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2828 FM i-xvi 21/08/12 2:32 PM Page iMedicalLaboratoryScienceReviewFourth Edition

2828 FM i-xvi 21/08/12 2:32 PM Page iiOnline Resource CenterDavisPlus is your online source for a wealth of learning resources andteaching tools, as well as electronic and mobile versions of our products.Visit davisplus.fadavis.comStudentsInstructorsUnlimited free access.Upon Adoption.Sign up today to see what’savailable for your title.Password-protected library oftitle-specific, online course content.Taber’s online resources are now available across manyof the DavisPlus resource pages.Look for this iconto find Taber’s resources!Explore more online resources from est.comThe complete Davis’s Drug Guidefor Nurses database with over1,100 monographs on the web.The power of Taber’s CyclopedicMedical Dictionary on the web.Find more than 60,000 terms,1,000 images, and more.The complete database for Davis’sComprehensive Handbook ofLaboratory and DiagnosticTests with Nursing Implicationsonline. Access hundreds ofdetailed monographs.www.fadavis.com

2828 FM i-xvi 21/08/12 2:32 PM Page iiiMedicalLaboratoryScienceReviewFourth EditionROBERT R. HARR,MS, MLSAssociate Professor of Public and Allied HealthBowling Green State UniversityBowling Green, Ohio(ASCP)

2828 FM i-xvi 21/08/12 2:32 PM Page ivF. A. Davis Company1915 Arch StreetPhiladelphia, PA 19103www.fadavis.comCopyright 2013 by F. A. Davis CompanyCopyright 2013 by F. A. Davis Company. All rights reserved. This product is protected by copyright. Nopart of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic,mechanical, photocopying, recording, or otherwise, without written permission from the publisher.Printed in the United States of AmericaLast digit indicates print number: 10 9 8 7 6 5 4 3 2 1Senior Acquisitions Editor: Christa FratantoroManager of Content Development: George W. LangDevelopmental Editor: Dean W. DeChambeauArt and Design Manager: Carolyn O’BrienAs new scientific information becomes available through basic and clinical research, recommended treatmentsand drug therapies undergo changes. The author(s) and publisher have done everything possible to make thisbook accurate, up to date, and in accord with accepted standards at the time of publication. The author(s),editors, and publisher are not responsible for errors or omissions or for consequences from application of thebook, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice describedin this book should be applied by the reader in accordance with professional standards of care used in regard tothe unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.Library of Congress Cataloging-in-Publication DataHarr, Robert R.Medical laboratory science review / Robert R. Harr. — 4th ed.p. ; cm.Rev. ed. of: Clinical laboratory science review / [edited by] Robert R. Harr. c2007.Includes bibliographical references.ISBN 978-0-8036-2828-1 — ISBN 0-8036-2828-5I. Clinical laboratory science review. II. Title.[DNLM: 1. Clinical Laboratory Techniques—Examination Questions. 2. Biomedical Technology—Examination Questions. 3. Chemistry, Clinical—methods—Examination Questions. QY 18.2]610.72 4—dc232012014596Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients,is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) TransactionalReporting Service, provided that the fee of .25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers,MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system ofpayment has been arranged. The fee code for users of the Transactional Reporting Service is: / .25.

2828 FM i-xvi 21/08/12 2:32 PM Page vPrefaceThe primary purpose of the Medical Laboratory Science(MLS) Review is to assist candidates who are preparing forcertification or licensure examinations in clinical laboratory science. This review can also be used by those whowish to update their medical laboratory knowledge andrenew their theoretical skills. In addition, educators inmedical laboratory science and medical laboratory technician programs may wish to recommend this review as astudy guide for their students as they progress through thecurriculum.The MLS Review is designed to facilitate learning.Unlike other review books, the questions create a progression of related content. Explanations accompanying eachquestion expand upon the content. The Fourth Editionincludes 200 new questions for a total of more than 2,250multiple-choice questions grouped into 10 content areas.Questions appear together with answers, short explanations, test item classifications, and taxonomy levels. Thequestions of each section comprise a thorough review ofthe discipline and are ordered to facilitate the coherentunderstanding of the subject. Mock certification examscan be created using the accompanying CD to provideadditional practice. The MLS Review provides a rapid andefficient review and self-assessment. It can be used to prepare for the computer adaptive examinations for medicallaboratory scientist (MLS); medical laboratory technician(MLT); technologist in blood banking, chemistry, hematology, microbiology, and molecular biology given by theAmerican Society of Clinical Pathologists (ASCP) Boardof Certification; and for certification exams sponsored bythe American Medical Technologists (AMT).The review begins with the Introduction section, whichincludes information on the design of the questions, useof this book to prepare for an examination, and test-takingskills. The introductory section is followed by questionsarranged within 10 content areas. Each area contains a listof references, which are also recommended for further review. A mock comprehensive certification examination isgiven at the end of the question sections using questionsselected from the book. This exam will help the studentsto determine their levels of retention and learning fromthe book. The CD contains a database with over 700 questions different from those in the book, including over200 images with accompanying questions. Students canuse the CD program engine to create customized examsfor specific subjects or exams based upon difficulty.The materials in the MLS Review were prepared by educators and clinical experts who have national recognitionfor their accomplishments in medical laboratory science.Materials from recent developments in practice as well asmajor textbooks were used in formulating these questions.Peer review of the questions was performed as part of thepublication process. The MLS Review has been designedas an individual guidebook for measuring personal knowledge and test-taking skills. It should prove to be a valuabletool for ensuring the success of the student preparing fora national certification exam, course exams, or licensure,and for the practitioner updating theoretical skills.v

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2828 FM i-xvi 21/08/12 2:32 PM Page viiReviewersL ORRAINE D OUCETTE , MT(ASCP), CLS(NCA)Assistant Professor, CoordinatorMedical Laboratory Technician ProgramSchool of Health Professions, Wellness and PhysicalEducationAnne Arundel Community CollegeArnold, MarylandR ICHARD H. M ILLER , P HD, MBA, MLS(ASCP)CMFormer Program Director & InstructorClinical Laboratory Technology ProgramSouthwest Georgia Technical CollegeThomasville, GeorgiaC AMELLIA S T . J OHN , ME D , MT(ASCP)SBBAssociate ProfessorDepartment of Clinical Laboratory SciencesSchool of Health ProfessionsUniversity of Texas Medical Branch at GalvestonGalveston, Texasvii

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2828 FM i-xvi 21/08/12 2:32 PM Page ixContributorsT HOMAS S. A LEXANDER , P H D, D(ABMLI)R OBERT H ARR , MS, MLS(ASCP)Immunologist, Summa Health SystemProfessor of Clinical ImmunologyNortheast Ohio Medical UniversityRootstown, OhioChapter 3 ImmunologyDirector, LSG & AssociatesSanta Monica, CaliforniaChapter 7, Section 7.11 ParasitologyAssociate ProfessorDepartment of Public and Allied HealthMLS Program DirectorBowling Green State UniversityBowling Green, OhioChapter 5 Clinical ChemistryChapter 6 Urinalysis and Body FluidsChapter 8 Molecular DiagnosticsChapter 10 Photomicrographs and Color PlateExaminationD ENISE H ARMENING , P H D, MT(ASCP)V IRGINIA C. H UGHES , MS, MLS(ASCP)SBBDirector of the Online Masters in Clinical LaboratoryManagementAdjunct Professor, Department of Medical LaboratorySciencesCollege of Health SciencesRush UniversityChicago, IllinoisChapter 1 HematologyAssistant Professor and DirectorMedical Laboratory Science ProgramDixie State College of UtahSt. George, UtahChapter 4 ImmunohematologyL YNNE S. G ARCIA , MS, CLS, FAAMP AMELLA P HILLIPS , ME D , MT(ASCP)SMEducation Coordinator, Program in Medical LaboratoryScienceBowling Green State UniversityBowling Green, OhioChapter 7 MicrobiologyChapter 9 Education and ManagementM ITRA T AGHIZADEH , MS, MT(ASCP)Former Assistant Professor (Retired)University of Maryland School of MedicineBaltimore, MarylandChapter 2 Hemostasisix

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2828 FM i-xvi 21/08/12 2:32 PM Page xiContentsPrefacevCHAPTER3.1Introduction xiiiDesign of Questions xiiiPrepare for Your CertificationExamination xivTest-Taking Skills xivC HAP T ER 1Hematology 11.11.21.31.41.51.61.71.8C H AP T E RBasic Hematology Concepts andLaboratory Procedures 3Normocytic and Normochromic Anemias 9Hypochromic and MicrocyticAnemias 14Macrocytic and NormochromicAnemias 16Qualitative and Quantitative WhiteBlood Cell Disorders 18Acute Leukemias 21Lymphoproliferative andMyeloproliferative Disorders 26Hematology Problem Solving 312 TER75Basic Principles of Immunology 77Immunologic Procedures 83Infectious Diseases 88Autoimmune Diseases 99Hypersensitivity 103Immunoglobulins, Complement,and Cellular Testing 106Tumor Testing and Transplantation 109Immunology Problem Solving 1134 s and Immunology of BloodGroups 123ABO Blood Group System 126Rh Blood Group System 130Testing for Antibodies 134Compatibility Testing 140Transfusion Reactions 145Components 149Donors 1544.9Hemolytic Disease of the Newborn(HDN) 1584.10 Serological Testing of BloodProducts 1624.11 Immunohematology ProblemSolving 16441Coagulation and FibrinolyticSystems/Reagents and Methods 43Platelet and Vascular Disorders 48Coagulation System Disorders 53Inhibitors, Thrombotic Disorders,and Anticoagulant Drugs 57Hemostasis Problem Solving 653 ImmunologyCHAPTER5 Clinical Chemistry5.15.2171Instrumentation 173Blood Gases, pH, and Electrolytes 190xi