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clinical pathology > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

what 3 things affect the quality of laboratory results?

A

Quality of sample (pre-analytic)
Quality of analysis (analytic)
Quality of lab and patient records (post-analytic)

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2
Q

In what phase does most errors in human medicine occur?

A

Pre-analytic phase

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3
Q

What technical factors can affect pre-analytic errors?

A

Test selection
Sample tube and fill (make sure using proper tube and fill it to specific line indicated, also make sure tubes are in date)
Sample collection ( use proper needle size etc.)
Sample identification
Sample handling and delayed processing

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4
Q

What Physiologic factor affects pre-analytic errors?

A

Patient preparation

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5
Q

What is the difference between serum and plasma chemistry?

A

Serum chemistries are allowed to clot (clotting factors have been removed)

Plasma chemistries contain clotting factors (proteins) in the tube that interact with the sample and keep it from clotting

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6
Q

What tubes are used for whole blood/plasma?

Ex: complete blood count

A

EDTA tube (purple top)

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7
Q

What tubes are used for plasma chemistry?

Ex: plasma chemistry, ammonia

A

Lithium heparin (green top)

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8
Q

Can green top tubes be used for CBC?

A

yes

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9
Q

What tubes are used for coagulation testing?

A

Citrate (blue top)

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10
Q

What tube is used for most biochemical tests?

A

Serum (with and without separator)

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11
Q

What sample is submitted for chemistry panels, serology, vitamin E, and most endocrinology tests except for endogenous and insulin ACTH?

A

Red top labeled serum

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12
Q

What sample is submitted for for ACTH endogenous & ACTH and insulin?

A

EDTA labeled plasma

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13
Q

What sample is submitted for hemograms, PCR tests, lead, selenium, and knott’s heartworm and BVDV PI testing in calves?

A

EDTA labeled whole blood

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14
Q

Do you centrifuge EDTA whole blood samples?

A

NO!

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15
Q

What sample is for toxicology testing of copper, iron, nitrate/nitrite, zinc, and pre- purchase drug screens?
Can also be used for most clin path chemistry tests

A

Green top labeled heparinized plasma

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16
Q

What is submitted for Knott’s heartworm and many toxicology tests including selenium and lead?

A

Green top labeled Heparin whole blood

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17
Q

What sample is submitted for most comparative coagulation tests?

A

Blue top labeled citrate plasma

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18
Q

Serum vs. plasma?

Potassium, LDH, P

A

Serum>plasma

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19
Q

Serum vs. plasma

AST, CK in cattle/sheep

A

Serum>plasma

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20
Q

Serum vs. Plasma

total proteins, globulins

A

Plasma>serum

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21
Q

What sample tube would you choose if you needed an anticoagulant selection?

A

Lithium Heparin (green top)

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22
Q

What can happen to serum tube blood with EDTA contamination?

A

Increased potassium/ decreased Ca 2+ and Mg 2+

Decreased bicarbonate, ALP, CK, glucose, amylase and lipase can also be decreased

23
Q

What order of tubes do you place blood in to prevent EDTA contamination?

A

serum tube first then EDTA tube

24
Q

How do dextrose containing fluids affect blood samples?

A

Low sodium, potassium, chloride from fluid dilution

high glucose from dextrose

25
Q

What important factors should be remembered when handling and shipping sample?

A

Samples should be kept cool to minimize cell changes but wrapped in paper towels to prevent freezing and lysis of RBC and WBC

Blood smears should be made from freshly collected blood and submitted with tubes to facilitate blood smear exam and ensure accurate results

26
Q

What are some pre-analytic problems that can occur with old blood samples?

A

Cell lysis, Erythrocyte swelling, and platelet activation

27
Q

What are some other pre analytic factors that can occur with aged samples

A

Platelet, leukocyte, and erythrocyte clumps

Clot formation

28
Q

What pre-analytic problems can occur with prolonged storage of samples?

A

Decreased glucose because glycolysis continues in the cells even after collection

Increased K+ because it leaks from the erythrocytes in K+ rich RBC’s

29
Q

What animals have potassium rich RBC’s

A

Horses, Japanese dog breeds, camelids, pigs, sheep, and some cattle

30
Q

What pre- analytic factors can affect the sample during storage?

A

Exposure to light
Evaporation (when sample left uncovered)
Freezing

31
Q

What occurs when the sample is exposed to light?

A

Bilirubin is degraded

32
Q

What occurs when the sample is left uncovered and undergoes evaporation?

A

Electrolytes are falsely increased because there is less water so more concentrated

33
Q

What occurs when the sample gets frozen?

A

Falsely increased electrolytes due to the sublimation of water

34
Q

What can occur in the sample if the patient is not properly fasted before collection?

A

Lipemia

35
Q

What are some analytic factors that can affect the results from the sample?

A 
Test performance
Quality control (how good lab actually is)
Results review
Equipment limitations
Calibration inaccuracies
36
Q

What can you do to improve quality control?

A

Examine stained blood films!

37
Q

What do you want to do if you have thrombocytopenia or leukopenia in your test results?

A

Check a blood stained smear to look for cell clumping

38
Q

In what species, is cellular clumping very common?

A

CATS!

39
Q

What are sometimes counted as leukocytes in manual and automated cell counters?

A

Nucleated RBC’s

40
Q

IN what disease states are nucleated RBC’s common ?

A

Regenerative anemia
Lead toxicity
Marrow injury or disease
Other inflammatory diseases

41
Q

True/ False:

If more than 5 nucleated RBC’s are counted per 100 WBC then the WBC count will need to corrected

A

True

42
Q

What is the formula for a corrected WBC count?

A

(Measured WBC count X 100) / (100 + nucleated RBC)

43
Q

2 ways to differentiate a nucleated RBC from a lymphocyte

A

Nucleated RBC’s have:
complete rim of cytoplasm
more eosinophilic cytoplasm

44
Q

What are the primary biochemical methodologies?

A

Photometry and Electrochemistry

45
Q

what is spectrophotometry used for?

A

Wet chemistry to measure the absorbance of light

A=cal (Beer’s law

46
Q

How is dry chemistry evaluated?

A

Reflectance (see how much light is reflected back)

47
Q

what are some matrix issues that affect the analysis of the blood sample?

A 
Lipemia 
icterus 
Hemolysis
Hyperproteinemia 
Drugs
48
Q

Looks like tomato juice interferes with spectrophotometric assays? due to lysis of RBC’s

A

Hemolysis

49
Q

Occurs when animals have not been properly fasted before blood collection or with hyperlipidemic syndromes?

A

Lipemia

50
Q

Can dilute out normal substances like K+, Na+, Cl- in the aqueous component and causes decreased concentration of these (ion exclusion effect)

A

Lipemia

51
Q

What is the ion exclusion effect?

A

analyzer measures electrolytes by adding H20 to the sample –> lipemia displaces amount of H20 added to the sample so analyzer measures from a smaller fraction resulting in fewer electrolytes being measured

52
Q

Looks like orange juice due to increased bilrubin in sample

A

Icterus

53
Q

There is a 5% chance you will get an abnormal test result in a healthy animal when measuring ______ value

A

1

54
Q

There is a 64% chance you will get an abnormal test result in a healthy animal when measuring _____ values

A

20

clinical pathology (6 decks)

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