Sunday, February 8, 2015

Hematology and chemical pathology mnemonics

An awesomite requested for Pathology hematology bottles mnemonics. I asked him (or her) to send notes and attempted to make lame mnemonics on the same.

Uploading the notes + mnemonics for reference:

THE PURPLE ONE (aka “Lavender”)
These bottles are generally used for haematology tests where whole blood is required for analysis.

ADDITIVE: EDTA (ethylenediaminetetraacetic acid)

COMMON TESTS:
Full blood count (FBC)
Erythrocyte sedimentation rate (ESR)
Blood film for abnormal cells or malaria parasites
Reticulocyte
Red cell folate
Monospot test for EBV
HbA1C for diabetic control
Parathyroid hormone (PTH)*
less commonly used for: ciclosporin/tacrolimus levels, some viral PCR tests, G6PD, ACTH level*, porphyria screen*, plasma metanephrines*, fasting gut hormone screen*

Mnemonic: PurplE
P: Parasite, PTH, PCR, Porphyria
E: EDTA


THE PINK ONE
The pink bottles work in the same way as the purple ones, but are specifically used only for whole blood samples being sent to the transfusion lab.

ADDITIVE: This tube also contains the anticoagulant EDTA.

COMMON TESTS:
Group and save (G&S) -o
Crossmatch (XM) –
Direct Coomb’s test (aka direct antiglobulin test) for autoimmune haemolytic anaemia

Mnemonic: We could remember that pink is similar the colour of blood (red) and that's why it's used in blood being sent in transfusion labs.

THE BLUE ONE
The blue bottle is used for haematology tests involving the clotting system, which require inactivated whole blood for analysis.

ADDITIVE: Contains buffered sodium citrate

COMMON TESTS:
Coagulation screen including Bleeding time for platelet function, Prothrombin time (PT) for extrinsic pathway, activated partial thromboplastin time (APTT) for intrinsic pathway, and thrombin time (TT) or fibrinogen assay for the final common pathway
D-dimer for thrombosis e.g. due to DVT or PE
INR for monitoring patients on warfarin (this is calculated from the prothrombin time)
activated partial thromboplastin ratio (APTR) for monitoring patients on IV heparin infusions (this is calculated from the APTT)
anti-Xa assay for monitoring patients on high-dose low molecular weight heparins like tinzaparin
less commonly used for: specific clotting factors e.g. factor VIII, factor IX, von Willebrand factor, thrombophilia screen, lupus anticoagulant.

Mnemonic: Sing the song, "Blue is my heart so cold"
Modify it to "Blue is my blood so clotted" :P
So the blue bottle is for studying the clotting system.
Next to B is the alphabet C: Blue Buffered sodium Citrate!

THE YELLOW ONE (aka “Gold”)

ADDITIVE: this tube is known in the lab as the SST (serum separating tube). It contains two agents; silica particles and a serum separating gel. The silica particles work to activate clotting and cause the blood cells to clump together. The serum separator consists of an inert polymer gel which floats as a layer between the blood cells and plasma to form a physical barrier between them. This means that the sample can be centrifuged (spun) in the lab and the separated serum easily removed.

COMMON TESTS:
Biochemistry tests are the ones you will encounter most commonly:
urea and electrolytes (U+E) – this includes urea, creatinine, sodium and potassium
C-reactive protein (CRP)
liver function tests (LFTs) – this includes bilirubin, ALP, AST/ALT, GGT, total protein and albumin
amylase assay
bone profile - this includes calcium, phosphate, ALP and albumin
magnesium assay
iron studies - this includes serum iron, ferritin, transferrin saturation and total iron binding capacity
lipid profile – this includes cholesterol, LDL, HDL and triglycerides

Mnemonic: Yellow makes cells go low, oh so slow.
So that's why it's separating serum from the cells (going low), and uses silica (slow).

THE GREY ONE
The grey bottle is only used for two tests, so compared to the yellow one it’s fairly easy to remember! It is used for biochemistry tests requiring whole blood for analysis.

ADDITIVE: contains two main agents. Sodium fluoride acts as an antiglycolytic agent to ensure that no further glucose breakdown occurs within the sample after it is taken. Potassium oxalate acts as an anticoagulant. Some variants of the grey bottle use EDTA as the anticoagulant instead.

COMMON TESTS:
Glucose - this can be fasting or non-fasting, or part of a glucose tolerance test (GTT)
Lactate
less commonly used for: blood Ethanol if not for legal purposes.

Mnemonic: Grey: GrEy: Glucose r Ethanol y

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