CSMLS MLA Exam cheat sheet

Scope of practice: the MLA performs pre-analytical and some post-analytical tasks (collection, accessioning, processing, aliquoting, instrument loading, data entry); result interpretation and releasing diagnostic reports belong to the technologist or pathologist.

Order of draw (CLSI GP41, skin puncture and venipuncture): blood culture bottles, then sodium citrate (light blue), serum tube with or without clot activator or gel (red/gold), heparin (green), EDTA (lavender), glycolytic inhibitor (grey).

Additive actions: EDTA chelates calcium (hematology); sodium citrate reversibly binds calcium (coagulation, 9:1 blood-to-additive ratio); heparin potentiates antithrombin (chemistry); fluoride inhibits glycolysis and oxalate binds calcium (glucose, lactate).

Rejection criteria: unlabelled or mislabelled specimens, missing or mismatched requisition, wrong tube for the test, clotted anticoagulated blood, gross hemolysis when it interferes, insufficient volume, expired collection device, and improper transport temperature.

Specimen integrity checks: verify label against requisition (two identifiers), inspect for hemolysis, lipemia, icterus, clots, and volume; document and report discrepancies rather than silently correcting them.

Critical (panic) values must be phoned to the responsible caregiver within a defined turnaround time, read back verbatim, and documented with date, time, value, recipient name and caller.

Quality indicators for the pre-analytical phase: specimen rejection rate, mislabelling rate, collection turnaround time, hemolysis index, and patient/specimen identification error rate; these are tracked and trended.

Turnaround time = report time minus collection time; the pre-analytical portion typically accounts for the majority of laboratory errors, so collection and transport steps carry the highest risk.

Patient identification: use at least two independent identifiers (full name plus date of birth or unique health number); never use room or bed number; label at the bedside immediately after collection.

Venipuncture order and technique: apply tourniquet for no more than 1 minute, cleanse with 70% isopropyl alcohol and allow to dry, use the appropriate gauge needle (21–23 G for routine adult draws), and release the tourniquet before removing the needle.

Hemolysis avoidance: use appropriate needle gauge, avoid excessive vacuum or pulling on a syringe plunger, do not shake tubes, allow alcohol to dry, and avoid drawing from a site distal to an IV line.

Capillary (skin puncture) collection: warm the site, cleanse, puncture the side of the fingertip or heel (medial or lateral plantar surface in infants), wipe the first drop, and avoid squeezing to prevent hemolysis and tissue fluid dilution.

Timed and special collections: 24-hour urine requires discarding the first void, collecting all subsequent voids including the final one at the endpoint, refrigeration or appropriate preservative, and documented start/stop times.

Transport requirements: most chemistry and hematology specimens are transported at room temperature; ammonia, blood gases, lactate and some hormones require ice or immediate analysis; light-sensitive analytes (bilirubin, vitamin B12) need amber protection.

Blood culture collection: collect before antimicrobial therapy, cleanse the bottle septum, inoculate aerobic and anaerobic bottles, and never refrigerate; transport at room temperature.

Chain of custody: for forensic, workplace drug testing or legal specimens, maintain an unbroken documented record of every person who handled the specimen, with signatures, dates and times.

Routine Practices (previously Universal Precautions) apply to all blood, body fluids, secretions, non-intact skin and mucous membranes regardless of perceived risk; treat every specimen as potentially infectious.

Hand hygiene is the single most effective control measure; perform it before and after patient contact, after glove removal, and after contact with contaminated surfaces.

Personal protective equipment: gloves for all specimen contact, gowns when splash risk exists, face and eye protection for splash or aerosol-generating procedures; remove PPE before leaving the work area.

Sharps safety: never recap, bend or break needles by hand; use engineered sharps containers located at point of use, fill to no more than the marked line, and report every needlestick immediately.

Post-exposure management: wash the site with soap and water, flush mucous membranes, report immediately, and follow the institution's protocol for source testing (HIV, HBV, HCV) and post-exposure prophylaxis.

Chemical safety: the WHMIS/SDS system provides hazard classification, handling, and first-aid information; know the location of the eyewash station and emergency shower and keep access unobstructed.

Biological spill response: contain, don appropriate PPE, absorb with disposable material, disinfect with an appropriate concentration of sodium hypochlorite (typically 1:10 dilution of household bleach for blood), absorb, and dispose as biomedical waste.

Fire safety: use the RACE sequence (Rescue, Alarm, Contain, Extinguish/Evacuate) and PASS for extinguisher use (Pull, Aim, Squeeze, Sweep); know the location of alarms and exits.

Confidentiality: personal health information must not be disclosed to unauthorized persons; share only on a need-to-know basis and use secure channels for any transmission or discussion.

Informed consent for specimen collection: explain the procedure, purpose, risks, and alternatives in plain language, confirm the patient understands, and respect the right to refuse.

Professional boundaries: do not perform procedures outside your scope of practice; escalate complex or ambiguous situations to a technologist, supervisor, or the appropriate regulated professional.

Error disclosure: report errors and near-misses honestly and promptly through the incident reporting system; concealment is a professional and ethical failure.

Patient-centred communication: use plain language, avoid jargon, use a qualified interpreter when language or hearing barriers exist, and confirm understanding by teach-back.

Conflict of interest and gifts: decline gifts or benefits that could influence judgment; declare any personal or financial interest that might affect professional decisions.

Mandatory reporting and legal duties: report suspected abuse, communicable disease as required by public health legislation, and unsafe practice according to employer policy and applicable law.

Continuing competence: maintain certification through continuing education, reflective practice, and self-assessment; document activities and keep records for audit.

Telephone critical value reporting: identify yourself and the institution, confirm the patient identifiers, state the test and value, obtain read-back, and document the exchange.

Handling an angry or distressed patient: acknowledge the concern, listen without interrupting, state what you can do, and escalate to a supervisor when the issue exceeds your authority.

Privacy in physical spaces: discuss results only in private areas, avoid names on whiteboards or visible screens, and position monitors away from public view.

Documentation standards: record objectively, contemporaneously, legibly, and with date, time and signature; never alter or backdate a record; correct errors with a single line, initials, date and reason.

Cultural safety: recognize that beliefs, language, and past experiences with the health system affect care; ask about preferences and adapt communication accordingly.

Conflict resolution: address issues directly and respectfully, focus on the problem not the person, and use the chain of command when resolution is not reached.

Team communication: use structured handover (e.g., identify patient, situation, background, assessment, recommendation) to reduce omissions and misunderstandings.

Social media and photography: never post patient information, images, or specimens; personal devices must not be used to capture health information.

Short-draw citrate tube: the 9:1 blood-to-additive ratio is critical; underfilled tubes give falsely prolonged coagulation times and must be rejected and recollected.

IV line contamination: draw and discard a waste volume or use a designated line per policy; specimens drawn above an infusing line are diluted and unsuitable for chemistry.

Hemolyzed samples: falsely increase potassium, LDH, AST, and free hemoglobin; falsely decrease glucose and bilirubin depending on method; recollect when interference is clinically significant.

Lipemia and icterus: lipemia interferes with optical and some electrolyte methods; document the index and follow laboratory policy for reporting or recollecting.

Specimen stability examples: blood gases and lactate require immediate analysis on ice; ammonia on ice; coagulation testing should be processed within the laboratory's defined window; glucose in a grey tube is stable longer than in serum.

Contamination sources: EDTA contamination from a lavender tube drawn before a chemistry tube falsely raises potassium and lowers calcium and magnesium; follow the correct order of draw.

Requisition and label mismatch: never relabel or alter a specimen label to match a requisition; reject and recollect with correct identification.

Temperature excursions: document any deviation from required transport temperature and notify the laboratory; do not accept compromised specimens without assessment.

Risk assessment before task: identify the hazard (biological, chemical, physical, ergonomic), the route of exposure, and the control measure before starting the procedure.

Hierarchy of controls: elimination, substitution, engineering controls (biosafety cabinet, sharps container), administrative controls (procedures, training), then PPE as the last line of defence.

Centrifuge safety: balance tubes, use sealed safety cups or lids, wait for complete stop before opening, and inspect for breakage; aerosols are the main hazard.

Biomedical waste segregation: sharps into puncture-resistant containers, liquid blood and body fluids into designated containers, and non-anatomical waste per municipal and institutional rules.

Chemical spill: evacuate the immediate area, consult the SDS, use the spill kit, ventilate, and report; do not attempt cleanup of an unknown or highly hazardous chemical without training.

Latex allergy: identify at-risk patients and staff, use latex-free gloves and supplies, and recognize symptoms ranging from contact dermatitis to anaphylaxis.

Ergonomics and repetitive strain: adjust chair and bench height, alternate tasks, use proper lifting technique, and report pain early.

Immunization and health surveillance: hepatitis B vaccination is recommended for laboratory staff; report exposures and illnesses per occupational health policy.

Accessioning: assign a unique laboratory number, verify the requisition against the specimen, enter the correct test menu, and flag priority (STAT, routine, timed).

STAT versus routine: STAT specimens are collected, transported, and processed immediately; the laboratory defines the maximum turnaround time and monitors compliance.

Aliquoting: label secondary containers with two identifiers, the test, date and time, and the initials of the aliquoter; use appropriate tube type and volume for the analyzer.

Centrifugation parameters: follow the test-specific relative centrifugal force and time; serum and plasma tubes with gel barriers require a defined spin to form a stable barrier.

Storage and retention: know the required storage temperature (room temperature, 4 °C, −20 °C, −70 °C) and retention period for each specimen type; freeze only specimens intended for frozen storage.

Add-on testing: verify specimen stability and volume before adding tests; do not add tests to specimens that are unsuitable or beyond stability.

Instrument loading and reagent handling: check expiry dates, lot numbers, and onboard stability; record reagent changes and quality control results.

Specimen referral: package according to transport regulations (e.g., triple packaging for infectious substances), complete the referral form, and track the shipment.

Autonomy and consent: competent adults may refuse any procedure; document the refusal and inform the responsible caregiver.

Privacy legislation: personal health information is protected by law; access is limited to those who need it for care, and breaches must be reported.

Research and teaching specimens: use only with appropriate consent or ethics approval and de-identification as required.

Conflict of interest: disclose any relationship that could bias a professional judgment or recommendation.

Whistleblowing and patient safety: report unsafe practice through internal channels first, and use external regulators when internal channels fail.

Cultural and religious considerations: accommodate requests where safe and feasible (e.g., same-gender collector, dietary or fasting considerations) and document the accommodation.

Boundaries with patients and colleagues: maintain professional relationships, avoid dual relationships, and do not accept gifts that could create obligation.

Continuing professional development: track learning activities, reflect on practice, and maintain records for certification renewal.

Fasting requirements: typically 8–12 hours for glucose and lipid panels; water is allowed; document fasting status when required by the test.

Timed collections and diurnal variation: cortisol, iron, and some hormones vary by time of day; collect at the specified time and document it.

Therapeutic drug monitoring: collect at the correct time relative to dosing (trough before next dose) and document the dosing time; steady state matters for interpretation.

Pediatric collection: use the smallest appropriate volume, heel puncture for infants (not the fingers), and limit the number of punctures; document the site and method.

Geriatric and fragile patients: assess skin integrity, use smaller gauge needles, apply pressure longer, and monitor for hematoma.

Patients on anticoagulants or with bleeding disorders: apply firm pressure for at least 5 minutes (longer if indicated) and observe for hematoma.

Fistula or mastectomy limbs: avoid venipuncture on the affected side; use the opposite arm or follow the facility's protocol.

Patient preparation for urine culture: cleanse the area, collect a midstream specimen in a sterile container, and transport promptly or refrigerate.

Emergency preparedness: know the location of fire extinguishers, alarms, eyewash stations, spill kits, and the emergency evacuation route for your work area.

Chemical inventory and labelling: maintain an inventory of hazardous chemicals, ensure containers are labelled, and keep SDS accessible at all times.

Compressed gas safety: secure cylinders upright, keep away from heat, and use the correct regulator; never lubricate fittings.

Electrical safety: inspect cords and plugs, keep liquids away from electrical equipment, and report damaged equipment immediately.

Radiation and UV safety: follow posted warnings, use shielding and PPE, and never bypass interlocks.

Waste minimization and segregation: separate recyclable, general, biomedical, and chemical waste streams and follow local regulations.

Post-exposure follow-up: complete incident reports, attend occupational health follow-up, and monitor for symptoms per protocol.

Training and competency: complete annual safety training, demonstrate competency in spill response and PPE use, and document it.

Result entry and verification: enter results accurately, check for transcription errors, and flag critical or implausible values for review.

Critical value notification: report immediately to the responsible caregiver, read back the value, and document the notification.

Quality control review: review QC results before reporting patient results; investigate out-of-control results and document corrective action.

Proficiency testing: participate in external quality assessment, review results, and address any unacceptable performance.

Incident reporting: report errors, near-misses, and adverse events through the incident system and participate in root-cause analysis.

Documentation and audit: keep records of accessioning, QC, maintenance, and training; make them available for audit and accreditation.

Confidentiality of results: release results only to authorized persons and through secure channels.

Continuous improvement: use quality indicators and feedback to identify opportunities and implement changes.

Introduce yourself and your role, explain the procedure, and obtain verbal consent before collection.

Use two identifiers and confirm the patient's understanding before proceeding.

Respect privacy: close curtains or doors, expose only the necessary area, and keep the patient informed throughout.

Recognize and respond to anxiety, needle phobia, or pain: use distraction, positioning, and a calm approach; stop if the patient requests.

Communicate results only through authorized channels; do not interpret results or give medical advice.

Document refusals, difficulties, and any deviations from procedure.

Escalate concerns about patient safety or wellbeing to the appropriate professional.

Maintain professional boundaries and avoid personal or social relationships with patients.

Triple packaging for infectious substances: primary leakproof container, absorbent secondary packaging, and rigid outer packaging with the correct UN specification marking and labels.

Temperature control: use validated cool packs or dry ice as required; avoid direct contact of specimens with ice packs that could freeze them.

Documentation: include the requisition, referral form, and any required permits; keep a copy for the laboratory record.

Tracking: record shipment date, time, carrier, and tracking number; monitor arrival and condition.

Receiving inspection: check packaging integrity, temperature, and specimen condition on arrival; reject compromised shipments and notify the sender.

Regulatory compliance: follow national and international transport regulations (e.g., IATA, TDG) for dangerous goods.

Biological spill during transport: contain, disinfect, and report per protocol.

Training: personnel who package or ship infectious substances must be trained and certified as required.

No eating, drinking, smoking, or applying cosmetics in the laboratory work area.

Keep hands away from the face; wash hands before leaving the laboratory and after removing gloves.

Do not store food or drink in laboratory refrigerators or cabinets.

Keep work surfaces clean and decontaminated before and after work; use appropriate disinfectants.

Avoid mouth pipetting; use mechanical devices only.

Cover any cuts or breaks in the skin with a waterproof dressing before working.

Report any illness or exposure that could affect safety or specimen integrity.

Follow standard operating procedures and do not deviate without authorization.

Use structured communication tools (e.g., SBAR) for handovers and critical communications.

Respect the scope of practice of all team members and escalate appropriately.

Address conflict directly and respectfully, focusing on behaviour and impact rather than personality.

Participate in team meetings and quality improvement activities.

Provide constructive feedback and accept feedback openly.

Document communications that affect patient care.

Maintain confidentiality in all team communications.

Support a culture of safety where errors can be reported without blame.

Verify specimen identity and test requirements before processing.

Centrifuge according to the test-specific protocol and check for complete separation.

Aliquot into appropriately labelled tubes with two identifiers and the test name.

Store specimens at the required temperature and for the required duration.

Discard specimens according to the retention policy and biohazard waste rules.

Document processing steps, including time and personnel.

Monitor and maintain equipment (centrifuges, refrigerators) with logs.

Report and investigate any processing deviations.

Random urine: collect in a clean container; first morning sample is preferred for some tests.

Midstream clean-catch: cleanse, void a small amount, collect midstream, and cap.

24-hour urine: discard the first void, collect all subsequent voids including the final one, and keep refrigerated or on preservative.

Urine culture: collect before antibiotics, transport promptly, or refrigerate.

Body fluids (CSF, pleural, ascitic): collect aseptically in sterile containers and transport immediately; handle as potentially infectious.

Sputum: collect a deep-cough specimen, not saliva; early morning samples are preferred.

Stool: collect in a clean container; avoid contamination with urine or water.

Label all containers with two identifiers, date, and time.

Know the WHMIS/GHS hazard symbols and the meaning of each pictogram.

Consult the SDS for handling, storage, and first-aid information.

Store chemicals according to compatibility; never store oxidizers with flammables.

Use the fume hood for volatile or toxic chemicals.

Know the location of fire extinguishers and the PASS technique.

Follow the RACE sequence in a fire.

Report and clean up spills per protocol; use the spill kit.

Dispose of chemical waste according to regulations.

Record entries contemporaneously, legibly, and with date, time, and signature.

Correct errors with a single line, initials, date, and reason; never obliterate or backdate.

Use only approved abbreviations.

Protect records from unauthorized access and loss.

Retain records for the required period and dispose of them securely.

Release information only with authorization.

Audit records for completeness and accuracy.

Report breaches of confidentiality immediately.