ASCP MLT Cheat Sheet

Blood Banking

15-20% of exam
ABO/Rh Antibodies Compatibility Components Reactions

Chemistry

20-25% of exam
Electrolytes Enzymes Acid-Base TDM Interferences

Hematology

20-25% of exam
CBC Morphology Anemias Coagulation Differentials

Microbiology

15-20% of exam
Gram Stain Culture Biochemicals AST Specimens

Urinalysis + Fluids

5-10% of exam
Dipstick Sediment Casts CSF Synovial

Immunology

5-10% of exam
ANA HBV HIV Syphilis Complement

Laboratory Operations

5-10% of exam
QC Safety Specimens Instrumentation Compliance

Quick Facts

Exam MLT(ASCP)
Questions 100 MCQ
Time 2 hr 30 min
Format CAT
Pass 400 scaled
Scale 100-999
Fee $235
Delivery Pearson VUE

ABO Memory BL

Plasma logic reverses RBC logic
O RBC AB plasma Forward antigen Reverse antibody

RBC vs Plasma Compatibility BL

RBC

Avoid donor antigens
O is broad

Plasma

Avoid donor antibodies
AB is broad
Antigens vs antibodies

Blood Bank Picker BL

Forward/reverse agree → Report ABO
ABO discrepancy → Resolve first
Positive screen → Antibody panel
Known antibody → Antigen-negative RBC
No antibody history → Electronic XM
Transfusion reaction → Clerical check

ABO/Rh BL

Forward type Patient RBC antigens
Reverse type Patient plasma antibodies
Group O RBC Universal emergency RBC
Group AB plasma Universal donor plasma
Weak D donor Report Rh positive
Weak D patient Policy dependent

Screen vs Panel BL

Screen

Detects unexpected antibody
Few reagent cells

Panel

Identifies specificity
Many reagent cells
Find vs name

Compatibility BL

Antibody screen Unexpected antibodies
Panel Identify specificity
Major crossmatch Recipient plasma donor RBC
Electronic XM Validated negative screen
History antibody Honor forever
DAT In-vivo coating

Components + Reactions BL

RBC Oxygen capacity
Platelets Thrombocytopenia support
FFP Multiple factor replacement
Cryo Fibrinogen source
AHTR Clerical mismatch first
TRALI Acute respiratory distress

Chemistry QC CH

QC before patients, delta before panic
QC first Check specimen Check identity Hold results

Direct vs Indirect ISE CH

Direct ISE

Undiluted sample
Less lipemia effect

Indirect ISE

Diluted sample
Pseudohyponatremia risk
Undiluted vs diluted

Chemistry Picker CH

High potassium → Check hemolysis
Low sodium lipemic → Direct ISE
Metabolic acidosis → Anion gap
TDM ordered → Timing trough
Delta failed → Verify identity
QC shifted → Hold results

Chemistry Panels CH

Glucose Carbohydrate status
BUN Renal nitrogen
Creatinine Renal filtration marker
Bilirubin Heme breakdown
ALT Hepatocellular injury
ALP Cholestasis or bone
Troponin Myocardial injury

Chemistry Calculations CH

Anion gap Na - Cl - CO2
Osmolality Solute concentration
Delta check Prior-result comparison
Dilution factor Final over sample
Creatinine clearance Timed urine estimate
Corrected calcium Albumin-adjusted calcium

Interferences CH

Hemolysis False potassium high
Lipemia Photometric turbidity
Icterus Bilirubin interference
EDTA contamination Calcium falsely low
Direct ISE Lipemia resistant
Indirect ISE Pseudohyponatremia risk

Coag Screen HE

PT warfarin, aPTT heparin
PT extrinsic aPTT intrinsic INR warfarin

PT vs aPTT HE

PT

Extrinsic/common
Warfarin screen

aPTT

Intrinsic/common
Heparin screen
Seven vs twelve

Hematology Picker HE

Microcytic anemia → Iron studies
Macrocytic anemia → B12/folate
Schistocytes present → Hemolysis workup
Platelet clumps → Recollect citrate
Prolonged PT → Extrinsic pathway
Prolonged aPTT → Intrinsic pathway

CBC + Indices HE

MCV Cell size
MCHC Hemoglobin concentration
RDW Size variation
Reticulocyte Marrow response
Left shift Immature neutrophils
Pancytopenia All lines low

Microcytic vs Macrocytic HE

Microcytic

Low MCV
Iron/thalassemia

Macrocytic

High MCV
B12/folate
Small vs large

Morphology HE

Spherocytes Membrane loss
Schistocytes Fragmentation hemolysis
Target cells Liver or thalassemia
Teardrops Marrow infiltration
Sickle cells HbS disease
Auer rods Myeloid blasts

Coagulation HE

PT Extrinsic pathway
aPTT Intrinsic pathway
INR Warfarin monitoring
D-dimer Fibrin breakdown
Fibrinogen Clot substrate
Mixing study Deficiency or inhibitor

Cocci Split MI

Clusters catalase, chains strep
Staph clusters Strep chains Catalase split

Gram Positive vs Negative MI

Gram positive

Purple
Thick peptidoglycan

Gram negative

Pink
Outer membrane
Purple vs pink

Micro Picker MI

Clusters cocci → Catalase
Chains cocci → Strep workup
Oxidase negative rod → Enteric ID
Oxidase positive rod → Nonfermenter ID
Positive blood culture → Gram stain
AST invalid QC → Do not report

Gram ID MI

Staphylococcus Gram-positive clusters
Streptococcus Gram-positive chains
Enterococcus Bile esculin positive
Enterobacterales Oxidase negative rods
Pseudomonas Oxidase positive rod
Neisseria Gram-negative diplococci

Culture + AST MI

Blood culture Critical positive
Urine culture Quantify growth
Throat culture Group A strep
Chocolate agar Fastidious organisms
Kirby-Bauer Disk diffusion AST
MIC Lowest inhibitory level

Urine Casts UA

Casts localize damage to tubules
RBC glomerular WBC inflammation Waxy chronic

Transudate vs Exudate UA

Transudate

Pressure imbalance
Lower protein

Exudate

Inflammation
Higher protein
Pressure vs inflammation

Urinalysis UA

Specific gravity Concentration estimate
Nitrite Nitrate reducers
Leukocyte esterase WBC enzyme
Blood pad Heme pigment
RBC casts Glomerular bleeding
Waxy casts Chronic renal stasis

Body Fluids UA

CSF Process immediately
Bacterial CSF Neutrophils high protein
Light criteria Exudate classification
Urate crystals Needle negative
CPPD crystals Rhomboid positive
Amniotic fluid Fetal lung testing

HBV Markers IM

Surface antigen means current infection
HBsAg current Anti-HBs immune IgM acute

Treponemal vs Nontreponemal IM

Treponemal

Specific confirmation
Often stays reactive

Nontreponemal

Screen/monitor
Titer follows therapy
Confirm vs monitor

Immunology Serology IM

ANA Sensitive nonspecific screen
Anti-dsDNA SLE association
Anti-CCP RA specificity
HBsAg Current HBV infection
Anti-HBs HBV immunity
RPR/VDRL Nontreponemal monitoring
IgM Primary response
IgG Placental transfer

Random vs Systematic Error OP

Random

Imprecision
Isolated event

Systematic

Bias
Shift or trend
Scatter vs bias

Operations Picker OP

Unlabeled specimen → Reject
QC out → Troubleshoot first
Critical verified → Notify provider
Needlestick occurs → Wash/report
Chemical spill → SDS procedure
Corrected result → Document correction

Quality + Safety OP

Preanalytical Before analysis
Analytical During measurement
Postanalytical After analysis
Random error Imprecision event
Systematic error Bias or shift
PT testing Patient-like handling
SDS Chemical safety
Critical value Notify and document

Common Traps

Scaled Score

400 is scaled ≠ 400 is not 40%

CAT Pacing

Answer every question ≠ No skipping ahead

Historical Antibodies

Honor history ≠ Do not ignore screen

Failed QC

Hold patient results ≠ Do not annotate later

Hemolyzed Potassium

Check specimen integrity ≠ Do not overdiagnose hyperkalemia

Positive ANA

Sensitive screen ≠ Not diagnostic alone

Dipstick Blood

Heme pigment test ≠ Not always RBCs

PT Sharing

Test like patients ≠ Never discuss answers

Last Minute

1. Chemistry and hematology dominate
2. Blood bank: resolve discrepancies first
3. History antibodies require antigen-negative RBCs
4. QC failure means hold results
5. Hemolysis raises potassium falsely
6. PT extrinsic; aPTT intrinsic
7. Gram stain guides workup
8. CSF cells deteriorate quickly
9. HBsAg means current HBV
10. RPR monitors; treponemal confirms
11. Critical values need documentation
12. 400 scaled is not percent

ASCP Medical Lab Technician (MLT)

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