Clinical Chemistry
A CMP is a combination of which other panels?
Combination of a BMP and a hepatic function panel
Name 2 high incidence antigens.
e, k, Kpb, Jsb, Lub
What type of media is MAC?
(Moderately) selective and differential
What would we expect to see in the peripheral blood of an individual with lead poisoning?
Basophilic stippling
What erroneous results would we expect to see in the instance of EDTA contamination?
What blood gas results would you expect to see in a patient with metabolic acidosis with respiratory compensation?
A decreased pH, decreased HCO3-, as well as a decreased pCO2
Antibodies to which antigen group are most commonly associated with a delayed hemolytic transfusion reaction?
Kidd
What organism causes folliculitis, furuncles and carbuncles?
Staph aureus
A 27-year-old patient just had a bone marrow exam. What is the expected percent cellularity of their BM?
73 +/- 10%
(100 - Age) +/- 10%
What two species does MALDI-ToF struggle to differentiate between?
E. coli and Shigella
What is the difference between turbidimetry and nephelometry and which one is more sensitive?
Both detect immune complex formation
Turbidimetry: decrease in light transmitted due to Ag-Ab formation
Nephelometry: detection of scattered or reflected light from a Ag-Ab complex
Nephelometry is more sensitive
What is the required time interval between RBC apheresis donations?
16 weeks
How do we distinguish Bacillus anthracis from other Bacillus sp.?
Non-motile, non-hemolytic, ground glass/Medusa head morphology
A 25-year-old African American woman applies to donate blood. She is asymptomatic and has no known medical conditions. Routine screening includes a hemoglobin electrophoresis test, which reveals:
HbA: 60%
HbS: 38%
HbA2: 2%
HbF: <1%
What is the most likely diagnosis, and explain why these electrophoresis results appear this way.
Diagnosis: Sickle cell trait (HbAS)
Explanation: In sickle cell trait, the patient has one normal β-globin gene (HbA) and one sickle β-globin gene (HbS). This results in the presence of both HbA and HbS on electrophoresis, with HbA typically being higher than HbS (~60:40 ratio), and no symptoms under normal conditions.
what does CMV stand for, how does one become infected, and what methods reduce the risk of infection?
1. Cytomegalovirus--> Often asymptomatic in healthy people, but dangerous in immunocompromised patients and newborns
2. CMV is carried in donor white blood cells
3. Leukoreduction (CMV-negative donor also acceptable)
There are two major ways to assess renal function. Which one is the older more problematic way- what is it and why is it problematic? Which new method is recommended by the NKF and why?
1. eGFR--> estimates based off of muscle mass, historically has used race and gender in the calculation
2. Cystatin C--> not affected by diet, race, or gender (CKD-EPI 2021 equation also acceptable answer)
An 82-year-old woman with a history of congestive heart failure receives 2 units of packed red blood cells for symptomatic anemia. One hour into the second unit, she develops acute dyspnea, hypertension, jugular venous distension, and bilateral crackles on lung exam. Chest X-ray shows pulmonary edema. BNP is elevated.
What is the most likely transfusion reaction, and what steps should be taken to manage and prevent it in future transfusions?
Most likely reaction: TACO (Transfusion-Associated Circulatory Overload)
Management: Stop transfusion, give diuretics, provide oxygen support
Prevention: In future transfusions, use slower infusion rates, and transfuse smaller volumes
Which one would be positive for Group A strep AND Enteroccocus?
a. Bacitracin
b. Bile esculin
c. PYR
d. Beta-lactamase
c. PYR
What is the most common cause of acquired thrombophilia?
Anti-Phospholipid Antibody Syndrome
What disorder of primary hemostasis mainly affects kids and ften follows bacterial infection with E. coli O157:H7 or Shigella?
Hemolytic Uremia Syndrome (HUS)
Name 4 immunosuppressant drugs.
Cyclosporine, tacrolimus, sirolimus, mycophenolate, everolimus
Following a FMH a positive rosette test is obtained. Flow cytometry results indicate that 3.2% fetal cells were present in the mother. How many vials of Rhogam will be given to this mother?
(3.2*50/30) = 5.3 -> 6 + 1 = 7
(%fetal cells*50)/30 --> always round up and add one
What are the XV reactions and hemolysis patterns for:
a. H. parainfluenzae
b. H. influenzae
c. H. haemolyticus
d. H. aegyptius
X (-), V(+), XV (+); beta-hemolysis (-)
= Haemophilus parainfluenzae
X (-), V(-), XV (+); beta-hemolysis (-)
= Haemophilus influenzae
X (-), V(-), XV (+); beta-hemolysis (+)
= Haemophilus haemolyticus
X (-), V(-), XV (+); beta-hemolysis (-)
= Haemophilus aegyptius
What is the gold standard for HIT diagnosis?
Serotonin release assay
What are the following media pairs are used for?
a. Thayer Martin and Martin Lewis
b. BCYE and Regan Lowe
c. Todd Hewitt and Lim Broth
d. TCBS and HE
a. Neisseria gonorrhoeae
b. Legionella/Bordetella
c. Group B Strep
d. Enterics, specificially Vibrio spp. and Salmonella/Shigella