LAB DIAGNOSTICS KEYPOINTS REVISION

EDITED AND ANSWERED BY KAMRUL HALEEM

MARK FORMAT
MCQs: 40X1=40%
T/F: 10X.5=5%
SHORT: 6X5=30%
CASE: 2X5=10%

1. Primary and secondary thrombocytosis.

Criterion Primary thrombocytosis Secondary thrombocytosis
Age(years) Frequent>20, often>40 All ages

Complications Thrombosis, hemorrhage Very rare

Splenomegaly Often Rare
Platelets >1,000,000/ul >1,000,000/ul
Duration >2 years Days to weeks
Platelet function Impaired Normal
Platelet morphology Large, dysmorphic Large normal
Causes Stem cell defect Reactive

2. What are laboratory tests for detection of intravascular hemolysis?

• Plasma hemoglobin level
• Urine hemoglobin level
• Urine hemosiderin level
• Serum hepatoglobin level

3. What is the clinical significance of OBT(Occult Blood Test)?

Chemical and immunology method. Significant to detect hemorrhage of digestive tract and
screening of digestive tumors

4. The clinical significance about POX, NSE+NaF, ALP, Fe.

POX:
 Positive: neutrophilic, eosinophilic and monocytic
 Negative: lymphoid, erythroid cells
NSE+NaF:
 Strongly positive: monocytic series
 Weak or negative: granulocytic series
 Positive in monocytes can be inhibited by NaF
ALP:
 Increase: infections, aplastic anemia, leukmoid reaction, acute lymphocytic anemia
 Decrease: chronic and acute granulocytic anemia
 Differential diagnosis: leukmoid reaction and CML chronic phase, PNH and AA
Fe
 Absence: criterion of iron deficiency
 Sideroblasts increase: hemolytic anemias, hemochromatosis

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 LAB DIAGNOSTICS KEYPOINTS REVISION
EDITED AND ANSWERED BY KAMRUL HALEEM

 Ringed sideroblasts: lead poisoning and sideroblast anemia

5. What is DIC and its laboratory findings?
 Coagulation cascade and platelets are activated
 Coagulation factors and platelets decrease obviously
 Fibrinolytic system is activated
 From high-coagulation to hyperfibrinolysis
Plt <100×109/L or progressive descent
Fbg <1.5g/L or progressive descent ,or >4g/L
FDP >20mg/L
D-dimer Positive or higher than before
PT Shorten or prolong over 3 seconds
APTT Shorten or prolong over 10 seconds

6. The clinical significance of PT,APTT,D-D.

PT:
 Increase:
PT is a measure of all factors of the extrinsic coagulation system
PT is a good criterion for assessing the protein synthesis capacity of the liver
PT is good for adjustment and for monitoring the level of oral anticoagulation therapy
 Decrease: thrombophilia or thrombosis diseases
APTT:
 Increase:
Deficiency or reduced activity of factors Ⅷ, Ⅸ, Ⅺ or Ⅻ;
Deficiency in HMWK and prekallikrein;
Presence of inhibitors of coagulation factors ;
Presence of heparin. (Serine protease :Ⅱ, Ⅶ, Ⅸ, Ⅹ, Ⅺ,Ⅻ)
 Decrease: thrombophilia or thrombosis diseases
D-D
 Fibrin(ogen) degradation products :are a sign of the increased risk of bleeding.
 Fibrin degradation products :as products of secondary hyperfibrinolysis, indicate the
formation of blood clots.

7. The characteristic of hematocytes’ development.

 Cell size: from large to small
 Cytoplasm: amount, color, granules
 Nucleus: size and shape
chromatin :fine and sparse to coarse and condensed
membrane :inconspicuousn n n to conspicuous
nucleoli :predominant to vanish
 Ratio of nucleus to cytoplasm : changes from high to low.

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 LAB DIAGNOSTICS KEYPOINTS REVISION
EDITED AND ANSWERED BY KAMRUL HALEEM

8. The difference between glomerular proteinurine and renal tubular proteinurine.

Glomerular:
Selective glomerular proteinuria: glomerular permeability↑ for midsized proteins 50~70kD,
albumin、transferrin，
Nonselective glomerular proteinuria: glomerular permeability↑ ↑ for HMW proteins
50~150kD, albumin、IgG、IgM, ＋ ～ ＋＋＋＋
Tubular:
tubular reabsorption↓ for LMW proteins 10~70kD, α1 -microglobulin,β2 –microglobulin,

9. What is the clinical significance of detecting Immunoglobulins?

Hypogammoglobulinemia:
 Caused by a wide spectrum of diseases
 A decrease in Ig caused by reduced synthesis of Ig, increased loss of Ig,
hypercatabolism or a combination of all
Polyclonal gammopathy:
 Affecting several types of one Ig class
 Caused by various diseases eg. Chronic liver disease
Monoclonal gammopathy:
 Only one type of Ig class involved
 Excessive proliferation of B-cell clone synthesizes Ig
10. Describe the clinical features of autoimmune disease (at least 4).
 Most occur in female(Women have auto-immune diseases three times greater than men),
prevalence is rising with age, and some have inherited factor (Certain races have more auto-
immune diseases than others).
 High titer of autoantibodies or sensitized lymphocytes can be detected.
 Pathological feature is immune inflammation.
 Autoimmune diseases have phenomenon of overlap.
 The cause of autoimmune diseases is not known, and always appear to be spontaneous
or idiopathic，some are relate to viral infection or taking some drugs.
 The course of disease is long, and some often accompanied by immunologic deficiency
or malignant tumor.
 Immunosuppressive drug, such as corticosteroids will show a certain therapeutic effect .

11. As most common used cardiac marker, Troponins ’s advantages and disadvantages?
Advantages:
 The greatest sensitivity and specifity I detecting MI
 It is released only when myocardial necrosis occurs
 It is detectable in serum 3-8 hous after an AIMI and its level remains elevated for 7-10
days
Disadvantages:
 False positive values due to release of cTnI from skeletal muscle
 cTnI is not elevated in the presence of renal diseases
 In case of a negative result the test should be repeated after 2 hours

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 LAB DIAGNOSTICS KEYPOINTS REVISION
EDITED AND ANSWERED BY KAMRUL HALEEM

12. Why the glycohemoglobin indicates a person’s long-term glucose level?

The half-life of hemoglobin is defined by the red cell survival time which is relatively
constant at 100-120 days, thus glycated hemoglobin are particularly suited as a long-term
parameter for assessing the blood glucose concentration. It indicates the average blood
glucose level in the 2-3 months before the test, a high value means the patient is at greater
risk of diabetic complication

13. List the classification of tumor marker; give an example for each type.
 Oncofetal antigens, e.g. CEA, AFP
 Carbohydrate molecules with epitopes recognized by monoclonal antibodies, e.g. CA 19-
9, CA 125, CA 153
 Differentiation and proliferation antigens, e.g. PSA
 Hormones, e.g. HCG in testicular cancer
 Proteins, e.g. monoclonal immunoglobulins and Bence Jones protein in multiple
myeloma

14. Please describe the normal types of infection in hospital.

 Urinary tract infections
 Respiratory tract infections
 Gastrointestinal tract and related organs infections
 Bloodstream infections
 Skin and soft tissues infections
 Post-operative wound infections

15. What is sexually transmitted disease? Please describe the route of transmission.
The disease transmitted by the sexual behavior or similar sexual behavior and cause multi-
organic disease
Routes of transmission:
 Sexual contact
 Indirect contact
 Transmitted by blood or blood preparation
 Transmitted by placenta

16. What is the diagnostic criteria for diabetes?

 Symptoms of diabetes (ie polyuria, polydipsia and unexplained weight loss) plus: a
random plasma glucose concentration > 11.1 mmol/L
a fasting plasma glucose concentration > 7.0 mmol/L
 With no symptoms, diagnosis should not be based on a single plasma glucose
determination. At least another plasma glucose on another day with a value in the diabetic
range is essential

17. What is the aotuimmune diseases and antinuclear antibodies?

 Autoimmune diseases are associated with loss of immunological tolerance.
Autoantibody and sensitized lymphocytes attacks its own tissues as though they were

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 LAB DIAGNOSTICS KEYPOINTS REVISION
EDITED AND ANSWERED BY KAMRUL HALEEM

foreign substances.
 ANA is the general name of a group of autoantibodies, and the target antigen is cell
nuclear components

18.What is the clinical significance of Extended-Spectrum β- Lactamase-Producing

bacterium (ESBLs)?
 ESBLs are beta-lactamases that hydrolyze extended spectrum cephalosporins with an
oxyimino side chain.
 ESBLs producing isolates should be considered resistant to all extended- spectrum
penicillins, cephalosporins, and monobactams even if they appear to be susceptible to
these agents in vitro.

19. How to differentiate Jaundice in laboratory?

Type of jaundice Blood Urine
Hemolytic jaundice Indirect bilirubin increases Urobilinogen increases
Urine bilirubin negative
Hepatic jaundice Direct bilirubin and indirect Urine bilirubin increases
bilirubin increase
Obstructive jaundice Direct bilirubin increases Urine bilirubin increases
Uribilinogen negative

20. What is isoenzyme and its function in diagnosis?

Isoenzymes are different forms of an enzyme which catalyze the same reaction, but which
exhibit different physical or kinetic properties, such as isoelectric point, pH optimum

21. Why HDL cholesterol is referred to as "good cholesterol” ?

Low HDL cholesterol becomes major risk factor for heart disease where as high LDL
cholesterol is a significant risk factor for coronary heart disease, thus HDL-c is referred to as
the “good cholesterol”. The laboratory test for HDL actually measure the cholesterol part of
HDL not the actual concentration of HDL in blood

22. What is the indication of detecting complement components ?

 Systemic Lupus Erythematosus(SLE)
 Generalized vasculitis
 Glomerulonephritis
 Cryoglobulinemia
 Recuurent infections – as seen in deficiency in C3,C5 or C6 to C9

23. What is the definition of M protein?

Monoclonal immunoglobulin or immunoglobulin fragment, immunoglobulin derived from an
abnormally proliferating clone of neoplastic plasma cells. M protein has uniform structure
and electrophoretic rate, and no activity of antibody

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 LAB DIAGNOSTICS KEYPOINTS REVISION
EDITED AND ANSWERED BY KAMRUL HALEEM

24.What are indicators for recovery from acute hepatitis B?

 Significant decrease of HBsAg concentration 3 weeks after onset of illness
 Disappearance of HBeAg within 12 weeks
 Disappearance of HBsA within 3-4 months
 Occurance of anti-HBs

25. Tell the resistance mechanism of MRSA .

Staphylococcus aureus changes the penicillin-binding protein, then it is resistant to multiple
classes of antimicrobial agents

26.If you suspected the patient was syphilis infection, what tests do you choose?
 Dark field microscopy
 Serological screening tests
 Serological confirmatory tests
 PCR

27. Contents relating to hepatitis B and C.

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