- Universal red cell donor
- Group O — O red cells carry no A or B antigen; O negative is the emergency universal donor because it also lacks the D antigen.
- Universal red cell recipient
- Group AB — AB plasma has neither anti-A nor anti-B, so an AB patient can receive red cells of any ABO type.
- ABO isoagglutinins
- Naturally occurring antibodies to the ABO antigen a person lacks: group A has anti-B, group B has anti-A, group O has both, group AB has neither.
- Forward vs reverse ABO typing
- Forward tests the patient's red cells with anti-A/anti-B reagents; reverse tests the patient's plasma against A1 and B cells. The two must agree.
- ABO discrepancy
- A mismatch between forward and reverse typing. Resolve it (repeat with washed cells, review age/diagnosis/transfusion history) before transfusing.
- Bombay phenotype (hh)
- Lacks the H antigen (the A/B precursor), so no A, B, or H antigen; types as O but makes potent anti-H and needs Bombay (hh) blood.
- D antigen
- The most immunogenic Rh antigen. Rh-negative people readily form anti-D after exposure; anti-D causes the classic severe HDFN.
- Direct antiglobulin test (DAT)
- Detects red cells already coated in vivo with antibody or complement; run on washed patient cells with no incubation. Used in HDFN, AIHA, transfusion reactions.
- Indirect antiglobulin test (IAT)
- Detects in vitro sensitization by incubating patient plasma with reagent cells; basis of the antibody screen, antibody ID, and antiglobulin crossmatch.
- Anti-human globulin (AHG) reagent
- The Coombs reagent that bridges IgG or complement bound to red cells, producing visible agglutination in the DAT and IAT.
- Antibody screen
- Tests patient plasma against 2–3 reagent screening cells to detect clinically significant unexpected (non-ABO) antibodies before transfusion.
- Major crossmatch
- Donor red cells tested against recipient plasma — the clinically essential test that detects recipient antibodies that could destroy transfused cells.
- Electronic (computer) crossmatch
- Acceptable when the antibody screen is negative and there is no antibody history; its only remaining job is confirming ABO compatibility.
- Dosage effect
- An antibody reacts more strongly with homozygous (double-dose) than heterozygous cells; classic for Kidd (Jka/Jkb) and Duffy antibodies.
- Kidd antibodies (anti-Jka)
- Show dosage and fall below detection between exposures, so they are missed on screening and cause delayed (anamnestic) hemolytic transfusion reactions.
- Acute hemolytic transfusion reaction
- The most dangerous reaction — almost always an ABO mismatch from an ID/clerical error. Fever, flank pain, and free hemoglobin in post-transfusion plasma.
- Febrile non-hemolytic transfusion reaction (FNHTR)
- A temperature rise of at least 1°C with chills during transfusion, without hemolysis; from recipient antibodies to donor leukocytes/cytokines.
- Delayed hemolytic transfusion reaction (DHTR)
- Days after transfusion: falling hemoglobin, a newly positive DAT and antibody screen — an anamnestic antibody (often Kidd) re-emerging.
- Hemolytic disease of the fetus and newborn (HDFN)
- Maternal IgG crosses the placenta and hemolyzes fetal red cells. Classic severe form: anti-D in a sensitized Rh-negative mother; ABO HDFN is milder.
- Rh immune globulin (RhIG)
- Anti-D given to D-negative mothers to prevent anti-D alloimmunization after exposure to D-positive fetal cells.
- Kleihauer-Betke test
- Quantifies fetal red cells in maternal blood (fetal hemoglobin resists acid) to calculate the RhIG dose after a fetomaternal hemorrhage.
- Platelet storage
- 20–24°C (room temperature) with continuous gentle agitation, up to 5–7 days. Never refrigerated — cold activates and clears platelets.
- Washed red blood cells
- Plasma (including IgA) removed; used for IgA-deficient patients or those with repeated allergic/anaphylactic reactions.
- Irradiated blood components
- Prevent transfusion-associated graft-versus-host disease by inactivating donor lymphocytes; used in immunocompromised recipients.
- Cryoprecipitate
- Concentrates fibrinogen, factor VIII, von Willebrand factor, and factor XIII; used for fibrinogen replacement.
- Acquired B phenomenon
- Bacterial deacetylase modifies the group A sugar so anti-B reagent weakly reacts; seen in gram-negative sepsis or colon carcinoma.
- Lewis blood group system
- Lewis antigens are adsorbed onto red cells from plasma, not synthesized by the red cells — a unique feature of the system.
- Muddy-brown granular casts
- The hallmark of acute tubular necrosis, formed from sloughed tubular epithelial debris.
- Red blood cell casts
- Indicate glomerular bleeding; characteristic of acute glomerulonephritis. Casts localize the finding to the kidney.
- White blood cell casts
- Indicate renal inflammation/infection such as pyelonephritis.
- Broad and waxy casts
- Seen in chronic renal failure with marked urine stasis — long-standing, severe renal damage.
- Oval fat bodies
- Renal tubular cells filled with absorbed lipid; seen in nephrotic syndrome with heavy proteinuria.
- Hexagonal urine crystals
- Cystine crystals — diagnostic of cystinuria, an inherited disorder of cystine transport.
- Ascorbic acid (vitamin C) interference
- High urine vitamin C causes falsely low or negative blood, glucose, and bilirubin reagent-strip pads.
- Bacterial meningitis CSF pattern
- High WBC with neutrophil predominance, high protein, and LOW glucose (bacteria consume it).
- Viral meningitis CSF pattern
- Lymphocyte-predominant pleocytosis with normal glucose and normal-to-mildly elevated protein.
- Normal CSF glucose
- About 60–70% of the simultaneous plasma glucose; always interpret CSF glucose against a paired plasma sample.
- Light's criteria
- Distinguish a transudate from an exudate in serous fluid; meeting any one criterion (fluid:serum protein or LDH ratios, or high LDH) makes it an exudate.
- Nitrite + leukocyte esterase
- Reagent-strip screen for urinary tract infection; both positive strongly suggests infection.
- Specific gravity (strip vs refractometer)
- The reagent-strip pad reads only ionic solutes; a refractometer responds to all solutes, so they disagree with heavy non-ionic solutes like contrast media.
- Anion gap
- Na − (Cl + HCO₃), normally ~8–12 mmol/L. A high gap = metabolic acidosis from unmeasured acids (lactate, ketoacids, toxins).
- Hemoglobin A1c
- Reflects average glucose over ~2–3 months; ≥6.5% is diagnostic of diabetes, 5.7–6.4% is prediabetes.
- Oral glucose tolerance test (diabetes)
- A 2-hour value of ≥200 mg/dL after a 75-gram glucose load is diagnostic of diabetes mellitus.
- Friedewald equation
- LDL = total cholesterol − HDL − (triglycerides ÷ 5); valid only when triglycerides are below ~400 mg/dL.
- Cardiac troponin
- The most cardiac-specific and sensitive marker of myocardial injury; the standard biomarker for diagnosing myocardial infarction.
- CK-MB role today
- With high-sensitivity troponin, CK-MB's main remaining use is estimating infarct size and detecting reinfarction (shorter half-life).
- Alkaline phosphatase (ALP)
- Rises in cholestatic liver disease and in bone disease (bone turnover); a key cholestasis marker.
- AST:ALT ratio > 2:1
- Suggests alcoholic liver disease; both enzymes mark hepatocellular injury.
- Lipase vs amylase
- Lipase is more pancreas-specific and stays elevated longer than amylase in acute pancreatitis.
- Calculated serum osmolality
- 2 × Na + glucose/18 + BUN/2.8. An osmolal gap (measured − calculated) over ~10 suggests a toxic alcohol.
- Respiratory vs metabolic acidosis
- Both lower pH; respiratory has a high PCO₂ (moves opposite pH), metabolic has a low HCO₃ (moves with pH).
- Blood gas reference ranges
- pH 7.35–7.45, PCO₂ 35–45 mmHg, HCO₃ 22–26 mmol/L.
- Therapeutic drug monitoring trough
- The lowest (pre-dose) concentration; measured to ensure the drug stays in range and is not subtherapeutic or toxic.
- Primary hyperparathyroidism pattern
- High parathyroid hormone (PTH) with high serum calcium.
- Cystatin C
- A GFR marker unaffected by muscle mass, unlike creatinine — a more reliable estimate of glomerular filtration.
- Acute intermittent porphyria test
- Elevated urinary porphobilinogen is the key diagnostic finding.
- Mean corpuscular volume (MCV)
- Average red cell size: microcytic <80 fL, normocytic 80–100 fL, macrocytic >100 fL — the first step in classifying anemia.
- Microcytic anemia causes
- Iron deficiency (low ferritin, high TIBC), thalassemia, anemia of chronic inflammation, sideroblastic anemia.
- Macrocytic anemia causes
- B12 or folate deficiency (megaloblastic — hypersegmented neutrophils), liver disease/alcohol, reticulocytosis, myelodysplastic syndrome.
- Iron-deficiency anemia labs
- Low ferritin, high total iron-binding capacity (TIBC), low transferrin saturation, and a microcytic hypochromic smear.
- Ferritin
- The body's main iron-storage protein; a low ferritin is the most specific indicator of iron deficiency.
- PT / INR
- Measures the extrinsic and common pathways (tissue factor, factor VII); monitors warfarin.
- aPTT
- Measures the intrinsic and common pathways (factors XII, XI, IX, VIII); monitors unfractionated heparin.
- Vitamin-K-dependent factors
- Factors II, VII, IX, and X (mnemonic 1972). Warfarin lowers them; the PT prolongs first because factor VII has the shortest half-life.
- Hemophilia A vs B
- Hemophilia A = factor VIII deficiency; hemophilia B (Christmas disease) = factor IX deficiency. Both prolong the aPTT.
- Auer rods
- Needle-shaped cytoplasmic inclusions of fused primary granules in myeloblasts — diagnostic of acute myeloid leukemia.
- Philadelphia chromosome
- t(9;22) translocation producing the BCR-ABL1 fusion gene — the hallmark of chronic myeloid leukemia (CML).
- t(15;17) PML-RARA
- Pathognomonic for acute promyelocytic leukemia (APL).
- JAK2 V617F mutation
- Found in most myeloproliferative neoplasms, including polycythemia vera.
- Reed-Sternberg cells
- Large binucleate cells diagnostic of Hodgkin lymphoma.
- Schistocytes
- Fragmented helmet/triangle red cells of microangiopathic hemolytic anemia (DIC, TTP, HUS); a negative DAT supports a mechanical cause.
- DIC laboratory findings
- Prolonged PT and aPTT, low platelets, low fibrinogen, and an elevated D-dimer from widespread clotting and fibrinolysis.
- Teardrop cells (dacrocytes)
- Suggest myelofibrosis with extramedullary hematopoiesis.
- Howell-Jolly bodies
- Nuclear remnants in red cells, normally removed by the spleen; their presence indicates a post-splenectomy or hyposplenic state.
- Hereditary spherocytosis test
- Increased osmotic fragility — spherocytes rupture readily in hypotonic solution.
- Factor V Leiden
- The most common inherited thrombophilia; factor V resists inactivation by activated protein C, raising venous thrombosis risk.
- Reticulocyte count stain
- Supravital stains (new methylene blue) precipitate residual ribosomal RNA in reticulocytes, gauging marrow response.
- Sickle cell mutation
- Glutamic acid replaced by valine at position 6 of beta-globin, producing hemoglobin S and sickle-shaped cells.
- IgM antibody
- A pentamer, first made in the primary immune response, and the most efficient complement activator. Cannot cross the placenta.
- IgG antibody
- The most abundant serum immunoglobulin, dominant in the secondary response, and the only class that crosses the placenta (so it causes HDFN).
- IgA antibody
- The predominant immunoglobulin in mucosal secretions (GI, respiratory, urogenital tracts).
- Type I hypersensitivity
- Immediate, IgE-mediated mast-cell degranulation — allergy and anaphylaxis.
- Type II hypersensitivity
- Antibody-mediated cytotoxicity against cell-surface antigens — e.g. a hemolytic transfusion reaction.
- Type III hypersensitivity
- Immune-complex deposition — serum sickness and systemic lupus erythematosus.
- Type IV hypersensitivity
- Delayed, T-cell-mediated, appearing 48–72 hours later — contact dermatitis and the PPD (tuberculin) reaction.
- Antinuclear antibody (ANA)
- Autoantibodies against nuclear components; the indirect immunofluorescence screen on HEp-2 cells is the gold standard for SLE.
- Rheumatoid factor
- An autoantibody, usually IgM, directed against the Fc region of the patient's own IgG.
- MHC class I vs class II
- Class I presents endogenous antigen to CD8+ cytotoxic T cells; class II presents exogenous antigen to CD4+ helper T cells.
- Complement central step
- Cleavage of C3 by a C3 convertase — the convergence point of the classical, alternative, and lectin pathways.
- Natural killer (NK) cells
- Innate lymphocytes that kill target cells without antigen-specific receptors.
- Heterophile (Monospot) test
- Detects heterophile IgM antibodies of infectious mononucleosis that agglutinate animal red cells and are not adsorbed by guinea pig kidney.
- Syphilis serology
- Nontreponemal screens (RPR/VDRL) are confirmed by treponemal tests (e.g. MHA-TP/FTA-ABS).
- Gram stain interpretation
- Read the reaction (color), morphology (shape), and arrangement. Gram-positive retains crystal violet (thick peptidoglycan); Gram-negative is pink.
- Catalase test
- Adds H₂O₂ to Gram-positive cocci; bubbling (positive) = staphylococci, no bubbling (negative) = streptococci/enterococci.
- Coagulase test
- Distinguishes Staphylococcus aureus (coagulase-positive, clots rabbit plasma) from coagulase-negative species like S. epidermidis.
- Streptococcus pyogenes
- Beta-hemolytic group A strep; catalase-negative, bacitracin- and PYR-positive.
- Streptococcus pneumoniae
- Alpha-hemolytic, optochin-sensitive, bile-soluble Gram-positive diplococcus.
- Enterococcus identification
- Catalase-negative Gram-positive cocci in chains; bile-esculin positive and grows in 6.5% NaCl.
- Oxidase test
- Detects cytochrome c oxidase; positive in Pseudomonas and Neisseria, negative in Enterobacterales.
- Escherichia coli
- Oxidase-negative, lactose-fermenting Gram-negative rod (pink on MacConkey); a common cause of UTIs.
- Pseudomonas aeruginosa
- Oxidase-positive non-fermenting Gram-negative rod producing blue-green pigment and a grape-like odor.
- Proteus mirabilis
- Urease-positive, swarming, non-lactose-fermenting Gram-negative rod.
- Acid-fast stain
- The Ziehl-Neelsen stain detects mycolic-acid-rich cell walls; identifies Mycobacterium species such as M. tuberculosis.
- Minimum inhibitory concentration (MIC)
- The lowest antimicrobial concentration that visibly inhibits growth; compared to CLSI (M100) breakpoints to report susceptibility.
- Kirby-Bauer disk diffusion
- Gives a categorical susceptibility result from zone-of-inhibition diameters using a standardized 0.5 McFarland inoculum.
- Cryptococcus neoformans
- Encapsulated budding yeast seen with India ink; associated with bird droppings and severe infection in the immunocompromised.
- Candida albicans germ tube
- A germ tube extending from the yeast with no constriction at its base presumptively identifies Candida albicans.
- Listeria monocytogenes
- Motile beta-hemolytic Gram-positive rod that grows at 4°C (cold enrichment); catalase-positive.
- Levey-Jennings chart
- Plots daily control values against the mean with ±1, ±2, and ±3 SD bands to reveal trends and shifts in test performance.
- Westgard 1₃s rule
- Reject the run when one control value exceeds ±3 SD; investigate before reporting patient results.
- Westgard 1₂s rule
- A warning (not an automatic rejection) when one value falls between ±2 and ±3 SD; inspect with other multirules.
- Accuracy vs precision
- Accuracy is closeness to the true value; precision is reproducibility of repeats (measured by SD and CV). A method can be precise but inaccurate.
- Proficiency testing
- Blind samples sent to many labs and compared to verify a lab's accuracy against peers; a CLIA requirement for many analytes.
- Delta check
- Compares a patient's current result with a recent prior result; a large unexplained change flags a possible specimen mix-up or error.
- CLIA
- The Clinical Laboratory Improvement Amendments — federal regulations setting minimum quality standards for all U.S. clinical laboratory testing.
- Sensitivity vs specificity
- Sensitivity = the fraction of true positives a test detects; specificity = the fraction of true negatives it correctly identifies.
- Beer's law
- Absorbance is proportional to analyte concentration and path length; the basis of quantitative spectrophotometry.