American Medical Technologists Medical Laboratory …

 

 

American Medical Technologists
Medical Laboratory Technician (MLT) Certification Competencies
and Examination Specifications

Summary Table

Work Area

General Laboratory
Chemistry
Hematology
Coagulation and Hemostasis
Immunology and Serology
Immunohematology
Blood Banking and Transfusion Services
Microbiology
Urinalysis and Body Fluids

Number of
Questions
30
41
38
11
8
22
17
20
23
210

Percentage of
Exam
14.3%
19.5%
18.1%
5.2%
3.8%
10.5%
8.1%
9.5%
11.0%
100%

Question Weightings, Work Areas, Task Areas, and Competencies

I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
Total

Number
of items

[30] I. General Laboratory (14.3% of exam)

Laboratory quality

• Demonstrate knowledge of quality control for all laboratory procedures and the acceptance or

rejection of an analysis based on quality control rules

• Demonstrate knowledge of quality control terminology to include:

linearity
accuracy
precision
reliability
delta OD

coefficient of variation pre-/postanalytical
skewness
mean value
standard deviation
shift, trend Levey-Jennings charts

confidence limit
normal distribution
standard deviation index (SDI)

• Understand the differences between accuracy and precision
• Review all kit/procedure package inserts to assure that accurate and up-to-date testing

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procedures are being executed

• Employ quality improvement (TQM, CQI, PIC)
• Demonstrate knowledge of proficiency testing

Laboratory laws and regulations

• Know laws and regulations governing the laboratory (OSHA, CLIA, HIPAA)

Laboratory safety

• Employ laboratory safety
• Employ Universal / Standard precautions
• Employ equipment safety to include sharps for needle disposal
• Employ chemical hazard safety and Safety Data Sheets (SDS)
• Employ proper infection control

Laboratory instrumentation, maintenance, and principles of operation

• Employ manual laboratory instrumentation, including the use of glassware and pipettes, and the

cleaning and maintenance of instruments

• Calibrate instruments knowing the difference between testing technologies requiring calibration

and those requiring only quality control checks
• Balance centrifuge and know centrifugation durations
• Employ automated laboratory instrumentation

Laboratory mathematics

• Apply laboratory mathematics; understand and calculate essential indices such as mean,

standard deviation, and coefficient of variation

• Demonstrate understanding of designations/abbreviations used for weights and measures
• Demonstrate understanding of normal solutions, molar solutions, percentage solutions (w/w,
w/v, and v/v), calculate equivalent weight and dilutions used most frequently in the clinical
laboratory

General microscopy

microscope

• Demonstrate knowledge of microscopy, including types of microscopes and parts of binocular

• Use and clean binocular microscope and calibrate ocular micrometer

Phlebotomy and specimen collection, including specimen handling and integrity

• Collect, handle, and process all specimens for analysis (including infant collection)
• Understand the differences between serum, plasma, and whole blood
• Employ safety precautions when collecting blood samples
• Employ procedures to prevent hemolysis
• Collect blood in collecting tubes for analysis (clotted blood and anticoagulated blood)
• Employ proper order of draw when collecting blood in multiple types of vacuum tubes

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• Employ proper anticoagulants for each analysis and know effects of improper anticoagulant use
• Know procedure for blood culture collection
• Know the proper labeling of blood tubes including sentinel event with blood bank armbands
• Perform infant blood collection through heel puncture
• Perform glucose tolerance test
• Know length of time in which samples clot
• Handle and preserve body fluids for chemical analysis
• Preserve urine specimens
• Process irretrievable specimens (CSF, tissue, etc.)
• Determine the suitability of specimens for analysis
• Determine preanalytical, analytical, and/or postanalytical causes of erroneous results

• Assure continual accuracy of patient identification (including STAT, call reports for inpatient and

• Match name, MR, DOB, registration number, and other identifiers with tests and orders to

confirm positive patient identification

• Demonstrate knowledge of waived testing in the clinical laboratory

Patient identification

outpatient, etc.)

Waived testing

[41] II. Chemistry (19.5% of exam)

General knowledge

• Define clinical chemistry terminology:
spectrophotometry densitometry
refractometry electrophoresis
turbidimetry nephelometry
osmometry mass spectrometry
chromatography enzyme linked immunoassay (ELISA)
chemiluminescence

fluorescence polarization immunoassay (FPIA)

• Define terminology related to principles of clinical laboratory instrumentation:

radiant energy visual spectrum/wavelength
end point reactions diffraction grating
kinetic/rate reactions random access
Beer-Lambert Law

Instrumentation

• Demonstrate knowledge of the components of a spectrophotometer
• Demonstrate understanding of the visual spectrum and wavelength
• Perform spectrophotometric procedure
• Demonstrate understanding of the Beer-Lambert Law
• Demonstrate the ability to operate and describe the principles of operation of osmometer,

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nephelometer, random access analyzers, blood gas analyzers, discrete analysis
• Demonstrate the ability to perform and describe the principles of immunoassay
• Describe the principles of electrophoresis
• Describe the importance of preventative maintenance; chemistry analyzer maintenance

Renal function tests

• Describe physiology and know anatomy of the kidneys
• Perform common renal function tests (non-protein nitrogens), clearance tests, and estimated

• Perform renal function tests and correlate results to pathological conditions affecting kidney

glomerular filtration rate

function; know reference limits

Hepatic function tests

• Demonstrate understanding of the anatomy and physiology of the liver
• Describe types of bilirubin and types of jaundice, and understand the formation of bilirubin and

• Understand and perform common hepatic function tests
• Correlate test elevations to the different types of jaundice (hemolytic/prehepatic, hepatic,

urobilinogen

posthepatic)

Carbohydrate metabolism

• Define carbohydrate metabolism terminology
lipogenesis

carbohydrate
monosaccharide
disaccharide
polysaccharide
glycogen

ketones
insulin renal threshold
glycolysis diabetes mellitus
glycogenesis A1C hemoglobin
glycogenolysis

• Describe insulin and carbohydrate metabolism, carbohydrate digestion, and types of diabetes
• Describe the principles of tests for carbohydrate metabolism in body fluids, including tests for

glucose in blood, urine, and cerebrospinal fluid, glucose tolerance tests, gestational diabetes
screening tests, and A1C hemoglobin

• Perform and interpret tests for glucose analysis to include all tests for carbohydrates and

reducing substances, and those performed on blood, urine, and spinal fluid

• Perform oral glucose tolerance test; recognize and differentiate normal glucose tolerance and

diabetic glucose tolerance, and hypoglycemic (flat) curves
• Describe the significance of A1C and the treatment of diabetes

Protein analysis

• Describe the structure and function of plasma proteins; synthesis, distribution, catabolism, and

excretion of proteins; protein classification

• Describe principles of protein electrophoresis; recognize and interpret normal and disease

patterns in serum protein electrophoresis

• Perform tests measuring total protein, albumin, and globulin

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• Demonstrate knowledge of clinical protein analysis and correlate test results with disease states

Enzymology

• Demonstrate understanding of enzymology concepts:

Isoenzymes (CK, ALP, LD)

o Clinically significant enzymes (CP, ALT, GGT, ALP, AST, CK, LD, amylase, lipase)
o
o Cardiac enzymes and related cardiac markers (troponin and myoglobin)
o Pancreatic enzymes
o Enzymes associated with the liver

• Demonstrate knowledge of the methodology for measuring enzyme activity
• Perform enzyme analyses
• Describe enzymes that are elevated in liver disease; correlate with liver disease, including types

of jaundice

• Describe enzymes of the pancreas; correlate amylase and lipase with pancreatic disease
• Demonstrate knowledge of cardiac marker tests: troponin T and I, myoglobin, B natriuretic

peptide (BNP), and C-reactive protein (CRP)

• Describe cardiac enzymes and interpret test results; correlate elevations of cardiac markers

including their rise and fall with cardiac events

• Demonstrate knowledge of the phosphatases; correlate elevations with disease states

Endocrinology

• Demonstrate understanding of endocrinology concepts:
o Glands and hormones of the endocrine system
o Function of hormones
o Feedback mechanisms
o Conditions associated with hypo- and hypersecretion of hormones

• Demonstrate knowledge of thyroid function tests (thyroxin, TBG, free T3, free T4, TSH)
• Demonstrate knowledge of growth hormones; correlate test results with disease states
• Demonstrate knowledge of reproductive hormones (FSH, LH, estriol, estradiol, estrogen,

testosterone, 17-ketosteroids); correlate test results with disease states

• Demonstrate knowledge of hormones secreted during pregnancy (HPL, HCG, prolactin)
• Demonstrate knowledge of 24-hour urine endocrinology testing (5HIAA); correlate test results

with disease states

• Perform endocrine function tests

Lipids

• Demonstrate knowledge of concepts related to lipids:

lipid
Ester
alcohol

fatty acid
cholesterol (total, HDL, LDL)
triglycerides

lipoprotein

• Describe the function of protein in the lipoprotein complex, and understand the metabolism of

cholesterol and triglycerides

• Demonstrate knowledge of lipid analyses and correlate hyperlipidemia with coronary artery

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disease; describe the classification of hyperlipidemias; know desirable limits for total
cholesterol, LDL, and HDL
• Describe the digestion of fat
• Demonstrate understanding of lipid analyses

Water and electrolytes

• Demonstrate knowledge of electrolytes in body fluids (characteristics, fluid compartments and

movements, electrolyte balance, reference limits for electrolyte profiles, expression of
concentration of electrolytes) and understand common causes of electrolyte imbalances

• Define hyponatremia, hypernatremia, hypokalemia, and hyperkalemia
• Measure electrolytes; describe methodology for measurement and calculate osmolality

Acid-base balance

• Demonstrate understanding of concepts related to acid-base balance; hydrogen ion

concentration (pH); regulation of acid-base balance by kidneys and lungs

• Demonstrate understanding of relationships between pH, bicarbonate, and carbonic acid

(Henderson-Hasslebach equation)
• Describe common acid-base imbalances
• Describe the measured and calculated parameters in an arterial blood gas analysis (ABG); relate

abnormal ABG test results to causative conditions

Cerebrospinal fluid (CSF)

• Demonstrate understanding of cerebrospinal fluid (CSF) formation, characteristics, volume,

function, and collection

• Demonstrate understanding of abnormal findings of CSF analysis

Other chemistry procedures

125, CA 19, HER2

• Demonstrate understanding of tumor markers; discuss usage of B-HCG, CA 27-29, PSA, CEA, CA

• Perform therapeutic drug monitoring and drugs of abuse testing; understand peak and trough,

screening and confirmatory, methodologies used

• Understand the principles of fetal wellness (fibronectin, AFP, L/L ratio, Δ450)

[38] III. Hematology (18.1% of exam)

General knowledge

• Apply knowledge of terminology related to hematology:

leukocytes
erythrocyte
thrombocytes
reticulocytes
hematopoiesis
anemia

nucleated red blood cell (NRBC)

complete blood count (CBC)
RBC, WBC, PLT morphology

RBC indices (MCV, MCH, MCHC)
red cell distribution width (RDW)
erythrocyte sedimentation rate (ESR)

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hemoglobin (HGB)
hematocrit (HCT)
sodium citrate
red blood cell (RBC)
white blood cell (WBC)
plasma

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erythropoietin (EPO)
leukemia
RBC, WBC inclusions
serum

platelet (PLT)
ethylenediaminetetraacetic acid (EDTA)
• Know functions and cellular structures of blood (RBC, WBC, PLT)
• Know maturation series of erythrocytes, leukocytes, and thrombocytes; erythrocyte production

buffy coat
differential (DIFF)

and destruction

• Prepare and stain peripheral blood smear and bone marrow slides
• Examine peripheral blood smear and correlate with CBC
• Understand bone marrow aspiration procedure; touch preps from bone biopsies and bone

marrow aspiration

Erythrocyte procedures

• Demonstrate knowledge of RBC count (manual and automated methods)
• Demonstrate knowledge of hemoglobin (manual and automated methods)
• Address interfering substances in hemoglobin measurement
• Demonstrate knowledge of hematocrit (manual and automated methods)
• Demonstrate knowledge of reticulocyte counts and calculations (relative count, ARC, CRC, RPI)
• Calculate red blood cell indices: MCV, MCH, MCHC
• Demonstrate knowledge of erythrocyte sedimentation rate (ESR) – Westergren
• Know types of specimens producing falsely-elevated ESR values

Leukocyte procedures

• Demonstrate knowledge of WBC differentials
• Demonstrate knowledge of maturation series of the granulocytes (neutrophils, eosinophils,

and basophils) and nongranulocytes (lymphocytes, monocytes)

• Understand leukocyte disorders and correlation with WBC differential
• Demonstrate knowledge of WBC count (manual and automated methods)
• Calculate absolute WBC counts
• Calculate corrected leukocyte counts for nucleated red blood cells
• Perform cytogenetic and molecular assays
• Perform cytochemical staining
• Demonstrate knowledge of cytogenic abnormalities associated with hematologic neoplasms
• Demonstrate knowledge of molecular diagnostic tests relevant to the diagnosis of hematologic

• Demonstrate knowledge of blood smear evaluation of platelets; know thrombocyte (platelet)

neoplasms

Thrombocyte procedures

maturation series

• Perform platelet count (manual and automated methods)
•

Identify sources of error and corrective actions for plate counts

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Special procedures

• Demonstrate knowledge of eosinophil count
• Demonstrate knowledge of body fluid analysis, counts, and related morphology (synovial fluid,

CSF, serous fluid)

• Demonstrate knowledge of body fluid cytospin preparation and morphology
• Demonstrate knowledge of sickle cell screen
• Demonstrate knowledge of semen analyses
• Demonstrate knowledge of hemoglobinopathy evaluation; hemoglobin electrophoresis
• Demonstrate knowledge of molecular assays (malaria slide preparation and evaluation)

Automated instrumentation

• Demonstrate knowledge of CBC/Diff using automated hematology instrumentation; know cell

Interpret patient data using WBC/RBC histogram or cytogram

counter principles (impedance, flow cytometry)
• Know which CBC parameters are measured directly
•
• Perform QC and investigate QC failures
• Perform maintenance protocols
•
• Demonstrate knowledge of flow cytometry

Identify sources of error and perform corrective action for hematological tests

[11] IV. Coagulation and Hemostasis (5.2% of exam)

General knowledge

• Define terminology associated with coagulation:

prothrombin time (PT)
activated partial thromboplastin time (APTT)
International Normalized Ratio (INR)
fibrin degradation products (FDP)
platelet function test
Coumadin® (warfarin)

hemostasis

coagulation
factors

thrombin

fibrinogen
heparin

sodium citrate

name)

• Collect and process coagulation specimens
• Adjust anticoagulant-to-blood ratio when indicated
• Describe the coagulation cascade and list coagulation factors (Roman numerals and common

• Understand principles of hemostasis (primary, secondary, and fibrinolysis)
• Understand intrinsic, extrinsic, common pathways, and associated factors
• Correlate hemostatic disorders with laboratory evaluation (coagulation, thrombocyte, and

vasculature disorders)

• Perform molecular testing and understand molecular assays in coagulation

Coagulation procedures

• Perform prothrombin time, partial thromboplastin time (PTT or APTT), fibrinogen, and D-dimer

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