RECALLS page 1-15 Flashcards
(286 cards)
1
Q
What should you do if the bar code reader is not working?
A
Reboot the scanner.
2
Q
What should be done after a new validation of a machine?
A
Train the staff.
3
Q
What is the function of a regulatory body?
A
To protect the public.
4
Q
A patient submits a urine sample and requisition with physician and clinic info, but no test ordered. What should you do?
A
Call the physician and ask.
5
Q
What is the function of a modem?
A
Data transmission.
6
Q
In which type of software is data retrieval easiest?
A
Database (or spreadsheet, depending on context).
7
Q
Dialysis setup in a community increases test volumes in which sections of the lab?
A
Biochemistry and Hematology.
8
Q
Best way to communicate with a colleague who has a language barrier?
A
Use diagrams to explain.
9
Q
If asked to perform a test you’re unfamiliar with, what should you do?
A
Discuss the situation with a supervisor.
10
Q
A technologist is confused about a new staining procedure. What should they do?
A
Refer to the SOP.
11
Q
Lab manager is implementing a new protocol. Best way to share info?
A
Post in the information system electronically.
12
Q
You’re training a new employee who is clearly not listening. What should you do?
A
Discuss the issue privately.
13
Q
An MLT makes a mistake. What should you do?
A
Correct them immediately, before wrong results are released.
14
Q
An MLT is changing QC results. What should you do?
A
Report to a supervisor.
15
Q
A normally calm MLT suddenly becomes angry. What should you do?
A
Show empathy.
16
Q
An MLT is frustrated due to lab circumstances. What should you do?
A
Motivate them.
17
Q
What should NOT be done to avoid miscommunication?
A
Use of jargon.
18
Q
A new technologist is not following lab protocol. What should you do?
A
Speak to them privately.
19
Q
A colleague is stressed and demotivated. What should you do?
A
Direct them to support programs.
20
Q
Management introduces rotating shifts. What should you do?
A
Suggest improvements to management.
21
Q
Management introduces Lab Technician positions. What should you do?
A
Attend the info session.
22
Q
What is a disadvantage of point-of-care testing?
A
It is more expensive and requires personnel training.
23
Q
To which patient can collection be refused?
A
An aggressive patient.
24
Q
What kind of violation is giving test results to a family member over the phone?
A
Breach of confidentiality.
25
What kind of violation is mislabeling a specimen?
Negligence.
26
When should you assess the learning needs of your team?
Before performing unfamiliar procedures.
27
What is required when transporting aliquots?
Accession number.
28
How do you track a urine sample during culture?
Using the accession number.
29
How is patient data protected?
Through logins and passwords.
30
Your lab gets a result of 600 on a proficiency test, others get 90. What’s the likely cause?
Transcription or multiplication error.
31
How should smoking awareness among employees be addressed?
Distribute educational materials.
32
Why is inventory done?
To reduce waste.
33
Nurses are doing phlebotomy and causing lab errors. What should you do as a technologist?
Investigate the cause and help solve the issue.
34
What is the purpose of OLA (Ontario Lab Accreditation)?
Standardization of procedures.
35
What must be included in the setup of the Laboratory Information System (LIS)?
Identification code and password for each user.
36
Why is it important for the lab to have an inventory management system?
To maintain an adequate amount of critical supplies.
37
What term describes a duplicate test on a sample that produces identical results?
Precision.
38
Which of the following is considered a key determinant of health?
Gender.
39
What does it mean when a QC organism shows a smaller than acceptable zone size?
The inoculum is too heavy.
40
When is work considered complete in the lab?
When you finish reporting pending reports.
41
Which TAT (Turnaround Time) should be monitored to assess the effectiveness of a newly installed pneumatic tube system?
Pre-analytical.
42
What should be done first when many leaking urine samples are received in the lab?
Document each incident.
43
What should be done first when an outpatient is physically combative prior to phlebotomy?
Ensure an exit is possible for both the technologist and the patient.
44
What should be done when collecting a blood specimen from an adolescent in-patient with family members present?
Ask the patient if they would like the family members to remain.
45
What action should be taken when an in-patient is missing an identification band prior to phlebotomy?
Have the patient’s nurse attach the identification band.
46
What action constitutes a violation of the CSMLS Professional Code of Ethics?
Refusing to perform phlebotomy because the patient is HIV positive.
47
What is required in the LIS to ensure security and accountability?
Identification code and password for each user, and limited access to the system.
48
What component is responsible for autoverification in the lab?
Middleware.
49
What strategy should be taken when an increased number of routine CBCs are received during a prolonged staff shortage?
Utilization review.
50
Which action is considered negligence in laboratory practice?
Performing tests without quality control (QC).
51
What first-aid measure should be taken first when a needlestick injury occurs?
Clean the site with soap and water.
52
What should be done first when many leaking urine samples are received in the lab?
Documentation (followed by root cause analysis and process improvement).
53
What is the best way to reduce repetitive injury from pipetting?
Alternate pipetting with other tasks.
54
What is the first step when a mass casualty is reported during a holiday?
Activate the laboratory emergency plan.
55
What is the first action to take when a patient faints during venipuncture?
Withdraw the needle.
56
A technologist feels overwhelmed from repeatedly assisting with phlebotomy. What is the appropriate action?
Request a review of the workload.
57
What process is described in a chemical hygiene plan?
Handling requirements.
58
What should be done first when a new coworker consistently fails to replenish analyzer reagents?
Discuss the concern directly with the coworker.
59
What should be done when a technologist is disrespectful to a nurse who frequently interrupts their work?
Engage in reflective practice.
60
What is the first step when aiming to improve an existing lab process?
Analyze the process.
61
What should a technologist do when frustrated by having to explain their profession to other healthcare workers?
Participate on an interprofessional team.
62
What scenario represents a breach of confidentiality?
Discussing patient results with a spouse.
63
What are the three major components of WHMIS?
Safety Data Sheets (SDS), labels, and training.
64
What should be done first when discovering a coworker has released an incorrect report?
Notify the appropriate healthcare practitioner.
65
What should a technologist do if they disagree with a policy requiring them to check in every 2 hours with security?
Follow the policy.
66
What is the purpose of laboratory accreditation?
To ensure the reliability of results.
67
What information is needed when sending a lab sample to another laboratory?
Full name, hospital ID number, and accession number.
68
What should an MLT do if they have a minor cut before starting work in the lab?
1. Wear gloves, 2. Inform the lab manager.
69
If an MLT misses a lab staff meeting, what is the best way to disseminate the information to them?
1. Written communication, 2. Record and post the meeting.
70
If a machine is broken, what is the best way to communicate the issue?
1. Record and post the information, 2. Include it in the monthly meeting summary.
71
Who should be involved in the redesigning of a laboratory?
1. Laboratory personnel, 2. Hospital manager.
72
What should be done during blood extraction for a pediatric patient?
Give them something to do (distraction technique).
73
How should you handle a nervous patient before a blood draw?
Be clear and concise.
74
A patient is crying during blood collection. What should you do?
Give them an empathy statement.
75
A 16-year-old patient refuses blood collection. What is the best action?
Don’t extract and document.
76
In which situation do Standard Precautions apply?
Wear gloves when taking blood.
77
How can healthcare resources be maximized?
Review the machine before purchase.
78
A lab result was released to the nursing station but the test was not ordered. What should you do next?
Check the ID on the specimen label.
79
You discover a colleague is being aggressive toward a patient. What should you do next?
Report to management.
80
What is the first step to take in a blood spill?
Cover with paper towels and soak with bleach.
81
How should you dispose of a spreader used to make a blood smear?
Dispose of it in a sharps container.
82
The cell washer is not functioning properly. What should you do?
Do not use it; perform manual washing.
83
An increase in leukemic patients leads to increased testing in which departments?
Hematology and Transfusion.
84
In what situation can a CO₂ fire extinguisher be used?
Electrical fires (e.g., fusebox).
85
Your external QC result is 90, but other labs report 600. What should you do next?
Investigate (check the multiplier and test performed), then report to management.
86
What is the total magnification when using a 10x ocular and a 10x objective lens that is 16 mm long?
100x (10 × 10 = 100)
87
What is the first thing an MLT must do to add a test to a previously submitted sample?
Check the collection time of the blood.
88
Which of the following is considered a health determinant?
Gender.
89
What is the primary benefit of the Laboratory Information System (LIS)?
It tracks specimens from the time of collection to the release of results.
90
How should you handle a nervous patient during blood collection?
Put them in a supine position.
91
What is professionalism?
(Implied answer: Demonstrating ethical conduct, accountability, respect, and competence in one’s role.)
92
What trend indicates reagent deterioration in QC?
Downward trend.
93
What should be done when the linearity of a machine is exceeded?
Dilute the sample with saline.
94
What is the effect of alcohol on osmolality?
It increases osmolality.
95
What is the best method to measure osmolality?
Freezing point depression.
96
Indirect bilirubin is high in which condition?
Pre-hepatic/hemolytic jaundice.
97
What is most important in ion-selective electrode (ISE) testing?
Membrane check.
98
CO₂ measurement in blood is based on what principle?
ISE (Ion Selective Electrode) principle.
99
How is a 24-hour urine sample for electrolytes preserved?
Refrigeration.
100
A 24-hour urine for electrolytes appears cloudy. Volume is measured. What is the next step?
Centrifuge the sample.
101
K+ result is 6.9 mmol/L in a healthy individual with normal other results. What should be done?
Validate and check the specimen.
102
A specimen for potassium testing is highly hemolyzed. What is the next step?
Request a new draw.
103
Which test should be done first: blood gas, troponin, glucose, or electrolytes?
Blood gas.
104
What should be done when a critical calcium result is found?
Phone the doctor.
105
What is the gold standard for drug testing?
Gas chromatography and mass spectrometry.
106
What could cause high creatinine in a diabetic patient?
Diabetic nephropathy.
107
What is the most useful test for determining a recent myocardial infarction (MI)?
Troponin.
108
What is a risk when using lyophilized serum?
Error in reconstitution.
109
What is the TAT (turnaround time) for electrolytes?
1 hour.
110
What test is used to monitor glucose control?
HbA1c.
111
If serum glucose is 5 mmol/L, what is the expected CSF glucose?
3.0 mmol/L (about 50–60% of serum).
112
A diabetic patient has high glucose but normal sodium and other parameters. What is the likely cause?
Metabolic acidosis.
113
Acetaminophen is 80 µmol/L, measured 12 hours after the last dose. What should be done?
Report as a critical value.
114
What does a very high CV (coefficient of variation) indicate?
Low precision.
115
Serum osmolality and urine osmolality are both high. What condition does this indicate?
Diabetes Mellitus (DM).
116
Serum osmolality is high but urine osmolality is low. What condition does this suggest?
Diabetes Insipidus (DI).
117
A urea serum level is 7.8 mmol/L (normal is 2.1–7.1). What does this indicate?
High urea (potential renal involvement).
118
What does decreased HCO₃ suggest?
Lactic acidosis or metabolic acidosis.
119
A patient has: Ca = 2.18, Na = 140, K = 7.1. The specimen is verified and results are unaffected. Which result should be reported to the doctor?
Potassium (K = 7.1 mmol/L is critical).
120
Urea is normal but creatinine is high. What is the next step?
Repeat the test.
121
What markers are expected in uncontrolled diabetes mellitus?
Ketones and lactic acid.
122
What is the wavelength range of a 540 nm light source with a 30 nm bandpass?
525–555 nm.
123
What disease is indicated by high urea, creatinine, and uric acid?
Renal impairment.
124
QC is within range. Urea = 20+ mmol/L and Creatinine = 900+ µmol/L. What should you do next?
Repeat Creatinine (or both tests).
125
An instrument range is 500–1000, but a test result is 1200. What should you do next?
Dilute the sample 1:4 in saline.
126
A hemolyzed sample is received. Which test will fail autoverification?
Potassium.
127
High ketones and glucose indicate what disease?
Uncontrolled Diabetes Mellitus.
128
What illness is commonly found in food-insecure households?
Diabetes Mellitus.
129
Where should a standard solution be reconstituted?
Volumetric flask.
130
What is an important precaution when performing a blood alcohol test?
Keep the cap closed at all times.
131
An increased osmolal gap is seen in which condition?
Ethylene glycol poisoning.
132
Where should urine test strips be stored?
In a dark, dry location.
133
Why does potassium increase an hour after blood collection without centrifugation?
Potassium leaks from RBCs into the serum.
134
What does excess fist pumping during blood collection cause?
Hemolysis.
135
Which of the following is correct when performing a 24-hour urine collection?
Discard the first morning collection on the first day.
136
Patient results: Na = 145, K = 5.0, TG = 6.0. Which result may fail autoverification?
Triglycerides (TG = 6.0 mmol/L is likely to flag).
137
Electrolyte results: Na = 126, K = 4.5, Cl = 106, CO₂ = 25. What condition could this suggest?
Addison’s disease.
138
What is the effect of insufficient incubation time in immunoassays?
• Non-competitive assay: Falsely low result
• Competitive assay: Falsely high result
139
What is typically elevated in acute renal failure?
Blood Urea Nitrogen (BUN) and serum creatinine.
140
What are key lab findings in Hemolytic Uremic Syndrome (HUS)?
Low platelet count, low RBC count, and elevated creatinine.
141
What is the difference in urea and creatinine levels between acute renal failure and HUS?
• Acute Renal Failure: Both urea and creatinine are elevated.
• HUS: Creatinine is elevated, but urea may not be as markedly increased; other features like thrombocytopenia are present.
142
What is the function of a calibrator?
To verify accuracy and precision of an instrument, especially on receipt, after service/repair, and on a regular schedule.
143
What is the principle of Direct ISE?
The undiluted serum is in direct contact with the electrode; ion activity is measured in plasma water.
144
What is the principle of Indirect ISE?
The serum is diluted (typically 1:16 to 1:34) with buffer before contact with the electrode membrane.
145
What compensates metabolic acidosis?
Hyperventilation (not hypoventilation) to blow off CO₂ (respiratory compensation).
146
What instrument is used for liver enzyme tests?
Spectrophotometer with tungsten lamp.
147
A very high digoxin level is seen 12 hours after intake, and the patient has taken an antidote. What is the likely cause?
Interference from antidote antibodies leads to false high results by interfering with Ag-Ab complexes.
148
A sample is received in a crushed ice slurry. What test is this likely for?
Ammonia or arterial blood gas (ABG).
149
When are trough and peak levels of acetaminophen monitored?
Trough is before the next dose; peak is typically 30 min–2 hours after administration (exact timing varies by protocol).
150
What are the general steps in an immunoassay?
1. Antigen binds to specific antibody
2. Enzyme or label binds to complex
3. Substrate reacts with enzyme
4. Signal is measured (e.g., fluorescence, color change)
151
What is the difference between QC and QA?
• QC (Quality Control): Operational techniques to meet quality requirements (e.g., daily test performance monitoring).
• QA (Quality Assurance): Systematic activities to ensure quality throughout the process (e.g., SOPs, audits).
152
What device is used for preparing calibrators to measure accurate volumes?
Volumetric pipette or volumetric flask.
153
What is the PDCA (Plan, Do, Check, Act) cycle used for?
Quality improvement.
154
What does an upward shift in QC indicate?
Possible wrong calibrator dilution; remake calibrator and rerun.
155
What does a gradual downward trend in QC values suggest?
Deterioration of controls.
156
What does a shift in the QC graph indicate?
Pipette not calibrated properly.
157
A new validated software is added to LIS. What is the next step?
Train the personnel.
158
What is an example of preventive maintenance?
Calibration as per the user’s manual.
159
The glucose mean is 5.4 mmol/L, SD = 0.1 mmol/L. What should you do if the result is 5.1 mmol/L?
Reject the result (as it’s 3 SD below the mean).
160
What does a systemic error affect in QC data?
The mean.
161
What could a black area while performing Köhler illumination indicate?
Need to adjust centering screws.
162
What is the negative predictive value for D-dimer in DIC testing?
80–90%.
163
QC is within range, but potassium is 5.5 / 7.1 and the sample is grossly hemolyzed. What should be done?
Reject the sample.
164
QC is okay, potassium is 5.2 mmol/L, but the sample is grossly hemolyzed. What should be done?
Reject the sample (normal range: 3.5–5.1 mmol/L).
165
On an LJ (Levey-Jennings) chart, the last run is +1 SD. What should you do?
Accept the result.
166
How many results typically fall within ±2 SD in a normal distribution?
95% (or 19 out of 20 results).
167
A pipette meant to deliver 20 µL now only delivers 0.2 µL. What should be done?
Recalibrate the pipette.
168
What does a shift on a QC chart indicate?
Systemic error.
169
QC results show a gradual decrease over 10 days. What is the most probable cause?
Reagent deterioration.
170
QC is within ±2 SD in the morning (Hgb = 4.1). In the afternoon, Hgb = 4.8 (outside ±2 SD). What should you do?
Reject the afternoon run.
171
What is used to establish a normal Gaussian curve for lab analytes?
Coefficient of Variation (CV or COV).
172
What is the effect on sodium QC results if calibration standards are over-diluted?
A positive shift.
173
What is the laboratory’s role in point-of-care testing?
Monitor that quality control procedures are followed.
174
What must be done with testing material received from an external proficiency testing program?
Assay the material in the same manner as patient samples.
175
What are the three major components of WHMIS?
Safety Data Sheets (SDS), labels, and training.
176
In which condition does systemic error apply?
Shift in the mean (e.g., consistent bias).
177
What does a 95% confidence limit mean in QC?
1 in 20 results can fall outside ±2 SD.
178
Three QC levels are outside the acceptable range. What should be done next?
Follow troubleshooting procedures (do not call service immediately unless unresolved).
179
What should be done after repairing a machine?
Calibrate and run quality control (QC).
180
Two QCs are run; one is outside ±2 SD. What is the next step?
Do not report—repeat the control.
181
A shift is observed on a Westgard chart. What is the best explanation?
Pipette not calibrated, instrument error, or probe not aspirating correctly.
182
A trend is observed on a Westgard chart. What is the most likely cause?
Degraded reagent, old tungsten lamp, or the instrument needs calibration.
183
How is standard deviation (SD) calculated if mean and CV are given?
SD = (CV × mean) / 100.
184
How should Westgard rule violations be handled?
Identify the rule violated and follow appropriate corrective action (e.g., repeat control, troubleshoot instrument, do not release patient results until resolved).
185
What inclusion body represents denatured hemoglobin?
Heinz bodies.
186
What represents denatured RNA in red blood cells?
Basophilic stippling.
187
What inclusion body represents denatured DNA?
Howell-Jolly bodies.
188
What is the required centrifuge speed for INR testing?
(Not specified here — typically around 3000 rpm for 15 minutes; confirm per lab SOP.)
189
Which RBC inclusion is not stained with Romanowsky stain?
Heinz bodies (stained with supravital stains like BCB or NMB).
190
What stain demonstrates HbH inclusions?
New Methylene Blue (supravital stain).
191
What is used to destain a Romanowsky stain?
Methanol.
192
What does non-specific esterase stain differentiate?
Myelocytes from monocytes.
193
What stain is useful in differentiating AML?
Myeloperoxidase.
194
Which leukemia stains positive with myeloperoxidase?
Acute Myeloid Leukemia (AML).
195
What distinguishes AML from ALL?
Auer rods (present in AML).
196
What is indicated by an increased LAP (Leukocyte Alkaline Phosphatase) score?
Leukemoid reaction.
197
What is not found in intravascular hemolysis?
Increased haptoglobin.
198
What does a high M:E (myeloid:erythroid) ratio suggest?
Chronic Myeloid Leukemia (CML).
199
What is a characteristic of a reactive lymphocyte?
Low N:C (nucleus-to-cytoplasm) ratio.
200
Hematocrit >50% can cause what effect on PT results?
Prolonged PT.
201
PT normal, APTT prolonged, TT elevated. Likely anticoagulant?
Low molecular weight heparin.
202
PT = 20 sec, APTT = 80 sec. Which factors may be deficient?
Factors in both intrinsic and extrinsic pathways.
203
PT = 12 sec (normal), APTT = 65 sec (prolonged). What is likely deficient?
Intrinsic pathway factors (Factors VIII, IX).
204
INR = 1.1, PTT = 80 sec. Which factor or disorder is likely?
Intrinsic pathway factor deficiency (e.g., VIII, IX).
205
APTT is prolonged. What is the next step?
Perform factor assays (start with VIII and IX).
206
PT normal, APTT = 56 sec. What is the next test?
50/50 mixing study.
207
PBS shows many spherocytes. What should you do?
Perform Direct Antiglobulin Test (DAT).
208
Which anticoagulant inhibits vitamin K activity?
Warfarin.
209
What distinguishes blasts from promyelocytes?
Presence of azurophilic (primary) granules in promyelocytes.
210
A shift to the left in histogram indicates what condition?
Microcytic anemia.
211
What parameter is not affected by gross lipemia?
MCV (Mean Corpuscular Volume).
212
What condition causes high MCV and requires pre-warming at 37°C?
Cold agglutinin disease.
213
What is the ESR result in polycythemia vera?
Normal ESR.
214
What finding is unexpected in polycythemia vera?
Low WBC count.
215
What RBC morphology is typical in megaloblastic anemia?
Oval macrocytes.
216
May-Hegglin anomaly is associated with which morphology?
Giant platelets and Dohle-like bodies.
217
What microscope is best for observing platelets?
Phase contrast microscope.
218
How are reactive lymphocytes differentiated from normal lymphocytes?
Decreased N:C ratio.
219
Polycythemia vera with decreased platelets — what is the next step?
Repeat platelet count and compare with slide.
220
How should anticoagulant be adjusted if hematocrit (Hct) is very high?
Decrease the quantity of anticoagulant.
221
What differentiates WAIHA from hereditary spherocytosis?
Positive Direct Antiglobulin Test (DAT) in WAIHA.
222
Which test is used to monitor warfarin therapy?
Prothrombin Time (PT) — detects extrinsic factor inhibition.
223
Which test is used to monitor vitamin K antagonists?
PT.
224
Which test is used to monitor heparin therapy?
aPTT — detects intrinsic pathway factors.
225
Which factor is activated by Factor XIa?
Factor IX.
226
What does a left shift in the RBC histogram indicate?
Presence of microcytes.
227
Neutropenia without blasts in a newborn by coulter counter — next step?
Review the peripheral smear manually.
228
What is not seen in DIC?
Thrombocytosis.
229
What is a significant lab finding in DIC?
Increased D-dimer.
230
What is not seen in megaloblastic anemia?
Thrombocytosis.
231
What is an unexpected finding in hemolytic anemia?
Increased haptoglobin.
232
What test confirms the presence of HbS?
Hemoglobin electrophoresis.
233
What is a screening test for HbS?
Solubility test (acid dilution — HbS is resistant to denaturation).
234
What reagent is used to measure Hbs?
Sodium hydrosulfite.
235
In what condition are target cells seen?
Thalassemia (also in liver disease and hemoglobinopathies).
236
What lab parameter is falsely increased due to fragmented RBCs?
Platelet count.
237
What does a high platelet count by machine but low count manually indicate?
DIC (due to RBC fragments miscounted as platelets).
238
What test should be done for suspected sickle cell anemia?
Hemoglobin electrophoresis.
239
What condition is indicated by low globulin and increased gamma?
Multiple Myeloma (MM).
240
High MCV, low Hgb, and macro-ovalocytes are characteristic of what condition?
Vitamin B12 deficiency (megaloblastic anemia).
241
What is not seen in bacterial infection?
Hypersegmentation (seen in megaloblastic anemia).
242
What factor does not affect blood smear preparation?
Sample age (if used within acceptable limits).
243
What happens in iron deficiency anemia (IDA)?
Low iron, low ferritin, increased TIBC.
244
What happens to TIBC in IDA?
TIBC is increased.
245
Romanowsky stain shows dark blue nuclei and deep purple neutrophils. What’s the issue?
Stain is too alkaline.
246
Clots in a CBC tube affect which results?
CBC and platelet count.
247
Schistocytes in a blood smear are characteristic of what condition?
Hemolytic Uremic Syndrome (HUS).
248
You observe schistocytes in a blood smear. What lab parameters are affected?
RBC, platelet count, and mean platelet volume (MPV).
249
Which result is correlated with neutropenia?
WBC count of 1.5 × 10⁹/L.
250
WBCs appear pale on Romanowsky stain. Cause?
Alkaline pH.
251
MCV = 114 fL. What should be done next?
Pre-warm the sample to 37°C.
252
Blood smear is intensely stained. What caused it?
Blood drop was too large.
253
How do you differentiate promyelocytes (PML) from blasts?
Azurophilic granules present in promyelocytes.
254
Osmotic fragility test shows hemolysis starting at 0.65% NaCl and ending at 0.45%. Diagnosis?
Hereditary spherocytosis.
255
What is typically seen in a PBS of a patient with CLL?
Increased WBCs, lymphocytes, and smudge cells.
256
In a normal adult with high urobilinogen but no liver disease, what else is expected?
Decreased haptoglobin and hemoglobin (signs of hemolysis).
257
RBC, MCV, and MCHC values are given. How do you calculate Hgb?
RBC × 3.
258
What is the formula for calculating hemoglobin using MCV and RBC?
Hgb = (MCV × RBC) / 1000.
259
WBC shows +++ on an automated analyzer. What should you do?
Dilute the specimen.
260
INR = 1.0 and Bilirubin = 200 µmol/L. What might cause this discrepancy?
Lipemia.
261
Both PT control and patient PT test result are increased. What should you do?
Retest with a new reagent lot number.
262
Hgb is decreased, Plt = 12 × 10⁹/L, with increased polychromasia and schistocytes. What is the diagnosis?
Thrombotic Thrombocytopenic Purpura (TTP).
263
What RBC morphology is associated with chronic blood loss?
Microcytic hypochromic cells.
264
Which results correlate with primary identification of Chronic Myelogenous Leukemia (CML)?
BCR/ABL1 positive (or t(9;22) positive) and <5% blasts.
265
What causes hypercoagulability in Factor V Leiden mutation?
Resistance to cleavage by activated protein C.
266
Lab values: Iron ↑, TIBC ↓, Ferritin ↑, % Saturation ↑. What condition is indicated?
Hemochromatosis.
267
Which condition presents with equal amounts of Hgb A and Hgb A2?
β-thalassemia trait.
268
How do you differentiate CML from Polycythemia Vera?
Leukocyte Alkaline Phosphatase (LAP) score.
269
What inclusions are seen in a Romanowsky-stained smear of a patient with G6PD deficiency?
Heinz bodies. (Note: Requires supravital stain for confirmation.)
270
High reticulocyte count in anemic patient suggests what?
Normal erythropoietic activity (e.g., response to blood loss or hemolysis).
271
What should you do if a plasma product is received without dry ice?
Reject the specimen.
272
A schistocyte is seen in a patient with suspected PNH. What is the next step?
Prepare a new peripheral smear.
273
What reagent is added to coagulation tests to initiate clotting?
Calcium chloride.
274
ESR (Erythrocyte Sedimentation Rate) is useful in diagnosing what kinds of disease?
Chronic illnesses and hematological disorders (e.g., autoimmune disease, infections).
275
A sample shows a right shift in the RBC histogram. What is the most likely source?
Newborn (larger, macrocytic red cells typical of neonates).
276
In a patient with Multiple Myeloma, which situation requires further investigation?
Low ESR (others like Bence-Jones protein and monoclonal band are expected findings).
277
A disease presents with a high bleeding time and normal PT. What is the likely diagnosis?
Von Willebrand’s Disease.
278
A sample is stored at room temperature (22°C). Within how many hours must ESR be set up?
Within 4 hours.
279
Normal RBC count, 15 retics per 1000 RBCs observed. What does this indicate?
Normal erythropoiesis.
280
What is given to a patient with Hemophilia A?
Recombinant Factor VIII.
281
Which coagulation factor deficiency does not cause bleeding?
Factor XII (F12).
282
What is an expected abnormality in neonatal blood?
Increased reticulocytes, nRBCs, and high WBCs (e.g., normoblasts 0.159 × 10⁹/L, retics 40 × 10⁹/L).
283
In flow cytometry, which cell type shows the most forward scatter?
Monocyte (due to larger size and complexity).
284
In flow cytometry, if many cells are passing through at once, what needs to be controlled to maintain single-cell flow?
Hydrodynamic focusing (flow control or sheath flow).
285
What differentiates a monocyte from a myeloblast?
Non-specific esterase (NSE) positivity (monocyte); Myeloblast is positive for MPO.
286
Lab values: Na = 140, K = 5.2, TG = 6.5. Which result is most likely to fail autoverification?
HbA1c (likely due to poor correlation with high triglycerides or out-of-range limits).
