivity test because:

very specific, very sensitive, stays for years after the infection

Catalase pos G+ cocci from (dubircle??) ulcer , slide coag neg, 6.5% NaCl Pos, Bile
Neg,
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ID as S. bovis, consider normal flora, assume S. aureus and perform tube coag (can’t
remember 4th choice)

Important part to ID dermatophytes

macrocondia
chlamydospore
blastoconidia

Purpose of caffeine in diazo reaction for bilirubin?

remove bili bound to albumin
precipitate other compound with negative inference
ppt other compounds with positive interference
increase reaction with unconjugated bili

Low WBC, RBC and PLT, causes?

Folate deficiency of liver disease
Low B12 absorption

Pt 5 day differential result with Hgb slowly dropping, cause of result change (MCV
went from 93-92 in 4 days to 72 on 5th day)?
Developing iron def
interference due to lipemic sample
Sample from wrong pt

Calculate LDL from given values

Calculate # of units needed to obtain 4 units that are K and E negative (frequencies
were provided)

Calculate # of Rhogam to be given if 95 ml maternal hemorrhage.

1. Picture of Fusobacterium
2. A thin, gram-negative bacillus with tapered ends isolated from an empyema
specimen grew only on anaerobic sheep blood agar. It was found to be indole positive,
lipase negative, and was inhibited by 20% bile. The most probable identification of
this isolate would be:
a. Bacteroides
b. Fusobacterium
c. Clostridium
d. Porphyromonas
3. Picture of Taenia proglottid
a. Taenia saginata
b. Taenia solium
c, Dypilidium Caninum
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4. Plate of Auer rods, where do you see them
a. AML
b. CML
5. A beta-hemolytic, catalasa positive, gram-positive coccus is coagulase negative by
the slide coagulase test. Which of the following es the most appropriate in
identification of this organism?
a. Report a coagulase-negative Staphylococcus
b. Report a coagulase-negative Staphylococcus aureus
c. Reconfirm the hemolytic reaction on a fresh 24-hour culture
d. Do a tube coagulase test to confirm the slide test
6. Hairy Cell plate, the picture looked blurry
a. atypic linfocite
b. hairy cell leukimia
c. normal linfocite
7. Plate of toxic granulation
8. During the past month, Staphylococcus epidermidis has been isolated from blood
cultures at 2-3 times the rate from the previous year. The most logical explanation for
the increase in these isolates is that:
a. The blood culture media are contaminated with this organism
b. The hospital ventilation system is contaminated with Staphylococcus epidermidis
c. There has been a break in proper skin preparation before drawing blood for culture
d. A relatively virulent isolate is being spread from patient to patient
9. Which test differentiates E coli O157:H7
a. Manitol
b. Sorbitol
c. Lactosa
10. A clean catch urine sample was taken:
TSI: acid slant/acid butt; no H2S gas produced
Indole: positive
Motility: positive
Citrate: negative
Lysine decarboxylase: positive
Urea: negative
VP: negative
This organism most likely is:
a. Klebsiella pneumoniae
b. Shigella dysenteriae
c. Escherichia coli
d. Enterobacteria cloacae
11. A gram-negative bacillus has been isolated from feces, and the confirmed
biochemical reaction fit those of Shigella. The organism does not agglutinate in
Shigella antisera. What should be done next?
a. Test the organism with a new lot of antisera
b. Rest with Vi antigen
c. Repeat the biochemical test
d. Boil the organism and retest with the antisera
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12. Asacarolitic organism, DNasa + Oxidasa +- Moraxella catarrhalis
13. Propionibacterium acnés – Blood culture contamination
14. The reverse CAMP test, lecithinase production, double zone hemolysis, and Gram
stain morphology are all useful criteria in the identification of:
a. Clostridium perfringens
b. Streptococcus agalactiae
c. Propionibacterium acnes
d. Bacillus anthracis
15. CNA and PEA
16. Case: From a pleural liquid it was recoverd a vancomycin, clindamycin (I think and
another antibiotic, can’t remember) susceptible. On sheep blood agar was chewy or
sticky and in McK it was pink, they concluded that it was Klebsiella, what do you do
next?
a. Report Klebsiella
b. It’s not a common site for klebsiella to grow
c. The plates does not match klebsiella
17. A patient with Meningococci in peniciline treatment. A Gram was made and there
where Gram- cocci. It was cultured and at 48 hours there where no organism. What
happened?
a. The diagnostic was erroneous
b. Antibiotic inhibit the bacteria
c. Patient created antibodies against the bacteria
d. Bacteria produced Betalactamasa
18. when you prepare sheep blood agar, what do you do next?
19. Urine for culture and routine completely spilled- obtain a new sample
20. add KOH and a fishy odor comes out- clue cells
21. Parasite that migrates to lungs- Ascaris lumbricoides
22. A 47 year old was in antibiotic treatment. She had diarrhea for 4 consecutive
days, what should you do next?
23. Mycobacterium process
24. Stool sample question
25. 57% Hematocrit is normal in:
a. Male
b. Female
c. One year old
d. New born
26. Siderotic granules: prussian blue
27. transudate
a. Contains bacterias
b. Something about natural cells
c. Inflamation
28. An alkaline urine refrigerated becomes turbid because of:
a. Amorphous urates
b. Wbc
c. Amoruphous phosphates
d. Bacteria
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29. Cristales in sinovial fluid
a. Gota
b. Pseudogota
30. Negative strip, clinitest +
a. Glycosuria
b. Juvenile diabetes
31. Urinalisis and everything was ok except ketones 3+
a. Acetest
b. Ictotest
32. Mean of 140 with 2s and falls in 95% what is the range?
33. 4g of NaCl is added to water until 2500ml is reached. What is the concentration?
4/2500=.16%
34. Absorbance=(abs unk/abs std)x [std]
35. Elevated ALT
36. The best diagnostic for an alcoholic
a. AST
b. ALT
c. GGT
37. In which of the following conditions would a normal level of creatine kinase be
found?
a. acute myocardial infarct
b. hepatitis
c. early muscular dystrophy
38. Elevated ALP
a. biliary obstruction
b. hepatitis
39. what should you evaluate in a antacid overload?
40. If the creamy layer of a red tube is discarded and chemistry is done, which result
may be affected?
41. cases of acidosis and alkalosis
42. IDA common case
43. Icteric sample
44. A BUN- Creatinine case
45. Histogram, they presented WBC, RBC y platelets. What is the cause of
interference in the WBC
a. NRBC-
b. Retics
c. platelet clott
46. Breast cancer marker- CA 15-3
47. Antibodies against TSH
a. Carcinoma-
b. Graves
c. Hashimoto
48. What should you do to a pregnant woman that in the 2hpp had 500mg of glucose
in fasting
a. Give glucola
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b. Do another fast blood
c. Change to 5 hpp
49. If a particle has the same isolectric point as the pH
a. It moves slowly
b. It moves faster
c. doesn’t move at all
50. Control fall out 3 standard deviations, which rule is broken?
51 Why ANA test is good?
a. Array immuno disease
b. Diagnose of SLE
c. Descartes Sjorgrens
52. Patient with anti-HCV + y anti-HBs +, what does he have?
a. Hep A
b. Hep B
c. Hep C
d. Hep D
53. ELISA was HIV +, What should you do next?
a. Report to the dr HIV +
b. Repeat ELISA with original sample
c. Obtain a new sample
54. Case of a patient that had everything elevated and platelets super high, RBC, Hct
a. Polycythemia vera
b. Polycythemia vera absolute
c. other types of PV that can’t remember
55. Bands of IgG to what their associate?
56. Howell Jolly plate
57. NRBC exercise
58. A plate of a lot of platelets, what do you do?
a. Repeat in the machine
b. Ask for a new sample and process it in the machine
c. Dilute and do a manual count
59. What is RDW
60. 2ml of blood is collected in a .5ml citrate tube, how is affected the pt
a. Decreases because of the inadequate ratio
b. Increases because of the inadequate ratio
c. Normal
61. Aspirin affects?
62. Why RBC in saline are better than those in CPDA-1?
a. Less glucose
b. More donor plasma
63. Girl with menorrhagia and elevated ptt
a. DD
b. Afibrinolemia
c. Ristocetin
64. Mother with mf agglutination
a. do kleihauer to mother’s cell
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b. do kleihauer to baby cell
65. Who is the best donor?
a. Patient that received a transfusion 8 months ago
b. Woman that gave birth 4 weeks ago
c. Man that donate blood 10 weeks ago
d. Patient with Hgb in 12
66. To prevent Graft vs Host
Para evitar Host vs Graft que le das
a. Irradiated
b. Leukocyte reduce
67. Temperature for thawing FFP
68. Patient in operating room, intraoperative blood
a. Transfuse the patient in24 hrs if it was maintain at 1-6C
b. Do a crossmatch and then transfuse
c. can give to other patients
69. Lectin use
70. Blood bank panels

Blood bank: focused on discrepancy and DAT

Micro/Mycology: high yield notes specially enterobacterace chart, I got about 9
questions from both areas mostly were recalls
Urinalysis: strip tests and discrepancy
Chem/Immunology: memorize bilirubin (conjugated and unconjugated), urobiloinogen
pre,hepatic and post hepatic results.
1)what causes postprandial lipemia
2)for some measurement (can’t remember exactly) the absorbance cutoff is0.700 and
the measured viral antigen is 0.300 what does this mean? +/- or undetermined
results.
3)patient fasting glucose is 128 and 2hr level is [Link] should be done?
Repeat test, do glucose tolerance… can’t remember other choices.
4) Cushing syndrome ACTH and Cortisol levels
5)Monocytosis seen in what? TB, mononucleosis, hypersensitivity.
6) young woman with sore throat, malaise and cervical lymphadenopathy then given
antigen or antibody levels to CMV and EBV and had to determine if it is coinfection,
CMV or EBV.
7) One ANA question with fluorescing speckled and centromere patter and I think it
was CREST and scleroderma.
8) patient prostate gland was remove a year ago due to cancer, yet his current PSA is
positive? Is the test not specific, is the sample not his, his cancer came back

Heme/ coag
1)There is a picture that I came across in two different questions and I think it was
hemagglutinin
2)Reduced EPO is due to what? PV or secondary PV
3)Philadelphia chromosome

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4)Megakaryocyte CD marker
5)lupus anti coag what does it do
6)recognize DIC lab results
7)Manual RBC calculation
8)MI patient who was treated with streptokinase. Which of the results sugesst that
treatment wasn’t successful. PT 12, PT 25,PTT 200 or D-dimer +

Where are urine crystals formed? Options 1)where distaled tubules, proximal tubules,
loop of henle or bladder.
2) 2 questions about someone who had Duffy antibody but no longer has it. They need
blood what do you do? Options where cross match only or do pannel are the ones I
remember.
3) which is used as control in micro? It was something for ecloi vs something else for
indole test. options for urease, lysine?
4) question about adh in chemistry and water
5) questions about sodium and chloride
6) question about Mcv
7) coefficient of variation formula
8) what is Tsh used for? Some of the options were to detect thyroid cancer, something
about t4
9) where is lymphocyte from? Not bone marrow but another one I forgot but bone
marrow was option.
10) something about Sudan stain and what’s it used for? Options were lipids, fats,
proteins and something else
I had a lot of micro and blood bank questions more than anything else.

1) Transudate definition (is it purulent, high cellular WBC count, etc?)

2) Urine color matching choose which one is correct ( I put port wine- porphyrin)
3) Which is more significant found in urine (pH 8.0, +1 protein, bilirubin +)
4) Know how to read immunodiffusion arcs (identity, partial, non-identity)
5) If you see band at start of serum protein electrophoresis what should you do?
A. report as abnormal
B. perform immunodiffusion
C. check to make sure it’s serum
6) Low serum iron, low TIBC, normal ferritin? anemia of chronic disease
7) beta-hCG
8) picture of enterobius vermicularis egg- use cellophane tape
9) Sensitivity vs specificity
10) several metabolic/respiratory alkalosis and acidosis questions
11) correlate RBC morphology with disease
12) hyaline casts may be confused with? mucus, fats or crystals (I put mucus)
13) semen analysis (abstinence, lubrication?)
14) calcium ion electrode measures what?

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15) bronchiolitis in young children and immunocompromised- respiratory syncytial
virus
16) Diphtheria- use loeffler and tinsdale tellurite
17) CD definition- antigenic determining characteristics
18) 3-4 antibody panels
19) cross- match unit calculation
For example: How many units of group O RBC units should you phenotype, in order to
fulfill the request for two cross-matched units?
K negative 91%, Fya negative 37%
STEP 1: 0.91 x 0.37 = 0.33
STEP 2: Divide 1 by the number you calculated in first step 1/0.33 = 3
Since you need to cross-match 2 units, need to pull 3×2 = 6 units
20) triglyceride calculation ( cholesterol = LDL + HDL + VLDL) ***VLDL = TG/5
21) tumor marker for colon cancer- CEA

1. Differentiate btw Enterobacter- Lysine and Arginine

2. Burr cell- uremia
3. Pre-hepatic/ hepatic/ obstruction and bilirubin levels
4. UA results and correlate to disease
5. Couple questions that provide coag results and ask what is wrong. Controls?
Instrument?
6. Lupus anticoagulant
7. Rotavirus specimen- stool
8. Differentiate btw EBV and CMV infection
9. serum Na: SIDAH
10. Staph. aureus ferments mannitol
11. Some ABO discrepancy
12. 1 ANA
13. EPO in what? PV? Aplastic anemia?
14. Heinz body stain
15. Pic of polyagglutionation and asked what is the cause? The same pic actually
came up 2x LOL
16. Pseudomonas aeroginosa vs putida
17. Catalase pos bacilli in blood culture. Non beta hemolytic, non motile, Penicillin
resistant
18. TSI and some biochemical results and what is the organism?
19. Pasturella- cat bite
20. Blastoconidia
21. Legionella test
22. GN anaerobe in blood culture
23. Calculate transferrin saturation
24. Hepatitis marker
25. HTLV confirmation test
26. Which blood group antigen is not stable in storage?
27. What is in the saliva of a Le(a+b-) individual?
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28. PCR erroneous results?
29. What causes postprandial lipemia?
30. Treponemal test
31. High Hct in coag sample. What should you do?
32. What does CO2 electrode measure?
33. BGA pH controls
34. serum Na while other electrolytes are normal. What should you do next?
35. Pic of stomatocytes
36. Enterococcus vs Group D strep
37. Aeromonas is oxidase pos
38. 1 panel but it asked about the characteristics of the antibody and not just
antibody ID
39. Cushing- hyperglycemia
40. 1 mycology
41. Mycoplasma has no cell wall so penicillin is not effective
42. Monitor PA and NAPA
43. What affects HgbA1c?
44. What can cause a in ESR?
45. False positive in UA reagent strips

1(Picture of S. haematobium)
From which source are you most likely to see this parasite?
[Link]
[Link]
[Link]
[Link]

2 This catalase positive, gram positive bacilli with diptheroid morphology is highly
resistant to many antibiotics and is associated with immunocompromised patients.

A.)C. diptheriae
B.)C. jeikeium
C.)L. monocytogenes
D.)E. rhusiopthiae

3 A chart with susceptibilities (of which I can’t remember) for K pneumoniae asking
how the results should be reported. I’m pretty sure it was an ESBL producing
organism according to the results.

4 Which of the following is most likely to penetrate through unbroken skin?

A. Necator americanus
B. Trichuris trichura
C. Enterobius vermicularis

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5. Which is an appropriate specimen to diagnose Dracunculus medinensis?
[Link]
B. Skin snipping
[Link]

6. Which is the agent of hand foot and mouth disease?

A. Herpes
B. Coronavirus
C. Coxsackie A
D. Reovirus

7. A flat colony with green metallic sheen grows on blood. What’s the likely TSI
reaction?
(A picture with 4 different tubes)
1. A/A
2.K/A
3.K/K
4.K/A +gas +H2S

8. How would you differentiate Group A from Arcanobacterium?

A. PYR
B. Catalase
[Link]
D. Hemolysis studies

[Link] likely species for: Small gray colonies that are gamma hemolytic, bile esculin
positive, PYR negative, Gram positive cocci in short chains and small clusters
A. Group A
B. Group B
C. Enterococcus
D. Strep bovis

10. Decontamination choice for Pseudomonas in AFB culture

A. Oxalic acid
B. NALC

11. How would you differentiate Micrococcus and Staphylococcus?

A. Coagulase
B Oxidase
C Novobiocin

12. How would you differentiate V parahaemolyticus from V cholerae?

A. Sucrose
B Glucose

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C Some other sugar
D You can’t

13 (Picture of Epidermophyton)
Which species is this organism most likely to be?

14. Gram positive cocci, catalase negative,vancomycin resistant, LAP negative

A. Leuconostoc
B. Pediococcus
C. Group A
[Link] aureus

[Link] 1 bottle for blood culture was sent to the lab from a baby,what would you do
next?
[Link] stain
[Link]
[Link]
[Link] in an agar
[Link] is the purpose of lectins?
3.8 yr old in er had a alkaline dark brown urine,what do you expect to see in his urine?
[Link] cells and hyaline cast
[Link] cast and granular cast
[Link] cells and red cells
[Link] cells and white cells
[Link] is decrease in females who have their menstrual period?
[Link]
[Link]
[Link]
[Link]
[Link] is chloride shift?

[Link] is chloride shift?

[Link] will increase in gamma globulin?alpha 1 antitrypsin?
[Link] is the best specimen for cmv?
4.a picture of tear drop,correlates with [Link] b12 and folate [Link] inflammation
[Link] for rotavirus?
[Link] of 1.2 and t4 18 (high t4 and normal tsh)-secondary hyperthyroidism
[Link] acidosis know the normal values
7. Disease in target cell
8. At ph 8.6 beta globulin is faster than?
[Link] brown urine in alkaline,what cells will you see?waxy and granular?glitter cells
and hyaline?
[Link] 1+,bili +1,occult [Link] one is the most pathogenic?
[Link] test in urine for what?

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[Link] in potassium affects what?liver lungs or heart?
13 ionized calcium left in room temp for an hour,it will affect result due to [Link] in
ph [Link] [Link] of glucose?
14 electrical empedance measures what?
[Link] assay-thrombin time
[Link]-prolonged pt,Ptt,ddimer,decrease in fibrinogen
[Link]-ss positive specked Ana at 1:340,is it sle sjogensen syndrome?
[Link] of urine [Link] used is it bright field,polarized or electron?
[Link] fluid I think it was pleural exudate has white count of 500 and is turbid,is it
because it’s purulent,chylous,lipemic?
[Link] of strep pneumoniae?
[Link] of lag phase micro what are the igG and IgM?
[Link] results in empedance what is the cause?pinching the tubing
reagent,compressor?
[Link] for [Link]?
[Link]-charcoal yeast
[Link] -tcbs seashells
[Link] of fussarium what agar to use?
[Link] of window,recovery phase of hepatitis,interpret…
[Link] of rbc agglutination,what to do?prewarm sample at 37 degrees
[Link] period-decrease in ferritin
[Link] poisoning,what will you test?ph,ammonia,k?
[Link] c what test needed?is it hgb electrophoresis?
[Link] eating fatty foods what will increase?chylomicrons,ldl hdl no choice of
triglycerides
[Link] is going to buy new equipment how do you know if it is working well?
coefficient of variation,sd of difference,regenerating result?
[Link] agar?
[Link] must contain how many my of fibrinogen?
[Link] storage
[Link]-peptedoglycan
[Link] pneumoniae-lancet shape-sensitive to what? Bacitracin,Vanco,or penicillin
[Link] of kbst stain
[Link] spp-bacterial contamination of the skin while drawing a clot
42.a black clot in a unit of bag means bacterial contamination
43.a picture of an rbc graph,is it normocytic,macrocytic,microcytic
[Link] test
[Link] in immuno is what cell?lymphocyte t,b lymhpocye
[Link] of basophil but the choice was sensitivity to mast cells
[Link] cell
[Link] typing problems
[Link] identification
[Link] of western blot hiv,how do you report it according to cdc
[Link] is the best for hiv test?is it pcr?

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The most common cause of sperm agglutination is presence of sperm antibodies
Swarming; indole negative (proteus mirabilis)
Swarming; indole positive (proteus vulgaris)
Picture of rouleaux; the cause of this can be prom the proliferation of (plasma cells-
multiplemyeloma)
Picture of csf electrophoresis; what would the tech do next
Fresh frozen plasma was thawed at 10am and then stored at 4C to be picked up at 3,
what should the tech do
2mL of blood and .5 mL ofanticoagulant; what would happen for results of apt
Agar was poured into a 100 mL container instead of the normal 150 mL container.
What would happen?
LDL calculation
hCg can be detected in
hemophilia B is a deficiency in factor IX
cell lysis in the classical pathway is caused by___ (know which numbers ex: C8, C5
etc.)
urine was delayed in being refrigerated, what happens; increased pH increased
amorphous, casts dissolve
cause of cloudy CSF- crystals
calculate anion gap
calculate LDL
know what the different malarlia looks like in a blood smear
antibody panels
O positive man had a strong anti-e, he will be incompatible with what percent of what
blood Rh type
Forward type as A, reverse type as AB; what is the cause
Mom is A dad is O; gave results of baby which ended up being A pos with a positive
DAT and a hemoglobin of 8.1. Which one gave a misleading result? I put DAT
If the PT controls were okay and the aptt controls were okay, what do you do next?
Choices were replace thrombin, replace activator, etc.
What is used to differentiate primary from secondary hypothyroidism; choices were
T3, free T4, TSH, and TBH or something along those lines
Abnormal cells in the bone marrow with a high nucleus to chromatin ratio with few
present nucleoli; choices were atypical lymphocytes, monoblasts, lymphoblasts
Pinworm-use the tape prep
Replace fibrinogen in a patient using what product
Mixed field reactions are caused by having; two cellpopulations
Histogram principle
Calcium-ion elective electrode principle
Normal iron and TIBC; pernicious anemia
Significant titer is; 4 fold between acute and convalescent

What is increased with mumps ( Amylase, Lipase were options )

I had three urine pictures, one was tyrosine, cystine and x-ray leftover
Definition of a transduate
i had about 6 bloodbank panels
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what does the hair test confirm ( I believe it was T. rubrum / T menta but I am not
sure )
what is the cv is the 80-100 is within 2SDs (5.5% , 10% )
burr cells = uremia
stomatocytes= liver disease
spikey cells = slides not dry yet
what is blastoconidia
picture of blastomyces
difference between pseudo aer and pseudo putida
Which bacteria is LF , A/A and indole positive ( i put kleb oxytoca )
two questions about CRYO, storage temperature/ time and what needs to be cross
matched
Mother is Apos baby is O neg , positive DAT what is the cause ( I put Kell antibodies
made by mother , another option was baby made antibodies against mother)
R1R1 mother, R1r father, what genotypes are impossible
person donates blood on jan 1st 2016, glycerol solution is added on jan fifth and
frozen , what is exp date ( jan 1st 2017, jan 5th 2017, jan 1st 2026, jan 5th 2026)
Know what happens to salt glucose and potassium when ADH is increased
Hepatitis markers
Syphilis markers for someone in the tertiary phase

1)Cystic fibrosis green pigment -?

2)Alkali (that was the exact word )what happens co2, co3, ph?

3)Plt pooled at rt, how long held for ? 2,5,12,24 hrs

4)Pic of crystals in acidic urine

5)Antler hypha what bacteria?

6)Prolonged pt, ptt and tt-?

7)First titer till 120 , second till 50, what is it ? Pnh, mycoplasma …? Something in that
nature

8)300 , what gives energy to things? K, copper, calcium ?

9)What grows on chocolate agar?

10)Aldosterone ?

11)Double zone , beta lactase?

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12)Viewing crystals or urine under microscope , use 10x or 40 more light, less light .
Something like that?

13)All analytes were out of wack, due to water not correct for Chem or reagents ,
something like that?

14)Mother donating rbc to son , what do you do… Wash, irradiate ect…

15)Where heme c and s found… Extrinsic , intrinsic, warfarin, heparin

Which of the following will 1st to increase after MI?

LD
CK-MB
Myoglobin
Trop I

Which of the following parasite cause autoinfection in immunocompromised px?

[Link]
[Link]
[Link]
[Link]

Which of the following causes antibody against TSH?

SLE
Hashimoto’s Dse
RF
Grave’s Dse

What RBC inclusion can be seen on blood smear of a child who accidentally ingested
moth balls?
Heinz bodies
Pappenheimers

Howell Jolly bodies

Which of the following causes decrease HbA1c?

IDA
Hemolytic Anemia
Sickle cell

Which of the following cells releases histamine/heparin?

Neutrophil, Eosinophil
Eosinophil, Basophil
Basophil, Mastcell
Mastcell, Eosinophil
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Which of the following Mycobacteria we can acquire from tap water?
M. leprae
M. gordonae
M. bovis
M. tuberculosis

Which of the following analytes is cofactor for most of 300 enzymes?

Zinc
Magnesium
Calcium
Potassium

Which of the following condition is the most common cause of increase anion gap?
Metabolic alkalosis
Respiratory alkalosis
Metabolic acidosis
Respiratory acidosis

[Link] bacteria will show positive and negative for the following. Bile esculin, 6.5na,
Camp, bacitracin. I choose [Link], S. Agalactia, enterococcus . Other option has
s. Virdian, S. Aureus…
2. I will bacteria when exposed to light change color m kansasii
3. Contained tap water [Link]
4. Anti body panel that had anti k. How would the panel show specific or sensitivity
can’t remember. I choose run enzyme panel not sure is that correct.
5. Had to calculate LDL
6. A questions which had odd results for glucose, sodium, BUN. What would be
affected osmolslity 2na + glucose/20+bun/3
7. Double zone bacteria how to confirmation positive reverse CAMP test.
8. Gram negative anaerobes jaw surgery veillonella
9. A panel that ha anti d and p1
10. Waxy cast or fatty cast I think dye suban o oil.
11. Aeromonas gran negative, beta hemolytic, oxidase positive
12. N meningitis OPNG negative
13. Picture of histoplasma, and one about fluid being drained from the lungs.
14. Picture of aspergillus
15. Zygomycota sporengium
16. Malasezzis furfural- oil or olive oil
17. Auto infection strangyloides
18. Chromogenic agar I think. It was a picture of a agar one side clear organism had
different color sheep blood agar all agate looks the same
19. K ISE- valinomycin
20. Person overdose on salicylate decrease ph- I choose metabolic acidosis
21. ALP ph 9.6- pagets
22. Cocaine metabolite- benzoylecgonine

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23. Group A pod mother had and miss carriage d neg, weak d beg… Is the patient a
candidate for rhig
24. I have to calculate diagnose for rhig twice. Whole blood divide by 30. Rbc by 15
25. Hba1c affected by hemolytic anemia
26. Caffein for diazo rxn why?
27. Bilirubin- 450nm
28. Pituitary gland – increased TSH and T4
29. Increase bilirubin and urobilinogen
30. Release heparin/ histamine – basophils and mast cells
31. Cryo store at RT from 2pm pt scheduled to be transfused at 3pm what would you
do?
32. Irradiated blood for pt receiving blood from mother
33. Positive RPR negative FTA for syphilis -false positive
34. Pictur of a waxy cast
35. Alpha thalassemia-hgb Bart and Hgb h
36. Eosinophils in Urine/ intestinal nephritis
37. know the difference CML and AML
38. Questions about multiple myeloma
39. Increase platelet and wbc
40. Issoagglutinin of Type O- anti A, anti B, anti AB
41. Beta and gamma bridge
42. HTLV- confirmatory test- western blot

Blood Bank
– make sure you know the antibody panel and how to identify the clinical significant
ones I got about 2 panels. Use the one shown here in wordsology.
– make sure you know how to interpret ABO blood typing. I got a question asking if
Anti A is pos and Anit B neg and A1 cell Pos and B cells Pos. what should the
technologist report. Also I got a question asking what should the technologist do if
Anti A is mixed feel and Anti B is Pos and A1 cell Pos how would you interpret it. Also
got tuns of questions about ABO discrepancies. If there is a autoantibody reacting only
at room temperature which would it be. ect

Clinical Chem
I was asked to calculate
– Molarity -creat clearance- osmolarity- anion gap, coefficient of variation, and I had to
know the metabolic syndrome and the conditions that can cause them. LDL
calculation as well.

Microbiology
– tons of questions!
know the different in distinguishing [Link] from K. oxytoca. know about the
differential medias. Thanks to the high yield notes most of the questions surrounded
them.

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Hematology
know how to calculate MVC, MCHC, Manual differentials or wcb, rbc, and one of
platelet was there [Link] the different leukemia CML, ALL and lymphomas and how
to distinguish them.
those are my recall in a nut shell. HIGH YIELD NOTES HELPED

BLOOD BANK
[Link] antigens are found in the saliva of group A, Le(a+b-) individuals? – Le a (other
options included A, H, Le b in different combos)
2. Given a mini panel of antibody reactions. The serum is tested against Group 0 RBCs
and cord cells. Reacts with all adult cells, no reaction with cord cells. What antibody? –
Anti-I
3. Given panel of antibody reactions, have to determine which ones are causing the
reaction and choose the choice that corresponds to them. – In mine, the antibodies
were anti-Le a and Le b, but the answer to the question was ‘Is absorbed from the
serum onto red cells.’
4. I had 2 questions with the same picture, a cold agglutinin picture. The first question
asked what disease/infection it was associated with (Mycoplasma pneumoniae) and
the second asked what would cause this blood picture (cold reacting antibodies).
5. Blood comes up positive for HTLV-I/II, what do you do next? – I put repeat the test
that was just run. (It said which test in the question, I believe it was EIA, so ‘repeat
EIA,’ but I’m not 100% sure. Other options were western blot, etc.)
6. O neg, Rh pos patient now has a positive DAT. What will their typing results look
like now? Includes Rh control. – I chose the answer where everything was negative
except the Rh control was positive.
7. Which antibody degrades upon standing, making it hard to detect? – I didn’t know
the answer. I think I chose Lewis. CW was an option and I don’t remember the rest.
8. Lots of discrepancies, either due to ABO or reagents/technique, but all situational. I
don’t know how else to prepare yourself for them other than knowing the basics well
and being able to apply them to reason your way through.
9. Given mother blood type (AB-) and baby type (O+), what do you do next? – Since O
blood type is impossible from AB mom, get a new heelstick from baby. Other options
were get a sample from father, administer RhIg.
10. Mixed field reaction observed. What caused it? – I chose transfusion with O cells.
11. Donor deferral question

IMMUNO
1. ANA pattern, asked what antibody would make that pattern.
2. Patient comes in with mild flu-like symptoms. Given table with IgG and IgM titer
values for EBV, CMV and toxoplasma. Have to determine if primary infection with just
one or coinfection of EBV, CMV.
3. Biggest problem with PCR? – I chose contamination with nucleotides.
4. What HBV disease marker is found in individuals with a past infection? – HbcAb

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MICRO/MYCOLOGY
1. Aeromonas, based on description of reactions.
2. Patient comes in with lesions on arm, given description of what is seen in culture. –
I guessed, but I’m pretty sure it was Sporothrix schenkii
3. Blastoconidia – definition. Options included definition of arthroconidia.
4. Enterobacter, given description of reactions – can’t remember if the species was
cloacae or aerogenes, both were options. Other options were K. pneumo and oxytoca.
5. Following a throat infection, patient is having kidney problems. What bacteria
causing it? – S. pyogenes, other strep species as other options.
6. Patient has walking pneumoniae and is prescribed penicillin. 2 weeks later, still
sick. What happened? – Bacteria produces a beta lactamase.
7. Make a gram stain of CSF at night, how do you store until culture the next day?
8. Potassium permanganate in auramine-rhodamine stain for Myco. – Quenching
agent
9. Specimen of choice for rotavirus? – Stool
10. Took a swab sample from a wound and incubated on three different medias
(including anaerobic media). Nothing grew. What happened? – Swab material inhibited
the sample.
11. Latex agglutination for S. aureus – Protein A and clumping factor
12. Given TSI results, what do you report? – The results pointed to Salmonella, so I
chose ‘do Salmonella typing’ but another choice was to call the Dr. and immediately
report Salmonella type organism. Others were, report normal fecal flora and do
Shigella typing.

HEMATOLOGY
1. Burr cells blood picture – Uremia
2. Stomatocytes blood picture – Liver disease
3. Badly discolored blood picture with very spiky cells. What caused this? – Slide not
dry
4. Retic count 18.3% along with really messed up blood picture. What do you do next?
– Heinz body stain (Supravital stain was also an option)
5. Iatrogenic anemia – due to excessive blood draws.
6. WBC and platelet count normal. Normocytic, normochromic anemia. RBC count
very low and retic % is 0.1. – Pure red cell aplasia. Pretty sure I had never heard of
this before the exam, but I figured it out. Other options included aplastic anemia.
7. HgbA1C values would be decreased in – hemolysis/hemolytic anemia
8. What is the second, irreversible step in platelet aggregation studies? Or something
like that. – I had no idea, guessed change in platelet shape. Upon googling, it seems
‘release of nucleotides’ or something related would be correct.
9. Know about the reagents used for PT and PTT in the automated coag studies. I had
2 questions where the controls were off (and therefore patient results were off) but
you needed to know which reagent to replace.
10. What cell type is increased in mononucleosis? – Lymphs
11. What will cause a decreased ESR?
12. Lupus anticoagulant causes what? – Increased risk of thrombosis

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13. Sample taken from indwelling catheter. Patient isn’t on any anticoagulants yet PTT
and TT are way elevated. – Heparin contamination (from catheter)

CHEMISTRY/UA & BF
1. In which case is Mg monitored? – Eclampsia. Other options were vomiting and
diarrhea.
2. I had two UA questions where I was given a list of results and had to choose the
disease that correlated with them. – Acute tubular necrosis and renal calculi.
3. 2 or 3 questions on dipstick false positive/negatives. Make sure you know these
pretty well. I studied them because other people mentioned it and still had trouble. –
Blood and glucose were the two I know for sure were asked about.
4. Hemolytic anemia/prehepatic issue, choose correct results for unconjugated &
conjugated bili, urobilinogen, and urine bilirubin.
5. Patient taking primidone showing toxicity, but blood levels normal. What do you do
next? – Test phenobarbital level.
6. Sperm count can be done on semen sample when… – Liquefaction is complete
7. Tumor marker seen in pancreatic cancer – CA 19-9
8. Cortisol and ACTH levels in adrenal Cushing’s.
9. Given values for fasting glucose and random glucose. What do you do next to
diagnose diabetes? – Both are over diagnostic values, so nothing else needed for
diagnosis.
10. Fasting glucose 120. What’s the diagnosis? – Impaired fasting glucose.
11. Pheochromocytoma – Metanephrines

1. Burr cell – uremia

2. pyr – know POS and NEG orgs
3. BE and NaCl – know orgs POS/neg for them (entero, Grp D, Viridans)
4. KNOW TSI slants blindfolded – if its A/A and gas productio0n wht is it.. entero,
serratia, s bovis, grp D strep (my question, I think those were the choices, or close to
it)
5. CAMP test POS and NEG ctrls (agalac and pyog)
6. 1 ANA – it had things with like 4 colors green yelloow orange and red all over it
looked like a f-ing picasso painting so I totally guessed
7. know the thyroidism chart for inc and dec in TSH, t4 and T3
8. know PTH effects on Ca+
9. Know about aldosterone inc and dec and when it happens, (Conns) and effect on Na
and K
10. Cushings is hyperglycemia
11. PTH and Ca+ relationship
12. something about perfringens i think
13. a tough hemoglobin C question
14. rouleaux is undetectable at what phase
15. CMV best to do viral culture (i think, but i guesses)
16. ESRD (1.010 sg and waxy casts predominate)
17. a couple of thrombin/ antithrombin questions

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18. no VWF
19. know about heparin contamination and mixing studies and TT/fibrinogen times
20. HBA1C
21. rotavirus – stool
22. HTLV confirmation testing
23. weak D epitope something
24. whats wrong with this stain – acidic so change pH
25. sezary – t cell or congenital t cell (difference)
26. Amylase – mumps
27. something about rubella I forgot
28. enzyme effect on certain Abs (destroy, enhance)
29. about 4 questions about diabetes ( insipidus, mellitus, the ref ranges for cutoffs for
diagnjosing)
30. Conn’s sydrome Aldo increases
31. jeikiem quesition about somehing idk
32. know different between glom nephritis. Pyelonephritis, nephrotic disesase, (conj,
unconj, urobili)
33. had 1 metabolic acidosis question
34. had the PCR question – denature, anneal, extend
35. had a hypo hashimoto question about tsh inc
36. troponin stays in the system longest
37. 1 syphilis question… just know whats POS and NEG for each of he 3 phases ( the
rpr and VDRL)
38. an aeromonas question where it gives you the rx it was something like oxi POS,
and some other rxns
39. know the TSI slants ( I have a story for common imvic orgs that helps so if you
want it let me know)
40. a really crappy grainy picuture of what looks like rbc
agglutination/flocculation/some other crap … that sais what should you do next – I
chose heinz body stain (actually got this exact pic twice)
41. intrinsic resistances to common drugs (kleb amp R, Micrococcus R furosamide,
stenotrophomonas Bactrim Res , etc)
42. a lot of aldosterone related questions (like 5) and diseases associated with them
43. a couple of coag cascade questions like when to do an F8 assay
44. when to do PT (warfarin therapy)
45. TB testing PPD is T-cell mediated type 4 hypersensitivity rxn
46. know common markers for B and T lymphs (CD 19, 20/ CD 2,3,5,7, 4/8 mature)
47. if pt and ptt are inc what do you do next (exactly waht do you do next)
48. a s-load of bilirubin (like 7) know what happens in prehep, hep, post hepatic and
nephrotic syndrome, when you would expect to see jaundice associated with what
Bilirubin, etc
49. absolutely no parasitology
50. no myocology
51. almost no hematology
52. no AB/Ag frequencies
53. know (sensitivity = TP/TP +FN) and those others (SPECificity = TN/TN+TP)
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(PRECISION = TP/TP+FP)
54. a bunch of lab ops questions (3 or 4)
55. no [Link]
56. a couple of tiny screen panels like if you have nothing thru iat in screen cells 1
and 2 except patient sample shows up +/- on iat what do you perform next bla bla bla
……..a lot of “what do you perform next questions” related to BB so brush up on
panels, DAT, IAT and discrepancies

Thalassemias
Dimorphic fungi
Enterobacteriaciae biochems
Differentiating non-Lancefield streps
ABO discrepancies
G6PD deficiency
Transfusion testing requirements
Transfusion reactions
Elution, adsorption, absorption
Immunological testing types and methods
Pre, post, and hepatic jaundice (unconjugated, conjugated, bilirubinuria, urobilinogen,
etc in each)
Gold standard chemistry tests, methods, and reagents used in them
DIC and MAHA characteristics and complications
Renin angiotensin system
Electrophoretic patterns
Type 1-4 hypersensitivity reactions
Cardiac markers
Coagulation studies and factor deficiencies
Inhibitors and what they inhibit in micro media
Urinary casts and associated conditions
ALL, AML, CML
Which preservatives are best for which stage of parasite and source of specimen.

Mycoplasma- why it doesn’t stain

Mycobacterium- kinyon stain, auramine stain sensitivity, fast/ slow growers,
scotochtomogen definition.
campylobacter pic, it’s growth condition,
Enterobacteriaceae biochemicals
Parasitology pics
Common urine isolate
Antibiotics
Dimorphic fungi
Pork associated organism

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Diff btw Proteus mirabilis& vulgaris
Gram pos cocci pics, other test if not agg pos.
Vitek ms definition, (can’t remember clearly but second question goes like – cannot
differentiate btw s. Pneumo and given options)
Fungi pics

**SURE POINTS: Heinz bodies (there were two questions with the exact picture in my
exam, I answered G6PD deficiency and anti-malarial drug (now this might be a bit
confusing bec the one I had have hypersegmentation, ovalocytes and tear drop cell;
focus on the HEINZ BODIES!)
Klebsiella oxytoca (indole + as compared to K. pneumonia which is -) I also
recommend Sohail’s notes on Enterobacteriaceae (GNB; all of the high yield notes
really, they were all very helpful! memorize them if you can)
Alnernaria microscopic picture
Alkaline ph (9.4) I chose Paget’s disease bec of ALP.
Virus transported for 92 hours or something = Lyophilized (I’ve read this recall here,
thank you so much!)
Olive oil = Malassezia furfur
CK (normal), cT (elevated) = Acute myocardial infarction (don’t be confused, since
troponins increase faster than CK, this findings can be possible). Order of
increase/peak: MTCAL (myoglobin, troponin, CK-MB, AST, LDH)
Bilirubin, Urobilinogen values (what disease association do they inc or dec)
ALP = obstruction
Chronic hepatitis = anti-smooth muscle antibody
Releases heparin/histamine = Basophils/mast cells
If Se and Le genes are both inherited, what phenotype? = Le(a-b+)
Pheochromocytoma = test for METANEPHRINE
Urinalysis results increase RBC (also strongly positive in strip) BUT neg in almost all of
it = glomerulonephritis
Another one is almost all were positive in rgt strip and in microscopy, but the highlight
was the presence of waxy cast so I chose= Nephrotic syndrome/dse
End stage of degeneration (renal failure) = waxy cast
HgbA1c decrease in = hemolysis (hemolytic anemia)
Lipoprotein that transport the majority of cholesterol=LDL
VLDL (endogenous triglycerides); Chylomicrons (exogenous TAG)
Gram neg cocci present after jaw surgery= Veillonella
Micrococcus = Resistance to Furazolidone
Tap water bacillus=Mycobacterium gordonae
Examination of semen sample, can proceed to sperm count = once the liquefaction is
complete
Alpha thalassemia = Hgb Bart/Major (other choices were hgb D, sickle cell, etc)
Aeromonas hydrophila =GNB A/A G(+) on TSI, oxidase +
Procainamide = NAPA
Main metabolite of cocaine = benzoylecgonine
Type 1 hypersensitivity stimulated by = IgE
**Calculations: RhIg, Creatinine Clearance,
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**NOT QUITE SURE: Graph of ECA (Epinephrine, Collagen and ADP), two of them
changed from 0 (either inc or dec), the other one is just 0. They will ask you which
ones are normal/abnormal
They wavelength of the spectro was set to 540 but for some reason the staff keeps
getting erroneous (higher than the normal) transmittance, what seemed to be the
problem? I chose halogen quartz as being the problem
I’ve read this from some of the recalls posted, about the calculation of potassium?
Upon administration of insulin, the glucose decreased, find the value of potassium
(given values of insulin and glucose, I don’t know the sol’n, please look for it if you
can, I ignored this and then it appeared on my exam, haha tragic)

**other pointers to study/focus : Ab panel/ID, RhIg computation, ABO discrepancies;

Bilirubin, Urobilinogen (Pre-hepatic, Hepatic, Post-hepatic), Acid Base Balance
(metabolic/resp-acidosis/alkalosis); Sensitivity(TP)/Specificity(TN); ANA patterns. They
were generous with the normal values, so you just have to take note of the abnormal
results. Don’t be scared with the long questions or results. Just focused on the
abnormal ones and also with pt history.

BLOOD BANK
ABO compatibility with blood groups-very important
Blood product that has highest capability of transmitting hepatitis
Temperatures for storage of blood products, how long, ABO compatibility and
condition or reason for transfusing product
Platelet temperature and PH- temperature of blood before processing( room temp).
OR schedule- how many units to prepare given blood group and antibody of patient
Kell frequency- 91% negative for antigen
Antigens of ABO system: Le with no Se( Lea+b-), Le with Se ( Lea-b+).
ABO discrepancy- subgroups of A, anti-A1 lectin
Cold antibodies and warm antibodies
Mixed field reactions- check transfusion history first
Controls for D-testing , Du test and AB+ control
Weak D- Missing epitopes, position effect.

IMMUNOLOGY
T-cell, B-cell lymphomas
IgG and IgM- which rises first
Hep A graph: antigen in stool-IgM-IgG
IgE- basophils and mast cells
Classic and alternate pathway complements
RA- IgM produced, autoantibodies to the Fc portion of IgG
FTA, RPR,VDRL, which is for testing reinfection, late stage and early stage
Treponemal antibody agglutination
Infectious mono- reactive lymphs and monocytes
Hepatitis- antigens and antibodies tested for each stage

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HEMATOLOGY
Transferring- TIBC
Child swallowed naphthalene ball- Heinz bodies
Heinz bodies- DNA
RBC inclusions and corresponding diseases
Anemias and what to find in RBC- pictures
Sources of error like in ESR and Hb
Stomatocytes- liver disease
Oxidant drugs, anti-malarial drugs effect on RBC
Hemoglobin electrophoresis- cellulose acetate-C S F A and the Hb it migrates with
Hemoglobinopathies- sickle cell solubility test and sources of error
Thalassemia- alpha- Barts and HbH
Beta- cooley’s anemia
Myelodysplastic syndrome- essential thrombocytemia( increase in PLT,
splenomegaly).

COAGULATION
Mixing studies
PT & Aptt Factors
Protein C- how aspirin affects test( prolonged, increased or unaffected)
Platelet aggregation_ graph for ADP, epinephrine and collagen
Both PT and Aptt prolonged and then corrected

URINALYSIS
Bilirubin crystals- liver disease
Eosinphils in urine- interstitial nephritis
Monosodium urate- highly birefringent
HCG- pregnancy
Creatnine clearance- (UV/P)*(1.73/A)
Rhabdomyolysis- myoglobin

CHEMISTRY
Glucose levels-nomal and abnormal
ADH- increase water absorption
Iron test
Liver enzymes; hepatobiliary- ALP, GGT, 5NT
Hepatocellular- ALT AST
CK, troponin- MI
Amylase and lipase- pancreatitis, source of error
Solution/buffer for most ISE methods
Blood gases
Bilirubin – conjugated and unconjugated, urobilinogen
Hemolytic, hepatic, biliary obstruction
Immunosuppressant- tacrolimus- use whole blood
Azotemia- increase in BUN

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TSH
Pheochromocytoma- VMA
K ISE- valinomycin

MICROBIOLOGY
Anaerobes- chopped meat agar( iron and glycerol)
Micrococcus- resistant to furazilidone
Aeromonas- A/A, oxidase+
Acinetobacter- wounds
Erysipelothrix- H2S+, catalase+
Veillonella(g- cocci) and peptostreptoccus( gram+ cocci) – anaerobes causing jaw
abscess
Picture of agar with chromoblastomycosis
Picture of blastomyces dermatitis
Geotrichum- arthroconidia
K. Pneumoniae and K. Oxytoca( indole+)
How to transport viruses after 96 hrs
Malasezzia furfur- oil
Zygomycota- sporangium

a person overdoses on salicylate and goes to the ER. WHAT WOULD BE TESTED?
a) pH
B) Ammonia
c)creatinine
d) BUN

A staph like organism is isolated from a wound culture in is resistant to all GPC
antibiotics and to Vancomycin, using the automated bichemical method.
what should the tech do.
a. do a gram stain
b. recallibrate the machine
c. report as not Susceptible?

If the stock solution had 9ml of saline and i add 1ml of serum making it 1;10
six test tubes labled Ato F contains 0.5ml saline in each.
i add 0.5ml of the stock solution to tube A and mix and the add 0.5ml to tube B and
mix and add 0.5ml to tube C and mix until i reach tube F.
What would be the dilution in tube F?

mycology (a recall question about zygomycete = sporangiospore). I also got

calculations for Creatinine Clearance, Hemocytometer count (if they show you
squares, make sure you take into account both sides of the hemocytometer). Bacillus
anthras reactions were on there (non-motile, non hemolytic, catalase positive etc.) I
got a picture with pappeinheimer bodies ( poor pictures). I also got a picture that
looked like a slide with really prominent burr cells (abnormally sharp looking burr

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cells) and it asked what could have caused it, I am not sure of the answer but I picked
that the slide was not dry. I also got what is TP+TP=FN I had to pick what is was
(sensitivity). Another picture that looked like Heinz bodies and asked what stain to use
(answer was Heinz body stain). There were a lot of small panels for blood bank. Know
what the RBC inclusions are made of (DNA, RNA, Hgb). A question about what fungus
you can test with hair ( I picked Microsporum audounii) There was a question about
Micrococci (answer Resistant to fluconazol). Rapid latex test for Staphylococcus
aureus and what it’s detecting. Something about Sodium dithionate and sickle cell (I
chose severe anemia). I had to Identify a picture with Blastomyces Dermatiditis. Know
when to do an elution, adsorption, descreptancies like when to test with Anti-A1. Know
the difference between in Blood Bank reactions with PCH, Polyagglutinine. Know if
HDN is caused by Anti-D or ABO group. Know K antigen frequency and if it will cause a
reaction. Asked a question about HIV. Know the different types of electrophoresis, had
some situational questions about Multiple Myeloma and whether to test with a
different type before confirmation.

Px chem result, you’ll see he has metabolic acidosis, what test are you going to order
next, do you test for salicylate or lead poisoning?

Graph which shows the order of serologic markers for hepa a; which is the correct one

Antibody panel answer is the one with anti fya

Picture of tear drop cell, bilirubin crystals, burr cells.

A lot of mycology questions, describe histoplasma, molds that needs olive oil, what is
the hair something test use for to differentiate 2 fungi

CHEM…analyes elevated…which disease?(ALP-Paget`s bone,bilrubin-obstruction or

liver disease,primaryhypothyroidism,skeletal muscle injury etc.)
HDL quantitation,TIBC
HEMATO…smear with cells(H-J bodies,Heinz),which anemia from results?corrected
wbc count,mixing studies,[Link] hbs
[Link]……3,4 abdy panels,storage and life time for cryoppt n ffp
MICRO…reaction given,find organism…([Link],strep gp
A,[Link],[Link])
veilonella,[Link],micrococci
OTHERS…nephrotic syndrome(fatty cast)aminoaciduria(cysteine)ANAflourscent
pattern,CV calculation,PCR components,procainaide assay….

For the ASCP certification the questions I received were mainly Blood Bank (LOTS of
DATs, If mother is type A- and baby is B+ what is the most likely cause of a HDFN?,
What is the next step to determine if the reaction is due to Rh or ABO discrepancy?
Know how to recognize common discrepancies, etc.)
-Lots of Microbiology questions. The flow charts helped me SO much here. Even if I
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wasn’t sure of the answer, I was able to eliminate wrong answers to reach a
conclusion.
-I got 4 questions regarding RPR’s and VDRLs.
-1 question over parasitology
-A question that showed various titers of IgG and IgM for CMV and EBV and you were
to determine if it was an active infection of both or just one of the viruses
– 1 or 2 questions regarding Westgard rules and a graph
– Other subjects I remember: Cushing’s Disease, Metabolic/ Respiratory reactions
(Bottom line approach makes it easy), Thyroid diseases, ANA, Specificity vs
Sensitivity, Bombay phenotype
Most of the questions are phrased differently than LabCE though. They are very
situational (Ex. A nurse draws a tube of blood for testing but is left out for 12 hours
what tests can be run or do you reject it? Your controls are out of range what could be
the cause? Do you continue and process patient samples?) .

rbc inclusion associated when a toddler ingests a moth ball (naphthalene) — i believe
the answer is Heinz bodies. t(15;17) for promyelocytic leukemia or M3. APTT and PT
mixing studies. for microbiology i had one question about Erysipelothrix and another
about Bacillus anthracis. i didnt get any blood gas and ANA questions at all.

BLOOD BANKING, most of them were about ABO discrepancies, DAT, HDN and they
were all situational hehe. I had some questions about blood component storage and
processing (take note of the storage temp and shelf life of each and how they are
processed), transfusion rxns and donor deferral. Oh and I had several panels but they
were all obvious (there was a pattern). For HEMATOLOGY, they gave me more or less
5 abnormal blood pictures and I had to identify which disease is specific to that
corresponding blood picture (example: Burr cells – Uremia) I had one which goes
“What red cell inclusion would appear on an infant’s blood smear after accidentally
swallowing a mothball?” — I believe the answer is Heinz bodies. I had questions about
sickle cell anemia, some leukemias, PT and APTT, mixing studies, and platelet
aggregation. I was also asked to calculate for MCV and corrected white cell count. For
CLINICAL CHEMISTRY, memorizing the reference values (refer to Polansky on this one)
for each analyte especially bulirubin, BUN, glucose, and blood gases would do you
great help. Most questions were of case study type. You must be familiar with the
enzymes and hormones. Diseases/conditions I repeatedly encountered were
Hyperthyroidism, lactic acidosis, respiratory/metabolic acidosis/alkalosis, SIADH,
Addison’s and Cushing’s disease, diabetes mellitus and diabetes insipidus to name a
few. I was asked to solve for osmolality, anion gap and creatinine clearance too. For
MICROBIOLOGY, it is important to memorize or be familiar with the biochemical
reactions (the charts in this site helped me a lot) for each bacteria especially Strep
(CAMP, PYR, hemolysis, growth on 6.5% NaCl, bile esculin etc) and Enterobacteriaceae
(IMVIC, TSIA etc). Also take note of the specific culture media for certain bacteria (ex:
Fletcher medium – Leptospira). Some species that I could remember from my exam
were Erysipelothrix rhusiopathiae and Bacillus anthracis. I also had questions about
Fungi and their biochemical reactions and a few about viruses and parasites

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(autoinfection – Strongyloides). For URINALYSIS AND BODY FLUIDS, all that I can
remember is that I was given a photo of a cast and crystal and I had to identify which
types were shown and something about CSF, exudates and transudates. For
IMMUNOLOGY/SEROLOGY, they were mostly about immunoglobulins and serial
dilution. I had one question about PCR. I was asked to identify one ANA pattern too
and the corresponding disease. And last but not the least, I had a few questions about
TOXICOLOGY that I was completely clueless of.

Mycology: identification based on descriptions or microscopic view of the organism

Bacteriology: like you said, straight forward- biochem tests, growth on what media, so
on… then identify which bacteria.

Blood bank: mostly ABO grouping discrepancies and Antibody screen probs- what u
should do if u encounter this and that; and two questions about how many units do u
need if you want this antigen-negative blood (given its frequencies in the population)

Hematology: cells in the smear ID; computations- diff count, cell counts; then which
stain to use for this type of inclusion, hemoglobin suddenly decreases, platelet
aggregation

Chemistry- i was asked to read and interpret HIV-1 immunoblot; questions about
Hemolytic anemia (bili, urobili,haptogobin); i was asked about in what condition do
you need to monitor Magnessiun, or when does K+ increase.

AUBF- nitrite question, when to suspect presence of contrast dye, reagent strip
interferences

Know your GNR flowchart. I got at least 7 questions out of it. Include moraxella and
acinetobacter to it because I neglected to include those to my chart.

Sharpen up on your antibody panel screen. I got at least 7 questions from it.

MYCOLOGY!! I got at least 9 questions including pictures. I think I bombed half of it.

I didn’t get lots of chemistry, I can guarantee you that. I braced myself for that subject
and end up not getting many.

I got a few questions in hemo that included a couple coagulation questions about
mixing studies and lab results for DIC TTP ITP.

Hematology:
Picture of RBC inclusions- i think i got HJ Bodies
Lots of Anemias IDA, DIC lab findings
Low RBC Low HGb Elevated MCV MCHC- cause

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Stomatocytes picture- what disease
Protein C
Predominant cell type lineage in CLL
Causes of incr & dec ESR
Lots of PT & PTT result disease correlation
Coagulation factors
Platelet Disorder

Chemistry
COV computation
Bilirubin result after caffeine for DB and IB
Inc Gluc dec Na K – disease
findings in SIADH
Cushings
VMA – disease

Blood Bank
Lots of ABO discrepancies and resolution
Cryoppt storage and expiration after pooled
Platelet apheresis
Mixed Field
Antibody screening
Calculation of number of units and frequencies given

Immunology
ANA pictures and diseases

Micro
Aeromonas rxn
Memorize the chart here on high yield very helpful(thank u so much wordsology)
zygomycete
blastoconidia

What do protein c and s do?

Salmonella enteritidis reaction in TSI
Outcherlony diagram
What is the billirrubin measures before add caffein, and after?
How do yo differenciate Yersinia enterocolitica vs Yersinia pestis?
A dilution in a tube 1:20 and then you took 2 mL of the dilution and add 3 mL of water,
if the result is 120 mg/dl, how many would be the original?
Graves disease
Haptoglobin decreased
Enzymes for diagnostic muscle distrophy check ast, alt, ggt, ck, LD, Alkaline
phosphatase….
Organism that need fatty acids on medium to grow…

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Lupus erythematose, what happen with complement decrease or increased, due to
what….

-picture of echinocyte
-picture of blastomyces dermatitidis
-Stomatocyte picture: what disease is related? LIVER DISEASE.
-no bloodbank panel but really lots of DAT. ABO descrepancies. And what are the
remedies. (focus more on this)
-chemistry. how to measure hdl. I chose thin-layer but I really dont know.
Ultracentrifugation was not on the choices.

1. Negative, positive control for CAMP, BILE ESCULIN, 6.5% NaCl, Bacitracin
Choices were mainly Strep family. Study them.
2. Hba1c – 5%, FBS – 155mg/dL
– good long term control but poor recently
3. Caffeine for Diazo reaction
– to measure unconjugated bil
4. Enzyme uses pnp maintained in pH 9.8 increase in what dse
– Pagets
5. Elevated lipase buy normal amylase appearance of plasma
– Lipemic
6. Measurement of iron
– step1: addition of acid
– step 2: addition of reducinh agent
– step 3: add color rgt
7. Estrogen increase in pregnant women
– Estriol
8. Female patient on mesntruation
– I forgot the exact choices but I choice the lab results correlating with IDA
9. TIBC
– Trasferrin
10. Stomatocytes
11. Burr cells
12. Echinocytes
13. Alternaria
14. [Link]
– study the autoimmune diseases part. Slide 4 was on my test. Exact image.
15. Pheocromocytoma, measure
– Cortisol or Metanephrines : torn between these two hahaha
16. Blastoconidia
17. Definition of Oliguria
18. Measurement of FLM
– phosphatidyl
19. Indole positive, A/A TSI
– K. oxytoca

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20. Present after jaw surgery
– if the question was looking for gram neg: Veilonella
– if gram pos: Peptostreptococcus
21. Detextion of Rubella
– IgG 2 weeks interval
22. Zygomycete
– i answered the one with sporangiospore
23. The famous HEINZ BODIES on napthalene something haha
24. SIADH
– decreases Na
25. Case study about urine but the clue was present fat bodies
– Nephrotic
26. Azotemia
– Im really not sure with my answer because the choices have
A. increase bun
B. increase creatinine
But I picked BUN
27. Just remember that in Protein C taking warfarin therapy
– it would decrease
28. The blood glucose was given 390mg/dl, potassium 4.2mmol after insulim
administration glucose is 215 potassium is now? Note that this is kot the exact values
given
– I really do not know the answer but as insulin increase, potassium would decrease.
Just know how to solve this because the choices were values
29. Olive oil
– Malassezia furfur
30. Rotavirus test
– i also dont know the answer but I picked electron microscopy something
31. Sezary cells
– T cells
32. Case study about skin testing blabla
– T cells also
33. Negative and positive control for anti-E
– DcE/DcE, dce/dce
34. Virus specimen was received. What would u do when sending it to other lab or
shipment (cant remember exactly)
– I answered lypholized because shipment of viruses are -70, 4C storage
35. Sensitivity formula
36. Aggregation studies that I dont know. They presented me a graph with collagen,
adp and epinephrine
37. Latex agglutination in S. Aureus
– protein a and clumping factor
38. Know the antibodies that would react at IS, AHG and 37C
39. Antibodies not enhanced by enzymes
40. Bilirubin
– 450nm
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41. About ISE
– KCl

Please know the frequency of anti-K and anti-k

Blood bank
– 5-6 questions about Abo discrepancy ( geeez)
– 2 antibody panels- find the antibody and choose which additional cells are used to
rule in and out the antibody.
– 5-6 general questions about blood bank, technique, Dat
-2-3 about blood products

Micro
– I drew my gpc and gnb chart put before I answered any of my micro question. I got
4-5 question about gpc, gnb
– 1 question about micrococcus
– 2 question about plasmodium – which one is not show on the blood smear in troph
-4-5 mycology question( at this point, I was like:” why am I so not lucky”
Immunology:
– Ana positive shows what pattern
– picture and pick what kind of pattern: rim, speckle, ect
– chart of 1st and 2nd expose and tell them which a, b, c, d line are first and second
response
– 1-2 hepatitis questions… But not in a traditional form of questions . One question
was like : which blood product has a greatest risk transfer hep b( so I guess this is
kinda a blood bank questions)
Chem:
I got few easy ones: such as amalyse for mumps, tn/ tp
2-3 blirubin questions
Urine:
3-5 questions
Heme

I had mostly Heme and Bloodbank. Heme was mostly hemagrams with abnormals
asking for diagnosis or possible interference and some nrbc/wbc corrections, plt est
and rbc inclusions, bloodbank I had tons of RH questions and basic antibody ID from
warm and cold. Know your enzymes and effects. DAT IAT screening, donor
qualifications. Chem I had some enzyme questions and calculations for GFR, AG, and
creat clearance. Coag was basic intrinsic and extrinsic questions, know INR and the
discrepancies with the times of pt and ptt. Micro, had about 10 to 15 questions.

-I had a lot of mycology question (5) I believe, I’m pretty sure I got all of them wrong.
They told me description and showed me a picture and I still got it wrong. I never
really studied mycology and the ones I did never showed up.
-Had a picture of a pinworm and needed to know its real name and I didn’t get any

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more parasite questions after that.
-Chemistry: Effect of hemolysis on chemistry analytes, effect of IV line on chemistry
analytes, Diabetes, non-ketoacidosis coma, enzymes for liver, enzymes to help ID
muscle problems, cardiac enzymes, what creatinine clearance was (not the formula
but what it actually tests–the physiology of it), a weird LDL + HDL methodology that
came up twice (how can you separate them–I thought it was ultracentrifugation but
that wasn’t even a choice, so if anyone knows please help enlighten me), given a
bunch of analytes and their result (without the reference range) and was expected to
know which one should be repeated (on it was BUN, osmo, Cl-, Na+, K+, and yeah…
wasn’t sure of the answer on this one either). How to tell hepatic from an obstruction
and what the test would show
-Urinalysis: what it means if someone has a normal serum glucose but a positive
glucose urine test,picture of a cast with refractile circles and they asked you what
other tests will help confirm it(?, choices were Sudan black, oil red O, picked oil Red O
for some reason)–the almost exact picture can be found on labce
-Immunology: i had a question where it showed a picture of serum IFE and a gamma
band and a light chain, and told you that the urine light chain had that light chain as
well. Then asked what your next action could be: potential multiple myeloma, redo it
again because ULC and S-IFE were not the same.
-Had some trouble shooting question and what would you do if the control you
reconstituted were all whacky on all of your analyzers. Check the H2O you used, used
new lots, or used fresh control.
-BB: panels are usually straightforward (I mean they do give some choices so that
helps), but the tricky ones were the What would you do next if your forward had a
positive Anti-B but your serum all came negative (reincubate at 37, report it out,
redraw,) or for antibody screen if you wanted to rule out certain things what would
you do (requires your knowledge about enzyme and its effect on on the different
antigens)–what helped me to remember some were Duffy= gets Destroyed by
enzyme
-Micro: the charts given on this site honestly are really helpful. they nitpick, I had one
where I had to differentiate between Morganella and Providencia but it gives you a list
of three different tests, and if you knew the answer it’s pretty simple because usually
there’s one really wrong answer in all the other choices. Some mnemoics:
MINOP )mirabilis Indole neg, o(something) positive—sorry my brain is getting fried at
the moment, or K-PIN (klebsiella pneumoniae indole neg, E-COP (entero cloceae
orthine positive), recommend making sure you memorize the chart on this site.
-what organisms would you look for in a patient with Cystic fibrosis
-Anaerobes Gram negative cocci that causes a disease involving the jaw
-know how to read a TSI slant and ID the organism from it
-know the differences between the Gram negative bacilli (like Enterobactericeae are
all oxidase – (except plesimonas) vs the Oxidase+ GNB (like Aeromonas and the
others), know the HACEK (the disease associated with them I got a question that told
me symptoms and what it looked like and the biochemical and was expected to know
it)
-Had two antibiotics question what other antibiotic would used to help ID a mecA gene
(or something like that)–choices were vanco, ampicillin, penicillin, methicillin.
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-What would you need to know in order to see the effect of a Therapeutic drug
Hematology
-Had two questions where I was told whether serum Iron, ferritin, and TIBC was and
had to ID the disease, had two questions on the same picture about what the disease
could be and what I would expect the lab values to be
-There’s a labce question where it shows you four different pictures of an abnormal
RBC morphology: know those (basically what target cells mean, sphereocytes,
teardrops, schitocytes)
-What kind of drug would cause a hypochromic RBC–i answered malarial drug, but
who knows..

-the virulence factor of N. gonorrheae,

-which mycobacterium is associated with contaminated H2o.
-glycerol effect on RBC (when will it expire–basically 10 years after the glycerol was
added)

Lots of immunology and mycology.

Chemistry questions
Analyzer questions: flow cytometry how does it count the cells?
Identify a fungi by looking at picture of hyphae: I think it was Alternaria
Identification of anaerobic bacilli based on biochemical tests
2 questions requiring me to identify fungi genus based on description of fungal
morphology. I remember “septate, hyaline, basidiomycota, arthroconidia” as
keywords. Sorry can’t remember more keywords for this one.
Zygomycota: what are defining characteristics of this fungi
Purpose of check cells in blood banking, and what is a possible reason / lab error that
would cause check cells to be negative?
Patient has a soft goiter and low TSH: what is the next lab test that should be done?
How long after whole blood donation should platelets be separated from RBCs?
How long after whole blood donation should plasma be separated from RBCs?
Coagulation mixing study: prolonged PT / PTT that corrects slightly with mixing study.
Pt is not on anticoagulants. What could cause this?
Calculate creatinine clearance from pt lab values
Seemed to be lots of iron / transferrin questions. I realized during exam that I don’t
understand purpose of transferrin very well.
There was a question on what CBC (iron changes? Transferrin?) a young healthy
woman on hormonal birth control would have
CLL usually proliferation of T cells?
Several questions on Heinz bodies and what could cause it (oxidative damage)

Micro
-Atleast 5 Mycology questions (wth), I was clueless on all of them
-No Parasitology for me
-3 Strep questions that can be easily answered by flow chart on this site (add bile
solubility for Strep B-hemolytic to it)

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-Staph questions – can be answered by flow chart on this site (add Mannitol to it)
-5 Enterobacteriace questions – Knowing IMVICs, TSIs, H2S producers, Lactose
Fermenters and I used flow charts from yellow and purple book (Flow chart on this site
is good, but I already was committed to bottom line approach)
-Nocardia – branching
-A/A+g what would you expect to see on HE agar – orange

Chem/BF
-Oral Contraceptives – Increase in serum Fe
-ABGs!! – I had 3 acid/base disorders, one with partial compensation
-Calculate Osmolality (2 times), one of them didn’t have the answer (i tried both
formulas), picked the closest one to the correct calculated osmolality
-Calculate Anion Gap
-Chylomicrons cause layer at top of tube
-Hashimoto’s – T4 decrease, TSH increase
-Turbid synovial fluid – (I put because of crystals)
-aHCG – Pacreatic CA or testicular? I picked Pacreatic
-4 Routine dipstick discrepancies
-Uroblilinogen false pos = Porphobilinogen
-Atleast 5 Jaundice questions – (know the urobilinogen reference range (along with the
bilirubin reference ranges) something like 0.2 EU for urobilinogen) – Table in yellow
and purple book made most easy
-caffeine benzoate in bilirubin assay – Accelerator

Blood Bank
-Easy Panels (just identify, you have to use the Pearson Vue dry erase sheet to write
out the antigens (not a big deal, but i guess if you are practicing, practice by writing
out just the antigens on a sheet of paper.)
-ABO discrepancies (cold agglutinin, Roleux, no reaction on reverse type)
-Most severe HDN – ABO (BOC book)
-2 – RhIG calculation – Calculate vials, calculate feto-maternal hemorrage volume
(same as BOC book/Media lab)
-QC for granulocytes (Yellow and purple book)
-Bombay Phenotype – hh
-Avoid allergic rxn something IgA – IgA/Washed RBCs

Hematology
-2 questions – given absolute lymphocyte count, calculate CD56/calculate CD4 (I used
50% CD4, 25% CD8, 15% B, 15% NK – relative to calculate) – numbers came out
where there was a clear cut answer
-Calculate LAP score
-Calculate Corrected WBC
-Myeloid Leukemia question that had indices, <10 blasts (thanks wordsology)
-Lots of blood smears, identify disease (look for the hallmark rbc/wbc

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deformity/inclusion – answers were mostly clear
-2 Histograms (identical to BOC book)

Immunology/Molecular/Other
-Trepanomal highest specificity – FTS
-No ANAs!!…i thought this was going to be huge
-Flourometry – protect yourself from what – excited light or emitted light?
-PCR steps – the one that starts with Denature, Anneal
-Basophil – histamine/heparin
-ASCP CEUs required ?

Had some very specific molecular bio and other related questions that were total
greek to me, meant to be answered wrong on the computer adaptive test i guess. I
had one (impossible) question in which B and C were the exact same answer (I picked
B). Most pics were very pixelated, they looked like resized avatars. Those ASCP
questions need to be QC’d.

specific gravity in urine testing, polycythemia vera, Burr cell, stomatocytes, CLIA
requirement in competency, Cushing syndrome, defer donor in blood bank, lipemia
interference, a few myco questions related to dimorphic, dermatophytes,
blastoconidia, 2 ANA questions, CSF storage temp, diabetes, blood-gas, hemolytic
anemia, DIC, Lupus, confirmed test method for HTLV, Pseudomas, Addision, how to
detect early renal failure, a few UA case study questions, etc…

As for what I was asked – I was given a panel – these are easy points. Really, they give
you the possible antibodies and all you have to do is focus on those. I was asked some
very basic things like, B cells produce…. Thrombin time and why it would be increased
or affected. I was asked about Beer’s law (yeah… I totally look over that… not). I was
asked about absorbance, also I had two hematology histograms – see pages 204/205.
It was like those but not those questions. I had several (maybe 4) TSI slants…
sometimes I was given the picture, sometimes not. I was given two or three questions
about agars and what grows on them, or if they were this color, what did that mean. I
had several questions about which of the following would be VP positive, this positive
and this positive and I’d have to pick the answer. I think I had three of those. I had a
question about keratitis and the answer was Acanthamoeba…The Bottom Line book
has a lot of quick and easy ways to remember things, like for keratitis and
Acanthamobea… Kerry, aCanthamoeba causes Keratitis; associated with trauma to
the eye. I was asked about Enterobius vermicularis… both were a pic to id it from
(very similar to the ones in BOC but just had more of them in it), and then a question
about what test you’d use to ID it but it still gave you the picture of Enterobius, so
make sure you can ID them. I had some questions about glucose ox. converts glucose
to gluconic acid …….. I picked and the answer is H2O2.. thank you bottom line! I had
two questions that gave you a urinalysis and it would show you a pH and then say
they found these crystals… what would you do. There is one like this in the BOC book.
All you’re doing is looking at the pH and then thinking, is those crystals acidic or?

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What should you do? I had several questions about D/fetal/mom… those are to be
expected. I had several questions about prehepatic. hepatic and post/obstructive…
several, maybe 4 or 5? Sometimes they were easy and sometimes I had to really think
about them. There is a wonderful chart in the Bottom line book that is a life saver if
you ask me. Also, be prepared to see enzyme questions – liver and heart. I think I had
two or three. I had several questions about discrepancies in ABO… like is it an auto,
allo, subgroup, rouleaux…. I knew going in that BB was going to be my weakest. Uh, I
did not have any questions regarding hep B, but I did have some on hep A. I had
several questions on principles of antigen-antibody testing, like immunofixation,
agglutination, etc. I had some questions on elutions, adsorption, neutralization so
make sure you look over those and understand them.

I did not get any questions on crystals (none that required me to ID them), none on
casts at all. I did get asked about the nephron and what is happening where, filtration
rate, silly stuff. I did have some questions regarding rbcs and disorders or diseases so
be ready for those.

IMViC system
Many GN Bacilli
Factor deficiencies
Typical Mycology organisms
Renal pathology. (Success urinalysis section was the best study material)
~5 leukemia questions
Although rare I had about 6-8 panels that were no as direct as Labce

Use anything possible to remember any and everything that you have to think twice
about while studying.
ie:
IMViC
PEE: IM (+) positive you’ll have to PEE
Proteus Vulgaris
E. coli
Edwardsiella
Are “IM” indole & methyl red positive. Along w/ studying chart off wordsology you will
be able to id organisms w/ out a doubt.

1. What enzyme is increase in mumps?

a. Lipase
b. Creatine Kinase
c. Lactate dehydrogenase
d. Amylase (I answered this one because I associate the saliva with amylase)

2. Cushing syndrome causes

a. Hyperglycemia
b. Hypoglycemia

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c. Hypercalcemia
d. Hypocalcemia
***(I think high glucose since Cushing syndrome has high cortisol, which increases
glucose)

3. Case studies about lactic acidosis, and which patient reflects lactic acidosis.

4. What is (TP x 100)/(TP + FN)

a. Sensitivity (I answered this one)
b. Specificity
c. Precision
d. Reproducibility

5. Questions about two methods showing positive and negative result

Positive Negative
Method 1 50 98
Method 2 100 90

***I could not remember the choices but it is about if Method 1 is more specific than
Method 2 or is Method 2 more sensitive than Method 1.

6. Preferred specimen for tacrolimus (but I could not remember the other names of
the drugs)
***I think I selected whole blood

7. Preferred testing for Legionella.

***I could not remember the other choices but answered urine antigen testing ( I read
this question before).

8. What is the immunity test (I think it was immunity, I could not remember but
something like that) for CMV?
a. Latex agglutination
b. Heterophile test
c. Culture
d. Electron microscopy
***I got this one wrong coz I selected latex agglutination but I could not remember the
source but it says viral culture. Check this
link [Link]

9. Specimen for rotavirus

***I answered stool

10. Specimen for whooping cough

***I answered nasopharyngeal swab
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11. Sezary syndrome is:
a. T cell lymphoma
b. B cell lymphoma
***I could not remember the other choices. I think it is T cell

12. Which of the following shows dosage (or does not show dosage, I could not
remember) but memorize the antibody that shows dosage
a. M
b. FYa
c. E
d. Leb

13. Questions about appearance of 3 CSF tubes.

14. Question about describing sensitivity of syphilis ( I could not remember the
choices)

15. Patient has walking pneumonia but treatment shows penicillin resistance because:
***One of the choices “no cell wall”

16. Magnesium must be monitored in

a. Pre-vomiting
b. Pre-eclampsia (im not sure but I selected this one)
c. Diarrhea

17. Antibody panel to rule out

18. Increase in jaundiced with pancreatic mass (something like that)

a. AFP
b. CA19-9
c. CEA
d. Beta-hcg

19. Normocytic, normochromic, normal WBC, normal platelet, but retics is 0.1%
a. Pure red cell aplasia
b. Fanconi’s anemia
c. Aplastic anemia

20. Blood smear picture that looks like Howell bodies, the retic is 18%, the
technologist should stain with?
a. Stain Heinz- body staining
b. Prussian stain
c. Repeat retic
***(it confuses me because Retic was 18% and the blood smear looks Howell bodies
but I selected Heinz body staining)

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21. What is the problem or effect of dextran sulfate as anticoagulant in blood
transfusion (something like that)
a. Destroy D antigen (something like that)
b. Solubility like antigen activity
***Cold not remember otherrchoices

22. Pictures of Stomatocytes, what disease is associated?

23. Pictures of Burr cell, what disease is associated?

24. CBC result, Hct did not match Hgb (Hbg x3), what causes the false increase of
Hgb?
***one of the choices is lipemia

25. Rouleux is undetectable at?

a. Room temp
b. AHG phase
c. Could not remember other choises
d. IS

26. Target cell blood smear, what is the effect of target cell on instrument (something
like that)

27. Adrenal cushing syndrome causes:

a. ↑ACTH ↑cortisol
b. ↑ACTH ↓cortisol
c. ↓ACTH ↓cortisol
d. ↓ACTH ↑cortisol

28. Pic of blood smear with artifact something like:

29. TSI = A/A and oxidase +

a. Aeromonas
b. Pseudomonas
c. Enterobacteriaceae
d. Serratia

30. Pink colony on Mac, citrate positive, Lysine=neg, Ornithine posiive, Arginine
positive
a. Kleb Pnuemonia
b. Kleb oxytoca
c. E. aerogenes
d. E. cloceae

31. Cystic fibrosis associated with P. aeruginosa and organism that is catalase
positive, oxidase positive:
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a. Acinetobacter
b. B. cepacia
c. Could not remember other choices

32. Disease associated with unconjugated bilirubinemia

33. ANA picture that look like the pic (I answered centromere, be familliar with ANA
pattern)
34. Donor deferral questions

35. Acid-fast bacilli, potassium permanganate is used as: (I saw this on ASCP-BOC
book)
a. Quenching agent
b. Mordant
c. Dye
d. Decolorizing agent

36. Gram negative tapered ends

a. Fusobacterium
b. I could not remember other choices

37. Pic of coccidiodes

38. Platelet irreversible aggregation
39. Calculation of cell count

Lactose fermenter, Oxidase + , A/A… choices are enterobacter, pseudo, hafnia and
seratia..
then, picture of red cell inclusion, TP/TP + FN

(1) Inappropriate ADH secretion sydrome;

(2) Specifications of FFP refrigerator;
(3) Components of PCR;
(4) Interpretation of blood smear with sickle cells;
(5) Interpretation of blood smear with polychromatophilic cells;
(6) Interpretation of blood smear with tear drop cells, ovalocytes;
(7) Separation and storage temp of FFP;
(8) Temperature requirement after cryoprecipitate thawing;
(9) Biochemical tests in identifying bacteria like Pseudomonas, Erysipelothrix, etc.;
(10) Antibody panel (simpler than what are given in labce;
(11) Urine chemistry (interpretation of results & clinical significance);
(12) Best presumptive test for stool in dx of rotavirus;
(13) Image of a fungus (Aspergillus);
(14) Motility test for Yersinia (I found it in your Enterobacteria flowchart);
(15) Strength of H antigen: O, A2, B, A2B, A1, A1B;
(16) S-s-u rare blood group (100th question in my exam :));
(17) Expiry of blood when 40% glycerol added;

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(18) Donor deferment following aspirin intake;
(19) Interpretation of immunodiffusion (with images);
(20) Photometric measurement of iron;
(21) Laboratory picture of hemolytic patient in reference to serum ferritin, iron,
transferrin and transferrin saturation;
(22) Secondary hyperthyroidism (increased total T4 and TSH);
(23) Ion affected by Bromide measurement;
(24) Clinical significance of target cells;
(25) Characteristics of Micrococci;
(26) Hallmark feature of chronic hepatitis B;
(27) Indole difference between Klebsiella oxytoca and K. pneumoniae;
(28) Helicobacter pylori for antral gastritis (biochemical tests);
(29) Anaerobic cocci associated with jaw abcess (choices were Peptostreptococcus &
Veillonella);
(30) Clostridium perfringens (double zone of hemolysis);
(31) Equivalent color produced with Hektoen if TSI is A/A, gas;
(32) Interpretation of forward/reverse ABO typing, Rh and antibody screen;
(33) Effect of ACTH administration to blood cell count;
(34) Calculation of the number of blood units for compatibility testing given the % of
specific blood group antibodies (2 questions);
(35) VLDL as the carrier of endogenous TAG;
(36) Indicator of nutrition (I answered Prealbumin);
(37) AFP as tumor marker (found in this website);
(38) Enzymes to dx skeletal muscle disorder (exactly mentioned in this website) –
AST, LD, CK;
(39) The first cardiac biomarker to rise ff AMI (exactly mentioned in this website) –
Myoglobin;
(40) Heaprin as circulating anticoagulant (found in this website);
(41) Protein S and C, their role in hemostasis;
(42) APTT and PT questions (the coagulation diagram in this website is amazing);
(43) Factor 5 Leiden mutation;
(44) Pheochromocytoma (VMA) – found also in this website;
(45) Cushing sydrome (cortisol increased) – found in this website “Adrenal gland”;
(46) Anemia classification based on blood indices;
(47) MCV, MCHC values determination based on an image of blood smear showing red
blood cells;
(48) Markers for T lymphocyte like CD3 (choices were based on the role of the specific
T cell);
(49) May-Hegglin (found exactly in this website) – giant platelets, thrombocytopenia
and hemolysis;
(50) Pelger-Huet anomaly – clinical significance; and
(51) Hb H in Alpha Thalassemia.

Procaine assay-NAPA
Blood unit expiration date when glycerol is added
Apolipoprotein A- HDL
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Donor requirements- pick the one that didn’t make the cut. My answer was HCT 37
Lots of antibody panels
What’s indicative of teardrops? Had 2 questions referring to teardrops
Had one on the stain being too blue and what do you do? Decrease ph buffer
Classic Ida pbs
Muscle damage enzymes- ast, ck, ld
Cushings and addisons. Which one has increased glucose and dec
Herease?
Which mycobacteria is in drinking water?
Which parasite can cause auto infection?
What does the rbc morphology look like with hookworm that’s been there for years
How is ldl extracted from HDL? Heparin-manganese
What is creatinine clearance?
What’s the purpose of the caffeine in bilirubin? Take the albumin off
I had no ANA questions
Difference between yersinias? Motility at 25
Acute hepatitis markers
Calculate cv, question gave sd and mean and you had to pick which one had the best
cv
One dilution question. It stated off with a 1:2 and made a 1/3 out of that.
Increase urine glucose, what else should correlate with it on a diabetic patient.
No rhizoids- Mucor
I would suggestion writing down the normal ranges whenever they are given to you.
Some questions have it and some don’t. It’s helpful for the ones that don’t.
I had a couple acid base questions.
Mixing study questions
Fungal stain- cotton blue

Microbiology.. Dimorphic Fungi. Differentiating characteristics of the Enteros. TSI of

[Link] , E. cloacea, P. mirabilis and P vulgaris.
LDC : SEA Salmonella, E. coli, Arizona
ODC: YEP + SMS Y. entercolitica Edwardsiella, P mirabilis and Enteros Salmo,
Morganella and Serratia

++–
E coli
Morganella
Edwardsiella
–++
Enterobacter
Serratia
-+–
Salmonella
++-+
Providencia

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-+-+
Arizona
Citrobacter

1. Musty basement odor: Nocardia

2. B. anthracis – non motile, non beta hemo
Bacillus spp : motile, beta hemolytic
3. Increased in cathecolamines : Pheochromocytoma
4. Elevated level of aminolevolinic acid in urine is due to presence of : LEAD
5. Order of draw
6. IFA ANA PATTERNS : i got 3
7. Increased platelets, splenomegaly + bleeding is seen in : Essential Thrombocytosis/
Thrombocythemia
8. Branched chain DNA – Signal amplification
9. Purpose of AHG : Detect immunoglobulins present on surface of RBC and serum
10 Picture of PBS.. Too PINK all crenated RBCs and a few WBC all bathe in pink: Acidic
TIBC measure of : FE bound to transferrin
Pseudo Pelger huet anomaly : Myoproliferative disorders
Least reaction with ANTI H : A1
Compute WBC with Hemocytometer
Know all these:
Define: Characteristics of Mucor, Absidia and rhizopus
CV calculation
DILUTION
AB PANEL
RBC morphology and associated disorder : Burr cells and Schistocytes
Obstructive Liver dse.: ALP and GGT
Biliary Obstruction : Conjugated increased

The Sezary syndrome question, the whooping cough question, and the CMV question
specifically

1. Sezary cell
2. 3 questions about Sensitivity vs Specificity (compare 2 methods)
3. Antibodies detected in Speckled pattern of ANA
[Link] controls were outside 3SD, while the Non-enzymatic controls were within
2SD, What’s the cause? (something like that)
[Link] about blastoconidia (sorry but I suck in Myco, I just guessed)
[Link] VDRL result of CSF is positive. But the lab ran out of the reagent. The RPR
is done but negative, what should the technologist do next?
Some choices: report is as negative. report as positive, inactivate the CSF and do RPR
again, plus one more choice.
7. 2 questions about presence/absence of Bilirubin and Urobilinogen in hemolytic
anemia. (you need to be familiar with this)
[Link] to diagnose Muscular dystrophy

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[Link] familiar with the Enterobacteriaceae reactions.
[Link] familiar with reactions of Strep regarding NaCl, BE, etc. (I had couple of
questions)
[Link] discrepancies
[Link] of decreased zone of inhibition in Oxacillin disk diffusion
some choices: using 1.0 McFarland suspension; media pH is 7.2, more
[Link] should you do sperm count?
choices:As soon as it is received,
Within 3 hours,
Before Liquefaction,
After liquefaction is complete.
[Link] is added before doing cell count of Synovial fluid?
[Link] of peripheral smear and you have to check the disease associated with it

1. PSA px with prostate gland removed 12 months ago, has a somthing like increase
PSA result. so what is the condition?
a. Test sensitivity
b. Test specificity
c. Recurrence of dse
d. i forgot the other choice

2. Blood collected from EDTA for bld typing and antibody screen, shows MF rxn on
AHG and IS.
a. report result
b. adsorb somthing like that
c. recollect serum specimen
d. i forgot again sorry

3. What causes weak D?

– i answered missing epitope

4. What enzyme increases in alcoholic px something like that

5. 8 yr old px has osmolality of 297, metabolic acidosis, increase glucose

a. lead poisoning
b. ethyl glyco
c. salicylate

6. What is the effect of target cells in automation

7. Walking pneumonia – no effect using penicillin

8. Positive blood rgt strip and negative RBCs in microscopic exam

a. outdated SG strip
b. Ascorbic acid
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c. diluted alkaline urine
d. preoteinemia

9. Rotavirus – stool

10. “adrenal” cushing syndrome

11. Vomiting affects what electrolytes

12. severe normochromic normocytic anemia, normal WBC and platelet hast 0.1%
retic count
a. red cell aplasia
b. fanconis anemia
c. aplastic anemia

13. presence of dextran in blood typing something like that, what can be an error

14. ph is 7.0 and SG is >1.050 problem

15. picture of pinkish and crenated RBCs with 1 granulocyte that has pink nucleus,
what is the cause?
a. pH buffer
b. ethanol fixing

16. Potassium permanganate – quenching agent

17. i had 3 ana patterns

18. what is the product of irreversible aggregation

19. heparin contamination in sample from catheter

20. i had 2 RBC pictures, identify the morphology and disease

21. how to check if the streptokinase does not function well

22. cushing syndrome

a. hypoglycemia
b. hyperglycemia
c. hypercal
d. hypocal

23. i had 1 antibody panel, it does not only ask for the antibody but it asks for the
characteristics of that antibody that causes the reaction, so hard T.T
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24. describe bastoconidia

25. Lipemia causes increase or decrease hemoglobin?

[Link] and procainamide

27. what is the purpose of caffeine in bilirubin assay

[Link] is the common error in PCR test

29. Bombay phenotype

30. preferred testing for legionella

31. increased in jaundice with pancreatic mass

32. picture of rouleux formation

33. what rgt deteriorates when in use

a. MN
b. Le
c. Jka
d. Fya

34. lewis antibodies in saliva of Le(a+b-)

35. Hba1c levels result in px with sickle cell disease and hemolytic anemia

Aquired B, what A1 lectin is, TSI slant reactions ( I had two questions about this),
Entomoeba histolytica, normal volume of sperm, sickle cell electropheresis, sickle cell
anemia photos, AFP, LDL, rbc indicies, corrected wbc count, anion gap…(I have had
this all three times), Hep B stages of infection, passive immunity, aquired immunity,
urine casts and where they are formed, CSF fluid, staph questions, strep questions,
veionella- not sure if I spelled it correctly, mycobacterium, nocardia, I had a few BB
questions on Bombay

what nutrient is incorpriate in anaerobic ager to aid the growth of anaerobes I choses
(glycerol and iron). A bacterial with A TSI A/A or acid over acid meaning the
organisming is a fertermnt muciod pink on MacConkey nonmotile but indol positive I
chose (klebsiella oxcitical). Omg this question right out of the BOC the question ask
what are the characteristics of Microcouse is show they were suscepibal to
(Furazolidone) to is question 125 from the BOC. The difference between Yersina
entrocolitica and peptis and I chose ( motility). And question 235 from the BOC
twisted around a blood culture grew a grew a bacterial that was thought to be a

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contaminate something of the sought and I chose (propionibactterium) and question
from the BOC 330 twisted around.A mycobacterial that cause a water contaminat I
chose (mycobacterium Gordonae) and it was right. Anther question BOC 313. The
same way when stain acid fast bacilli with truant auramine-rhodamine stain potassium
Permanganate is used to I chose ( quenching florencent background) and I was right is
a quenching agent. Another similar question from the BOC to 304 to 307 why are first
morning sputum needed for mycobacteria I chose (because if septum is held
overnight the septum is invaded).
For chermistery I remember the following.
Instead of the whole liver panel they ask similar BOC 144, 145 ezyme do u see most in
obstrctive jundiace or hepatoculluar obstruction between ALP and ALT and other
ezymes I chose ( ALP) question. A caculation question of creatinine clearance question
no the formula C=uv/p know that u always divide the total urine by 1440 and this is =
to your volum. What you use to measure and instrument that absorb a flurecent light
and transmit it at a large wave light I chose (. Flurometer) another question an
instrument that. And an ezyme Usero measure choles something I chose (GGT)
beause I thougt of alcohol when I saw the word coholes and didn’t see any thing about
the lipid test so I went with that. BOC question 311 in the chermistery section the
same question to detect barbiturate abuse when analyzing urine specimen I chose
( gas chromatography and mass spectrometry).

PSA reference values and free/total ratio and what 7% free PSA means. HepB “anti-
core window”. Free fatty acids to grow what fungus. Lots of blood bank ABO
discrepancies. Pos DATs, mf reactions. LOTS of blood bank and quite a few urinalysis
on the whole. Lewis antibodies in saliva of Group A Le(a-b+). HUS associated with E.
coli. A few questions about Bilirubin and urobiliogen in urine/serum/feces.
Direct/Indirect Bili. Know pre/post hepatic jaundice. A question about Erchlich’s test
for urobilin/porpho test. Factor V Leiden and what it does. Coumarin therapy and how
it affects. Theophylline therapy in babies and test for toxicity of what? HepB ANA
homogenous/speckled/anti-smooth muscle/or anti-thyrotropine?…. What does plasmin
do. Lots of urine strip test questions, like . CSF standing in room temp for 3 hours
affects: immunoglob neutralization, glucose, etc. CSF should be stored for later testing
how: -20C, -70C, RT, etc. Cushings shows: hyper/hypoglycemia or hypo/hyper calcium.
Question about inappropriate ADH syndrome: decreased serum sodium, increased
glucose, etc. Mg needs to be monitored in: severe vomitting, head injury, etc. bHCG
level for positive control. Salmonella Paratyphi A. Sickle Cell test interference. Low
serum erythropoein levels in what disease. Normocytic/Normochromic severe anemia
with 0.1% retics; Fanconi’s anemia? One calculation: corrected WBC count.
Pheochromocytoma. Catecholamines in urine. What does 5HIAA in urine mean. Given
electrolyte panel and blood gases, what to measure: ethyl glycol, lead, salicylate, etc.
Given picture of Auer Rods, confimatory testing (Phili Chromosome?)
Absolute/Relative lymphocytosis/lymphopenia. A few questions (at least 3) about
precision/sensitivity/specificity with true positives, false pos, true negs and false negs.
My question was TP/(TP+FN)=? What are blastoconidia. Stain for cryptosporidium.
Mycoplasma and arylsulfatase testing. Seminal fluid volume, motility, abnormal %.
Distinguishing characteristic of micrococcus (furazolidone resistant). Non-fluorescing
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bacteria like Pseudomonas. I hope this helps!! Lot’s of random detailed questions….
These are probably the harder questions since I can remember them. Ex. of an “easy”
question I got would be: shape of tyrosine crystals in urine, but not too many of those
gimmes. It was hard, not gonna lie.

Tumor marker to monitor breast cancer(CA-15-3). Test for inflammation(CRP). Sweat

test ..which of the following is used to clean the skin…70% alcohol, Water, Betadine.
Respiratory Alkalosis. Anti Immune disease with an elevated ALP. Clinitest result turns
quickly from blue to orange and back to blue….is this test pos or neg? 10ml of
chemical sol spilled in the lab…pull the fire alarm, clean the spill, ask everybody to
evacuate the lab? test to identify hairy cell? class of leukemia FM1 and FM3. what is a
look back test procedure in QC that is more than one times out for a particular test.

– if there is a rouleaux formation on the blood what will you do? (bunch of choices-
forgot what the choices was) = saline replacement
– Slide of a smear = it was metamyelocyte
– Slife of immature celles (mye,meta,looks like blasts etc) what test to confirm? a. ph
chromosome b. sudan c. oil red d. pas = Not sure with the answer but I choose “a”
– xmatch: DCe/DCe recepient, xmatched with 4 donors, DCE/DCE, dCe/DCE, etc.-
anyway there were 4 donors and 2 of them incompatible then asked what Ab is
present: Choices: a, C and D b. E and D c. anti c d. anti E ( sorry not perfectly sure
what the right choices are but you get the point)
– Some urine strip questions (yup I think I had 4 of them!) = patient came from
radiology with urine sg 1.054 done on refractometer and 1.028 on strip what are you
going to do or something : a. strip deterioted b. result matched c. calibrate the
refractometer d. correlate result with ph
– rgt strip protein negative but SSA 2+ what the cause? cant remember the exact
choices the only one I remembered for this is , false neg due to amorphour urates or
other protien present,
– I had a pix of electropheresis of SLE: a rim b. centromere c. nucleolar d. diffuse – I
think I answered centromere here not sure
– What rgt deteriotes faster when in use a. MN b. Le c. Jka d. Fya
– Jka ruled out but not anti c and anti Kell. tested for Ag Anti Kell = Anti c +? a.
comfirmed c but cannot rule out k b. cannot rule out c. confirmed K but not c d.
confirmed c but kell can neither be ruledout or confirmed
– nephrotic dse what is seen? a alpha 2 b. albumin, c. gamma d. alpha 1 (not sure
with the exact wording on this but you get the point)

>For ISE measurements, a ____ membrane is used to selectively bind potassium.

> RIST test detects what?
> Using compensated polarized light, what is positive (blue) for birefringence?
Uric Acid or Calcium pyrophosphate?
> Lab Management questions regarding turn around time and MSDS(?)
> In an exchange transfusion for cases of Rh HDN, whose blood type (mother or baby

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or father or just Group O negative red cells) do you transfuse?
> Safety precautions you have to take when a lab personnel is electrocuted. What to
do when he/she is “stuck” to the electric source itself?

PS- Here are the ‘patterned questions’

(questions that were given in a row referring to the same topic)
-I had ALOT of antibody panels
-Microbiology Enterobacteriaceae identification pictures
(the micro charts on this site were VERY helpful)
-Interpretation of Blood Gas results (NOT “metabolic acidosis/alkalosis”, but what
caused it- vomiting, hypokalemia, renal impairment, etc)

Passed. Some of what I got: Antibody least likely to display dosage, Bilirubins in
hemolytic anemia, Tumor marker question, calculate RBC count from hemocytomer
with given dilution and squares counted, slide with picture of stomatocytes what
disease state, diabetes given fasting 128 Glucose tolerance >200, badly stained slide
with crenated rbcs what caused, formula given specificity or sensitivity, fluorescence
protect yourself from what, slide with blast with auer rods stains most beneficial for
diagnosis, slide with RBC agglutination saw twice one time incompatible transfusion
other cold agglutinin, RBC H/H given rule of 3 do not correlate lipemia, bile stained
“mammillated” (yes BS wording) Ascaris lucky guess, 1+ leukocyte esterase no WBC’s
seen why, list of Coag results post surgery indicative of what, an acute hep question
(again BS wording) made more difficult than should of been think I got right, unit
released brought back within 30 min but “entered” (damnit into what) on floor
discard, picture of TSI tube what org. My take I feel like I was tested on reading
comprehension more than my ability to not kill someone, would not be surprised if I
got exactly 400. I think I changed a couple that I was on the fence on, problem is I
think they were right initially. About 4 questions were related in that I had no idea but
after seeing the other question I could deduce the answer to the initial question. Had
no full Ab panels but some weird mini panels, some discrepancies (not exactly easy),
no cardiac enzymes, no thyroids, maybe one blood gas, one or two fungals (probably
missed maybe got lucky). Anywho, study hard and you should do fine. Thanks and
good luck.

Hi there!

I used your website over the past two months to prepare for the ASCP MLS exam. I
took my exam this morning and passed! I just wanted to say thanks to you for putting
this site together. It allowed me to organize a study plan that worked.

To those who are preparing to take the exam, study his micro charts! They include
everything you need to know to make it through the micro questions on the exam.

Questions I saw on the exam today (July 2013): abnormal PT and APTT results, ANA
patterns, RIST vs. RAST, lots and lots of micro biochemical reactions, several antibody
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panels, abnormal cells on peripheral slides and hematology values, many questions
over liver enzymes and bilirubin metabolism, a few over the thalassemias, a couple of
parasitology and mycology questions, one question over education objectives, one
protein electrophoresis, corrected WBC calculation (nRBC), two dilution calculations

Materials I used to study:

LabCE: I was scoring between 51-55% on computer adaptive setting, 78-80% on the
MT 100 question practice exam, and 75-80% on subject tests
Clinical Lab Science Review: A Bottom Line Approach by Patsy Jarreau
Polansky notecards
Wordsology
YouTube videos ( especially over the thalassemias and bilirubin metabolism and
associated diseases)

I used this website to organize my study plan. I studied for a little less than two
months for a few hours per day. The week before the test, I reviewed the main four
subjects and studied several hours per day.

Hope this helps! Good luck.

Hi I took the test today and passed. I have to say it was very hard and like others have
mentioned I was pretty sure I had failed around question 50. MY questions certainly
didn’t get any easier at the end! There were about 20 I was certain of the answers,
kind of straight fact questions. MANY seemed to be the same as John (from March
2013) mentioned above. READ them very very carefully and make sure you know
exactly what they are asking. AND some were so vague! I got the one about the unit
being “entered” on the floor. Literally the question was ” A unit of blood was issued at
11:15a. After being entered on the floor it was returned at 11:40a. What do you do
with the unit?” I am with John-entered into WHAT-the med record? the unit entered?–
which now seems like the most logical-but many questions were like that. Minimal
information, and what seems to be the correct answer not being there. My favorite (!)
was this one: “A med tech sets up QC on new TSI slants using [Link] and [Link].
The results were as follows: [Link]: alkaline slant, acid butt, H2S. [Link]: alkaline
slant, acid butt. The answers were: 1. accept QC; 2. Run 2 H2S negative organisms; 3.
Run ATCC strain of E. coli, 4. Reincubate. WELL I am a micro tech and first of all most
ecoli is not H2S positive, and P. mirablis is H2S positive. And why wouldn’t you have
run an ATCC strain in the first place? So the results are screwy to begin with. But out
of those choices–What the ????. I picked 2, but who knows!? Looking back I think if
you REALLY learn what is on the Polansky cards, and the Clinical Lab Science Review:
A Bottom Line Approach by Patsy Jarreau, you will be good. I CANNOT emphasis
enough learning bilirubin stuff–urine and blood results for prehepatic, hepatic, post
hepatic biliribin and urobilinogen -lots of questions–know the references ranges for
total, direct, indirect, conjugated, unconjugated, urine, and blood, know what diseases
that elevated values match up to. Maybe because micro is easier for me there
seemed to be less of that on there. It seemed like mostly blood banking, chemistry,

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and hematology. Weird hematology pictures-got the same pictures twice with 2
completely different sets of questions. Know the stains! The only math I had was
indices-not just knowing how to calculate them, but using the calculations to
diagnose, and a manual RBC count. A few small cell panels. I was really surprised by
how minimal and vague some of the questions were. “A known alcoholic comes to the
ER. He has cardiac symptoms. His glucose is 180. What test do you run next?”
choices; HgBA1C, magnesium, alcohol, glucose tolerance. OMG!! Most of the urine
questions were about discrepant dipstick results. A couple mycobacterium questions. I
did see the “pass” on the screen but I was so unnerved by the test and shaking, I had

to sit in my car for awhile before leaving .

I studied on and off for a few months before taking this exam, which I highly DON’T
recommend. Bob Harr was my program director, so I had his book memorized
because he and all of my other teachers used questions from his book for our exams. I
also used the review book by Patsy Jarrean, along with this site and LABCE. I was very
fortunate with my clinical experience and was able to use that knowledge for most of
the questions. When I took the LABCE exams, I was scoring in the upper 400’s and
lower 500’s. Questions on LABCE repeated themselves semi-often and some of the
explanations for correct choices were unhelpful. For example, if I got a question wrong
it would say “Answer: 41565 was the correct answer. Description: 41565 is the correct
answer.” If you can get a classmate to buy a subscription and share their password
with everyone else, I would do that.

The exam wasn’t too bad. For every question I had no idea what to pick, I guessed B
(like Harr said). Take your time, I had an hour left when I finished. I went back through
and tried to memorize as many questions as I could, mainly for this site. I didn’t
change a single answer, it is best not to second guess yourself. You can take a
calculator in with you, but you leave everything, even watches and pens, behind. They
give you a marker and a dry-erase board so you can write anything down. I
immediately wrote all the micro charts from this site, along with a few calculations.
You can take a break any time, but time still ticks down. I took a 15 minute break just
to clear my head and walk around. They also provide sound-proof headphones, if you
would like to use them.

My advice, schedule your exam early because dates can fill up fast. I tried to sign up
for a day during the first week of the month, but there was only 1 slot available the
whole month. Pearson doesn’t just offer medical related exams, they do stuff for all
trades. Also, make sure you send your transcripts in advance to ASCP or they will not
send you the certificate. It takes about 3-5 weeks to send your certificate if you have
everything submitted.

Because I don’t want to give incorrect answers and steer you wrong, I tried to say
most of the choices that I can remember. I scored in the upper 400’s on the ASCP, so

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I’m no genius. Also, double check all my answers before studying. Answers with a
question mark are ones that I am not 100% sure are correct. Also note that if I only
list 3 of 4 answers, that’s because I cannot recall the 4th choice. There may be
another “better” answer that I cannot remember.

The majority of questions on your exam will probably be on your weakest areas, as
confirmed by me and a few classmates. I studied 3/4 of the main areas hard, but got
screwed by my weakest.

So…here’s the questions I recall from my exam:

Blood Bank:
1) Mother Le(a-b-), what would cause this? – mother loses lewis antigens while
pregnant
2) Mom is A+ baby is B+ elution shows: Acell 2+, Bcell 2+, SC1 0, SC2 0, SC3 0 –
what antibody is present?
3) Given a panel, all but one cell reacted at AHG. Asked which cell should be used to
rule out Anti-C and gave 4 more possible cells as choices.
5) One ABO discrepancy, asked the cause. Reactions: Anti A 4+, Anti B 0, A cells 0, B
cells 0
6) Number of rhogam vials to give mother if fetal blood is 62.
7) Cause of weak D – missing epitope….?
8-12) I had 5 panels. Make sure you know how enzymes affect panels. Half of my
panels had an enzyme column.
13) An O positive Patient has a known anti-K. Which of the following is true?
A) 93% of O blood will be compatable
B) 7% of O blood will be compatable
C) 93% of A blood will be compatable
D) 3% of A blood will be compatable

Chemistry:
1) LDL calculation – straight up, no gimmicks
2) HDL was 34, Trig was 400, and cholesterol was 235. LDL was directly tested and
was 169. (P.S. if you know the correct answer to this, please tell me. I know that you
cannot calculate the LDL if the Trig is above 400, but I keep second guessing myself)
A) Report out calculated LDL
B) Retest Triglycerides and recalculate LDL
C) Retest cholesterol and recalculate LDL
D) Recollect while fasting
3) Gave 4 anion gap equations and asked which one would give an error – one had a
negative value
4) Asked the definition of an automated delta check
5) Analyzer is set to delta check sodium at +/-7. Of these results, which would delta
check? (and yes, there were 2 that would “technically” delta check”)
Day 1: 137
Day 2: 141

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Day 4: 132
Day 5: 137
Day 7: 136
Day 8: 142
Day 10: 134

A) Day 1
B) Day 4
C) Day 8
D) Day 10

6)Patient with HA1C of 5%, glucose is 150. – Patient was following diet for beginning
of 3 months and stopped.
7&8)Know your chemistry enzymes from the chart on this site. It is EXTREMELY
helpful.
Which of the following is increased in skeletal muscle disorder
ALP is elevated in____
9) Bromide affects which electrolyte?
10) HDL precipitation, what is the use of Heparin-manganase?

Heme:
1) Picture of sickle cells – asked which reagent should be used to diagnose
2) 4 year old has increased N/C ratio with cells containing 2 nucleoli. (no picture)
Choices:
A) Lymphoblast
B) Monoblast
C) Reacive Lymph
3) Caused increased ESR
4) Picture of sickle cell and target cells – asked which disease
5) Picture of poly and Macrocytes – asked which anemia
6) Low WBC, low RBC, low Platelet count – asked which lab test would be useful to add
on for anemia diagnosis
7) Blood was opened for a long period of time, what would happen to pH, pCO2 and
pO2
8) Blood with strong cold antibody will – agglutination on smear
9) Picture of agglutination, asked increase in what causes it?
A) Red blood cells
B) Neutrophils
C) Histamines
D) Platelets
10) Blood smear was staining darker blue – reduce pH buffer
11) A control blood smear was made that covered 60% of the slide. The red cells
stained pink while white cells had their nuclei stain dark blue to light blue. The white
cells were clustered at the tail end.
A) Accept

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B) Reject – white cells clustered at tail
C) Reject – Red cell color is incorrect

Micro:
1) CSF has gram positive beta hemolytic bacilli catalase+, oxidase-. What Should you
do?
A) report out normal flora
B) perform indole and…something else
C) perform motility at room temp and 35
2) Hektoen agar, what color would and A/A bacteria change?
A) Yellow
B) Green
C) Black
D) Clear
3) Showed a picture of mycobacterium that was grown in dark. When left in light for 8
hours, it turned yellow and has significantly less growth.
4) Cigar shaped gram positive staining organism – candida
5) Had your Fletcher’s media for Leptospira question
6) Gram stain (can’t remember the site, but I think it was some sort of oral lesion)
grew a gram positive cocci and a gram negative bacilli. On the aerobic culture, only
the cocci grew. What is the bacteria. – Bacteroides
7) Bacteria with tapered ends – Fusobacterium
8) Showed 4 TSI slants, asked which one would be for Salmonella
9) How to tell Yersinia pestis from other Yersinia species – Motility test
10) Swarming bacteria, which test should you do next – Indole (for Proteus sp.)
11) A beta hemolytic gram positive cocci is growing on a blood plate. It is catalase
positive, coag negative, oxidase negative, 6.5% NaCl positive.
A) Report as normal flora
B) Repeat the catalase and report out Enterococcus
C) Repeat the coagulase and report out Staph aureus
D) Repeat the oxidase and report out Micrococcus

Others:
1) Doc sends a throat swab for rotavirus – call for clarification
2) Normal DDMR and abnormal FDP, what disease
A) VWD
B) Fibrinolysis
C) DIC
3) Which factor mediates prothrombin to thrombin
4) Ran controls and PT was normal, PTT was abnormal. Replaced controls and got
same results. What should you do next?
A) Change out the Recombiplastin
B) Change out the CaCl
C) Rerun controls
D) Run patient tests

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5) 5HIAA – carcinoid tumors
6) Positive RPR but negative FT-ABS. What would cause?
7) Had your pyelonephritis question from your practice questions.
8) Question about coccidioides rapid agglutination test.
9) PT, PTT, and TT were abnormal – Factor 5 inhibitor
10-13) 3-4 questions about PCR, Rotavirus, and viral stools. I wouldn’t be surprised if I
missed all of them.
14) Picture of a Renal Epithelial cell

Hey guys! Took the exam yesterday for the second time and PASSED!!! Thank you
Sohail for this website and thanks to everybody who took from their time and shared
they’re recalls. Follow Sohail guideline of study and materials. I strongly recommend
the high yield notes specially Micro, LabCE is a super useful tool, don’t be afraid or
discourage of the adaptive simulation, at the beginning I was scoring between 50-60%
by the last week before the ASCP exam I was scoring 75% up. Read and understand
every explanation given even if you got it right. I manage to remember a lot from my
exam, I tried to put it in order of subject, hope it comes in handy!

Bacteriology
1. Bacteria isolated from a wound TSI A/A, oxidase (+), The most likely organism is:
Aeromonas
2. Plate cocci in chains. Patient with endocarditis, alpha hemolysis, bile esculin (+),
NaCl (no growth). The most likely organism is: Strep. Galloliticus (bovis)
3. Patient with pharyngitis complicates to glomerulonephritis. The most likely
organism is: Strep. Pyogenes
4. Preferred rapid test for Legionella pneumophilia Ag: Ag in urine
5. Bacteria LAP(-), Bile esculin (+), NaCl (growth), PYR(-): Leuconostoc
6. Organism isolated in Hecktoen: TSI K/A, H2S (+), PAD (-), Lysine decarboxylase (-),
Urea (+), citrate (+). What should the technologist do? Report as normal flora
7. Child with walking pneumonia due to Mycoplasma and is prescribed penicillin. 2
weeks later, still sick. What happened? The microorganism doesn’t have cellular wall
8. Latex agglutination for S. aureus – Protein A and coagulase
9. Child with cat scratch, BGN, catalase (-), oxidase (-), motile. The most likely
organism is: Bartonella henselae
10. Difference between P. aeruginosa and P. putida? Growth on 42C
11. Bacteria grows pink on McConkey, Indol(-), citrate (+), Lysine decarboxylase (-),
ONPG (+): Enterobacter cloacae

Virology
12. Rotavirus specimen: stool

Parasitology
13. Parasite that doesn’t present schizont and trophozoite: P. falciparum

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Mycology
14. Test of hair penetration allows to differentiate: [Link]/ T. rubrum
15. Patient comes in with lesion on arm, the organism presents delicate hyphae with
microconidias: Sporotrix schenki
16. What are blastoconidias? Something about budding between mother and daughter
(check)

Urinalysis
17. Urine with pH 4.5: diet high in proteins
18. Urine at 10C measured in a refractometer SG 1.024, 1000 mg of glucose. What
should the technologist do? Correction of the refractometer due to glucose
19. Strip RBC (+), microscope (-), this is due to what? Diluted alkaline urine

20. Patient that physically appears to be pregnant but the HCG is negative. U/A
decreased SG and proteins: trace, why the test result in negative? A. low SG B. False
negative because of the protein trace C. There’s no HCG detectable because it’s
produce 6-8 days after conception.

21. CSF for culture, MLS only manages to perform Gram stain in his shift, what should
the technologist do? Incubate at 35C
22. Urinalysis result for a child had tubular renal cells 25-30, granular casts: tubular
necrosis
23. Fecal fat methods: extraction and process

Immunology
24. ANA pattern with fluorescing speckled or nucleolar (check every pattern)
25. Pancreas cancer marker: CA 19-9
26. Long term marker of hepatitis that is also in acute infection: Anti-HBc
27. Screening test for HTLV-I (+), HTLV-II (-): Report HTLV-I by Western Blot
28. Patient titles EBV>IgG 1:128, IgM1:10, CMV IgG>1:128, IgM1:38, IgG<[Link] Acute
infection with Toxoplasma
29. HbeAg Abs cutoff 0.700, patient 0.300: indeterminate
30. IgE RIST: measures Total IgE

Hematology and coagulation

31. CBC with RBC: 2.46 Hgb: 14 Hct: 36%- Lipemic sample
32. Plate of peripheral slide, RBC’s and WBC’s looked pinkish- Inadequate pH
33. False decreased in ESR: sample more than 8 hours to be tested
34. Plate RBC all agglutinated (not rouleaux), what’s causing this? Mycoplasma
35. The same plate of agglutinated RBC, with witch condition is associated? Cold
autoantibody
36. Plate with Burr cells: Uremia (HUS)
37. Plate with stomatocytes: Liver disease
38. 2-year old girl with anemia Normo-Normo, Retics 0.1%, WBC and Platelets normal:
Pure Red Cell Aplasia

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39. Table of CBC results. Two methods to measure Hgb (method 1: 14g/dL, method 2:
13g/dL), the second method utilized Lyse. What happen? HgbC cristals are Lyse
resistant
40. Plate with RBC (hyperchromic, anisocitosis), inclusions (1-2/ RBC) in Wright.
Patient has 18.5% of retics. What should the technologist do? Use Prussian Blue
41. Reactive Monocitosis: Tuberculosis
42. MI patient who was treated with streptokinase. Which of the results suggests that
treatment wasn’t successful? PT 25
43. What affects HgbA1C: Life span of RBC
44. Calculate % of Saturation- UIBC 185 Fe 125
TIBC= 185+125=310 %sat (125/310)*100=40%
45. A patient is tested for primidone, what other test can you perform? Phenobarbital
46. PT normal (11s), PTT (56), Mix 1:1plasma (47)
a. factor XII deficiency b. factor VIII deficiency (chose this one) c. fibrinolysis d.
something about stypven
47. In what condition do you find abnormally low erythropoietin? Policitemia Vera
48. Patient whit autoimmune condition presents infection with S. pyones, S. aureus
and (__) what is the possible deficiency? Neutrophils
49. Sample taken from indwelling catheter. Patient isn’t on any anticoagulants yet PTT
and TT are way elevated: Heparin contamination (from catheter)
50. In the second phase of platelet aggregation what is irreversible? Fibrin formation
51. Lupus anticoagulant causes: thrombocytosis
52. Controls and patient PTT elevated, control and patient PT elevated:
thromboplastin was added by error
53. Rouleaux are undetectable at what phase? AHG

Blood Bank
54. Patient with DAT (+)
Rh patient Rh control
IS 0 IS 0
AHG + AHG +

55. EDTA tube: report DAT+

Polyspecific IgG Complement
IS 0 0 0
AHG 1+ 0 1+

56. Anti-A Anti-B A B

4+ 4+ 2+ 2+
What would the technologist do? Test with cell panel

57. Anti-A Anti-B A B

0 2mf+ 4+ 0
Discrepancy due to Bx-subgroup

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58. Whole blood donation stops at 390ml: PRBC (low volume unit)
59. Le(a) Le(b) IS 37 AHG
0 + 1+ 0 0
0 + 1+ 0 0
+ 0 0 +/-2w +/-2w
+ 0 0 +/-2w +/-2w
Glycolipid absorbed from plasma
60. Patient A+, Le (a+b-): has Le(a)
61. Antibody that deteriorates in storage: P1
62. Pregnant woman O-, anti-D, anti-C, anti-I, previously she had anti-Le(a), baby is
A+ with DAT (+), anti-D and anti-C are identified, which blood would you give? O-
without C
63. Table. Choose positive controls to test for anti-c and negative control to test anti-
Fy(a): C+c+ for the positive control and Fy(a) for the negative control
64. Detection of ab where 11 tubes resulted negative in AHG, but when added CC 4 of
them didn’t agglutinated. Machine didn’t dispense correctly the saline in the wash

65. Table. IS 37 AHG CC

SCI 0 0 0 2+
SCII +/- +/- 0 2+
Add 4 drops of serum

66. Baby A+, DAT-, Mother O- before birth: Do rosette test

67. Patient DAT (4+), IAT(+), did eluate and the results are DAT(2+) they auto absorb
serum and keeps reacting to SC-I and SC-II in AHG, what should you do? Panel cells
(there was also enzyme panel cells, report DAT or make another auto absorption)

68. Anti-A Anti-B Rh Du Control D

0 0 3+ + –
IS 37 AHG CC
SC I 0 0 0 2+
SC II 0 0 0 2+
Patient cells 0 0 2+ not tested
Presents auto-allo ab

69. A panel that anti-Fy(a) was present but can’t rule out anti-E, so the answer to the
panel was: anti-Fy(a), anti-E
70. There was a small case to choose which component is the best to give for the
deficiency
71. Which donor should you differ? donor received Hep B immunoglobulin 8 weeks
ago

Instrumentation and quality

72. Patient with Hct 62%, the sodium citrate tube was centrifuged and noticed that de
blood plasma ratio was low. What should the MLS do?

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a. take sample with more anticoagulant b. take sample with less anticoagulant c. take
sample in heparin d. report
I chose report, the high Hct can be from a new born sample or it can be a dehydrated
patient
73. Coagulation machine, controls and patient where run in duplicate. Controls where
normal, patient 1 PT normal PTT abnormal, patient 2 PT abnormal PTT normal
a. CaCl2 b. Thromboplastin c. something about a light (chose this one, check) d.
controls
74. Instrument linearity something about comparing means: Paired T-test
75. Calibration of blood gases analyzer: 2 buffers with known pH and constant
temperature
Chemistry
76. Formula TP/(TP +FN): Sensitivity
77. Absorbance formula: 2-log%T
78. Patient is tested for Procainamide and results negative, what other test can you
do? NAPA
79. Patient with fasting blood 155mg/dl and random 225mg/dl: Do OGTT
80. Enzyme controls resulted in 3SD below the mean and the controls with no enzyme
resulted in 2SD below mean. What is causing this?
a. controls where left at room temperature d. something about they being in
deterioration
81. What causes postprandial lipemia? Fatty acids
82. Cause for decreased serum Na? Hyperglycemia
83. Patient with elevated Ca and normal PTH: Metastasized cancer
84. What increases in Cushing? ACTH and Cortisol
85. Positive strip for glucose, negative clinitest: presence of Glucose
86. Patient with hyponatremia, all the other electrolytes were normal: hyperglycemia
87. pCO2 electrode measures: pH
88. Patient had dyspnea caused by anesthesia, what should be measured?
Pseudocholinesterase
89. Patient fasting 120mg/dl, non-fasting 160mg/dl: impaired

1.) PTH effects on Ca+

2.) Solution/buffer most ISE use?
3.) Effect aldosterone has on Na and K?
4.) What is the purpose of Protein C and S? (choices: act as natural anticoagulant,
activates protein coagulants.. etc..)
5.) What happens if ionized calcium sits out?
[Link] in ph [Link] [Link] of glucose?
6.) Electrical impedance measures what?
7.) antacid poisoning,what will you test?
A)ph B) ammonia C)k
8.) Enzyme controls resulted in 3SD below the mean and the controls with no enzyme
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resulted in 2SD below mean. What is causing this?
a. controls where left at room temperature d. something about they being in
deterioration
9.) amniotic fluid cannot be tested for bilirubin on regular chemistry analyzer as
serum bilirubin because???A) they are demanding, B) they are biochemically different,
or C) it is just too turbid.
10.) What does ISE measure?
11.) what happens to salt glucose and potassium when ADH is increased
12.) after eating fatty foods what will increase?
A) chylomicrons B) ldl C) hdl
12) HDL was 34, Trig was 400, and cholesterol was 235. LDL was directly tested and
was 169.
A) Report out calculated LDL
B) Retest Triglycerides and recalculate LDL
C) Retest cholesterol and recalculate LDL
D) Recollect while fasting
13) a person overdoses on salicylate and goes to the ER. WHAT WOULD BE TESTED?
a) pH
B) Ammonia
c)creatinine
d) BUN

1. PTH = normal, and patient elevated Ca+ may caused by Metastasized cancer
4. what is the purpose of protein C and S? Inactivates F. 5 and F. 8
8. b. QC being deterioration ( QC enzyme is unstable at RT, but no enzyme also shift
below 2SD)
12. a. Chylomicrons (turbid and milky serum) also called Postprandial Lipemia
10. ISE measures ionized Ca++, pH dependent
9. b. they are biochemically different
3. Effect of increased Aldosterone enzyme: Na= high, K= low, Hypertension, Conn’s
disease. For decrease : Na= low, K= High
11. ADH is increased : Diabetes insipidus Na = high, K = low, Glucose =N
7. Antacid overdose, test Magnesium
13. measure pH since needed to know acid-base balance. (Ammonia, BUN, Creatinine
all evaluate severe liver disease, kidney failure)
5. affect pH if ionized Ca++ sit out

1. Procedure #1 detected 50/100 true positives and 100/100 true negatives

Procedure #2 detected 80/100 true positives and 70/100 true negatives
a. procedure 1 is more sensitive
b. procedure 2 is more sensitive
c. procedure 1 is more sensitive and specific
d. procedure 2 is more sensitive and specific

1) B is the correct answer choice. This concept will be on your exam. Know it well
because these are guaranteed points. Sensitivity refers to the percentage of true
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positives who are correctly identified as being positive. Specificity refers to the
percentage of true negatives who are correctly identified as negative. In theory, you’d
want a test to be 100% sensitive and 100% specific. In reality, this is very difficult to
achieve. For example, an HIV test that is extremely sensitive (near 100%) will identify
every individual who really has HIV but it may also falsely identify many people as
having HIV when they don’t really have it (the sensitivity is high but specificity is low).
On the other hand, a very specific test will not falsely identify anyone as having HIV
but it will also fail to identify some who do have it.
So for this question, you can clearly see that Procedure 2 is more sensitive than
Procedure 1 – this eliminates choices A & C. You can also see that Procedure 1 is more
specific than Procedure 2 so you can eliminate choice D. You are left with choice B
which is clearly true.

2. TP/TP+FN = ?
a. sensitivity
b. specificity
c. precision
d. variance

2) A is the correct answer. The equation is the formula for calculating sensitivity.
Sensitivity = Number of True Positives/(Number of True Positives + Number of False
Negatives). It is important that you differentiate sensitivity from specificity. Specificity
= Number of True Negatives/(Number of True Negatives + Number of False Positives)

3. What might the following indicate?

urine: RBCs, WBCs, nitrite, bacteria
a. pyelonephritis
b. glomerulonephritis
c. nephrotic syndrome
d. renal calculi

3) The correct answer is A. The presence of WBCs and nitrites in urine is a classical
indication of a bacterial infection of the urinary tract (pyelonephritis). The nitrites are
a result of gram negative bacteria reducing urinary nitrates to nitrites. The presence
of WBCs is due to a bacterial infection attracting a neutrophilic response from the
body. The answer is NOT “glomerulonephritis” b/c that can be a result of a whole
variety of different causes, including diabetes, SLE, drugs or pathogens.

4. Why is albumin the first protein to be detected in tests for renal failure?
a. its molecular size is largest
b. its molecular size is smallest
c. it is very negatively charged

4) The correct answer is B. In healthy folks, the kidneys prevent albumin and other
proteins from entering the urine as waste. If the kidneys are damaged however, it will
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allow proteins to pass into the urine. The first type of protein to appear in urine is
albumin as its molecular size is smaller than most other proteins.

5. Cortisol excess will result in _____

a. hypernatremia
b. hypokalemia
c. elevated glucose levels in blood
d. decreased glucose levels in blood

5) The correct answer is C. Cortisol counteracts insulin. It will increase levels of

glucose in blood (Ilyanok, N).

6. What is the reason for the following discrepancy?

Front Type
Patient cells vs anti-A demonstrate a reaction strength of 3+
Patient cells vs anti-B demonstrate a reaction strength of 3+

Back Type
Patient serum vs reagent A cells demonstrate a reaction strength of 3+
Patient serum vs reagent B cells demonstrate a reaction strength of 0

a. This patient demonstrates depressed anti-B production due to old age

b. This patient has multiple myeloma
c. This patient may be type A2B
d. The 3+ reaction against reagent A cells is due to dirty glassware

6) The correct answer is C. The front type suggests that the patient is type AB but the
back type suggests he is type B. This is considered an ABO discrepancy. The
explanation is that this person is most likely A2B and thus producing anti-A1.
Approximately 20% of people who are type A are type A2 while 80% are type A1.
(Epps-Clarke, L)

7. This spiral-form organism is seen in urine and cultured on Fletcher’s media

a. Borrelia
b. Leptospira

7) The correct answer is B. There isn’t much to remember about Leptospira for this
exam so just try to remember that Fletcher’s media is used to culture it.

8. Organism that gives off a bleach-like odor in culture?

a. Actinobacillus
b. Eikenella

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8) The correct answer is B. A key identifying characteristic for Eikenella corrodens is
the production of a bleach-like odor. It is a gram negative bacteria that also causes
pitting on agar plates.

9. Presence of rheumatoid factor in blood may result in false positives for what test?
a. VDRL
b. FT-ABS

9) The correct answer is A. The presence of rheumatoid factor in the blood may result
in false positive results with the VDRL test. The VDRL test is a nonspecific serological
screening test for syphilis – a variety of factors may cause it to give you a false
positive result. These include rheumatic fever, some drugs, pregnancy and leprosy.
On the other hand, FT-ABS is a test specific for treponema pallidum as it detects
antibodies against T. pallidum.

10. Disease associated with the following results? Elevated TSH; Elevated T3; Elevated
free T4
a. hypothyroidism
b. hyperthyroidism
c. pituitary tumor

10) The correct answer is C. Since TSH, T3 and T4 are all elevated, this suggests a
pituitary tumor. The tumor is causing production of excess TSH, which is in turn
causing elevated production of T3 and T4. Answer choice A is wrong because
hypothyroidism would present with low T3 & T4 and high TSH. Answer choice B is
wrong as hyperthyroidism would present with high T3 & T4 and low TSH.

11. If excess PTH is released, what would you find in elevated amounts in serum?
a. Calcium
b. Potassium

11) The correct answer is A, because PTH causes an elevation of calcium in the blood.
This happens in several ways; including bone resorption (bone breakdown which
releases calcium into blood), and increased calcium uptake by the kidneys and
intestines (so less is lost by your body). Try to understand the following diagram
concerning calcium homeostasis as it’s likely to account for 1 or more questions on
your exam.

12. Mucoid, pink colonies on plate; produces gas; indole (+). On TSI tube you see
yellow on the slant and yellow in the deep. What organism is this?
a. Salmonella
b. E. coli
c. Klebsiella pneumonia
d. Klebsiella oxytoca

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12) The correct answer is D. To answer this question you’ll use process of elimination
and some knowledge you would have gained while training in a micro lab. Since a
yellow color is produced on the slant aspect of the TSI tube, the organism can ferment
lactose or sucrose. Keeping in mind that this is a lactose fermenter, take a look at the
Enterobacteriaceae chart (in the micro section) and immediately rule out everything
on the right-hand side of the chart (like Salmonella) since the organism in question is
a LACTOSE FERMENTER. Next, recognize that a mucoid appearance is due to the
presence of a capsule. If you have rotated in a microbiology lab by now, you may
recall that klebsiella has a mucoid appearance while E. coli produces dry colonies –
rule out E. coli. You are down to only choices C & D. Which one of these two mucoid,
lactose fermenters is the organism in question? The only way to differentiate them is
via the indole test. Klebsiella oxytoca is indole positive while Klebsiella pneumoniae is
indole negative. The answer is Klebsiella oxytoca.
By the way, this is a tricky question. You may have been tempted to rule out
Klebsiella earlier because all Klebsiella (other than Klebsiella oxytoca) are indole
negative while E. coli are indole positive. However, recognize that E. coli colonies
appear dry while Klebsiella colonies appear mucoid on agar. You will see this when
you train in a micro lab.

13. PAD (+); indole (+); Organism stains gram negative. What is it?
a. P. vulgaris
b. P. mirabilis

13) The correct answer is A. Follow the chart for gram negative bacilli. What organism
is PAD + and Indole +? That would be Proteus vulgaris. For practical purposes (and by
extension for the exam), it’s important to know that P. vulgaris is Indole positive and
P. mirabilis is Indole negative. This was on the exam because it is practical knowledge.

14. You see a curved gram negative bacilli. It was cultured from the GI tract of a
person with ulcers. What test would you do next to confirm its identity?
a. test for Urease
b. culture the organism in agar
c. H2S test

14) The correct answer is A. If you only know a few things about helicobacter pylori,
you should know this: It is curved, can infect the GI tract, and the urease it produces
may cause ulcers.

15. Enzyme controls run on a machine give results around -3 standard deviations.
Samples run on the same machine give results of less than 1 standard deviation.
What could be the problem?
a. controls are recently expired
b. controls were left at room temp for several days

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15) The more likely answer is B. In this case, there is clearly a major problem with the
controls. As you probably know, enzymes are very sensitive to temperature. While
most enzymes work more rapidly at higher temperatures, they will also be denatured
by temperatures far beyond their acceptable range, losing much of their functionality.
Choice A is incorrect because the control wouldn’t start giving results this erroneous
(being off by 3 standard deviations is pretty bad!) just because it recently expired.

16. HIV-1 & HIV-2 combination ELISA test is positive in a patient with symptoms of
immune deficiency. Western blot was inconclusive for HIV-1. What do you do next?
a. rerun western blot for HIV-1
b. do a CD4 cell count
c. do HIV-2 ELISA
d. do HIV-2 western blot

16) The correct answer is D. You are PRETTY SURE that the person has EITHER HIV-1
or HIV-2 b/c the combo ELISA test tells you so. This test is a cheap, catch-all test so
it’s run first. However, this test can give you false positives and you don’t want to go
around telling someone they have this disease unless you’re sure they have it. Thus, a
more expensive, time consuming and sure confirmation for the ELISA test is a
Western Blot. This test is specific so it can differentiate btwn HIV-1 and HIV-2. Since
the Western Blot for HIV-1 came back as inconclusive, there’s probably a good chance
that the ELISA test originally detected HIV-2. Thus you would run a Western Blot for
HIV-2 in order to confirm.

17. What are the steps of PCR?

a. transduction, transcription, annealing
b. annealing, denaturation, transcription
c. denaturation, annealing, transcription

17) The correct answer is C. PCR is an artificial process generating multiple copies of a
particular DNA sequence. The first step involves denaturation of the bonds between
the two complementary strands so they separate (unzip) from each other; Next, short
DNA primers attach (anneal) to one of the separated DNA strands; Finally, DNA
Polymerase extends the DNA along the primer, transcribing a new strand of DNA
based on the mirror image strand opposite the primer.

18. RAST test detects what?

a. IgE to particular antigens
b. IgM
c. IgG

18) The correct answer is A. RAST is a blood test used to determine specific IgE
antibodies to known antigens.

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19. After collecting a blood sample in an EDTA tube for CBC, you find that the
Hematocrit is very high (67%). What should you do next?
a. collect blood again, but use less sodium citrate in the tube
b. collect blood in heparin
c. report these results

19) The correct answer is C. There may be several reasons for a high hematocrit –
including the obvious possibility that this is a newborn who demonstrate a normal
hematocrit range of 55to 68%. Another likely reason for a high hematocrit is
dehydration – the individual just happens to have less fluid in the body. Less frequent
causes include Polycythemia Vera or high hematocrit due to blood doping, a favorite
of several infamous athletes including Lance Armstrong. Note that blood doping with
EPO is a very bad idea because the increased viscosity may very well lead to a heart
attack or stroke as you’re receiving the First Place Gold Medal! Answer choice A is
wrong for two reasons: (1) you use EDTA rather than sodium citrate for CBC blood
collection and (2) blood collection is a standardized practice and thus your goal in
testing the hematocrit is to determine the actual hematocrit – not to artificially disturb
the ratio of anticoagulant in order to arrive at a normalized determination of
hematocrit! Answer choice B is wrong because you don’t collect CBC specimens in
heparin – you use EDTA (Natallia Ilyanok).

20. When you conduct a procedure using fluorescence, it’s important to protect
yourself from the:
a. cover light
b. emitted light
c. exciting light

20) The correct answer is C – the exciting light is the dangerous, high energy light
produced by the machine. Answer choice B refers to the lower energy light produced
when excited electrons (previously excited to higher energy levels by the machine)
fall back to lower energy levels. The cover light is just regular light helping you see
what’s happening.

21. Blood was collected on Nov 1. Blood was then frozen in glycerol on Nov 5. What
should the expiration date read?
a. Nov 1; 1 year from now
b. Nov 5; 1 year from now
c. Nov 1; 10 years from now
d. Nov 5, 10 years from now

21) The correct answer is C. Blood is sometimes frozen in order to preserve rare
types. Glycerol is used in the freezing process. Once frozen, the expiration date of the
blood is extended to 10 years from the date of phlebotomy. If the blood is needed, it
is defrosted and the new expiration time becomes only 24 hours from the time it is
defrosted (Polina Gurevich).

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As an aside, we recently had a patient with anti-U antibody. We needed to give this
person blood from a donor who is negative for U antigen. Unfortunately, only 0.01% of
the population is negative for U antigen. We were able to find this blood in
frozen/glycerolized form at the New York Blood Center. We had to have a good idea of
what time the patient would need to receive the blood though. That’s b/c once
defrosted, the blood is only good for 24 hours before it expires.

22. A person was successfully treated for syphilis 12 years ago. However, he has just
come in again, worried about having been re-infected. What would you look for in his
blood?
a. TP-A
b. VDRL

22) The correct answer choice is B. To determine if this patient has been re-infected
you would have to perform a VDRL test. Answer choice A is incorrect because a TPA
test may remain active for the life of the patient so it is not useful in determining
reinfection or treatment.

23. A patient demonstrates a positive antibody screen. You suspect either Jka, K or c
antibodies. You know from a previous history that this patient has Jka antigen on their
red cells. You then react the patients serum with cells positive for certain antigens
and see the following:
Patient serum vs: reagent K cells reagent c cells
Reaction strength: 0 4+
What can you conclude about the antigenic makeup of this patients red cells?
a. confirm patient as having K and c antigens on their red cells
b. rule out c antigen on the patients cells and confirm K antigen on their cells
c. rule out c and K antigens on patients red cells
d. rule out c antigen but cannot confirm the presence or absence of K antigen on the
patients red cells

23) D is the correct answer choice. Use the process of elimination. I strongly urge you
try to understand the reasoning here because it is a perfect example of a secondary
level question. As a secondary level question you will first make one determination
and then use that determination to come to a final conclusion. Reread this question
carefully at the end to be sure you’re actually answering the question. First, the
question tells you that the patient has Jka antigen on his cells – you don’t even need
to worry about this because none of the answer choices address Jka! Next, we rule out
the possibility of K antibody because testing of the patients serum against cells
positive for the K antigen demonstrated a reaction strength of zero; thus the patient is
not producing anti-K antibody – However, the question is not asking you to determine
what antibody the patient is producing! It’s asking you to go further and determine
the antigenic makeup of the patients red cells – the fact that the patient is not
producing anti-K antibody could mean either of two things with regard to whether the
patient has K antigen on his cells: (1) the patient is antigenically positive for K so

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that’s why he’s not producing antibody against his own cells or (2) the patient is
antigenically negative for K but has never been exposed to K antigen through a
foreign blood transfusion so his body has never been prompted into producing anti-K
antibody. So you essentially cannot confirm the presence or absence of K antigen on
the patients red cells. Finally, the patients serum reacted strongly against cells with c
antigen on them and thus he is definitely producing anti-c antibody – if he produces
anti-c antibody then we can rule out the presence of c antigen on his red cells
because he would not produce an antibody against his own cells!

24. Urine protein chemistry dipstick (Reagent strip) detected no proteins but
sulfosalicylic acid (SSA) test did detect proteins. Why?
a. reagent strip was expired
b. Bence-Jones proteins in urine

24) The correct answer choice is B. Unlike the urine protein chemistry dipstick
(Reagent strip) which only detects albumin, the SSA test detects albumin as well as
other proteins like Bence-Jones proteins.

25. I was shown a picture of what I believe were several immature granulocytes in a
peripheral blood smear. What stain should you use next to figure out this persons
problem?
a. specific esterase
b. non specific esterase
c. LAP

25) This question cannot be answered because I don’t have a picture of the immature
granulocyte presented. The picture of the granulocyte itself was the clue to which
type of stain ought to be used. I only included the wording of this question to show
you the types of questions you may encounter. You may already be aware that special
leukemia stains are used to help distinguish one type of cell from another. For
example, leukocyte specific esterase identifies granulocytes (which show red
granules) while leukocyte nonspecific esterase identifies monocytes and
megakaryocytes (which show black granules).

26. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) would result in

what in blood?
a. excess potassium
b. excess sodium
c. excess non-serum water (?something like that?)
d. deficient potassium
e. deficient sodium

26) The correct answer is E – deficient sodium (aka hyponatremia). SIADH is a disease
characterized by release of excess ADH (antidiuretic hormone) from the posterior
pituitary. Anti (against) diuresis (urine production) means that you won’t be urinating
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as much so body fluid levels increase. This will dilute the concentration of sodium in
your body.

27. Fiber strands in urine resemble what under the microscope?

a. waxy cast
b. hyaline cast
c. WBC cast
d. fine granular cast

27) The correct answer is B. Fiber strands (commonly fibers from diapers) resemble
hyaline casts and may be mistaken for such.

28. Which of the following regulates myocyte contraction?

a. myoglobin
b. cardiac troponins
c. CK-MB

28) The correct answer is B. Troponins are contractile proteins that regulate muscle
contraction along with tropomyosin and calcium. Recall that troponin levels in blood
may be used to determine if someone has suffered a cardiac injury.

29. HBa1c levels cannot always be used to monitor glucose levels in conditions such
as:
a. sickle cell disease
b. HIV
c. Tuberculosis

29) The correct answer is A – Hba1c levels cannot be used to monitor blood glucose
levels in patients with sickle cell disease. As you may know, sugars tend to attach to
RBCs over time. The HBa1c test measures this degree of glycation of RBCs (if you
have more sugars in blood you’ll have more sugar attaching to the RBCs over time).
Any disorder that causes RBCs to die prematurely (sickle cell disease, G6PD
deficiency, etc) will result in an underestimation of the Hba1c levels b/c the old,
glycated cells deformed and died, being replaced by newer cells which are not very
glycated. Thus, the test is not valid in patients with sickle cell disease.

*Percentage of correct diagnoses

*Total Correct Scans/Total # of Studies
*Accuracy= TP=TN/ALL Scans
(note ALL Scans are TP+FP+FN+TN)
1. Accuracy A+D/A+B+C+D

2. False Negative (for example: cutting off the wrong leg)

Scan disagree with gold standard
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 -Scan normal
-Gold standard abnormal

(for example: taking medicine you don’t need)

Scans disagree with gold standard
-Scan abnormal
3. False Positives -Gold standard normal

*Percentage of scans that accurately predict

normality
*TN/ALL
(note ALL negatives are TN +FN)
Negative Predictive NPV=TN/(TN+FN)
4. Value D/C+D

*Percentage of scans that accurately predict

abnormality
*TP/ALL
(note ALL positives are TP + FP)
Positive Predictive PPV=TP/TP+FP
5. Values A/A+B

* Compare your exam to the gold standard or

reference test
* Calculated values verify
-Quality of your exams
6. QA Statistics -Limitations of your lab

TP/(TP +FN)
*Identify patients with disease
7. Sensitivity Sensitivity = A/A+C

TN/(TN+FP)
*Identify patients without disease
8. Specificity Specificity = D/B+D

* Sensitivity
* Specificity
*Positive Predictive Value
Test Validation and *Negative Predictive Value
9. Statistics *Accuracy

10 (Normal or No Pathology)
. True Negative Your scans and the gold standard agree

11 (Finding the presence of disease)

. True Positives Your scans and the gold standard agree

Accuracy
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Precision

Standard Deviation

Sensitivity

Specificity

Controls= Assayed and Unassayed

Delta Check

Youden Plot for?

Levey-Jennings= know Westgard Multi Rules

Know some common Maths like Molarity, Dilution,

Know about Lab Safety like Fire safety, Radiation sign, Bio Hazard sign, Fire
extinguisher classes, Biological safety Cabinets, Accrediated Agencies.

KNow just the principles of Instrumentation, All you need to know the basic idea about
instrument, just 2-3 lines—> Spectrotophotometry(stary light and filetr?)= for
example this method measures light in a Narrow Wavelength Range.

Fluorometry

Turbidimetry

osmometry

chromatography

Electrophoresisi

Potientiometry

coulometry

Amperometry

(1) Rh- mother has increase titer of anti-D. After delivery, the DAT is strongly (+) but
the baby is Rh-

a) inadequate washing
b) added monoclonal anti-D sera instead of anti globulin (or vise versa)

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 c) or maternal antibodies blocking the antigenic site

C: maternal antibody blocking the antigenic site giving you a false negative D typing
at immediate spin and IAT. The baby’s RBCs are coated with maternal IgG that the
anti-D in the commerical reagent can’t bind to the baby’s red cells so you get a false
typing.

(2)3 units of FFP requested for A – patient

Available: A- =1unit
A = 6units
O- = 5 or something
a) transfuse A units
b) transfuse O negative
C) don’t remember more options

The Rh typing doesn’t matter when transfusing FFP units because there aren’t any
RBCs in FFP so you can transfuse A- or A+ or AB+ or AB-

(3)What is the reason for this discrepancy or What would you do to resolve this
discrepancy?

Patient cells Patient serum

anti-A anti-B A cells B cells
3+ 3+ 1+ 0
Answer: This is a reverse group discrepancy, most likely to a subgroup of A.
comment?
A2 subgroup is most commonly seen in patients that are AB, about 25% of them make
anti-A1. So this is most likely due to A2B patient making anti-A1

(4) In forward, reverse reaction… reaction in forward, but no reaction in reverse, what
will do you?
A. Incubate at room temp for 15-20 minutes. The reverse reaction is usually due
some immunodepressed event and the reactions will reveal.
Comment:
The reverse typing antibodies, i.e. anti-A and anti-B and anti-A,B contain IgM as well
as IgG antibodies. IgM antibodies are enhanced after room temperature and 4C
incubation so incubation at room temp or 4C will enhance and usually reveal these
antibodies.

(5)You suspect someone might have Jka, K and c antigens on their red cells. You
figure out that they don’t have Jka. You also test their serum and see the following:

reagent K cells reagent c cells

patient serum: 0 4+
What can you conclude?

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a. confirm patient as having K and c antigens on their red cells
b. rule out c and confirm K on their red cells
c. rule out c and K
d. rule out c but cannot confirm the presence or absence of K

Answer: D is the correct [Link] fact that the patient hasn’t made anti-K doesn’t
tell you if they are positive or negative. They could be negative for K antigen and
never make anti-K. The only thing that you know if that their blood is reacting with c
antigen and most likely they made anti-c because they are c antigen negative.

(6)What is RHOGAM, when are you going to give it and what will it do to the patient?

In a nut shell it’s an injection containing passively acquired anti-D. It is given to D

negative mothers during 28 weeks of pregnancy and up to 72 hours after delivery to
prevent the formation of actively acquired anti-D from a baby that’s D positive.

(7)In an emergency, what blood type of blood would you give if the red cells are
needed or plasma is required and the blood type is unknown?

In emergency situation when there is no time to perform proper tests give O- RBCs
and AB FFP. These are the universal blood type for RBCs and plasma products.

(8)Would you phenotype a patient who had been transfused within the last 3 months?

No because you may get mixed field typing which is the patient’s blood and
transfused blood and may get false results.

(9) What is the isoagglutinations in type O?

Anti-A, anti-B and anti-A,B(10).Mother B Rh(-), Father AB Rh (+). Child 1 A Rh(-) Child
2 B Rh (+). Which is correct

[Link] is rule out [Link] cannot rule out (answer) [Link] 1 can rule out d.
Child 2 can rule out

your comment: Based on this information you can’t not rule out the father. Do you
know how to do a punnet square? If you do a square, you can see how this the
mother can be a BB or BO and the father is a AB can have babies which is A, B, AB
and O when the mother is BO but when the mother is BB the babies can only be B or
AB.

(11)Anti- F will not react with:

a. cDE CDE

b. Cde CdE

c. Cde Cde

d. eDe CDe

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Answer and Comment: anti-f reacts with RBCs that are c+e on the same haplotype.
So will not react with RBCs that are cDE or CDE or CDe or CdE or Cde or cdE but only
with cDe or cde. Does this make sense?

(12)The same antibody was found in 3 different patients. The results of testing are
listed below. Which antibody is most likely to be present?

IS 37 AHG

Patient 1 0 2+ 0

Patient 2 2+ 0 0

Patient 3 0 0 2+

a. Anti – Jka

b. Anti- K

c. Anti- M

d. Anti- Leb

Answer and comment: You want to chose a antibody that is known to commonly react
at all phases and that is common enough where it’s most likely to be found in 3
different patients. The likely answer is anti-M

(13)Which of the following is detected primarily in the antiglobulin phase of the

crossmatch:

a. Anti- Fya ( answer)

b. Anti- M

c. Anti- B

d. Anti- P1

Anti-M, B, P1- are typically IgM and may agglutinate saline suspended cells at room
temperature.

Comment: Anti-Fya contains mainly IgG and these are more likely to react in the
antiglobulin phase of testing.

(14) The most common cold agglutinin? Answer: Anti-I should be the correct answer

a. I

b. P1

c. M

(15)Multiple antibodies on the panel, what do you do next?

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You run a select cell panel to rule in and rule out antibodies

(16)Adminsitration of Rhogam to pregnant mother , how will it affect the child?

It is not known to affect the child

Multiple Myeloma= Rouleaux, viscous serum and Bone lesion

Chronic Myleogenous Leukemia= Lap low and + philadelphia Chromosome.
Hodgkins’s Lymphoma= ReedSternberg cell +, Bimodal Pattern
Non Hodgkins= No RedSternberg cell, No pattern
Gaucher disease= Glucocerbroside, wrinkled or striated cytolasm
Myelofibrosis= Teardrop cells
——————————————————————————————
Exam Questions from Hematology:
[Link] what Condition or disease you expect to see the following Blood Smear?

2. What disease is associated with the following Blood Smear?

3) What Test to screen Sickle cell disease? Do remember the full name of the test.
Solubility Test, Sodium Dithionate

4) Blast cell= 6%, Meta= 3% , myelo=20%, Promyelo= 3%,

WBC=1.8 *10^3, Red Blood cells= 4.6 *10^6, Plt: 903*10^3.
Segs =50 %, Bands= 17%, Lymph=13%, Mono=3 %
This result is consistent with?
a. Neutrophilic Lekomoid reaction
b. Chronic Myelocytic Leukemia
[Link] Myelocytic Leukemia
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5)CD 3+, CD4-, CD8+, Surface Ig(-) , Cell Marker?
a.B Cells, b.T cell, [Link] Cell?

6) MCV =92, MCHC= Normal

Automated cell counter gave result as Microcytic, Normochromic , What’s the next
step?
7) You see lots of eosinophil with a high LAP score, what do you do?
a. Report as 4+ b. Grade according to the Reaction c. Order a New blood sample
8) When you see Rouleaux on Blood Smear, how will you fix the issue?

9) APTT and TT all prolonged?

a. Factor 5 [Link] C [Link] 9
10) Patients with DIC?
a. Normal APTT and TT?
b. APTT prolong TT normal
c. APTT normal and TT prolonged
11) Lupus Anticoagulant = Dilute Russel’s Viper Venom screening.

AST and ALT= both ends with T = HeapaTTTitis= focus on T on hepatitis= so its
Acuter Viral Hepatitis
GGT and Alp= PluGGed= focus on P and G= means Bile Obstruction(plugged)

Muscle =S=ASt, C=Ck, L=LD so AST, CK and LD in mucular dystrophy.

I Am Peter Pan with Lips= Amylase and Lipase in Pancreatis
Respiratory= R= Reverse= ph high Co2 low vise versa

Metabolic = MD= direct = in this case HCO3 and Ph= Ph high Hco3 high

1) Bile Esculin Agar= Group D Strep and Enterococci are positive

2) 6.5% Nacl Broth= Only Enterococci grow, Group D Strep Does not.
3) Optochin Disk = Strep. Pneumoniae is sensitive, Strep Viridian is Resistant.
Remember (oPtochin has letter P and pneumonia also starts with P )
4)Bile Solubility: S. pneumonia is Bile soluble.
5) Bacitcin disk sensi= Group A Strep.
6) SXT = Both Group A and Group B strep are Resistant.
7)Novobiocin= Staph. Epi is (+) whereas Staph Saphro is (-)
8) PYR + = Group A strep and Enterococci
9) Campt Test= Strep Group B positive.
10) Hippurate Hydrolysis= Greoup B Strep (+)
Listeria= Cold Enrichment, Tumbling Motility, Umbrella Growth. Motile at 25 degree
Centigrade but not at 37 degre. The only Motile one among Gram pos Bacillus Aerobic
Bacteria.

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Nocardia= Branched, Partially Acid Fast like Mycobacterium.
B. Anthracis= Spore Forming, Ground Glass Bambmoo shoot like structure, Medussa
Head, Causes Anthrax and cutaneous ulcer from handling wool hides in Live Stock.
B Cereus = So this Organism is responsible for Food Poisoning, Toxin Fried Rice.(Just
Remember Morning Cereal as food and name of this organism is also Cereus similar
name and it causes Food poisoning)
Lactobacillus= Pleomorphic, Flora of Vagina.
Erysipelothrix= H2S+, So causes skin infection in Fisherman or Butchers or rose
Growers, In short it causes Occupational infection.
Corynebacterium= Chinese letter like, Black Colonies on Tindale Agar or Loeffler Agar
Medium. , Confirm by growth in Potassium Tellurite Agar . Highly Toxic Organism.
Need to confirm toxicity by ELEK test to check if organism is a producer of toxin, if it
produces then you can report that Species is Toxic.
1) Lactose Ferm= E Coli , Enterobacter,Klebsiella = Mucoid, Citrobacter= slow
Fermenter.
Klebiseilla has 2 types and can be differentiated on the basis of Indole Test. Kleb
Oxytoca is Indole + and Kleb Pneumina is Indole -, How will you remeber which one is
Ibdole (+)—-> just remember Oxytoca like oxygen and so
indole +
2) Non Lactose Fermenter= Salmonella, Shigella, Proteus, Morgan and Pseudomonas.
Remember Proteus has 2 types and can be differentiated on the basis of Indole Test
Proteus Vulgaris is Indole + and Port Mirabilis is Indole –
So how do I remember which is positive , just compare Vulgaris with Volcano and its
hot and firy and so Indole +

3) TSI reactions = A= Acid means Ferment lactose, sucrose or Glucose

Alkaline =K= No Fermentation.
A on Top means ferment Lactose or Sucrose, A on Bottom means Ferment Glucose.
A/A = Ferment through out Slant (Body) and Butt (Bottom)
K/A= means does not ferment Lactose but just Ferment Glucose.
SO look at the Table #4 and see the TSI table.
Colum 1 =A/A = EEKY = first 3—> EEK are Lactose Fermenter and Yersenia just
Ferment Sucrose, so the Agar plate with EEK will be pinkish but not with Yersenia bcos
its not Lactose Fermenter.
2nd Column = A/A and H2s+ = Citrobacter.
3rd column = K/A= Non Lactose Fermenter , just Glucose Fermenter and does not
produce H2S (negative)= SS-PP-M
4th Column= K/A and H2S+= Saci-Pred= Salmonella, Proteus and Mr. Edward
I just kept Citrobacter so you can remeber that Saci-Pred= H2S+ but Citrobacter had
already been placed in column 2 bcos its slow lactose fermenter and have TSI of A/A
type.
Column 5= K/K= zero nothing, No fermentation and No H2S=Pseudomonas. Only
Organism which is Oxidase + among this group.

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4)Phenyl De Aminase +=PD+=PPM=prot, prov and Morganella.
5)Urease += same like PPM just add K= Klebsiella so= PPM-K = Prot, Prov , Morgan
and kleb.
Special case: But remember not all of providencia Species are Urease (+) only
and only Providencia Rettgeri among the Providencia Species is urease (+) and also
Klebseilla is Slow Urease +
6)Citrate += Enter-SePr/K = entero, Serratia, Proteus and Klebsiella.
7)Oxidase + = The ones which end with (-onas)= Pseudomonas and Pleisimonas.
8)H2S+= Saci-PrEd= sexy predator= Sal, Citro, Proteus and Mr. Edwardsiella.
9)Non Motile = The ones ending with (-ella)= Klebsiella and Shigella :)_
Remember how Klebsieilla is pronounced Kleb-siiieeellla takes a long time to read so
this organism is very mucoid and cannot move bcos it takes long to read
10)Indole += E coli , K Oxytoca (remember as Oxygen), P. Vulgaris (Volcano), Mr.
Edward and Mrs Morgan (they both work at my Lab) and finally 2 of which start with P
i.e—> Providenscia and Pleisimonas.
These Bacteria will always Grow on Choclate AGar and 10 % Co2 because it supplies
both X and V Factors. They do not Grow on Blood Agar because of NADase in the agar
( which inactivates NAD) but will grow on Horse or Rabbit Agar which contains no
NADase.
Exception on Growing in Blood Agar can happen only when this bacteria grow around
colonies of S Aureus as S. Aureus produces NAD and Hemolyse the Blood cells
releasing Hemin as well and this Phenomenon is known as Satellitism.
Both H Influenzae and H. Haemolytics (Not Para’s) need both X and V Factor
Both Haemolytics (Haemolytics and ParaHaemolytica)= Hemolyse
Both Para (Para Influenz. and Para Haemolytia) need V (NAD) and don’t need (X)
[Link] and H Ducreyi = Reactions are exactly opposite For H Aphro= – – – +
and H Ducreyi = + – – –
Diplococci = Neisseria Species and Moraxella
Neisseria Species Grow on Choclate and selective Media ( MTM, Martin Lewis and NYC)
Neisseria Gonnorhoea Very Resistant ot Penicillin and causes STD
All 3 Neiserria’s Ferment GLucose
Gonnorhea = Only Glucose
Meningitis= starts with M SO ferments Glucose and Maltose
Lactamica = Starts with L and has M in the middle= SO Fermenrs Glucose + Maltose+
Lactose
Fusobacterium = Fus Fus= Brain Abcess, spindle shaped (brain like structure so
attack Brain)
Last 3 causes Pulmonary Infection and Bacteroides infects below Diaphragm
Brick Red Flouresce = Porphyromas, Prevotella and Veillonella
Indole (+)= Fuso Bacterium and Porphyromas and Both organsims are sensitive to 2
Antibiotics

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12) Citrobacter vs Salmonella Reaction. organism grows on Mac Conkey but its
colorless , has all reaction conisistent with Citrobacter. Whats the issue? ANswer=
Problem with Agar Plate, Run a Control, because Citrobacter a slow Lactose Fermenter
will be turning agar into Pinkish color not white.

13)RhIg= Rhogam , calculate how many vials needed for 50 cells Fetal Blood? (Whole
Blood)
Answer = 50/30= 1.6 round to 2 and add 1= 3 vials needed.

Incase of RBC just divide by 15 not 30 and then round off and add 1 to final answer.

14) Apo Liporprotein is major protein of? = answer= HDL

15)Fresh Frozen Plasma Storage Temperature?

16)Irradiated Blood for?
17)One Panel given with multiple antibodes , what will be your next step= Do Select
cell Panel.

18)Another Panel shows 2 antibodies which could not be rules out, but the option only
shows Ant-jka, Anti Jka and k, Anti k
I could not rule out Anti Jka and k so thats the answer both of them.

19)In case of Old people or immuno suppressed people, what BO discrepancy ?

20) Know ABO discrepancy for Sub Group of A.
21) Weak D + in what scenarios?
22) Go to BOC for ASCP book Blood Bank section, Page # 25 Do Question # 168, 169,
174, 180, 181, 182, 185, 190, 192, 196. I had atleast 5 Questions from the above
mentioned Questions, So make sure you do those ABO dicrepency and screening cells
cross match Questions , Understand them real good.
22)BOC Page 17 Question # 119 to 165 . Glance on this Questions, you will get atleast
3 Questions from mother and new Born antibodies and how to fix, calculate the RhIG,
Rosette Test etc.

23) When do you use washed Redcells and when do you use Leukocyte Reduced
Cells?
24)Cystic fibrosisi caused by which organism?
25)Which Neiserria Species is increasingly resistant to Penicillin?= N Gonorrohea.

26)Whats the reason on not doing Zinc protoporphyrin (ZPP) for Lead Poisoning on
Kids ? Page # 115 Q-274, but it does not give reason.

Normally Kids are tested for whole Blood Lead not ZPP or EPP which are for adults ,
the exact reason look it up on Internet.I think I got it wrong.
27) Cociane Metabolized to?
28)Procainamide metobilite = NAPA N Acet procanimide.
BOC Page # 113 Just do from 256 to 274 you will see all this type of Questions.
Metabolites type QUestion.
29) Know Antiepileptic Drug, Manic Depressant Drug, and Bronchial Passage relaxant
drugs. AGain you will find it on page 114.

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30)TSH for ?= distinguish primary and secondary Hyperthyroidism or Hypothyroidism.
31)TSH is low in Kid, what Test you going to do to confirm for hyperthyroidism? T3 or
Free T4?
32) Exposure to AIr for Blood Gas? pH and O2 high and Co2 and PCO2 low

33)
Picture of RBC cast= Glomerulonephritis. See Page 394 Q-104.
34)page 405 Review Body Fluid From Question # 166 to 216 Memorise them by heart
LoL, Instead of confusing yourself from wrong Questions Posted on Indeed.
So focus on Questions from Body Fluid such as # 167 Turbid CSF=WBC and Bacteria,
Incase of Synovial Fluid why is cloudy?= Crystals or WBC, Q # 173 in regular case
strong birefringent is monosodium urate but when compensated polarised filter used
its opposite, in this case Positive Birefringent will be Calcium Pyro which Blue when
parallel.
Q # 175 Page # 407 on BOC…what is prinicpal Mucin?
Q # 179 I explained alreasdy MSU is negative Birefringent in case of Compensator,
Know exudate Vs Transudate, Cystic Fibrosis, Q #187, 205, 206, PSA tumor Marker?
Fecal Fat Test?
Synovial Fluid = small clot= Inflammation. Q # 208 —>exact same Question on ASCP.
So from this Few Questions I got 5 on Body Fluid.
Q34) Do all the Questions on Fungi from BOC only. No need to spend extra time on
this useless thing. I got 5 and I hate Mycology but 10 minutes review on BOC Book for
the first time in life and I believe its my last time too just before entering the exam
center saved me. I got Question about cigar shaped –> check on BOC, its just 3 pages
on Fungi., Mucor= Rhizoid, Malasala fur fur LoL no idea how to pronounce this shit. u
will find it on BOC again.
Q35)DOn’t spend time on Mycobacterium I got Zero Questions.
Q. Why is albumin the first protein to be detected in tests for renal failure?

a. its molecular size is largest

b. its molecular size is smallest

c. it is very negatively charged

—————————————————————————————-

Corr wbc count with 50 cells ( I changed it to wbc X 50 divided by (nRbcs + 100),

ANA patterns, abs, diseases

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conj and unconj bili, urobilinogen,inc and dec

coag inc and dec ptt,pt

cocaine metabolite,
moth ball intoxication ( i guessed basophilic stippling still cant find it)
moth ball intoxication will see what in RBC ?

(Naphthalene is the main chemical compound used in moth balls):”The most common
toxic effect observed in the laboratory following oral ingestion or inhalation of
naphthalene is hemolytic anemia, evidenced by a rapid decrease in hemoglobin and
hematocrit levels, an elevated reticulocyte count and serum bilirubin level, and the
presence of Heinz bodies on a peripheral blood smear.”

know which anemias are micro/macro/hypo/hyper, I calculated rbc indices to rule out
answers.

question on lyme disease i forgot what it asked.

how to measure HDL (precipitate out other lipoproteins)

density of proteins in decreasing to ascending order I dunno what IDL is but I put it in
between VLDL and LDL.

Normal total CK but increase in troponin in what? (got it down to unstable angina or
acute M.I)

urine from catheter rapid analysis only need to setup which two plates for micro?

nitroprusside detects what? Acetone

gardn vaginalis needs= human blood Agar

c-reactive protein =inflammation

guy is coughing, pnemoniae ruled out= bordatella

ersipelothrix bacteria = butchers and meat cutters

Reactions for enterobactericiae: know the main differential ones

morganella vs providencia =citrate

mycobacterium in tap water? gordonae

what stain to see lipid? i said oil red o only one that made sense

no cell markers, only molecular was pcr steps eaaaaasy

A1, A2 and anti- H

picture of dysmorphic rbcs and asked why (got it down to oxidizing drugs or
antimalarial drug)

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Listeria= cold enrichment

c. dificile not reverse camp pos, =its perfringens

—-> Very important—> one said strep b was neg on CAMP test w/ s. aureus, do what
next (do biochem rxns for b or run CAMP with beta lysin s. aureus I chose this)

inc in pmns in bact mening, lymphs in viral

small qc zones b/c 1.0 mcfarland standard used

alpha thal has hgb H disease and barts

at end of protein electro which is closest to the cathode (gamma and beta)

asked about a csf electrophoresis showing anodal band to albumin (picked normal
results)

lactic acidosis 2 questions, and how to measure it

know both diabetes and icto test .

after getting blood thru IV what do potass levels do? decrease

which worm causes autoinfection

had 2 questions, one which increases/or falsley inc hgA1c and what decreased A1c=
increases in HgS and iron defiecency

decreases in Hem0lytic anemia and RBC destruction.

met acidosis= diabetic ketoacidosis = Increase in Anion Gap

excess edta causes ?

what hepatis ag/ab will make sure vaccination has occured = Ag s= active, Ag
E=infectious Antibody S= Immune.

mucor has =no rhizoids

strep a in= glomerularnephritis

disease with bite cells or blister cells

monitor antithrobin3 with monitoring what = TT Thrombin Time

Why is albumin the first protein to be detected? Low mol weight

burn patient w Pseudomonas aeruginosa accompany with ? another bac teria= S

Aureus

morganella vs providencia

how many bag blood to prepare platelet apheresis

Page 162 of 312

PCR Steps?

alpha thalassemia with what Hb?

small qc zones b/c 1.0 mcfarland standard used

diabetes and icto test

measure HDL?

baby w RH+ O mom w Rh- O baby need transfusion what blood should give?

muscle dystrophy what enzyme increase = LD, CK and AST.

teardrop RBC what disease =myelofibrosis

anion Gap increase indicate what disease = Lactic acidosis, Diabetic ketoacidosis,
Metabolic acidosis.

blood gas use what tube/synringe to transport = Heparin anticoag and ice and tested
ASAP

CNS smear what condition = see BOC Lab determination for Hematology.

proteus,klebsiella rxn
how many grams are needed to make a 3% solution of NaCL. Calculations= review
some common Maths.

Calculate LDL= Total chol-HDL-TG/5

What would cause a false positive for protein on a UA test strip= radiographic Dye

What do you do if you see your coworker …gosh I can’t remember what my coworker
was doing but it was a silly question. I chose tell my supervisor?

LDL is made up of mostly ? Apo B and Cholestrol.

which fat LDL, HDL, VLDL has the most cholesterol= LDL most cholestrol.
glycosis has an end result of ? = pyruvate, Lactate or lactic acid.

———————————————————————————-

1) HACEK group what belongs to.

2) PAS stain negative and sudden black stain positive what disease.

3) Yellow, Turbid urine what should be?

4) APTT, PT and TT all prolonged?

5) Patients with DIC, patient RBC decreased, Platelet decrease?

6) Rhogham , how many vials equal to blood?

7) ESR increase in what? Choices were A) Ammonia B) Platelet c) Fibrinogen.

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8) What is standard practice. A) student read parasite slide that instructor gave
them B) student memorize coag cascade and gave exam C) student fix instrument
after reading operator manual.

9) Alk/acid butt question, citrate positive and something more.

10) Antibody panel I had 2 questions.

11) TP/TP+FN, but it was with wording and long sentence.

12) This spiral-form organism is seen in urine and cultured on Fletcher’s media.

13) Synovial fluid collected in anticoagulant tube, what do you use to dilute the
specimen?

14) HBa1c levels control , but glucose levels high today why?

15) Respiratory acidosis/alkalosis, metabolic alkalosis/acidosis.

16) ANA Picture

17) Rh- mother has increase titer of anti-D. After delivery, the DAT is strongly (+) but
the baby is Rh-

a) inadequate washing

b) added monoclonal anti-D sera instead of anti globulin (or vise versa)

c) or maternal antibodies blocking the antigenic site

18) 15 units of platelet requested for A – patient

Available: A- =1unit

A = 6units

O- = 15 or something

a) transfuse A units

b) transfuse 15 O negative

C) find out need of 15 unit need or not.

19) Cryo = 80ul

20) Bhcg is negative and patient think she is pregnant, but all test are negative.

21) 17- ketosteriod

22) Disease associated with the following results? Elevated TSH; Elevated T3;
Elevated free T4

23) Only FT4 with something what is it for something like that?

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24) Picture with renal epithelial cells in urine to identify.

25) Spherocytosis is what condition.

26) If clumping RBC what what would u do, increase angel of slide, decrease angel
something like that.

27) If rbc to blue what would u do? Decrese PH, increase ph of buffer.

28) Blood was collected on Nov 1. Blood was then frozen in glycerol on Nov 5. What
should the expiration date read?

a. Nov 1; 1 year from now

b. Nov 5; 1 year from now

c. Nov 1; 10 years from now

d. Nov 5, 10 years from now

28) Fiber strands in urine resemble what under the microscope?

[Link] cast

[Link] cast

[Link] cast

[Link] granular cast

A. Fiber strands can be mistaken for hyaline casts.

29) Something with CMV and EBV virus.

30) Mold picture aspergillums.

31) Giardia and another fungi picture.

32) Instrument gave Platelet only 30 what would you see per field under microscope?
3-10, 10-15 something like that.

33) Proteolytic enzyme treatment of red cells usually destroys which antigen?

A. Jka

B. E

c. Fya

D. k

A. Is C

34) Q. Which of the following antigens gives enhanced reactions with its
corresponding antibody following treatment of the red cells with proteolytic enzymes?

Page 165 of 312

A. Fya

B. E

C. S

D. M

A. B, RH Ab’s are enhanced by enzymes.

35) MIC what is it..minimum inhibitory concentration.

36) Autoclave temperature.

37) Cardiac marker elevate in acute MI?

38) If in emergency what kind a blood would you give? autologus, direct, homologous
something like that.

__________________________________________________________________________

1. Von Willebrand Disease

2. Bernard- Soulier Disease (this is the answer)

3. Congenital afibrinogenemia

4. Glanzmann’s thrombasthenia

5. Alpha hCG marker of malignancy:

6.

1. Choriocarcinoma

2. Testicular Cancer

3. Pancreatic (answer)

4. Nonseminomatous

5. If the protein elevation from B1B2 and gamma are to merge

together, what immunoglobulin would I indicate?

1. IgM

2. IgA (answer)- this starts to form alpha2 end gamma

3. IgD

4. IgE

5. What are DAT applications?

1. What is RHOGAM, when are you going to give it and what will it do to the
patient?
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 1. In an emergency, what blood type of blood would you give if the red cells are
needed or plasma is required and the blood type is unknown?

1. Would you phenotype a patient who had been transfused within the last 3
months?

1. Potassium is high but the blood sample is not hemolyzed, patient does not show
symptoms what do you think happened?

1. Control was high even after you repeat it, what’s the next step that you would
do?

I would re run calibration

1. What is the isoagglutinations in type O?

1. Parasites that cause autoinfection in immunocompromised patient….

1. Storage Temperature and time for RBC, PLTS, CRYO, FFP…

1. RBC storage time – Storage temperature 1-6 degrees Celsius, shelf life
35days CPDA-1. 42days AS-1

2. Platelets storage time – Storage 20 – 24 degrees Celsius shelf life 5 days

with agitation

3. Cryoprecipitate storage time – shelf life12 monts, after thawing transfuse

within 6 hours

4. FFP storage time- Shelf life 12 months, after thawing, tansfuse within 24
hours.

1. What is the meaning of beta and gamma zone merge

Ans. Beta zon- total hemolysis, the colony or bacteria on Red blood Agar plate lyses
the RBCs, therefore surrounding of the colony appear as clear or transparent

Which of the following index will be exchanged if moved out the buffy coat in Lipemia
specimen? (Lipemia can falsely elevate ALT and AST. Additionally, it can indicate that
the patient did not adequately fast for 12-18 hours before having the specimen
collected. In this situation, glucose and triglycerides will be elevated.)

1. Triclycerides

2. HDL (answer)

3. LDL or VLDL

4. CM

5. Chlolesterol

6. What is the truw Ca? How do you measure it

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50% Ca is free + 40 % + bind to protein + 10 % bind to anion (phosphate etc.) =
100% total Ca

1. What does Hgb M mean?

Hgb M is methemoglobin. Normail patient Hgb M is about 1%

1. WBC: 22.0 could see dohle body, toxic granules. According to this case which is
correc?

1. Bacterial infection

2. Vital infection

3. What is the specific test for E. coli?

1. Anti- F will not react with:

1. cDE CDE

2. Cde CdE

3. Cde Cde

4. eDe CDe

5. Which product we should use when the patient has fever when transfusion
the blood?

1. WBC- reduce RBCs

2. Irradiated RBC

3. Wash RBC

4. What else could cross placenta except Anti-D (IgG)?

Ans. Bilirubin, Drugs, gases, hormone…

1. Blood culture in aerobic and an anaerobic bottle are negative, but in gram stain
smear shows gram positive bacteria. What should you do next?

1. After 2 days of blood culture, technician found gram positive cocci, what should
you do next?

1. Report to doctor (answer)

2. Gram positive cocci culture

3. Maybe contaminated by skin when collecting specimen

4. What is the reason for Synovial Fluid Turbidly?

1. Crystals

Page 168 of 312

 2. Protein (answer)

3. immunoglobulin

4. Mother Rh(-), but DAT(+) her baby is Rh (-). What is the reason for
discrepancy?

Ans. DAT(+) – baby RBC is sensitized by antibody.

1. Mother B Rh(-), Father AB Rh (+). Child 1 A Rh(-) Child 2 B Rh (+). Which is

correct

1. Parental is rule out

2. Parental cannot rule out (answer)

3. Child 1 can rule out

4. Child 2 can rule out

5. Produce #1 detected 50/100 true positive and 100/100 true negative.

Produce 2# detected 80/100 true positive and 70/100 true negative

1. Produce 1 is more sensitive

2. Produce 2 is more sensitive

3. Produce 1 is more sensitive and specific

4. Produce 2 is more sensitive and specific

5. TP/TP +FN =?

1. Sensitivity

2. Specificity

3. Precision

4. Variance

5. What might the following indicate? Urine: RBCS, WBCs, nitrite,

bacteria.

1. a. Pyelonephritis- kidney infection caused by

bacteria or virus

2. Glomerulonephritis- renal disease usually affects both

kidneys. Blood or protein in urine.

3. Nephrotic syndrome – Nephrotic syndrome is a group of

symptoms that include protein in the urine, low blood
protein levels, high cholesterol levels, high triglyceride
levels, and swelling
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 4. renal calculi – A kidney stone is a solid mass made up of
tiny crystals.

1. Why is albumin the first protein to be detected in tests for renal failure?

1. It’s molecular size is large

2. Its molecular size is smallest

3. It is very negatively charged.

4. Cortisol excess will result in…. ( An excess ofcortisol can also lead to a
decrease in insulin)

1. Hypernatremia – is a common electrolyte problem and is defined as

a rise in serum sodium concentration to a value exceeding 145
mmol/L

2. Hypokalemia – is a lower-than-normal amount of potassium in the

blood.

3. Elevated glucose levels in blood

4. Decreased glucose level in blood. (answer)

1. What is the reason for this discrepancy or what would you do to resolve the
discrepancy.

Patient cells Anti- A 3+, Anti- B 3+ Patient serum A cell 1+ B cells 0

1. This spiral- form organism is seen in urine and cultured on Fletcher’s media

1. Borrelia – is a genus of bacteria of the spirochete phylum

2. Leptospira – is a genus of spirochaete bacteria, including a small number

of pathogenic and saprophytic species. Spiral Shaped.

3. Organism that gives off a bleach like odor in culture?

1. Actinobacillus – a genus of gram-negative, immotile and nonspore-

forming, oval to rod-shaped bacteria occurring as parasites or
pathogens in mammals, birds, and reptiles

2. Eikenella corrodens – is a fastidious gram-negative facultative

anaerobic bacillus – the colonies are small and greyish, they
produce a greenish discoloration of the underlying agar and smell
faintly of bleach (answer)

3. Presence of rheumatoid factor in blood may result in false positive

for what test?

Page 170 of 312

Ans. VDRL – The VDRL test is a screening test for syphilis. It measures substances,
called antibodies that your body may produce if you have come in contact with the
bacteria that cause syphilis. This bacteria is called Treponema pallidum.

1. 36. Diseases associated with the following results? Elevated TSH; Elevated T3;
Elevated free T4

1. a. hypothyroidism – is disorder in which the parathyroid glands in

the neck do not produce enough parathyroid hormone (PTH).

2. b. Hyperthyroidism – means your thyroid makes too much thyroid

hormone. Secretes excessive amounts of the free (not protein bound, and
circulating in the blood thyroid hormones, triiodothyronine (T3)
and/or thyroxine (T4) (ANSWER)

3. c. Pituitary tumor

1. If excess parathyroid hormone (PTH) is being released, what would you find in
elevated amount of serum?

1. Calcium – High levels of PTH cause serum calcium levels to increase and
serum phosphate levels to fall.

2. Potassium

1. Mucoid, pink colonies on plate; produces gas; indole (+). On TSI tube you see
yellow on the slant and yellow in the deep. What organism is this? Indole
positive test- Indole positive test- appearance of pink layer on top (E.g.
Escherichia Coli)

2. Salmonella

3. [Link]

4. Klebsilelle pneumonia – Gram-negative, non-motile, encapsulated, lactose

fermenting, facultative anaerobic, rod shaped bacterium

5. Klebdiella oxytoca – is a Gram-negative, rod-shaped bacterium that is closely

related to K. pneumoniae, from which it is distinguished by being indole-
positive. K. oxytoca is characterized by negative methyl red, positive VP,
positive citrate, urea and TSI gas production, is AA, and negative for TSI sulfide,
DNAse,SIM motility and PAD.

6. PAD (+); indole (+); organism stain gram negative. What is it?

1. Proteus vulgaris – is indole positive, Gram negative

2. P. mirabilis – indole negative , gram negative

3. You see curved gram negative bacilli (rod shape). It was cultured from the
GI tract of a person with ulcers. What test would you do next to confirm its
identity?
Page 171 of 312
Ans. Urease.

1. Enzymes controls run on a machine give results around -3 standard deviations.

Samples run on the same machine give results less than 1 SD. What could be
the problem?

1. Controls are expired

2. Controls were left a room temperature

3. HIV- 1 and HIV-2 combination ELISA test is positive in a patient with

symptoms of immune deficiency. Western blot was inconclusive for HIV-1.
What do you do next? (Enzyme-linked immunosorbent assay is a test that
uses antibodies and color change to identify a substance)

1. Re run western blot for HIV-1

2. Do a CD4 cell count

3. Do HIV- 2 ELISA

4. Do HIV- 2 western blot (answer)

5. Steps to polymerase chain reaction (PCR)? PCR – is a biochemical

technology in molecular biology to amplify a single or a few copies
of a piece of DNA across several orders of magnitude, generating
thousands to millions of copies of a particular DNA sequence.

1. Transduction, transcription, annealing

2. Annealing, denaturation

3. Denaturation, annealing, transcription (answer)

4. A radioallergosorbent test RAST test detects what?

Answer. IgE to particular antigen. RAST- is a blood test used to determine what
substance a person is allergic to.

1. 45. After collecting blood sample in an EDTA tube you find that the
hematocrite is very high (67%) What would you do?

1. a. Collect blood again, but use less sodium citrate

2. b. Collect blood in heparin

3. c. Proceed with what you already.

4. 46. When you conduct a procedure using fluorescence it is important to

protect yourself from the :

1. a. Cover light

2. b. Emitted light
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 3. c. Exciting light

4. 47. Blood was collected on November 1. Blood was frozen in

glycerol on November 5t. What should the expiration date read?

1. a. November 1: 1 year from now

2. b. November 5: 1 year from now

3. c. November 1: 10 years from now

4. d. November 5: 10 years from now.

5. 48. A person was successfully treated for syphilis 12 years

ago. However he has just come in again worried about having
been reinfected. What would you look for in he blood?

1. a. TP-A

2. b. VDRL ( answer)

3. 49. You suspect someone might have JKa, K ,and C

antigen on their red cells. You figure out that they don’t
have Jka. You also test their serum and see the
following. What would you conclude?

Reagent K cells reagent cells

Patient serum 0 4+

1. a. Confirm patient as aving K and C antigen on their red cells

2. b. Rule out c and confirm K on their red cells (answer)

3. c. Rule out C and K

4. d. Rule out C but cannot confirm the presence or absence of K.

5. Reagent strip detected no proteins but sulfosalicylic acid test (is used in urine
tests to determine urine protein content) did. Why?

1. Reagent strip is expired

2. Bence Jones protein in urine (Bence Jones proteins are a part of regular
antibodies, called light chain)

3. 51. Fiber strands in urine resemble what under the microscope?

1. a. Waxy cast

2. b. Hyaline cast

3. c. WBC cast

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 4. d. Fine granular cast

5. Which of the following regulates myocyte contraction? (a refers to

a contraction initiated by the myocyte cell itself instead of an
outside occurrence or stimulus such as nerve innervations)

1. Myoblobin – is an iron- and oxygen-binding protein found in

the muscle tissue of vertebrates in general and in almost all
mammals

2. Cardiac troponins – T (cTnT) and troponin I (cTnI) are cardiac

regulatory proteins that control the calcium mediated
interaction between actin and myosin.

3. Creatine kinase-MB (CK- MB)

4. HbA1c level cannot always be used to monitor glucose levels

in conditions such as;

Answer: Sickle Cell Disease

1. Western blot was run for HIV testing and the result as indeterminate. What
should you do next?

1. Rune again

2. Do ELISA

3. What happens when there is intravascular hemolysis?

Answer. Decrease heptoglobin – Haptoglobin is an acute-phase reactant whose

principal clinical utility is in defining conditions of hemolysis.

1. A postpartum female with a history of transfusion test positive for Anti- D. What
is your next step?

1. Report result and Anti-D

2. Screen for additional antibodies (answer)

3. No further testing is required

4. Assume the anti- D is rhogam and report result

5. The same antibody was found in 3 different patients. The results of testing
are listed below. Which antibody is most likely to be present?

IS 37 AHG

Patient 1 0 2+ 0

Patient 2 2+ 0 0

Patient 3 0 0 2+
Page 174 of 312
1. Anti – Jka

2. Anti- K

3. Anti- M

4. Anti- Leb

5. Difference between Citrobacter and Salmonella.

1. Bilirulin: RGT strip (-), Icto test (+)?

1. Which of the following antigens gives enhanced reactions with its corresponding
antibody following treatment of the red cell with proteolytic enzymes?

1. Fya

2. E (answer)

3. S

4. M

5. Proteolytic enzyme treatment of red cells usually destroys which

antigens?

1. JKa

2. E

3. Fya (answer)

4. K

5. Reagent strip detect no protein but sulfosalicylic acid test did. Why?

1. Reagent strip was expired

2. Bence Jones protein in urine

3. A blood sample is left on a phlebotomy tray for four hours

before it is delivered to the laboratory. Which group of test
could still be performed?

1. Glucose, Na, K, Cl, PC02

2. Urine acid, BUN, creatin (answer)

3. Total and direct Bilirubin

4. CK, ALT, ALP, ACP

5. This suspicious form, that measure 25 um, was removed

in an eye sample. It is associated with which of the
following disease?
Page 175 of 312
Answer: Amoebic Keratitis – Amoebic infection of the cornea is the most serious
corneal infection, usually affecting contact lens wearers

1. Eosinophilia (most commonly seen as a result of allergic reaction, medication

reaction, parasitic infection) is commonly found in which of the following
disorder(s):

Answer: Parasitic infection and allergic reactions.

1. All of the following are sources of serum alkaline phosphate except

1. Liver

2. Placenta

3. Intestine

4. Brain

5. Which of the following is detected primarily in the antiglobulin phase of

the crossmatch:

1. Anti- Fya ( answer)

2. Anti- M

3. Anti- B

4. Anti- P1

Anti-M, B, P1- are typically IgM and may agglutinate saline suspended cells at room
temperature.

1. What to do with an eosinophil when encountered in a leukocyte alkaline

phosphatase (LAP) count?

2. What is the BNP test? A brain natriuretic peptide (BNP) test measures the
amount of the BNP hormone in your blood. BNP is made by your heart and
shows how well your heart is working. Normally, only a low amount of BNP is
found in your blood

3. The most common cold agglutinin?

1. I

2. P1

3. M

4. Procedure for Lactic acid test…

Answer: blood needs to be collected and immediately chilled, separated within one
hour

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 1. For synovial fluid to check mucin clot, what do you add?

Answer: the adding of acetic acid to normal synovial fluid, which causes clot formation
The compactness of the clot and the clarity of the supernatant fluid are the criteria on
which the result is based.

————————————————————————————————

Part -2

Q-Effects of caffeine (coffee) on conjugated and unconjugated bilirubin?

A. The Jendrassik and Grof reaction uses a diazo reagent with caffeine as an
accelerator.

Q. Gardnerella Vaginalis, in order to culture, what nutrient(?) do you add?

A. colistin-oxolinic acid blood agar

Q. Many gram neg bacilli in the urine and nitrite is negative, why?

A. The bacteria that is present is not a nitrate-reducer/ and The urine was in the
bladder for an insufficient amount of time for nitrate to be reduced to nitrite

Q.-Muscle tremor(?), increased Na, decreased K in the body, what hormone causes
that? (ADH or Aldosterone?)

A. Answer is Aldosterone. This hormone causes inc. blood pressure, retention of Na+,
and excretion of K+. ADH increase leads to increase water retention via distal tubules
and secretion of Na+

[Link] RBC product is delievered, proper storage temperature?

A. Delivery is 1-10C, and storage is 1-6C

[Link] AHF products was thawed/prepared at 10 am, patient has X-ray at

2 pm (takes about few hours), what will you do with the product? Proper storage is at
room temp, the expiration is 6 hours, and 4 hours if pooled.

[Link] anion gap due to (metabolic acidosis or metabolic alkalosis?)

A. Anion gap is Na+K – (Cl+HCO3). Metbolic alkalosis means high hco3, this would
decrease the anion gap. Metabolic acidosis means decreased hco3, which would
increase the anion gap.

[Link] the ACETEST completely rule out ketoacidosis?

[Link], the ACETEST reaction, sodium nitroprusside, does not react with beta-
hydroxybutyrate

[Link] see something gram negative under the microscope. You culture it and it gives
off a bleach like odor. What is it

Page 177 of 312

A. Eikinell corrodens, also causes pitting on agar.

Q: Reagent strip detected no protein but sulfosalicylic acid test did. WHy?

a. reagent strip was expired

b. bence jones proteins in urine

A. Reagent strip detects albumin, whereas SSA detects proteins in general. So,
answer is bence jones proteins caused reaction with SSA test.

Q: Fiber strands in urine resemble what under the microscope?

[Link] cast

[Link] cast

[Link] cast

[Link] granular cast

A. Fiber strands can be mistaken for hyaline casts.

Q. newborn-Meningitis-Hydrolyze sodium hippurate. Next test to confirm diagnosis?

A) Optochin disk

B) Bacitracin test

C) CAMP test

D) Coagulase test

A. answer is C, Hippurate hydrolysis and CAMP test confirm strep group B, S.

agalactiae.

Q. A CSF culture from a 1 year old child shows no growth on blood agar or MacConkey,
and a few small, smooth, transparent colonies on chocolate agar. A gram stain reveals
tiny pleomorphic gram-negative rods. the technologist set up XV STRIPS and a rabbit
blood agar. The next day, he observes growth between the X and V strips and no
hemolysis on the rabbit agar plate. What should be reported.

A. Haemophilus influenzae

Q. 2. Proteolytic enzyme treatment of red cells usually destroys which antigen?

A. Jka

B. E

c. Fya

D. k

A. Is C
Page 178 of 312
Q. Which of the following antigens gives enhanced reactions with its corresponding
antibody following treatment of the red cells with proteolytic enzymes?

A. Fya

B. E

C. S

D. M

A. B, RH Ab’s are enhanced by enzymes.

Q. Procedure #1 detected 50/100 true positives and 100/100 true negatives.

Procedure #2 detected 80/100 true positives and 70/100 true negatives.

a. procedure 1 is more sensitive

b. procedure 2 is more sensitive

c. procedure 1 is more sensitive and specific

d. procedure 2 is more sensitive and specific

A. B, procedure 2 is more sensitive, detection of disease. The other are entirely wrong
or partly wrong.

Q. TP/TP+FN = ?

a. sensitivity

b. specificity

c. precision

d. variance

A. The question is one of sensitivity, so answer A. Specificity would be TN/TN+FP

Q. What might the following indicate?

urine: RBCs, WBCs, nitrite, bacteria

a. pyelonephritis

b. glomerulonephritis

c. nephrotic syndrome

d. renal calculi

A. Answer A is correct.

Q. Why is albumin the first protein to be detected in tests for renal failure?

Page 179 of 312

a. its molecular size is largest

b. its molecular size is smallest

c. it is very negatively charged

A. B is correct. These are not good choices because its really damage to the
reabsorption process that allows albumin to pass, including other proteins. Since
Albumin is a very low molecular weight protein, answer B is the right choice. C, is
opposite, because of Albumin’s very negative charge, it does not end up in urine.

5. Cortisol excess will result in _____

a. hypernatremia

b. hypokalemia

c. elevated glucose levels in blood

d. decreased glucose levels in blood

A. C is correct choice. Cortisol is an insulin antagonist, which prevents cell glucose

uptake, thereby increasing blood glucose levels.

Q.. What is the reason for this discrepancy or What would you do to resolve this
discrepancy?

Patient cells Patient serum

anti-A anti-B A cells B cells

3+ 3+ 1+ 0

A. This is a reverse group discrepancy, most likely to a subgroup of A.

Q. This spiral-form organism is seen in urine and cultured on Fletcher’s media

a. Borrelia

b. Leptospira

note: I had this question on the exam so I will update this one.

A. B, Leptospira

Q. . Organism that gives off a bleach-like odor in culture?

a. Actinobacillus

b. Eikenella

A. B, Eikenella

Q. Presence of rheumatoid factor in blood may result in false positives for what test?

Page 180 of 312

a. VDRL

A. VDRL and RPR, because both have same false positives. EBV infection, pregnancy
and other autoimmune disorders.

Q. Disease associated with the following results? Elevated TSH; Elevated T3; Elevated
free T4

a. hypoparathyroidism

b. hyperparathyroidism

c. pituitary tumor

A. C is the correct choice. I think answer choices A and B were meant to be hypo and
hyper thyroidism. Hypothyroidism presents with increased TSH and decreased T4 and
T3. Hyperthyroidism presents with decreased TSH and increased T4 and T3.
Secondary hyperthyroidism presents with increased TSH, T4 and T3. Secondary
hypothyroidism presents with decreased presents with decreased TSH, T4 and T3.

Q. If excess PTH is being released, what would you find in elevated amounts in serum?

a. Calcium

b. Potassium

A.. PTH regulates calcium release from bones, and an excess of PTH would lead to
increase calcium and decreased phosphorous.

Q. Mucoid, pink colonies on plate; produces gas; indole (+). On TSI tube you see
yellow on the slant and yellow in the deep. What organism is this?

a. Salmonella

b. E. coli

c. Klebsiella pneumonia

d. Klebsiella oxytoca

A. B is correct choice. E. coli is indole, lactose positive, and presents A/A, G on TSI.
Salmonella is indole lactose negative and presents with Alk/A, H2S+ TSI. Klesbsiella
has the same TSI as E. coli but is indole negative.

Q. PAD (+); indole (+); organism stains gram negative. What is it?

a. P. vulgaris

b. P. mirabilis

A. A, is correct choice. P vulgaris is indole +

Q. You see a curved gram negative bacilli. It was cultured from the GI tract of a
person with ulcers. What test would you do next to confirm its identity?
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a. Urease.

A. Urease (H. pylori.)

Q. Enzyme controls run on a machine give results around -3 standard deviations.

Samples run on the same machine give results of less than 1 standard deviation.
What could be the problem?

a. controls are expired

b. controls were left at room temp

A. B is correct. Enyzmes are more active at 4 degrees celsius, and are preserved
best. Enzymes will degrade quickly at room temp.

Q. HIV-1 & HIV-2 combination ELISA test is positive in a patient with symptoms of
immune deficiency. Western blot was inconclusive for HIV-1. What do you do next?

a. rerun western blot for HIV-1

b. do a CD4 cell count

c. do HIV-2 ELISA

d. do HIV-2 western blot

A. D is correct choice. The FDA states that if an HIV1/2 ELISA is postive and a
subsequent HIV-1 Western blot is negative or inconclusive, and ELISA for HIV-2 should
be performed only if there are no symptoms…but, in this case the patient has immune
deficiency symptoms, so an HIV-2 Western Blot test should be performed.

Q. Steps of PCR?

a. transduction, transcription, annealing

b. annealing, denaturation, transcription

c. denaturation, annealing, transcription

A. C is the correct choice.

Q. RAST test detects what?

a. IgE to particular antigens

A. The RAST test is a specific alergen test whereas RIST is a general allergt test.

Q. After collecting a blood sample in an EDTA tube, you find that the Hematocrit is
very high (67%). What should you do next?

a. collect blood again, but use less sodium citrate in the tube

b. collect blood in heparin

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c. proceed with what you already have

A. A is coorect choice. A hematocrit > 55% requires an adjustment in the

anticoagulant used in coag assays, NaCitrate tubes. This concept is a bit confusing
becasue we usually learn that coagulation tests require 3.2% sodium citrate with a
blood to aniticoagulant ration of 9:1. If you have never had to make this adjustment,
you might think that a high hemaocrit >55%, will mean a deviation from the 9:1 ratio
in favor of more blood, thus the blood to anti-coagulant ration will be greater than
9:1…but, this is not the case. The high hematocrit means less plasma, thus you have
excess anticoagulant. So the high hematocrit adjustment means you need to remove
excess antocoagulant.

Q. When you conduct a procedure using fluorescence, it’s important to protect

yourself from the:

a. cover light

b. emitted light

c. exciting light

A. B is correct choice.

Q. Blood was collected on Nov 1. Blood was then frozen in glycerol on Nov 5. What
should the expiration date read?

a. Nov 1; 1 year from now

b. Nov 5; 1 year from now

c. Nov 1; 10 years from now

d. Nov 5, 10 years from now

A. C is correct choice, 10 years from date of draw.

Q. A person was successfully treated for syphilis 12 years ago. However, he has just
come in again, worried about having been reinfected. What would you look for in his
blood?

a. TP-A

b. VDRL
Answer is VDRL —> Unlike non-treponemal tests, which show a decline in titers or
become nonreactive with effective treatment, most treponema-specific tests usually
remain reactive for life. Because of the persistence of reactivity, possibly for the life of
the patient, treponemal tests are of no value to the clinician in determining relapse,
reinfection, or treatment efficacy. Therefore, a reactive treponemal test result only
indicates exposure to T. pallidum at some time during a person’s life. It does not
indicate that the person currently has an active syphilis infection.

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Q. You suspect someone might have Jka, K and c antigens on their red cells. You
figure out that they don’t have Jka. You also test their serum and see the following:

reagent K cells reagent c cells

patient serum: 0 4+

What can you conclude?

a. confirm patient as having K and c antigens on their red cells

b. rule out c and confirm K on their red cells

c. rule out c and K

d. rule out c but cannot confirm the presence or absence of K

A. D is correct choice.

24. Reagent strip detected no proteins but sulfosalicylic acid test did. Why?

a. reagent strip was expired

b. bence jones proteins in urine

25. I was shown a picture of what I believe were several immature granulocytes in a
peripheral blood smear. What stain should you use next to figure out this persons
problem?

a. specific esterase

b. non specific esterase

c. LAP

26. Syndrome of inappropriate ADH secretion would result in what in blood?

a. excess potassium

b. excess sodium

c. excess non-serum water (?something like that?)

d. deficient potassium

e. deficient sodium

27. Fiber strands in urine resemble what under the microscope?

a. waxy cast

b. hyaline cast

c. WBC cast

d. fine granular cast

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28. Which of the following regulates myocyte contraction?

a. myoglobin

B. cardiac troponins

c. CK-MB

29. HBa1c levels cannot always be used to monitor glucose levels in conditions such
as:

a. sickle cell disease

Q. The most common cold agglutinin?

A. Anti-I, is responsible for cold agglutinin disease. anti-P causes PCH, and anti-e
causes Warm Autoimmune Hemolytic Anemia

Q. Synovial fluid collected in anticoagulant tube, what do you use to dilute the
specimen?

A. Saline or Phosphate buffer with hyaluronidase…..you can’t use acetic acid because
it disrupts the hyaluronic componenet and will form a clot

Q. Bloodbank, in forward, reverse reaction… reaction in forward, but no reaction in

reverse, what will do you?

A. Incubate at room temp for 15-20 minutes. The reverse reaction is usually due
some immunodepressed event and the reactions will reveal.

Q. Lactic acid blood collection and processing?

A. Collect in Grey top, Sodium Fluoride, chill immediately and separate within 1 hour.

Q. Synovial fluid… what makes its cloudy turbity

A. White/cloudy is crystals….yellow/cloudy is WBC’s, imflammtion or infection. red, or

xanthchromic color is bleeding

Q. Rice body inclusions in synovial fluid indicate what disease?

A. Rice body inclusions are seen in Rhematoid arthritis

Q. Bacteria acquired by butcher (or meat packer)?

A. Brucella abortus, disease brucellosis

[Link] crystal in synovial fluid… it causes what disease? (gout? psudogout?)

A. pseudogout, calcium pyrophosphate…..They are positively birefringent, appearing

blue when aligned parallel with the slow axis of the compensator and yellow when
perpendicular.

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Calcium pyrophosphate are rhomboid shaped crystals. monosodium urate crystals
are negatively birefringent, needles, and cause gout.

Q. For synovial fluid to check mucin clot, what do you add?

A. acetic acid-this causes a clot to form in normal synovial fluid…a poor clot formation
with cloudiness is an indication of inflammation.

Q. When a test cross-react with Rheumatoid factor… relation with Sensitivity and
Specificity?

A. Cross reacting would produce a false positive , this would related to

specificity….which is TN/TN+FP…….sensitivity is TP/TP+FN

Q. This is platelet-vessel wall interaction,Bleeding time prolonged,Platelet counts

decreased and on peripheral smear, the platelets are increase in size. choose best
answere:[Link] Willebrand disease 2. Bernard-Soulier syndrome [Link]
afibrinogenemia 4. Glanzmann’s Thrombasthenia

A.. Bernard-Soulier disease

Q. alpha hCG marker of malignancy:

Choose best answere:a.) Choriocarcinoma

b.)Testicular cancer

c.)Pancreatic

d.)nonseminomatous

A. C is correct, marker of pancreatic cancer

Q. if the protein elevation from B1B2 & gamma are to merge together what
immunoglobulin would it indicate?

a.)IgM

b.)IgA

c.)IgD

e.)IgE

A. B is correct….

Q. fungus organism grows well with oil overlay technique(malassezia furfur)

A, Malassezia furfur

Q. HACEK group, what’s in it?

A. Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

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Q. when [Link] in in CSF, (i can’t remember exactly, does it have capsule or pili
something like that…)

A. It has a lipooligosaccharide (LOS) that acts as an endotoxin and hemolyzer…

responsible for septicemia……capsule that prevenst phagocytosis, and pili for
attachment and cell internalization.

Q. Rickettsia…rickettsi

A, Carried by Dermancter tick causes Rocky Mountain Spotted fever.

Q. -there was few questions about Fungus. with petridish picture,morphology.

and microscopic pictures, like Alternaria spp, Geotrichum spp, Trichosporon spp.

Q. What else elevates HA1c?

A. IDA, blood transfusions and other diseases that cause abnormal RBC turnover

Q. – pH7.56, pCO2=17.6, HOC: 38

A. This is termed a mixed acid-base disorder or a complex acid base disorder. I know
for sure becasue I was having trouble with this question and decided to use the online
acid-base disorder calculator….so it agrees

Q. -pH. 7.25 PCo2=36, bicarb: 17

A. metabolic acidosis

Q. CEA marker for what cancer?

A. Colectoral, colon cancer

———————————————————————————————–

Calculate LDL = check book

What would cause a false positive for protein on a UA test strip = Radioactive Dyes.
There were a few questions of interpreting lab results to determine which anemia =
calculate from MCV and MCHC
LDL is made up of mostly ? = cholestrol (Apo LipoProtein B)
which fat LDL, HDL, VLDL has the most cholesterol = LDL

glycosis has an end result of ? = Pyruvate and lactate

Why is albumin the first protein to be detected? = Low weight

burn patient w Pseudomonas aeruginosa accompany with ? another bacteria= Staph

Aureus.

morganella vs providencia= check my Table.

how many bag blood to prepare platelet apheresis= check blood bank book.

PCR steps= already discussed before.

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alpha thalassemia with what Hb?= Hgn A2 and F.= slight high and Low Hgb A

moth ball intoxication will see what in RBC= Heinz Bodies and Basophilic stippling.

small qc zones b/c 1.0 mcfarland standard used=0.5

icto test= for Bilirubin

muscle dystrophy what enzyme increase=AST, CK and LD.

teardrop RBC what disease= Myelofibrosis.

anion Gap increase indicate what disease= Diab. Ketoacidosis.

blood gas use what tube/synringe to transport= heparin and kept on ice immediately.

anaerobic bacteria= Review them. its just plain and simple in page 159 Bottom Line
book.

proteus,klebsiella rxn= check my micro Table.

Corr wbc count with 50 cells ( I changed it to wbc X 50 divided by (nRbcs + 100),

Blood bank discrepancies, panels, enzymes, what to do next, =check freezer temp
every 4 hrs!

ANA patterns, abs, diseases= check Bottom Line page 45 tables.

conj and unconj bili, urobilinogen,inc and dec= very easy check Bottom line Table.

cocaine metabolite, moth ball intoxication = Heinz and Basophillica stippling

know which anemias are micro/macro/hypo/hyper, I calculated rbc indices to rule out
answers.= check by MCV and MCHC.

question on lyme disease= Borrelia Burg.= Dear Tick.

how to measure HDL= (precipitate out other lipoproteins)

apoliprotein A is in what lipoprotein.=HDL

density of proteins in decreasing to ascending order I dunno what IDL is but I put it in
between VLDL and LDL.

Normal total CK but increase in troponin in what? = unstable angina or acute M.I

nitroprusside detects what?= Acetone. page 88 review table Bottom Line

gardn vag needs= human blood

c-reactive protein= inflammation.

guy is coughing, pnemoniae ruled out= bordatella

ersipelothrix and butchers disease.

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Reactions for enterobactericiae: know the main differential ones

morganella vs providencia =citrate

mycobacterium in tap water?= gordonae

what stain to see the cells in the cast?= i said oil red o only one that made sense

picture of dysmorphic rbcs and asked why ? =(got it down to oxidizing drugs or
antimalarial drug)

Listeria= cold enrichment

c. dificile not reverse camp pos,= its perfringens

very important Question—>one said strep b was neg on CAMP test w/ s. aureus, do
what next=Answer–> (do biochem rxns for b or run CAMP with beta lysin s. aureus I
chose this)

increase in pmns in bact mening, lymphs in viral

small qc zones b/c 1.0 mcfarland standard used=0.5

alpha thal has hgb H disease and barts.

at end of protein electro which is closest to the cathode= (gamma and beta)

asked about a csf electrophoresis showing anodal band to albumin =(picked normal
results)

lactic acidosis 2 questions, and how to measure it.

after getting blood thru IV what do potass levels do?= decrease

which worm causes autoinfection= check Parasitology.

had 2 questions, one which increases/or falsley inc hgA1c = Hg S or IDA(iron Def
Anemia)
what decreased A1c= Hemolysisi or RBC destruction.

high pH and something but what enzyme (Pagets was the answer b/c ALP (Alkaline
pH)

met acidosis= diabetic ketoacidosis

what hepatis ag/ab will make sure vaccination has occured= Hep Ab S

mucor has =no rhizoids (from Mycology)

Glomerularnephritis = Strep A

disease with bite cells or blister cells= Hemolytic and DIC

monitor antithrobin3 with monitoring what= TT

Page 189 of 312

————————————————————————————————

1. Beer's law states that the darker the color produced, the more light absorbed in the
specimen; the more light absorbed, the

A. Lower the concentration of the analyte

B. Higher the concentration of the analyte

C. More light transmitted

D. Longer the wavelength required

2. What is the normality of a solution of sodium hydroxide (molecular weight=40)

containing 20 grams in 100 mL of solution?

A. 5.0N

B. 1.0N

C. 0.5N

D. 0.4N

3. Carbohydrates are organic compounds of 1. carbon 2. hydrogen 33. oxygen

A. 1 and 2 only

B. 1 and 3 only

C. 2 and 3 only

D. 1,2, and 3

4. If test results are within +/-2 standard deviations, the ratio of test results beyond
the +/-2 SD limit will be 1 out of

A. 3

B. 5

C. 20

D. 300

5. To make a 1:5 dilution of serum sample, dilute

A. 1.0 mL of serum + 5.0 mL of diluent

B. 1.0 mL of serum + 4.0 mL of diluent

C. 1.0 mL of serum + 6.0 mL of diluent

D. 5.0 mL of serum + 1.0 mL of diluent

6. WHich one of the following is a function of gamma globulin?

Page 190 of 312
A. Transports glucose

B. Regulates body temperature

C. Performs as fibrinogen for blood coagulation

D. Provides humoral immunity

7. Which instruments do NOT measure concentrations of a particular molecule but of

the total ions and molecules in general (number of moles per kilogram of water)?

A. Osmometers

B. Spectrophotometers

C. Blood gas analyzers

D. Immunochemical analyzers

8. Osmolality of a solution is determined by measuring

A. Freezing point depression

B. Refractive index

C. Specific gravity

D. Ionic strength

9. Most methods for the determination of blood creatinine are based on the reaction
of creatinine and

A. Sulfuric acid

B. Alkaline picrate

C. Acetic anhydride

D. Ammonium hydroxide

10. All of the following influence glomerular filtration EXCEPT

A. Decreased renal blood flow and cardiac failure

B. Cardiac failure and renal or urinary calculi

C. Renal or urinary calculi and decreased renal blood flow

D. Hyperglycemia and renal tubule malfunction

11. Unconjugated bilirubin is also known as

A. Conjugated bilirubin

B. Prehepatic bilirubin

Page 191 of 312

C. Total bilirubin

D. Biliverdin

12. Alkaline phosphatase is GREATLY elevated in

A. Kidney disease

B. Liver disease

C. Myocardial infarction

D. Obstructive jaundice

13. The ketone bodies include acetoacetic acid, acetone, and

A. Lactic acid

B. 3-hydroxy butyric acid

C. Oxaloacetic acid

D. Acetic acid

14. Blood glucose levels are directly regulated by the hormone

A. ACTH

B. Insulin

C. Thyroxin

D. Hydrocortisone

15. Albumin, alpha1, alpha2, beta, and gamma globulin are electrophoretic fractions
of

A. Hemoglobin

B. Amino acid

C. Serum protein

D. Serum lipoprotein

16. Which one of the following methods could be used to study protein abnormality?

A. Isoenzyme electrophoresis

B. Immunoelectrophoresis

C. Electrophoresis of penicilliamine-treated serum

D. Blood viscosity studies

Page 192 of 312

17. Which of the following enzymes are present in heart muscle? 1. lactic
dehydrogenase (LDH) (LD) 2. creatinine phosphokinase (CPK) (CK) 3. serum glutamic
oxaloacetic transaminase (SGOT)

A. 2 only

B. 1 and 2 only

C. 2 and 3 only

D. 1,2, and 3

18. Most of the plasma thyroxine (T4) is

A. Bound to globulin

B. Bound to albumin

C. Free

D. Bound to cholesterol

19. Sodium is responsible for the maintenance of

A. Blood coagulation

B. Osmotic pressure of body fluids

C. Cardiac muscle contractions

D. Salt intake

20. When using a buffer with a pH of 8.6, each of the serum proteins in an electrical
field migrates toward

A. The positive pole

B. The negative pole

C. Either pole

D. Both poles

21. The end-product of purine metabolism is

A. Urea

B. Creatine

C. Creatinine

D. Uric acid

22. When six or more consecutive daily values are distributed on one side of the mean
but maintain a constant level, it is known as a

Page 193 of 312

A. Normal distribution curve

B. Mean deviation curve

C. Shift

D. Trend

23. The degree that a procedure deviates from a known value or from a calculated
mean value is known as

A. Coefficient variation

B. Quality control

C. Stardard deviation

D. Percent deviation

24. Which one of the following hemoglobin determination methods is recommended

by the International Committee for Clinical Laboratory Standards and the National
Committee for Clinical Laboratory Standards?

A. Oxyhemoglobin

B. Sulfhemoglobin

C. Methemoglobin

D. Cyanmethemoglobin

25. When using white blood cell pipets for performing a white cell count, blood is
diluted

A. 1:200

B. 1:50

C. 1:20

D. 1:10

26. An RBC exhibiting hypochromia would be described as being

A. Variable in shape

B. Packed with hemoglobin

C. Markedly bluish in color

D. Markedly pale in central color

27. When performing automated cell counts, most automated cell counted
instruments

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A. Count nucleated red blood cells with erythrocytes

B. Count nucleated red blood cells with platelets

C. Count nucleated red blood cells with leukocytes

D. Do not count nucleated red blood cells

28. Supravital staining of red cells with a deficiency of G-6-PD will demonstrate the
presence of

A. Howell-Jolly bodies

B. Rubriblasts

C. Heniz bodies

D. Plasmodium species

29. The type of anemia usually associated with severe burns is

A. Macrocytic

B. Aplastic

C. Hemolytic

D. Microcytic

30. The principle involved in some automated blood cell counters is based on the

A. Amount of hemoglobin in the red cell

B. Size of the particle being counted

C. Weight of the hemoglobin in the red cell

D. Value of the cell indices

31. During the maturation of a blood cell, the nuclear chromatin pattern becomes

A. Finer

B. More dense

C. Less dense

D. More acidic

32. As a general rule, when a blood cell matures

A. The cell increases in size

B. The cell decreases in size

C. There is no change in the cell's size

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D. The nucleus increases in size

33. An elevated leukocyte count with increased numbers of neutrophilic granulocytes

USUALLY indicates

A. Bacterial infection

B. Viral infection

C. Infectious mononucleosis

D. Allergic reaction

34. Which of the following tests is used to measure capillary fragility?

A. Tourniquet

B. Bleeding time

C. Prothrombin time

D. Partial thromboplastin time (PTT)

35. On most automated cell counted, background counts are made using

A. Distilled water

B. Highly-diluted blood

C. Diluting fluid

D. Lysing reagent only

36. Brilliant cresyl blue or new methylene blue are stains used for counting

A. Reticulocytes

B. Platelets

C. Malaria

D. Howell-Jolly bodies

37. Cerebral spinal fluid patients with post-cerebral hemmorrhage appears

A. Clear (colorless)

B. Bright red

C. Light yellow or straw colored

D. Greeen

38. The distance between the ruled surface and cover slip of the hemacytometer is

A. 0.1 cm
Page 196 of 312
B. 1.0 cm

C. 0.1 mm

D. 1.0 mm

39. On an automated blood cell counter, the two parameters affected by a high
background count would be

A. WBC and Hgb

B. RBC and Hgb

C. RBC and WBC

D. Hct and WBC

40. Leukemia may be suspected when a manual hematocrit determination reveals

A. Hemolysis

B. Icteric plasma

C. A high hematocrit

D. A heavy buffy coat

41. Hansel's stain is appropriate for

A. Circulating eosinophiles

B. Phagocytic neutrophils

C. Nasal secrection for eosinophiles

D. Leukocytes in spinal fluid

42. Reticulocytes contain

A. DNA remnants

B. RNA remnants

C. Basophilic granules

D. Howell-Jolly bodies

43. A substance that produces a prolonged prothrombin time when given orally is

A. Heparin

B. Protamine sulfate

C. Saliclate

D. Coumadin
Page 197 of 312
44. The screenign or presumptive test for the osmotic fragility of red cells is normal
when hemolysis begins in

A. 0.50% NaCl

B. 0.85% NaCl

C. 0.90% NaCl

D. 1.34% NaCl

45. Clot retraction can be employed as an indicator of

A. Factor VII deficiency

B. Factor X deficiency

C. Hemophilia

D. Platelet function

46. Which stage of the coagulation process would be affected by a deficiency of

Factor VIII?

A. First

B. Second

C. Third

D. Fourth

47. Fibrinogen determinations are performed on

A. Serum only

B. Plasma only

C. Either serum or plasma

D. Any body fluid

48. In serologic tests for syphulis, reagin reactivity may result from an acute or
chronic infection such as

A. Pneumonia

B. Infectious hepatitis

C. Lupus erythematosus

D. Helicobacter pylori

49. The quantity of inactivated serum used for qualitative VDRL test is

A. 0.02 mL
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B. 0.05 mL

C. 0.10 mL

D. 0.15 mL

50. Which one of the following is characteristic of any antigen?

A. High molecular weight

B. High order of specificity

C. Foreign to animal

D. Produced by action of antibody

51. The RA latex test is used as a screening test for

A. Rheumatoid arthritis

B. Thyroiditis

C. Vulvovaginitis

D. Infectious mononucleosis

52. The accepted and usual time and temperature used for the inactivation of serum
is

A. 25 C for 1 hour

B. 37 C for 30 min

C. 56 C for 30 min

D. 56 C for 10 min

53. Group O patients can safely recieve plasma from a donor who is group

A. A only

B. AB only

C. O only

D. A, AB, or O

54. Rh immune globulin is given to an Rh (D)

A. Positive mother with an Rh(D) negative fetus

B. Positive mother who has an Rh(D) negative husband

C. Negative mother who has delivered an Rh(D) positive fetus

D. Negative mother with an Rh(D) negative fetus

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55. Which one of the following may detect a hemolytic transfusion reaction?

A. Urine porphyrins

B. Serum haptoglobin

C. Post-transfusion red blood count and hemoglobin

D. Pre-transfusion bilirubin

56. To determine if a patient is A1 or A2, the blood is typed with

A. Anti-A serum

B. Anti-AB serum

C. Anti-A2 serum

D. Dolichos biflorus serum

57. When a patient has been sensitized, which of the following tests would be used to
help identify the antibody that is attached to the patient's cells IN VIVO?

A. D(u)

B. Elution

C. Direct anti-human globulin test

D. Indirect anti-human globulin test

58. Who is credited with processing the most readily acceptable theory of ABO
inheritance?

A. Weiner

B. Landsteiner

C. Levine

D. Bernstein

59. During the crossmatch procedure, a negative rsult on the addition of Coombs
control cells indicated that the

Discuss

A. Crossmatch is compatible and the blood may be infused

B. Crossmatch is incompatible

C. Antiglobulin reagent is inactivated, neutralized, or not added to the test.

D. Antiglobulin reagent is detecting antibody globulin, indicating adequate washing

during the crossmatch procedures.

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60. The major cation found in the extra cellular fluid is

A. Chloride

B. Potassium

C. Sodium

D. Bicarbonate

61. Antihuman serum globulin reagent

A. Is produced in humans

B. Occurs naturally in most humans

C. Is produced in laboratory animals

D. Never detects complement-dependent antibodies

62. Blood group A individuals have

A. Anti-A in their serum

B. Anti-B in their serum

C. Antigen A and B on their red cells

D. Anti-O in their serum

63. A donor who recently tested positive for HBsAg should be deferred

A. For 6 months

B. For 1 year

C. For 5 years

D. Permanently

64. Antihuman serum globulin (Coombs) is NOT used in performing

A. Reverse typing

B. Immunoglobulin testing

C. D(u) testing

D. Autoagglutination tests

65. A mother is Rh(D) negative. The father is homozygous Rh(D) positive. All of their
offspring will be

A. Erythroblastotic

B. Homozygous Rh(D) positive

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C. Heterozygous Rh(D) positive

D. 50% Rh(D) positive and 50% Rh(D)negative

66. According to Landsteiner, when a specific antigen is present on blood cells, the
corresponding antibody

A. Is present in the serum

B. Is absent from the serum

C. Is present in the blood cells

D. May or may not be present depending on the agglutinogens present

67. Cell/antibody mixtures used in tube testing to determine ABO Group should be
centrifuged for

A. 15-30 seconds @ 1000

B. 2 min @ 2000

C. 3 min @ 3000

D. 5 min @ 5000

68. Water-soluble pigments are produced by

A. Yeasts

B. Pseudomonas aeruginosa

C. Staphylococcus epidermidis

D. Group A streptococcus

69. A reactive fluorescent treponemal antibody (FTA-AB) test

A. Indicates no infection

B. Confirms the presence of treponemal antibodies

C. Indicates the severity of infection

D. Is positive during the chancre stage

70. Which of the following is a strict anaerobe?

A. Bacillus anthracis

B. Listeria monocytogenes

C. Clostridium botulinum

D. Nocardia asteroides

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71. Optochin is used to help identify

A. Streptococcus pneumoniae

B. Staphylococcus aureus

C. Streptococcus pyogenes (group A)

D. Strepococci producing alpha hemolysis

72. A trophozoite of Entamoeba histolytica usually contains

A. Bacteria and coarse granules in the cytoplasm

B. Eccentrically located endosome in the nucleus

C. A coarse, granular, blunt pseudopod

D. Red blood cells int he cytoplasm

73. Which media is used to ISOLATE Staphylococcus aureus from specimens that have
mixed bacterial flora such as feces?

A. Mannitol salt agar

B. An enrichment broth

C. MacConkey agar

D. Eosin methylene blue agar (EMB)

74. A fladellate frequently found in the urine of female patients is

A. Trichomonas hominis

B. Entamoeba coli

C. Trichomonas tenax

D. Trichomonas vaginalis

75. Which organisms are described as minute, very plemorphic, sometimes

coccobacillary, gram-negative rods that must have media enriched with X and V
factors?

A. Escherichia coli

B. Listeria monocytogenes

C. Haemophilus influenzae

D. Bacillus anthracis

76. Bordet-Gengou and Eugon agar base with fresh blood is used for the isolation of

A. Haemophilus
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B. Bordetella

C. Pasteurello

D. Yersinia

77. According to the Lancefield scheme of classifying the Streptococcus species, the
neterococci are placed in group

A. A

B. B

C. C

D. D

78. Strepococcus pneumoniae

A. Is consistently gram-positive even in old cultures

B. Grows best at slightly acid pH

C. Is motile

D. Capsules are produced by virulent strians

79. Which one fo the following test differentiates Staphylococcus aureus from other
types of staphlococci?

A. Oxidase

B. Coagulase

C. Catalase

D. Fibrinolysin

80. The etiologic agent of chancroid is

A. Haemophilus aegyptius

B. Haemophilus ducreyi

C. Haemophilus influenzae

D. Bordetella pertussis

81. Safranin in a Gran stain is used as a

A. Mordant

B. Decolorizer

C. Secondary stain

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D. Primary stain

82. The organism that can cause rheumatic fever and/or glomerular nephritis is

A. Staphylococcus aureus

B. Streptococcus pyogenes

C. Streptococcus viridans

D. Staphylococcus haemolyticus

83. A variety of media may be safely stored for months is care is taken to

A. Maintain them at room temperature

B. Retain their moisture

C. Avoid exposing them to light

D. Maintain them in an incubator

84. In the 1980s, Ewing, Bergey, and the Centers for Disease Control and Prevention
(CDC) divided the Enterobacteriaceae into several different tribes. Which one of the
following is NOT a valid tribe under their classification scheme?

A. Escherichieae Escherichia-Shigella

B. Citrobactereae Citobacter

C. Salmonelleae & Shigellaeae Salmonella-Shigella

D. Edwardsielleae Edwardsiella

85. In Taenia saginata, the larval stage develops in

A. Cattle

B. Swine

C. Fish

D. Man

86. A floatation method for concentration of ova and cysts used

A. Ammonium sulfate

B. Zinc chloride

C. Zinc sulfate

D. Concentrated formalin

87. The infective stage of the hookworm is the

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A. Rhabditiform larva with a short buccal cavity

B. Rhabditiform larva with a long buccal cavity

C. Filariform larva with a pointed tail

D. Filariform larva with a notched tail

88. Enterobius vermilcularis is a

A. Hookworm

B. Pinworm

C. Filarial worm

D. Flat worm

89. The cystic stage of development has NOT been demonstrated in which of the
following organisms?

A. Balantidium coli

B. Endolimax nana

C. Trichomonas vaginalis

D. Iodamoeba butschlii

90. The egg of the Schistosoma characterized by a pronounced lateral spine is

A. Schistosoma mansoni

B. Schistosoma haematobium

C. Schistosoma japonicum

D. Schistosoma hepatica

91. Fungi are commonly identified on their basis of their

A. Serologic and biochemical characteristics

B. Staining properties with polychrome dyes

C. Solubility in 20% potassium hydroxide

D. Sporulation and the arrangement of spores on the hyphae

92. The modified Griess nitrite test, when positive to any degree, is virtually dianostic
of

A. Significant bacteriuria (10(5) organisms per milliliter of urine)

B. Any bacteriuria (10(1) to 10(5) organisms per milliliter of urine)

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C. Bilirubin in the urine

D. Phenylalanine in the urine

93. In the formation of urine, the function of the glomerulus is

A. Simple filtration

B. Secretion

C. Selective re-absorption

D. Re-absorption of water

94. In using a urinometer to measure specific gravity, the correction facotr for each 3
degrees C higher or lower than calibration temperature is

A. +/- 1.001

B. +/- 0.100

C. +/- 0.010

D. +/- 0.001

95. Which of the following tests is specific for urinary glucose?

A. Benedict's

B. Clinitest

C. Pandy

D. Dip stick

96. Microscopic examination of urinary sediment discloses small, motile cells having
an oval "head" with a rather long, delicate, whip-like tail, These cells are most likely
identified as

A. Proteus vulgaris

B. Trichomonas vaginalis

C. Spirochetes

D. Spermatozoa

97. Metabolic acidosis can be detected by testing urine for the presence of

A. Ketone bodies

B. Protein

C. Glucose

D. Uric acid
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98. Freezing point depression measurements are part of which one of the following
urine test procedures?

A. Hydrometry

B. Osmolality

C. Refractive index

D. Specific gravity

99. Dilute normal urine is usually

A. Pale yellow

B. Dark yellow

C. Reddish-yellow

D. Amber

100. The ketone test area on a dip stick is impregnated with

A. Alkaline copper

B. Nitroprusside

C. Ferric chloride

D. 2,4 dichloraniline

__________________________________________________________________________

The 30 X 50 um ovum illustrated in the image are most commonly observed by

microscopic examination of transparent adhesive tape mounts of perianal skin of
children who have complained of nocturnal anal pruritus. From the list of answer
choices below, select the most likely presumptive identification.

Enterobius
vermicular
is

Enterobius vermicularis is a correct response. Enterobius ova are oval in outline

with flattening along one margin, simulating a deflated football. The shell is smooth
and slightly thickened. A well-developed larva is commonly observed internally, which
retracts away from the inner shell membrane, leaving an open space.

Necator americanus is an incorrect response. Necator ova, although also oval in

outline, are not flattened on one side and the outer shell is thin and transparent.
Although the inner yolk sac retreats, leaving a clear space beneath the shell, further
development into an embryo is not observed.

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Isospora belli is an incorrect response. Isospora oocysts are also oval in outline and
have a smooth, thin outer shell. Internally, a single spherical sporocyst may be
observed, but more typically mature oocysts are noted which contain two sporocysts.
One is advised to search further in a smear preparation for detection of oocysts with
double sporocysts to ensure an accurate identification.

Trichuris trichiura is an incorrect response. Trichuris ova are easy to recognize with
their barrel-shape and a distinctive protruding, convex, hyaline polar plug at each
end. The shell is smooth but relatively thick and the internal developing embryo
reaches the inner lining of the shell without leaving an open space.

__________________________________________________________________________

Generally speaking, infant RBCs demonstrate the presence of the ____ antigen, which
gradually decreases as one ages. Conversely, the ____ phenotype is not expressed at
birth, but increases in frequency as one ages.

i;
I

From birth onwards – “i” antigen slowly decreases on the RBC surface, while “I”
antigen increases reciprocally. It’s a unique characteristic of this particular pair, with
no other pair of common blood bank relevant antigens demonstrating such a trait.

In practice, while auto anti-i is rarely seen, when suspected, one could simply react
the patient’s serum with cord RBCs, expecting to see a strong reaction. Meanwhile,
reacting the patient’s serum with adult RBCs would yield a weak or no reaction.

__________________________________________________________________________

A patient admitted to the hospital for ongoing fever produces the following laboratory
results:

RBC count: 3.56 x 1012/L

WBC count: 57.5 x 109/L

Platelet count: 375,000/uL

Differential count: 3 blasts, 10 myelocytes, 6 metamyelocytes, 12 bands, 64 segs, 4

lymphocytes, and 1 monocyte

LAP score = 155.

Which of the following conditions correlates closely with this patient's results?

Leukemoid
Reaction

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A high white blood cell count, usually 50-100 x 109/L with a left shift is a common
finding in leukemoid reactions. In addition, a key feature of a leukemoid reaction is a
high LAP score.

Chronic Myelogenous Leukemia (CML) is highly associated with the Philadelphia

chromosome, or translocation (9;22)(q34;q11). CML typically shows a low LAP score,
in contrast to the findings in this case.

Finally, Paroxysmal Nocturnal Hemoglobinuria (PNH) is also associated with a low LAP
score, which excludes this as the correct answer.

__________________________________________________________________________

For a substance to be immunogenic it must be:

Recognized as
non-self

Only non-self antigens can be immunogenic. Self antigens are normally recognized by
the immune system as part of the host, so an immune response does not normally
occur. Non-self antigens are immunogenic since they have the potential to cause an
immune response.
__________________________________________________________________________

Based on the morphologic features of this 40 um (in diameter) ovum as seen in the
upper photomicrograph the accompanying scolex of the adult worm as illustrated in
the lower image, select the presumptive identification of this cestode from the
multiple choice answers listed below.

Taenia
solium

Taenia solium is the correct response. Although the spherical ova with their thick,
striate shell and internal hooklets does not rule out Taenia saginata, the scolex of T.
solium, with its distinctive rostellum armed with a ring of hooklets, serves to
exclude T. saginata, the scolex of which is flat and rounded and devoid of an armed
rostellum.

Taenia saginata is an incorrect response. Taenia saginata ova are similar in

appearance to those of T. solium, with a thick striated shell and three pairs of hooklet
observed interiorly. Distinctive is the scolex of the adult worm with a round, smooth
anterior end devoid of an armed rostellum.

Hymenolepis nana is an incorrect response. Hymenolepis ova have a thin outer

non-striated shell and an inner membrane within which three pairs of hooklets are
contained. The scolex of the adult worm also has an armed rostellum, but in contrast
to T. solium, is small and projects outward.

Diphyllobothrium latum is an incorrect response. Diphyllobothrium ova are large

(up to 70 um), and have a thin smooth shell with a distinctive, inconspicuous non-
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shouldered operculum at one end. The scolex of the adult worm is long and narrow
with a dorso-ventral groove surrounded on either side by lateral lip-like folds.
__________________________________________________________________________

Warfarin-based (coumarin derivative) oral anti-coagulant therapy is commonly

monitored with :

PT/
INR
Coumarin derivatives inhibit the vitamin K dependent Factors (II, VII, X) which can be
measured with the PT and monitored frequently with the INR assay.
__________________________________________________________________________

I reside inside red blood cells, where I grow and grow until the cells are eventually
destroyed.

Plasmodium falciparum
gametocytes

The gametocytes of Plasmodium falciparum are the only malarial organisms that
assume a characteristic banana shape.

__________________________________________________________________________

The antecubital area is usually the site used for venipuncture because of its
accessibility. Which of the following veins is NOT located in the antecubital area.
Median cubital
vein
Femoral vein
Basilic vein
Cephalic vein
The femoral vein is located in the groin area along with the femoral artery. It is not
used for routine venipuncture.
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__________________________________________________________________________

Which of the following conditions would produce these results in an anemic patient:
MCV = 115, MCH = 30, MCHC = 34

pernicious
anemia

Pernicious anemia is the only choice that is a macrocytic anemia, meaning the MCV is
increased. In this case, the MCV is 115 (normal range 80-100 fL) which means this
patient is suffering from a macrocytic anemia. Sickle cell anemia, aplastic anemia,

and iron deficiency

anemia are all
microcytic or
normocytic anemias.

__________________________________________________________________________

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Page 213 of 312
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Page 216 of 312
H2S Positive : Si Ed poop Salmonella.

 Si : Citrobacter

 Ed: Edwardsiella

 Poop: Proteus

 Salmonella typhi

H2S (+) is black and a poop is somehow black

What is the organism that causes/ is associated with Cystic Fibrosis?

Possible answers: Pseudomonas aeruginosa, Burkholderia cepacia

What is the screening test for sickle cell disease?

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ANS: SOLUBILITY TEST

PRINCIPLE:

Hemoglobin S is less soluble in a reducing agent than other forms of hemoglobin.

NOTES:

The solubility test is the most common screening test for sickle cell or presence of
HbS. It is based on the relative insolubility of HbS when combined with a reducing
agent such as sodium dithionite. When anticoagulated blood is mixed the reducing
agent, the red cells will lyse due to the presence of saponin and the hemoglobin in the
red cells will be released.

The solubility test cannot be used to differentiate sickle cell disease (homozygous for
HbS) from sickle cell trait (heterozygous for HbS).

Hemoglobin electrophoresis is considered the diagnostic procedure and is

especially important considering that there are other hemoglobin variants that will
also cause a positive solubility test, such as HbC Harlem.

If HbS is present, it will form liquid crystals and give a cloudy or turbid appearance
to the solution. If HbS is not present, the solution will appear transparent.

SOUCES OF ERROR:

1. A patient with an exceptionally high hematocrit may give a false positive result,
while an individual with a very low hemoglobin may give a falsely negative
result.

2. Unstable hemoglobins may give a false positive result.

3. False positives can occur with elevated plasma proteins and lipids.

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The reactivity of blood group A is confirmed by detecting the presence of which
immunodominant sugar molecule?

N-acetyl-D-neuraminic acid

L-fucose

N-acetyl-D-galactosamine

N-acetyl-D-glucosamine

D-galactose

The A gene codes for production of N-acetylgalactosaminyltransferase, an enzyme

which binds N-acetylgalactosamine (GalNAc) to the H structure (L-fucose). N-
acetylglucosamine is a sugar substance thought to be useful in treatment of Crohn’s
Disease, osteoarthritis, and inflammatory bowel disease. N-acetyl-D-neuraminic acid is
nothing I’ve ever seen associated with blood banking (but it sounds cool, doesn’t it?).
In my opinion, the best way to recognize the full sugar name is to remember the
abbreviation. GalNAc would likely point you towards something containing a “…gal…”
in the answer.

The mating of parents of which two ABO phenotypes can potentially produce offspring
with ALL of the common four blood types?

AB and O

AB and A

AB and AB

A and B

AB and B

Each individual inherits one ABO gene (A, B, or O) from each parent. Considered
together, the two genes determine the ABO phenotype. A problem like this could be
solved using a simple Punnet Square (see below), where the possible phenotypes of
the offspring are filled in using the various parental combinations. Try out the various
combinations to see if any give you the possibility of all four types. When you are
doing this, don’t get hung up on using only homozygous parental genotypes.
Remember, two alleles make up each gene, and the “O” allele is silent. So, a parent of
blood group phenotype “A,” for example, could have a genotype of either “AA” or
“AO”. If you assume “AO” as the genotype for one parent and “BO” for the other, all
four blood types are possible in the offspring, as illustrated in the table below.
B O

A AB AO

O BO OO

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Bombay phenotype (Oh) individuals may have antibodies with all the following
specificities EXCEPT:

Anti-A

Anti-B

Anti-H

Anti-O

Anti-A,B

The ubiquitous presence of questions about Bombay phenotypes on standard exams

would incorrectly lead you to assume that the Bombay phenotype is quite common.
This couldn’t be farther from the truth, as Bombay is spectacularly rare! Whether you
ever actually see a case, you will likely need to answer a question about Bombay on a
standard exam. For this question, you must recall that the Bombay phenotype and the
Bombay genotype (hh), mean that an individual is missing the H structure both on
RBCs as well as in plasma and secretions (the Bombay person is a non-secretor, or
sese). Since an intact H structure is a prerequisite for addition of the A and B antigens,
you will then be able to deduce that the following antibodies can be present in the
serum of a Bombay individual simply because you know the corresponding antigen is
missing: anti-A, anti-B, anti-A,B, and anti-H. O, of course, is not an antigen, it’s the
lack of A and B antigens, so anti-O is not a legitimate antibody.

Which cells agglutinate most strongly with Ulex europaeus lectin?

A2 and O

A1 and A2

O and A1B
B and A2B

A1 and B

Lectins are biologically active substances extracted from a plant (in this case, a Gorse
bush). Ulex lectin, when mixed with human red cells, gives reactivity we’d expect to
see if we used actual anti-H. So, if the H structure is present on a cell, which it is in all
of the possible choices, we could expect the cells to agglutinate with Ulex europaeus.
The strength of reactivity, however, is very dependent on both the amount of H
antigen present and the accessibility of the antibody to the fucose sugar (“H
structure”). The main blood groups agglutinate with the following relative strength
with anti-H or Ulex lectin: O > A2 > B > A2B > A1 > A1B. Cells of Group O and A2 not
only have the most H antigen of all the groups, but also have a molecular structure
that leaves fucose very accessible to anti-H. As a result, these cells agglutinate very
strongly with Ulex. Group B cells react variably, since the addition of the
immunodominant sugar, galactose, can hinder accessibility to the H Structure. Group
A1 and A1B will react very weakly or not at all with anti-H, due to those types having
very little H and to the molecular structure of these antigens and the location of the
addition of terminal sugars.
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Immune A and B alloantibodies differ from non-red cell stimulated (naturally
occurring) A and B alloantibodies in that the immune antibodies:

Are generally IgG

Are unable to cross the placenta

Can be enhanced in reactivity by incubation at 4C

Cause direct agglutination at room temperature

Rarely cause clinical hemolysis

This question isn’t really about ABO so much as it’s about characteristics of IgG and
IgM antibodies in blood banking. In short, naturally occurring antibodies are generally
of the IgM class, not able to cross the placenta, enhanced in reactivity by incubation
at 4C, and can cause direct agglutination at room temperature. These antibodies,
aside from the ABO blood group, are not usually capable of causing clinical hemolysis.
IgG antibodies are typically what you ultimately get from red-cell stimulated antibody
formation, and they can cross the placenta and are not very reactive (if at all) at 4C
and room temperature. They “like” the AHG phase of testing and 37C, and generally
are more likely to cause clinical hemolysis.

Which ABH substances would you expect to find in the saliva of a group A secretor?

H only

H and A

H and B

H and O

A
The secretor status of an individual (genotype SeSe or Sese) determines the formation
of H antigen in secretions, which in turn creates opportunity for A and B antigen
formation, if either (or both) gene is inherited. So, to answer this question, realize that
if you are a secretor, you will have both H and A substance in secretions if you are
group A. It is estimated that almost 80% of the general population are secretors. And,
you would never fall for the “O” antigen in secretions, would you? There is no such
thing as O antigen!

Which of the following is the best explanation for why the ABO system is the most
important blood group system in transfusion safety?

ABO is the only blood group system in which reciprocal antibodies are normally
produced for the antigens an individual lacks

ABO antibodies are capable of causing rapid, severe intravascular

hemolysis

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 Reactions with ABO antibodies are the most common cause of transfusion-related
death

ABO antibodies are often implicated in severe hemolytic disease of the fetus and
newborn

Routine ABO forward and reverse grouping is difficult to interpret and fraught with
error

B is the best answer because of the great severity of ABO mismatch. While ABO is
famous for the reciprocal antibodies, it is not the only blood group with “naturally
occurring” antibodies. Transfusion-related acute lung injury (TRALI) is currently the
most common cause of transfusion-related death (though hemolytic transfusion
reactions are second to TRALI). Answer D is incorrect because the HDFN caused by
ABO antibodies is generally mild. In group O moms, the antibodies are predominantly
IgG, not IgM (as is more common with other blood groups), and ABO HDFN is much
more likely than with non-group O moms. Answer E is a subjective statement; only a
minority of samples submitted for ABO typing would have discrepancies that cause
difficult in interpretation (and we do a darn good job even with those!).

A 26 year old pregnant female is being tested prior to a scheduled C-section

tomorrow. Her cell grouping (forward typing) is consistent with blood group O, while
her serum grouping (reverse grouping or back-typing) appears to be group A. The
most common reason for this type of ABO discrepancy is:

Bombay phenotype

She is a non-secretor

Clerical errors or a sample mix-up

Use of an uncalibrated centrifuge

She has undiagnosed acute myelogenous leukemia (AML)

Issues with the integrity or identity of the sample are more likely than any other
choice to cause this ABO discrepancy. Bombay phenotype is extremely rare. Secretor
status will not affect the ability to detect A and B antigens on red cells. An
uncalibrated centrifuge might make a difference in testing, but ABO system
antigens/antibodies are so hearty that they are likely to not be effected by over- or
under-centrifugation. Finally, while group A patients with AML can have an acquired
weakening of their A antigen due to hematologic malignancies, such an event would
be less common than a sample integrity issue.

An ABO discrepancy between forward and reverse grouping owing to weak-reacting or

missing antibodies could be BEST explained by which of the following:

Patient has a subgroup of blood group A

Patient is very old or very young

Patient has acquired B phenotype

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Patient has antibodies to low incidence antigens

Patient has antibodies against preservatives in reagent cells

In the very old and very young, the natural expression of isoagglutinins can either be
depressed or delayed, respectively. Group A subgroups often lead to missing red cell
(forward) reactions, and the acquired B phenotype results in extra red cell reactions;
neither typically leads to missing antibody reactions. Antibodies to low incidence
antigens or reagents would give extra antibody reactions rather than missing
reactions. Other causes of weak-reacting or missing antibodies are: Patients with
leukemias demonstrating hypogammaglobulinemia (e.g., CLL), patients with
lymphomas; patients using immunosuppressive drugs, congenital
agammaglobulinemia, and immunodeficiency diseases.

A blood donor has the genotype hh, AB. What is his apparent red cell phenotype
during routine forward and reverse group typing?

AB

Cannot be determined

Without an H allele (i.e., with either a HH or Hh genotype), the “H antigen” cannot be

formed. As a result, the A and B red cell antigens that should have been made due to
the AB genotype would not be formed (“no H, no A or B”). This person’s red cells
would appear to be group O (though they are better described as “Bombay” or “Para-
Bombay“; yes, another Bombay phenotype question!).

Approximately what percentage of group A individuals could be further classified as

subgroup A1?

20%

40%

60%

80%

>95%

The vast majority of group A patients are either subgroup A1 (about 80%) or A2
(about 20%). A1 and A2 red cells have both quantitative and qualitative differences in
the A antigen present on their surfaces, and this is discussed in another answer
below.

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Which of the following statements is TRUE regarding the A2 blood group?

Dolichos biflorus lectin agglutinates A2 but not A1 RBCs

Ulex europaeus lectin will react stronger with A1 than with A2 RBCs

A2 RBCs have more H antigen than A1 RBCs

If anti-A1 is made by an A2 person, it is usually clinically significant

Most A2 individuals have a different form of anti-B than A1 individuals

The major difference between the A1 and A2 subgroups is quantitative; A1 RBCs have
about five times more A antigen than A2 RBCs (and, as a result, much less H antigen).
There are also, however, some qualitative differences between these two subgroups,
as evidenced by the fact that A2 individuals can, on occasion, make anti-A1 (1-8% of
the time). This antibody, while we talk about it a lot and it can lead to ABO
discrepancies in serum typing, is usually (though not always) clinically insignificant.
Most A2 people have exactly the same antibody that A1 people have: Anti-B. The
lectin of Dolichos biflorus, in concentrations used in laboratories, only agglutinates
RBCs containing A1 specificity, while the lectin of Ulex europaeus agglutinates RBCs
with increased H antigen, like most A2 RBCs.

Which of the following genes codes for production of the same basic antigen as the H
gene?

Le

Lu

Se
A

The Se (or “secretor”) gene product is an enzyme that adds a fucose sugar to a
glycoprotein chain called a “type 1 chain.” This results in formation of the “H antigen”
on these chains, which are found primarily in secretions (get it? “Se” for “secretions!”)
and plasma. Some people call this “Type 1 H antigen.” The H gene product is also a
fucose-transferring enzyme (a “fucosyl transferase” or “FUT”) that makes H on “type
2 chains,” primarily on the red cell surface. So, two different genes code for enzymes
that cause formation of basically the same antigen, just on different types of chains.

The labels have come off of some of the testing reagents in your Blood Bank. Your
tech is trying to find her anti-B, and she asks you what color anti-B should be. You
reply:

"Green"

"Orange"

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"Blue"

"Yellow"

reagent anti-B is colored yellow, while reagent anti-A is colored blue (I’m told this
varies in other countries, so check your local blood bank if you are out of the U.S.). I’m
sure there is some Latin correlation or something, but it’s just silly to me! Why the
heck wouldn’t you make anti-B “blue”? As dumb as I think this question is, variants of
it have appeared on standardized examinations.

Which of the following statements is TRUE regarding Hemolytic Disease of the

Fetus/Newborn (HDFN) caused by ABO antibodies?

Hemolysis is typically severe in ABO HDFN

ABO HDFN rarely occurs during the first pregnancy

ABO HDFN is most common with O mothers and A babies

A negative cord blood direct antiglobulin test excludes ABO HDFN

ABO HDFN occurs less commonly than Rh HDFN

HDFN caused by ABO incompatibility between mother and child is, in fact, the most
common form of HDFN. In virtually all situations, ABO HDFN is seen with a group O
mother and a group A or B child. Group O individuals carry IgG ABO antibodies that,
unlike the primarily IgM antibodies in non-group O people, are transported across the
placenta and enter the fetal circulation. These antibodies (either anti-A, anti-B, or anti-
A,B) are “naturally occurring,” like all ABO antibodies, so the interaction may occur
during the first pregnancy (unlike the classic form of HDFN due to Rh antibodies,
which usually occurs in second pregnancies and beyond). However, the relatively
weak ABO antigen expression on the surface of fetal and neonatal red cells means
that the clinical and laboratory sequelae (including hemolysis) of ABO HDFN are
usually not severe. In fact, affected babies may have a negative direct antiglobulin
test (DAT).

Name the three genes responsible for the production of Rh antigens.

RHAG, RH1, and RH2

RHAG, DCE, and dce

RHAG, RHD, and RHCE

RHD, RHCc, and RHEe

RHD, RHCE, and RHce

In order to have normal Rh antigens on RBCs, all three genes must be present. RHD
and RHCE are located on chromosome 1. RHD codes for the presence or absence of
the D antigen. RHCE has 4 alleles: RHCe, RHCE, RHce, and RHcE. The inheritance
pattern determines the presence or absence of the C, E, c and e antigens. RHAG (Rh
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associated glycoprotein) is located on chromosome 6. The presence of this gene
allows the proteins resulting from RHD and RHCE to be incorporated into the RBC
membrane. The absence of these genes can result in a rare condition known as
“Rhnull,” in which the patient has no Rh antigens of any type on their RBCs. Rhnull
patients will typically have hemolytic anemia of varying severity, along with displaying
unusual RBC shapes known as “stomatocytes” (“mouth cells”). This question
contributed by Bill Turcan.

Which of the following is TRUE regarding the weak D phenotype?

It occurs when the D antigen has missing or abnormal parts (epitopes)

It is easily distinguished from partial D by serologic testing

It was historically identified by an indirect antiglobulin test

Types 1, 2, and 3 are at risk for making anti-D if D+ blood is given to them

It usually results from inheritance of the R0r' genotype

Weak D (formerly known as “Du“) occurs when someone who is actually D-positive
has fewer D antigens on their red blood cells than are normally present. This
quantitative problem may cause problems with routine Rh typing, as testing the RBCs
with anti-D either gives either no reaction or a reaction that is much weaker than the
typical strong reactions expected in a D-positive person (i.e., they may appear to be
D-negative). This usually is a result of mutations affecting (but not eliminating)
portions of the D antigen. Weak D red cells that react negatively with laboratory anti-
D (which contains a mixture of IgG and IgM anti-D) are shown to be D-positive when
an indirect antiglobulin test (IAT) is performed (see my video called “Weak in the D’s”
on my video page for more details). In this setting, the IAT is called a “weak D test.”
We used to think that most weak D happened due to inheritance of an allele coding
for the C antigen on the opposite chromosome to a D allele (like choice E, and known
as “C in trans”), but specific antigen-weakening mutations far outweigh that scenario.
Weak D and partial D (where the D antigen has missing and abnormal parts) may
have overlapping features, and cannot be reliably distinguished except by Rh
genotyping. Partial D is a problem because those patients may develop anti-D when
transfused D-positive RBCs, so the distinction is important. A 2015 expert taskforce
recommended Rh genotyping for all serologic weak D patients and pregnant moms, to
determine if the person has weak D types 1, 2, or 3. Those types are NOT at risk for
developing anti-D from transfusion of D-positive RBCs or delivering a D-positive baby,
while other types should be treated as if they were D-negative. Complicated, I know!
Dr. Connie Westhoff explains it much better than I in the BBGuy Essentials Podcast,
Episode 005!

Which of the following red blood cell abnormalities is associated with the Rhnull
phenotype?

Stomatocytes

Ovalocytes

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Acanthocytes

Spherocytes

Schistocytes

Stomatocytes (“mouth cells”) are associated with Rhnull, which is a complete lack of
all Rh antigens (not just D), caused either by mutations leading to inactive Rh genes
or by mutations leading to defects in RHAG (the associated glycoprotein membrane
structure that must be present for Rh antigens to be expressed). A mild hemolytic
anemia is also seen in these patients. Schistocytes are seen in intravascular
hemolysis, spherocytes in extravascular hemolysis, ovalocytes in iron-deficiency
anemia, and acanthocytes in the McLeod syndrome associated with the lack of Kx
antigen (as well as other non-blood bank stuff).

A patient has the following Rh phenotype:

D:+ C:+ c:+ E:+ e:+

What is her most likely Rh genotype? NOTE: Due to an issue with displaying answers
with superscripts and subscripts, all answer choices will lack such formatting. For
example, “R1” will display as “R1”

R1R1

R1R2

R2r

R0ry

R2r"

Blood banking students must be able to quickly and fluently convert phenotype
information into possible genotype combinations. Even though the Wiener
terminology is dated and his genetic theories incorrect, all blood banks (and those
who write test questions) assume that you know the Rh haplotypes indicated by the
terminology above. If this is new to you, take some time to review the Rh terminology
module elsewhere on the site. For review, the combinations are as follows:

D Positive Haplotypes D Negative Haplotypes

R1: DCe r’: dCe

R2: DcE r”: dcE

R0: Dce r: dce

Rz: DCE ry: dCE

For questions such as this, I think that the best strategy is to start by seeing which
combinations could even possibly result in a patient with the specified phenotype

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(even though the question is asking for most likely, start with possible). A quick
examination shows that choices A, C, and E can be ruled out immediately, since none
of them would result in a phenotype with all five main Rh antigens present. Choices B
and D, however, would both give the correct combination. So, you need more
information, right? Fortunately, of the eight combinations in the table above, only four
occur with substantial frequency (I call those the “Big Four,” and they are in red in the
table above). For this question, simply evaluate whether either option contains a
combination that is out of the Big Four. Note that both combinations (R1 and R2) in
choice B are in the Big Four, but only one of the two (R0) in choice D is in the Big Four.
As a result, R1R2 is always more likely for this phenotype than [Link] is true
regardless of the race of the patient (though race will be an issue in later questions).

A Caucasian patient has the following Rh phenotype:

D:+ C:+ c:+ E:- e:+

Which of the following is his most likely Rh genotype?

R1R0

R1r

R0r

R1R1

R0r'

ryr'

four most common Rh haplotypes (the “Big Four”) are R1, R2, R0, and r, as mentioned
previously. These four occur with differing frequencies in Caucasians and African-
Americans, as follows:
Caucasians: R1 > r > R2 > R0

African-Americans: R0 > r > R1 > R2

For strategy, start again by determining which of the combinations are possible; I
hope that you will agree that choices A, B, and E are possible and choices C, D, and F
will not result in the appropriate phenotype. Next, eliminate choices where one or
more of the haplotypes is not a member of the Big Four; choice E is eliminated by that
strategy. Finally, compare the relative frequencies in the requested racial population.
In this case, given that R1 is the most frequent haplotype in caucasians, and it is
present in both choice A and choice B, you are left with deciding whether R0 or r is
more common in caucasians. A glance at the table above shows you that r is more
common (in fact, it is over ten times more common), and so choice B is the correct
answer.

An African-American patient has the following Rh phenotype:

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D:+ C:+ c:+ E:+ e:+ f:-

Which of the following is her most likely Rh genotype?

R1R2

R0Rz

R2r'

Rzr

R0ry

This is a rather complex question, requiring you to pull multiple facts together to
make an intelligent choice. There are two ways to approach this; I’ll give you the
“proper” way first, then the faster way in the second paragraph. Here’s the “proper”
approach: First, look at which choices are possible. Ignoring the “f” for a moment,
when it comes to the five main Rh antigens, a quick examination will show you that
ALL of these choices are possible. However, the lack of “f” enables you to eliminate
some things right away. Remember that “f” is an antigen present when both “c” and
“e” are present in the same allele (in other words, when a person inherits an RHce
allele). So, you can exclude any of these choices that include either the R0 (Dce) or r
(dce) haplotypes. So, choices B, D, and E are excluded. Now, we are left with choice A
and C. Going back to the “Big Four” Rh haplotypes we discussed previously, you will
note that choice C (R2r’) is automatically going to be less likely than choice A (R1R2)
because the r’ haplotype is not part of the Big Four. So, choice A is most likely, and
you didn’t even need to know the race of the patient to establish that fact in this case
(Note that this logic works when the question is asked about the “most likely”
genotype; certainly, the patient could have the R2r’ genotype, but it is clearly less
likely than R1R2).

In an earlier explanation, I mentioned a second strategy for solving these types of

problems: Immediately rule out those choices that have haplotypes that are not in the
Big Four, and then evaluate what is left. That strategy works GREAT in this question!
You would immediately eliminate choices B, C, D, and E, and be left with choice A
only! If choice A meets all of the criteria in the question, then by definition it is the
most likely genotype. As outlined in detail above, choice A DOES perfectly match the
phenotype listed, so it is most likely.

Several genotypes are possible for an individual that has a phenotype of:

D+C+E+c+e+

Which of the following genotypes is NOT possible?

R1R2

R2r'

R1r"

R0r"

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Rzr

. The answers are written in the Wiener Rh nomenclature, as outlined above. It is

easier to understand which Rh antigens are present in a given genotype by converting
the Wiener shorthand to the Fisher-Race nomenclature (for example, R1r = DCe/dce).
Even though neither of these terminology systems accurately reflect the genetics of
the Rh system, they are commonly used in blood banking. When a patient carries the
first five Rh antigens, six possible genotypes could lead to that phenotype (can you
figure it out? Take a second and try before you read the next sentence).

Those six are: R1R2, R1r”, R2r’, R0ry, RzR0, and Rzr. The R0r” genotype in choice D
will produce a phenotype that is missing the C antigen.

A 35 year old O-negative male trauma patient receives a transfusion of two units of O-
positive red blood cells before his blood type is known. After his typing is completed,
he is switched to O-negative and he receives 10 additional type-specific RBC units. He
survives and is transferred to the surgical ICU. Which of the following is TRUE
regarding his situation?

He has an 80% chance of forming anti-D

He is at high risk for an acute hemolytic transfusion reaction

He has a 20-25% chance of forming anti-D

He should immediately be given 20 vials of Rh Immune Globulin (RhIG)

He should be carefully monitored for signs of delayed hemolysis

Historically, blood bankers would say that D-negative people receiving D-positive red
cell transfusions had a close to 80% chance of forming anti-D (and that the risk didn’t
really change regardless of how many D-positive units a person received). That
statistic was based on exposure to D in D-negative healthy people, however, and the
reality is that most patients getting this type of exposure are far from healthy! Current
studies have shown the risk to be closer to 20-25% in hospitalized patients, which is
still really high, but not nearly as high as we thought. It is very unlikely that this man
will develop an acute hemolytic reaction, unless he already has a pre-formed anti-D
(from a previous D-positive transfusion). Even a delayed hemolytic reaction is unlikely
in this situation, as the transfused cells will likely no longer be around by the time any
antibody could be formed. So, the final question is whether prevention is indicated in
the form of RhIG. I personally do not think that such an intervention is the greatest
idea, due to the facts that a) A large amount of RhIG would be required (at least 20
vials, which could be given intravenously), and b) If the RhIG works (coating and
resulting in clearance of the D-positive RBCs from the circulation), you might THEN be
dealing with the consequences of hemolysis. I don’t believe in it, but there are those
who feel strongly the other way.

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What percentage of blood specimens derived from the Caucasian population will have
a positive agglutination result with the anti-c reagent?

15%

35%

50%

80%

100%

This is a complicated way to ask the question, “What percentage of the Caucasian
population is c positive?” 80% of Caucasians are positive for the c antigen. The c
antigen is present in 96% of those of African descent and 47% of Asians.

Which alloantibody is most likely to be produced if a patient that has the Rh genotype
of R1R1 is transfused with red blood cells that have an Rh genotype of R0R0?

Anti-D

Anti-C

Anti-c

Anti-E

Anti-e

A patient has a chance to produce an alloantibody if they are exposed to a red blood
cell antigen they lack on their own red blood cells. In this case a patient with the Rh
genotype of R1R1 (or DCe/DCe) lacks the Rh antigens E and c. The patient is exposed
to red blood cells with the Rh genotype of R0R0 (Dce/Dce). The transfused red blood
cells carry the c antigen the patient lacks. This can result in the production of Anti-c.

Which of the following techniques will not assist in differentiating between the
antibodies Anti-D and Anti-LWa?

Testing the patient plasma against cells that have been treated with ficin or
papain

Testing the patient plasma against D-negative cord cells

Performing an adsorption/elution procedure using D-negative adult cells

Testing the patient plasma against cells that have been treated with 0.2 M DTT

Testing the patient plasma against cells from a donor that is currently pregnant

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There is a phenotypic relationship between the Rh and LW (“Landsteiner-Wiener”)
systems. LW antigens (including high frequency LWa and LWab and low frequency
LWb) are strongly present on D-positive cells and weakly present on D-negative cells.
As a result, anti-D and a weakly reacting Anti-LW may give the same test results (this
led to initial confusion of the LW antigens with the D antigen). Treating test RBCs with
enzymes such as ficin or papain will not allow you to differentiate between the
antibodies, as both D and LW antigens are resistant to such treatment. LW antigens
are present on D-negative cord cells, while the D antigen is not. LW antigens are also
present on D-negative adult cells, while the D antigen is not. LW antigens are
destroyed by treatment with sulfhydryl reagents such as 0.2 M DTT; by contrast, the D
antigen is present on DTT-treated RBCs. Finally, LW antigens are depressed on the
RBCs of pregnant women, while the D antigen remains unchanged. Using the
techniques listed in choices B, C, D and E will give you differentiation between Anti-D
and Anti-LW antibodies.

In which of the following groups is Weak D testing required if the initial D typing
results appear negative?

Routine testing of pregnant female blood recipients

Rh typing of allogeneic (volunteer) whole blood donors

Pretransfusion testing for sickle cell anemia patients

Pretransfusion testing for cardiac surgery patients

Confirmatory testing of D-negative RBC received by a transfusion service

Weak D testing is required to be performed on all blood donors who test initially D-
negative on routine Rh typing. The Weak D test is required by AABB Standards even if
the final product to be transfused is mostly plasma. If D antigen testing was stopped
at the immediate spin phase on a blood product that is actually from a donor with the
Weak D phenotype, that product would falsely be labeled as “D-negative” when it is
actually D-positive. Since the falsely labeled product would most likely be transfused
to a D-negative patient, the patient could make immune Anti-D as a result. When
performing pre-transfusion testing on patients, however, the weak D test is not
required. A patient that is D-negative at the immediate spin phase will usually receive
D-negative blood products. Transfusing a D-negative blood product to a patient that is
really weak D positive will not cause the patient any adverse effects of transfusion
due to the D antigen. Finally, weak D testing is not required when a transfusion
service is confirming the Rh type of RBC units labeled as D-negative. For more detail
on weak D, see my video called “Weak in the D’s“, the glossary entry on weak D, and
finally, the BBGuy Essentials Podcast, Episode 005.

Which of the following is a true characteristic of Anti-D?

Primarily IgG isotype

Binds complement efficiently

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Hemolysis due to anti-D leads to prominent schistocyte formation

Fails to react with D positive cells that have been treated with ficin

Fails to react with D positive cells that have been treated with dithiothreitol (DTT)

Anti-D is an IgG antibody that can cause hemolytic disease of the fetus/newborn
(HDFN) and hemolytic transfusion reactions. The D antigen is not destroyed by
treatment with either enzymes (like ficin) or sulfhydryl reagents (like DTT), so anti-D
would still react with D-positive cells following treatment with either reagent. Anti-D is
not an efficient complement-binding antibody, so the hemolysis caused by
incompatibility tends to be extravascular (where RBCs are coated with antibody and
not immediately hemolyzed but are destroyed/removed in the spleen or liver).
Extravascular hemolysis typically results in spherocyte formation rather than
schistocytes.

Anti-G will react with red blood cells of each of the following phenotypes except:

D+C-

D-C+

D-C-

D+C+

rG

Anti-G is an antibody that reacts, shockingly, with the G antigen (also known as
“Rh12”). While that seems easy enough, what is not obvious is that the G antigen
itself is actually the result of a common amino acid at position 103 of either the RHD
or RHCE protein. Inheritance of the RHD allele at the RHD site, or inheritance of either
or both of the RHCe and RHCE alleles at the RHCE site result in the presence of the
serine at that position (for the RHD allele, on the RHD protein; for the RHCe and/or
RHCE alleles, on the RHCE protein). As a result, G is best thought of as being present
on an RBC that has the antigens D and/or C. Anti-G, then, will agglutinate cells that
are positive for the D antigen only, the C antigen only, or both the D antigen and the
C antigen. The only RBC phenotype that will show no agglutination is a cell that is
both D negative and C negative (most D-negative cells are also G-negative due to the
fact that most D-negative individuals have the genotype rr). (EXCEPTION: Rare cells
have been described that are D-negative and C-negative but G-positive; i.e., they are
D-C-G+. This scenario results from inheritance of a gene called rG [say it like this:
“little r-G”]. Anti-G will show agglutination with these RBCs because the G antigen is
present. This phenotype is not found on routine antibody panels).

If a patient had a positive direct antiglobulin test (DAT) with Anti-IgG, what would
happen if you performed a Weak D test on the patient cells?

A false-positive result

A false-negative result
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An indeterminate test result

A valid test result

A valid test result if an Rh control is tested in parallel

The Weak D test is nothing more than an indirect antiglobulin test (IAT). Cells that are
coated with IgG will agglutinate whenever you add a reagent that contains Anti-IgG,
as is done in the last step of an IAT. Anti-IgG is added in both the direct and indirect
antiglobulin tests (see the blog post on DAT vs. IAT if you are confused). Cells that
have a positive DAT (i.e., are already coated with antibody) will of course agglutinate
in the antiglobulin phase in an IAT. In this case, the patient has a positive DAT. The
patient cells will give false-positive agglutination during the Weak D test since Anti-
IgG is added prior to reading the AHG phase of testing. To get an accurate Weak D
typing in this case, the antibody coating the cells must be removed. This can be
accomplished by adding a chemical such as Chloroquine diphosphate to the cells.
Chloroquine causes a gentle elution that removes the coating antibody without
destroying the antigen integrity of the cells. Once the DAT on the patient cells is
negative, an accurate Weak D typing can be obtained.

Which of the following phenotypes is seen more frequently in Caucasians than in

African-Americans?

Fy(a-b-)

S-s-U

R0 haplotype

K+ phenotype

The Fy(a-b-) phenotype is far more common in African Americans than Caucasians
(68% vs. very rare). S-s-U- is seen in about 1% of African-Americans, but is essentially
never seen in Caucasians. The R0 haplotype (also known as “Dce”) is the most
frequently seen Rh haplotype in African-Americans, while R1 (“DCe”) is most common
in caucasians (R0 is actually fourth in frequency in Caucasians). The K antigen,
however, is present in 9% of Caucasians vs. only 2% of African-Americans.

Patients with which of the following red cell phenotypes are resistant to Plasmodium
vivax malaria?

Fy(a-b-)

Rh(null)

McLeod phenotype

S-s-U-

Bombay phenotype

Le(a-b-)
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The Fy(a-b-) (“Duffy A-negative, B-negative”) phenotype is associated with resistance
to P. vivax infections. Nearly 100% of natives of West Africa, and approximately 68%
of U.S. African-Americans have this phenotype. Caucasians are almost never Fy(a-b-).

Which of the following red blood cell antigens has increased expression following
incubation with proteolytic enzymes?

Duffy (Fy) antigens

MN antigens

Lewis (Le) antigens

Ss antigens

Kell antigens

For most blood banking students, memorizing the effect of proteolytic enzymes on the
major blood group antigens is something that is important primarily for being able to
answer questions on tests. However, we do actually use the information in real life. M
and N antigens, as well as all the major Duffy (Fy) antigens, show decreased
expression following exposure of red cells to proteolytic enzymes (think “Duffy is
destroyed”). On the other hand, the same enzymes lead to stronger expression of
Lewis (and all ABO-related blood group) antigens. Rh and Kidd (Jk) antigens also show
strengthened expression following enzyme treatment of the red blood cells. NOTE:
The enzyme effect may seem like such a minor point, but you are very likely to see
this information on exams. In real life, enzyme reactions are used to confirm or refute
the presence of a particular antibody. For example, if an antibody suspected to be an
anti-Fya gets stronger following enzyme treatment of the red cells, it’s pretty unlikely
to be a Duffy antibody.

You are told that a patient has the “McLeod Syndrome.” Which of the following is true
regarding this situation?

The patient might be susceptible to Streptococcus infections

The patient most likely has stomatocytes in his blood

The patient has increased levels of Kell blood group antigens

The patient may present with seizures or involuntary movements

The level of Kx antigen is increased in his blood

The “McLeod Syndrome” is caused by absence of an antigen known as “Kx.” This

syndrome is quite rare, and is seen almost exclusively in males (since it is linked to
the X-chromosome). Kx (which was formerly considered part of the Kell blood group
system) is a transmembrane protein that may play a role in maintaining red blood cell
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membrane stability. As a result, people with McLeod have abnormal RBCs, in
particular acanthocytes (not stomatocytes). Affected adults may develop a
neurological disorder resembling Huntington’s Disease (chorea), seizures,
cardiomyopathy, and a poorly defined muscular abnormality with elevated creatine
kinase levels. They may also have decreased Kell system antigens (this part of the
syndrome is called the “McLeod phenotype“). Perhaps McLeod’s most famous
association is with Chronic Granulomatous Disease (CGD), an inherited deficiency of
NADPH oxidase, in which catalase-positive organisms like Staphylococcus aureus may
cause chronic, recurrent, severe infections (God help me; I’m writing about
microbiology! Someone stop me!).

Which of the following lectins is matched appropriately with its target antigen?

Vicea graminea: N antigen

Dolichos biflorus: H antigen

Salvia: A2 antigen

Ulex europaeus: A1 antigen

Ulex europaeus: Sda antigen

Lectins are substances derived from seeds of different plants (especially flowers)
which act kinda like antibodies; i.e., they agglutinate RBCs of particular phenotypes.
NOTE: It’s really a little bit more complicated than that, because there are some
things that we can do with concentrations that will change the lectin specificity.
Lectins are useful in differentiating blood groups by their reactivity (or lack thereof)
with a particular lectin or group of lectins. Here are the lectin associations you should
know:

Dolichos biflorus: Agglutinates RBCs of A1 phenotype

Ulex europaeus: Agglutinates RBCs carrying H antigen (more H, more agglutination)

Vicea graminea: Agglutinates RBCs carrying N antigen

Salvia, which is used in polyagglutination workups and agglutinates cells of the Tn

type of polyagglutination, is not really one that has to be committed to memory!

Which of the following red cell antigens is NOT weakly expressed or absent on red
blood cells from a term neonate?

K ("Big K") antigen

I antigen

A antigen

Le(a) antigen

P1 antigen

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ABO antigens, while present on fetal and neonatal RBCs, are not fully developed until
between age 2 and 4 (ABO antibodies, by the way, are not reliably present until after
age 4-6 months). The I antigen is found on adult RBCs, while the other I/i antigen, i, is
strongly present on fetal and neonatal RBCs (you can remember this easily with the
following mantra: “Big I in big people, little i in little people”). Lewis antigens are also
not found in significant quantities on neonatal RBCs; this is part of the reason that
Lewis antibodies don’t usually cause hemolytic disease of the newborn (the other is
that the antibodies, being IgM, can’t cross the placenta). P1 antigens, being built on
similar chains as ABO antigens, are likewise weakly expressed at birth. Kell antigens,
on the other hand, are well-expressed on newborn RBCs, as well as on RBC
precursors. The presence of Kell antigens on RBC precursors is the reason that anti-K
can cause such significant anemia in K-positive babies born to K-negative moms with
anti-K, as the antibody powerfully suppresses RBC formation in the precursor cells,
resulting in severe fetal and neonatal anemia (note that it’s not really a hemolytic
process, but many people still call it Hemolytic Disease of the Fetus/Newborn).

Which of the following is NOT TRUE about the I blood group system?

Auto-anti-I is associated with Mycoplasma pneumonia

Auto-anti-i is associated with infectious mononucleosis

i antigen is stronger on neonatal RBCs than adult RBCs

Patients with auto-anti-I may require a “prewarmed" crossmatch before transfusion

Antibodies in this system are usually clinically significant

Remember the easy way to think about I/i antigens: “Big I in big people, little i in little
people,” and you won’t go wrong. These antigens are biochemically and structurally
related to ABO antigens but are distinct, and they typically cause issues with the
formation of “cold antibodies,” usually cold autoantibodies. Although such antibodies
are very common, most of them do NOT cause hemolysis (i.e., they are not clinically
significant. Once the antibodies are found, however, it may be difficult to find blood
that is crossmatch-compatible without warming up the reaction mixture first
(“prewarmed crossmatch“). These cold antibodies may cause hemolysis of transfused
and native red blood cells, especially in the two classic scenarios listed above.

Which of the following is TRUE of the P1PK and GLOB blood group systems?

The P antigen is the point of entry of Plasmodium vivax into the red cell

Anti-P1 is a common cause of hemolytic disease of the fetus/newborn

Anti-P1 is an insignificant antibody neutralized by pigeon egg white fluid

The lack of three main antigens in these systems may lead to the McLeod syndrome

Antibodies against P1PK/GLOB antigens are not associated with hemolytic transfusion
reactions

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The P1PK and GLOB blood group systems are really odd. First, the names: The “P1”
and “PK” parts are easy enough (P1 and Pk are the names of the two main antigens in
the system). The “GLOB” system name stands for “globoside,” and the P antigen is
the main antigen in that system. The P1, Pk, and P antigens are related biochemically
and were once part of the same group of “P antigens.” Even though the ISBT now
classifies them as part of two different systems, we often discuss them as if they were
all one screwy group. Here are some of the weird things:

-The P antigen is the point of entry for Parvovirus B19 into the red cell.

-The P1 antigen is found in hydatid cyst fluid and pigeon egg whites (either fluid can
be used to neutralize anti-P1).

-Most examples of anti-P or anti-P1 are benign, naturally occurring, IgM class
antibodies that are boring as heck (no hemolytic transfusion reactions and no
hemolytic disease of the fetus/newborn).

-One example of anti-P associated with paroxysmal cold hemoglobinuria is not so

boring (see next question).

-Very rare persons lack all three P-related antigens (P, P1, and Pk), and as a result,
make an antibody against all three (anti-PP1Pk) that can cause hemolytic transfusion
reactions and spontaneous abortions when present in pregnant ladies.

A 5 year old child had an upper respiratory infection 5 days ago. Today, his mother
brings him to the emergency room because his urine was bright red this morning.
Upon admission, he appears pale, his hemoglobin is 6.9 g/dL, his urine and serum
have free hemoglobin, and his direct antiglobulin test (DAT) is weakly positive with
anti-C3 only (anti-IgG is negative). Which of the following is most likely TRUE?

The most likely diagnosis is Paroxysmal Nocturnal Hemoglobinuria

The antibody specificity is most likely anti-P

The child should be tested for syphilis

Transfusion should wait until antigen-negative blood is available

The antibody is most likely a high-titer IgM antibody

This case is a fairly classic presentation of Paroxysmal Cold Hemoglobinuria (PCH), a

transient, autoimmune hemolysis that most frequently occurs in children in
association with a viral infection. PCH is caused by an unusual IgG (not IgM) antibody
that reacts in a very strange way. Most IgG antibodies react with their target antigens
at body temperature (37C), but not this antibody! This IgG, known famously as the
“Donath-Landsteiner biphasic hemolysin” binds to the P antigen on the patient’s own
RBCs in cold temperatures (4C in the laboratory, and in the cooler extremities in the
body), and fixes complement to the surface of the RBC. The antibody then dissociates
and hemolyzes the red cell when the temperatures get warmer! This “biphasic”
hemolysis (bind in the cold, hemolyze when it’s warm) can be detected through the
use of the so-called “Donath-Landsteiner Test,” in which the blood bank tries to mimic
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the cold to warm temperature change. Hemolysis only when the patient serum and
test RBCs go from cold to warm constitutes a positive D-L test and confirms the
diagnosis. PCH was formerly seen most often in patients with syphilis, but this
association is far less common today (so no need to test the poor 5 year old for
syphilis!). The autoantibody here, targeted against the P antigen as mentioned above,
will generally not destroy transfused P-positive RBCs, so if transfusion is necessary
due to intense hemolysis, P-positive units may be used (good thing, too, since P-
negative units are really rare!). The clinical situation is what distinguishes this
hemolysis from that seen in cold autoimmune hemolytic anemia (choice E).

The inheritance of this null leads to a syndrome with hematologic and chemical
abnormalities. The syndrome includes a mild compensated anemia, reticulocytosis
and stomatocytosis. A decrease in haptoglobin and an increase in bilirubin are also
seen. The null can have two origins, regulator and amorphic. Name that null!

Rh(null) phenotype

Kell null phenotype

McLeod phenotype

Bombay phenotype

In(Jk)

Rh(null) syndrome is rare, and is characterized by a complete lack of all Rh antigens.

It is caused by either a mutation in the gene for the Rh-related Antigen (RHAG)
(“regulator” type) or a mutation in the RHCE genes along with a deletion in the RHD
gene (“amorphic” type). Rh proteins are essential parts of the red cell membrane
(passing through the membrane 12 times). The absence of the Rh proteins leads to an
alteration of the RBC lipid bilayer, causing the abnormal laboratory results. Question
contributed by Bill Turcan, June 2015.

Inheriting this null for the common antigens in the corresponding blood group system
leads to a resistance to the malaria parasite, Plasmodium vivax. Name that null!

Bombay phenotype

Jk(a-b-)

Fy(a-b-)

Le(a-b-)

Kell null

Red blood cells with the Fy(a-b-) phenotype are resistant to invasion by Plasmodium
vivax merozoites. The null is the result of a homozygous inheritance of the silent Duffy
allele sometimes called FY or Fy (which is actually an altered FY*B allele). The FyFy
genotype that leads to the Fy(a-b-) phenotype is extremely common in West Africa

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and is found in 68% of African-Americans. Question contributed by Bill Turcan, June
2015.

The rarest of all blood types is characterized by the absence of the common H
antigen. This leads to the production of a naturally occurring hemolytic Anti-H. People
with this null can only be transfused with red blood cells from other people with this
null. Name that null!

McLeod phenotype

Bombay phenotype

Rh(null) phenotype

In(Lu)

MkMk

The Bombay phenotype, Oh, can also be written as “H-.” The homozygous inheritance
of the h allele, hh, prevents a fucose sugar from being added to the precursor
structure, paragloboside, on the red cell surface. This fucose-paragloboside structure
is the H antigen. The lack of the fucose prevents the ABO genes from adding their
sugars and creating the regular ABO blood types. Those with the Bombay phenotype
also lack active “secretor” alleles (they are sese), and as a result, they also cannot
produce H antigen in secretions or plasma. All Bombay cells will type as group O using
routine testing. The patient plasma will be incompatible with all antibody screening
and panel cells. The only RBCs that will be compatible with the patient will be those
from others with the Bombay phenotype. Please see the Bombay Video for more
details. Question contributed by Bill Turcan, June 2015.

This null produces red blood cells that are resistant to lysis by the addition of 2M Urea,
allowing for donor compatibility screening for this phenotype without using antisera.
Name that null!

Fy(a-b-)

Lu(a-b-)

Le(a-b-)

Jk(a-b-)

Co(a-b-)

The rare Kidd null phenotype is caused by the inheritance of two mutant, silent alleles
at the JK locus (there are multiple mutant alleles that lead to a lack of Kidd antigen
expression). This genotype produces no Kidd antigens on the red blood cells, and
these patients may form anti-Jka, anti-Jkb, and anti-Jk3 (an antigen present when
either Jka or Jkb is present). The Kidd glycoprotein has a specific function:
Transportation of urea across the red blood cell membrane (in fact, the Kidd gene,
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SLC14A1, was formerly known as “Human Urea Transport Gene 11” or “HUT11”).
Normal RBCs are lysed rapidly in the presence of 2M urea (a pretty high
concentration), because the urea is transported quickly across the cell membrane,
water follows because the cell becomes hypertonic, and the RBC explodes due to the
excess volume. Jk(a-b-) RBCs can’t transport the urea nearly as quickly, however, so
they do not lyse until 30 minutes or more have elapsed. Reference labs can use this
fact to quickly screen for Jk(a-b-), Jk3 negative RBCs by adding 2M urea to multiple
samples of donor cells (though they don’t do this all that often anymore). RBCs that
do not lyse can then be confirmed as negative by serologic or molecular techniques,
thus saving time, expense, and potentially scarce reagents. Question contributed by
Bill Turcan, June 2015.

This null produces a naturally occurring antibody formerly called “anti-Tja.” This
antibody is actually a combination of three antibodies against three separate antigens
in two different blood group systems. This antibody also has an association with
miscarriages early in a pregnancy. Name that null!

Oh phenotype

Kell null phenotype

Rh(null) phenotype

Fy(a-b-) phenotype

p phenotype

The p (“little p”) phenotype is the rarest of five possible phenotypes in the P1PK and
GLOB blood group systems. This phenotype does not produce any of the three main
antigens of these systems: P, P1 or Pk. The antibody originally known as anti-Tja is
now known as “anti-PP1Pk.” This is actually three separable antibodies that will
agglutinate red blood cells that are positive for any of those three antigens. The
placenta and fetus contain a large amount of P and Pk antigens. Anti-Tja (being IgG)
can damage the placenta and cause fetal demise in the first trimester of pregnancy as
a result. Don’t be confused: Anti-PP1Pk does not typically cause hemolytic disease of
the newborn (HDFN)! Instead, the fetus is harmed indirectly through the antibody
attack on the placenta. Question contributed by Bill Turcan, June 2015.

This null phenotype is found in a blood group system that is phenotypically linked to
the secretor status of the patient, and has antigens formed in body fluids such as
saliva. Name that null!

Le(a-b-) phenotype

Lu(a-b-) phenotype

Fy(a-b-) phenotype

Jk(a-b-) phenotype

Co(a-b-) phenotype

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The Lewis null phenotype is not that rare, as 22% of African-Americans and 6% of
Caucasians are Le(a-b-). The rare phenotype in the Lewis system is actually the one
where the two main antigens are both positive: Le(a+b+). The two common
phenotypes, Le(a+b-) and Le(a-b+), reveal the secretor status of the patient, without
any need to conduct a secretor test. A patient that is Le(a+b-) is a non-secretor while
a patient that is Le(a-b+) is a secretor, by definition ( see the Lewis system video for
more details). An Le(a-b-) patient lacks an active LE allele (FUT3), which is also
described as the lele genotype. Such patients could be either non-secretors or
secretors, and the secretor test that is performed on a saliva sample from the patient
is positive in approximately 80% of these individuals. Question contributed by Bill
Turcan, June 2015.

Treating red blood cells with a sulfhydryl reagent such as DTT will artificially create
red blood cells of this null without a rare recessive genetic background origin. Name
that null!

Rh(null) phenotype

McLeod phenotype

In(Jk)

Kell null phenotype

Fy(a-b-) phenotype

Kell null, or KoKo, red blood cells can be created in the antibody identification
laboratory by treating the RBCs with a sulfhydryl reagent (such as DTT, 2-ME, or AET).
This reagent destroys the disulfide bonds that assist in antigen expression in the Kell
blood group system. These Kell null cells can be used to identify an antibody against a
high incidence antigen in the Kell blood group system, such as Anti-Kpb. Question
contributed by Bill Turcan, June 2015.

There can be multiple genetic reasons for a null phenotype in a blood group system.
One system has a null that famously can have three possible genetic origins, two of
which do not actually involve the blood system genes at all. Name that null!

Le(a-b-) phenotype

Lu(a-b-) phenotype

Fy(a-b-) phenotype

Jk(a-b-) phenotype

Rh(null) phenotype

The Lutheran null phenotype, Lu(a-b-), has three possible genetic origins. The true null
is the autosomal recessive LuLu. The homozygous inheritance of this silent gene
produces no Lutheran antigens on the red blood cells. People with this version of the
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null phenotype can produce all Lutheran blood group system antibodies including the
rare Anti-Lu3. The Lutheran null phenotype can also be produced by one of two
suppressor genes. The autosomal dominant suppressor gene is called “In(Lu).” The X-
linked dominant suppressor gene is called “XS2.” Each of these suppressor genes
limits the expression of Lutheran antigens on red blood cells. Routine phenotyping
appears to show no Lutheran antigens present. Adsorption/elution techniques are
needed to confirm the presence of Lutheran antigens. Because these people have
normal Lutheran genes, just weakened Lutheran antigens, they do not produce
Lutheran antibodies except to those antigens to which they are truly negative.
Question contributed by Bill Turcan, June 2015.

McLeod syndrome is associated with the null in a blood group system that has only
one antigen. The null can also result in X-linked chronic granulomatous disease in
males. Name that null!

Kx system

MNS system

Kell system

Rh system

I system

The Kx blood group system has only one antigen, Kx, that assists in anchoring the
antigens in the Kell blood group system to the red blood cell membrane. The lack of
this antigen results in the McLeod syndrome and a weakened expression of Kell
antigens. The syndrome features a compensated hemolytic anemia (classically
associated with the presence of acanthocytes), elevated serum creatinine kinase, and
certain neuromuscular disorders. There’s a pretty good chance that you were tempted
to choose “Kell” here, as McLeod is taught in association with the Kell system.
However, Kx is in fact a separate blood group system, one whose lone antigen lives
next door to the Kell system antigens on the red cell membrane (See the Kell Video
for more information). Question contributed by Bill Turcan, June 2015.

This null produces red blood cells that lack the structures Glycophorin A and
Glycophorin B and all antigens located on those structures. This results in the absence
of an entire blood group system in these patients. Name that null!

KoKo (Kell null)

Oh

McLeod phenotype

Rh(null) phenotype

MkMk

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Homozygous inheritance of the very rarely seen Mk allele (GYP*01N) will produce red
blood cells that lack Glycophorin A and Glycophorin B. GPA and GPB are the structures
that carry the MNS blood group system antigens, so these patients will not produce
antigens such as M,N,S,s and U. The more famous (and more common) antigen-
negative phenotype in this system is the homozygous inheritance of a null allele for
glycophorin B inheritance (GYP*NULL), leading to a complete lack of GPB and the
antigens carried by it (S, s, and U). The S-s-U- phenotype is seen in roughly 1% of
African-Americans.

If a patient has a positive antibody screen, a request for a red blood cell (RBC) product
transfusion will be delayed due to the extra testing that is now required to identify the
antibody and find compatible RBC’s. Which of the following antibodies would be most
likely to cause the shortest transfusion delay?

Anti-K

Anti-Jk(a)

Anti-E

Anti-s

If a patient has an antibody against a red blood cell antigen, their compatibility with
the donor population is decreased. A patient with a so-called “clinically significant”
antibody must receive RBCs that test (“phenotype”) negatively for the corresponding
antigen. An antibody is considered clinically significant if it can either cause a
hemolytic transfusion reaction or hemolytic disease of the fetus and newborn (HDFN).
Such antibodies are usually antibodies of the IgG isotype that cause agglutination at
37C. The lower the frequency of the antigen in the population, the better chance you
have of finding compatible RBC’s for the patient. In this case the antigen frequencies
(in a primarily U.S. Caucasian donor pool) are: K: 9%, Jka: 77%, E: 29%, s: 89%. Since
the frequency of K is 9% in these donors, a patient with anti-K is compatible with 91%
of the population.

When a patient makes an immune antibody, red blood cell products are phenotyped
and products that are antigen-negative for the corresponding antibody selected for
transfusion. RBC products are already pre-phenotyped to prevent interactions with
one immune antibody. Which antibody is it?

Anti-K

Anti-D

Anti-E

Anti-A

Anti-Le(a)

All blood products are pre-phenotyped for the D antigen. This is the first and most
important antigen in the 50+ antigen Rh system. This can be confusing since the
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labels on blood products do not read “D positive” or “D negative,” but as “Rh positive”
or “Rh negative” (even though this is technically incorrect). Taken literally, the
designation “Rh positive” would mean that a red cell is positive for all Rh antigens,
when in reality it has only been tested for one antigen: D (but I digress…). With other
blood group systems, in most cases we only test the to-be-transfused red cells for a
particular antigen after the patient makes an antibody, but the D antigen is so
immunogenic that we do not wait for the patient to make the antibody. A D-negative
patient that is exposed to a full unit of RBC’s has about a 22% chance of making Anti-
D (we used to think that number was much higher, but new research in hospitalized
patients reveals the above risk, which is still quite high!). Even exposure to less than 1
ml of D positive RBCs can result in anti-D production in a D-negative patient. Blood
products are also pre-phenotyped for the A and B antigens, so you might have been
tempted to choose “anti-A.” Anti-A and anti-B are “naturally occurring” antibodies
(rather than “immune” antibodies), as they are produced without exposure to RBC
antigens through pregnancy, transfusion, or transplantation.

A patient has anti-c. If 80% of donors are c-positive and 68% are C-positive, how many
RBC units will the transfusion service need to test in order to find 2 units that are
compatible with the patient?

3 units

4 units

7 units

10 units

18 units

When doing this calculation you need 2 pieces of information, the number of RBC
products desired and the frequency of the corresponding antigen in the population. In
this case 2 RBC products are requested. The frequency of the corresponding antigen,
c, is 80%. This means that the patient is compatible with 20% of the population. The
formula for the calculation is:

So, for this case, using the numbers above, the calculation would be:

Note that the C frequency of 68% in the question above is completely irrelevant in
your calculations about c-compatibility. Also please note that frequencies like this may
or may not be given on standardized exams (for pathology board exams, they often
are given, but for SBB exams, they usually are NOT given).

If a patient has Anti-c and Anti-S, how many RBC units will the transfusion service
need to test in order to find 2 units that are compatible with the patient?

(Frequency data: c = 80%, C = 68%, s = 90%, S = 55%)

5 units

12 units
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22 units

32 units

42 units

For this question, the same general formula used in the previous question is
applicable:

When the patient has more than one antibody, as in this question, you simply multiply
the compatibility frequencies of each antigen to calculate the percentage of RBC units
compatible (the numerator of the calculation above). The frequency of the c antigen is
80% (20% compatible with the patient) and the frequency of the S antigen is 55%
(45% compatible with the patient, so you multiply 0.2 x 0.45, which equals 0.09.
Plugging in that value with the need to find 2 compatible units looks like this:

A patient has a positive antibody screen and positive antibody panel. The patient
specimen is retested with antibody panel cells that have been treated with the
enzyme called “ficin.” The antibody panel is now negative. Which of the following
antibodies is most consistent with these results?

Anti-D

Anti-K

Anti-Jk(b)

Anti-Fy(a)

Anti-Le(a)

Ficin is a so-called “proteolytic enzyme” that destroys certain common antigens found
on red blood cells. The antigens are: Fya, Fyb, M, N, S, s, Xga (see image below). If a
patient has an antibody against one of these antigens, the test result will be negative
after the reagent red cells are treated with the enzyme, since there is no longer a
target antigen for the antibody. Keep in mind that the patient still has the antibody
itself. The antibody is just not detected using antibody screening cells or antibody
panel cells that have been treated with ficin. One more time, to be clear (because
beginners get this confused quite a bit): Blood Bank enzymes destroy antigens, not
antibodies.

A patient has a positive antibody screen and a positive antibody panel. All tested cells
are positive 3+ at the AHG phase of reactivity. The only tested cell that is negative is
the autocontrol. You phenotype the patient and discover that he is negative for the
following antigens: E, Fy(a), S, and Jk(b). You locate a testing cell that has this antigen
negative phenotype. The cell reacts 3+ at the AHG phase. Of the following choices,
which is the most likely specificity of the antibody/antibodies?

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Allo-anti-k

Auto-anti-k

Allo-anti-E, -Fy(a), -S, -Jk(b)

Allo-anti-E, -Fy(a), -S and auto-anti-Jk(b)

Warm-reacting autoantibody

Since the autocontrol test was negative, this antibody is not likely to be an
autoantibody. However, the pattern is consistent with at least one alloantibody
against a high-frequency antigen. We say this because of the fact that a
phenotypically matched cell is incompatible with the patient’s serum, with a negative
autocontrol. If the patient had multiple antibodies against common antigens (choice
C), the cell described in the question should have been compatible with patient
specimen.

The k (“little k”) antigen is present in 99.9% of the population, and blood banks do not
routinely include phenotyping for k in routine testing. As a result, if a person is k-
negative and makes anti-k, this is exactly the way an alloantibody against a high
frequency antigen like k would look.

A patient has a positive antibody screen and a positive antibody identification panel.
All tested cells are positive 3+ at the AHG phase of reactivity. The autocontrol is also
positive 3+ at the AHG phase. The patient has never been transfused or pregnant.
Which adsorption technique would you use to complete the case?

Cold alloadsorption

Cold autoadsorption

Warm alloadsorption

Warm autoadsorption

Since the patient has never been exposed to allogeneic red blood cells, the test
results indicate the patient has an autoantibody. You can use an adsorption technique
to confirm this panagglutination testing pattern reactivity. The antibody reacts at the
AHG phase of testing. This indicates a warm autoantibody and the autoadsorption
should take place at 37C. Since the patient has not been transfused or pregnant in the
last 3 months, you can use the autologous patient cells to conduct the adsorption. The
autoadsorption will act to “soak up” the autoantibody and leave behind serum that
can then be used to screen for additional antibodies (the “left-behind” serum is known
as “adsorbed serum“).

A patient with sickle cell disease who was transfused 2 units of red blood cells 2
weeks ago at another facility presents to your transfusion service for the first time.
The clinician is requesting phenotypically matched red cells. What serologic technique
can be used to obtain the patient phenotype in this case?

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Wash the patient's red cells with hypotonic saline (0.3%)

Wash the patient's red cells with hypertonic saline (1.2%)

Treat the patient's red cells with the enzyme ficin

Perform a cold-autoadsorption on the patient specimen

Incubate the patient's red cells with chloroquine

Performing a phenotype on a patient who has been recently transfused is a special

challenge in the laboratory. In patients with sickle cell disease, the hypotonic saline
wash may be useful. RBCs with hemoglobin S (HbS) react differently than RBCs with
hemoglobin A (HbA) when exposed to hypotonic (0.3%) saline. Recently transfused
RBCs, which contain HbA, will hemolyze in the presence of hypotonic (0.3%) saline
(the interior of the RBC appears hypertonic to the surrounding environment, water
rushes in, and the red cell goes “BOOM!”). The patient’s own RBCs (with HbS) are far
more resistant to this type of osmotic hemolysis, and will not be hemolyzed. In most
cases, this difference allows us access to the patient’s own RBCs after multiple
hypotonic (0.3%) saline washes, since the recently transfused RBCs are destroyed.
The remaining autologous RBCs can then be tested and phenotyped. Ficin would not
be expected to separate patient from the transfused red cells, and there is no reason
to do a cold autoadsorption. Chloroquine acts to weaken HLA and Rh antigens on
RBCs, and may be used to assist in testing when a patient has a warm autoantibody.
Molecular genotyping is another technique not listed among these answers that is
absolutely possible in modern transfusion services.

You identify an RBC alloantibody in a patient. Your lab performs tube testing with LISS
potentiation. Which antibody would be eligible for antibody screens and crossmatches
using the “prewarm technique”?

Anti-E (reacting at 37C and AHG phases)

Anti-S (reacting at AHG phase)

Anti-K (reacting at AHG phase)

Anti-M (reacting at immediate spin phase)

Anti-Le(a) (reacting at AHG phase)

Anti-M is usually an IgM-isotype, cold-reacting antibody that has no clinical

significance. Once an antibody with these characteristics is identified, the laboratory
may choose to use the prewarm technique to provide compatible RBCs for transfusion
to the patient. The phrase simply means that all reagents, cells, and serum are kept
at body temperature both before and during the antibody screening or crossmatching
procedure. The prewarm technique allows you to provide RBCs for transfusion to a
patient with a cold-reacting antibody without phenotyping the RBCs for the
corresponding antigen. If the antibody in question shows agglutination at the AHG
phase of testing using the prewarm technique, you must provide the patient with
RBCs that are phenotyped for the corresponding antigen against the patient antibody.
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Anti-M may contain an IgG component that can cause this problem. NOTE that this
technique is only approriate after the antibody is identified! It is usually poor practice
to simply “prewarm away” an unknown cold-reacting antibody without having an idea
of what it is! Some cold-reacting antibodies can have wide thermal amplitudes and
cause significant hemolysis despite being nonreactive with prewarming, so the this
technique should not be used as a substitute for proper antibody identification.

Which of the following antibodies could be identified using a patient specimen

collected in a red top tube (plain glass), but may not be identified if a purple top tube
(EDTA anticoagulant) was used for the collection?

Anti-M

Anti-E

Anti-Fy(a)

Anti-Jk(a)

Anti-Jka is an antibody that can bind complement. Although it is not common, weak
reacting Anti-Jka antibodies may require the presence of complement in the
laboratory test in order to be identified. The purple top tube contains EDTA, which
binds calcium to prevent coagulation of the sample (and prevents complement from
activating at the same time). This may cause you to miss identifying one of these
uncommon complement-binding dependent antibodies.

If you are saying to yourself, “Wait a minute! We use EDTA tubes in our blood bank
laboratory. Are we running the risk of missing one of these uncommon antibodies?,”
the answer is, “You are probably missing them anyway.” Check the anti-human
globulin (AHG) reagent you are using for the AHG phase of testing in your lab. In order
to detect a complement binding dependent antibody you must use an AHG reagent
that contains anti-complement (usually anti-C3d). This antibody is found in the
“polyspecific” AHG reagent. This reagent contains both anti-IgG and anti-C3d, allowing
you to detect the bound complement. If you are using monospecific AHG, which only
contains anti-IgG, you may not detect this antibody regardless of whether you use a
red or purple top tube. In order to detect a complement dependent antibody, you
must use a specimen collected in a red top (plain glass) tube and polyspecific AHG
that contains anti-C3d. This is usually only done when you have a patient with a
suspected antibody that is not detected using routine testing.

A 70 year old female who is thrombocytopenic due to recent chemotherapy for acute
myelogenous leukemia is scheduled to receive a single unit of apheresis-derived,
irradiated, leukocyte-reduced platelets. You walk in just as the transfusion is about to
begin and see that the nurse is about to spike the unit with a standard IV infusion set
connected directly to her left arm. You say:

"No problem"

"Wait a second! This product must be infused through a microaggregate filter"

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 "Wait a second! This product must be infused through a standard blood
filter"

"Wait a second! This product must be infused through a leukocyte reduction filter"

"Wait a second! This product must be washed before it is infused"

Blood products must be administered through special IV tubing known as a “standard

blood infusion set.” These sets can have either one straight line or be “Y-shaped,” but
in either case, the component runs through a standard blood filter that typically has a
pore size of about 170 microns (a range of 170-260 microns is considered
“standard”). When you remember that RBCs have a diameter of about 8 microns, you
can see that this filter would only filter out large particles and blood clots, and should
do little with the blood components themselves. Microaggregate filters are not
required, they are rarely used. Leukocyte reduction is done as a part of the apheresis
collection process (plus the product was already called “leukocyte reduced”), so
additional leukocyte filtering is not needed. Finally, there is no information in the case
presentation to suggest that washing would be required for this patient.

A “microaggregate” blood filter has an approximate filter screen size of:

170 microns

40 microns

15 microns

10 microns

5 microns

Microaggregate filters, while approved for use with all components, are rarely used for
routine transfusions. They were introduced years ago as a possible mechanism to
prevent adult respiratory distress syndrome (ARDS) in transfusion recipients, but they
are pretty much obsolete today. They have a screen size of roughly 40 microns, and
they are designed to filter small aggregates of dead cells, clots, and particles.
Microaggregate filters are still sometimes used for reinfusion of blood salvaged either
during or after a surgery.

A nurse who is transfusing a patient with two units of red blood cells, one unit of
apheresis platelets, and two units of fresh frozen plasma (FFP) calls you. She says that
the hospital materials department is running short on blood infusion sets, and wants
to know if there is any way to minimize the number of sets she uses while transfusing
these products. Which of the following is the best advice?

She can use the same infusion set for up to four hours, for any combination
of the products

She must change the set after each product is infused

She may use the same infusion set for all of the products

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 She must use a blood infusion set for the red cells, but a regular IV set is ok for the
platelets and plasma

She must use a different set for each product type (one for RBCs, one for platelets,
one for FFP)

OK, so the easy part is this: All blood components (even platelets and plasma) must
be infused through a filter, and regular IV sets do not come with a filter. So, choice D
is not acceptable. Every manufacturer of standard blood filters has their own set of
rules in their package insert, but in general, you can use the same set for multiple
products up to a maximum of 4 hours. Most manufacturers do not require the user to
change the infusion set after each product, and most allow multiple different products
to be infused through the same set.

Fill in the blanks: In general, red blood cell transfusions should start at a flow rate of
approximately __ mL/minute for the first __ minutes of the transfusion.

2 mL/min; 5 minutes

2 mL/min; 15 minutes

5 mL/min; 15 minutes

5 mL/min; 30 minutes

10 mL/min; 5 minutes

Manifestations of many (not all) severe complications of transfusion are seen within
the first 15-20 minutes of transfusion. This includes symptoms of acute hemolytic,
anaphylactic, and septic transfusion reactions. As a result, transfusions of all blood
products should start slowly for the first 15 minutes or so, and the blood recipient
should be closely monitored. There are various recommendations, but in general,
starting at 2 ml/min for the first 15 minutes is reasonable for all products. After that
time, the transfusion can be given as rapidly as the patient will tolerate it (but always
within 4 hours!). RBC transfusions typically are tolerated well at about 4-5 ml/min,
which means that an average-sized unit (300-350 ml) will be completed in 90 minutes
or so (including the slower first 15 minutes).

The transfusion service issues 2 units of red blood cells to the ICU for transfusion to a
66 year old male who had an acute myocardial infarction two days ago and now has a
hemoglobin of 7.5 g/dl. He has mild congestive heart failure, so the cardiologist has
requested that the units be infused slowly. How long does the transfusionist have to
transfuse the two units to this patient?

2 hours total

3 hours total

3 hours for each unit (6 hours total)

4 hours total

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4 hours for each unit (8 hours total)

This scenario illustrates why transfusion services are reluctant to issue more than one
unit at a time for use by a single patient. The rule of transfusion time limits is simple:
From the time the unit leaves monitored storage, it must be transfused within 4
hours! This is true whether there is one or ten other units issued at the same time
(you don’t get extra time if you take more units!). In most patients, this is pretty
simple, but this patient has volume overload potential, so both units might not be
infused in four hours. One little clue to how some try to get creative with this: It is NOT
COOL for clinical staff to try to game the system by putting units in unmonitored
refrigerators or non-blood bank supplied coolers! Unless your facility is one of the few
that is set up with transfusion service-monitored storage units, PLEASE don’t allow
anyone to put blood in a regular refrigerator!

A unit of red blood cells is signed out of the transfusion service at 9:00 am, to be
given to an oncology patient who has come in to the facility for an outpatient
transfusion. At 9:45 am, the nurse responsible for the transfusion calls to report that
the patient’s initial IV has blown, and that the staff are having a very hard time re-
establishing access. The nurse, a regular blood donor, does not want the unit to go to
waste, so she asks you for help. She states that the unit still feels cool to the touch.
Which of the following statements is the MOST LIKELY to be your advice?

Don't bring the unit back; just finish the transfusion within 4 hours if
possible

Don't bring the unit back; just finish the transfusion within 6 hours if possible

Throw the unit into the trash and come get a new one as it is compromised

Return the unit to the transfusion service where it will be accepted into inventory

Return the unit to the transfusion service where its temperature will be taken and a
decision made

There is no specific standard from either the AABB or the FDA regarding how long a
unit of blood can be out of monitored storage until it can no longer be accepted back
into inventory. The regulation that does apply here is that units of red cells must stay
at a temperature less than 10C when they are shipped. Each facility is required to set
up its own time limit, based on that maximum temperature value, and validate that
limit by testing what actually happens (i.e., how long does it take a unit to exceed 10C
in that specific facility). By far, the most common limit that transfusion services arrive
at is 30 minutes (this is the so-called “30 minute rule”). There’s nothing magical about
30 minutes; it’s just a number that people have used since a study was published
showing that units of RBCs set on a counter at room temperature take about that long
to exceed 10C). So, most facilities end up with a 30 minute limit beyond which the
unit will be discarded if returned. But, the time limit to transfuse the unit is 4 hours
from when it leaves the transfusion service! As a result, if the unit came back to the
transfusion service, it would likely be discarded, but if it is transfused, it’s all good as
long as it is infused within 4 hours! That leads to choice A as the most likely advice
you would give to our conscientious nurse. IMPORTANT NOTE: Remember, the “30
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minute rule” is not actually a rule at all! Each facility must validate their own time
limit. Inspectors will cite facilities that say, “Oh, we just use the ’30 minute rule'”
without any additional thought.

Which of the following is a TRUE statement regarding the administration of blood

products?

Blood warmers are required for patients with cold agglutinin disease

Blood issued in syringes for neonates does NOT need to be filtered at the
bedside

Granulocytes from a CMV-positive donor should be leukocyte-reduced before

transfusion

After identifying the patient and starting the transfusion, it is acceptable to remove
the "bag tag" from the unit

The bag and infusion set must be returned to the transfusion service after the
transfusion is complete

When transfusion services prepare an aliquot of blood for a neonatal transfusion with
a syringe, they generally filter the product before placing it in the syringe (often
through a built-in filter in the syringe kit). As a result, the blood need not be filtered
again before administration (especially since the syringe aliquot expires in 4 hours,
giving little time for clot formation). Note: Check with your facility to ensure that this
is how they operate. The remaining statements are false. Blood warmers may be used
in patients with cold agglutinins, theoretically to decrease the risk of hemolysis from
the receipt of “cold blood,” but their use in that situation is not required (nor is the
benefit proven). Granulocyte concentrates (composed of “leukocytes”) should never
be “leukocyte-reduced!” Think about it for a second…yeah, it doesn’t make sense,
does it? The bag tag and all identifying information should always stay attached to the
unit, even after properly identifying the patient and unit. Finally, while some facilities
choose to require the return of the bag after transfusion, there is no regulation that
mandates the practice.

Which of the following is an acceptable solution to be infused in the same intravenous

line with a blood component?

0.45% USP saline

5% dextrose in water (D5W)

Lactated Ringer's Solution

Normosol-R (pH 7.4)

Vancomycin solution

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OK, so here’s the deal: The best solution to run in the same line with a blood
component is normal saline (0.9% USP). Everything else is not as good, and some
non-approved things may be harmful. Hypotonic solutions like 0.45% (half-normal)
saline and dextrose-only solutions will cause RBC destruction for osmotic reasons (the
RBCs appear hypertonic, so fluid rushes in and bursts the cell). Drugs (including
antibiotics like vancomycin), total parenteral nutrition (TPN) supplements, or other
medications can also damage the blood component. Lactated Ringer’s (LR) is a
terrible solution to put in the same line with blood products, primarily because LR
contains 2.7 mEq/L of calcium (potentially enough to overwhelm the citrate
anticoagulant in blood products and clot the blood). Granted, this doesn’t happen
often (despite the widespread use of LR in operative settings, often in the same line
as blood), but it absolutely CAN occur. As part of their package inserts, the FDA has
approved several crystalloid solutions as acceptable to infuse with blood components.
These include Normosol-R (pH 7.4) and two different Plasma-Lyte solutions.

A 65 year old female with gram-negative sepsis secondary to a ruptured colon is

receiving a red cell transfusion. Her temperature has been fluctuating wildly between
37C up to a maximum of 39.6C for the past 8 hours. Prior to the start of the
transfusion, her temperature is 38C. Thirty minutes into the transfusion, however, her
temperature is 39.5C. She does not appear agitated, and her other vital signs are
unchanged. What is the FIRST thing that the person responsible for infusing the blood
should do?

Order a gram stain of the unit, as it was likely contaminated

Request a transfusion reaction workup from the blood bank

Stop the transfusion

Consult with infectious disease for an antibiotic change

Request that the attending physician come to evaluate the patient STAT

While all of the other options are things that might be done, the most important (and
FIRST) step that the person administering the transfusion should take is to STOP THE
TRANSFUSION! This is a difficult and complicated scenario, one that will most likely
take a while to evaluate. The history of a fever before the transfusion does not
eliminate the possibility that the patient may have a fever now for a different reason!
If the unit was mismatched in the blood bank or at the bedside, or if there is any other
undetected incompatibility or contamination of the unit, the WORST thing the
transfusionist could do is continue to infuse the blood into the patient. First, stop the
transfusion, keep the line open with saline, and THEN call for help to figure out the
whole situation. I always recommend to blood bank staff ask if the transfusion has
been stopped before embarking on a workup. NOTE: I acknowledge that in urgent
situations, the need to infuse blood in a complex patient with fluctuating
temperatures such as this may trump the evaluation of every temperature increase. I
just don’t believe that you can ignore the first spike. In these situations, blood banks
can work with clinical teams to rule out significant issues quickly so that the
transfusion can continue.

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Which of the following is TRUE about premedication of patients before they receive
transfusion?

Premedication is required by AABB Standards

Premedication is very beneficial in most cases

Premedication reliably masks fever from an acute hemolytic reaction

Premedication with diphenhydramine and prednisone is most common

Premedication is not an effective way to prevent reactions

Premedication of transfusion recipients became popular a number of years ago as an

attempt to reduce the incidence of benign transfusion reactions such as febrile
nonhemolytic and mild allergic (urticarial) reactions. Typically, patients would be
given 325 mg of acetaminophen and 25-50 mg of diphenhydramine prior to
transfusion (choice D). Despite its widespread use, there were (and are) no great
studies proving premedication actually worked! It has never been required (choice A),
and there has been concern that acetaminophen premedication may block fever but
not other uncomfortable aspects of a febrile nonhemolytic reaction (though it is hard
to believe that a little bit of acetaminophen could block the fever of an acute
hemolytic reaction reliably). The few studies that have been done, summarized nicely
in an article in Transfusion in 2007 by Aaron Tobian and colleagues at Johns Hopkins,
show that premedication is not an effective way to prevent reactions, and routine use
should be discouraged.

A 39 year old female with a history of acute myelogenous leukemia (AML) has
received numerous platelet transfusions in the past three days, with no measurable
increase in her platelet count from approximately 10,000/mcL. Which of the following
would least likely to contribute to her lack of response?

She is febrile to 39.1C

She is O negative and has received O positive platelets

She is O negative and has received A negative platelets

She has an enlarged spleen

She has delivered six children

Rh incompatibility does not affect how well a patient responds to a platelet

transfusion, because there are no Rh antigens on platelets. Even if this patient formed
anti-D, that antibody would not affect the response to platelet transfusion. Fever and
splenomegaly are well-known contributors to a decreased response to platelet
transfusion. Platelets DO have ABO antigens on their surface, so a group A platelet
transfusion to a group O recipient (who has anti-A) would not be expected to have an
optimal response. Finally, pregnancy (with delivery) is an excellent stimulator of HLA
antibodies, which may directly lead to platelet refractoriness.

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A 14 year old boy has a hemoglobin level of 6.9 g/dL following a spinal fusion surgery.
He has a documented history of IgA deficiency and his mother reports that he had a
“serious reaction” to a previous transfusion. Assuming that you have all of the
following readily available in your Blood Bank, which is the best choice?

Red blood cells, leukocyte reduced

Red blood cells, irradiated

Red blood cells, pooled

Red blood cells, deglycerolized

Red blood cells, unmodified

This is the kind of annoying question that you should expect to see on standardized
exams. When you read this question, the answer that you WANT to choose is “Red
blood cells, washed” (because you remember that washing removes IgA, which could
cause this poor young man to have an anaphylactic transfusion reaction). BUT,
“washed RBC’s” is not a choice! Remember that deglycerolized RBCs are essentially
to washed RBCs, because washing to remove the glycerol in a previously frozen unit
removes essentially all of the plasma, too. Blood from an IgA-deficient donor is also
acceptable. None of the other interventions would work. Some blood bankers believe
that giving IgA-deficient products to IgA-deficient patients is unneccesary until that
patient has a reaction. Some would just transfuse this boy with an unmodified blood
product, but advise careful, close monitoring. The argument is that there are levels of
IgA deficiency, and unless someone is severely depleted, chances are good that they
won’t make the antibody. If, however, you decide that IgA-deficient products are in
order (as I personally would in this case), something that depletes IgA is warranted.

A 59-year-old male is admitted with major trauma following an automobile accident.

His blood type is O-negative, but you are out of O-negative blood. Which of the
following blood products would be UNACCEPTABLE to transfuse?

AB positive red blood cells

O positive red cells

A negative platelets

AB positive FFP

B positive FFP

Individuals who are group O may only receive group O red cells. Think about it; they
have anti-A and anti-B, so transfusion of cells carrying either of those antigens would
lead to destruction of the cells. Since an O-negative patient, by definition, lacks A or B
antigens on their own red cells, they can receive plasma from any donor, including the
AB and B plasma donors listed in the question (also remember that group AB FFP can
be given to anyone due to its lack of anti-A and anti-B). Rh is not a consideration with
FFP, and should not be a major consideration in red cell transfusions in the emergency
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setting above (especially for a male), but future transfusions might be affected by
development of an anti-D from transfusion of Rh-positive red cells. Out-of-group
platelet transfusions (choice B) are generally acceptable in adult recipients.

Which of the following is the correct relative order for shelf life of these blood
products, from shortest to longest?

AS-3 red cells < Thawed Cryoprecipitate < Irradiated red cells < Apheresis platelets
< Frozen PF24 < Granulocytes

Granulocytes < Thawed Cryoprecipitate < AS-3 red cells < Apheresis platelets <
Frozen PF24 < Irradiated red cells

Thawed Cryoprecipitate < Granulocytes < Apheresis platelets < Irradiated

red cells < AS-3 red cells < Frozen PF24

Granulocytes < Apheresis platelets < Thawed Cryoprecipitate < AS-3 red cells <
Frozen PF24 < Irradiated red cells

Irradiated red cells < Granulocytes < Thawed Cryoprecipitate < Apheresis platelets <
AS-3 red cells < Frozen PF24

Thawed cryoprecipitate has a 6 hour shelf life (4 hours if pooled under open
conditions). Granulocytes have a 24 hour shelf life. Apheresis platelets expire 5 days
after collection (7 days with very specific testing restrictions). Irradiated red cells
expire either a maximum of 28 days from irradiation or at the time when they were
going to expire before they were irradiated (42 days after collection with additive
solution preservation). AS-3 red cells expire 42 days after collection. Finally, frozen
PF24 expires one year from the collection date.

A 55 year old male has a gastrointestinal hemorrhage. A bleeding arteriovenous

malformation in the sigmoid colon is identified and resected, and the patient
stabilizes. His hemoglobin is 5.4 g/dL. The clinician calls you to ask about the
expected post-transfusion hemoglobin if he gives the patient 4 units of red blood cells.
You say:

Approximately 6.6 g/dL

Approximately 7.4 g/dL

Approximately 8.2 g/dL

Approximately 9.4 g/dL

Approximately 11.4 g/dL

This is admittedly a somewhat silly question, but bear with me on it, OK? My point
here is for you to recognize that in an average-sized person, in the absence of
bleeding, each unit of red cells should raise the hemoglobin approximately 1 g/dL (or
hematocrit approximately 3%). If the patient is bleeding, hemolyzing, larger than
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average, or smaller than average, however, the prediction will probably not be
accurate. Obviously, this is nothing more than a useful approximation.

A nurse calls the blood bank about the designation “leukocyte-reduced” on a unit of
platelets. Her patient is a 56 year old male who had an allogeneic stem cell transplant
two weeks ago. She asks you why this patient should receive leukocyte-reduced
platelets. Which is the best response?

Everyone gets leukocyte-reduced now; don't worry about it!

This modification will help prevent transfusion-associated graft vs host disease

This modification will help prevent hemolytic transfusion reactions

This modification will completely prevent transmission of cytomegalovirus

This modification will help prevent febrile transfusion reactions

Reduction of the transfused white blood cell load is broadly accepted for three main
indications:

Prevention of febrile non-hemolytic transfusion reactions

Prevention of HLA alloimmunization

Prevention (mostly, but not completely) of cytomegalovirus (CMV) transmission

Leukocyte reduction does not help with prevention of acute hemolytic reactions
(typically caused by clerical or administration error). Transfusion-associated graft vs.
host disease (TA-GVHD) is a brutal, usually fatal complication of blood transfusion that
is caused by viable transfused T-lymphoctes, and the patient described in this case is
at risk. However, since no one knows the minimum number of T-lymphs that may
cause TA-GVHD, it may NOT be prevented by leukocyte reduction. As a result,
irradiation is the proper modification to prevent TA-GVHD. See the video on leukocyte
reduction for more information, including why this modification may not completely
prevent CMV transmission.

In the United States, fresh frozen plasma (FFP) made from whole blood must be
placed in the freezer within how many hours after collection?

2 hours

4 hours

6 hours

8 hours

24 hours

48 hours

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In order to best preserve labile coagulation factors (V and VIII especially) and meet
the standard U.S. definition of the product, whole blood-derived plasma must be
placed in the freezer within 8 hours in order to be eligible for the name “FFP” (the
interval is a little bit less, 6 hours, for plasma collected in ACD preservative during
apheresis procedures).

A new blood center medical director is evaluating quality control requirements for
various blood products made at her facility. Which of the following is TRUE regarding
the requirements for fresh frozen plasma in the United States?

There are no QC requirements for FFP in the United States

All FFP units tested must contain at least 400 mg of fibrinogen

All FFP units tested must contain at least 80 IU of factor VIII

All FFP units tested must contain at least 1 IU/mL of all coagulation factors

95% of FFP units tested must contain less than 5.0 x 10^6 white blood cells

Surprisingly (given the requirements for most blood products), there are no specific
requirements for quality control testing of FFP in the United States from either the
FDA or AABB (this is not true outside of the U.S.). Several of the above statements are
generally true, however, including that FFP contains about 400 mg of fibrinogen and
about 1 IU/ml of all other coagulation factors. The white blood cell number is the
definition of “leukocyte-reduced” blood products in the U.S., but most centers do not
specify that plasma units are leukocyte-reduced (WBCs in plasma are generally
considered non-viable due to their poor survival of the freezing/thawing process).

What is the average lifespan of a circulating platelet in a healthy individual?

10 days
7 days

5 days

3 days

1 day

“Normal” platelets circulate for approximately 9-10 days in a healthy individual. This
range, however, may be dramatically reduced in situations of bleeding, consumption,
and autoantibody formation. Of near equal importance is the fact that simply having a
low platelet count (below 50,000 or so) decreases the circulating lifespan of a platelet,
as a higher proportion of the platelets are used for baseline maintenance of vascular
integrity and in response to vascular challenges. Also note that the lifespan of an
individual platelet does not equate to the storage interval (“shelf life”) for a unit of
platelets for transfusion.

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For whole blood-derived platelets (WBD Platelets), which of the following shelf life
intervals is correct?

Pooled WBD platelets (open system): 24 hours

Pooled WBD platelets (closed system): 5 days

Irradiated WBD platelets: 24 hours

Washed WBD platelets: 6 hours

Leukocyte-reduced WBD platelets: 7 days

WBD platelets have similar shelf life requirements as apheresis-derived platelets. Any
product modified in an open system (by pooling or washing, for example) receives a
shortened shelf life. For WBD platelets (or any product stored at 20-24C), the shelf life
drops to 4 hours. However, the shelf life of products modified in a closed system is not
affected (choice B). Irradiation does not affect shelf life unless the product is normally
stored for more than 28 days, so WBD platelets are not impacted. Finally, leukocyte
reduction is done under aseptic conditions, but it alone cannot extend a 5 day platelet
product to 7 days of storage.

A 66-year-old female suffers a motor vehicle accident outside of Pittsburgh. As part of

her resuscitation, she receives several units of pooled whole blood-derived platelets
(with four individual units in each pool). Which of the following statements is most
accurate about pooled whole blood-derived platelet concentrate?

It is the platelet product most commonly used in the U.S.

It is more expensive than apheresis-derived platelets

It is expected to give an equivalent numeric response to apheresis-derived

platelets
It carries a higher risk of anti-HLA antibody formation than apheresis-derived
platelets

It carries a higher risk of bacterial contamination than apheresis-derived platelets

The relative merits of apheresis-derived (AD) and whole blood-derived (WBD) platelets
have been debated for years among blood bankers. The “battle,” however, has long
been decided in favor of AD-platelets, as over 85% of U.S. platelet transfusions are
with AD-platelets. However, as Dr. Mark Yazer pointed out in a BBGuy Essentials
Podcast, it might be time for us to look at WBD platelets again. Let no one fool you:
WBD platelets are less expensive, cost less (generally), have equivalent hemostatic
and numeric (platelet count) effects, equivalent risk of HLA antibody induction, and
the same risk of bacterial contamination (see the podcast referenced above for that
discussion) as AD platelets.

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A blood center collects whole blood from a donor, separates the plasma by
centrifugation, and places that plasma product in the freezer. If the product is placed
in the freezer at 23 hours after collection, which TWO coagulation factors would you
be expecting to decline most rapidly in comparison to plasma in the freezer at 7.5
hours?

Fibrinogen

Factor V

Factor VII

Factor VIII

Factor IX

von Willebrand Factor (vWF)

In stored blood, the two factors that degrade most rapidly are factors V and VIII (factor
VII, while it degrades very rapidly in the body, is more stable in storage conditions). As
a result, the requirement to freeze plasma quickly when it will be used for transfusion
comes from a concern about the viability of these two factors, and led to the
emphasis on getting plasma into the freezer within 8 hours (“fresh frozen plasma” or
FFP). This is not as big a deal as we used to think, since products such as “Plasma
frozen within 24 hours” (PF24) retain plenty of these labile factors to be effective. In
fact, while we still say that factors V and VIII are the “labile coagulation factors,” some
studies (such as one quoted in the AABB Circular of Information) show that there is no
significant difference in factor V content between “8 hour max before freezer” FFP and
“24 hour max before freezer” PF24 (Note that the same study showed that the
anticoagulant Protein C is likewise significantly decreased in PF24).

A 25-year-old A, Rh-negative male is given a single unit of A, Rh-positive red blood

cells while being treated for major injuries from a bicycle accident. He stabilizes
immediately after the transfusion and does not receive additional D-positive units. The
trauma anesthesiologist is a former Clinical Lab Scientist, and he asks you the risk
that this patient will form anti-D. You say:

Less than 5%

About 20%

About 50%

About 80%

Nearly 100%

The D antigen is the most immunogenic (antibody-inducing) non-ABO red cell antigen.
Healthy people who are D-negative and are exposed to this antigen via transfusion
have historically been considered quite likely to form an antibody; approximately 80%
for a full unit exposure. However, newer data supports the fact that in hospital

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settings, the number is closer to 20%. Incidentally, the risk is not significantly different
if the same person gets two, three, or more units. Apparently, some people respond to
exposure and some just don’t, and quantity of exposure is not as major an issue as
you would expect.

FILL IN THE BLANKS: Each unit of platelets collected by apheresis (apheresis-derived

platelets) should contain at least ________ platelets, while units of whole blood-derived
platelets should have at least ________.

3.0 x 10^11; 5.5 x 10^10

3.0 x 10^11; 3.0 x 10^10

5.5 x 10^10; 3.0 x 10^10

3.5 x 10^11; 5.5 x 10^10

1.0 x 10^11; 3.0 x 10^10

Yes, I understand that this question is not fun. No, I don’t feel badly about asking it.
Yes, you can expect to see questions that expect you to know this level of detail on
standardized examinations! These numbers are part of standard quality control
requirements for centers collecting these products, and these minimum thresholds
must be met in 90% of all such products tested.

A 15 year old male is undergoing spinal surgery, and the family requests directed
donor blood from an older sibling and an uncle. Of the following interventions, which is
the MOST IMPORTANT that the blood bank should perform prior to issuing this blood?

Irradiate the units

Wash the units

Perform HLA crossmatch on the unit

Leukocyte-reduce the unit

Premedicate the recipient

Transfusions from family members are more likely to be from donors who fairly closely
match the HLA type of the recipient. In particular, if the donor is HLA-homozygous and
the recipient shares one HLA haplotype, this is known as the “one-way HLA match.” In
this setting, an HLA-heterozygous recipient may not recognize the transfused T-
lymphocytes from an HLA-homozygous donor as foreign, so the donor T-lymphocytes
can potentially proliferate unchecked and cause Transfusion-associated Graft-vs-Host
Disease (TA-GVHD). You can find a more detailed explanation in the “Why do we
irradiate” video. Irradiation does a really good job of inactivating transfused T-
lymphocytes and rendering them incapable of attacking the recipient’s tissues and
essentially eliminates the risk of TA-GVHD.

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Which of the following is the transfusion complication that causes the MOST reported
deaths in the United States per year?

Post-transfusion Hepatitis C infection

Post-transfusion Hepatitis B infection

Post-transfusion HIV infection

Acute Hemolytic Transfusion Reactions

Transfusion-related Acute Lung Injury

Bacterial contamination of transfused blood products

This one is just to see if you are paying attention! Even though we are in the
transfusion-transmitted infection section, you should be aware that TRALI is known to
cause more deaths than any of the other entities listed (this is borne out in the FDA-
reported fatality statistics site, where you can view the annual reports and see that
TRALI is the reported cause of more transfusion fatalities than any other entity).

Which of the following is NOT a feature or disease associated with Human T-cell
Lymphotropic Virus (HTLV-I/II) infections in at least some circumstances?

No symptoms whatsoever

Transfusion transmission through cells and not plasma

Mycosis fungoides

Tropical spastic paraparesis

Adult T-cell Leukemia/Lymphoma

Interestingly, though blood banks have been required to test for HTLV for more than
20 years, everyone recognizes that actual HTLV infection is usually not a huge clinical
problem. The vast majority (over 99%) of truly infected patients never have
symptoms. However, the rare patients that do so may get diseases that sound pretty
nasty. Adult T-cell Leukemia/Lymphoma (ATL) is associated with HTLV-1 infection, and
HTLV-associated myelopathy (HAM) (as “tropical spastic paraparesis” is better known
today) is associated with both HTLV-1 and HTLV-2 infections (though the association
with HTLV-2 is less firmly established). Both are serious illnesses, but they happen
rarely. It is also interesting to note that due to near-universal leukocyte reduction of
cellular blood products before transfusion, the risk of HTLV infection is thought to be
significantly lower today than in days past (the current estimate of risk of HTLV
transmission is approximately 1 in 4,000,000 transfusions).

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Which of the following is true regarding cytomegalovirus (CMV) transmission through
donated blood?

Leukocyte reduction of blood products does not lessen the risk of CMV transmission

Most adults have severe flu-like symptoms when infected with CMV

Testing for CMV antibodies is required for all platelet donors

CMV transmission is reduced by irradiation of blood products

CMV may cause severe disease in transplant recipients

CMV is primarily white cell-based rather than plasma-based (after established

infection), so leukocyte reduction (removing the vast majority of the white blood cells
from cellular blood products like red cells and platelets) does substantially limit the
risk of transfusion transmission significantly (but does not eliminate that risk). The
majority of adults have been exposed to CMV, but most never know that the infection
was anything other than a simple cold (if they have any symptoms at all!). Anti-CMV
testing is not required in any context, but virtually all blood centers test at least a
portion of their donors for this antibody (to accomodate requests for “CMV-
seronegative” blood products). Irradiation does nothing to prevent CMV transmission,
and this can be missed because many patients who get irradiated blood products also
get “CMV-reduced-risk” products (either leukocyte-reduced or CMV-seronegative).
However, irradiation is done for prevention of transfusion-associated graft vs. host
disease and not for CMV transmission prevention. CMV is a big problem for
immunocompromised people, like cancer patients on chemotherapy or transplant
recipients, where the virus may cause damage to the lungs, gastrointestinal tract,
brain, eyes, and liver, and was often fatal historically (however, today’s treatment
options make infection in these patients less dangerous today). See the video on why
we leukocyte reduce blood for more information on CMV.

Which of the following is NOT currently a test that must be performed on all donated
blood in the United States?

Anti-Hepatitis B core antigen (anti-HBc)

Anti-Hepatitis B surface antigen (anti-HBsAg)

Nucleic Acid Test for West Nile Virus (WNV NAT)

Anti-Human T-cell Lymphotrophic Virus (Anti-HTLV-I/II)

Anti-Human Immunodeficiency Virus 2 (anti-HIV-2)

The test for the Hepatitis B surface antigen itself (HBsAg) and not the antibody test
(anti-HBsAg) is required. If we did anti-HBsAg on every donor, then everyone who has
been vaccinated for Hepatitis B would end up being deferred! The remaining tests are
all required (including anti-HIV-2, which is done in combination with anti-HIV-1).

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Which of the following transfusion-transmitted hepatitis viruses is most commonly
associated with chronic/carrier-state infections?

Hepatitis A virus

Hepatitis B virus

Hepatitis C virus

Hepatitis D virus (delta agent)

Hepatitis G virus

HCV is famously and classically associated not only with chronic hepatitis (seen in
about 75% of cases), but also with infections with a very long latent period between
infection and clinical symptoms. Public health officials have made great efforts to try
to get people at risk for HCV (previous transfusion recipients, clotting factor
recipients, and IV drug users, especially) tested for the virus. Unfortunately, the
majority of HCV infections do not cause symptoms, so it is not terribly uncommon to
find an HCV-infected blood donor who has no clue that he or she is infected.

U.S. blood donors are tested for all of the following infectious diseases with a required
test using enzyme immunoassay (EIA) or chemiluminescent immunoassay (ChLIA)
technology EXCEPT:

Chagas disease

Hepatitis C Virus

Hepatitis B Virus

Human Immunodeficiency Virus

West Nile Virus

All of these agents are detected using EIA or ChLIA technology (which are very similar
and used for basically the same tests, just on different testing platforms). Note that
for HIV, HBV, and HIV, nucleic acid testing (NAT) is also used in addition to EIA/ChLIA.
Both EIA and ChLIA are very sensitive and quite specific as well, making them useful
for screening blood donors. Unfortunately, due to the low levels of actual disease in
our blood donors, we see false positive reactions from these tests, as well, despite the
high specificity. West Nile Virus in U.S. blood donors is detected only through NAT.

Which of the following is the most accurate description of the “window period” for a
particular potentially transfusion-transmitted organism?

The time from exposure to the organism until the appearance of clinical symptoms

The time from infection until the appearance of clinical symptoms

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The time from infection until laboratory detection of the organism

The time from entry into the cell until the appearance of infectious virus in the cell

The time from exposure until the detection of virus by nucleic acid testing

The window period is the time during which one of the viruses that we spend so much
time worrying about (like HIV or HCV) is most likely to transmitted to a patient. The
window period has a very specific definition: The time from actual infection to the
time that the infection is detectable on laboratory testing. This definition is very
similar to the “incubation period” which is the period between exposure to the
organism to the onset of actual clinical symptoms, and may be longer or shorter than
the window period. Two other choices represent the “latent phase” (choice A) and the
“eclipse phase” (choice D). The last option, though similar to window period and
incubation period, is too specific for either and does not meet the definition.

Which of the following statements MOST ACCURATELY describes current blood donor
testing for Chagas disease in the United States?

Screening is done by a combination of a question and a blood test

Most of the blood transfused in the United States is from donors who have NOT been
tested for Chagas disease

All donors must be tested for Chagas disease at every donation

The approved confirmatory test is a recombinant immunoblot assay (RIBA)

A donor testing repeatedly reactive for Chagas on one donation is eligible for re-entry

Donors have been permanently deferred based on their report of a history of Chagas
disease for many years, but since late 2006, blood centers have had the ability to test
donors for antibodies to Trypanosoma cruzi (the parasite that causes the disease)
using an EIA test. Despite this ability, until recently, neither the FDA or the AABB
mandated Chagas testing. However, an FDA guidance in December 2010 changed
that. According to that guidance, blood collection facilities may elect to use selective,
one-test-per-lifetime testing of donors rather than testing every donor every time, and
this is the strategy of almost all centers. The approved confirmatory test for anti-
[Link] is an enzyme strip immunoassay, not RIBA (which, as mentioned above, is the
now-discontinued method of confirming anti-HCV results). Finally, if a donor tests
repeatedly reactive with the approved EIA screen even one time, he/she is indefinitely
deferred. As of now, there is no re-entry protocol defined by the FDA.

Which of the following infectious disease screening tests is matched correctly with its
appropriate United States confirmatory test?

Anti-HBc: Neutralization by soluble HBc antigen

Anti-HIV-1,2: Immunofluorescent assay (IFA)

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Anti-HCV: Western blot (WB)

HBsAg: Recombinant immunoprecipitation assay (RIPA)

Anti-HTLV-I/II: Chemiluminescent Immunoassay

Anti-HBc: No confirmatory test.

Anti-HCV: Historically, “recombinant immunoblot assay” or RIBA. However, RIBA is not

currently manufactured in the U.S., and it is therefore not available for anti-HCV
confirmation. As a result, most blood donor testing labs will take a specimen testing in
a repeatedly reactive manner and re-run it using a different manufacturer’s anti-HCV
test as a way of “confirmation,” and blood collection establishments use that
information to determine whether “lookback” is required for an anti-HCV result.

HBSAg: Neutralization performed by adding anti-HBsAg to the sample before re-

running the test to detect HBsAg. The antibody should “neutralize” the HBsAg, making
the result at least 50% less strong than originally seen.

Anti-HTLV-I/II: For years, no confirmatory test, but now the U.S. FDA has approved a
western blot for use to confirm repeat reactive anti-HTLV-I/II results.

You may not have liked answer B, remembering (correctly) that “western blot” was
traditionally used as the confirmatory test for reactive anti-HIV EIA/ChLIA tests.
However, immunofluorescent assay (IFA) is an alternate, acceptable confirmatory test
for anti-HIV (and many facilities prefer it, as it may give fewer “indeterminate”
results). The rest of the choices are incorrect, as follows:

Anti-HBc: No confirmatory test.

Anti-HCV: Historically, “recombinant immunoblot assay” or RIBA. However, RIBA is not

currently manufactured in the U.S., and it is therefore not available for anti-HCV
confirmation. As a result, most blood donor testing labs will take a specimen testing in
a repeatedly reactive manner and re-run it using a different manufacturer’s anti-HCV
test as a way of “confirmation,” and blood collection establishments use that
information to determine whether “lookback” is required for an anti-HCV result.

HBSAg: Neutralization performed by adding anti-HBsAg to the sample before re-

running the test to detect HBsAg. The antibody should “neutralize” the HBsAg, making
the result at least 50% less strong than originally seen.

Anti-HTLV-I/II: For years, no confirmatory test, but now the U.S. FDA has approved a
western blot for use to confirm repeat reactive anti-HTLV-I/II results.

A donor’s blood sample is being tested for anti-HBc via enzyme immunoassay (EIA).
The test has a result that is just over the cutoff for positivity. A newly trained (but
competent) technologist repeats the test in duplicate, and finds that both of the
repeated tests have results that are just under the cutoff for positivity. Which of the
following is TRUE?

His blood can be used for transfusion

He is permanently deferred from blood donation

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His results are reported as repeat reactive

The testing equipment is most likely malfunctioning

The technologist was wrong to repeat the testing

This is a description of how initially reactive EIA/ChLIA results are correctly handled.
Despite the tech being new, he or she did exactly the right thing! A result of initially
reactive should lead to the test being repeated on the sample in duplicate. If both of
the repeat tests have non-reactive results, then the entire test is reported as “non-
reactive” and there are no consequences to the donor or the availability of the donor’s
blood for transfusion. If, however, either or both of the repeat tests are reactive, then
the donor’s results are “repeat reactive” and several things happen: First, the donated
blood will not be used for transfusion; second, the donor will be deferred for an
appropriate time (dependent on the test involved and whether or not the donor has
had previous reactive results); and third, previous recipients of blood products from
the donor may need to be notified (depending on confirmatory results, if applicable,
and the disease marker that is repeat reactive).

A blood donor has a reactive discriminatory nucleic acid test (NAT) for HIV, but a non-
reactive anti-HIV-1,2 enzyme immunoassay test (EIA). Which of the following best
describes his donor status and chances of donating again?

He is permanently deferred without the possibility of donating again

He is indefinitely deferred without the possibility of donating again

He is indefinitely deferred but may be retested for future donation no

sooner than 8 weeks from his original donation date

He is indefinitely deferred but may be retested for future donation no sooner than 6
months from his original donation date
If he is negative for all HIV markers on testing performed by his physician, he may be
re-entered as a donor

He is not deferred

According to an FDA guidance from 2010, donors with a reactive discriminatory NAT
for HIV but a negative EIA/ChLIA will be “indefinitely” deferred but may be considered
for re-entry testing no sooner than 8 weeks from the donation date. “Indefinite”
deferral sounds a lot like “permanent deferral,” but it is slightly looser (see the
definition here). Please note that donor centers are not forced to offer this re-entry
testing; it is done at the discretion of the facility’s medical director, and some do not
choose to allow it. The same opportunity for re-entry is true for donors who test in the
same way for hepatitis C virus (reactive NAT but negative anti-HCV); the difference is
that for HCV re-entry, the waiting period is 6 months rather than 8 weeks. Finally,
testing performed outside of blood donor testing labs is wonderful and happy news for
the donor, but it has no bearing on the donor’s status. Re-entry testing must be
performed in (or at least managed by) an accredited blood donor testing laboratory.

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In the United States, which of the following donor testing results would by law lead to
notification and recommended disease testing of recipients of previously donated
blood from the tested donor (“lookback”)?

Repeat reactive anti-HIV-1,2 EIA with indeterminate western blot

Reactive individual donor multiplex NAT with reactive discriminatory HCV

NAT but not HIV or HBV

Repeat reactive anti-HCV EIA with nonreactive anti-HCV on a second testing platform

Repeat reactive anti-HBc (second occurrence)

Reactive HBV NAT with repeat reactive HBsAg

Lookback is a process designed to identify patients who are at increased risk of

transfusion-transmitted disease as a result of getting blood from a previously
negative-testing donor who is now reactive for a particular organism. FDA sets up
these criteria, and they are in fact federal law for notification of donors with positive
HIV and HCV results. However, for EIA testing (choices A and C), lookback is only
required for confirmed positive results. Choice A would not trigger lookback because
the result is indeterminate. Choice C is more tricky. Remember, RIBA is the historical
confirmatory test for anti-HCV, but it is no longer available in the U.S., so if a center
has received approval to use testing on a different platform to manage repeat
reactive anti-HCV results, this donor’s nonreactive anti-HCV on that platform would
not trigger lookback, either. For choice B, lookback is required by FDA in this
uncommon situation even though this donor almost certainly had a false positive test.
The lookback period extends to one year from the current donation. Finally, there is
no law defining lookback for results for hepatitis B testing. As a results, repeat
reactive anti-HBc results do not trigger a lookback (though any remaining blood
products in inventory would be removed, recipients of previous donations are not
automatically tested for hepatitis B). While most blood centers would notify
recipients of blood collected 1 year before the most recent negative donation for the
donor mentioned in choice E, there is again, no law that requires that process.

A blood donor has a reactive multiplex nucleic acid test (NAT) with a test kit that
detects HIV, HBV, and HCV nucleic acids. No other donors were tested at the same
time (i.e., this was an “individual donor sample”). All other serologic tests for these
three viruses are non-reactive, and her “discriminatory” NATs are non-reactive for all
three organisms. Which of the following is true?

The donor is not deferred and the donated unit may be used

The donor is not deferred but the donated unit is discarded

The donor is deferred for 6 months but the donated unit may be used, as this is a
false positive

The donor is deferred and the donated unit is discarded, but she may
resume donating after 6 months

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The donor is indefinitely deferred and the donated unit is discarded

This donor indeed has experienced what is almost certainly a “false positive”
multiplex NAT (technically, the donor result is described as “Non-discriminated
reactive”). In fact, the FDA allows blood centers to counsel donors in this situation that
they are not infected, and that their results were likely false positive. However, the
FDA also says that these donors must be deferred for at least six months (though
centers may elect to defer them permanently). After six months has passed, the
donor may be allowed (at the discretion of the center) to begin donating again,
without having any qualifying testing done first. Under previous rules, donors in this
situation were deferred permanently, but this strategy was outlined by the FDA in
guidances from 2010 and 2012. Note that this situation only applies if the test was an
individual donation (non-pooled) multiplex NAT rather than a mini-pooled NAT. In mini-
pooled NAT, if individual samples are negative, the donor is not deferred at all.

Which of the following U.S. blood donors would be permanently or indefinitely

deferred from donating blood in the future, with NO possibility of re-entry under
current guidelines?

A 4-gallon donor who tests positively for anti-HBc on two occasions

A first-time donor who tests positively for anti-HTLV-I/II by EIA

A two-time previous donor with reactive anti-HIV-1,2 testing and a negative western
blot

A platelet donor with non-reactive anti-HIV-1,2 but a positive HIV-1 nucleic acid test
(NAT)

A first-time donor with repeat reactive anti-HBc and HBsAg, and a negative
HBV NAT

Let’s take these one by one. Before 2010, a two-time anti-HBc-reactive donor was
permanently deferred, without possibility of re-entry. FDA, however, changed that
with a 2010 guidance for re-entry for these donors. TWO reactive anti-HTLV screening
tests (not one) are required before a donor is permanently deferred for anti-HTLV
(Note: Now that a confirmatory test for anti-HTLV is approved by the FDA, a positive
confirmatory result would lead to permanent deferral, regardless of whether the anti-
HTLV test was the first or second that had occurred). A negative western blot
following a reactive anti-HIV screen means that the donor MAY be tested for re-entry
eight weeks from the date of the donation (this is not automatic. Individual facilities
can choose to do this or to simply permanently defer someone in this situation). Many
find choice D surprising; a donor with a positive HIV-1 NAT alone may be re-entered,
by current FDA requirements (like choice C, at the discretion of the facility medical
director); see the FDA guidance from 2010. Donors who test repeatedly reactive for
both anti-HBc and HBsAg are permanently deferred, regardless of the HBV NAT result
or the HBsAg confirmatory neutralization test.

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A regular blood donor tests positively on July 1 for West Nile Virus (WNV) on blood
donor testing. When contacted on June 3, he states that he “feels terrible” and is
actually on the way to his doctor’s office at that moment. The next day, he reports
that he has been diagnosed with West Nile Fever and feels slightly better. Which of
the following is TRUE?

He is deferred from donating blood until 120 days from the date of his
diagnosis

He is very likely to suffer meningoencephalitis within a week or two

FDA requires that all recipients of this man's blood for the 6 months preceding this
donation be notified so they can be tested for WNV

If he had donated in January, the infection would have been unknown, since WNV
blood donor screening is only done in summer and fall

The WNV screening test used was most likely an enzyme immunoassay

This donor illustrates several principles of WNV disease, testing, and donor
management. First, his presentation with “West Nile Fever” is actually a little bit
unusual, since 80% of those with WNV are completely asymptomatic. The good news
for him is that of the 20% who are symptomatic, nearly all have a mild, self-limited
illness, and very few actually progress to more severe disease such as
meningoencephalitis. WNV testing is done year-round, despite the fact that infections
happen pretty much only in the summer and fall, making choice D incorrect. It is done
using nucleic acid testing (NAT), not EIA or the similar chemiluminescent
immunoassay (ChLIA). Despite his diagnosis, notification of previous recipients is
actually not required by FDA. Collection facilities are required to quarantine and
retrieve all in-date blood products collected up to 120 days before the positive
donation and 120 days after the donation. While any units found in that search will be
destroyed, FDA only requires that a facility “consider” notification of recipients (it’s a
surprising amount of leeway from the FDA, actually). Finally, his donor status: He is
deferred for 120 days from the date of his clinical diagnosis, since it is later than the
date of his donation that gave a positive test. After that time, he can resume donating
at the discretion of the facility medical director.

Which of the following events is most likely?

A unit of apheresis platelets contaminated with Staphylococcus epidermidis

A unit of pooled whole blood derived platelets contaminated with Bacillus cereus

A unit of red blood cells transmitting hepatitis B

A unit of fresh frozen plasma transmitting HTLV

A unit of cryoprecipitate transmitting malaria

Platelet contamination with gram-positive skin flora is by far the most likely of these
scenarios. Numbers vary, but many accept that there is about a 1 in 3000 unit risk of
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bacterial contamination of platelet products, and that skin flora make up the vast
majority of those contaminations. Fortunately, few of those contaminants actually
cause septic transfusion reactions (see the Blood Bank Guy Essentials Podcast,
episode 003, for further discussion on platelet septic reactions). Bacillus CAN certainly
contaminate platelets, but FAR less often than a coagulase-negative staphylococcus.
HBV transmission is relatively rare, with a reported risk of roughly 1 in 1,000,000
transfusions. The last two possibilities are essentially “never” events! FFP won’t
transmit HTLV because HTLV lives in white blood cells, which are destroyed by the
freeze-thaw cycle that FFP undergoes. Malaria is a red cell parasite, and CRYO would
not be expected to transmit the parasite at all.

A 5th time blood donor has a repeat reactive anti-HCV EIA on a donation from August
5, 2015. His HCV NAT is also positive. His previous donations are listed in the chart
below:

Donation Number Donation Date Donation Type

5 8/05/2015 (current) Whole Blood

4 10/01/2011 Platelets

3 6/25/2011 Whole Blood

2 10/07/2010 Whole Blood

1 9/30/2008 Platelets

Which of the following statements is true regarding required lookback?

Recipients of blood products from donation 4 only must be notified

Recipients of blood products from donations 4 and 3 only must be notified

Recipients of blood products from donations 4, 3, and 2 only must be

notified
Recipients of blood products from donations 4, 3, 2, and 1 must be notified

None of the blood product recipients from these previous donations must be notified

According to lookback regulations for HCV testing (see the FDA guidance document),
for donors positive on a current donation, lookback extends to ten years from the
current donation or one year from the last negatively-testing donation (whichever is
shorter). In this case, the donor’s lookback period extends from the date of his last
negative donation (donation 4; 10/1/2011) to one year before that date (10/1/2010).
As a result, donations 4, 3, and 2 would be included, and recipients of those products
should be notified and tested for HCV.

The positive predictive value of an anti-HIV-1,2 EIA screening test is:

Low because the test isn't very sensitive

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High because the test is overly sensitive

Low because the incidence of infection is low

High because the incidence of infection is low

Low because the test has poor specificity

High because the test has poor specificity

The anti-HIV-1,2 screening test (which can be either done by EIA or

chemiluminescence testing) is actually an EXCELLENT test, with very high sensitivity
(about 99.9%) and specificity (about 99.8%). However, because blood collection
facilities are dealing with a population (blood donors) in which the incidence of
infection is quite low, the positive predictive value (PPV) of a repeat reactive
screening test is quite low (meaning that many with a positive test do NOT have HIV).
PPV is calculated by dividing the number of true positives by the sum of true positives
and false positives (TP/[TP+FP]), and it is highly affected by the incidence of disease
in a given population. Basically, the lower the incidence of a disease in that
population, the worse the PPV, even with an excellent test like anti-HIV screening. See
other statistical resources for a more in-depth discussion of PPV.

Which of the following represents the correct order in which markers for HIV become
detectable after infection (from earliest to latest)?

HIV-1 NAT, anti-HIV 1,2, p24 antigen

anti-HIV-1,2, p24 antigen, HIV-1 NAT

p24 antigen, HIV-1 NAT, anti-HIV-1,2

HIV-1 NAT, p24 antigen, anti-HIV-1,2

anti-HIV-1,2, HIV-1 NAT, p24 antigen

Even though p24 antigen is no longer required for US blood collection facilities, the
order that the markers become positive is important for blood banking students to
know. HIV-1 RNA generally becomes detectable by NAT (whether by PCR or TMA)
about 9-10 days after infection, making it the most valuable test to decrease the
window period and prevent transmission of early infections. p24 antigen is the next
marker to become positive, about 16 days after infection, while the EIA for anti-HIV-
1,2 does not become positive until 20-22 days after an acute HIV infection.

Which of the following represents the correct order in which markers for HBV become
detectable after infection (from earliest to latest)?

HBV NAT, anti-HBs, HBsAg

HBV NAT, HBsAg, anti-HBc

anti-HBc, HBV NAT, HBsAg

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HBsAg, HBV NAT, anti-HBc

HBsAg, anti-HBc, HBV NAT

This and the previous question illustrate a pretty simple point that everyone should
remember about blood donor testing. In general, the order of positivity of markers is
predictable. It goes like this: First NAT, then antigen tests, then antibody tests. Testing
for HBV illustrates this principle perfectly. Before we had HBV NAT (“recommended”
but functionally mandated in a 2012 FDA guidance), HBsAg was reliably the first HBV
serologic test to become detectable following HBV infection (this is partly due to the
overproduction of HBsAg by viral demand, with “spillover” of HBsAg from the
hepatocytes into the circulation); this still may take a couple of months, however
(anti-HBc follows HBsAg by a few days, by the way). HBV NAT has been reported to
take up to 40 days off of the “window period” between infection and lab detection by
HBsAg!

————————————————————————————————

Chemistry:
ALP GGT ALT AST LD
1. Liver disease Inc Inc Inc Inc Inc

2. the longest cardiac enzyme elevated ——- troponin 10 to 14 days

myoglobin – 1st enzyme to elevate for 24 hours
LD - elevated for 5 days
Question is presented in graph , choose the right graph.

3. OGTT-when is the pC considered diabetes know the normal value after 30 mins, 1
hr, 2 hr, 3 hr

3. know the picture of protein electrophoresis: Nephrotic Syndrome, Hepatic Cirrhosis

4. Differential Diagnosis for Jaundice: Billiary Obstruction

Total Bilirubin Direct ( conjugated) Indirect (unconjugated) Urine
Urobilinogen
Inc Inc NL
Dec
Study other cases they might change the [Link]-hepatic, hepatic
Billiary obstruction is considered post- hepatic

[Link] —— inc in Cushing syndrome, dec in Addison’s dse.

6. Acid base balance: remember the NV and you can easily answer the question. IF
Respiratory acidosis, resp. alkalosis, metabolic acidosis, metabolic alkalosis
ph = 7.35 – 7.45
p CO2 = 35 – 45
HCO3 = 22-26

[Link]: How many ml of 95% alcohol are needed to prepare 100 ml of 70 %

alcohol?
answer = 73.7 ml use the formula VI C1 = V2 C2

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8. reason for synovial fluid turbidity: I don’t know the answer
a) crystal
b) protein
c) immunoglobin

[Link] CA tumor marker: For advanced CA : They may pick one from this marker,
remember this.
CA 15-3
CA 27-27
Truquqnt R/A
For Primary Breast CA, Recurrent or metastatic:
Estrogen and progesterone receptors
HER -2 – Neu

10) Alpha HCG marker of malignancy:

a) choriocarcinoma ——- B
b) testicular CA ——- alpha & B
c) pancreatic CA ——– alpha
d) non seminomatous

11) If CHON elevation from BI B2 and gamma are to be merge together what
immunoglobulin will it
indicate? a) IgM , b) IgA, c) IgD, d) Ig E

12) Which one of the following would change if remove out the buffy coat in lipemia?
sorry i don’t know the answer.I guessed triglycerides.

13) What is the true calcium? ionized calcium

14) What is located between beta and gamma fraction? CRP

15) Impaired Glucose Tolerance is defined as: read on GTT lecture (diabetes) the
abnormal value

[Link] does ISE measure CO2? gas sensing electrode

17) What is osmolality? a measure of what look for the answer

18) Hypothyroidism —- know the result of T4 dec , T3 dec, TSH inc.

19) Transferrin – glycoproteins that binds with iron.

What is the result of transferrin in Hemolytic anemia? INCREASE
Remember this decrease in iron deficiency and chronic illnesses

20) Haptoglobin – proteins that binds with free HGB

What is the result of haptoglobin in hemolytic anemias? INCREASE

21) know how to compute LDL

22Emphysema ——- alpha 1 antitrypsin deficiency

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23) pheochromocytoma——– inc in ACTH

24) effect of blood sample exposure to air

25) Effect of refrigeration to blood glucose

Microbilology:

1)What is the biosafety level and biologic safety cabinet used for poxvirus?
answer: Biosafety level III and Safety cabinet II

2) Columbia colistin- nalidixic acid agar is a———– selective type

3) Enrichment medium for isolation of Legionella ———– Buffered charcoal yeast

extract agar
some of the choices Regan lowe, tindale agar , Loeffler medium ,read what is this for
they might change the question to this.

4)Ampicillins are beta – lactam that act on: cell wall

5) quality test for autoclave———– spore test weekly with B . stearothermo

7) Schuffner dots , where do you see this?

8)Vi antigen ——Salmonella typhi

9) Epstein – Barr Virus- Infectious mononucleosis

10) Cytomegalovirus ( CMV)- disease of immunocompromised hosts

11) Berkholderia cepacia ————- associated wt pneumonia in CYSTIC FIBROSIS pts.

12) Borrelia burgdorferi ————– causes Lyme disease

13) Ricketsia ———————— Weil Felix Reaction

14) Cryptococcus neoformans —— India ink

15Virion —— complete virus particle

16) what is interferon?

17) What is the meaning of beta and gamma zone merge? hemolysis, complete
rupture of RBC

18) specific test for E. Coli———– Indole test

19) read what organism seen in CSF as to age of the patient . this is a case which you
will identify the organism .

20) picture of sporothrix schenckii

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Hematology:

1) auer rods seen in —————–AML (acute myelocytic leukemia) KNOW THE PIC
2. Identify the picture and know the disease ass wl it:
hypersegmented neutrophil
pappenheimer
Dohle bodie
promyelocyte
sickle cell
tear drop cells
pseudo pelger huet picture
Basophilic stippling picture and ass disease
Smudge cells ——- seen in what kind of leukemia (CLL)
3) HgB electrophoresis
4) ALL ( acute lymphocytic leukemia) ———-most common in children
5) Acute leukemia ——— many blast cells
6) ESR inc —– tilted tube
7) manual white blood cell count——– acetic acid is used as diluent
8) osmotic fragility—— inc in hereditary spherocytosis
9) PT-detects deficiencies in extrinxic and common pathways; use to monitor
coumadin theraphy
10) Anti thrombin III ——- heparin co factor; deficiencies ass. wl thrombosis
11) Inc LAP -seen in polycythemia vera and leukemoid reaction -dec in CML
12) What is Bernard – Soulier Syndrome
13) What is Von Willebrand disease

AML - Sudan Black (+), CAE (+), peroxidase (+); Auer rods - Adult

ALL - PAS (+), Oil red O (+); Children

CML - Low LAP score; 10% blasts in the BM, plenty of tear drop cells

CLL - presence of smudge cells

- Pictures of abnormal inclusions in RBC
- Platelet disorder

BLOOD Banking:

1) Know how to detect antibodies in BLOOD Panel: I got 1 question only

2) Formula how to give Rhogam
3) 1 vial of Rhogam = 30 IU of fetal blood ; 1 vial of Rhogam = 15 IU of whole
blood
to covert ug to IU ————- ug x 5 = IU
Ex: 6 ug x 5 = 30 IU
4) Antigens destroyed wl the use of enzymes: M N Ss Duffy
Antigens enhanced RH Kidd Lewis P
5) phenotyping of Rh antigens
6) Know the cold antibodies and warm antibodies
7) Leukocyte reduced RBC’s ———— given in pt wl history of febrile reaction
8) Read changes in stored blood what happen?
9)Read blood donor requirement?

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I) panel shown cells 1-10 were positive, but cell 3 & 6 were enhanced and
agglutinated, what antibody is it: a) fya *B) E C) MN, S etc

II) this panel was very confusing b/c from Coombs it was anti-C , but in AHG all cell
were reacting (+), except 1cell (-) in middle probably cell 6 or 7. But it didn’t ask
which antibody it is , rather which cells should be used.
> Cold agglutinationin syndrome ( I, P1 etc)
>how mucin clot in synovial fluid—– I chose acetic acid
> what does HÁČEK group include

Immunology:
1) Auto – antibodies :
anti smooth muscle ——– auto immune heaptitis
anti -ds DNA —————- SLE
anti -Mitochondrial ——– billiary cirrhosis
2) Interferons
3) Prozone
4) Ouchterlony Technique
5) nephelometry
6) Non treponemal test for SY
7) Indirect Flourescent Antibody ——– T. pallidum
8) Heterophile Antibodies —— test for infectious mononucleosis
9) Anti HBs ———- recovery and immunity
10) Wester blot ———— confirmatory test for HIV
11) Know serial dilution :: 1:2 @ 6th test tube
12) What is anamnestic?
13) Croprecipitate —— know expiry date , a case study to answer when to give when
pooled.
14) what is hh?
15) what causes false + to HIV?
13)Principle of agglutination
a) floccullation
b) precipitation
14) ENA + , what does it indicate
a) rheumatoid disease
b) detect extractable antibodies (ant-sm, anti- RNP, anti-ssa etc)
c) confirm SLE

Urinalysis:

1) Read about Clinitest

2) Case study: how to know the dx as —-pyelonephritis, cystitis, glumerulonephritis,
3) crystal in acidic and alkaline urine: picture
4) What causes alkalinity of urine?
- Lots of Question on ISE
- Read on synovial fluid——- what causes turbidity?
- READ on principle of instrumentations: Spectrophotometry,
Nephelometry,Coulometry, etc

12) total Bilirbin——– increase # Serum bilirubin—-increase

Urine bilirubin——increase Urine urobilirubin——absent
Fecal urobilirubin—–absent AST. ——– increase

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 ALP ————increase
a) hepatocellular
b) hemolytic
c) obstructive

case: CK Normal, Troponin- Increased

. acute myocardial infarction
.Unstable angina

aerobic gram negative cocci isolated after jaw injury

.veillonella
branhamella

what is seen in chronic active hepatitis?

anti-smooth muscle antibody

what is true about B lymphocytes?

has immunoglobulin surface marker

in cases of pancreatitis, normal amylase maybe seen in

decreased triglycerides

after ingestion of napthalene balls, what should be the expected blood picture?
{oxidizing agent}
HEINZ BODIES

picture of microsporum or epidermophyton

a zygomycetes without rhizoids
mucor

HbA1c is decreased in what case?

iron deficiency anemia

what is measured if your substrate is p-nitrophenyl phosphate in paget’s disease?

ALP

what is measured in the urease method in determination of BUN?

NAD

the sputum of patient with cystic fibrosis should be cultured for

burkholderia cepacia

what tests that will differentiate morganella from providencia

swarming

the virulence factor of neisseria meningitides

polysaccharide capsule, pili, endotoxin

LAP score=0
chronic myelogenous leukemia

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acute pancreatitis- lipase remains elevated up to seven days, amylase =normal

in doing LAP score you see eosinophilia what should you do?
do not include eosinophils in LAP score

[Link] is Calcium measured in ISE?

Ionized Calcium

[Link] the picture of:

E. coli:
E. nana:
E. histolytica:

[Link] interval which a recipient sample maybe used for crossmatching if the
patient has been recently transfused, has been pregnant? 3 days

4. Refrigeration of blood samples what is affected?

inc potassium, dec glucose , dec enzymes

tryglicerides not affected

[Link] strip (-), Ictotest (+), What does this mean?

- Difference in sensitivity levels

- Rgt strip can detect 0.5 mg /dl of bilirubin while Ictotest from 0.05 -0.1
mg/ dl.
- Ictotest is a tablet test based on diazotization; (+) blue or purple color in
60 seconds

[Link] is affected in lactic acidosis?

- a form of metabolic acidosis

- dec PH, inc Lactate, dec Oxygen
- deep and rapid breathing , vomiting, and abdominal pain
- caused by diabetic ketoacidosis, liver or kidney diseases, medication
( phenformin), HIV
drugs ( antiretrovirals) , arsenic poisoning

[Link] for Lactic Acid test

- used as an indirect assessment of oxygen level in tissues and to determine
the cause of
lactic acidosis

8. Culture media for Legionella

- buffered charcoal-yeast extract (BCYE) agar media

9. CPT blood was drawn @ 10 Am, pooled @ 11:30 am. Patient has xray @ 2 pm, what
will you do with the product?
- transfuse the blood before xray

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 1. Enzymes:
Destroy = M N S Duffy
Enhance = Rh Lewis I Kidd

Cold Antibodies: M N Pi I Lewis S

Warm Antibodies : RH Kell Duffy Kidd

[Link] (+) for RPR ( Rapid Plasma Reagin ) – Non treponemal test for Rickettsia

- LE
- RF
- IM
- Infectious Hepatitis
- Leprosy
- Malaria
- Pregnancy
- Aging process
- Pneumococcal pneumonia

12. Read about PCR

13. Read about RIA – radioimmunoassay
14. Study ANA test Pattern with picture:

Feedback
This is an example of a mix of homogeneous and speckled ANA patterns.

In this sample notice the speckled ANA is the dominant pattern in the interphase cells
(a) and some speckling in the area outside of the chromosomal area of the mitotics
(b).
Also notice the smooth staining of the chromosomal area of the metaphase mitotic
cells (c). This represents the presence of a homogeneous ANA pattern.
1. Peripheral (rim) – the central protein of the nucleus is only slightly stained or
not stained at all , but nuclear margins fluoresce strongly and appear to extend
into the cytoplasm
- i.e. anti – DNA
- associated with SLE in the active stage of the dis. and in Sjogren’s dis.

1. Homogenous ( diffuse) – the whole nuicleus fluoresces evenly

- i.e. anti – DNA
anti – Histone
anti – DNP

- typically seen in Rheumatoid disorders

- Inc. titres are suggestive of SLE
- Dec. titres maybe found in SLE, RA, Sjogren’s syndrome and Mixed Connective
Tissue Dis. ( MCTD)
-

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 1. Speckled - a grainy pattern with numerous round dots of nuclear
fluorescence, without staining of the nucleoli
- i.e. anti – RNP
anti – Sm ……. Specific for SLE
- occurs in the presence of antibody to any extractable nuclear antigen devoid of
DNA or histone
- the antibody is detected against the saline extractable nuclear antigens
- antiobodies to Sm antigens is highly specific for SLE and as a “ marker “
antibody.
-
-

1. Nucleolar - a few round, smooth nucleoli that vary in size will fluoresce when
examined with UV.
- i.e. anti- nucleolar
- present in 50% with Scleroderma, Sjogren’s syndrome, SLE
-
-

1. Anti centromere - discrete and speckled

- Highly selective for CREST
-

Primary Billiary Cirrhosis

In order to understand the ANA test (antinuclear antibody test), it is first important to
understand different types of antibodies.
 Antibodies are proteins, produced by white blood cells, which normally circulate
in the blood to defend against foreign invaders such as bacteria, viruses, and
toxins.
 Autoantibodies, instead of acting against foreign invaders, attack the body’s
own cells. This is an abnormality.
 Antinuclear antibodies are a unique group of autoantibodies that have the
ability to attack structures in the nucleus of cells. The nucleus of a cell contains
genetic material referred to as DNA (deoxyribonucleic acid).
An ANA test (antinuclear antibody test) can be performed on a patient’s blood sample
as part of the diagnostic process for certain autoimmune diseases.
How the Test Is Performed
To perform the ANA test, sometimes called FANA (fluorescent antinuclear antibody
test), a blood sample is drawn from the patient and sent to the lab for testing. Serum
from the patient’s blood specimen is added to microscope slides which have
commercially prepared cells on the slide surface. If the patient’s serum contains
antinuclear antibodies, they bind to the cells (specifically the nuclei of the cells) on
the slide.
A second antibody, commercially tagged with a fluorescent dye, is added to the mix of
patient’s serum and commercially prepared cells on the slide. The second
(fluorescent) antibody attaches to the serum antibodies and cells which have bound
together. When the slide is viewed under an ultraviolet microscope, antinuclear
antibodies appear as fluorescent cells.
 If fluorescent cells are observed, the ANA test is considered positive.
 If fluorescent cells are not observed, the ANA test is considered negative.
ANA Titer

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A titer is determined by repeating the positive test with serial dilutions until the test
yields a negative result. The last dilution which yields a positive result (fluorescence
observed under the microscope) is the titer which gets reported. Here is an example:
1:10 positive
1:20 positive
1:40 positive
1:80 positive
1:160 positive (reported titer)
1:320 negative
Parts of an ANA Report
An ANA report has three parts:
 Positive or negative
 If positive, a titer is determined and reported
 The pattern of fluorescence is reported
Significance of ANA Pattern
ANA titers and patterns can vary between laboratory testing sites, perhaps because of
variation in methodology used. These are the commonly recognized patterns:
 Homogeneous - total nuclear fluorescence due to antibody directed against
nucleoprotein. Common in systemic lupus erthematosus (SLE).
 Peripheral - fluorescence occurs at edges of nucleus in a shaggy appearance.
Anti-DNA antibodies cause this pattern. Also common in SLE.
 Speckled - results from antibody directed against different nuclear antigens.
 Nucleolar - results from antibody directed against a specific RNA configuration
of the nucleolus or antibody specific for proteins necessary for maturation of
nucleolar RNA. Seen in patients with systemic sclerosis (scleroderma).
Positive ANA Test Result Explained
Antinuclear antibodies are found in patients who have various autoimmune diseases,
but not only in autoimmune diseases. Antinuclear antibodies can be found also in
patients with infections, cancer, lung diseases, gastrointestinal diseases, hormonal
diseases, blood diseases, skin diseases, and in elderly people or people with a family
history of rheumatic disease. Antinuclear antibodies are actually found in about 5% of
the normal population, too.
ANA test results are just one factor considered when a diagnosis is being formulated.
A patient’s clinical symptoms and other diagnostic tests must also be considered by
the doctor. Medical history is also significant because some prescription drugs can
cause “drug-induced antinuclear antibodies”.
Incidence of ANA in Various Diseases
Statistically-speaking, the incidence of positive ANA test results (in percent per
condition) is:
 Systemic lupus erythematosus (lupus or SLE) - over 95%
 Progressive systemic sclerosis (scleroderma) - 60-90%
 Rheumatoid arthritis - 25-30%
 Sjogren’s syndrome - 40-70%
 Felty’s syndrome - 100%
 Juvenile arthritis - 15-30%
Subsets of the ANA tests are sometimes used to determine the specific autoimmune
disease. For this purpose, a doctor may order anti-dsDNA, anti-Sm, Sjogren’s
syndrome antigens(SSA, SSB), Scl-70 antibodies, anti-centromere, anti-histone, and
anti-RN.
The ANA test is complex, but the results (positive or negative, titer, pattern) and
possible subset test results can give physicians valuable diagnostic information.

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Several different serum tests are used to detect autoimmunity. These are conditions
where the immune system acts directly against the bodys own tissues. One test, the
ANA, or anti-nuclear antibody test, detects antibodies that are directed against
various components of the nucleus of the cell. These include antibodies that have
been formed against double-stranded or single-stranded DNA (two ways in which the
cells DNA can be found in the serum after being released from old and dying cells).
Other components of the nucleus such as histones are also released from old cells and
can also become targets of the immune response. When they appear they may be
markers for excess or inappropriate immune responses directed against ones own
tissues. Physicians in our group test for various autoantibodies in order to
characterize patients as those who might have a tendency for autoimmune
responses. Those who test positive have been found to have a higher risk for
recurrent pregnancy loss and are more likely to benefit from therapeutic
interventions (see diagram).
Consequences

-Antinuclear Antibody (ANA) positive, speckled pattern.

-Autoantibody to DNA leads to inflammation in the placenta.
-Autoimmune disease screening in the woman is negative (No evidence of lupus or
rheumatoid arthritis).
A blood test determines the presence of antibodies to polynucleotides, histones and
DNA. This process involves running 27 different tests on a sample of blood.
The presence of antibodies is also tested for by doing the ANA test. This is a less
sensitive test but one that many doctors have already done on their patients before
we ever see them.
The test is reported as a titer and a pattern. Any titer above 1:40 is significant. The
titers can get into the thousands such as 1:2,500. This simply means that the test is
positive when the blood serum is diluted many times.
The pattern is reported as homogeneous, nucleolar or speckled:
-Homogeneous: the antibody is to the ss DNA or ds DNA.
-Nucleolar: the antibody is directed to the polynucleotides.
-Speckled: the antibody is directed against the histones.
Some women demonstrate a mixed pattern of speckled/homogeneous. These same
antibodies appear positive in women with lupus, rheumatoid arthritis, Crohn’s disease
and other autoimmune diseases. They are usually in high titers. Pregnancy losses,
infertility and IVF failures cause the titers to be much lower and a low positive titer
does not mean that you have or are getting an autoimmune disease; however, this is
ruled out during the testing.
In women with autoimmune diseases these antibodies cause inflammation in joints
and organs. In women with no autoimmune diseases but a positive antibody, the
antibody causes inflammation around the embryo at the time of implantation or in the
placenta after implantation. This inflammation is exactly the same as occurs if you get
a splinter under your fingernail. The tissue around the splinter gets hot, red and
swollen and it happens quickly.
15. Read about MIC for susceptibility test to report in microbiology
16. Epstein Barr Virus, How to detect? Know the procedure.
- infectious mononucleosis
- test to detect:
a) Mono spot
b) CBC
c) EBV serology

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 - can help detect if an individual has an infection due to EBV, and
if they are prone
to future infections due to dormant virus.
- VCA-IgM
VA-IgG Tests ———- help to identify current infection
EA-D
EBNA Test ————– help to dx future infection due to an existing
dormant virus.

d) throat culture
e) Liver profile
17.HgA1c 5, blood gluscose 200 gm/dl. What does this mean?

- Glucose normal for the past month, currently high.

18. Know how to answer acid /gas case study.

Know the Normal Value to be able to answer case study.

PH = 7.35 - 7.45
PCO2 = 35 - 45
HCO3 = 22 – 26

19. 10% sodium hypochlorite – for cleaning surfaces

20. Know how to identify pictures of Leukemias

ALL
AML
CLL
CML

1. Identify ABO discrepancy case study

– what to do next
-what is causing the discrepancy
2. Identify Enterobacteria organism.: Use the flash card

EKE ESCP KES PMP PMPK SKY YESC KEEPS

I
M V C:
1. coli + + - -
KES - - + +
Shigella + + + +
Salmonella - + - -
Edwardsiella + + - -

3. Identify picture of microorganism.

Gram (+) or gram (-)

4. Bilirubin Urobilinogen
Pre hepatic
Hepatic
Post Hepatic inc dec

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 5. Effect of exposure of blood to air
– C02 dec, PCO2 dec, PH inc

- dec Ca, dec acid phosphatase, dec glucose, dec bilirubin

26. 17 ketosteoid is produced in

– Adrenal gland

27. Read on Weil Felix Reaction

- test for Rickettsia—— Typhus fever

- this test involves testing of certain strains of Proteus vulgaris

28. Read on Syphilis

- Treponema pallidum
- Reagin – non treponemal antibodies
- Darkfield Microscopy - test of choice for patient with SY
- Non Treponemal Method: - a flocculation ( or agglutination ) test
1) VDRL - can be used to test for CSF
2) RPR - contains charcoal ; can’t be used for CSF ; Causes of
False (+)
- LE
- RF
- IM
- Infectious Hepatitis
- Leprosy
- Malaria
- Pregnancy
- Aging process
- Pneumococcal pneumonia

9. Steps in agglutination

- Sensitization
= 1 step in agglutination
st

= physical attachments of antibody molecules to antigens on the RBC membranes

- Lattice Formation
= establishments of cross – links between sensitized particles and antibodies
resulting in aggregation (clumping), is a much slower process thant the sensitization
phase

30. Dilution:
1st tube 2nd tube 3rd tube 4th tube 5th tube 6th tube
0.1 Serum 0.5 serum
0.9 diluent 0.5 diluent

What is the dilution in the 6th tube? 1:320

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 1. What causes synovial fluid turbidity?
Choices: a) Fibrinogen b) crystals c) immunoglobulins d)
fibrinogen III

- SF — Increase content of hyaluronic acid ( mucin)

- Mucin clot test — precipitation of SF with weak acetic acid
- Immunoglobulins , immune complexes, complement —— produced by
cells in the imflamed joints
- Normal SF does not clot , viscous, and clear
- SF that clots suggests the presence of synovitis and is cause by
fibrinogen

32. Green top tube , blood is collected and refrigerated for 3 hours. Should you not
accept?
My answer: plasma should be separated before refrigeration

33. Malabsoption test? Fecal fat

34. Fungus picture? My answer penicillium

[Link] of organism for HACEK

- Haemohilus ( H . parainfluenza, aphrophilus, paraphrophilus )

- Actinobacillus ( actinomycetemcomitans )
- Cardiobacterium hominis
- Eikenelle corrodens
- Kingella ( K. kingae)

36. Prevents replication of virus?

Interferon

37. Result of hemodilution?

- low serum electrolytes

8. As a result of hemolysis

- freezing canm cause hemolysis

- dec K, dec LDH, dec AST, normal uric acid

8. automaterd method for measuring Chloride which generates silver ions in the
reaction.
- cystic fibrosis
- Coulometry

39. Purpose of documentation log.

40. Diagnosis of a case study:

Glomerulonephritis
Pyelonephritis
Cystitis

41. Fetal lung maturity

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42. Which of the following methods is MOST reliable for determining the appropriate
dosage of Rh immune globulin to give to an identified Rh immune globulin candidate
after delivery?

Flow cytometry is the most reliable method of those listed. It is a quantitative

method, whereas Keihauer-Betke and the rosette test are very subjective tests.

43. Hemoglobin electrophoresis uses an electric field to separate hemoglobin

molecules based on differences in net electrical charge. The rate of electrophoretic
migration is also dependent on the ionic radius of the molecule, the viscosity of the
solution through which it is migrating, the electrical field strength, temperature, and
the type of supporting medium used.
44. Thin-layer chromatography is particularly useful as a tool in the identification
of:
- Drugs
45. Know Blood Panel
46. Know Paternity Testing
47. Study Weak D in Blood Banking
48. Machines set @ 150 wavelenght, then wavelength @ 0 when used. What is the
problem?

49. Release of results to whom?

My answer : Dentist

50. Read on immunoassay

51. B lactam Test —— grm (-)

2. Study Anion Gap

[Link] – enzyme in MI elevated the longest

54. Study MI enzymes

5. Liver Disease : study other

My answer: ALT AST

6. Study Ferritin and transferring levels in :

Hemochromatosis
Iron deficiency anemia
Anemia of chronic diseases
Thalassemia

7. Monoclonal graph . What to do next?

- multiple myeloma
- presence of Bence jones protein in the urine
- monoclonal gammopathy

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Bone marrow cytology in a dog with multiple myeloma. There are large numbers of
plasma cells (*) in the aspirate, some of which are binucleate. Hematopoietic cells
(both myeloid [M] and erythroid [E]) are found in normal numbers and maturation
sequence.

1. Myeloma Cells with rouleax cells

1. Labs: Findings
1. Chemistry panel with Serum Calcium
1. Serum Protein Electrophoresis and Urine Protein electrophoresis for
Monoclonal Peak
1. M Protein in either serum or urine: 97% of patients
2. Serum M Protein by electophoresis (82%) or immunofixation (93%)
3. Urine M Protein by electrophoresis: 75%
1. Hypercalcemia
1. Serum Calcium >11 mg/dl (present in 13% of patients)
Renal Insufficiency
. Serum Creatinine >2 mg/dl (present in 23% of patients)
1. Complete Blood Count with platelets
Normochromic Normocytic Anemia
. Hemoglobin <12 grams/dl (present in 65% of patients)
1. Bone Marrow Aspiration and biopsy
2. Peripheral Smear
Myeloma Cells
Rouleaux of Red Blood Cells
1. (ESR)-Increased >50 mm/hour in most cases (except bence-jones Myeloma)
1. Serum Viscosity
1. Urinalysis  Bence-Jones Protein
1. Rouleaux of Red Blood Cells
Suggested sequence of immunologic testing : M spike on serum protein
electrophoresis
Serum:
-Immunoelectrophoresis
-Immunofixation
-Quantitation of immunoglobulins by radial immunodiffusion or nephelometry
- Screening for croglobulins
- Determination of serum viscosity of IgM, IgA, or IgG , or signs and symptoms
suggestive of
Hyperviscosity
Urine:
- Screening of urine for increased protein, e.g. sulfosalicylic acid
- Total protein assay of a 24 hour urine specimen
- Urinary protein electrophorsis
- Urinary immunoelectrophoresis
- Immunofixation

58. Salmonella in the diarrhea. Know how to ID.

9. Providencia organism
60. Proteus Vulgaris organism
61. Culture media for Legionella?
Hematology: Target Cells, DIC, CLL, PAS(+)&SUDAN (+)? Smudge cells, Big Platelet
4. Inc. ESR causes: Study othe causes My answer ; Inc Plt
65. Rouleaux formation due to ?

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 a) Slow or fast smearing
b) Angle of the smear
6. Ferritin : Increase Ferritin , Normal TIBC ——– inflammatory process
7. Hereditary Chromatosis; DNA analysis of the following: C282Y, H63D, S65C
8. Know the cases for Deferral of blood donors: My answer: Pt with CMV

69. Tests affected by blood hemolysis?

- Increase: K, LD, AST, Plasma Hgb
- Decrease : T4
- F. Elevated: Phosphorus, Total CHON, Albumin, Magnesium, Calcium, Acid,
Phosphatase

1. Affected by exposure of lights to blood: Decrease : Vitamin A and B6, Beta-

carotene, Phorphyrins, BilirubinShould be wrapped in aluminum foil immediately
after collection.

***OK Some are these are Based Only on Mine and Others’ Reports on the Test. The
questions are randomly selected, so you never know you may end up with***
 You really only need the ref ranges for the common tests, it gives you the
ranges for the more esoteric tests. Know if the value given is above or below
the normal values. It will be the same for the hormones & enzymes they will use
elevated or increase. The important thing is to interpret them as to the disease
process like in thyroid hormones. Most of the time they give the normal values
with the question in [Link] the blood gas normal values.
 Study most common diseases : Diabetis, Liver Function, Cardiac Markers
 Know your charts enzyme elevation.
 Make sure you know the disease states really well…i.e. what lab tests (mostly
chemistry and hematology) you would expect with various diseases…the exam
has tons of questions of that kind.
 Know Renal water, electrolytes and acid-base balance.
 Master the physiology renal function.
 The test often gives example blood gas result and you will need to interpret.
 Know most common calculations in lab manual like: LDL, Anion gap, FTI
 The key with reviewing micro I think is organization. The one thing that has
helped me is to group all the organisms I have ever studied into groups like
gram positives versus gram negatives, then subgroup the gram negatives into
bacilli, coccobacilli etc. I take big groupings like anaerobes and break up
everything into subgroups like GPC, GNC, GPB etc. When I have it organized like
that, sometimes I’ll notice that everything in a particular group shares certain
characteristic e.g most GNDC are oxidase positive. I also use a lot of
mneumonics to remember the reactions. Like I use PEPCS for H2S gas producing
enterobacteriaceae (think “pepsi, the soda that produces gas”) gives me
[Link], Enterobacter, [Link], Citrobacter, Salmonella.
 be able to identify the antibody pattern for EBV on a graph2.) be able to identify
IGG/IGM and which is displayed graphically. The exact same graph is in the
Patsy Jarreau book.3.) 120 lb malnourished man is seen in the ER. What would
be indicative of his condition? listed were BUN, OSMOS, CRP, HAPTOGLOBIN.
they all had abnormal values next to them, but i can’t remember.4.)ANA
Patterns for RA and SLE
5.) I got A LOT of questions about iron deficiencies. be able to identify iron
deficiency, hemachromatosis, etc..

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 6.) This is seen in alpha thalssemia. choices- increased A2 and F, Barts and H
disease, persistence of F
7.) I got a question about “dry tap” – Mylefibrosis
8.) CSF electrophoresis and multiple sclerosis. Choices- IgG Monoclonal, IgM
Monoclonal, IgG Oligcolonal, IgM Olicolonal
9.) Patient comes in on a sunday and AB screen neg and receives on unit,
following wednesday SC III is positive in the AHG phase. Choices- recollect,
assume AB and ID for AB, perform autoabsorbtion, re-test sample from sunday
10.)know about acquired B antigen
 11.) you perform daily maintenance and you get the message “excessive shift”
for K. what do you do? Choices- Assay new control, replace membrane,
recalibrate, clean ISE.
12.) Patient has been coming in the past 5 days getting blood draw and on 3/19
his hemoglobin suddenly drops. Why? Choices-lipemia, chronic anemia, iron
deficiency, wrong patient. Everything else matched just hemoglobin was
significantly changed.
13. Automated hematocrit was 33.0 you perform a manual and you get 33.5.
Choices- report automated result, redraw specimen, report manual, etc.
14.) bacili is seen microscopically in urine, but nitrite portion of strip is neg why?
15.) know what causes spherocytes in blood
16.) Know what causes false positives on urine strip
17.) know what causes auto infection- strongyloides
18.) nematode egg that is transparent and bile colored
19.) know what enzymes are increased in biliary obstruction, hepatitis, cardiac
etc.
20.) positive control for hcg is weakly pos and negative is neg. Patient result is
positive. choices- release results, rerun controls with new control batch,
recollect patient sample.
21.)be able to calculate half life for meds
22.) effects of sulfa drugs and what’s seen on a smear
23.) know relative and absolute lymph
24.) storage requirements for Cryo
25.) know phenotyping
know both diabetes and icto test more sensitive
after getting blood thru IV what do potass levels do? dec
which worm causes autoinfection
had 2 questions, one which increases/or falsley inc hgA1c and what decreased A1c (i
think Hgb S is one of the answers)
high pH and something but what enzyme (Pagets was the answer b/c ALP (Alkaline
pH)
met acidosis= diabetic ketoacidosis
excess edta causes
what hepatis ag/ab will make sure vaccination has occured
which dermatophyte has antler like pseudohyphae (wtf??) got this wrong
mucor has no rhizoids
strep a in glomerularnephritis
disease with bite cells or blister cells
monitor antithrobin3 with monitoring what
Why is albumin the first protein to be detected?
burn patient w Pseudomonas aeruginosa accompany with ? another bac
morganella vs providencia
how many bag blood to prepare platelet apheresis

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PCR
alpha thalassemia with what Hb?
moth ball intoxication will see what in RBC
small qc zones b/c 1.0 mcfarland standard used
diabetes and icto test
measure HDL?
baby w RH+ O mom w Rh- O baby need transfusion what blood should give?
muscle dystrophy what enzyme increase
teardrop RBC what disease
anion Gap increase indicate what disease
blood gas use what tube/synringe to transport
CNS smear what condition
Corr wbc count with 50 cells
anaerobic bacteria
proteus,klebsiella rxn
interpret enzyme results
math calculation…something like, how many grams are needed to make a 3% solution
of NaCL.
Calculate LDL
What would cause a false positive for protein on a UA test strip
There were a few questions of interpreting lab results to determine which anemia
LDL is made up of mostly ?
which fat LDL, HDL, VLDL has the most cholesterol
glycosis has an end result of ?

[Link] is Calcium measured in ISE?

Ionized Calcium

[Link] the picture of:

E. coli:

E. nana:

E. histolytica:

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[Link] interval which a recipient sample maybe used for crossmatching if the
patient has been recently transfused, has been pregnant? 3 days

4. Refrigeration of blood samples what is affected?

inc potassium, dec glucose , dec enzymes

tryglicerides not affected

[Link] strip (-), Ictotest (+), What does this mean?

- Difference in sensitivity levels

- Rgt strip can detect 0.5 mg /dl of bilirubin while Ictotest from 0.05 -0.1
mg/ dl.
- Ictotest is a tablet test based on diazotization; (+) blue or purple color in
60 seconds

[Link] is affected in lactic acidosis?

- a form of metabolic acidosis

- dec PH, inc Lactate, dec Oxygen
- deep and rapid breathing , vomiting, and abdominal pain
- caused by diabetic ketoacidosis, liver or kidney diseases, medication
( phenformin), HIV
drugs ( antiretrovirals) , arsenic poisoning

[Link] for Lactic Acid test

- used as an indirect assessment of oxygen level in tissues and to determine
the cause of
lactic acidosis

8. Culture media for Legionella

- buffered charcoal-yeast extract (BCYE) agar media

9. CPT blood was drawn @ 10 Am, pooled @ 11:30 am. Patient has xray @ 2 pm, what
will you do with the product?
- transfuse the blood before xray

10. Enzymes:

Destroy = M N S Duffy
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 Enhance = Rh Lewis I Kidd

Cold Antibodies: M N Pi I Lewis S

Warm Antibodies : RH Kell Duffy Kidd

[Link] (+) for RPR ( Rapid Plasma Reagin ) – Non treponemal test for Rickettsia

- LE
- RF
- IM
- Infectious Hepatitis
- Leprosy
- Malaria
- Pregnancy
- Aging process
- Pneumococcal pneumonia

12. Read about PCR

13. Read about RIA – radioimmunoassay

14. Study ANA test Pattern with picture:

Feedback
This is an example of a mix of homogeneous and speckled ANA patterns.

In this sample notice the speckled ANA is the dominant pattern in the interphase cells
(a) and some speckling in the area outside of the chromosomal area of the mitotics
(b).

Also notice the smooth staining of the chromosomal area of the metaphase mitotic
cells (c). This represents the presence of a homogeneous ANA pattern.

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a. Peripheral (rim) – the central protein of the nucleus is only slightly stained or
not stained at all , but nuclear margins fluoresce strongly and appear to extend
into the cytoplasm
- i.e. anti – DNA
- associated with SLE in the active stage of the dis. and in Sjogren’s dis.

b. Homogenous ( diffuse) – the whole nuicleus fluoresces evenly

- i.e. anti – DNA
anti – Histone
anti – DNP

- typically seen in Rheumatoid disorders

- Inc. titres are suggestive of SLE
- Dec. titres maybe found in SLE, RA, Sjogren’s syndrome and Mixed
Connective Tissue Dis. ( MCTD)

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 -

c. Speckled - a grainy pattern with numerous round dots of nuclear

fluorescence, without staining of the nucleoli
- i.e. anti – RNP
anti – Sm ……. Specific for SLE
- occurs in the presence of antibody to any extractable nuclear antigen devoid
of DNA or histone
- the antibody is detected against the saline extractable nuclear antigens
- antiobodies to Sm antigens is highly specific for SLE and as a “ marker “
antibody.

-
Page 296 of 312
 -

d. Nucleolar - a few round, smooth nucleoli that vary in size will fluoresce when
examined with UV.
- i.e. anti- nucleolar
- present in 50% with Scleroderma, Sjogren’s syndrome, SLE

e. Anti centromere - discrete and speckled

- Highly selective for CREST
-

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Primary Billiary Cirrhosis

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In order to understand the ANA test (antinuclear antibody test), it is first important to
understand different types of antibodies.

 Antibodies are proteins, produced by white blood cells, which normally circulate in
the blood to defend against foreign invaders such as bacteria, viruses, and toxins.
 Autoantibodies, instead of acting against foreign invaders, attack the body's own
cells. This is an abnormality.
 Antinuclear antibodies are a unique group of autoantibodies that have the ability to
attack structures in the nucleus of cells. The nucleus of a cell contains genetic
material referred to as DNA (deoxyribonucleic acid).

An ANA test (antinuclear antibody test) can be performed on a patient's blood sample
as part of the diagnostic process for certain autoimmune diseases.

How the Test Is Performed

To perform the ANA test, sometimes called FANA (fluorescent antinuclear antibody
test), a blood sample is drawn from the patient and sent to the lab for testing. Serum
from the patient's blood specimen is added to microscope slides which have
commercially prepared cells on the slide surface. If the patient's serum contains
antinuclear antibodies, they bind to the cells (specifically the nuclei of the cells) on
the slide.

A second antibody, commercially tagged with a fluorescent dye, is added to the mix of
patient's serum and commercially prepared cells on the slide. The second
(fluorescent) antibody attaches to the serum antibodies and cells which have bound
together. When the slide is viewed under an ultraviolet microscope, antinuclear
antibodies appear as fluorescent cells.

 If fluorescent cells are observed, the ANA test is considered positive.

 If fluorescent cells are not observed, the ANA test is considered negative.

ANA Titer

A titer is determined by repeating the positive test with serial dilutions until the test
yields a negative result. The last dilution which yields a positive result (fluorescence
observed under the microscope) is the titer which gets reported. Here is an example:
1:10 positive
1:20 positive
1:40 positive
1:80 positive
1:160 positive (reported titer)
1:320 negative

Parts of an ANA Report

An ANA report has three parts:

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 Positive or negative
 If positive, a titer is determined and reported
 The pattern of fluorescence is reported

Significance of ANA Pattern

ANA titers and patterns can vary between laboratory testing sites, perhaps because of
variation in methodology used. These are the commonly recognized patterns:

 Homogeneous - total nuclear fluorescence due to antibody directed against

nucleoprotein. Common in systemic lupus erthematosus (SLE).
 Peripheral - fluorescence occurs at edges of nucleus in a shaggy appearance. Anti-
DNA antibodies cause this pattern. Also common in SLE.
 Speckled - results from antibody directed against different nuclear antigens.
 Nucleolar - results from antibody directed against a specific RNA configuration of
the nucleolus or antibody specific for proteins necessary for maturation of nucleolar
RNA. Seen in patients with systemic sclerosis (scleroderma).

Positive ANA Test Result Explained

Antinuclear antibodies are found in patients who have various autoimmune diseases,
but not only in autoimmune diseases. Antinuclear antibodies can be found also in
patients with infections, cancer, lung diseases, gastrointestinal diseases, hormonal
diseases, blood diseases, skin diseases, and in elderly people or people with a family
history of rheumatic disease. Antinuclear antibodies are actually found in about 5% of
the normal population, too.

ANA test results are just one factor considered when a diagnosis is being formulated.
A patient's clinical symptoms and other diagnostic tests must also be considered by
the doctor. Medical history is also significant because some prescription drugs can
cause "drug-induced antinuclear antibodies".

Incidence of ANA in Various Diseases

Statistically-speaking, the incidence of positive ANA test results (in percent per
condition) is:

 Systemic lupus erythematosus (lupus or SLE) - over 95%

 Progressive systemic sclerosis (scleroderma) - 60-90%
 Rheumatoid arthritis - 25-30%
 Sjogren's syndrome - 40-70%
 Felty's syndrome - 100%
 Juvenile arthritis - 15-30%

Subsets of the ANA tests are sometimes used to determine the specific autoimmune
disease. For this purpose, a doctor may order anti-dsDNA, anti-Sm, Sjogren's

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syndrome antigens(SSA, SSB), Scl-70 antibodies, anti-centromere, anti-histone, and
anti-RN.

The ANA test is complex, but the results (positive or negative, titer, pattern) and
possible subset test results can give physicians valuable diagnostic information.

Several different serum tests are used to detect autoimmunity. These are conditions
where the immune system acts directly against the bodys own tissues. One test, the
ANA, or anti-nuclear antibody test, detects antibodies that are directed against
various components of the nucleus of the cell. These include antibodies that have
been formed against double-stranded or single-stranded DNA (two ways in which the
cells DNA can be found in the serum after being released from old and dying cells).
Other components of the nucleus such as histones are also released from old cells and
can also become targets of the immune response. When they appear they may be
markers for excess or inappropriate immune responses directed against ones own
tissues. Physicians in our group test for various autoantibodies in order to
characterize patients as those who might have a tendency for autoimmune
responses. Those who test positive have been found to have a higher risk for
recurrent pregnancy loss and are more likely to benefit from therapeutic
interventions (see diagram).

Consequences

-Antinuclear Antibody (ANA) positive, speckled pattern.

-Autoantibody to DNA leads to inflammation in the placenta.
-Autoimmune disease screening in the woman is negative (No evidence of lupus or
rheumatoid arthritis).

A blood test determines the presence of antibodies to polynucleotides, histones and

DNA. This process involves running 27 different tests on a sample of blood.

The presence of antibodies is also tested for by doing the ANA test. This is a less
sensitive test but one that many doctors have already done on their patients before
we ever see them.

The test is reported as a titer and a pattern. Any titer above 1:40 is significant. The
titers can get into the thousands such as 1:2,500. This simply means that the test is
positive when the blood serum is diluted many times.

The pattern is reported as homogeneous, nucleolar or speckled:

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-Homogeneous: the antibody is to the ss DNA or ds DNA.
-Nucleolar: the antibody is directed to the polynucleotides.
-Speckled: the antibody is directed against the histones.

Some women demonstrate a mixed pattern of speckled/homogeneous. These same

antibodies appear positive in women with lupus, rheumatoid arthritis, Crohn's disease
and other autoimmune diseases. They are usually in high titers. Pregnancy losses,
infertility and IVF failures cause the titers to be much lower and a low positive titer
does not mean that you have or are getting an autoimmune disease; however, this is
ruled out during the testing.

In women with autoimmune diseases these antibodies cause inflammation in joints

and organs. In women with no autoimmune diseases but a positive antibody, the
antibody causes inflammation around the embryo at the time of implantation or in the
placenta after implantation. This inflammation is exactly the same as occurs if you get
a splinter under your fingernail. The tissue around the splinter gets hot, red and
swollen and it happens quickly.
15. Read about MIC for susceptibility test to report in microbiology

16. Epstein Barr Virus, How to detect? Know the procedure.

- infectious mononucleosis
- test to detect:
a) Mono spot
b) CBC
c) EBV serology
- can help detect if an individual has an infection due to EBV, and
if they are prone
to future infections due to dormant virus.
- VCA-IgM
VA-IgG Tests ---------- help to identify current infection
EA-D
EBNA Test -------------- help to dx future infection due to an
existing dormant virus.

d) throat culture
e) Liver profile

17.HgA1c 5, blood gluscose 200 gm/dl. What does this mean?

- Glucose normal for the past month, currently high.

18. Know how to answer acid /gas case study.

Know the Normal Value to be able to answer case study.

PH = 7.35 - 7.45
PCO2 = 35 - 45
HCO3 = 22 - 26

19. 10% sodium hypochlorite – for cleaning surfaces

20. Know how to identify pictures of Leukemias

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 ALL
AML
CLL
CML

21. Identify ABO discrepancy case study

- what to do next
-what is causing the discrepancy

22. Identify Enterobacteria organism.: Use the flash card

EKE ESCP KES PMP PMPK SKY YESC KEEPS

I M V C:
E. coli + + - -
KES - - + +
Shigella + + + +
Salmonella - + - -
Edwardsiella + + - -

23. Identify picture of microorganism.

Gram (+) or gram (-)

24. Bilirubin Urobilinogen

Pre hepatic
Hepatic
Post Hepatic inc dec

25. Effect of exposure of blood to air

- C02 dec, PCO2 dec, PH inc

- dec Ca, dec acid phosphatase, dec glucose, dec bilirubin

26. 17 ketosteoid is produced in

- Adrenal gland

27. Read on Weil Felix Reaction

- test for Rickettsia------ Typhus fever

- this test involves testing of certain strains of Proteus vulgaris

28. Read on Syphilis

- Treponema pallidum
- Reagin - non treponemal antibodies
- Darkfield Microscopy - test of choice for patient with SY
- Non Treponemal Method: - a flocculation ( or agglutination ) test
1) VDRL - can be used to test for CSF
2) RPR - contains charcoal ; can’t be used for CSF ; Causes of
False (+)
- LE
- RF
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- IM
- Infectious Hepatitis
- Leprosy
- Malaria
- Pregnancy
- Aging process
- Pneumococcal pneumonia

29. Steps in agglutination

- Sensitization
= 1st step in agglutination
= physical attachments of antibody molecules to antigens on the RBC
membranes

- Lattice Formation
= establishments of cross – links between sensitized particles and antibodies
resulting in aggregation (clumping), is a much slower process thant the
sensitization phase

30. Dilution:
1st tube 2nd tube 3rd tube 4th tube 5th tube 6th
tube
0.1 Serum 0.5 serum
0.9 diluent 0.5 diluent

What is the dilution in the 6th tube? 1:320

31. What causes synovial fluid turbidity?

Choices: a) Fibrinogen b) crystals c) immunoglobulins d)
fibrinogen III

- SF --- Increase content of hyaluronic acid ( mucin)

- Mucin clot test --- precipitation of SF with weak acetic acid
- Immunoglobulins , immune complexes, complement ------ produced
by cells in the imflamed joints
- Normal SF does not clot , viscous, and clear
- SF that clots suggests the presence of synovitis and is cause by
fibrinogen

32. Green top tube , blood is collected and refrigerated for 3 hours. Should you not
accept?
My answer: plasma should be separated before refrigeration

33. Malabsoption test? Fecal fat

34. Fungus picture? My answer penicillium

[Link] of organism for HACEK

- Haemohilus ( H . parainfluenza, aphrophilus, paraphrophilus )

- Actinobacillus ( actinomycetemcomitans )
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 - Cardiobacterium hominis
- Eikenelle corrodens
- Kingella ( K. kingae)

36. Prevents replication of virus?

Interferon

37. Result of hemodilution?

- low serum electrolytes

38. As a result of hemolysis

- freezing canm cause hemolysis

- dec K, dec LDH, dec AST, normal uric acid

38. automaterd method for measuring Chloride which generates silver ions in the
reaction.
- cystic fibrosis
- Coulometry

39. Purpose of documentation log.

40. Diagnosis of a case study:

Glomerulonephritis
Pyelonephritis
Cystitis

41. Fetal lung maturity

42. Which of the following methods is MOST reliable for determining the appropriate
dosage of Rh immune globulin to give to an identified Rh immune globulin candidate
after delivery?

Flow cytometry is the most reliable method of those listed. It is a quantitative

method, whereas Keihauer-Betke and the rosette test are very subjective tests.

43. Hemoglobin electrophoresis uses an electric field to separate hemoglobin

molecules based on differences in net electrical charge. The rate of electrophoretic
migration is also dependent on the ionic radius of the molecule, the viscosity of the
solution through which it is migrating, the electrical field strength, temperature, and
the type of supporting medium used.

44. Thin-layer chromatography is particularly useful as a tool in the identification

of:

- Drugs

45. Know Blood Panel

46. Know Paternity Testing

47. Study Weak D in Blood Banking

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48. Machines set @ 150 wavelenght, then wavelength @ 0 when used. What is the
problem?

49. Release of results to whom?

My answer : Dentist

50. Read on immunoassay

51. B lactam Test ------ grm (-)

52. Study Anion Gap

[Link] – enzyme in MI elevated the longest

54. Study MI enzymes

55. Liver Disease : study other

My answer: ALT AST

56. Study Ferritin and transferring levels in :

Hemochromatosis
Iron deficiency anemia
Anemia of chronic diseases
Thalassemia

57. Monoclonal graph . What to do next?

- multiple myeloma
- presence of Bence jones protein in the urine
- monoclonal gammopathy

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Bone marrow cytology in a dog with multiple myeloma. There are large numbers of
plasma cells (*) in the aspirate, some of which are binucleate. Hematopoietic cells
(both myeloid [M] and erythroid [E]) are found in normal numbers and maturation
sequence.

1. Myeloma Cells with rouleax cells

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 I. Labs: Findings

A. Serum Protein Electrophoresis and Urine Protein electrophoresis for

Monoclonal Peak
1. M Protein in either serum or urine: 97% of patients
2. Serum M Protein by electophoresis (82%) or immunofixation (93%)
3. Urine M Protein by electrophoresis: 75%
B. Chemistry panel with Serum Calcium
1. Hypercalcemia

a. Serum Calcium >11 mg/dl (present in 13% of patients)

Renal Insufficiency

a. Serum Creatinine >2 mg/dl (present in 23% of patients)

C. Complete Blood Count with platelets
Normochromic Normocytic Anemia

a. Hemoglobin <12 grams/dl (present in 65% of patients)

D. Bone Marrow Aspiration and biopsy
E. Peripheral Smear
Myeloma Cells
Rouleaux of Red Blood Cells
F. Erythrocyte Sedimentation Rate (ESR)
Increased >50 mm/hour in most cases (except bence-jones
Myeloma)
G. Serum Viscosity
H. Urinalysis
Bence-Jones Protein

2. Rouleaux of Red Blood Cells

Suggested sequence of immunologic testing : M spike on serum protein

electrophoresis

Serum:
-Immunoelectrophoresis
-Immunofixation
-Quantitation of immunoglobulins by radial immunodiffusion or nephelometry
- Screening for croglobulins

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- Determination of serum viscosity of IgM, IgA, or IgG , or signs and symptoms
suggestive of
Hyperviscosity

Urine:
- Screening of urine for increased protein, e.g. sulfosalicylic acid
- Total protein assay of a 24 hour urine specimen
- Urinary protein electrophorsis
- Urinary immunoelectrophoresis
- Immunofixation

58. Salmonella in the diarrhea. Know how to ID.

59. Providencia organism

60. Proteus Vulgaris organism

61. Culture media for Legionella?

63. Hematology:
Target Cells

DIC

CLL

PAS (+) and SUDAN (+) is what?

Smudge cells

Big Platelet

64. Inc. ESR causes: Study othe causes

My answer ; Inc Paltelet

65. Rouleaux formation due to ?

Choose:
a) Slow or fast smearing
b) Angle of the smear
c)
d)

66. Ferritin :

Increase Ferritin , Normal TIBC -------- inflammatory process

67. Hereditary Chromatosis; DNA analysis of the following

C282Y
H63D
S65C
68. Know the cases for Deferral of blood donors:

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 My answer: Pt with CMV

69. Tests affected by blood hemolysis?

- Increase: K, LD, AST, Plasma Hgb
- Decrease : T4
- Falsely Elevated: Phosphorus, Total protein, Albumin, Magnesium, Calcium,
Acid
Phosphatase

70. Affected by exposure of lights to blood:

- Decrease : Vitamin A and B6, Beta-carotene, Phorphyrins, Bilirubin
Should be wrapped in aluminum foil immediately after collection.

1. Blood gas was exposed to air for 1 hour and the Ph rised, b/c
a) CO2 was lost
b) HCO3 was retained
c) PCo2 was retained

2. Decrease TSH, increase T4. (3-4 quest this type)

a) pregnancy
b) primary hypothyroidism.
c) secondary hypothyroidism

3. Rh- mother has increase titer of anti-D. After delivery, the DAT is strongly (+) but
the baby is Rh-
a) inadequate washing
b) added monoclonal anti-D sera instead of anti globulin (or vise versa)
c) or maternal antibodies blocking the antigenic site

4. PAS (+), Sudan black II (+)

a) acute myelogenous
b) acute promyelogenous
c) chronic lymphocytic
d) acute monocytic

5)calculate the anion gap. ------------------> this question was also given to me on my
previous exam too

6) what is the ratio of T helper - T suppressors. Calculate from data given:

Total WBC -----19740
Lymphocyte----- 22%
Segments--------%
T3-------#
T4-------#
T8-------#

7) Another similar question: calculate B cells

Total WBC---------#
Segs------------#
Lymphocyte-----#
Eos, baso-------#

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8) Identify picture of dimorphic fungi isolated from pulmonary disease patient
The picture was single blue capsulated looked like crypto or yeast but the options
were
a) histoplasma capsulatum
b) blastomyce
c) eccinococcus immitus
d) para...

9) a 3 yrs old baby swallowed organophosphate pesticide. What's the best analysis
a) serum protein
b) serum glucose
c) urine arsenic
d) urine mercury

10) Cryoprecipitate was thawed @11:00am and stored in 20-24oC until requested @
1:00pm
a) don't wait transfuse immediatly
b) discard b/c it's storage temp 1-6o C
c) transfuse within 6 hours of pooling

11) 3 units of FFP requested for A - patient

Available: A- =1unit
A = 6units
O- = 5 or something
a) transfuse A units
b) transfuse O negative
C) don't remember more options

2-3 Quest in bilirubin: data given:

12) total Bilirbin-------- increase #

Serum bilirubin----increase
Urine bilirubin------increase
Urine urobilirubin------absent
?Fecal urobilirubin-----absent
AST. -------- increase
ALP ------------increase
a) hepatocellular
b) hemolytic
c) obstructive

13)Principle of agglutination
a) floccullation
b) precipitation

14) ENA + , what does it indicate

a) rheumatoid disease
b) detect extractable antibodies (ant-sm, anti- RNP, anti-ssa etc)
c) confirm SLE

3-4 panels :

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 I) panel shown cells 1-10 were positive, but cell 3 & 6 were enhanced and
agglutinated, what antibody is it
a) fya
*B) E
C) MN, S etc

II) this panel was very confusing b/c from Coombs it was anti-C , but in AHG all cell
were reacting (+), except 1cell (-) in middle probably cell 6 or 7. But it didn't ask
which antibody it is , rather which cells should be used.
> Cold agglutinationin syndrome ( I, P1 etc)
>how mucin clot in synovial fluid----- I chose acetic acid
> what does HÁČEK group include

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