KEY WORD: BURGER

1. ROULEAUX primarily causes problems in the ABO reverse grouping, antibody screening, and
compatibility testing procedures.

2. ROULEAUX DOES NOT INTERFERE WITH THE AHG PHASE OF TESTING because the patient’s serum is
washed away prior to the addition of the AHG reagent.

3. EXOTIC PETS such as iguanas, snakes, and turtles are known to carry Salmonella. Young children who
do not practice good handwashing after touching family pets are particularly at risk for infection.
Natural medicinal products made from snakes or other animals known to carry SALMONELLA have been
implicated in cases of SALMONELLOSIS.

4. In the genus Pasteurella, P. MULTOCIDA is the species commonly recovered in clinical specimens. This
gram-negative coccobacillus is a normal inhabitant of the oral cavity of domestic animals. HUMANS
MOST OFTEN BECOME INFECTED FROM A BITE OR SCRATCH OF A CAT OR DOG, which produces a rapidly
progressing, painful, suppurative wound infection. Penicillin is an effective drug for the treatment of
Pasteurella infections.

5. ORTHOSTATIC (POSTURAL) PROTEINURIA: A persistent benign proteinuria occurs frequently in young

adults and is termed orthostatic proteinuria, or postural proteinuria. It occurs following periods spent in
a vertical posture and disappears when a horizontal position is assumed. Increased pressure on the renal
vein when in the vertical position is believed to account for this condition. Patients suspected of
orthostatic proteinuria are requested to empty the bladder before going to bed, collect a specimen
immediately upon arising in the morning, and collect a second specimen after remaining in a vertical
position for several hours. Both specimens are tested for protein, and if orthostatic proteinuria is
present, a negative reading will be seen on the first morning specimen, and a positive result will be
found on the second specimen.

6. CYSTINE crystals appear as colorless, HEXAGONAL plates and may be thick or thin. Crystals are found
in an ACID URINE.

7. RADIOGRAPHIC DYE CRYSTALS: Crystals of radiographic contrast media have a very similar appearance
to cholesterol crystals and also are highly birefringent. Differentiation is best made by comparison of the
other urinalysis results and the patient history. Cholesterol crystals should be accompanied by other
lipid elements and heavy proteinuria. Likewise, the specific gravity of a specimen containing
radiographic contrast media is markedly elevated when measured by refractometer.

8. ACUTE INTERSTITIAL NEPHRITIS: Urinalysis results include hematuria, possibly macroscopic, mild to
moderate proteinuria, numerous WBCs, and WBC casts without bacteria. Differential leukocyte staining
for the presence of INCREASED EOSINOPHILS may be useful to confirm the diagnosis.

9. ACUTE TUBULAR NECROSIS: Urinalysis findings include mild proteinuria, microscopic hematuria, and,
most noticeably, the PRESENCE OF RTE CELLS AND RTE CELL CASTS containing tubular fragments
consisting of three or more cells. As a result of the tubular damage, a variety of other casts may be
present, including hyaline, granular, waxy, and broad.
10. URINE REAGENT STRIP FOR LEUKOCYTES: Additional advantage to the chemical LE test is that it
detects the presence of leukocytes that have been lysed, particularly in dilute alkaline urine, and would
not appear in the microscopic examination.

11. Hepatitis B Immune Globulin (HBIG) is an injected material used to prevent infection following an
exposure to hepatitis B. HBIG does not prevent hepatitis B infection in every case, therefore persons
who have received HBIG must wait 12 months to donate blood to be sure they were not infected since
hepatitis B can be transmitted through transfusion to a patient. (HARMENING)

12. Donors who have taken piroxicam, aspirin, or anything with aspirin in it within 3 days of donation
may not be a suitable donor for platelet pheresis; these medications inhibit platelet function. There is no
restriction for whole blood donation. (HARMENING)

13. Ingestion of medications that irreversibly inhibit platelet function (aspirin) within 36 hours of
donation precludes use of donor as sole source of platelets. (HENRY)

14. For aspirin or aspirin-containing medications, plateletpheresis donors should be deferred for 48
hours after ingestion of aspirin. (AABB)

REQUIREMENTS OF ALLOGENEIC DONOR QUALIFICATION (HENRY)

15. Age: At least 16 years or minimum age determined by state law

16. Whole blood volume collected: Maximum of 10.5 mL/kg

17. Donation interval:

a. 8 weeks after whole blood donation

b. 16 weeks after two-unit red cell collection

c. 4 weeks after infrequent apheresis

d. At least 2 days after plasma, platelet, or leukocyte apheresis

18. Blood pressure

a. Systolic pressure between 90 mm Hg and 180 mm Hg

b. Diastolic pressure between 50 mm Hg and 100 mm Hg

19. Pulse: Regular and between 50 and 100 beats per minute

20. Temperature ≤37.5° C orally

21. Hemoglobin/hematocrit

a. Females: ≥12.5 g/dL / 38% (Henry)

b. Males: ≥13.0 g/dL / 39% (Henry)

c. AABB Females and males: ≥12.5 g/dL / 38%

22. Drug therapy

a. Finasteride, isotretinoin—defer 1 month after last dose

b. Dutasteride—defer 6 months after last dose

c. Acitretin—defer 3 years after last dose

d. Etretinate—defer indefinitely

e. Bovine insulin manufactured in the United Kingdom—defer indefinitely

f. Ingestion of medications that irreversibly inhibit platelet function (aspirin) within 36 hours of donation
precludes use of donor as sole source of platelets

23. General medical history:

a. Free of major organ disease, cancer, abnormal bleeding tendency

b. Family history of Creutzfeldt-Jakob disease or recipient of dura mater or human pituitary growth
hormone—defer indefinitely

24. Pregnancy: Defer if pregnant within the past 6 weeks

25. Recipient of blood transfusion or tissue transplant: Defer for 12 months from time of
transfusion/transplant

26. Vaccinations and immunizations

a. Recipient of toxoid, synthetic, or killed viral, bacterial, or other vaccine—no deferral

b. Recipient of live, attenuated intranasal flu vaccine—no deferral

c. Recipient of live attenuated viral or bacterial vaccine—2- or 4-week deferral from the time of
vaccination

d. Smallpox vaccine—refer to current FDA guidance

e. Other vaccines including unlicensed vaccines—12-month deferral from time of vaccination

27. Infectious diseases—indefinite deferral

a. Viral hepatitis after 11th birthday

b. Positive test for hepatitis B surface antigen or HBV NAT

c. Repeat reactive test for anti-HBc on more than one occasion

d. Clinical or laboratory evidence of HCV, HTLV, HIV, or T. cruzi infection by current FDA regulations

e. Previous donation associated with hepatitis, HIV, or HTLV transmission

f. History of babesiosis or Chagas’ disease

g. Stigma of parenteral drug use

h. Injection of nonprescribed drugs

i. Risk for vCJD according to current FDA guidelines

28. Infectious diseases—12-month deferral

a. Mucous membrane exposure to blood

b. Nonsterile skin or needle penetration

c. Sexual contact with an individual with a confirmed positive test for hepatitis B surface antigen

d. Sexual contact with an individual with viral hepatitis

e. Sexual contact with an individual with HIV infection or behavioral risk for HIV infection according to
current FDA guidance

f. Incarceration in a correctional institution for longer than 72 consecutive hours

g. History of syphilis or gonorrhea

29. West Nile virus: Defer according to current FDA guidance

30. Malaria

a. Confirmed diagnosis—defer for 3 years after becoming asymptomatic

b. Travel to or residence in an endemic area as defined by the CDC—defer according to FDA guidance

31. When a fire is discovered, all employees are expected to take the actions in the acronym RACE:
a. RESCUE—rescue anyone in immediate danger

b. ALARM—activate the institutional fire alarm system

c. CONTAIN—close all doors to potentially affected areas

d. EXTINGUISH/EVACUATE—attempt to extinguish the fire, if possible or evacuate, closing the door

32. If the salicylate anion is ingested, RESPIRATORY ALKALOSIS OCCURS FIRST, FOLLOWED BY MILD
METABOLIC ACIDOSIS.

33. ENDOTOXINS are composed of the LPS portion of the outer membrane on the cell wall of GRAM-
NEGATIVE BACTERIA.

34. SEPTIC or ENDOTOXIC SHOCK is a serious and potentially life-threatening problem.

35. Leptospires are obligately aerobic and can be grown in artificial media such as FLETCHER’S semisolid,
Stuart liquid, or Ellinghausen-McCullough-Johnson-Harris (EMJH) semisolid media.

36. The direct antiglobulin test (DAT) is used to detect in vivo sensitization of RBCs. In the tube method,
the patient’s RBCs are washed thoroughly to remove any unbound antibody, and then AHG reagent is
added.

a. If IgG antibodies or complement are coating the RBCs, agglutination will be observed.

b. If neither is present, no agglutination will be observed. Coombs’ control cells are added to validate
the negative test.

c. WHEN IgG ANTIBODIES ARE DETECTED, THE NEXT STEP IS TO DISSOCIATE THE ANTIBODIES FROM THE
RBC SURFACE TO ALLOW FOR IDENTIFICATION.

d. Elution techniques are used to release, concentrate, and purify antibodies. The methods used to
remove the antibody change the thermodynamics of the environment, change the attractive forces
between antigen and antibody, or change the structure of the RBC surface.

37. An antibody identification panel is a collection of 11 to 20 group O RBCs with various antigen
expression. The pattern of antigen expression should be diverse so that it will be possible to distinguish
one antibody from another and should include cells with HOMOZYGOUS EXPRESSION of Rh, Duffy, Kidd,
and MNSs antigens.

38. ACUTE TUBULAR NECOSIS: Urinalysis findings include mild proteinuria, microscopic hematuria, and,
most noticeably, the presence of RTE cells and RTE cell casts containing tubular fragments consisting of
three or more cells. As a result of the tubular damage, a variety of other casts may be present, including
hyaline, granular, waxy, and broad.

39. SPURIOUS INCREASE IN WBC COUNT

a. PLATELET CLUMPING

b. Cryoglobulin, cryofibrinogen

c. Heparin
d. Monoclonal proteins

e. Nucleated red cells

f. Unlysed red cells

40. SPURIOUS DECREASE IN WBC COUNT

a.Clotting

b. Smudge cells

c. Uremia plus immunosuppressants

41. MALDI TOF MS: Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass
spectrometry (MS) offers the possibility of accurate, rapid, inexpensive identification of bacteria, fungi,
and mycobacteria isolated in clinical microbiology laboratories. The procedures for preanalytic
processing of organisms and analysis by MALDI-TOF MS are technically simple and reproducible, and
commercial databases and interpretive algorithms are available for the identification of a wide spectrum
of clinically significant organisms. Although only limited work has been reported on the use of this
technique to identify molds, perform strain typing, or determine antibiotic susceptibility results, these
are fruitful areas of promising research. Thank you Christine!

42. Group D Enterococcus (Enterococcus spp.)

a. Alpha, beta or gamma hemolytic

b. Bile esculin positive

c. Growth in 6.5% NaCl

d. PYRase positive

43. Group D Non-Enterococcus (Streptoccus bovis and S. equinus)

a. Alpha, beta or gamma hemolytic

b. Bile esculin positive

c. No growth in 6.5% NaCl

d. PYRase negative

44. The genus LEUCONOSTOC consists of catalase-negative, gram-positive microorganisms with irregular
coccoid morphology. Biochemical identification is based on the absence of catalase, PYR, and LAP
activities; hydrolysis of esculin in the presence of bile; growth in the presence of 6.5% NaCl; and
production of gas from glucose. (Harr, 31)

a. Gram positive, catalase negative coccus

b. PYR and LAP negative

c. Bile esculin hydrolysis, variable (Mahon table 15-3)

d. 6.5% NaCl, variable (Mahon table 15-3) Thank you Andrea!

45. SPUTUM: The objective is to separate the representative sample from the contaminated sample
before culture or culture evaluation. Bartlett’s method for scoring sputum and the Murray-Washington
method for contamination assessment document the association of 10 to 20 squamous epithelial cells
(SECs) per ×10 microscopic field with unacceptable specimens and 10 to 25 PMNs per ×10 field with
significant specimens. Thank Ma'am Imelda!

46. Clotted blood sample (clotting): SPURIOUS DECREASE in WBC, RBC, platelets, hemoglobin and
hematocrit. Spurious increase in MCHC. Henry

47. PAGE: RBC protein identification techniques that distinguished 15 membrane proteins using sodium
dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Bands migrate through the gel, with
their velocity a property of their molecular weight and net charge, and are identified using Coomassie
blue dye. The glycophorins, with abundant carbohydrate side chains, are stained using periodic acid–
Schiff (PAS) dye.

48. A2 and A2B individuals can produce naturally occurring anti-A1.

49. A1 and A1B, individuals may produce naturally occurring anti-H.

50. SUBGROUP OF B, B3: B3 phenotype generally results from the inheritance of a rare gene at the ABO
locus and is characterized by a MIXED FIELD PATTERN OF AGGLUTINATION with anti-B and anti-A,B.

51. SUBGROUP OF B, Bx: Bx RBCs typically demonstrate WEAK AGGLUTINATION with anti-B and anti-A,B
antisera.

52. FRESH BLOOD FOR NEONATAL TRANSFUSION: Special requests for fresh whole blood may be
received in occasion for selected patients such as the NEONATAL PATIENT. Fresh blood provides the
greatest oxygen-carrying capacity because it has the maximum level of 2,3 DPG and minimal amounts of
the metabolic waste products such as potassium when compared with older blood. Thank you Dynell!

53. SHELF-LIFE, INTRAOPERATIVE AUTOLOGOUS BLOOD: the blood generally does not leave the OR;
however, if some of the blood is to be stored postoperatively, it must be labeled with the patient’s full
name, medical record number, date and time of collection, and with “For Autologous Use Only.” The
blood may be stored at room temperature for up to 6 hours or at 1°C to 6°C for up to 24 hours, as long
as the latter temperature has begun within 4 hours from the end of collection.

a. 1°C to 6°C for up to 24 hours

b. Room temperature for up to 6 hours

54. HIV TEST, INDETERMINATE WESTERN BLOT RESULT:

a. Specimens that have some of the characteristic bands present but do not meet the criteria for a
positive test result are considered to be indeterminate. This result may be produced if the test serum is
collected in the early phase of seroconversion or if the serum contains antibodies that cross-react with
some of the immunoblot antigens, producing false-positive results. False positives may be caused by
antibodies produced to contaminants from the cells used to culture HIV to prepare the antigens for the
test; to autoantibodies, including those directed against HLA, nuclear, mitochondrial, or T-cell antigens;
or to antibodies produced after vaccinations.

b. The use of recombinant antigens instead of viral lysates has reduced the incidence of false-positive
results. IF AN INDETERMINATE TEST RESULT IS OBTAINED, IT IS RECOMMENDED THAT THE TEST BE
REPEATED WITH THE SAME OR A FRESH SPECIMEN; if the test is still indeterminate, testing may be
performed with a new specimen obtained a few weeks later, and if the pattern converts to positive, it
can be concluded that the first specimen was obtained during the early phase of seroconversion. Failure
of an indeterminate test pattern to convert to positive after a few weeks strongly suggests that the
pattern is due to a false-positive test rather than HIV infection. During this period, additional tests that
detect components of the virus, such as HIV nucleic acid or p24 protein, can be performed to provide
more conclusive results.

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55. Normal fasting plasma glucose (FPG) < 100 mg/dL

56. IMPAIRED fasting glucose (IFG) is defined as a fasting plasma glucose level that ranges between 100
and 125 mg/dL. Thank you Tonee!

57. PROVISIONAL diagnosis of diabetes mellitus is made when FPG ≥ 126 mg/dL.

58. The DIAGNOSIS OF DIABETES MELLITUS must be confirmed by one of the three methods: A plasma
glucose analysis that yields any one of the following results is diagnostic for the presence of diabetes
mellitus, provided that unequivocal hyperglycemia is apparent. If unequivocal hyperglycemia is not
apparent, the glucose result must be confirmed by repeat analysis on a subsequent day using any one of
the following three methods. However, the American Diabetes Association does not recommend the
OGTT for routine clinical use.

a. An individual expressing physical symptoms and a casual plasma glucose level of ≥200 mg/dL.

b. Fasting plasma glucose level that is ≥126 mg/dL (fasting defined as no caloric intake for minimum of 8
hours)

c. Plasma glucose level of ≥ 200 mg/dL at 2-hour point of an OGTT as described by the WHO.

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59. Pseudohyponatremia can occur when Na+ is measured using indirect ion-selective electrodes (ISEs)
in a patient who is hyperproteinemic or hyperlipidemic. An indirect ISE dilutes the sample prior to
analysis and as a result of plasma/serum water displacement; the ion levels are falsely decreased.

60. Measurement of sodium: Most analyzers use a glass ion-exchange membrane in its ISE system for
Na+ measurement. There are two types of ISE measurement, based on sample preparation: direct and
indirect. Direct measurement provides an undiluted sample to interact with the ISE membrane. WITH
THE INDIRECT METHOD, A DILUTED SAMPLE IS USED FOR MEASUREMENT. THERE IS NO SIGNIFICANT
DIFFERENCE IN RESULTS, EXCEPT WHEN SAMPLES ARE HYPERLIPIDEMIC OR HYPERPROTEINEMIC.
EXCESS LIPIDS OR PROTEINS DISPLACE PLASMA WATER, WHICH LEADS TO A FALSELY DECREASED
MEASUREMENT OF IONIC ACTIVITY IN MILLIMOLES PER LITER OF PLASMA, WHEREAS THE DIRECT
METHOD MEASURES IN PLASMA WATER ONLY. IN THESE CASES, DIRECT ISE IS MORE ACCURATE.
61. Formula for calculating IRON SATURATION

Iron saturation (%) =

(serum iron/ TIBC) x 100

62. CD38: Plasma cell and prognostic indicator of CLL

63. MARKERS of hairy cell leukemia: Typical cases of HAIRY CELL LEUKEMIA show strong positivity for B-
cell markers (CD19, CD20, CD22) coupled with bright expression of CD11c, CD25, CD103, tartrate-
resistant acid phosphatase (TRAP, demonstrated by immunohistochemical analysis or cytochemical
stain), DBA-44, and annexin A1. (Rodak)

64. The LUPUS INHIBITOR is the most frequently occurring inhibitor and one of the commonest cause of
a prolonged APTT encountered in the laboratory.

a. Dilute Russell viper venom time (DRVVT)

b. Platelet neutralization procedure (PNP)

65. Acute lymphoblastic leukemia (ALL)

a. Early pre-B cell or common ALL accounts for 60 to 70% of all cases (CD 10)

b. T cell leukemias account for 10 to 20% of the cases

c. Rarest subclass is B-cell leukemia, and it represents the L3 variant of the FAB classification (Burkitt’s
type)

66. The majority of cases of CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) appear to involve the B
lymphocyte. Take note:

a. CLL: most common appear to involve the B lymphocyte

b. ALL: most common is the early pre-B cell or common ALL

67. LEUKEMOID REACTION (LR) Clinical syndrome resembling leukemia in which the white blood cell
count is elevated to greater than 25,000/mcL in response to an allergen, inflammatory disease,
infection, poison, hemorrhage, burn, or severe physical stress. Leukemoid reaction usually involves
granulocytes and is distinguished from chronic myelogenous leukemia by the use of the leukocyte
alkaline phosphatase staining of neutrophils.

68. Orthostatic proteinuria: increased protein in urine only when an individual is in an upright position.

69. Urine reagent strip for PROTEIN: sources of error/interference

a. FALSE-POSITIVE: Highly buffered interference alkaline urine, pigmented specimens, phenazopyridine,

quaternary ammonium compounds (detergents), antiseptics, chlorhexidine, loss of buffer from
prolonged exposure of the strip to the specimen reagent, high specific gravity

b. FALSE-NEGATIVE: Proteins other than albumin, microalbuminuria

70. Urine reagent strip for BLOOD: sources of error/interference

a. FALSE-POSITIVE: Strong oxidizing agents, bacterial peroxidases, menstrual contamination

b. FALSE-NEGATIVE: High specific gravity/crenated cells, formalin, captopril, high concentrations of

nitrite, ascorbic acid greater than 25 mg/dL, unmixed specimens

71. Hemolytic jaundice, hemolytic disease

a. Urine bilirubin: negative

b. Urine urobilinogen: +++

72. Hepatic jaundice, liver damage

a. Urine bilirubin: positive or negative

b. Urine urobilinogen: ++

73. Obstructive jaundice, biliary obstruction

a. Urine bilirubin: +++

b. Urine urobilinogen: negative (strip, normal)

74. Bronchoalveolar lavage is becoming an important diagnostic test for Pneumocystis carinii in
immunocompromised patients. With P. carinii, characteristic amorphous material is seen
microscopically under low power and organisms are visible under high power.

75. HAPTENS are nonimmunogenic materials that, when combined with a carrier, create new antigenic
determinants.

76. Characteristic Diagnostic Profile of EPSTEIN-BARR VIRUS

a. SUSCEPTIBILITY: If the patient is seronegative (lacks antibody to VCA)

b. PRIMARY INFECTION: Antibody (IgM) to VCA is present; EBNA is absent. High or rising titer of antibody
(IgG) to VCA and no evidence of antibody to EBNA after at least 4 weeks of symptoms

c. REACTIVATION: If antibody to EBNA and increased, antibodies to EA are present, patient may be
experiencing reactivation.

d. PAST INFECTION: Antibodies to VCA and EBNA are present.

77. DIAGNOSIS OF RUBELLA

a. For diagnosis of current or recent rubella infection, paired sera (acute and convalescent) should be
obtained.

b. The acute sera should be collected as soon after rash onset as possible or at the time of exposure.
Convalescent sera should be obtained 7 to 21 days after the onset of the rash or at least 30 days after
exposure if no clinical symptoms appear.

c. Undiluted serum will give a positive reaction if at least 10 ± 1 IU/mL of antibody is present. This
indicates that the individual has immunity to rubella.
d. When a semiquantitative test is performed with acute and convalescent sera from the same patient, a
fourfold increase in titer is considered to be significant. This typically indicates infection.

78. Inadequate washing of cells in antiglobulin testing

a. False negative AHG test

b. Unbound immunoglobulins may neutralize the antiglobulin reagent

c. CORRECTION: WASH CELLS THOROUGHLY, according to the procedure being followed.

79. The P1 ANTIGEN DETERIORATES RAPIDLY ON STORAGE. When older RBCs are typed or used as
controls for typing reagents or when older RBCs are used to detect anti-P1 in serum, false-negative
reactions may result.

80. LOW-INCIDENCE ANTIGENS UNRELATED TO THE PRINCIPAL BLOOD GROUP SYSTEMS

a. Low-incidence antigens unrelated to the principal blood group systems are defined as antigens with
an incidence of less than 1%.

b. Examples of this type of antigen include the WRIGHT blood group system, which is independent of all
other blood group systems, as well as Swann (Swa), By, Mta, and Tra antigens