Module 7 & 8: Labs and Genetics Flashcards by Allison Bower

Why is a CBC (or H&H) ordered at 28 weeks?

Peak time for hemodilution and risk for anemia

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MCH (mean corpuscular hemoglobin): the average amount of __________ _________ inside a red blood cell. Macrocytic RBCs are large, so tend to have a________MCH, while microcytic RBCs would have a _________ value.

oxygen-carrying hemoglobin;

higher, lower

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MCHC (mean corpuscular hemoglobin concentration): calculation of the _________ ________ of hgb inside a red cell. Decreased MCHC indicates ____________which is seen in conditions where the hgb is abnormally _________ inside the red cells, such as ______________ anemia and __________. Increased MCHC values (___________) is seen in conditions where the hgb is abnormally __________inside of cells, such as in _____ patients.

average concentration;
hypochromia; diluted; iron deficiency and thalassemia;
hyperchromia; concentrated; burn

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MCV (mean corpuscular volume): a measurement of the
_________ ________of RBCs. MCV is _________ when RBCs are ______than normal (_________), as in ______________ (__________). A _________ MCV tells us that cells are ______ than normal (_______) as seen in _______________ anemia or __________.

average size;
elevated; larger; macrocytic; vitamin B12 deficiency (pernicious anemia);
decreased; smaller, microcytic; iron deficiency or thalassemia

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Hgb (hemoglobin): measures the amount of _____________protein (hemoglobin) in the blood.

oxygen-carrying

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hct (hematocrit): measures the __________ of red blood cells in a given volume of whole blood

percentage

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The increased plasma volume, along with this increase in red blood cell mass ultimately expands the maternal blood volume by as much as ___________%. ______________ __________ describes the proportionately greater increase in plasma volume as compared to the rise in RBCs.

35-40%; Physiologic anemia

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In iron deficiency anemia, the MCH, MCHC, and MCV are __________.

decreased

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The RBC indices: 
A. Measure MCV, CBC, MCH, Hgb, and hct 
B. Help diagnose certain infections 
C. Reflect Hgb amount and characteristics 
D. Measure the level of hemodilution

C. Reflect Hgb amount and characteristics

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Stained Red Cell Smear: a microscopic examination that screens for abnormalities in the ____, ____, ______, or _________ of _____.
Anemia due to lack of iron causes ________ (____), ________ (____) RBCs which can be seen on a smear. This blood smear is also used to assess the adequacy of _________cells.

size, shape, color, or structure of RBCs.
hypochromic (pale); microcytic (small);
platelet

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ormal, non-pregnant WBC ranges from ____________mm3. During labor and early postpartum, the WBC can normally be as high as _________mm3. A WBC of above ________ mm3 should not be interpreted as a sign of infection or other pathology in an asymptomatic pregnant woman; however, further investigation is warranted.

5,000-10,000; 25,000; 12,000

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Differential Smear: identifies the _______ of each type of __________.

percentage; white blood cell

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A shift to the ____ denotes that the neutrophils, in particular the ___________ cells have __________ in number.

left; immature; increased

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When neutrophils increase:
A. It causes a “shift to the right”
B. Lab results commonly indicate more immature cells
C. Above 5,000 mm3 , it is abnormal
D. A repeat level should be done in 12 hours

B. Lab results commonly indicate more immature cells

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he non-pregnant woman normally has a platelet count of ________to___________ mm3. During normal pregnancy, the count progressively ____.

150,000 to 400,000;drops

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The platelet count in pregnancy:
A. Increases only with hypertensive disorders
B. Is normally between 100,000 and 350,000 mm3
C. Should be done at the first visit and again close to
term
D. Drops as gestational age increases

D. Drops as gestational age increases

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Most often an __________ _________ _______ is used for the initial antibody screen, since this test is sensitive to anti-Rh antibodies.

indirect coombs test

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The indirect Coombs test:
A. Is done if the general antibody screen is positive for
Rh antibodies
B. Measures the degree of sensitization to Rh negative
blood
C. Is done at 28 weeks gestation to determine ABO
incompatibility
D. Is done at the first visit to detect antibodies to Rh
positive blood

D. Is done at the first visit to detect antibodies to Rh

positive blood

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All women have testing for Rh incompatibility with
the routine prenatal lab panel.
True / False

True

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The _________ and ______ tests for syphilis detect the presence of nonspecific antibodies elicited by the ______________; they are relatively inexpensive, very _________, and _________.

VDRL and RPR; spirochete; sensitive and fast.

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The syphilis test does not become positive until__ to __ days after the appearance of the chancre. The false-positive rate for women is ___ to ___%.

7 to 10; 1 to 2%

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A high syphilis titer (____) usually indicates active disease. A low titer (____) indicates a _________ test in 90% of cases. Occasionally a low titer may be due to ____or _________syphilis or __________ syphilis.

> 1:16; active disease;

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Treatment of primary syphilis usually causes a progressive decline to a negative VDRL/RPR titer within __ _____.

2 years

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Low syphilis titers persist in about ___ of cases 2 years after treatment, despite a fall in titer. This does not indicate _______ _______or _________.

50%; treatment failure or reinfection

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If the VDRL/RPR test is reactive (positive), to confirm the presence of Treponema Pallidum, either the fluorescent terponemal antibody-absorption test (_________) or the microhemagglutination assay for Terponema pallidum antibodies (_________) is ordered. Since these tests frequently remain positive even after successful treatment, clinicians use the titers of the ________ or ___ to monitor treatment.

FTA-ABS; TP-NHA; VDRL or RPR

``` Which of the following titers most likely indicates active syphilis? A. 1:4 B. 1:8 C. 1:16 ```

C. 1:16

When a woman has a reactive (positive) RPR or VDRL result, the next step is to: A. Begin treatment for active syphilis B. Reassure her of the normalcy of the result C. Order a FTA-ABS screen D. Obtain a more in-depth sexual history

C. Order a FTA-ABS screen

__________ has devastating fetal effects: Eye lesions, hearing defects, heart disease, IUGR, spleen and liver enlargement and CNS disorders. The incidence of congenital________ is highest when the woman contracts rubella in the ____ half of her pregnancy.

Rubella; rubella; first

The most frequently used test to detect _____ ______in serum is the hemagglutination inhibition test (HAI or HI).

rubella antibodies

Immunity is confirmed if the rubella titer is ___ or more. P

1:8

True/False Breastfeeding is not a contraindication to postpartum rubella immunization. Women should avoid becoming pregnant for at least ___ _____ after the vaccination.

True; 3months

. If the lowest dilution that a reaction can still be detected between the antibody and the antigen it is directed against is 1:20, then that is the result of the _______ _______. So when determining immunity, 1:20 is ____ immune than 1:10.

antibody titer; MORE

A rubella titer of 1:12 indicates immunity. A. True B. False

A. True

Only hepatitis __ screening is done routinely in pregnancy.

The risk that the newborn will develop hepatitis B is ___ to ___% if the mother is positive for the hepatitis B surface antigen, and as high as 90% if she is also positive for the _____.

10-20%; HBeAg

Infected newborns usually become HBV _______ and are at high risk for developing _________ _______ _______.

carriers; chronic liver disease

The ________ test is the screen for hepatitis B and is done routinely at the ______ prenatal visit. T/F: The presence of serum HBsAg indicates that the patient either has a current acute infection.

HBsAg; first False - may also indicate carrier status

What does a positive HBeAg indicate?

Acute Hepatitis B infection

Matching : (a) Immunoglobulin M (IgM) anti-HBc (b) IgG HBcAb 1. ____ Becomes predominant late in normal recovery and, together with HBsAb, may persist in noncarriers for many years. 2. ____ Appears during acute or recent HBV infection and is present for about 6 months.

1. B - IgG HBcAb becomes predominant late in normal recovery and, together with HBsAb, may persist in noncarriers for many years. 2. A - Immunoglobulin M (IgM) anti-HBc appears during acute or recent HBV infection and is present for about 6 months.

Women who are of __________, __________, and _________ descent are at a higher risk for being carriers of hemoglobinopathies and should be offered carrier screening.

African, Southeast Asian, and Mediterranean

The midwife should recommend ________ ______ if both parents are carriers. T/F: This is a fail-proof method.

genetic screening; False

Non-African individuals should be initially screened for hemoglobinopathies with a _____, and African women should screened with a _____ and _____________________.

CBC; CBC and hemoglobin electrophoresis.

``` An African-American woman presents for prenatal care. She desires screening for “anything that might hurt my baby”. Which screening tests would you offer her to screen for hemoglobinopathies? CBC CBC and Sickledex Hgb and hct CBC and hemolglobin electrophoresis ```

CBC and hemolglobin electrophoresis

Women at high risk for GDM should be screened at the first OB appointment. This includes: T/F: All women should be screened for GDM between 24-28weeks pregnant.

women with a history of GDM, women with known impaired glucose metabolism, and women with a BMI > 30. True

A false-positive result from the combination of the two HIV tests is ____. More likely to occur is a ELISA and an ______ or ________ Western blot. The Western blot can then be repeated at a later time (________) to determine the woman's status. The Western blot is a more complex test than the ELISA; it is ____ sensitive but _____ specific for HIV.

rare; positive, indeterminate or negative | 1 month; less sensitive, but more specific

HIV testing in pregnancy: Is done by 12 weeks gestation Is an optional lab test with a signed consent Consists of an ELISA and Western Blot if positive Has a 5% false-positive rate

Consists of an ELISA and Western Blot if positive

All women should receive a pap smear at their first OB visit. True False

False

Chlamydia testing in pregnancy is best done: With the DNA probe test If the woman has refrained from intercourse for 48 hours With symptoms of a UTI

With the DNA probe test

T/F: All of these women are at risk for TB: HIV positive women Women in close contact with TB infected individuals Foreign-born women from countries with high rates of TB Medically underserved women Women who abuse alcohol and/or IV drugs Women who are residents or employees of prisons Women who are health care providers who give care to high-risk groups

True

T/F: During a healthy, low-risk pregnancy, a complete urinalysis is usually performed generally at the first prenatal visit.

True

The diagnosis of ASB or symptomatic UTI is usually based on a colony count of _______ of a particular organism. However, lower counts may also be significant.

100,000/ml

T/F: Evidence supports that asymptomatic women do not need to have a urine dip stick routinely performed at each prenatal visit.

True

Testing for Asymptomatic Bacteruria (ASB) should be conducted: At the first prenatal visit At the first prenatal visit and at 28 weeks When the woman has symptoms of UTI At each prenatal visit

At the first prenatal visit

Women who have any GBS in their urine during a urine culture in pregnancy: Must be treated at the time of the urine culture Must receive intrapartum GBS prophylaxis Must be screened for vaginal GBS at 36 weeks

Must receive intrapartum GBS prophylaxis

T/F: All women should be screened for Trichomonas and other bacterial infections, with a wet prep at the first prenatal visit.

False - Screening for vaginal infections with a wet prep is indicated based upon the individual woman’s symptoms.

``` Urine drug screening in pregnancy: Is done routinely at the first OB visit Is mandatory if drug abuse is suspected Is best done by serum screen May or may not require informed consent ```

May or may not require informed consent

The _________ __________ __________ searches for antibodies directly attached to the patient's own red blood cells.

Direct Coombs Test

A positive direct coombs test on a baby's cord blood verifies the presence of ________ _________ on the neonate's RBCs. This tells you that maternal antibodies have passed through the placenta to the baby. The result of this is _______________________.

maternal antibodies; Rh D hemolytic disease of the newborn

The _________ _______ ________ finds antibodies that are in the patient's plasma (thus not directly- or indirectly- attached to the RBCs). These antibodies are capable of attacking Rh D Positive RBCs, but are not directly attached to the patient's Rh negative RBCs.

Indirect Coombs test

The ___________ __________ ________is performed prenatally on women to determine if Rh D antibodies are present in the maternal blood- these antibodies could attack an Rh positive baby.

Indirect Coombs test

T/F:The indirect coombs test is also the test used to guide management of pregnancies that are allo-immunized because when an Rh negative mother is exposed to the Rh positive blood of a fetus, she makes antibodies which can be measured using the Indirect Coombs test.

True

The ____________ _______ detects and measures the amount of fetal blood transferred from the fetus to the mother's blood stream. It quantifies the amount of the ________ ________ ; so that the practitioner knows how much Rhogam the Rh negative mom needs (after delivery, for example). Remember one dose of Rhogam covers only up to ___ ml of fetal blood exposure.

Kleihauer-Betke (KB) test; fetomaternal transfusion; | 15ml

The passing of _________ from parent to child is the basis of heredity.

traits

Our _________ hold the instructions that define our traits.

genes

Our genes are made of _____ and reside in our ____________.

DNA; chromosomes

T/F: Traits can be influenced by the environment.

True

Each trait has two _________.

alleles

_______________ is when both alleles are the same. _____________ is when you have one of each allele; one is __________ and one is ___________.

Homozygous | Heterozygous; dominant, recessive

_________ found in the cell nucleus holds the instructions for the cell function.

DNA

___________ contain instructions for building proteins.

Genes

___________ are efficient storage units for DNA.

Chromosomes

How many chromosomes is a human supposed to have?

Recent studies have shown that many environmentally induced differences are reflected in the __________.

epigenome

_________ genes occur when the epigenetic tags remain.

Imprinted

Environmental influences, like diet and exercise, can cause _____________ differences.

epigenetic

__________ is inheritance of an extra chromosome or loss of a chromosome.

Aneuploidy (ex.Trisomy 21)

____________ is an abnormal number of the entire haploid chromosome set.

Polyploidy (ex. triploidy - 3x the normal number of chromosomes)

_____________ occurs when a chromosome fails to pair up during meiosis, or pairs up but separates prematurely or fails to separate.

Non-disjunction

Turner's is an example of ____________.

monosomy

Klinefelters is trisomy of the _____ chromosome.

sex (x)

Genetic testing information needs to be provided through ___________ counseling.

non-directive

T/F: When explaining genetic testing, our beliefs about testing and what we would do if we were in her place is not part of the discussion. Our goal is to help each individual woman find her own answer to the issue, without giving them an answer or directing them to a specific course of action.

True

About ___% of couples who have a fetus affected with an open NTD have a negative family history.

95%

When is invasive genetic diagnostic testing (such as amniocentesis and chorionic villi sampling (CVS)) offered to woman as a 1st line testing (in other words without screening first)?

When the woman is over 35

If a woman does not want invasive diagnosis first, then the _________ ________ is the next most accurate test to offer.

integrated screen

First-trimester screening is done between ___ and ___ weeks gestation.

11 and 13

First trimester screening tests:

measurement of nuchal translucency (NT) by ultrasound AND serum free beta human chorionic gonadotropin (ß-hCG)& pregnancy-associated plasma protein-A (PAPP-A) by blood draw. (Also known as first trimester combined screening).

First trimester combined screening detects between ____ and ____% of Down Syndrome cases with a __% false positive rate and ___% of fetuses with trisomy 18 with a __% false positive rate. Nuchal translucency ultrasound alone detects ___ to ___%of Down Syndrome cases with a ___% false positive rate.

82 and 87%; 5%; 90%; 2% 64 to 70% ; 5%

Approximately ____ of first trimester fetuses with increased nuchal translucency measurements will have a chromosomal abnormality.

1/3

____ to ___ % of babies with Down syndrome will not be identified with the combined test, and___ to ____ 5 with nuchal translucency ultrasound alone. About ___% of women who have first trimester screening will have a false positive screening test. This means that the screening test is positive although the infant is not affected by Down Syndrome.

13 - 18%; 30 to 36%; 5%

T/F:The vast majority of women with positive screening tests will have a normal fetus.

True

_______ screening offers several potential advantages over _________ screening. When test results are_______, it may help reduce maternal anxiety earlier. If results are positive, it allows women to take advantage of_______ ____________ _______ which is only done at ____ to ____ weeks gestation. Detecting problems earlier in the pregnancy may allow women to ________ for a child with health problems. It also affords women greater __________ and less _________ if they elect to terminate the pregnancy (ACOG, 2007). First trimester combined screening has a slightly_________ detection rate (82-87%) for Down syndrome compared to the second-trimester quad serum screening (81%).

1st trimester; 2nd trimester; negative 1st trimester CVS; 10 to 12 weeks prepare; privacy; health risk better

The ____ trimester Quad screen detects about____% of fetuses with Down syndrome (ACOG, 2007). If the AFP is ___ and the hcG is _____, this indicates a higher risk of Down Syndrome. T/F: This combination of results is not related to accuracy of pregnancy dating.

2nd; 81%; AFP is LOW and hcG is HIGH True

The quad screen analytes are:

AFP (α-fetoprotein) βhCG unconjugated estriol. DIA (dimeric inhibin A)

The quad screen can be affected by factors such as_____, _________ _______, ___________ ______, and ___________ ________ ________. If pregnancy dates are known and a quad screen indicates a_________ level of AFP, this is considered a warning sign for a possible NTD. A woman with a positive Quad screen indicating a higher risk for NTD would be offered one or more of the following:

race, placental size, maternal weight, inaccurate pregnancy dating; higher Ultrasound for dating accuracy Targeted ultrasound to screen for NTD Amniocentesis for diagnosis

The Quad serum screen has a false-positive rate of about ___%.

Only 1 woman in ____ with a positive Quad screen will go on to have an affected fetus

T/F: False positives increase with age.

True

________________ combines both 1st trimester nuchal translucency measurement & serum markers (PAPP-A & βhCG) AND second trimester quad screen of AFP, βhCG, unconjugated estriol & DIA . Results are reported______ as a combined score in the 2nd trimester. Advantages of integrated screening include the highest Down Syndrome detection rate (_______%) of all the serum genetic screening tests.

Integrated screening; once; 94-96%

_____________ ____________ is similar to integrated screening, except the patient is informed of the first trimester screening result after the first trimester portion of the screening test.

Sequential screening