Recall (Nov.

2014)

ALTERNARIA FUNGI
SPECIMEN FOR RUBELLA- BLOOD
Lysostaphin Resistant- Micrococcus
GENTAMICIN RESISTANT-ENTEROCOCCUS
BACTERIA
PRESENT AFTER JAW SURGERYVEILLONELLA
CRITHIDIA LUCILAE- SLE
MUCOR AND RHIZOPUS- FUNGI PICS
ACINETOBACTER- NFO, UTI, DRUG
RESISTANT

ALTERNARIA

basal
body
nucleaus

kineoplas
t

Flagellum

DS DNA TEST FOR

SLE

Mucor sp.

Rhizopus sp.

Recall (Oct 2014)

N. MENINGITIDIS- VIRULENCE- ENDOTOXIN

CYSTIC FIBROSIS-BURKHOLDERIA CEPACIA
(-) CAMP S. agalactiae= Hippurate test, Reverse
CAMP
3 lactose fermenters, gram neg E.coli, Kleb,
Enterobacter
S. aureus, enterococci in stool- normal flora stool
Citrobacter vs Salmonella- MacConkey, LDC
Rotavirus EIA positive, next to do? Molecular test
CD4- inducer
Osmolarity

ASCP POINTERS- MICRO

10%

sodium hypochlorite= best disinfectant

Rickettsia test= detects Ab
Rubella = how to identify its immune class :
test IgM or IgG or both
Major difference of kinyoun and ZN = process
Penicillium picture = brush like conidiophore
Steam under pressure = 121C, 15 mins
Dermatophytes = macroconidia and
microconidia

ASCP POINTERS- MICRO

Lysostaphin

Resistant Micrococcus
CAMP test is doubtful- do other test (hippurate)
Do ID & AST- Pathogens (Enterococcus, Staph
not on Lactose fermenters)
Differentiate Morganella morgani and Prov.
stuartii- Ornithine and citrate
C. freundi & Sal. typhi citrate and MacConkey

ASCP POINTERS- MICRO

Y.

enterocolitica and Y. pestis differentiate- Y.

pestis (+) motility and ornithine (+)
Treponema seen urethral discharge of male
and female
Optochin resistant- Strep viridans
Bloody diarrhea- EHEC

ASCP POINTERS- MICRO

H.

influenza= satellitism = V factor

Lysine deaminase negative = yellow
Synergy = 2>1
E. coli trophozoite motility = pseudopod
Sal. enteritidis = TSI picture (K/A, gas, H2S)
Sal. paratyphi A = TSI (K/A no gas, no H2S)
Aspergillus= immunocompromised diabetic
patient sinuses

ASCP POINTERS- MICRO

Basitracin

test doubtful- do PYR

Serratia marcescens- Dnase test (+)
Burkholderia cepacia- cystic fibrosis
Mucoid colony, Lactose fermenter, indole (+)Kleb. oxytoca
Curvularia curved organism (picture)
Alternaria- agent of phaeohyphomycosis (pic)
Contact lens, corneal infection- Acanthamoeba

CURVULARIA

ALTERNARIA

Syncephalastrum

FUNGI: Opportunistic mycosis:

Penicillium

ASCP-Serology, BB, Immuno

Amplification

of Hep 2 nu cells = PCR,

NASBA, TMA
Target amplification method- PCR, RTPCR,TMA (Transcription mediated
amplification), qPCR- Real time PCR
Branched chain technology (bDNA)- signal
amplification, hybrid capture assay (HCA),
cleavage based amplification

ASCP-Serology, BB, Immuno

Probe

amplification- ligase chain reaction,

strand displacement amplification (SDA)
Thermocycler, Taq DNA polymerase, primersPCR reagents and materials
Fc portion of IgG- Rheumatoid factor
Anti smooth muscle Ab (ASMA) chronic
active hepatitis
Inc TSH, Inc thyroid Ab = Graves, hashimoto,
thyroid cancer?
Rim/peripheral pattern anti-dsDNA

Rim/peripheral anti-ds DNA

Speckled=anti- Sm, anti-RNP,

anti- Ro, anti -SSB

Homogenous- ssDNA, histone

ASCP Pointers

Anti-p24, anti-gp120, anti-gp41 (+) band = report as

reactive in Western Blot
High IgG, high total protein, low albumin- multiple
myeloma
CSF IgG oligoclonal band multiple sclerosis
Mixed lymphocyte culture compatible cells; very
low/no blastogenesis
Low C5- Neisseria infection (N. meningitidis)
Low C3 overwhelming infection
C3b- immune adherence& opsonization
C5a- chemotaxis and anaphylatoxin

ASCP Pointers
MHC

class I CD8 cells; class II = CD4

Anti-EBNA = past EBV ; 3 wks after acute
Destroyed by enzyme Duffy &MNSU, Xga
AHG detect IgG
Platelet concentrate from whole blood- 5.5 x
1011 and plateletpheresis= 3 x 1011 platelets
Leukocyte reduced RBC= 80% RBC ,
WBC 5 x 106

antiBga, Bgb,Bgc = HLA ag associated

urine- neutralize anti-Sda (Sid)
Rabbit erythrocyte stroma absorbs cold
autoantibodies from plasma
Anti-IgG (-) & anti-C3d (+) = pre warm tech./
adsorption of cold antibody
Anti-IgG (+) and anti C3d (+) = elution
Warm autoantibody= elution
Best blood group to be transfused to RH positive
infant with RH negative mother = group O negative
Review Ab panel/screen/ABO discrepancy/ Serial
dilution/ RH

Troubleshooting Incompatible
Crossmatches
Ab Screen

AC

Major
Xmatch

Possible problem

(-)

(-)

(+)

- ABO/Rh typing error

- Donor unit w/ (+) DAT
- Patient w/ low incidence Ab

(+)

(-)

(+)

- Patient alloantibody

(+)

(+)

(+)

- Patient autoantibody
-- Rouleaux

ASCP sample question

Anti-JKa = delayed hemolytic transfusion rxn
Sample question:
A patient with an anti-K and an anti-JKa in her plasma
needs 2 units of RBA for surgery. How many group
specific units would need to be screened to find 2
units of RBC? The frequency of JKa+ is 77% and K+
frequency is 10%.
A. 6
2 / .207 = 9.66 or 10

B. 10
C. 20
D. 36

A patient with an anti-K and an anti-JKa in her plasma

needs 2 units of RBA for surgery. How many group
specifc units would need to be screened to find 2
units of RBC? The frequency of JKa(-) is 77% and
K(-) frequency is 10%.
A. 10
2/ .077 = 25.97 or 26
B. 20

C. 26
D. 30

Which one has the lowest amount of H

antigen?
A. Type O
B.

Type A1

C.

Type A2
Type B

D.

O negative woman gave birth to an O positive

infant. The fetal blood volume was 5ml. How
many Rh vial(s) should be administered?
A.
B.
C.
D.

1
2
3
4

5/30= 0.16 + 1= 1.16

Which one is an IgG type associated with

PCH?
A. anti-P1
B. Anti-PP1pk
C.

Anti-P

D.

Anti-pk

The result of a DAT reveals the following:

Anti-IgG (+)
Anti-C3d (+)
What test should be performed next?
A. Antibody screen
B. Antibody test
C. Absorption

D.

Elution

The result of a DAT reveals the following:

Anti-IgG (+)
Anti-C3d (+)
Saline control (-)
Polyspecific AHG (+)
What test should be performed?
A. Treat RBC with chloroquine diphosphate
B. Autoabsorption
C. Alloabsorption
D.

Elution

The result of a DAT reveals the following:

Anti-IgG (-)
Anti-C3d (+)
Polyspecific AHG (+)
What test should be performed?
A. Treat RBC with chloroquine diphosphate
B. Autoabsorption
C. Alloabsorption
D.

Prewarmed technique

ASCP Pointers-CM
Viral

meningitis increase lymphocyte

Bacterial meningitis- increase neutrophil
Boric acid preserves protein
Decrease SG(<1.010) Diabetes insipidus
Increase SG (>1.010) Diabetes mellitus
constant low SG = renal tubular failure
Isosthenuria consistent 1.010= failure to
concentrate the urine

ASCP Pointers-CM
Hemoglobinuria-

clear red
Urine bilirubin obstructive jaundice
Urine urobilinogen- hemolytic anemia; Ehrlichs
Yellow foam urine- bilirubin (+)
Synovial fluid diluents
Sperm ct = process after liquefaction (30-60min)
Effect of ascorbic acid in glucose test

ASCP Pointers-CM
Why

shift to clinitest if (-) glucose rgt strip

test- detects reducing substance hence more
sensitive
Glucose reagent strip test- specific
Uric acid / monosodium urate= birefringent
under polarized light ; negative birefringence
under compensated polarized light

ASCP Pointers- CM
Cyanide

nitroprusside test (+) = cystinuria

Protein error of indicator= principle in CHON
reagent strip test
WBC, RBC, Bacteria = hazy urine
RBC lyzed in alkaline pH
Yeast mistaken as RBC
Alkaline urine- protein effect
(+) nitrite = cystitis, pyelonephritis

ASCP Pointers- chemistry

Increased

chloride in sweat= cystic fibrosis

Heparin = most blood chemistry analysis
Hemolysis acceptable= sodium test
Hemolysis not acceptable = potassium
Troponin test = Myocardial infarction
Float, turbid, milky, creamy serum=
chylomicrons
CA 19-9 and CEA = colorectal cancer

ASCP Pointers- chemistry

Lp(a)

= increased atherosclerotic CAD

LDL= CAD risk
Albumin/prealbumin = malnutrition
Cocaine = benzoylecgonine
Codeine, Heroine = morphine
Procainamide = NAPA (N-acetylprocainamide)
K+ analysis= Valinomycin
Hemoglobin A1C (<7%)= DM; monitor Tx

ASCP Pointers- chemistry

Heparin

= green
Function of wavelength selector
Instrumentation = photometric, aas,
flurometry
Phenytoin method measurement
Volumetric pipet
Fragile X syndrome
Bile is tested to detect?

ASCP Pointers- chemistry

>126

FBS (2x) = DM
NAD+= urea coupling reactant
immunoassay test= Creatine kinase (CK)
p-nitrophenylphosphate = ALP (hepatobiliary)
Oxidoreductase (oxidase) = uric acid, glucose,
cholesterol and triglycerides
Low pH, low pO2, increase pCO2 = delay in
blood gas analysis
Inc CO2, Dec HCO3 = COPD
Respiratory acidosis

ASCP Pointers
ROME

= respiratory Opposite, Metabolic equal

ph: 7.35-7.45
pCO2 :35-45
HCO3 or ctCO2: 22-26
Hyperkalemia= metabolic acidosis
Hyperventilation= respiratory alkalosis

 pH=

increased
pCO2= decreased
HCO3= normal
Answer: uncompensated respiratory alkalosis
pH= increased
pCO2= decreased
HCO3= decreased
Answer: compensated respiratory alkalosis

pH= 7.52
pCO2 = 20mmHg
HCO3= 24mmol/L
pO2= 100mmHg
The result most likely:

A.
B.
C.
D.

Hyperventilation
Hyperkalemia
Improper specimen collection
Improper storage

ASCP question
A patient has a low serum thyroid stimulating
hormone (TSH) and an increased serum T3.
Which of the following result would also be
expected?
A.
B.
C.
D.

Elevated free T4
Low free T3
Low total T4
Normal free thyroxine index

When serum potassium and phosphorus are

elevated which one is also expected to rise?
A. Calcium
B.
C.
D.

Magnesium
AST
LD

ASCP Pointers

PAS (+) = FAB M6 and ALL

MPO (+), SBB (+), NASDA (+) = FAB M1toM4
LAP score 10 = CML
High DIC = FAB M3
RBC, WBC too blue= poor washing,little buffer
Target cell, sickle cell, tear drop= thalassemia
N:C ratio decreases= blood cell maturation
Decrease nucleoli = blood cell maturation
Dohle bodies, giant platelets= May-Hegglin
azurophili granules, mucopolysaccharide defect=
Alder- Reilly anomaly

ASCP Pointers
Microcytic,

hypochromic- iron deficiency

anemia, sideroblastic anemia, thalassemia
Macrocytic, normochromic= megalobastic
anemia, folic acid deficiency, pernicious anemia
Normocytic, normochromic= aplastic anemia,
anemia of chronic disease, lead poisoning,
sickle cell disease (hemoglobinopathies) Hgb C,
SC
Alpha thalassemias= Hgb H & Hgb Barts
Corrected WBC count = 100 x uncorrected
WBC/ 100 + #nRBCs per 100 WBC

ASCP Pointers
Rule

of 3 = RBC x 3 = Hgb; RBC x 9 = Hct, Hgb

x 3 = Hct
Hgb F = resist acid elution ( Kleihauer-Betke)
= fetal cells in maternal circulation
Hgb S = valine replaces glutamic acid
Hgb C, Hgb E = lysine replaces glutamic acid
Hgb D = glycine replaces glutamic acid

ASCP Pointers
No

Hgb A = Hgb SS disease, Hgb C, Hgb

SC, Major beta thalassemia
Hgb electrophoresis = At pH 8.6, Hgb A
migrates fastest, and Hgb A2, C, E, O the
slowest; Hgb S migrates with Hgb D and Hgb G
Review pictures blast cells
Teardrop cell picture= myelofibrosis
(+) PAS = acute erythroleukemia

ASCP POINTERS
APTT

= Test for Intrinsic factor (8,9,11,12)

and common ( 1, 2, 5, 10)
= heparin and protamine sulfate
PT (INR) = Extrinsic &common (1, 2, 5, 10, 7)
= Vit. K and coumadin (warfarin)
TT = FIBRINOGEN
Bleeding time prolong, APTT high, Restociten
abnormal = von Willebrand

 Inc

APTT, Normal PT, Normal BT = Hemophilia

A, VWF Dse, Factor 8, Factor 9
vWF dse = Inc APTT, Normal PT , Inc BT
Factor 8 and 9 = Inc APTT, Normal PT , Inc BT

ASCP POINTERS
Bernard

Solier = lack glycoprotein Ib receptor,

Restociten abn.giant platelets, BT prolong,
normal APTT; REVIEW APTT MIXING
STUDY/LAP score
Platelet satellitism = use sodium citrate not
EDTA
D dimer (+), FDP (+) = DIC
D dimer (-), FDP (+) = primary fibrinogenolysis
Log document control = corrective actions
Maintenance = quality of machines/equipment

 Computation

= Anion gap, Corrective WBC ct

LAP score is 4+, 3+, 2+, 1+ = leukemoid
(+) MPO, (+) SBB =APL/ FAB M3
(+) PAS = ALL
(+) TRAP = Hairy cell leukemia
Spherocytes picture
D dimer = detect fibrin
Pseudo Pelger Huet = myeloproliferative dse

BT

CT

PT

APTT Stypven TT

Duckerts

Vascular
Disoder

Fibrinogen
def.

Prothrombi
n def

BT

CT

PT

APTT Stypven TT

Duckerts

Classic
N
Hemophilia

Factor VII
def

vWD

BT

CT

PT

APTT Stypven

TT

Ducker
ts

Parahemo N
philia

Hemophili
aB

Factor X
def.

BT

CT

PT

APTT

Stypven

TT

Duckerts

Hemophilia
C

Factor XII
def.

Factor XIII
def.

ABN

DIC

ABN

CYTOCHEMICAL
STAIN

Myeloperoxidase
Sudan Black B
(M1-M5)

Napthol AS-D
Chloroacetate
Esterase
(M1-M4)

Alpha napthyl
acetate
Alpha napthyl
butyrate
(M4, M5 )
(M6,M7
+ Napthylacetate

Periodic Acid
Schiff (PAS)
(ALL, M6)

Cytochemical stain
1.

Myeloperoxidase (MPO) stain

2.

(+) AML (granulocyte, monocyte, Auer rods)

(-) ALL

Sudan Black B ( phospholipids, proteins)

(+) AML (granulocyte, monocyte, Auer rods)

(-) ALL

Cytochemical stain
3. Esterases

Specific esterase stain (napthol AS-D

chloroacetate esterase stain) = granulocyte

(+) FAB M1, M2, M3, M4

(-) FAB M5

Non specific esterase stain (alpha napthyl

acetate and alpha napthyl butyrate) = monocyte

(+) FAB M5
(-) FAB M1, M2, M3, M4

Cytochemical stain
4. Periodic Acid Schiff (PAS)
(+) ALL
(+) FAB M6 (erythrolekemia)
5. Leukocyte Alkaline Phosphatase (LAP)
Low LAP score = CML, PNH
High LAP score = NLR, PV, CML in blast crisis

Cytochemical stain
6. Tartrate Resistant acid Phosphatase (TRAP)
(+) hairy cell leukemia
7. Perls Prussian Blue stain
(+) Siderocytes with iron inclusions
(siderocytic granules/pappenheimer bodies)
(+) HA, beta thallasemia major, sideroblastic Anemia
(+) Sideroblasts = nRBC with iron granules
Ringed sideroblasts= iron encircle nucleus
(+) MDS (Refractory anemia, RARS, sideroblastic
anemia)

Blood chemistry- leukemia

ALP = CML diagnosis

Vitamin B12= CML
Ca, K, phosphate, uric acid = ALL

What clotting factors are inhibited by

coumadin therapy?
A. II and VII
B. II and XI
C. V and VIII
D. XII and XIII

Bleeding time-15 mins (2-4mins)

Platelet count-200 x 109/L
PT- 13 sec (<14 sec)
APTT- 50 secs (20-40 sec)
Abnormal platelet aggregation in response to ristocetin
What is the most probable diagnosis?
A.
Bernard-Soulier syndrome
B.
Hemophilia A
C. Glanzmann thrombasthenia
D. Von Williebrands disease

Which of the following tests evaluates

fibrinolysis?
A. APTT
B. D dimer test
C. PT
D. Fibrinopeptides A and B

A positive non specific esterase stain indicates

differentiation into which cell type?
A. Monocytic
B. Lymphoid
C. Megakaryocytic
D. Plasmacytoid

What condition can be ruled out when positive

to myeloperoxidase stained peripheral blood
smear?
A. Acute myelogenous leukemia M1
B. Acute myelogenous leukemia M4
C. Acute myelogenous leukemia M5
D. Acute lymphocytic leukemia

Which cytochemical stain is used to detect

acute myelogenous leukemia M7?
A. Terminal deoxynucleotidyl transferase (TdT)
B. Myeloperoxidase (MPO)
C. platelet peroxidase
D. Sudan black b (SBB)

Hodgkin Lymphoma

EBV associated
(+) Reed Strenberg
cells = large
multinucleated cells
with large nucleoli
Mild anemia,
eosinophilia,
monocytosis
High LAP, ESR

Hairy Cell Leukemia (HCL)

B cell maliganacy (CD

19, CD20)
Marked splenomegaly
Pancytopenia
Cytoplasm show hair
like projection
(+) TRAP

Hairy Cell Leukemia (HCL)

Chronic Lymphocytic
Leukemia (CLL)

Which of the following stain/reaction show a

positive result in most patient with acute
lymphocytic leukemia?
A. Sudan black and peroxidase
B. Chloroacetate esterase
C. Non specific esterase
D. Terminal deoxynucleotidyl transferase

The leukemia commonly associated with

pediatric age group is:
A. Acute myeloblastic leukemia
B. Acute lymphoblastic leukemia
C. Chronic lymphoblastic leukemia
D. Chronic myelocytic leukemia

All of the following are characteristic of

myelodysplastic syndrome EXCEPT:
A. Lymphocytosis
B. Monocytosis
C. Ringed sideroblast
D. macrocytosis

What is the most common chromosomal

abnormality found in chronic myelogenous
leukemia?
A. t(8;14)
B. t(9:22)
C. t(1;12)
D. Trisomy 12

Thats all folks.

Remember C A L I
CALI-

Concentration
Association
Location
Imagination