Country of Publication: United States Publisher: Philadelphia : Wolters Kluwer/ Lippincott Williams & Wilkins, c2010. ; hematology, chemistry, et cetera, as well as lab management, lab government regulations, and quality assurance. Concise Review of Clinical Laboratory Science Table 1–1 Advantages and Disadvantages of Automation Advantages Disadvantages Increased work capacity per unit of time Minimized variability Reduced errors caused by manual manipulations Reduced sample volumes Reduced consumable costs Initial costs Discontinuity of product Technical skill required (4) Production of ancillary reports (5) Data … Chapter Ancillary Content: Textbook Materials. Design by 123DOC, P1: PBU LWBK192-FM LWBK192-Hubbard December 2, 2008 A Concise Review of Clinical Laboratory Science Second Edition i 13:43 P1: PBU LWBK192-FM LWBK192-Hubbard December 2, 2008 ii 13:43 P1: PBU LWBK192-FM LWBK192-Hubbard December 2, 2008 A Concise Review of Clinical Laboratory Science Second Edition Joel D Hubbard, PhD, MT (ASCP) Associate Professor, Program of Clinical Laboratory Science Department of Laboratory Sciences and Primary Care School of Allied Health Sciences Texas Tech University Health Sciences Center Lubbock, Texas iii 13:43 P1: PBU LWBK192-FM LWBK192-Hubbard December 2, 2008 Acquisitions Editor: John Goucher Managing Editor: Meredith Brittain Project Manager: Rosanne Hallowell Manufacturing Manager: Margie Orzech Marketing Manager: Allison Noplock Cover Designer: Melissa Walter Design Coordinator: Stephen Druding Production Services: Aptara, Inc c 2010 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business c 1997 by WILLIAMS & WILKINS 530 Walnut Street Philadelphia, PA 19106 All rights reserved This book is protected by copyright No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19016, via email at permissions@lww.com or via our website at lww.com (products and services) Printed in the United States of America Library of Congress Cataloging-in-Publication Data A concise review of clinical laboratory science / [edited by] Joel Hubbard.—2nd ed p ; cm Includes index ISBN 978-0-7817-8202-9 Medical laboratory technology—Examinations, questions, etc Medical laboratory technology—Outlines, syllabi, etc I Hubbard, Joel D (Joel David), 1952[DNLM: Laboratory Techniques and Procedures–Examination Questions QY 18.2 C744 2010] RB38.25.H83 2010 616.07 56—dc22 2008043981 DISCLAIMER Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the clinician to ascertain the FDA status of each drug or device planned for use in their clinical practice The publishers have made every effort to trace copyright holders for borrowed material If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet at: LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST 10 iv 13:43 P1: PBU LWBK192-FM LWBK192-Hubbard December 2, 2008 This book is dedicated to clinical laboratory science students everywhere In your upcoming role as professionals, remember that your job is important to the medical world as well as to the individual patient Be proud of the fact that you will be making a difference in people’s lives Always be excited about the unlimited opportunities available in your chosen profession and help lead the field of Clinical Laboratory Science well into the 21st century v 13:43 P1: PBU LWBK192-FM LWBK192-Hubbard December 2, 2008 vi 13:43 P1: PBU LWBK192-FM LWBK192-Hubbard December 2, 2008 PREFACE The arrival of the second edition of A Concise Review of Clinical Laboratory Science has long been anticipated by students and educators alike This review text is a valuable educational tool for both the novice and the experienced clinical laboratory scientist It is designed to be an updated and concise review of all disciplines of clinical laboratory science and will also serve as a tool for students of clinical laboratory science studying for national certification examinations, including the American Society of Clinical Pathologists Board of Registry exam, the National Certification Agency (NCA) exam, and the American Medical Technologist (AMT) exam Practicing clinical laboratory scientists and medical residents will also find this book to be an excellent source for review This book represents a culmination of the efforts and expertise of the faculty of the Clinical Laboratory Science program at Texas Tech University Health Sciences Center in Lubbock, Texas, and reflects over 100 years of combined medical technology experience All contributing authors reflect their professional excellence in their contributed chapters, not only as educators, but also as outstanding professionals in their field I encourage readers to send me feedback on this book at the following email address: joel.hubbard@ttuhsc.edu Text Format and Features Each chapter presents a concise summary of the most important facts and concepts in that subject area in an outline format Key points appear in bold for easy reference Boxes, tables, and figures throughout distill concepts and make them easier to comprehend Online menus at the end of each chapter point readers to supplementary Web-based materials What’s New in This Edition The second edition includes the most current and updated information An expanded chapter dealing with laboratory operations (Chapter 11) addresses topics such as management and organizational theory, professionalism, quality assurance, laboratory regulations, and delivery of an educational unit In addition, a new chapter on molecular pathology (Chapter 10) focuses on molecular laboratory methods and an overview on the testing of genetic diseases Additional Resources A Concise Review of Clinical Laboratory Science, second edition, includes additional resources for both instructors and students that are available on the book’s companion Web site at thePoint.lww.com/Hubbard2e vii 13:43 P1: PBU LWBK192-FM LWBK192-Hubbard viii December 2, 2008 Preface Instructors Approved adopting instructors will be given access to the following additional resources: r Image Bank (including color images referenced in the text) r Quiz Bank r Web Case Studies (including those referenced in the text) Students Students who have purchased A Concise Review of Clinical Laboratory Science, second edition, have access to the following additional resources: r Image Bank (including color images referenced in the text) r Quiz Bank r Web Case Studies (including those referenced in the text) In addition, purchasers of the text can access the searchable Full Text Online by going to the A Concise Review of Clinical Laboratory Science, second edition, Web site at thePoint.lww.com/Hubbard2e See the inside front cover of this text for more details, including the pass code you will need to gain access to the Web site 13:43 P1: OSO LWBK192-INDEX 400 LWBK192-Hubbard December 8, 2008 Index Micrococcaceae antibiotic susceptibility, 249 coagulase-negative staphylococci, 248 general characteristics, 246, 246t laboratory identification, 247–248 Staphylococcus aureus, infections, 246–248 Micrococcus, 242, 246, 246t, 247 Microcytic anemia, 117 Microcytosis, 113, 117 Microcytotoxicity studies, 195 Microcytotoxicity test, 186 Microfilament, 52 Microhemagglutination assay for Treponema pallidum (MHA-TP), 197 Microscopic sediment stains, 328 Microtubule, 52 Middlebrook, 274 Migration inhibition, 196 Migration rate, Mineral corticosteroids, 39 Minimum bactericidal concentration (MBC), 286 Minimum inhibitory concentration (MIC), 284, 285 Minute tapeworm, 294 Mitochondria, 52 Mitogenic substances, 181 Mixed-lymphocyte cultures, 196 Mixed-lymphocyte reaction (MLR), 186–187 MNS blood group system, 213 Modified oxidase test, 246 Molar absorptivity, Molarity, Mole, Molecular diagnostics, 360–367 biology of the cell, 360–362, 361 DNA-based human identification, 366–367 inherited genetic disease, 365 molecular diagnostic methods, 362–365, 363 molecular infectious disease, 366 molecular oncology, 365–366 Molecular testing, 288 Molluscum contagiosum, 309 Monochromator, Monoclonal antibodies, 177 Monoclonal anti-D reagents, 212 Monocyte/macrophage colony stimulating factor (M-CSF), 149 Monocyte-macrophages, 166 Monocytes, 149, 182–183 function of, 146–149 Monocytosis, 152 Monokines, 149, 184 Mononuclear cells, 329, 329, 353 Monosaccharides, 21 Monosodium urate monohydrate crystals, 348 Monospecific reagents, 224 Monospot test, 201 Moraxella, 270 Moraxella catarrhalls, 257t, 258 Moraxella lacunata, 270 Morbillivirus, 310 Motility, 350 Motivation, in laboratory, 369 Mouth, normal flora of, 242 MPO deficiency, 191 Mu heavy-chain disease, 170 Mucor species, 301 Mucus, 334 Multiparameter cell counters, 85 Multiple myeloma (MM), 116, 120, 169–170 Multiple sclerosis, 353 Multiple sclerosis (MS), 189 Myasthenia gravis, 189 Mycetoma, eumycotic, 305 Mycobacteria, 274–277, 275t, 276t, 277t Mycobacterial photoreactivity groups, 275, 275t Mycobacterium tuberculosis, OSHA guidelines for preventing transmission of, 380 Mycology characteristics hyphae, 297 pseudohyphae, 297 spores, 297–298 cutaneous mycoses, 303–304 definition of, 297 media and tests, 298–299 microscopy of clinical specimens, 299 opportunistic mycoses, 301–302 specimen collection and transport, 298 subcutaneous mycoses, 304–305 superficial mycoses, 303 Mycoplasma, 272 Mycoplasma hominis, 272 Mycoplasma pneumoniae, 272 Mycosel agar, 299 Myeloblastic sarcoma, 163 Myeloblasts, 146 Myelodysplastic syndromes (MDS), 125, 130, 160–161 Myelofibrosis with myeloid metaplasia, 114 Myeloid metaplasia (MMM), 159 Myeloid/erythroid (M:E) ratio, 99 Myeloma, multiple, 116, 169–170 Myeloperoxidase (MPO), 148, 182 Myelophthisic anemia, 123 Myeloproliferative disorders, 152 chronic and acute, 157–163, 157, 158t Myocardial infarction, 33, 34 Myoglobin, 325 Myotonic dystrophy, 365 N-acetylcysteine, 47 NaCl tolerance, 276 Nagler’s test, 281 Naloxone, 47 α-Naphthyl acetate esterase stain, 155 Narcotics (opioids), 47 Nasopharynx, collection of specimens from, 244 Natural immunity, 183 Natural killer cells, 182 NBT reductase tests, 196 Necator americanus, 295 Necrotizing fasciitis, 251 X-bar-B (XB ) statistical analysis, 90 Negri bodies, 310 Neisseria gonorrhoeae, 257–258 culture of, 257, 257t direct microscopic examination of, 257 infections, 257 Neisseria meningitidis, 242, 258 direct microscopic examination, 258 infections, 258 specimens for culture, 257t, 258 Nematoda, 294 Neonatal hypogammaglobulinemia, 192 Neonatal meningitis, 270 Neonatal sepsis, 251 Neonatal transfusion, compatibility testing for, 229 Nephelometry, 6, 16, 195 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 Index Nephritis, acute interstitial, 341 Nephrogenous cAMP, 44 Nephrons, 10, 313 Nephrotic syndrome, 11, 342 Neurologic porphyrias, 26 Neuromuscular disorders, 189 Neuropenia, 150, 151 Neutralization tests, 195 Neutrophilia pathologic, 151 physiologic, 151 Neutrophils, 182, 329, 339, 348 congenital and acquired qualitative disorders of, 152–153 hereditary hypersegmentation of, 153 New World hookworm, 295 Newborn, hemolytic disease of, 231–233 Nezelof syndrome, 192 Niacin, 25 accumulation of, 276 Niemann-Pick disease, 154 Nitrate reduction, 263, 276 Nitrite test, 326 Nitroblue tetrazolium (NBT) reductase test, 191 NK cells, 184 Nocardia asteroides, 256 Nocturia, 322 Nodular small cleaved-cell lymphoma, 176 Nodular-sclerosis Hodgkin’s lymphoma, 175 Non-B lymphocytes, 182 Nonglucose mellituria, 327 Nongonococcal urethritis, 272 Non-Hodgkin’s lymphomas, 176 Non-insulin-dependent diabetes mellitus, 22 Nonlactose fermenters, 263 Nonprotein nitrogen, 10 ammonia analytic methods, 21 increased levels, 21 carbohydrates classification, 21 factors that affect glucose levels, 21 glucose disorders, 22 metabolism, 21 methods of glucose analysis, 22 creatine abnormal levels, 20 analytic methods of, 20 urea, 20 disorders of, 20 uric acid abnormal, 21 analytic methods, 20 Nonrespiratory acidosis, 19 Nonrespiratory alkalosis, 19 Non-T lymphocytes, 182 Nontreponemal antibody detection, 197 Normal flora of gastrointestinal tract, 242 general characteristics, 241–242 of genitourinary tract, 242 of mouth, 242 of respiratory tract, 242 of skin, 242 Normality, Normetanephrine, 40 Normoblastic and megaloblastic maturation, 106 Normoblasts, 123 Normocytosis, 111 401 North American blastomycosis, 302 NRBCs, 115 Nuclear chromatin, 54 Nucleic acid amplification, 276, 276, 363–364 blotting, 364 hybridization, 308, 364 isolation, 362–365, 363 Nucleocapsid, 306 -Nucleotidase (5 -NT), 35 Null lymphocytes, 166 Nutritionally variant streptococci (NVS), 252–253 O phenotype, 209 Occult blood, 357 Occupational Safety and Health Administration (OSHA) final rule for occupational exposure to formaldehyde, 379–380 guidelines for preventing transmission of Mycobacterium tuberculosis, 380 regulations for occupational exposure to bloodborne pathogens, 377–379 regulations for occupational exposures to hazardous chemicals, 379 standards, 372 Okazaki fragments, 361 Old World hookworm, 295 Oligosaccharides, 21 Oliguria, 322, 340 Oliver-Rosalki assay, 33 Onchocerca volvulus, 296 Oncofetal antigens, 25 Oncology, 365–366 Oocysts, 290 Open canalicular system, 52 Ophthalmia neonatorum, 257 Opportunistic mycoses, 301–302 Optochin (ethylhydrocuprein hydrochloride), 253 Oral thrush, 301 Organelles, 360 Organ transplantation, 235–236 Organ-specific autoimmune diseases, 188 Ornithine decarboxylase, 259 Orthochromic normoblasts, 105, 115 Orthomyxoviruses, 309 Orthonitrophenyl-B-D-galactopyranoside (ONPG) test, 265 Osmolal gap, Osmolality, 6–7, 322 Osmometry, Osmotic diarrhea, 356 Osmotic pressure, Osteomyelitis, 247 Otitis, external, 269 Otitis media, 252, 258, 270 o-Toluidine (nonenzymatic method), 22 Ouchterlony method, 194 Outreach program for laboratory, 383–384 Ovalocytosis, 114 Ovaries, 44 abnormalities of function, 46 Oxidoreductases, 30 Oxygen saturation, 19 Oxygen transport, 102 P antigen, 214 P blood group system, 214 Packed red blood cells, 221–222 18:55 P1: OSO LWBK192-INDEX 402 LWBK192-Hubbard December 8, 2008 Index Pancreas cancer of, 13 disorders of, 13 functions of, 13 tests of exocrine function, 13 Pancreatitis, 13 Pancytopenia, 121, 172 Pancytosis, 121 Pantothenic acid, 25 Papain, 208, 226 Papillomaviridae, 308 Pappenheimer bodies, 115–116 Paracentesis, 345 Paradimethylaminobenzaldehyde, 326 Parafollicular cells, 41 Paragonimus westermani, 293 Parainfluenza, 309 Paramyxoviridae, 309 Paramyxoviruses, 309 Parasites, 242 Parasitology aschelminthes Ancylosfoma braziliense, 295 Ancylostoma duodenale, 295 Ascaris lumbricoides, 294 Brugia malayi, 295 Dracunculus medinensis, 295 Enterobius vermicularis, 294–295 Loa loa, 295 Mansonella, 295 Necator americanus, 295 Onchocerca volvulus, 295 Strongyloides stercoralis, 295 Trichinella spiralis, 295 Trichostrongylus spp., 295 Trichuris trichiura, 295 Wuchereria bancrofti, 295 definition of, 289 medical significance, 289 platyhelminthes cestoda, 293–294 trematoda, 292–293 protozoa, 289 Balantidium coli, 292 mastigophora, 290–292, 291 sarcodina, 289, 290 sporozoa, 289 specimen collection, transport, and processing, 296–297 Parathyroid hormone, 42–44 Paratyphoid fever, 202 Paroxysmal cold hemoglobinuria (PCH), 189, 214 Paroxysmal nocturnal hemoglobinuria (PNH), 125, 143 Partition chromatography, Parvoviridae, 308 PAS, 155–156 Passive latex agglutination, 202 Pasteurella multocida, 259 Paternity studies, 213 Paternity testing, 236 Pathologic neutrophilia, 151 Paul-Bunnell test, 202 PC deficiencies, 82, 83 pCO2 , 19 levels, 19 PCP, 48 Pediococcus, 253 PEG, Impetigo, 225 Pelger-Hu¨et anomaly, 153 Pelvis, 10 Penicillinase-producing Neisseria gonorrhoeae, 257 Pentagastrin, 355 Pentosuria, 327 Peptide bonds, 14, 14 Peptide hormones, 36 Peptostreptococcus, 242 Peptostreptococcus anaerobius, 282 Percent solution, Pericardial fluid, 345 Pericardial fluid, collection of specimens from, 244 Pericardiocentesis, 345 Periodic acid (HIO4 ), 155 Periodic acid-Schiff, 299 Peritoneal fluid, 345 Peritoneocentesis, 345 Peritoneum, 345 Pernicious anemia, 140, 189 Peroxidase, 155 Personal protective equipment (PPE), 377 Pertussis, 168 Pesticides, 47 pH, 19 of buffer, indicator dye, 20 meter, of seminal fluid, 351 of urine, 323 Phagocyte function and kinetics, 146–147, 147t of granulocytes and monocytes, 146–149 granulopoiesis, 149 leukocyte maturation, 146, 147t Phagocytes, 182 Phagocytic cell deficiencies, 191 Phagocytosis assays, 196 Phagosome, 147 Pharmacokinetics, 51 Pharyngitis, 251 Phencyclidine, 48 Phenobarbital, 50 Phenotypes, 209, 209t Phenylalanine deaminase, 264 Phenylethyl alcohol (PEA) sheep blood agar, 248, 279 Phenylketonuria (PKU), 14, 321, 335–337 Phenylpyruvic acid, 337 Phenytoin, 50 Pheochromocytoma, 41 Philadelphia chromosome, 158 Phosphatases acid phosphatase, 32 alkaline phosphatase, 32 Phosphofructokinase, 109 Phospholipid A2 , 53 Phospholipids, 23 Phosphoric acid-phosphate system, 19 Phosphorus, 42 Photodetector, Photometric method, 35 Photons, Phylloquinone, 25 Picornaviruses, 311 Piedra, 303 Pili, 240 Pinocytosis, 306 Pinworm, 294–295 Pituitary adenoma, 38 Pituitary gland, 37 Pityriasis versicolor, 303 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 Index Placental fraction level, 32 Placental proteins, 25–26 Plasma cortisol, 40 Plasma derivatives, 223 Plasma ferritin, 28 Plasma proteins, 14 Plasma renal flow, 10 Plasma transferrin, 110 Plasmapheresis, 218 Plasminogen, 68 Plasmodium falciparum, 289–290 Plasmodium malariae, 289–290 Plasmodium ovale, 289–290 Plasmodium species, 289–290 Plasmodium vivax, 289–290 Platelet activities, laboratory measurements of, 55 drug induced abnormalities, 66 function, 53–54 histograms, 88, 90 ineffective production of, 56 pathophysiology, 55–66 physiology, 52–55 quantitative platelet disorders, 55, 56, 59 ultrastructure, 52–53, 53 Platelet activating factor (PAF), 148 Plateletpheresis, 219 Platelets, 86, 223 Platyhelminthes, 292 Plesiomonas, 267, 269t Pleural fluid, 345 Plug formation, 53 Pneumocystis, 289 Pneumocystis carinii, 311 Pneumocystis carinii pneumonia, 311 Pneumonia, 251, 253, 271, 290 Pneumocystis carinii, 311 staphylococcal, 247 Pneumovirus, 310 Poikilocytosis, 114 Poisoning carbon monoxide, 47 food, 247 lead, 27, 47–48, 338 metal, 47–48 Poliomyelitis, 311 Poliovirus, 311 Polyagglutination, 210 Polybrene, 225 Polychromatic erythroblasts, 104–105 Polychromatophilia, 115 Polyclonal antibodies, 177 Polycystic ovary syndrome, 46 Polycythemia familial, 121 secondary absolute, 121 types of, 119 Polycythemia vera (PV), 121, 159 Polycythemias, 118–119, 120, 121 Polydermatomyositis, 190 Polydipsia, 342, 343 Polymerase chain reaction (PCR), 193, 308, 363–364, 363 Polymorphonuclear leukocytes (PMNs), 182 Polymyositis, 189 Polyomaviridae, 308 Polysaccharides, 21 Polyspecific reagents, 224 Polyuria, 322, 343 Pork tapeworm, 293 Porphobilinogen, 338 Porphyria cutanea tarda, 27 Porphyrias, 26–27, 126–128 acute intermittent, 126–127 chronic, 127 congenital erythropoietic, 127 variegate, 127 Porphyrin clinical importance, 26 methods of analysis, 27 synthesis, 26 Porphyrin test, 259 Porphyrinemia, 27 Porphyrinuria, 27, 338 Porphyromonas, 280 Positive direct antiglobulin test (DAT), 212 Posthepatic jaundice, 12 Postpartum fever, 251 Postpartum infections, 272 Postrenal azotemia, 20 Post-streptococcal glomerulonephritis, 200, 339 Potassium disorders of, 18 regulation of, 18 in urine, 314 Potassium hydroxide, 299 Potentiometric methods, Poxviridae, 309 Prealbumin, 14, 352 Precipitation assays, 194 Precipitation tests for protein, 327 Precursor cells, 98 Pregnancy testing methods for, 344–345 molecular characteristics of CG, 344 Prehepatic jaundice, 12 Prerenal azotemia, 20 Prevotella, 280 Primary biliary cirrhosis, 189 Primary familial hemochromatosis, 130 Primary hyperaldosteronism, 40 Primary hyperparathyroidism, 43 Primary hypoparathyroidism, 43 Primary hypothyroidism, 41 Primary syphilis, 196 Primidone, 50 Problem solving in laboratory, 383 Procainamide, 49 Procedures manual for laboratory, 375–376 Professionalism, in laboratory management, 370–371 Proficiency test, 372 Progenitor (committed) cells, 98 Progesterone, 45 Prohormones, 36 Prokaryotic organism, 238 Prolactin (PRL), 38 Prolymphocytic leukemia (PLL), 173 Promegakaryocytes, 54 Promyelocytes, 146 Pronormoblasts (rubriblasts), 104 Propionibacterium, 282 Propionibacterium acnes, 242 Propranolol, 49 Prorubricytes, 104 Prostacyclin, 54 Prostaglandins, 10 Prostate-specific antigen (PSA), 25 403 18:55 P1: OSO LWBK192-INDEX 404 LWBK192-Hubbard December 8, 2008 Index Protein electrophoresis, 7–8 Proteins, 14, 325, 362 amino acids, 362 analysis, 15–17 catabolism, 15 classification, 15 disorders of, 17 enzymes, 362 functions of, 15 hormone transport, 36 polypeptides, 362 precipitation tests for, 327 structure of, 14 synthesis, 15 translation, 362 in urine, 17, 314 Proteinuria, 339, 340, 341, 342 Prothrombin time (PT), 373 Protoporphyria, 27 erythrohepatic, 127 Protoporphyrin, 338 Protozoa, 289 Balantidium coli, 292 mastigophora, 290–292, 291 sarcodina, 289, 290 sporozoa, 289–290 Provider-performed microscopy (PPM), 373 Proximal convoluted tubule (PCT), 314 Proximal tubules, 10 Prozone, 208 Prussian blue stain, 99, 328 PS deficiencies, 83, 83, 83t Pseudoallescheria boydii, 305 Pseudocholinesterase (PChe), 35 Pseudohyphae, 297 Pseudohypoparathyroidism (PHP), 43 Pseudomembranous enterocolitis, 281 Pseudomonas aeruginosa, 268 identification of, 268 Pseudonephritis, athletic, 330 Pseudo-Pelger Hu¨et, 161 Psychotropic drugs, 50 Pure red cell aplasia, 125 PT ratio, 70 Pyelitis, 340 Pyelonephritis, 340 Pyoderma, 251 Pyridoxal, 253 Pyridoxine, 25 Pyridoxine-responsive sideroblastic anemia, 131 Pyruvate kinase (PK) deficiency, 144 Pyuria, 340, 341 Q fever, 202 Qualitative dipstick tests, 17 Quality assurance in laboratory management, 371–372 plan for, 376 Quality control, 374–375 plots for, 372 program for, 372 in urinalysis, 315–317 Quantitative fecal fat, 357–358 examination, 13 Quantitative real-time PCR, 364 Quantitative turbidimetric methods, 17 Quinidine, 49 Rabies virus, 310 Radial immunodiffusion (RID), 16, 194 Radiant energy, Radioallergosorbent test (RAST), 195 Radioimmunoassay (RIA), 193 Radioimmunoprecipitation assay, 193 Radioimmunosorbent test (RIST), 195 Radio-iodine saturated albumin (RISA), 113 Radioisotope labels, RAEB in transformation (RAEBIT), 161 Random midstream urine specimen, 318 Range, Rapid plasma reagin (RPR) test, 197, 273 Rappaport classification of non-Hodgkin’s lymphomas, 176 Reagent strip test, 321 Rebound thrombocytopenia, 55 Rebound thrombocytosis, 55 Red blood cells (RBCs), 86, 346, 347 abnormal forms of, 114–116 channel, 91 deglycerolized, 222 disorders, 118–120, 120 hemolysis caused by membrane disorders, 142–143 histograms, 89, 91 indices, 86, 117 intravascular destruction of, 110 leukocyte-poor, 222 measurements of, 110–113, 111 morphology, 113–116 packed, 221–222 in urine, 328, 329 washed, 222 Red blood count histograms, 89, 91 Red cell distribution width (RDW), 85, 86, 86t Reduviid bug, 291 Reed-Sternberg cells, 175 Reference electrode, Reflectance photometry, 336 Refractive index, 321 Refractometer, 316, 321 Refractometry methods, 15 Refractory anemia, 125, 160 Relapsing fever, 273 Relative anemia, 120 Relative polycythemia, 119 Releasing factors, 36 Renal, see Kidneys Renal azotemia, 20 Renal calculi, 11, 342 Renal disorders, 189 Renal failure, 11 acute, 11, 341 chronic, 11, 341 Renal insufficiency, anemia of, 122 Renal pelvis, 313 Renal synthetic products, 343 Renal system, 19, 313–314 normal constituents of urine, 314 structure and function, 313 urine formation, 313–314 Renal tubular epithelial cells, 329–330 Renal tubules, 313 Renin, 10, 343, 344 Renin-ADH system, 17 Renin-aldosterone system, 17 Reovirus group, 312 Reproductive hormones, 44–46, 44t 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 Index Reptilase time (RT), 72 Respiratory acidosis, 19 Respiratory alkalosis, 19 Respiratory infections, 258 Respiratory system, 18–19 Respiratory tract, normal flora of, 242 Restriction digestion, 364 Resume, 370 Reticulocyte count, 111, 123 Reticulocyte index (RI), 112 Reticulocytes, 95, 105 Reticulocytosis, 123, 145 Retroviridae, 310–311 Reverse cAMP test, 279 Reverse grouping, 210 Reverse transcriptase enzyme, 311 Reye’s syndrome, 12, 21, 309 Rh blood group system, 210–212, 211t antibodies in, 212 Rh immune globulin (RhIG), 233 Rh29, 212 Rhabdoviruses, 310 Rh-antigen-detection reagents, 212 Rheumatic fever (RF), 200, 251 Rheumatoid arthritis, 189, 348 Rhinoviruses, 311 Rhizopus species, 301 RHnull , 212 RIA, 195 Riboflavin, 25 Rickettsial infections, 282–283, 283t Ritchie formalin-ether method, 297 Ritter’s disease, 247 RNA, 361–362 isolation, diagnosis of, 362–363 viruses, 309–312 tests for viruses, 193 Rocket electrophoresis, 194 Rocky Mountain spotted fever, 202, 282 Roller drum method, 308 Rosenfield nomenclature, 210 Rosette formation, 190 Rosetting test, 232 Rouleaux formation, 116 Rouleaux, 210, 212 Roundworms, 294 Rubella serology, 202 Rubella syndrome, congenital, 202 Rubella virus, 310 Rubivirus, 310 Rubriblasts, 104 Rubricytes, 105 Sabouraud dextrose agar (SDA), 298 Safety program, 372 Safranin O, 241 St Louis encephalitis, 311 Salicylate, 47 Salicylate intoxication, 47 Salivary amylase, 21 Salmonella, 262 Sandfly Phlebotomus spp., 291 Sarcocystis, 289 Satellite phenomenon, 259 Scalded skin syndrome, 247 Scarlet fever, 200, 251 Schistocytes, 114 Schistocytosis, 114 Schistosoma haematobium, 293, 334 Schistosoma japonicum, 293 Schistosoma mansoni, 293 Schlichter test, 286 Sch¨uffner’s dots, 290 Scianna system, 216 Scleroderma, 190 SDA with cycloheximide, 299 Se gene, 209 Secondary absolute polycythemia, 121 Secondary hyperparathyroidism, 43 Secondary hypothyroidism, 42 Secondary syphilis, 196 Secretin test, 13 Secretors, 209 Secretory diarrhea, 355–356 Secretory function, 11 Seminal fluid, analysis of, 349–351, 350 Sensitivity, 177 Sepsis, 251 Septic arthritis, 348 Serologic tests for syphilis, 220 Serology, see Immunology and serology Serous body fluids, 345–347, 346t Serum bactericidal titer, 286 Serum protein electrophoresis (SPE), 15–16, 16 Serum sickness, 187 Severe combined immunodeficiency disease, 192 Sheehan’s syndrome, 46 Sheep blood agar, 278 Shigella, 262 Shingles, 309 Sickle cell anemia, 114 Sickle cells, 114 Sickle-cell disease, 131–132 Sideroblastic anemia, 27, 130–131 Sideroblasts, 99 Simple proteins, 15 Simulium fly, 296 Single dose-response curve, 51 Sinusitis, 258 Sinusoids, 11 Sixth disease, 309 Skin normal flora of, 242 and wound infections, 246 Small lymphocytic lymphoma, 176 Sodium disorders, 17 regulation of, 17 in urine, 314 Sodium nitroprusside, 326 Solid-phase immunoassays, 308 Somatostatin, 13 Southern blot hybridization, 193 Specific granule deficiency, 191 Specific immunity, 183 Specificity, 177 Specimen collection and handling, 372 Spectrophotometer, Spectrophotometry, 4–5, 363 absorption, atomic absorption, 5, 18 types of, Sperm counts, 350 Spermatozoa, 335 Spherocytes, 114 405 18:55 P1: OSO LWBK192-INDEX 406 LWBK192-Hubbard December 8, 2008 Index Spherocyte anemia, 118 Spherocytosis, 114 Sphingolipids, 23, 153 Spirochetes, 273–274 Treponema pallidum, 273 Spleen asplenia, 96 functions of, 95–96 internal structure, 95 lymphatic tissues, 96–97 splenomegaly, 96 Splenectomy, for polycythemia, 121 Splenic trapping, 109 Splenomegaly, 96 Sporangiospores, 298 Spores, 240, 298 Sporotrichosis, 304–305 Sporozoites, 289 Spot indole test, 279 SPS disk, 279 Sputum specimen, 244 Squamous cells, 329, 329 Stains acid-fast, 241 acridine orange, 241 auramine-rhodamine, 241 calcofluor white, 241 Gram’s, 241 methylene blue, 241 Standard curve, Standard deviation (SD), 2–3 Staphylococcal pneumonia, 247 Staphylococcus, 242, 246, 246t Staphylococcus aureus, 242 infections, 246 Staphylococcus epidermidis, 242 Staphylococcus pneumoniae, 242 Staphylococcus spp., 242 Stationary adsorption, 308 Statistics, descriptive, 2–3 Steady-state drug level, 51 Steatorrhea, 356 Stem cell erythropoiesis, 121 Stem cells, 98 disorders from unipotential production of, 120 anemias, 121–125 deoxyribonucleic acid, 138–142 globin chain, 131–138 polycythemias, 120, 121 Stenotrophomonas (Xanthomonas) maltophilia, 270 Sterilization, 287 Sternheimer-Malbin stain, 328 Steroids, 36 Stomatococcus, 246, 246t, 247 Stool specimen, 244 Streptobacillus moniliformis, 271 Streptococcal infection, treatment of, 253 Streptococcal serology, 200–201 Streptococcal TSS, 251 Streptococcus agalactiae, 250t, 251 Streptococcus anginosus, 251 Streptococcus bovis, 252 Streptococcus canis, 251 Streptococcus equinus, 252 Streptococcus equisimillis, 251 Streptococcus milleri, 251, 252 Streptococcus mitis, 252 Streptococcus mutans, 252 Streptococcus pneumoniae, 249–250, 250t, 253 Streptococcus pyogenes, 250–251, 250t, 253 Streptococcus salivarius, 252 Streptococcus sanguis, 252 Streptococcus spp., 242 Streptococcus zooepidemicus, 251 Streptococcus-like organisms, 253 Streptolysin O (SLO), 200, 250 Streptolysin S, 200 Strong autoantibodies, 210 Strongyloides stercoralis, 295 Stypven time, 70 Subacute bacterial endocarditis, 252 Subcutaneous mycoses, 304–305 Substances of abuse, 48 Succinylcoenzyme A (SCA), 99, 99–100 Sucrose hemolysis test, 143 Sudan black B stains, 154–155 Sulfamethoxazole-trimethoprim (SXT), 253 Sulfonamides, 334 Sulkowitch’s test, 338 Superficial mycoses, 303 Suprapubic aspiration, 318 Surface markers, 181 Surface receptors, 183 Survival disorders, hemolytic anemias, 142–145, 144t Sweat electrolytes, 13 Symbionts, 242 Syndrome of inappropriate ADH secretion (SIADH), 38 Synergy, 286 Synovial fluid, 347–348 collection of specimens from, 244 Synthetic function, 11 Syphilis, 235, 273 tests for, 197, 220 Syphilis serology, 196–197 Systematic lupus erythematosus (SLE), 189–190, 341 Systemic mycoses, 302–303 Szasz assay, 34 Tannenbaum and Schmidt theory, 368 T helper cells (TH ), 181 T lymphocytes, 96, 181–182, 183 T suppressor cells, 181 T3 resin uptake, 42 Taenia saginata, 294 Taenia solium, 293 Tamm-Horsfall protein, 330 Tanzer-Gilvarg assay, 33 Tapeworms, 293–294 Tart cells, 190 Tear drop cells, 114 Terminal deoxynucleotidyl transferase (TdT), 182 Tertiary hypothyroidism, 42 Tertiary syphilis, 196 Testes, 45 Testicular function, abnormalities of, 45–46 Testosterone, 45, 349 Testosterone secretion, deficiency in, 123 Tetrahydrocannabinol, 48 α-Thalassemia, 137–138 β-Thalassemia, double heterozygotes for, 137 Thalassemia major, 135–136 Thalassemia minor, 135, 136 α-Thalassemia, minor, 138 Thalassemias, 131, 135–138 THC, 48 Theophylline, 50 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 Index Theory of laboratory management, 368–369 Therapeutic apheresis, 219 Therapeutic drugs anticonvulsants, 49–50 antineoplastic, 50 antipsychotic, 50 bronchodilators, 50 cardioactive, 49 monitoring of, 50–51 psychotropic, 50 Thiamine, 25 Thin-layer chromatography (TLC), Thiophen-2-carboxylic acid hydrazide, susceptibility to, 276 Third-party payment, 382 Thoracentesis, 345 Threadworm, 295 3-Hydroxybutyrate, 326 Throat, collection of specimens from, 244 Thrombin, 52, 53 Thrombin clotting time (TCT), 71 Thrombocythemia, essential, 160 Thrombocytopenia, 55, 56, 63, 64, 96, 145 Thrombocytosis, 58, 121 Thrombomodulin, 69 Thrombotic thrombocytopenia purpura (TTP), 57 Thromboxane A2 , 53, 64 Thrush, oral, 301 Thymic aplasia, 167 Thymus, 96 Thyroid antibody screens, 42 Thyroid function, assays for, 42 Thyroid gland disorders of, 41–42 hormones of, 21, 41 Thyroid hormones, 36 Thyroiditis, 42 Thyrotoxicosis, 38, 42 Thyrotropin releasing hormone (TRH), stimulation test for, 36, 37 Thyrotropin (TSH), 41 Thyroxine-binding globulin (TBG), 41 Timed collections, 318 Tinea barbae, 304 Tinea capitis, 304 Tinea corporis, 304 Tinea cruris, 304 Tinea mentagrophytes, 304 Tinea nigra, 303 Tinea pedis, 304 Tinea rubrum, 304 Tissue hypoxia, 106, 111 Tn activation, 210 Togaviridae, 310 Total cholesterol analysis, 24 Total iron binding capacity (TIBC), 122 Total nitrogen determination, 15 Toxic aplastic anemias, 124 Toxic shock syndrome (TSS), 247 Toxicants, 46 specific drugs considered to be, 46–48 Toxicity, 46 Toxicology, 46 Toxoplasma, 289, 290 Toxoplasmosis, 169 Transaminases alanine transaminase, 32–33 distribution, 33 Transferases, 30 407 Transferrin, 17, 27, 28, 128 Transfusion reactions, 230–231 Transfusion-induced hemosiderosis, 231 Transfusion-transmitted diseases, 234–235 Transmittance, Transplants, 203–205 Transudates, 345 Trematoda, 292 Treponema pallidum, 273 Treponemal antibody detection, 197 Trichinella spiralis, 295 Trichomonas, 291, 292 Trichomonas vaginalis, 292, 334 Trichophyton mentagrophytes, 304 Trichophyton rubrum, 304 Trichophyton verrucosum, 304 Trichosporon beigelli, 303 Trichostrongylus spp., 295 Trichrome technique, 297 Trichuris trichiura, 295 Triglycerides, 23 analysis of, 24 levels of, 23 Trimethylaminuria, 321 Triple phosphate, 332 Triple sugar iron agar, 263 Trophozoites, 289, 292 Trypanosoma, 291 Trypanosoma brucei gambiense, 291 Trypanosoma brucei rhodesiense, 291 Trypanosoma cruzi, 291 Trypomastigotes, 291 Trypsin, 13, 226 Tubeless gastric, analysis, 355 Tuberculin skin test, 188 Tuberculosis screening program, 380 Tubular diseases, 11 Tubular dysfunction, 340 Tubular function, 10 Tubular necrosis, 321 Tubulointerstitial disease, 340 Tubulo-interstitial nephritis, 189 Tuftsin deficiency, 191 Tularemia, 202, 260 Tumor, 205–206, 205t Tumor markers, 25–26, 205, 205t Tumor-necrosis factor (TNFα), 183 Tungsten lamps, Turbidimetry, 5, 195 Turbidity, 320 Turner’s syndrome, 46 Tween hydrolysis, 276 2-Hour postprandial blood glucose, 22 Type diabetes mellitus, 22 Type diabetes mellitus, 22 Tyrosine, 334 metabolism disorders, 337 Tyrosinemia, hereditary, 337 Tyrosinuria, 321 Ulcers, leg, 132 Ultracentrifugation, 24 Unexpected antibodies, 225–228, 226t, 228, 228t Unipotential stem cell (CFU-Meg), 54 Universal precautions, in collection and handling of clinical specimens, 244 Unstable hemoglobins, 135 18:55 P1: OSO LWBK192-INDEX 408 LWBK192-Hubbard December 8, 2008 Index Urea, 20, 264 disorders of, 20 in urine, 314 Urea agar slant, 299 Ureaplasma urealyticum, 272 Urease, 260 Urease test, 276 Uremia, 20 Ureters, 313 Urethra, 313 Urethritis, 340 Uric acid abnormal, 21 analytic methods, 20 calculi, 343 crystals, 332 in urine, 314 Urinalysis, 322 automation of laboratory, 335 quality control in, 315–317 routine, 314–315 Urinary proteins, 17 Urinary schistosomiasis, 293 Urinary tract infections (UTIs), 11, 252, 320, 340 Urine collection of specimens from, 244 formation of, 313–314 normal constituents of, 314 specimen of chemical examination of, 322–327, 323t, 324t, 325t collection methods of, 317–318 metabolic products in, 335–339 casts, 330–331, 331, 340 normal and abnormal cells in, 328–330 sediment preparation, 327–328 physical examination of, 319–322, 319t quality control in urinalysis, 315–317 routine urinalysis, 314–315 types of, 317 Urine calcium, 338 Urine casts, 330–331, 331, 340 Urine porphobilinogen, 27 Urine porphyrins, 27, 338–339 Urine sediment, preparation of, 327–328, 329 Urine tests, 27 Urinometer, 321 Urobilin, 320 Urobilinogen, 11, 111, 326, 338 in urine, 314 Urochrome, 320 Uroerythrin, 320 Uroporphyrin, 26, 338 Uroporphyrinogen III cosynthetase, 127 Uroporphyrinogen III decarboxylase, 128 Urticaria, 187 UV absorption, 15 Vaccinia, 309 Vaginitis, 292 Vaginosis, bacterial, 282 Valproic acid, 50 Vanillylmandelic acid (VMA), 40 Vapor pressure, Vapor pressure depression, Varicella zoster virus, 309 Variegate porphyria, 26, 127 Variola virus, 309 Vaso-occlusive crises, 132 Vasopressin (ADH), 38, 343 Veillonella, 282 Vel antigens, 216 Venereal Disease Research Laboratory (VDRL) slide test, 197, 273 Venipuncture, 217 Ventricular puncture, 351 Very low-density lipoproteins (VLDLs), 23 Vesicular stomatitis virus (VSV), 310 Vibrio alginolyticus, 267 Vibrio cholerae, 267 Vibrio parahaemolyticus, 267 Vibrio vulnificus, 267 Vibrionaceae, 267 Viral adsorption, 308 Viral capsid antigen (VCA), 201 Viral culture, 306 Viral detection, 308 Viral meningitis, 353 Viridans streptococci, 252 Virology DNA viruses, 308–309 RNA viruses, 309–312 specimen collection, transport, and processing, 306–308 viruses, 305–306 Virus titers, 306 Viruses replication of, 306 size of, 305–306 structure of, 306 Viscosity of supporting medium, Visible agglutination, 208 Visible spectrum, Vitamin A, 24 Vitamin B12 , 139–140 Vitamin C, 24 Vitamin D, 24 Vitamin E, 24 Vitamin K, 24 Vitamin K–dependent factors, 69 Vitamins fat-soluble, 24–25 water-soluble, 25 Voges-Proskauer test, 264 Voltage, 86 von Willebrand’s disease (vWD), 79 von Willebrand’s factor (vWF), 52, 60 Vroom’s expectancy theory, 369 Vulvovaginitis, 301 Wacker method, 33 Waldenstr¨om’s macroglobulinemia (WM), 170 Warm autoimmune hemolytic anemias (AIHAs), 189 Warts, 308 Washed red blood cells, 222 WAS protein gene (WASp), 62 Water balance, 10 Watson-Schwartz test, 338 Wavelengths, WBC/myeloperoxidase (MPO) channel, 91–92 Weil-Felix test, 202 Weil’s disease, 274 Western blot assays, 193, 308, 311 White blood cells (WBCs), 86 histogram, 87–88 in urine, 328 Whole blood, 221 Whooping cough, 259 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 Index Widal’s test, 202 Wiener nomenclature, 210 Wiskott-Aldrich syndrome, 62 Work practices, 378 Wright’s stain, 52, 98, 146 Wroblewski-Ladue method, 33 Wuchereria bancrofti, 296 Xanthomas, 23 Xenoantibodies 245, 177 Xg system, 216 X-linked agammaglobulinemia (Bruton type), 167 X-linked G6PD deficiency, 109 Yeast infections, 341 Yeasts, 334 Yellow fever, 310 Zero-order kinetics, 31, 51 Ziehl-Neelsen acid-fast stain, 274 Zinc sulfate flotation method, 297 Zollinger-Ellison syndrome, diagnosis of, 355 Zoonotic infections, 282–283, 283t Zoophilic tinea capitis, 304 Zygomycoses, 302 Zygomycota, 298, 302 Zygospores, 298 409 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 410 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 411 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 412 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 413 18:55 P1: OSO LWBK192-INDEX LWBK192-Hubbard December 8, 2008 414 18:55 [...]... 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