MLS/MLT ASCP Exam Content Guidelines Per ASCP BOC

The ASCP Board of Certification presents the same exam content area for the MLS ASCP and MLT ASCP exams.

The MLS/MLT ASCP exam content guidelines comprise:

• Seven subjects including Chemistry, Blood banking, Immunology, Microbiology, Lab operation, Hematology, and Blood and other body fluids.
• All subjects are mentioned with question percentages so you can know where you need to put extra and least attention.
• The main topics of each subject are also mentioned for your clear understanding.

The American Society for Clinical Pathology (ASCP) Board of Certification (BOC) conducts more than 20 exams for lab professionals including MLT and MLS ASCP.

MLS ASCP exam is the certificate that goes to medical lab scientists and MLT ASCP goes to medical laboratory technicians.

The ASCP BOC presents specific exam content areas for each certificate, like the MLS/MLT ASCP exam content area.

This ASCP exam content is the same for both U.S. and international candidates.

In this article, we are going to explain the entire syllabus for the MLS/MLT certifiction exam for the proper preparation.

Blood Bank MLS/MLT ASCP Exam Content Guidelines

Blood bank covers 17-22% exam question for MLS ASCP and 15-20% for MLT ASCP.

The main topic of the blood bank MLS/MLT ASCP exam content guidelines are:

• Blood Products
• Blood Group Systems
• Blood Group Immunology
• Physiology and pathophysiology
• Serological and Molecular Testing
• Transfusion Practice

MLS ASCP Exam Content Area

MLT ASCP Exam Content Area

Blood Products

Further distribution of blood products are: Donors, Processing, Storage, Blood Component, Blood Component Quality Control (make them coma separated)

Donors

The MLS/MLT ASCP exam content that you have to cover in Donors are:

• Collection method
• Qualification
• Special donation
• Adverse reaction

Processing

This part concentrates on

• Labeling
• Testing

Storage

It covers the following vital contents

• Transportation
• Expiration
• Temperature requirements
• Stored products properties
• Additives/Anticoagulants

Blood Components

The blood components are specific to covering the content:

• Red blood cells (Washed )
• Fractionation products
• Plasma
• Red blood cells
• Leukocyte-reduced component
• Apheresis products
• Irradiated components
• Platelets
• Deglycerolized/Frozen red blood cells
• Cryoprecipitate AHF
• Granulocytes

Blood Group System

The blood products are classified into further categories, which are: Genetics, Biochemistry/Antigens, and Role of Blood Groups in Transfusion (make coma separated)

Genetics

Genetics of the blood group system overcome the following part:

• Blood groups inheritance
• Molecular
• Basic

Biochemistry/Antigens

• MNS
• Kidd
• ABO
• P1PK/Globoside(P)
• Kell
• High and low prevalence antigens
• Rh
• Duffy
• Platelet-specific
• Lutheran
• HLA
• Lewis
• Ii

Role of Blood Group in Transfusion

It aces two main topics:

• Antigen prevalence
• Immunogenicity

Blood Group Immunology

It comprises four further categories;’ these are Immunoglobulins, Immune Response, Antigen-Antibody Interactions, and Complement

Immunoglobulins

The immunoglobulins focus on areas

• Classes and subclasses
• Physical and biological properties
• Structure

Immune Response

This part is specific to navigating the following areas of MLS/MLT ASCP exam content

• Primary and secondary responses
• Macrophages, T and B cells

Antigen and Antibody Interaction

• Testing (Principles and methods)
• Principles

Complement

The information that you will cover in the complement are

• Biological Properties
• Classical and Other ways of mechanisms

Physiology and Pathophysiology

It consists of five times that are Blood Physiology, Coagulation and Hemostasis, Fetus and Newborn Hemolytic Disease, Anemia, and Transplantation.

Blood Physiology

It presents information about the specific exam content areas that is

• Cell metabolism
• Cell survival
• Blood volume a   circulation
• Function and composition  of blood (normal function and abnormal physiology)

Coagulation and Hemostasis

It concentrates on two main topics

• Platelet functions and disease
• Coagulation factors and diseases

Fetus and Newborn Hemolytic Disease

• Detection
• Pathophysiology
• Prevention
• Treatment

Anemais

The Anemai's main topics and sub-topics are

• Congenital and acquired (Pathophysiology, Detection, and Treatment)
• Immune hemolytic anemias: drug-induced, warm, cold (Detection, Treatment, and Pathophysiology)

Transplantation

• Solid organ
• HPC (Hematopoietic progenitor cell)

Serologic and Molecular Testing

It comprises the five more main sub-topics, including Routine Test, Reagents, Special Test and Reagents Application, Leukocyte/Platelet Testing, and Quality Assurance.

Routine Test

The specific areas that it covers are

• Direct antiglobulin testing
• Blood grouping tests
• Clinical significance and antibody identification
• Compatibility tests (Crossmatch and antibody detection)

Reagents

• Reagent red cells
• Antiglobulin sera
• Blood grouping sera

Special Test and Reagents Application

This part recognizes you with specific tests and applications.

• Elutions
• Molecular techniques
• Lectins
• Use of thiol reagents
• EDTA glycine-acid
• Column agglutination test
• Enzymes
• Adsorptions
• Immunofluorescence
• Solid phase
• ELISA
• Chloroquine diphosphate
• Enhancement media
• Titrations
• Neutralization/inhibition
•  Cell separations

Leukocyte/Platelet Testing

• Platelet testing
• Cytotoxicity

Quality Assurance

• Reagents
• Test procedures
• Blood samples

Transfusion Practice

It navigates the exam content areas that are Component Therapy, Patient Blood Management and Blood Administration, Extracorporeal and Apheresis Circulation, Transfusion Indications, and Transfusion Adverse Effects (Nonimmunologic reactions, Immunologic reactions, and Transfusion-transmitted diseases)

Urinalysis and Body Fluids MLS/MLT ASCP Exam Content

This subject is categorized into main topics and covers 5-10% of the total exam for both MLS and MLT ASCP.

• Urinalysis
• Body Fluids (e.g., Synovial, Semen, Amniotic, CSF, Serous, and, Feces)

Urinalysis

It covers main topics, which are Physical, Chemical, Microscopic, Renal Physiology, and Disease States.

Physical

• Specific gravity/osmolality
• Color & clarity

Chemical

• Confirmatory tests
• Reagent strip

Microscopic

• Microorganisms
• Casts
• Contaminants
• Cells
• Artifacts
• Crystals

Body Fluids (e.g., Synovial, Semen, Amniotic, CSF, Serous, and, Feces) (h3)

Covering content are Physical, Disease States, Physiology, Chemical, Microscopic, and Physiology.

Chemistry MLS/MLT ASCP Exam Content Area

Chemistry is divided into four parts and it is specific to cover 17-22% of the exam content for ASCP MLS and 20-25% for ASCP MLT.

• General Chemistry
• Protein and Enzymes
• Acid-base, Blood Gases & Electrolytes
• Special Chemistry

General Chemistry

It covers three main topics, which are: Carbohydrates, Lipids, and Heme Derivatives

Carbohydrates

• Physiology and Biochemical Theory (Metabolic pathways, chemical and physical properties, and abnormal and normal states)
• Test procedures (Glycated proteins, Principles, specimen collection, troubleshooting, special precautions,  Tolerance testing, and processing)
• Disease state correlation
• Test result interpretation

Lipids

• Biochemical theory and physiology (Normal and abnormal conditions, metabolic pathways, chemical, and physical characteristics (Triglycerides,  Phospholipids, Lipoproteins, Apolipoproteins, and Cholesterol))
• Test interpretation ( Special precautions, troubleshooting, interfering substances, and specimen collection)
• Test result interpretation
• Disease state correlation

Heme Derivatives

• Test Method (Rules, interfering substances, troubleshooting, specimen collection, and special precautions).
• Biochemical theory & physiology (Chemical and physical properties, abnormal and normal conditions, and metabolic pathways)
• Disease condition correlation
• Test consequence interpretation

Protein and Enzyme

It explains the topics, including Enzymes and Nitrogen-containing Compounds, including Protein

Enzymes

• Physiology & Biochemical theory ( normal and abnormal state, metabolic Pathways, chemical and physical effects (GGT, LD, CK, Lipase, AST/ALT, angiotensin-converting enzyme, amylase, and  Alkaline phosphatase))
• Test techniques (Principles, interfering substances, specimen collection, and troubleshooting)
• Disorder state correlation
• Test result interpretation

Nitrogen-Containing Compounds including Protein

• Biochemical theory and physiology (Physical and chemical possessions (Cardiac markers, Tumor markers, Ammonia, Creatinine, urea, amino acids, and Proteins))
• Test result outcomes
• Disorder state correlation
• Test strategies ( Clearances, troubleshooting, collection of specimens, and interfering substances)

Acid-base, Blood Gases & Electrolytes

This section explains two main parts:

• Acid-Base Determination
• Electrolytes

Acid-Base Determination

• Physiology and biochemical theory (O2 and CO2 transport, pH and H+ ion concentration, Normal and abnormal states, and Henderson-Hasselbach equation)
• Test procedures (Analytical principles, specimen gathering and processing,  interfering substances,  and specific precautions)
• Infection state correlation

Special Chemistry

It demonstrates four main topics with clear explanations.

Endocrinology, Vitamins and Nutrition, Therapeutic Drug Monitoring, and Toxicology.

Endocrinology

• Test methods (Principles (Immunoassay, Fluorescence), Stimulation/suppression tests, Special precautions, troubleshooting,  Sample collection & processing, and interfering substances)
•  Disease state correlation
• Test result interpretation

Vitamins and Nutrition

• Disease state correlation
• Test result interpretation
• Test methodology (Principles, specimen gathering and management, troubleshooting, and, special precautions)
• Biochemical theory and physiology (Normal and abnormal states, properties, and metabolism and action)

Therapeutic Drug Monitoring

• Pharmacokinetics (Toxic states, therapeutic states, metabolism, and excretion)
• Chemical and physical effects (Immunosuppressants (e.g., tacrolimus)), cardioactives (e.g., digoxin), Anticonvulsants (e.g., phenobarbital), and aminoglycosides (e.g., gentamicin).
• Test influences (Principles (Immunoassay) and sample collection and management, troubleshooting, and interfering)
• substances)
• Disease state correlation
• Test result interpretation

Toxicology

• Toxicokinetics (Toxic effects, signs & symptoms, excretion, and Metabolism)
• Physical and Chemical  properties (Drugs of abuse, Heavy metals (e.g., lead), Alcohols, Analgesics (e.g., acetaminophen))
• Test procedures (Enzymatic methods, immunoassay, interfering substances, s, specimen collection and processing, and troubleshooting)
• Test result interpretation
• Disease state correlation

Hematology MLS/MLT ASCP Exam Content Area

This subject is classified into four main major topics, and it presents 17-20% of the exam questions out of the total for ASCP MLS and 20-25% for ASCP MLT.

• Hematology Physiology (Bone marrow, blood, and body fluids)
• Hematology Disease State
• Hematology Laboratory Testing
• Hemostasis

Hematology Physiology (Bone marrow, blood, and body fluids)

Function, Destruction, and Production

Hematology Disease State

The main topics for this section are Erythrocytes, Leukocytes (WHO classification), Platelets.

Erythrocytes

• Anemia (Microcytic (Chronic inflammation, Sideroblastic, Thalassemia, and Iron deficiency), Normocytic (hyperproliferative, Hereditary hemolytic, Acute hemorrhage, and Acquired hemolytic), Macrocytic (Megaloblastic and  Non-megaloblastic),  Hemoglobinopathies)
• Erythrocytosis (Absolute and relative)

Leukocytes (WHO classification)

• Benign leukocyte disorders (Lymphoid and Myeloid)
• Myeloid neoplasia (Myeloproliferative neoplasms, Myelodysplastic syndromes, and Acute leukemia)
• Lymphoid neoplasia (Plasma cell dyscrasias, Chronic leukemia/lymphoma, and Acute leukemia)
• Hereditary anomalies

Platelets

• Quantitative abnormalities (Thrombocytopenia (Increased destruction, Decreased production, and Pseudothrombocytopenia) and Thrombocytosis)
• Qualitative defects (Glanzmann thrombasthenia,  von Willebrand disease, Bernard-Soulier syndrome)

Hematology Laboratory Testing

It is specifically designed to cover the following area

Cell Counts (blood & body fluids)

• Reticulocytes
• Automated
• Spurious results
• Manual

Differentials & Morphology Evaluation (including blood and body fluids)

Hemoglobin

• Qualitative (Sickle solubility, HPLC, and Electrophoresis)
• Quantitative

Hematocrit

Indices

Hemolytic Indicators (e.g., haptoglobin, LD)

Special Stains

• Myeloperoxidase
• Kleihauer-Betk
• Esterase
•  Prussian blue

Other Studies

• Heinz body
• G-6-PD
• ESR

Flow Cytometry Immunophenotyping

• Lymphocyte subsets
• Leukemia
• Lymphoma
• PNH

Molecular and Cytogenetic Testing

• BCR/ABL1
• Recurring cytogenetic abnormalities
• JAK2

Hemostasis

It is related to physiology, disease states, and laboratory determinations.

Physiology

• Vascular system
• Coagulation pathways
• Fibrinolytic pathway

Disease States

• Inhibitors
• Hypercoagulable states
• Fibrinolytic system
• Coagulation factor deficiencies  (Hereditary, Acquired)
• DIC

Laboratory Determinations

• Thrombin time
• Fibrinogen
• Platelet aggregation
• D-dimer
• von Willebrand assays
• Hypercoagulability assessment
• Heparin neutralization
• Thromboelastography
• Platelet function
• Inhibitor assays
• Anti-Xa
• Platelet function (e.g., PFA)
• APTT
• PT/INR
• Mixing studies
• Direct thrombin inhibitors
•  Platelet function

Immunology MLS/MLT ASCP Exam Content Area

The BOC chooses 5-10% of questions from immunology for both MLS and MLT exam. It is divided into six main topics and subtopics.

• Principle Immunology
• Disease of the Immune System
• Transplantation
• Infectious Disease Serology
• Serologic Procedures
• Test Results

Principle Immunology

Its further categories are

Immune System Physiology

• Genetics
• Macrophages, B, and T cells
• Primary and secondary response

Immunoglobulins

• Physical and biological properties
• Structure
•  Classes and subclasses

Antigen-Antibody Interactions

• Testing (methods and principles)
• Principles

Complement

• Biologic properties
• Classical and alternative pathway methods

Disease of the Immune System

Covering exam content of the disease of the immune system are:

Autoimmunity

• Organ-specific (e.g., Graves disease)
• Systemic (e.g., SLE)

Hypersensitivity

• I, II, III, IV

Immunoproliferative Diseases

• Monoclonal gammopathies (e.g., Waldenström macroglobulinemia, cell myeloma, plasma)

Immunodeficiency

• Acquired (e.g., HIV)
• Hereditary (e.g., SCID)

Transplantation

Tumor Immunology, Graft-versus-host Disease, and HLA Typing

Infectious Disease Serology

Stages of Infection of Borrelia burgdorferi and Treponema pallidum, Tuberculosis Infection (e.g., release assay, interferon-gamma, and PPD) and Epidemiology of Viral Pathogens and Clinical Significance (e.g., hepatitis (A, B, C), measles, HIV, rubella)

Serologic Procedures

Immunofluorescence, Thyroid Antibodies,  ANA, Cytokine Testing, Nontreponemal Syphilis Testing (e.g., RPR), Rheumatoid Factor, Treponemal Syphilis Testing (e.g., MHATP), and Labeled Immunoassays (e.g., ELISA)

Test Result

Disease State Correlation, Confirmatory Testing, and Interpretation

Microbiology MLS/MLT ASCP Exam Content Area

It is classified into four types and all the content covers 17-22% for MLS and 15-20% MLT exam of the total exam questions.

• Preanalytic Procedure
• Analytic Procedures for Bacteriology
• Analytic Procedures for Mycology, Parasitology, Virology and Mycobacteriology
• Postanalytic Procedures

Preanalytic Procedure

Further classifications are: Specimen Collection & Transport , Specimen Processing, and Stains: Method, Principle, & Interpretation.

Specimen Collection & Transport

• Transport systems of specimens and conditions for all organisms
•  specimen labeling and patient identification
• Specimen collection

Specimen Processing

• Media inoculation
• Slide preparation methods used for stains
• Incubation conditions
• Sample prioritization & rejection criteria
• Media

Stains: Method, Principle, & Interpretation

• Acid-fast
• Trichrome
• Acridine orange
• Gram
• Giemsa
  Modified acid-fast
• Calcofluor-white and KOH

Analytic Procedures for Bacteriology

It covers a huge area of the microbiology syllabus.

Blood and Bone Marrow

• Sample sources  (e.g., intravenous catheters, and peripheral)
• Sample consisting of skin flora and clinical effectiveness
• Continuous-monitoring systems
• Identification of major pathogens like Staphylococcus  aureus and colony morphology
•  Organism pathogenicity (e.g., virulence mechanisms, transmission, and etiology)
• Bone marrow infection (e.g., Salmonella spp.)
• Endocarditis common agents
• Resistance detection methods

Cerebrospinal Fluid

• Identification and colony morphology (including Streptococcus pneumoniae, Escherichia coli, Enterobacteriaceae, Staphylococcus aureus, Haemophilus influenzae, etc.)
• Specimen sources like reservoir, and lumbar puncture.
• Shunt infection common agents (e.g.,  Staphylococcus spp, Propionibacterium, coagulase-negative staphylococci, Cutibacterium spp.)
• Organism pathogenicity (e.g., virulence methods, etiology,
• transmission)
• Molecular method  and direct detection

Body Fluids from Sterile Sites (normal)

• Specimen resources (amniotic, pericardial, pleural, and  synovial)
• Indigenous organisms belonging to skin and mucosal surfaces
• Colony morphology and major identification (e.g.,  Haemophilus influenzae,  beta-hemolytic streptococci, Streptococcus
• Pneumoniae, Pseudomonas aeruginosa, Clostridium perfringens)
• Molecular methods
• Organism pathogenicity  (e.g.,  virulence process)

 Lower Respiratory

•  Specimen sources (bronchial brush, endotracheal aspirate, bronchial brush)
• Major pathogens identification and colony morphology
• Organisms comprising gram stain morphology and oral flora colony
• Importenance of quantitative and semiquantitative results
• Molecular techniques and direct detection (e.g., Bordetella pertussis, Streptococcus pyogenes)

Upper Respiratory

• Specimen sources (e.g., middle ear, nasopharynx, throat, sinus)
• Major pathogens identification and colony morphology
• Indigenous gram stain morphology and flora colony
• Organism pathogenicity (virulence mechanisms)
• Molecular technique and direct detection (Bordetella pertussis)

Gastrointestinal

• Colony morphology and major pathogens  identification (e.g., toxigenic Escherichia coli, Vibrio spp.,  Aeromonas spp., Campylobacter spp., Vibrio spp.,)
•  Molecular methods and direct detection (Shiga toxin, Clostridioides difficile)
• Helicobacter pylori detection method
• Organism pathogenicity

 Skin, Bone, and  Soft Tissue

• Specimen sources (e.g., biopsy, abscess, wound)
• Gram stain morphology
• Flora colony indigenous
• Pathogens (major) identification & colony morphology
• Organism pathogenicity

 Genital Tract

•  Specimen sources (e.g., endocervical, cervical, vaginal)
• Gram stain morphology and an Indigenous colony of organisms
•  Molecular detection (Streptococcus agalactiae, Trichomonas)
• vaginalis, Mycoplasma spp, Neisseria gonorrhoeae.)
• Pathogenicity of the organism (virulence mechanisms)
• Procedures for pathogens detection that are associated with vaginitis (Candida spp., Trichomonas, vaginalis, etc.)

Urine

• Specimen sources like catheterized, mid-stream clean catch, etc.,
• Major urinary pathogen identification, including Candida spp, Enterobacteriaceae, Staphylococcus saprophyticus, etc., and colony morphology.
• Clinical significance associated with colony counts 
• Culture correlates with urinalysis results.

Identification Methods (Interpretation, Theory, and Application)

• Rapid test used for identification of presumptive (oxidase, PYR, coagulase, etc.,)
• Colony morphology
• Identification of conventional biochemicals, including  Neisseria
• carbohydrate utilization, V and X factors, etc.
• Multiplex molecular methods
• Commercial kits
• MALDI-TOF MS
• Automated methods

Antibiotic Resistance And Antimicrobial Susceptibility Testing

• Application, Theory, Method, and Interpretation
• Intrinsic resistance patterns
• Major antibiotic classes' mechanisms of action
• major antibiotic classes, including ESBL, carbapenemases, beta-lactamases, etc.

MRSA/MSSA, ESBL/CRE, VRE Screening

• Specimen sources
• Molecular methods
• Culture methods

BSL-3 Pathogens & Select Agents

• Specimen sources, including lymph nodes, sputum, tissue, etc
• Presumptive identification’s rapid tests (e.g.,  Yersinia pestis, Bacillus anthracis) and colony morphology.
• Lab Response Network and Regional Laboratory Roles
• Organism pathogenicity, including transmission, etiology, etc.

Analytic Procedures for Mycology, Parasitology, Virology, and Mycobacteriology

Nocardia spp. and Mycobacteriology

• Specimen sources like soft tissue, lower respiratory, and blood.
• Disease state and major pathogens  (e.g., transmission, epidemiology, etc.,)
• Method of identification (MALDI-TOF MS, sequencing, probes)
• Organism pathogenicity like transmission, etiology, etc.
• Antimicrobial therapy
• Molecular methods direct detection

Virology

• Sample sources
• Disease state and major pathogens (transmission, etiology)
• Pathogens direct detection

Parasitology

• Sample sources, including respiratory, tissue, stool, etc.
• Direct detection of molecular
• Macroscopic and microscopic identification
•  Disease states and major pathogens (transmission, epidemiology, etc.,)

Mycology

• Sample source
• Major pathogens & diseases states (like epidemiology, transmission, etc.,)
• Major pathogen's microscopic identification
• Molecular and direct detection
• Growth characteristics  of pathogens and colony morphology (e.g.,  growth rate, incubation length, temperature, etc)
• Other identification procedures (MALDITOF MS, biochemical, etc.,)

Postanalytic Procedures

Issuing Corrected Reports, Auto Verification and Result Review, Critical and Urgent Value Reporting, Documentation Practices, Public Health and Prevention.

Laboratory Operation MLS/MLT ASCP Exam Content Area

Lab operation is divided into six categories, and it presents 5-10% (MLS/MLT ASCP) of the total exam.

• Troubleshooting and Quality Assessment
• Safety
• Laboratory Mathematics
• Instrumentation and Automated/Manual Methodology
  Basic Management Principles
• Education Principles

Troubleshooting and Quality Assessment

Postanalytical, Analytical, and Preanalytical, Compliance and Quality Control, Regulation (accreditation standards, proficiency testing, and competency assessment), and Point-of-care Testing.

Safety

Safety Practices and Programs, including Safe work practices, chemicals, and reagents safety data sheets, Use of PPE (personal protective equipment), etc. and Emergency Procedures (fire, needlesticks)

Lab Mathematics

• Normality, Molarity
• Dilutions, Volume, and Concentration
• Standard Curves
• Confidence Intervals, Mode, Median, and, Mean
• Predictive Value, Specificity, and Sensitivity

Instrumentation and Automated/Manual Methodology

• Basic Lab Equipment
• Osmometry
• Nephelometry
• Molecular Methods
• Mass Spectrometry
• Electrochemistry
• Photometry and Spectrophotometry
• Flow Cytometry
• Chromatography
• Hematology Instrumentation
• Automated Microbiology Processors
• Hematology Instrumentation
• Electrophoresis

Basic Management Principles

Education Principles

Check ASCP Chemistry Exam Content guildlines here?

Source: ASCP BOC.