ASCP-MLT questions and answers

Ferritin and hemosiderin are considered storage forms of iron.

Which substance(s) is/are considered iron storage compounds?

A positive DAT is consistent with a diagnosis of hemolytic disease of the newborn. A hemoglobin performed on the cord blood serves as an indicator of the severity of the disease.

In order to detect the presence of antibodies fixed on the RBC's of newborns one should:

The area of the federal government that ensures that the laboratory is stocked with gloves for their employees when performing tests on patient blood sample is:

Name the comprehensive written safety plan detailing the proper use and storage of hazardous chemicals in the workplace.

The lecithin-sphingomyelin ratio is a test for assessing fetal lung maturity that is useful in determining risk of an infant born with respiratory distress syndrome.

The Lecithin/Sphingomyelin ratio determination of amniotic fluid is useful in assessing the probability of:

Pink or Red stopper tubes can be used for Blood Bank!

Question options:

Charcot-Leyden crystals in stool are thought to be created from damaged eosinophil byproducts. These crystals have a strong association, although they are rare, with parasitic infections or allergic reactions.

Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of:

The red blood cell distribution width (RDW) increases as the severity of alpha thalassemia increases because of changing MCV as the bone marrow produces smaller cells. In addition, if Hemoglobin H bodies are present, they result in the formation of schiztocytes (RBC fragments) that can have an effect on the
MCV and RDW.

The Red cell Distribution Width (RDW) in alpha thalassemia is

This integrity of this specimen is compromised. The unit cannot be used.

What action should be taken if a large clot is noticed in a red blood cell unit while the product is being prepared for release to the patient?

Bacitracin susceptibility is a presumptive test for the identification of Lancefield group A Streptococcus.

Which of the following is a presumptive test for the identification of Lancefield group A Streptococcus:

What component is indicated for patients who receive directed donations from immediate family members to prevent transfusion-associated graft versus host disease (TA-GVHD)?

The most common specimen analyzed in the hematology section is:

Neutrophils are typically increased in urinary bacterial infections.

What type of white blood cell is seen MOST frequently in urine sediment with infections of the urinary system?

The negative antigen frequencies are used in the formula below to determine the percent of type-specific units that would be compatible for the patient. Negative antigen frequencies are determined by subtracting the percent antigen frequency from 100%. The negative antigen frequency for K in this case is .91 (1.00 -
.09) and the negative antigen frequency for Fya is .34 (1.00 - .66).

% compatible units available = 100 x (Neg frequency #1 x Neg frequency #2...)

For this case, the calculation is:

% compatible units available = 100 x (0.91 x 0.34) = 30.94 or 31% If the antigen frequencies for K = 0.09 and Fya = 0.66, what percent of type-specific units would be compatible for a patient with anti-K and anti-Fya?

Two CSF specimens were sent to the Lab with the following results:

Tube #1 = 11,200 rbc/μL

Tube #2 = 300 rbc/μL

The results on these CSF specimens are indicative of:

As magnification DECREASES, the opening of the iris diaphragm will...

Phase of reactivity is primarily at immediate spin (4+) and reactions get weaker at AHG (w+). There is no specific pattern of reactivity and the auto control is negative which rules out an autoantibody. This is a strong cold antibody which is still slightly present after incubation and washing.

Activation and binding of the antibody takes place at room temperature or colder. Eliminating this phase will prevent the antibody from binding. Cold antibodies usually are more of a nuisance to blood bankers and are not clinically significant.

When performing an antibody screen, both the screen cells are 4+ at immediate spin and W+ at AHG. The antibody panel shows 4+ reactions at immediate spin and W+ reactions at AHG and there is no specific match to the reaction pattern. The auto control is negative.

What would be a logical next step?

Albumin is a "negative" acute phase protein since it is found in decreased levels during acute phase response. Alpha-1-antitrypsin, fibrinogen, and ceruloplasmin are all "positive" acute phase proteins that are found in increased levels during acute phase response.

Which one of the following usually shows a decrease during an acute phase response?

An international, nonprofit organization that establishes standards of best current practice for clinical laboratories is

HLA-DR is a MHC class II(major histocompatibility complex) surface receptor on the cellular surface which is encoded by the human leukocyte antigen complex, or HLA.

DR antigens are found in which of the following systems:

The difference between glass and plastic red stopper tubes is that the:

Question options:

Hemoglobin H is a tetramer made of four beta globin chains. Hemoglobin H occurs when there is very limited alpha chain availability used to make normal hemoglobin A. Hemoglobin H forms in those affected with alpha thalassemia major as well as in people with the combination of two-gene deletion alpha thalassemia and hemoglobin Constant Spring.

Hematology

Which of the following combination of globin chains comprise Hemoglobin H?

Beer's law is based on the fact that absorbance is directly proportional to the concentration of a solution.
Therefore, stray light can alter the absorbance results in this type of assay.

Deviations from Beer's Law are caused by:

The document designed to protect phlebotomists from contacting hepatitis is the:

A person classified as an ultrarapid metabolizer (UM) has a polymorphism that enhances the catabolic activity of the enzyme. This means that a UM would need more of the drug to achieve a 'normal' level since he/she is rapidly metabolizing the drug.

Chem

In therapeutic drug monitoring, a person who is classified as an ultrarapid metabolizer (UM) would need
__________ of a drug metabolized by that enzyme.

Rule-out is a process by which antibodies are identified as being unlikely in a given sample because of the absence of an expected antigen-antibody reaction. In other words, the absence of a reaction is noted with a cell that is positive for the corresponding antigen.

Although rule-out procedures may vary somewhat from institution to institution, the following general principles apply:

Non-reactive cells are selected for rule-out. To be classified as non-reactive, a cell must NOT have reacted at any phase of testing in a given panel or screen.

Using the logic that if the rule-out cell is positive for a given antigen, it should have reacted with the corresponding antibody, you can rule-out antibodies that correspond to antigen positive cells.

To increase the probability that rule-out will not mistakenly eliminate a weakly-reacting antibody that exhibits dosage*, use only cells that are homozygous for the corresponding antigen for those systems that generally show dosage. Generally these include: C, c, E, e, Fya, Fyb, Jka, Jkb, M, N, S, and s.

In this case, it is only possible to rule out on screening cell 2 since it demonstrates a negative reaction with the patient serum. Anti-C cannot be ruled out since the C antigen is heterozygous on screening cell 2 with c. Anti-Fya cannot be ruled out since this antigen is not present on screening cell 2. Anti-M and anti-Jka can be ruled out since the antigens are homozyous while demonstrating a negative reaction on screening cell 2.

Rule-out, while very useful, can lead to error. Ruling out an antibody should be combined with other
supporting data to increase confidence in the solution; the more data collected, the higher the probability
that the final solution is correct.

*Dosage means that there are two "doses" of the same antigen present on the red cells . Antibodies that exhibit dosage react more strongly with homozygous cells (e.g., Jka Jka) than with heterozygous cells
(e.g., Jka Jkb) .
Based on the phenotype of the RBC screening cells, and patient results shown on the right, which of the following antibodies CANNOT be ruled out?

A laboratory scientist is working the night shift at a local hospital when the power goes out.

What is the course of action to continue to provide laboratory results?

The newest direction for laboratory testing procedures is

Blood bank
Once the seal on a unit of packed red cells is broken, how long can the unit be stored refrigerated prior to administration:

On the red cell membrane, there is a bicarbonate / chloride exchanger. This exchanger allows for bicarbonate to leave the red cells while chloride is allowed inside.

In blood, bicarbonate leaves the red blood cell and enters the plasma through an exchange mechanism with:

Darkfield microscopy allows a lower limit of resolution than bright-field microscopy which helps the tiny spirochetes to be seen in patient samples. In darkfield microscpy, there is a dark background where directly transmitted light is excluded by a dark-field condenser allowing only scattered light to be focused on the specimen. With dark-field microscopy bacteria appear luminous against a dark background.

Which of the following microscopic techniques is best suited for direct examination of the infectious agent of syphilis?

The microscopic features shown here represent Scopulariopsis species. In most instances, particularly if a patient does not have underlying immunologic or hematologic disease, Scopulariopsis species should be considered a contaminant when recovered from a sputum specimen. However, if there is clinical or X-ray evidence of mycotic pulmonary infection, additional daily induced sputum specimens should be obtained.

If Scopulariopsis species or any other hyaline mold is recovered from two or more successive specimens, its potential as a pathogenic agent should be considered. Scopulariopsis species have been reported as the agents of pulmonary fungus ball infections in patients with preexistent cavities and as a cause of pneumonia in patients with leukemia.

Invasive pulmonary disease by this agent has not been reported.

The fungus illustrated in this photomicrograph was recovered from an induced sputum specimen from a 74 year old man with chronic obstructive pulmonary disease. This isolate is most likely:

True Statements:

Urine should be well mixed prior to dipping the reagent strip. Prolonged immersion may wash out test reagents.

False Statements:

Urine should be centrifuged prior to dipping the reagent strip. When visually reading the reagent strip, all results can be read immediately after dipping the strip in the urine specimen.

Which of the following statements are TRUE regarding the reagent strip test procedure? (Choose ALL of the correct answers)

A monoclonal B-cell population (Kappa or Lambda predominant) with expression of CD19, CD20, CD23, and co-expression of CD5 is consistent with which of the following?

A patient has a WBC count of 4,000/mm3, a platelet estimation with 3 bizarre platelets/oil immersion field, hemoglobin, hematocrit, red cell count and indice values are within normal limits. Blue-staining inclusions are seen in the cytoplasm of many neutrophils. These inclusions fit the description of:

Serum calcitonin is normally produced by the C cells of the thyroid. It functions to reduce serum calcium by inhibiting release of calcium from bone. It is a peptide with a molecular weight of 3400, and has a half life of approximately 12 minutes. It is characteristically elevated in medullary carcinoma of the thyroid. Since medullary carcinoma often occurs as an autosomal disorder, family members of patients with this condition should be screened for serum calcitonin.

Serum calcitonin is typically elevated in which of the following conditions:

Protein in urine can be confirmed using sulfosalicylic acid (SSA) precipitation. The SSA reagent is added to a small volume of urine. Acidification causes precipitation of protein in the sample, which is subjectively graded as trace, 1+, 2+, 3+ or 4+. SSA reaction will detect albumin, globulins, and Bence-Jones proteins.

Which of the following would be the most appropriate method to confirm a positive protein from a urine dipstick:

Caffeine benzoate solution is used to split the unconjugated bilirubin protein complex releasing the bilirubin so that it can react with diazotised sulphanilic acid. The tartrate buffer creates an alkaline solution and converts the red acid bilirubin to a green coloured compound which can be measured spectrophotometrically.

Which substance is used in the Jendrassik-Grof method to accelerate the reaction of unconjugated bilirubin with the diazo reagent?

Which of the following agencies administers the certification test that you will be eligible to take at the end of your 4 semester?

The part of the microscope that holds the objective lenses is called the _______________.

The body of a tapeworm is composed of successive segments known as proglottids. Each mature proglottid has both male and female reproductive structures.

What is the anatomical feature of a tapeworm that possesses both male and female reproductive structures?

Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis?

Which of these advancements in the clinical laboratory has led to concerns about patient privacy

Howell-Jolly bodies are composed of DNA, usually left from the nucleus, that appears as a round, dark-staining inclusion in the cytoplasm of red blood cells. Howell-Jolly bodies can be found in various conditions including splenectomy and anemia.

Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called:

The activities conducted in a laboratory with a certificate of registration include:

A clinical laboratory scientist or medical laboratory scientist (or medical technologist in older terminology) may serve as all of the following except:

Patient's with diseases such as congential hemolytic anemias and aplastic anemias require frequent transfusions. Each unit of red cells contains 225 mg of iron, which puts these patients at risk for iron overload.
Blood Bank

Patients with diseases that require chronic transfusions are at risk for iron overload.

The dematiaceous molds can be broadly separated into two major groups: the agents of chromomycosis that grow more slowly, maturing only after 7 days or more of incubation, and the more rapidly growing species that most commonly are clinically insignificant commensals or contaminants when recovered from clinical specimens, but in rare situations may cause opportunistic infections called phaeohyphomycosis.

Dematiaceous molds can be broadly separated into two major groups; the agents of chromomycosis and
clinically insignificant commensals or contaminants. The agents of chromomycosis grow: more slowly than;
more rapidly than; or generally at the same rate as the clinically insignificant commensals or contaminants?

P. vivax characteristically displays Schuffner's dots and often enlarged RBCs along with brownish
granules. P. vivax can also have 12-24 merozoies in each cell, actually filling the entire RBC. This parasite also has very irreglar shapes often referred to as "Ameboid".
P. falciparum and P. malariae do not display Shuffner's dots, therefore could not be the correct choice.
P. ovale does display Shuffner's dots in all stages, but characteristically has about 8-12 merozoites in
rosettes or irregular clusters inside the RBC. Also, P. ovale characteristically shows enlarged, ovoid RBCs with fimbriated edges.
Identify the parasite of a patient with suspected malaria who demonstrates the following findings on a blood smear:
- Enlarged RBCs, some with fine brownish granules
- > 15 parasites in some cells
- Ameboid structures
- Schuffner's dots

All of the following tubes contain separation gel except:

Question options:

A blood culture to evaluate septicemia is performed in:

Diagnosis of malaria may require thick smears as well as conventional thin blood smears.

A definitive diagnosis of malaria can be made by:

Transpeptidase enzymes catalyze the final stage of peptidoglycan synthesis during cell wall formation.
Beta-lactam antibiotics bind with these enzymes, interfering with their function. The transpeptidase enzymes are also referred to as PBP's, or penicillin-binding proteins.

Beta-lactam antibiotics interfere with cell wall synthesis by:

Which of the following testing options would be classified as waived testing by CLIA standards?

The laboratory uses flammable chemicals for processing and staining patient specimens. One type of chemical used is ethanol.

What is the proper way to store this chemical in the laboratory?

A test with high specificity accurately detects the absence of disease. The more specific a test is, the fewer false-positive results will occur. A test with high sensitivity accurately identifies the presence of disease.
The more sensitive a test, the fewer false-negative results it produces. In the case stated in this question, the immunoassay has high specificity, so it has few false-positives and will accurately detect those individuals who do not have the disease or condition that is being tested for. However, the test has low
sensitivity, so it may not identify all individuals who actually have the disease; it may produce many false-
negative results.

The accuracy of an immunoassay is its ability to discriminate between results that are true positives and results that are true negatives. Two parameters of test accuracy are specificity and sensitivity.

Which of these statements apply to an immunoassay with high specificity, but low sensitivity?

During primary hypothyroidism, where a defect in the thryoid gland is producing low levels of T3 and T4, the TSH level is increased. TSH is released in elevated quantities in an attempt to stimulate the thryoid to produce more T3 and T4 as part of a feedback mechanism.

Serum TSH levels five-times the upper limit of normal in the presence of a low T4 and low T3 uptake could mean which of the following:

Immunology

The immunoglobulin molecule is made up of both heavy and light chains - the light chains can be comprised of which of the following:

Streptococcus pyogenes is the correct answer. Streptococcus pneumoniae is alpha-hemolytic which demonstrate a green area of partial hemolysis around the colonies. Staphylococcus aureus will produce complete hemolysis but is catalase positive. Streptococcus agalactiae is beta-hemolytic but only produces a partial clearing of the red blood cells in sheep blood agar.

Complete hemolysis of sheep blood agar as demonstrated by the image below would be seen in which of the following catalase-negative isolates?

To make a 1 : 10 dilution, 270 μL of diluent should be added to 30 μL of sample, .

A spinal fluid that is slightly hazy is briefly examined microscopically. The technologist performing the count decides to make a 1:10 dilution using 30 μL of sample.

What volume of diluent should be used?

The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of Aspergillus. Aspergillus has the ability to infect primarily immunocompromised hosts, and causes pneumonia and/or disseminates to other organs. Clinical

specimens should be inoculated onto primary isolation media, such as Sabouraud's dextrose agar.
Aspergillus spp. are fast growing and can be white, yellow, yellow-brown, brown to black or green in color.

The presence of hyaline, septate hyphae, and a young conidiophore with a foot cell and a swollen vesicle in a fungus culture are excellent clues indicative of:

Which of the following is a current title for clinical laboratory professionals with a 4 year degree?

White top tubes are used for blood cultures.

Question options:

The laboratory employee with a 4-year college degree who performs clinical analysis is the:

The Westgard multi-rule 22S describes the scenario where two consecutive data points fall outside +2SD or -2SD. If this occurs, then the run must be rejected. This situation is most likely caused by a systematic error.

Which of the following describes the Westgard multi-rule 22S?

A cardiac risk profile is performed in:

An employer who fails to provide sufficient personal protective equipment (PPE) for employees may be fined by the:

In combined fiscal years 2005 through 2009, transfusion-related acute lung injury (TRALI) caused the higest number of reported fatalities (48%), followed by hemolytic transfusion reactions (26%) due to non-ABO (16%) and ABO (10%) incompatibilities. Complications of microbial infection, transfusion-associated circulatory overload (TACO), and anaphylactic reactions each accounted for a smaller number of reported fatalities.

The liver is the primary target organ for the Hepatitis B virus (HBV). The inflammation caused by HBV can

result in permanent liver damage, including cirrhosis, liver failure, and even hepatocellular carcinoma.

What is the primary target of the Hepatitis B virus?

This patient is most likely suffering from an immediate-acting coagulation inhibitor; most commonly, lupus
anticoagulant. Notice that the addition of normal pooled plasma does not correct upon initial or incubated mix, which means that the inhibitor is not time or temperature-dependent.

Factor VIII is not the correct answer as a factor deficiency would have corrected upon the addition of normal pooled plasma. Factor VII is not the correct answer, as the aPTT assay does not account for factor VII activity or concentration.

The laboratorian completed the mixing study ordered for John Doe. The results are as follows:

Initial aPTT result: 167 seconds

Initial 1:1 Mix with Normal Pooled Plasma: 158 seconds

Incubated 1:1 Mix with Normal Pooled Plasma: 150 seconds

Which of the choices below would most likely explain the results for this patient?

Antidiuretic hormone, or ADH, has the important role of conserving body water by reducing the loss of water in urine by changing the water permeability of the distal tubule and collecting duct. An increase in ADH causes a concentrated urine since the water is retained and absorbed through the permeable membrane. An decrease in ADH causes the collecting ducts to retain very little water, instead it is excreted as urine.

Chemistry

Which of the following action describes the MAJOR property of antidiuretic hormone?

A combination of (nonselective) 5% sheep blood and (selective) MacConkey agars is sufficient for the recovery of the pathogenic microorganisms that are most commonly encountered in urinary tract infections (UTIs). MacConkey is the selective culture medium that is most commonly used to inhibit growth of gram-positive organisms (most UTIs are caused by gram-negative organisms).

Eosin methylene blue (EMB) is a selective agar that also inhibits the growth of gram-positive organisms.
Therefore, using only a combination of MacConkey and EMB would prevent the detection of a gram-positive organism, if this were the cause of the infection.

Chocolate agar or other enriched media may be needed in addition to blood and MacConkey if a more fastidious organism is suspected.

Thayer-Martin would be used specifically for recovery of Neisseria gonorrhoeae. Thayer-Martin (or Modified Thayer-Martin) inhibits other microorganisms and allows the selective recovery of both N. gonorrhoeae and N. meningitidis.

Microbiology

Which culture agar combinations below will usually be sufficient for MOST routine urine culture investigations?

Primary-Target glands (such as thymus, thyroid, parathyroid, etc.)

Secondary-Pituitary gland

Tertiary-Hypothalamus

Match the type of endocrine dysfunction with the appropriate organ:

1. Target gland

2. Pituitary gland

3. Hypothalamus

Blood bank

Which of the following is the most common subgroup of A?

Kell, Kidd, and Duffy are usually warm reacting IgG antibodies. The most common P system antibody is anti-P1, which is a frequently naturally occurring low titer IgM antibody, seen in most P2 individuals.
Blood bank

Which of the following blood groups is most frequently associated with cold agglutinins:

In sickle cell anemia, rapid hemoglobin turnover may be present. HbA1C and other glycated hemoglobin assays are not valid in rapid hemoglobin turnover and in abnormal hemoglobin conditions. Fructosamine measurements can be used because of shorter half life of albumin.

HbA1C measurements are NOT ordinarily used to monitor long-term diabetic control in a diabetic with sickle cell anemia.

Since cimetidine inhibits CYP2D6, less amphetamine will probably need to be given since it will not be able to be metabolized as readily.

Most drug interactions are like this: one drug inhibits or competes with the same CYP450 as another drug.
The end result is that higher concentrations of one, or both, drugs are present, leading to potential toxicity.

A patient is taking cimetidine for a stomach ulcer. This drug inhibits CYP2D6. The patient is now prescribed amphetamine for narcolepsy. Amphetamine is metabolized by CYP2D6.

What would you predict?

Certain recipients have increased risk for developing TA-GVHD. They are:

Neonates less than 4 months of age

Fetuses

Recipients with a congenital or acquired immunodeficiency, such as bone marrow or stem cell recipients, and patients receiving chemotherapy

recipients of donor units from a blood relative
Which of the following patients are at risk for transfusion-associated graft versus host disease (TA-GVHD) and require irradiated cellular blood products?
(Choose all that apply)

A zone of inhibition is the area around an antibiotic-infused paper disk that does not show any bacterial growth. The antibiotic impregnated on the disk will diffuse into the agar in the area surrounding the disk. If the bacteria are sensitive to the antibiotic, they cannot grow near the disk. The size of the zone is proportional to how sensitive the organism is. If the organism is resistant to the antibiotic, it will grow very closely to the disk.

The size of the zone of suppressed growth on a sensitivity plate using sensitivity disks is referred to as the zone of:

Delayed hemolytic transfusion reactions (DHTR) usually occur within which time period?

All the following characteristics are accurate for the influence of Health Insurance Portability and Accountability Act (HIPAA) except

If all newborns were tested, many positive DATs due to ABO incompatibility would be detected that are of no clinical significance.

Although many laboratories test infants born to group O Rh positive females due to the higher risk of ABO HDFN when the mother is group O, testing such infants is optional provided there is appropriate monitoring and follow-up for hyperbilirubinemia.

Blood Bank

Not performing direct antiglobulin tests (DATs) on newborns born to group O Rh positive mothers is acceptable good practice, providing there is appropriate surveillance and follow-up to detect hyperbilirubinemia.

1. A

2. A

3. B

4. A

5. B

6. B

A cardiovascular risk marker is an analyte in a body fluid that can be measured by the clinical laboratory and has been associated with the development of cardiovascular disease. Examples of risk markers include: LDL-C, triglycerides, and hs-CRP.

A cardiovascular risk factor is a condition (not a laboratory analyte) that is associated with an increased risk of developing cardiovascular disease. Examples of risk factors include: smoking, obesity, diabetes and hypertension.

Determine if each of the following is a cardiovascular risk marker or a cardiovascular risk factor.

1. Smoking

2. Obesity

3. Low density lipoprotein (LDL)

4. Hypertension

5. Triglycerides

6. High sensitivity-C-reactive protein (hsCRP)

These are tyrosine crystals

Urinalysis & Other Body Fluids True or false? Cystine crystals are present on this slide.

Small, dense LDL is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis. Small, dense LDL is associated with more than a three-fold increase in the risk of coronary heart disease.

Large, buoyant LDL is less atherogenic than small, dense LDL. The LDL phenotype A is normal. It is the so called 'B' pattern that is associated with increased risk.

Which of the following is most likely to interact with arterial walls, leading to deposition of cholesterol, and initiating or worsening atherosclerosis?

In an alkaline medium, potassium ferricyanide oxidizes hemoglobin to methemoglobin. Further reaction with potassium cyanide produces cyanmethemoglobin which has a maximum absorbance at 540 nm.
Color intensity is proportional to total hemoglobin concentration, which is how the hemoglobin levels are measured.

Hematology

In the hemoglobin methodology using potassium ferricyanide the following measurable reaction occurs: