Lab Med

Question 1

Plasma=?

Answer 1

Whole blood - RBC’s and wbc.

Question 2

Serum=?

Answer 2

Everything not in the clot.

Question 3

Lab med at UIHC includes what services? (Don’t mem, just review)

Answer 3

Lots. (chem, heme, immune, micro, molecular, transfusion, point of service, mailouts)

Question 4

What comprises a basic metabolic panel?

Answer 4

electrolytes, BUN, creatinine, glucose

Question 5

What falls under molecular category?

Answer 5

hereditary coagulopathies (not Heme department!), genetics, molecular infectious disease (not micro department!), oncology testing (not Heme department!)

Question 6

Plasma should be used for what tests?

Answer 6

Most chemistry.

Question 7

Serum should be used for what tests?

Answer 7

Serology (antibodies) & electrophoresis

Question 8

Whole blood should be used for what tests?

Answer 8

CBC, heavy metals, imunosuppressants

Question 9

I allow blood to clot, and take what’s left. This is?

Answer 9

Serum

Question 10

I centrifuge blood, take the supernatant. This is?

Answer 10

Plasma

Question 11

Red top tubes consist of what? Collect serum or plasma?

Answer 11

• Plastic with clot activators

- serum (recall serology, electrophoresis)

Question 12

What are problems with red tubes?

Answer 12

microclots, must wait 30 min to clot (aided by inversion)

Question 13

Serum separator tubes consist of? What color top? Clinical use?

Answer 13

• Basically a “red top” tube plus gel.
• Tiger
• Aspergillus galactomannan (avoids contamination from tube opening)

Question 14

EDTA tubes have what added? What color top? Clinical use?

Answer 14

• Potassium-EDTA to prevent clotting (for plasma or whole blood)
• Pink
• CBC, sed rate, DNA, or drug tests

Question 15

Plasma separator tubes have what added? Color? Use?

Answer 15

• Lithium heparin to prevent clotting and gel
• Green top
• metabolic panel and liver enzymes

Question 16

What are the problems of plasma separator tubes?

Answer 16

Don’t use for lithium drug levels or “some assays”

Question 17

What color top is a sodium citrate tube? Use? Problem?

Answer 17

• Blue
• coag tests!!
• Inadequate filling of tube (relative excess of anticoagulant)

Question 18

Trace metal tubes are what color top? Use?

Answer 18

• “Royal” (dark) blue

- contain NO trace metals, so use for metal tests. (but can use regular EDTA tube for lead test)

Question 19

What 2 priorities govern blood draw order?

Answer 19

1) Sterility

2) Additives

Question 20

What is proper draw order for the KEY examples? (note some are left out)

Answer 20

citrate (for coag tests), serum tubes (red and tiger), plasma tubes (Li-Hep), EDTA (plasma or whole blood)

[This would be: blue, red, green, pink]

Question 21

ACTH, ammonia, homocysteine, lactate, and cryoglobulin tests have what in common?

Answer 21

Add-on orders not allowed due to limited stability

Question 22

Hemolysis causes what tests to increase in value?

Answer 22

AST, LDH, K, Hgb

Question 23

Hemolysis causes what tests to decrease in value?

Answer 23

insulin

Question 24

Lipemia (usually due to triglycerides) causes what problems?

Answer 24

• hemolysis

- low visibility for optical tests (can use pheresis to remove lipid plasma)

Question 25

bilirubin/icterus causes what lab test problems?

Answer 25

spectrophotometry & common labs

Question 26

What problems face genetic testing?

Answer 26

cost, monopolies, reimbursement

Question 27

How are most tests reimbursed?

Answer 27

by diagnosis-related group (fixed amount for diagnosis regardless of number of tests or length of stay)

Question 28

patients have a hard time getting authorization for in or outpatient tests?

Answer 28

out. (in just gets crazy w/ deductibles, etc)

Question 29

Expensive tests are usually?

Answer 29

genetic to reference labs

Question 30

T/F Genes can be patented?

Answer 30

False, but true for anyone other than Myriad Genetics | What does that mean?

Question 31

T/F cDNA can be patented?

Answer 31

T (along w/ lab techniques)

Question 32

monopolies are big evil people and stuff.... especially when it comes to genetic tests...

Answer 32

...that's how he feels about them Monopolies are illegal. This is unprecedented though. Never before has something that could be patented created an automatic monopoly for the time period of the patent. You can't reverse engineer a DNA segment and then create a slightly different one. However, this doesn't create a monopoly in the way business usually thinks about it. Diagnostic companies can only 'monopolize one itty bitty segment', but they still will have to compete. Fascinating!

Question 33

What lab requires the patient only pay 20% of the test cost?

Answer 33

Athena

Question 34

SCA (spinocerebellar ataxia) is unique why?

Answer 34

group of diseases, mostly auto dominant, most expensive test there is because of those monopolies