HEMATOLOGY

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A Gaucher cell is best described as a macrophage with: "Wrinkled" cytoplasm due to an accumulation of glucocerebroside "Foamy" cytoplasm filled with unmetabolized sphingomyelin Pronounced vacuolization and deposits of cholesterol Abundant cytoplasm containing storage iron and cellular remnants

"Wrinkled" cytoplasm due to an accumulation of glucocerebroside "Chicken Scratch" Gaucher disease is a lipid storage disorder in which there is an accumulation of glucocerebroside in the macrophages because of a genetic lack of glucocerebrosidase, an enzyme required for normal lipid metabolism. Gaucher cells are found in the liver, spleen, and bone marrow.

If MORE THAN 500 PLATELETS are counted on each side a ____ dilution should be made. 1:10 1:20 1:100 1:200

1:200

Dilution for WBC count in AUTOMATED cell counters: 1:100 1:200 1: 50,000 1: 500

1:500

Counting area for manual RBC count: 0.2 mm2 1 mm2 4 mm2

0.2 mm2

MPV values should be based on specimens that are between ____ and ___ hours old. 1 and 4 hours old 4 and 6 hours old 6 and 8 hours old 16 and 18 hours old

1 and 4 hours old Platelets temporarily INCREASE by approximately 20% during the first hour.

Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of: 1 day 1.5 days 2 days 2.5 days

1 day

For heavy smokers, carboxyhemoglobin takes ___ to convert to cyanmethemoglobin but degree of error is probably not clinically significant

1 hour

M or mitosis: 1 hour 4 hours 8 hours 10 hours

1 hour CELL CYCLE. G0, nondividing cell; G1, cell growth (10 hours) S, DNA replication (8 hours) G2, protein synthesis (4 hours) M, mitosis (1 hour) followed by cytokinesis or cell division

Which ratio of anticoagulant to blood is correct for coagulation procedures? 1:4 1:5 1:9 1:10

1:9

What is the ratio of IRON TO PYRROLE in 1 heme portion of the hemoglobin molecule? 1 iron to 2 pyrrole rings 2 iron to 1 pyrrole ring 1 iron to 4 pyrrole rings 4 iron to 1 pyrrole ring

1 iron to 4 pyrrole rings The heme portion of the hemoglobin molecule consists of one iron (Fe2+) atom and four pyrrole rings that are joined to each other. A complete hemoglobin molecule consists of four heme molecules, each of which is attached to one molecule of the protein globin.

Counting area for manual platelet count: 0.2 mm2 1 mm2 4 mm2

1 mm2

When comparing spun microhematocrit results with hematocrit results obtained on an electronic cell counter, the spun hematocrit results may vary from ___ because of this trapped plasma (unless the cell counter has been calibrated against spun microhematocrits uncorrected for trapped plasma). 1 to 3% lower 1 to 3% higher 3 to 5% lower 3 to 5% higher

1 to 3% higher

Duplicate hematocrit results should agree within __ unit (%). 1% 2% 5% 15%

1% Hematocrit is the MOST REPRODUCIBLE.

Major elements of the flow cytometer: 1. Optics; 2. Fluidics; 3. Computer; 4. Electronics 1 and 2 3 and 4 1, 2 and 3 1, 2, 3 and 4

1, 2, 3 and 4

Provide an early indication of engraftment success after hematopoietic stem cell transplant

1. Immature reticulocyte fraction 2. Immature platelet fraction

EDTA is used in concentrations of ___ mg/1 mL of whole blood. 0.5 mg/1 mL of whole blood 1.5 mg/1 mL of whole blood 2.0 mg/1 mL of whole blood 2.5 mg/1 mL of whole blood

1.5 mg/1 mL of whole blood

EDTA is used in concentrations of _____ of whole blood 0.5 mg/1 mL of whole blood 1 mg/1mL of whole blood 1.5 mg/1 mL of whole blood 2 mg/1 mL of whole blood

1.5 mg/1 mL of whole blood

G1 or cell growth: 1 hour 4 hours 8 hours 10 hours

10 hours CELL CYCLE. G0, nondividing cell; G1, cell growth (10 hours) S, DNA replication (8 hours) G2, protein synthesis (4 hours) M, mitosis (1 hour) followed by cytokinesis or cell division

Fibrinogen, which has been implicated as a primary risk factor for thrombotic disorders, increases approximately _____ mg/dL per DECADE in the elderly (65 to 79 years), 174 from 280 mg/dL to over 300 mg/dL. 1 mg/dL per decade 5 mg/dL per decade 10 mg/dL per decade 20 mg/dL per decade

10 mg/dL per decade

Allow to sit dilution for ___ to ensure RBC lysis. Solution will be clear once lysis occurs.

10 minutes

Cover and mix well by inversion or use vortex and let stand for ___ @ RT to allow full conversion of hemoglobin to cyanmethemoglobin

10 minutes

For manual WBC count, the filled counting chamber should be allowed to stand for __ prior to performing the count to give the WBCs time to settle. 3 minutes 5 minutes 10 minutes 15 minutes

10 minutes

Microhematocrit read within ___

10 minutes

PT and APTT are prolonged when the fibrinogen level is ____ mg/dL or less. 100 mg/dL or less 130 mg/dL or less 150 mg/dL or less 200 mg/dL or less

100 mg/dL or less

Basophils remain in the maturation-storage phase for: 7 hours 8.5 hours 9.5 hours 12 hours

12 hours

PT reference range 11.5-14.5 12.6-14.6 21 25-35

12.6-14.6

Reference range of ESR for males 5 10 15 20

15 ESR, male (Westergren): 0-15 mm/hr (0-50 yo) ESR, male (Westergren): 0-20 mm/hr (>50 yo) ESR, female (Westergren): 0-20 mm/hr (0-50 yo) ESR, female (Westergren): 0-30 mm/hr (>50 yo)

What is the proper angle of needle insertion for phlebotomy? 5 degrees 15 degrees 35 degrees 45 degrees

15 degrees

For manual platelet count, the filled counting chamber should be allowed to stand for __ prior to performing the count to give the platelets time to settle. 3 minutes 5 minutes 10 minutes 15 minutes

15 minutes

Hemostasis specimen STORAGE temperature: 1 to 6 C 18 to 24 C 36.5 to 37.5 C 30 to 37 C

18 to 24 C Sodium citrate-anticoagulated whole blood specimens are placed in a rack and allowed to stand in a vertical position with the stopper intact and uppermost. The pH remains constant as long as the specimen is sealed. Specimens are maintained at 18° C to 24° C (ambient temperature), never at refrigerator temperatures. Storage at 1° C to 6° C activates factor VII, destroys platelet activity through uncontrolled activation, and causes the cryoprecipitation of large VWF multimers. Also, specimens should never be stored at temperatures greater than 24° C because heat causes deterioration of coagulation factors V and VIII.

Dilution for RBC count in AUTOMATED cell counters: 1:100 1:200 1: 50,000 1: 500

1: 50,000

In the manual reticulocyte count, what is the ratio of blood and new methylene blue stain? 1:1 1:2 1:3 1:4

1:! Mix equal amounts of blood and new methylene blue stain (2 to 3 drops, or approximately 50 mL each), and allow to incubate at room temperature for 3 to 10 minutes.

Surfaces in the specimen collection and processing area should be cleaned with: 70% isopropyl alcohol. 1:10 bleach solution. Soap and water. Any of the above

1:10 bleach solution.

If the WBC count is above 30 x 10 9th/L, it is advisable to use this dilution: 1:10 1:20 1:100 1:200

1:100 TYPICAL WBC DILUTION - 1:20 Above 30 x 10 9th/L - 1:100 100 to 300 x 10 9th/L - 1:200 Below 3 x 10 9th/L - 1:10

If FEWER THAN 50 PLATELETS are counted on each side, the procedure should be repeated by diluting the blood to: 1:10 1:20 1:100 1:200

1:20

An early indication of engraftment success after hematopoietic stem cell transplant. 1. RBC count; 2. Immature reticulocyte fraction; 3. Immature platelet fraction 2 only 1 and 2 2 and 3 1, 2 and 3

2 and 3

Sugar water test is performed within ___ of specimen collection

2 hours

Forward, low angle light scatter: 0 degree angle 2 to 3 degree angle 5 to 15 degree angle 90 degree angle

2 to 3 degree angle Forward-angle: 0 degree - cell volume Forward low-angle: 2 to 3 degrees - cell volume Forward high-angle: 5 to 15 degrees - internal complexity Orthogonal, side: 90 degrees - internal complexity

Smears should be made within ___ of collection

2 to 3 hours

Blood drop size in the manual wedge technique: 1 to 2 mm in diameter 2 to 3 mm in diameter 4 to 5 mm in diameter 5 to 6 mm in diameter

2 to 3 mm in diameter TOO LARGE A DROP: Long or thick film TOO SMALL A DROP: Short or thin film

If there are 25% to 50% macrocytic RBCs present per high-power field: 1+ 2+ to 3+ 4+

2+ to 3+

The number of platelets an average megakaryocyte generates is approximately: 25 to 50 50 to 200 200 to 500 2,000 to 4,000

2,000 to 4,000

Bone marrow reticulocytes have an average maturation of: 1 day 1.5 days 2 days 2.5 days

2.5 days

Eosinophils on maturation-storage phase: 1.5 days 2.5 days 3.5 days 4.5 days

2.5 days

To improve accuracy of the RETICULOCYTE COUNT, have another laboratorian count the other film; counts should agree within: 20% 30% 40% 50%

20%

When the correct area of a specimen from a patient with a normal RBC count is viewed, there are generally about ____ RBCs per 100x oil immersion field. 10 to 15 RBCs per OIF 20 to 25 RBCs per OIF 100 to 150 RBCs per OIF 200 to 250 RBCs per OIF

200 to 250 RBCs per OIF 4.2-6.1X10^12*

If an average of 10 platelets are seen per oil immersion field, what is the estimated platelet count? 50 x 10 9th/L 100 x 10 9th/L 200 x 10 9th/L 300 x 10 9th/L

200 x 10 9th/L For platelet estimate on a wedge smear: Factor is 20,000

What gauge of hypodermic syringe should be used for a male with a palpable vein 15 18 21 22

21 Adult with good veins, specimen < 25 mL: 20 or 21 gauge, thin-walled, 1.0 or 1.25 inches long Adult with good veins, specimen > 25 mL: 19 gauge, 1.0 or 1.25 inches long Child or adult with small, friable, or hardened veins: 23 gauge, winged-needle set; apply minimal negative pressure Transfer of blood from syringe to tube: 19 gauge, slowly inject through tube closure Syringe with winged-needle set: 20, 21, or 23 gauge, thin-walled; use only for small, friable, or hardened veins or specialized coagulation testing

The promyelocyte stage lasts about: 4 hours 12 hours 15 hours 24 hours 4.3 days

24 hours PROLIFERATIVE PHASE Myeloblast: 15 hours First identifiable cell in the granulocytic series Constitute approximately 1% of the total nucleated bone marrow cells Stage lasts approximately 15 hours Promyelocyte: 24 hours Constitutes approximately 3% of the nucleated bone marrow cells This stage lasts about 24 hours Myelocyte Approximately 12% of the proliferative cells existing in this stage Myelocyte to metamyelocyte lasts an average of 4.3 days Once the metamyelocyte stage has been reached, cells have undergone four or five cell divisions and the proliferative phase comes to an end MATURATION-STORAGE PHASE Metamyelocytes 45% Band 35% Segmented granulocytes 20% Segmented neutrophils in the maturation-storage compartment are frequently referred to as the marrow reserve. This reserve constitutes a 4- to 8-day supply of neutrophils.

In the preparing wedge smear from blood samples of polycythemic patients, the angle between the two slides should be: 25 30 35 45

25 When the hematocrit is higher than normal (i.e., 60%), as is found in patients with polycythemia or in newborns, the angle should be lowered (i.e., 25 degrees) so the film is not too short and thick.

The target INR for PULMONARY EMBOLISM (PE) treatment: 1 2 3 4

3 INR 2-3: Recommended for most indications (e.g., treatment or prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients who have had a myocardial infarction) INR 2.5 - 3.5: Recommended for patients with prosthetic heart valves INR 3: Pulmonary embolism (PE) treatment

WBC count should be performed within ___ of dilution

3 hours

Mix equal amount of blood & new methylene blue and allow to incubate @ RT for ____

3 to 10 minutes

Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is MANY. 0 1+ 2+ 3+ 4+

3+ Grading of Erythrocyte Morphology 0: Normal appearance or slight variation in erythrocytes. 1+: Only a small population of erythrocytes displays a particular abnormality; the terms SLIGHTLY increased or FEW would be comparable. 2+: More than occasional numbers of abnormal erythrocytes can be seen in a microscopic field; an equivalent descriptive term is MODERATELY increased. 3+: SEVERE increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is MANY. 4+: The MOST SEVERE state of erythrocytic abnormality, with the abnormality prevalent throughout EACH microscopic field; comparable terms are MARKED or marked increase.

Sodium citrate in the concentration of ___ solution has been adopted as the appropriate concentration for coagulation studies. 1.5% 2.8% 3.2% 3.8%

3.2%

The time from the last myelocyte mitotic division to the emergence of mature eosinophils from the marrow is about: 1.5 days 2.5 days 3.5 days 5 to 6 days

3.5 days

Rees-Ecker platelet count must be completed within __ to ensure against platelet disintegration.

30 minutes

In manual wedge technique, the PUSHER SLIDE is held securely in the dominant hand at about: 15 to 20 degree angle 30 to 45 degree angle 45 to 50 degree angle 80 to 90 degree angle

30 to 45 degree angle

Most coagulation studies are carried out at which temperature? -20C -70C 24C 37C

37C Most coagulation studies are carried out at 37C. The temperature of the incubator should not fluctuate more than ± 0.5C.

G2 or protein synthesis: 1 hour 4 hours 8 hours 10 hours

4 hours CELL CYCLE. G0, nondividing cell; G1, cell growth (10 hours) S, DNA replication (8 hours) G2, protein synthesis (4 hours) M, mitosis (1 hour) followed by cytokinesis or cell division

Counting area for manual WBC count: 0.2 mm2 1 mm2 4 mm2

4 mm2

Once the metamyelocyte stage has been reached, cells have undergone ____ cell divisions and the proliferative phase comes to an end. 1 or 2 cell divisions 2 or 3 cell divisions 4 or 5 cell divisions 6 or 7 cell divisions

4 or 5 cell divisions

The stage from myelocyte to to metamylocyte lasts an average of: 15 hours 24 hours 3.4 days 4.3 days

4.3 days

In the Ivy method of bleeding time, the blood pressure cuff is inflated to: 20 mm. Hg 30 mm. Hg 40 mm. Hg 45 mm. Hg

40 mm. Hg

Megakaryocytes develop into platelets in approximately __ days. 3 days 5 days 9 days 12 days

5 days

Forward high-angle light scatter: 0 degree angle 2 to 3 degree angle 5 to 15 degree angle 90 degree angle

5 to 15 degree angle 1. Forward light scatter 0°. This is diffracted light, which relates to the VOLUME of the cell. 2. Forward low-angle light scatter 2° to 3°. This characteristic can relate to SIZE or VOLUME. 3. Forward high angle 5° to 15°. This type of measurement allows for description of the REFRACTIVE INDEX of cellular components. 4. Orthogonal light scatter 90°. The result of this application of light scatter is the production of data based on reflection and refraction of internal components, which correlates with internal COMPLEXITY

For a patient with a reticulocyte count of 7.8%, a HCT of 30%, and with polychromasia noted, what is the RPI? 5.2 3.4 2.6 1.7

5.2 RPI = [(reticulocyte count)(HCT/45%)]/maturation time RPI = [(7.8)(30/45)]/2 RPI = 2.6

Using a 1:100 dilution, 210 cells were counted in the 4 corner squares of the counting chamber. What is the WBC count (/uL)?

52,500/uL If the unit being sought for is in (x10^9/L), multiply this to 0.001 to get 52.5x10^9/L

If 60 reticulocytes are counted in 1000 red blood cells, what is the reticulocyte count? 0.06% 0.6% 6.0% 60.0%

6.0%

Microhematocrit capillary tube size 7 mm length, 1 mm bore 7 cm length, 1 mm bore 11.5 cm length, 3 mm bore 11.5 mm length, 3 mm bore

7 cm length, 1 mm bore

Placement of fire extinguishers every ___ feet. 75 feet 100 feet 125 feet 150 feet

75 feet (22.86 meters) Fire extinguishers should be checked MONTHLY and maintained ANNUALLY. Placement of manual fire alarm boxes near the exit doors. Travel distance should not exceed 200 feet.

S or DNA replication 1 hour 4 hours 8 hours 10 hours

8 hours CELL CYCLE. G0, nondividing cell; G1, cell growth (10 hours) S, DNA replication (8 hours) G2, protein synthesis (4 hours) M, mitosis (1 hour) followed by cytokinesis or cell division

With 1% ammonium oxalate, the dilution is stable for ____

8 hours for platelet count

The life span of a platelet is about: 2 to 3 hours 1 to 3 days 8 to 11 days 60 to 80 days

8 to 11 days Maturation: 5 days

To evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets, should be observed per oil immersion field? 1 to 4 8 to 20 4 to 10 20 to 50

8 to 20

Basophils have an average circulation time of about: 7 to 10 hours 8.5 hours 12 hours 2.5 days

8.5 hours Basophils remain in the maturation-storage phase for approximately 12 hours. Basophils have an average circulation time of about 8.5 hours.

Basophils have an average circulation time of about ____ hours. 7 hours 8.5 hours 9 hours 12 hours

8.5 hours NEUTROPHILS (Pink) Maturation-storage phase: 7-10 days Circulating blood: 7-10 hours EOSINOPHILS (Orange) Maturation-storage phase: 2.5 days Circulating blood: Few hours (18) BASOPHILS (Blue) Maturation-storage phase: 12 hours Circulating blood: 8.5 hours

Ratio of blood to anticoagulant for coagulation testing: 1:4 1:9 4:1 9:1

9:1 9 PARTS BLOOD TO 1 PART ANTICOGULANT The phlebotomist must fill tubes for coagulation testing to full volume (or to the minimum volume specified by the manufacturer) to maintain a 9:1 ratio of blood to anticoagulant. Underfilling coagulation tubes results in prolonged test values.

PEANUT Aspirin ingestion has the following hemostatic effect in a normal person. A. Prolongs the bleeding time B. Prolongs the clotting time C. Inhibits factor VIII D. Has no effect

PEANUT Rouleaux of red cells when seen in the monolayer of a differential smear is characteristic of: A. Multiple myeloma B. Myelofibrosis C. Megaloblastic anemia D. Chronic myelogenous leukemia

PEANUT 1. Myeloblast stage lasts approximately: A. 15 hours B. 24 hours C. 36 hours D. 4.3 days 2. Promyelocyte stage lasts about: A. 15 hours B. 24 hours C. 36 hours D. 4.3 days 3. The stage from myelocyte to metamyelocyte lasts an average of: A. 15 hours B. 24 hours C. 36 hours D. 4.3 days

A B D

A manual white blood cell (WBC) count was performed. A total of 36 cells were counted in all 9-mm2 squares of a Neubauer-ruled hemacytometer. A 1:10 dilution was used. What is the WBC count? A. 0.4 × 109/L B. 2.5 × 109/L C. 4.0 × 109/L D. 8.0 × 109/L

A. 0.4 × 109/L

A protein that plays a role in both coagulation and platelet aggregation is: A. Factor I B. Factor VIII C. Factor IX D. Factor XI

A. Factor I Factor I (fibrinogen) is necessary for platelet aggregation along with the glycoprotein IIb/IIIa complex. Factor I is also a substrate in the common pathway of coagulation. Thrombin acts on fibrinogen to form fibrin clots.

Which inclusions may be seen in leukocytes? A. Döhle bodies B. Basophilic stippling C. Malarial parasites D. Howell-Jolly bodies

A. Döhle bodies Döhle bodies are RNA-rich areas within polymorphonuclear neutrophils (PMNs) that are oval and light blue in color. Although often associated with infectious states, they are seen in a wide range of conditions and toxic reactions, including hemolytic and pernicious anemias, chronic granulocytic leukemia, and therapy with antineoplastic drugs. The other inclusions are associated with erythrocytes.

Which results are associated with hemophilia A? A. Prolonged APTT, normal PT B. Prolonged PT and APTT C. Prolonged PT, normal APTT D. Normal PT and APTT

A. Prolonged APTT, normal PT Hemophilia A is associated with factor VIII deficiency. Factor VIII is a factor in the intrinsic coagulation pathway that is evaluated by the APTT and not the PT test. The PT test evaluates the extrinsic and common pathways.

Insufficient centrifugation will result in: A false increase in hematocrit (Hct) value A false decrease in Hct value No effect on Hct value All of these options, depending on the patient

A false increase in hematocrit (Hct) value Insufficient centrifugation does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.

Reverse isolation may be used for: A patient with the measles An adult patient with the flu A patient with tuberculosis A patient with severe burns

A patient with severe burns Patients requiring PROTECTIVE ISOLATION are those with compromised immune systems, such as neutropenic patients (those with abnormally low white blood cell counts); severely burned patients; and patients with compromised immune systems, such as patients with AIDS.

In which age group does acute lymphoblastic leukemia occur with the highest frequency? A. 1-15 years B. 20-35 years C. 45-60 years D. 60-75 years

A. 1-15 years Acute lymphoblastic leukemia (ALL) usually affects children from ages 1-15 and is the most common type of acute leukemia in this age group. In addition, ALL constitutes the single most prevalent malignancy in pediatric patients.

In which age group would 60% lymphocytes be a normal finding? A. 6 months-2 years B. 4-6 years C. 11-15 years D. 40-60 years

A. 6 months-2 years There is a relative neutropenia in children from ages 4 months to 4 years. Because of this, the percentage of lymphocytes is increased in this population. This is commonly referred to as a reversal in the normal differential percentage (or inverted differential).

Neutropenia is present in patients with which absolute neutrophil counts? A. <1.5 × 109/L B. <5.0 × 109/L C. <10.0 × 109/L D. <15.0 × 109/L

A. <1.5 × 109/L

A 50-year-old patient was admitted to the emergency department complaining of pain in her right leg. Her leg was red, swollen, and warm to the touch. Deep venous thrombosis was suspected, and the patient was started on heparin therapy. Which of the following is (are) the proper protocol to evaluate patients receiving heparin therapy? A. A baseline APTT and platelet count; APTT testing every 6 hours until the target is reached B. Repeat APTT after 5 days post heparin therapy to adjust the therapeutic dose C. Monitor the platelet count daily and every other day after heparin therapy is completed D. Monitor PT daily to adjust the therapeutic dose

A. A baseline APTT and platelet count; APTT testing every 6 hours until the target is reached The baseline platelet count and APTT should be performed on all patients prior to administration of heparin. The response to heparin therapy varies among different patients for the following reasons: (1) Heparin half-life is decreased in extended thrombosis, and (2) the anticoagulant activities of heparin change based upon nonspecific binding of heparin to plasma proteins. Therefore, heparin therapy should be closely monitored. Heparin dosage can be monitored by an APTT or activated clotting time (ACT) test but not by the PT. In addition, the platelet count should be monitored regularly during heparin therapy, because a decrease of the platelet count to 50% below the baseline value is significant and may be associated with HIT.

Insufficient centrifugation will result in: A. A false increase in hematocrit (Hct) value B. A false decrease in Hct value C. No effect on Hct value D. All of these options, depending on the patient

A. A false increase in hematocrit (Hct) value Insufficient centrifugation does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.

What would be the most likely designation by the WHO for the FAB AML M3 by the French-American-British classification? A. AML with t(15;17) B. AML with mixed lineage C. AML with t(8;21) D. AML with inv(16)

A. AML with t(15;17) AML with t(15;17) is classified under the category of AML with Recurrent Genetic Abnormalities by the WHO. Acute promyelocytic leukemia (PML; known as M3 under the FAB system) is composed of abnormal promyelocytes with heavy granulation, sometimes obscuring the nucleus, and abundant cytoplasm. Acute promyelocytic leukemia (APL) contains a translocation that results in the fusion of a transcription factor called PML on chromosome 15 with the alpha (α)-retinoic acid receptor gene (RARα) on chromosome 17.

Which condition will shift the oxyhemoglobin dissociation curve to the right? A. Acidosis B. Alkalosis C. Multiple blood transfusions D. Increased quantities of hemoglobin S or C

A. Acidosis Acidosis is associated with a shift to the right of the oxyhemoglobin dissociation curve and, therefore, increased oxygen release (decreased affinity of Hgb for oxygen). Alkalosis does the opposite. Multiple blood transfusions shift the curve to the left because the transfused blood is low in 2,3-DPG. Hgb S and Hgb C do not change the affinity of oxygen for hemoglobin; however, many hemoglobinopathies do. For example, Hgb Kansas causes a right shift and Hgb Chesapeake causes a left shift of the oxyhemoglobin dissociation curve.

A peripheral smear shows 75% blasts. These stain positive for both Sudan Black B (SBB) and peroxidase. Given these values, which of the following disorders is most likely? A. Acute myelocytic leukemia (AML) B. Chronic myelogenous leukemia (CML) C. Acute undifferentiated leukemia (AUL) D. Acute lymphocytic leukemia (ALL)

A. Acute myelocytic leukemia (AML)

SITUATION: A peripheral smear shows 75% blasts. These stain positive for both Sudan Black B (SBB) and peroxidase. Given these values, which of the following disorders is most likely? A. Acute myelocytic leukemia (AML) B. CML C. Acute undifferentiated leukemia (AUL) D. Acute lymphocytic leukemia (ALL)

A. Acute myelocytic leukemia (AML) AML blasts stain positive for Sudan Black B and peroxidase. Usually, fewer than 10% blasts are found in the peripheral smear of patients with CML, unless there has been a transition to blast crisis. The organelles in the cells of AUL are not mature enough to stain positive for SBB or peroxidase. Blasts in ALL are characteristically negative with these stains.

Which of the following is a predisposing condition for the development of DIC? A. Adenocarcinoma B. Idiopathic thrombocytopenic purpura (ITP) C. Post-transfusion purpura (PTP) D. Heparin-induced thrombocytopenia (HIT)

A. Adenocarcinoma Adenocarcinoma can liberate procoagulant (thromboplastic) substances that can activate prothrombin intravascularly. ITP - thrombocytopenia caused by an autoantibody. PTP - alloimmune thrombocytopenia caused by transfusion of blood or blood products. HIT - results from an antibody to heparin-PF4 complex causing thrombocytopenia in 1%-5% of patients who are on heparin therapy. In some affected persons, thrombosis may also occur.

Which of the following is correct regarding acquired thrombotic thrombocytopenic purpura? A. Autoimmune disease B. Decreased VWF C. Decreased platelet aggregation D. Decreased platelet adhesion

A. Autoimmune disease Acquired TTP is an autoimmune disease associated with autoantibodies produced against VWF cleaving enzyme (ADAMTS-13). This DEFICIENCY results in an INCREASE in plasma VWF and consequently increased platelet aggregation and thrombocytopenia.

Congenital dyserythropoietic anemias (CDAs) are characterized by: A. Bizarre multinucleated erythroblasts B. Cytogenetic disorders C. Megaloblastic erythropoiesis D. An elevated M:E ratio

A. Bizarre multinucleated erythroblasts

Congenital dyserythropoietic anemias (CDAs) are characterized by: A. Bizarre multinucleated erythroblasts B. Cytogenetic disorders C. Megaloblastic erythropoiesis D. An elevated M:E ratio

A. Bizarre multinucleated erythroblasts There are four classifications of CDAs, each characterized by: INEFFECTIVE ERYTHROPOIESIS, UNCONJUGATED BILIRUBIN, and BIZARRE MULTINUCLEATED ERYTHROID PRECUROSORS.

All of the following factors may influence the erythrocyte sedimentation rate (ESR) except: A. Blood drawn into a sodium citrate tube B. Anisocytosis, poikilocytosis C. Plasma proteins D. Caliber of the tube

A. Blood drawn into a sodium citrate tube EDTA and sodium citrate can be used without any effect on the ESR. Anisocytosis and poikilocytosis may impede rouleaux formation, thus causing a low ESR. Plasma proteins, especially fibrinogen and immunoglobulins, enhance rouleaux, increasing the ESR. Reference ranges must be established for different caliber tubes.

Which results would be expected for the prothrombin time (PT) and activated partial thromboplastin time (APTT) in a patient with polycythemia? A. Both prolonged B. Both shortened C. Normal PT, prolonged APTT D. Both normal

A. Both prolonged The volume of blood in a polycythemic patient contains SO LITTLE PLASMA that excess anticoagulant remains and is available to bind to reagent calcium, thereby resulting in prolongation of the PT and APTT. For more accurate results, the plasma:anticoagulant ratio can be MODIFIED by DECREASING THE AMOUNT OF ANTICOAGULANT in the collection tube using the following formula: (0.00185)(V)(100-H) = C, where V = blood volume in mL; H = patient's Hct; and C = volume (mL) of anticoagulant. A new sample should be drawn to rerun the PT and APTT.

A. Both prolonged The volume of blood in a polycythemic patient contains so little plasma that excess anticoagulant remains and is available to bind to reagent calcium, thereby resulting in prolongation of the PT and APTT. For more accurate results, the plasma:anticoagulant ratio can be modified by decreasing the amount of anticoagulant in the collection tube using the following formula: (0.00185)(V)(100-H) = C, where V = blood volume in mL; H = patient's Hct; and C = volume (mL) of anticoagulant. A new sample should be drawn to rerun the PT and APTT.

CML is distinguished from leukemoid reaction by which of the following? A. CML: low LAP; leukemoid: high LAP B. CML: high LAP; leukemoid: low LAP C. CML: high WBC; leukemoid: normal WBC D. CML: high WBC; leukemoid: higher WBC

A. CML: low LAP; leukemoid: high LAP CML causes a low LAP score, whereas an elevated or normal score occurs in a leukemoid reaction. CML cannot be distinguished by WBC count because both CML and leukemoid reaction have a high count.

Argatroban may be used as an anticoagulant drug in patients with: A. DVT B. Hemorrhage C. TTP D. Thrombocytosis

A. DVT Argatroban is a thrombin inhibitor drug and may be used as an anticoagulant in patients with heparin-induced thrombocytopenia (HIT) to prevent thrombosis. Argatroban is a small synthetic molecule that binds to free and clot-bound thrombin. Argatroban affects TT, PT, APTT, and ACT tests. The APTT test is recommended for monitoring the dosage with the target therapeutic range of 1.5 to 3.0 times the mean of the laboratory reference range. In patients with lupus anticoagulant or factor deficiencies, the baseline APTT is prolonged; in these conditions, the Ecarin time can be used as an alternative assay.

Factor V Leiden promotes thrombosis by preventing: A. Deactivation of factor Va B. Activation of factor V C. Activation of protein C D. Activation of protein S

A. Deactivation of factor Va Factor V Leiden is a single-point mutation in the factor V gene that inhibits factor Va inactivation by protein C. Activated protein C enhances deactivation of factors Va and VIIIa.

Iron deficiency anemia is characterized by: A. Decreased plasma iron, decreased % saturation, increased total iron-binding capacity (TIBC) B. Decreased plasma iron, decreased plasma ferritin, normal RBC porphyrin C. Decreased plasma iron, decreased % saturation, decreased TIBC D. Decreased plasma iron, increased % saturation, decreased TIBC

A. Decreased plasma iron, decreased % saturation, increased total iron-binding capacity (TIBC)

Which of the following may be associated with thrombotic events? A. Decreased protein C B. Increased fibrinolysis C. Afibrinogenemia D. ITP

A. Decreased protein C Protein C is a physiological inhibitor of coagulation. It is activated by thrombin-thrombomodulin complex. Activated protein C inhibits cofactors Va and VIIIa. The deficiency of protein C is associated with thrombosis. Increased fibrinolysis, afibrinogenemia, and ITP are associated with bleeding.

One of the complications associated with a severe hemophilia A is: A. Hemarthrosis B. Mucous membrane bleeding C. Mild bleeding during surgery D. Immune-mediated thrombocytopenia

A. Hemarthrosis In severe hemophilia A, factor VIII activity is less than 1%, resulting in a severe bleeding diathesis such as hemarthrosis (bleeding into the joints).

The following results were obtained on a patient: normal platelet count and function, normal PT, and prolonged APTT. Which of the following disorders is most consistent with these results? A. Hemophilia A B. Bernard-Soulier syndrome C. von Willebrand's disease D. Glanzmann's thrombasthenia

A. Hemophilia A Hemophilia A is associated with the deficiency of factor VIII resulting in bleeding and an abnormal APTT. The platelet number and function are normal in this disorder. Von Willebrand's disease is a disorder of platelet adhesion associated with decreased VWF and factor VIII, causing an abnormal platelet function test and an abnormal APTT test. Both Glanzmann's thrombasthenia and Bernard-Soulier syndrome cause deficient platelet aggregation, but do not cause an abnormal APTT.

Sickle cell disorders are: A. Hereditary, intracorpuscular RBC defects B. Hereditary, extracorpuscular RBC defects C. Acquired, intracorpuscular RBC defects D. Acquired, extracorpuscular RBC defects

A. Hereditary, intracorpuscular RBC defects Sickle cell disorders are intracorpuscular red cell defects that are hereditary and result in defective Hgbs being produced. The gene for sickle cell can be inherited either homozygously or heterozygously.

The portion of the DNA that is inactive during transcription to mRNA and stains DEEPLY with Wright stain: A. Heterochromatin B. Euchromatin

A. Heterochromatin Morphologically, chromatin is divided into 2 types: 1) HETEROCHROMATIN: Inactive, Dark; condensed clumping pattern "HID" 2) EUCHROMATIN: Active, Pale; DNA transcription into mRNA occurs; pale blue when stained with Wright Stain

Neutrophil phagocytosis and particle ingestion are associated with an increase in oxygen utilization referred to as respiratory burst. What are the two most important products of this biochemical reaction? A. Hydrogen peroxide and superoxide anion B. Lactoferrin and NADPH oxidase C. Cytochrome b and collagenase D. Alkaline phosphatase and ascorbic acid

A. Hydrogen peroxide and superoxide anion

Prolonged tests in patient with Hemophilia A APTT APTT, PT APTT, PT, TCT Thrombin clotting time

APTT Cryoprecipitate was originally prepared as source of factor VIII. Each unit should contain 80 units of factor VIII. Mild or moderate factor VIII deficiency is now treated with DDAVP (like in vWD deficiency) or factor VIII, or both. Severe factor VIII deficiency is treated with only factor VIII.

Neutrophil phagocytosis and particle ingestion are associated with an increase in oxygen utilization called respiratory burst. What are the two most important products of this biochemical reaction? A. Hydrogen peroxide and superoxide anion B. Lactoferrin and NADPH oxidase C. Cytochrome b and collagenase D. Alkaline phosphatase and ascorbic acid

A. Hydrogen peroxide and superoxide anion The biochemical products of the respiratory burst that are involved with neutrophil particle ingestion during phagocytosis are hydrogen peroxide and superoxide anion. The activated neutrophil discharges the enzyme NADPH oxidase into the phagolysosome, where it converts O2 to superoxide anion (O -), which is then reduced to hydrogen peroxide (H2O2).

What test is commonly used to monitor warfarin therapy? A. INR B. APTT C. TT D. Ecarin time

A. INR Warfarin is a vitamin K antagonist drug. It inhibits vitamin K-dependent factors (II, VII, IX, and X) and other vitamin K-dependent proteins such as proteins C and S. Warfarin therapy is monitored by the INR. An INR of 2.0-3.0 is used as the target when monitoring warfarin therapy for prophylaxis and treatment of DVT. A higher dose of warfarin (giving an INR of 2.5- 3.5) is required for patients with mechanical heart valves.

Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult? A. Iliac crest B. Sternum C. Tibia D. Spinous processes of a vertebra

A. Iliac crest

How do lipemic and icteric specimens affect automated hemoglobin measurement? A. Increase B. Decrease C. Same D. Inconsistent

A. Increase

In essential thrombocythemia, the platelets are: A. Increased in number and functionally abnormal B. Normal in number and functionally abnormal C. Decreased in number and functional D. Decreased in number and functionally abnormal

A. Increased in number and functionally abnormal In essential thrombocythemia, the platelet count is extremely elevated. These platelets are abnormal in function, leading to both bleeding and thrombotic diathesis.

The Coulter principle for counting of cells is based upon the fact that: A. Isotonic solutions conduct electricity better than cells do B. Conductivity varies proportionally to the number of cells C. Cells conduct electricity better than saline does D. Isotonic solutions cannot conduct electricity

A. Isotonic solutions conduct electricity better than cells do Electronic cell (Coulter) counters use the principle of electrical impedance. Two electrodes suspended in isotonic solutions are separated by a glass tube having a small aperture. A vacuum is applied, and as a cell passes through the aperture it impedes the flow of current and generates a voltage pulse.

Which of the following is most true of paroxysmal nocturnal hemoglobinuria (PNH)? A. It is a rare acquired stem cell disorder that results in hemolysis B. It is inherited as a sex-linked trait C. It is inherited as an autosomal dominant trait D. It is inherited as an autosomal recessive trait

A. It is a rare acquired stem cell disorder that results in hemolysis PNH is a rare acquired stem cell disorder that results in abnormalities of the red cell membrane. This causes the red cells to be highly sensitive to complement-mediated hemolysis. Because this is a stem cell disorder, abnormalities are seen in leukocytes and platelets, as well as in red cells. PNH is characterized by recurrent, episodic intravascular hemolysis, hemoglobinuria, and venous thrombosis.

Which of the following may interfere with the activated protein C resistance (APCR) screening test? A. Lupus anticoagulant B. Protein C deficiency C. Antithrombin deficiency D. Protein S deficiency

A. Lupus anticoagulant The lupus anticoagulant interferes with the APCR screening assay based on the APTT ratio with and without APC addition. Persons with the lupus anticoagulant have a prolonged APTT that renders the test invalid for APCR screening.

Waldenström's macroglobulinemia is a malignancy of the: A. Lymphoplasmacytoid cells B. Adrenal cortex C. Myeloblastic cell lines D. Erythroid cell precursors

A. Lymphoplasmacytoid cells Waldenström's macroglobulinemia is a malignancy of the lymphoplasmacytoid cells, which manufacture IgM. Although the cells secrete immunoglobulin, they are not fully differentiated into plasma cells and lack the characteristic perinuclear halo, deep basophilia, and eccentric nucleus characteristic of classic plasma cells.

All of the following are associated with intravascular hemolysis except: A. Methemoglobinemia B. Hemoglobinuria C. Hemoglobinemia D. Decreased haptoglobin

A. Methemoglobinemia Methemoglobin occurs when iron is oxidized to the ferric state. Normally, iron is predominantly in the ferrous state in the hemoglobin that circulates. During intravascular hemolysis, the red cells rupture, releasing hemoglobin directly into the bloodstream. Haptoglobin is a protein that binds to free Hgb. The increased free Hgb in intravascular hemolysis causes depletion of haptoglobin. As haptoglobin is depleted, unbound hemoglobin dimers appear in the plasma (hemoglobinemia) and are filtered through the kidneys and reabsorbed by the renal tubular cells. The renal tubular uptake capacity is approximately 5 g per day of filtered hemoglobin. Beyond this level, free hemoglobin appears in the urine (hemoglobinuria). Hemoglobinuria is associated with hemoglobinemia.

A 25-year-old woman saw her physician with symptoms of jaundice, acute cholecystitis, and an enlarged spleen. On investigation, numerous gallstones were discovered. Review the following CBC results: WBCs = 11.1 × 109/L RBCs = 3.33 × 1012/L Hgb = 11.5 g/dL Hct = 31.6 mL/dL MCV = 100 fL MCH = 34.5 pg MCHC = 37.5% PLT = 448 × 109/L WBC differential: 13 band neutrophils; 65 segmented neutrophils; 15 lymphocytes; 6 monocytes; 1 eosinophil RBC morphology: 3+ spherocytes, 1+ polychromasia What follow-up laboratory test would provide valuable information for this patient? A. Osmotic fragility B. Hgb electrophoresis C. G6PD assay D. Methemoglobin reduction test

A. Osmotic fragility The osmotic fragility test is indicated as a confirmatory test for the presence of numerous spherocytes, and individuals with hereditary spherocytosis (HS) have an increased osmotic fragility. The MCHC is elevated in more than 50% of patients with spherocytosis, and this parameter can be used as a clue to the presence of HS. Spherocytes have a DECREASED SURFACE-TO-VOLUME RATIO, probably resulting from MILD CELLULAR DEHYDRATION.

What term describes the change in shape of erythrocytes seen on a Wright's-stained peripheral blood smear? A. Poikilocytosis B. Anisocytosis C. Hypochromia D. Polychromasia

A. Poikilocytosis

Thrombin-thrombomodulin complex is necessary for activation of: A. Protein C B. Antithrombin C. Protein S D. Factors V and VIII

A. Protein C Protein C is activated by thrombin-thrombomodulin complex. Thrombomodulin (TM) is a transmembrane protein that accelerates protein C activation 1,000-fold by forming a complex with thrombin. When thrombin binds to TM, it loses its clotting function, including activation of factors V and VIII. Activated protein C deactivates factors Va and VIIIa. Protein S is a cofactor necessary for the activation of protein C.

What effect would using a buffer at pH 6.0 have on a Wright's-stained smear? A. Red cells would be stained too pink B. White cell cytoplasm would be stained too blue C. Red cells would be stained too blue D. Red cells would lyse on the slide

A. Red cells would be stained too pink The pH of the buffer is critical in Romanowsky stains. When the pH is too low (<6.4), the red cells take up more acid dye (eosin), becoming too pink. Leukocytes also show poor nuclear detail when the pH is decreased.

Precursor of orthrochromic normoblast A. Rubricyte B. Polychromatic erythrocyte C. Pronormoblast D. Prorubriblast

A. Rubricyte AKA as Polychromatic normoblast/erythroblast

A decreased osmotic fragility test would be associated with which of the following conditions? A. Sickle cell anemia B. Hereditary spherocytosis C. Hemolytic disease of the newborn D. Acquired hemolytic anemia

A. Sickle cell anemia Osmotic fragility is decreased when numerous sickle cells and target cells are present and is increased in the presence of spherocytes. Spherocytes are a prominent feature of hereditary spherocytosis (HS), hemolytic disease of the newborn, and acquired hemolytic anemia. The osmotic fragility test is increased in the presence of spherocytes, whereas this test is decreased when sickle cells, target cells, and other poikilocytes are present.

Features of secondary polycythemia include all of the following except: A. Splenomegaly B. Decreased oxygen saturation C. Increased red cell mass D. Increased erythropoietin

A. Splenomegaly Splenomegaly is a feature of PV but NOT characteristic of secondary polycythemia. The red cell mass is increased in both primary polycythemia (PV) and secondary polycythemia. Erythropoietin is increased and oxygen saturation is decreased in secondary polycythemia.

Which of the following is a characteristic of acute immune thrombocytopenic purpura? A. Spontaneous remission within a few weeks B. Predominantly seen in adults C. Nonimmune platelet destruction D. Insidious onset

A. Spontaneous remission within a few weeks Acute immune thrombocytopenic purpura is an immune-mediated disorder found predominantly in CHILDREN. It is commonly associated with INFECTION (primarily VIRAL). It is characterized by abrupt onset, and spontaneous remission usually occurs within several weeks.

Which of the following reactions are often positive in ALL but are negative in AML? A. Terminal deoxynucleotidyl transferase and PAS B. Chloroacetate esterase and nonspecific esterase C. Sudan Black B and peroxidase D. New methylene blue and acid phosphatase

A. Terminal deoxynucleotidyl transferase and PAS PAS is positive in about 50% of ALL with L1 and L2 morphology but is negative in ALL with L3 morphology (B-cell ALL). Terminal deoxynucleotidyl transferase is positive in all types of ALL except L3. Both terminal deoxynucleotidyl transferase and PAS are negative in AML.

Which of the following is a characteristic of Auer rods? A. They are composed of azurophilic granules B. They stain periodic acid-Schiff (PAS) positive C. They are predominantly seen in chronic myelogenous leukemia (CML) D. They are nonspecific esterase positive

A. They are composed of azurophilic granules Auer rods are a linear projection of primary azurophilic granules, and are present in the cytoplasm of myeloblasts and monoblasts in patients with acute leukemia.

Which laboratory test is affected by heparin therapy? A. Thrombin time B. Fibrinogen assay C. Protein C assay D. Protein S assay

A. Thrombin time Heparin is an antithrombin drug, and therefore increases the thrombin time test along with the APTT and PT. Heparin therapy has no effect on fibrinogen, protein C, or protein S assays. APTT is the test of choice for monitoring heparin therapy.

The most common subtype of classic von Willebrand's disease is: A. Type 1 B. Type 2A C. Type 2B D. Type 3

A. Type 1 VWF is a multimeric plasma glycoprotein that results in different subtypes of von Willebrand's diseasewith varied severity. The most common subtype is subtype 1, and 70%-80% of these cases are associated with MILD BLEEDING. TYPE 3 involves the TOTAL ABSENCE of the von Willebrand's molecule and is associated with SEVERE BLEEDING. Subtypes 2A and 2B result in DEFICIENCY of intermediate and/or high molecular weight portions of the von Willebrand molecule and are associated with 10%-12% and 3%-6% of cases of von Willebrand's disease, respectively.

Which factor deficiency is associated with a prolonged PT and APTT? A. X B. VIII C. IX D. XI

A. X Factor X, a common pathway factor deficiency, is most likely suspected, because both PT and APTT are prolonged. Other causes may include liver disease, vitamin K deficiency, and anticoagulant drugs such as Coumadin and heparin.

What substrate is used in a chromogenic factor assay? A. p-nitroanaline B. Chloropheonol red C. Prussian blue D. Ferricyanide

A. p-nitroanaline The chromogenic, or AMIDOLYTIC, assays use a color-producing substance known as a CHROMOPHORE. The chromophore used for the coagulation laboratory is p-nitroaniline (pNa). The pNa is bound to a synthetic oligopeptide substrate. The protease cleaves the chromogenic substrate at the site binding the oligopeptide to the pNA, which results in release of pNA. Free pNA has a YELLOW color; the color intensity of the solution is proportional to the protease activity and is measured by a photodetector at 405 nm.

Which factor deficiency is associated with a prolonged PT and APTT? A. X B. VIII C. IX D. XI

A.X

PEANUT, HEMA TURGEON 1. Observed when random errors or the lack of precision increase: A. Dispersion B. Shift C. Trend D. None of these 2. Control value direction moves progressively in one direction from the mean for at least 3 days: A. Dispersion B. Shift C. Trend D. None of these 3. Abrupt change is observed when a problem develops suddenly: A. Dispersion B. Shift C. Trend D. None of these

ACB

TTP differs from DIC in that: APTT is normal in TTP but prolonged in DIC Schistocytes are not present in TTP but are present in DIC Platelet count is decreased in TTP but normal in DIC PT is prolonged in TTP but decreased in DIC

APTT is normal in TTP but prolonged in DIC Thrombotic thrombocytopenic purpura is a platelet disorder in which platelet aggregation increases, resulting in thrombocytopenia. Schistocytes are present in TTP as a result of microangiopathic hemolytic anemia (MAHA); however, the PT and APTT are both normal. In DIC, the PT and APTT are both prolonged, the platelet count is decreased, and schistocytes are seen in the peripheral smear.

Abetalipoproteinemia is characterized by mild anemia and numerous on the peripheral blood smear. Acanthocytes Elliptocytes Echinocytes Stomatocytes

Acanthocytes Also seen in McLeod phenotype and Diego antigens. Additional: 1) McLeod (depressed Kell Ags) - Acanthocytes 2) Rh null disease - Stomatocytes 3) Diego: Mongolian ancestry Defect in carrier: - Hereditary Spherocytosis - Congenital Acanthocytosis - Southeast Asian Ovalocytosis 4) Leach Phenotype: Gerbich Null Ge-2-3-4 (depressed Kell Ags) Elliptocytes

Which conditions which shift the oxyhemoglobin dissociation curve to the right? Acidosis Alkalosis Multiple blood transfusions Increased quantities of hemoglobin S or C

Acidosis

Which of the following is the preferred method for monitoring heparin therapy at the POINT OF CARE during cardiac surgery? PT Activated Clotting Time Test (ACT) APTT TT

Activated Clotting Time Test (ACT) - Point of Care testing/Bedside PT: Warfarin/Coumarin/Coumadin APTT: Heparin therapy

Auer rods may be seen in all of the following except: Acute myeloid leukemia Acute promyelocytic leukemia Acute lymphoblastic leukemia Acute myelomonocytic leukemia

Acute lymphoblastic leukemia

Lipemia can cause turbidity in the cyanmethemoglobin method and a falsely high hemoglobin result. It can be corrected by: Reagent-sample solution can be centrifuged and the supernatant measured Adding 0.01 mL of the patient's plasma to 5 mL of the cyanmethemoglobin reagent and using this solution as the reagent blank Making a 1:2 dilution with distilled water (1 part diluted sample plus 1 part water) and multiplying the results from the standard curve by 2. Cannot be corrected

Adding 0.01 mL of the patient's plasma to 5 mL of the cyanmethemoglobin reagent and using this solution as the reagent blank

Using an electronic cell counter analyzer, an increased RDW should correlate with: Spherocytosis Anisocytosis Leukocytosis Presence of NRBCs

Anisocytosis The RDW parameter correlates with the degree of anisocytosis seen on the morphological examination. The reference range is 11.5%-14.5%.

The neutrophils in CGD are incapable of producing: Hydrogen peroxide Superoxide Hypochlorite All of the above

All of the above They cannot produce all these that's why it cannot kill bacteria.

CARDIOVASCULAR COMPLICATIONS of phlebotomy: Orthostatic hypotension Syncope Shock and cardiac arrest All of these

All of these

Isolation techniques: Prevent spread of infection from patient to hospital personnel Prevent spread of infection from patient to other patients Protect infection prone patient from pathogens All of these

All of these

VASCULAR COMPLICATIONS of phlebotomy: Bleeding from the site of the venipuncture and hematoma Pseudoaneurysm, thrombosis Reflex arteriospasm, arteriovenous fistula formation All of these

All of these Bleeding from the site of the venipuncture and hematoma formation are the most common vascular complications. Uncommon vascular complications that are not usually related to the technique include pseudoaneurysm, thrombosis, reflex arteriospasm, and arteriovenous fistula formation.

Which defect characterizes Gray's syndrome? Platelet adhesion defect Dense granule defect Alpha granule defect Coagulation defect

Alpha granule defect Gray's syndrome is a platelet granule defect associated with a decrease in alpha granules resulting in decreased production of alpha granule proteins such as platelet factor 4 and beta thromboglobulin. Alpha granule deficiency results in the appearance of agranular platelets when viewed on a Wright's stained blood smear.

Primary inhibitor of the fibrinolytic system? Protein C Protein S Alpha2 antiplasmin Alpha2 macroglobulin

Alpha2 antiplasmin

When acanthocytes are found on the blood smear, it is usually the result of Abnormal membrane permeability Altered membrane lipids Mechanical trauma Polymerization of hemoglobin molecules

Altered membrane lipids

Anemia due to decreased demand of tissues for oxygen: Anemia of chronic disorder Anemia of endocrine disease Anemia of renal disease Hemolytic anemia

Anemia of endocrine disease

Anemia due to failure of the kidneys to produce erythropoietin (EPO): Anemia of chronic disorder Anemia of endocrine disease Anemia of renal disease Hemolytic anemia

Anemia of renal disease

The WHO classification requires what percentage for the blast count in the blood or bone marrow for the diagnosis of AML? At least 30% At least 20% At least 10% Any percentage

At least 20%

Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)? Anti-I Anti-i Anti-M Anti-P

Anti-P

All of the following are causes of spurious decrease in MCHC, except: Autoagglutination High WBCs Spuriously low hemoglobin Spuriously high hematocrit

Autoagglutination SPURIOUS INCREASE IN MCHC Autoagglutination, clotting Hemolysis (in vitro, in vivo) Spuriously HIGH Hb Spuriously LOW Hct SPURIOUS DECREASE IN MCHC High WBC (>50,000/μL) Spuriously LOW Hb, Spuriously HIGH Hct

All of the following are causes of spurious increase in RBCs, except: Autoagglutination Cryoglobulin, cryofibrinogen Giant platelets High WBCs

Autoagglutination SPURIOUS INCREASE IN RBC Cryoglobulin, cryofibrinogen Giant platelets High WBC (>50,000/mL) SPURIOUS DECREASE IN RBC Autoagglutination, clotting Hemolysis (in vitro) Microcytic red cells

Which of the following conditions may produce spherocytes in a peripheral smear? Pelger-Huët anomaly Pernicious anemia Autoimmune hemolytic anemia Sideroblastic anemia

Autoimmune hemolytic anemia Differentiated from Hereditary Spherocytosis using DAT. HS: (-) DAT AIHA: (+) DAT Both increased OFT.

PEANUT Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia? A. Acute myeloid leukemia without maturation B. Acute promyelocytic leukemia C. Acute myelomonocytic leukemia D. Acute monocytic leukemia

Question number 1: Eosinophils remain in the maturation-storage phase for about: A. 2 days B. 2.5 days C. 3 days D. 3.5 days Question number 2: The time from the last myelocyte mitotic division to the emergence of mature eosinophils from the marrow is about: A. 2 days B. 2.5 days C. 3 days D. 3.5 days

B D

PEANUT 1. High WBC count that can cause turbidity and a falsely high hemoglobin result: A. WBCs > 10 x 10 9th/L B. WBCs > 20 x 10 9th/L C. WBCs > 50 x 10 9th/L D. WBCs > 70 x 10 9th/L 2. High platelet count that can cause turbidity and a falsely high hemoglobin result: A. Platelets > 150 x 10 9th/L B. Platelets > 200 x 10 9th/L C. Platelets > 500 x 10 9th/L D. Platelets > 700 x 10 9th/L

B D

Mean cell volume (MCV) is calculated using the following formula: A. (Hgb ÷ RBC) × 10 B. (Hct ÷ RBC) × 10 C. (Hct ÷ Hgb) × 100 D. (Hgb ÷ RBC) × 100

B. (Hct ÷ RBC) × 10 MCV is the average "volume" of the red cells. This is obtained by dividing the Hct or packed cell volume (PCV) by the red blood cell (RBC) count in millions per microliter of blood and multiplying by 10. The MCV is expressed in cubic microns (μm3) or femtoliters (fL).

A 19-year-old man came to the emergency department with severe joint pain, fatigue, cough, and fever. Review the following laboratory results: WBCs 21.0 × 109/L RBCs 3.23 × 1012/L Hgb 9.6 g/dL PLT 252 × 109/L Differential: 17 band neutrophils; 75 segmented neutrophils; 5 lymphocytes; 2 monocytes; 1 eosinophil; 26 NRBCs What is the corrected WBC count? A. 8.1 × 109/L B. 16.7 × 109/L C. 21.0 × 109/L D. 80.8 × 109/L

B. 16.7 × 109/L The formula for correcting the WBC count for the presence of NRBCs is: Total WBC × 100 or (21.0 × 100) ÷ 126 = 16.7 × 109/L where total WBC = WBCs × 109/L, 100 is the number of WBCs counted in the differential, and 126 is the sum of NRBCs plus WBCs counted in the differential.

If fewer than 50 platelets are counted on each side, the procedure should be repeated by diluting the blood to: A. 1:10 B. 1:20 C. 1:100 D. 1:200

B. 1:20

What is the approximate incidence of antiphospholipid antibodies in the general population? A. <1% B. 2% C. 10% D. 20%

B. 2% The incidence of antiphospholipid antibodies in the general population is about 2%.

If a patient has a reticulocyte count of 7% and an Hct of 20%, what is the corrected reticulocyte count? A. 1.4% B. 3.1% C. 3.5% D. 14%

B. 3.1% In anemic states, the reticulocyte percentage is not a true measure of reticulocyte production. The following formula must be applied to calculate the corrected (for anemia) reticulocyte count. Corrected reticulocyte count = reticulocytes (%) × Hct ÷ 45, the average normal Hct. In this case, 7 × (20 ÷ 45) = 3.1.

A 1:200 dilution of a patient's sample was made and 336 red cells were counted in an area of 0.2 mm2. What is the RBC count? A. 1.68 × 1012/L B. 3.36 × 1012/L C. 4.47 × 1012/L D. 6.66 × 1012/L

B. 3.36 × 1012/L

Normal adult blood volume is approximately: A. 2 to 3 liters B. 5 to 6 liters C. 7 to 8 liters D. 8 to 9 liters

B. 5 to 6 liters

What test is used to monitor heparin therapy? A. INR B. APTT C. TT D. PT

B. APTT Heparin dosage may be monitored by the APTT test. Heparin dose is adjusted to an APTT of 1.5-2.5 times the mean of the laboratory reference ranges. This level of APTT is equivalent to plasma heparin levels of 0.3-0.7 U/mL. The PT would be prolonged in heparin therapy, but the test is not as sensitive as the APTT. Heparin inhibits thrombin, and therefore, causes a prolonged TT. The TT test, however, is not used to monitor heparin therapy.

Which of the following is the preferred method to monitor heparin therapy at the point of care during cardiac surgery? A. APTT B. Activated clotting time test (ACT) C. PT D. TT

B. Activated clotting time test (ACT) The activated clotting time (ACT) is a point-of-care coagulation test used to monitor high-dose heparin therapy during cardiac surgery, cardiac angioplasty, hemodialysis, and other major surgeries. It is the preferred method to determine if sufficient heparin was administered to prevent clotting during surgery because it is MORE RAPID than the APTT test. The test uses a clot activator such as Kaolin or Celite to stimulate coagulation, and the time in seconds is linearly related to the dose of heparin administered. The ACT test is available in different formats, and the reference range varies depending on the method used. At low to moderate heparin doses, the ACT test does not correlate well with the APTT or the anti- factor Xa assay.

Factor V Leiden promotes thrombosis by preventing: A. Deactivation of factor Va B. Activation of factor V C. Activation of protein C D. Activation of protein S

B. Activation of factor V

A plasma sample submitted to the lab for PT testing has been stored for 25 hours at 4°C. The PT result is shortened. What is the most probable cause? A. Factor VII deficiency B. Activation of factor VII due to exposure to cold temperature C. Lupus inhibitor D. Factor X inhibitor

B. Activation of factor VII due to exposure to cold temperature Samples for evaluation of PT are stable for 24 hours if kept at room temperature. Prolonged exposure to cold will activate factor VII, resulting in decreased PT results.

Auer rods may be seen in all of the following except: A. Acute myelomonocytic leukemia (M4) B. Acute lymphoblastic leukemia C. Acute myeloid leukemia without maturation (M1) D. Acute promyelocytic leukemia (M3)

B. Acute lymphoblastic leukemia Auer rods are not seen characteristically in lymphoblasts. They may be seen in myeloblasts, promyelocytes, and monoblasts.

Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia? A. Acute myeloid leukemia without maturation B. Acute promyelocytic leukemia C. Acute myelomonocytic leukemia D. Acute monocytic leukemia

B. Acute promyelocytic leukemia

B. Acute promyelocytic leukemia The azurophilic granules in the leukemic promyelocytes in patients with acute promyelocytic leukemia contain thromboplastic substances. These activate soluble coagulation factors, which when released into the blood, cause DIC.

A patient with a vitamin B12 anemia is given a high dosage of folate. Which of the following is expected as a result of this treatment? A. An improvement in neurological problems B. An improvement in hematological abnormalities C. No expected improvement D. Toxicity of the liver and kidneys

B. An improvement in hematological abnormalities Administration of folic acid to a patient with vitamin B12 deficiency will improve the hematological abnormalities; however, the neurological problems will continue. This helps to confirm the correct diagnosis of vitamin B12 deficiency.

Using an electronic cell counter analyzer, an increased RDW should correlate with: A. Spherocytosis B. Anisocytosis C. Leukocytosis D. Presence of NRBCs

B. Anisocytosis The RDW parameter correlates with the degree of anisocytosis seen on the morphological examination. The reference range is 11.5%-14.5%.

The APTT results are not elevated in a patient receiving heparin. Which of the following factors may be associated with the lack of response to heparin therapy in this patient? A. Protein C deficiency B. Antithrombin deficiency C. Protein S deficiency D. Factor VIII deficiency

B. Antithrombin deficiency Antithrombin deficiency in patients receiving heparin therapy may lead to heparin resistance, and therefore, lack of prolongation of APTT results. Antithrombin is a heparin cofactor and as such increases heparin activity by 1,000-fold. The deficiency of AT is associated with a poor response to heparin therapy.

The WHO classification requires what percentage for the blast count in the blood or bone marrow for the diagnosis of AML? A. At least 30% B. At least 20% C. At least 10% D. Any percentage

B. At least 20% The WHO classification of AML requires that ≥20% of nucleated bone marrow cells be blasts, while the FAB classification generally requires ≥30%. WHO classifies AML into five subgroups: These are acute myeloid leukemias with recurrent genetic disorders; acute myeloid leukemia with multilineage dysplasia; acute myeloid leukemia and myelodysplastic syndromes, therapy related; acute myeloid leukemia not otherwise categorized; and acute leukemia of ambiguous lineage.

Inherited platelet dysfunction: A. Bernard-Soulier syndrome B. Bernard-Soulier syndrome, Glanzmann's thrombasthenia C. Uremia, multiple myeloma D. Uremia, multiple myeloma, vitamin B12 or folate deficiency

B. Bernard-Soulier syndrome, Glanzmann's thrombasthenia

Review the following CBC results on a 70-year-old man: WBCs = 58.2 × 109/L RBCs = 2.68 × 1012/L Hgb = 8.5 g/dL Hct = 26.5 mL/dL% MCV = 98 fL MCH = 31.7 pg MCHC = 32.6% PLT = 132 × 109/L Differential: 96 lymphocytes; 2 band neutrophils; 2 segmented neutrophils; 25 smudge cells/100 WBCs What is the most likely diagnosis based on these values? A. Acute lymphocytic leukemia B. Chronic lymphocytic leukemia (CLL) C. Infectious mononucleosis D. Myelodysplastic syndrome

B. Chronic lymphocytic leukemia (CLL) CLL is a disease of the elderly, classically associated with an elevated WBC count and relative and absolute lymphocytosis. CLL is twice as common in MEN, and SMUDGE CELLS (WBCs with little or no surrounding cytoplasm) are usually present in the peripheral blood smear. CLL may occur with or without anemia or thrombocytopenia. The patient's age and lack of blasts rule out acute lymphocytic leukemia. Similarly, the patient's age and the LACK OF ATYPICAL LYMPHOCYTES make infectious mononucleosis unlikely. Myelodysplastic syndromes may involve the erythroid, granulocytic, or megakaryocytic cell lines but not the lymphoid cells.

Which of the following platelet aggregating agents demonstrates a monophasic aggregation curve when used in optimal concentration? A. Thrombin B. Collagen C. Adenosine diphosphate (ADP) D. Epinephrine

B. Collagen

B. Collagen Collagen is the only commonly used agent that demonstrates a SINGLE-WAVE (monophasic) response preceded by a LAG time.

Aspirin prevents platelet aggregation by inhibiting the action of which enzyme? A. Phospholipase B. Cyclo-oxygenase C. Thromboxane A2 synthetase D. Prostacyclin synthetase

B. Cyclo-oxygenase Aspirin prevents platelet aggregation by inhibiting the activity of the enzyme cyclo-oxygenase. This inhibition prevents the formation of thromboxane A2 (TXA2), which serves as a potent platelet aggregator.

In addition to morphology, cytochemistry, and immunophenotyping, the WHO classification of myelo- and lymphoproliferative disorders is based upon which characteristic? A. Proteomics B. Cytogenetic abnormalities C. Carbohydrate-associated tumor antigen production D. Cell signaling and adhesion markers

B. Cytogenetic abnormalities In addition to morphology, cytochemical stains, and flow cytometry, the WHO classification relies heavily on chromosomal and molecular abnormalities.

An M:E ratio of 10:1 is most often seen in: A. Thalassemia B. Leukemia C. Polycythemia vera D. Myelofibrosis

B. Leukemia A disproportionate increase in the myeloid component of the bone marrow is usually the result of a leukemic state. The normal M:E ratio is approximately 4:1 in adults with normal cellularity.

Fibrin monomers are increased in which of the following conditions? A. Primary fibrinolysis B. DIC C. Factor VIII deficiency D. Fibrinogen deficiency

B. DIC Increased fibrin monomers result from coagulation activation. DIC is an acquired condition associated with spontaneous activation of coagulation and fibrinolysis. In primary fibrinolysis, the fibrinolytic system is activated and fibrin monomers are normal.

The osmotic fragility test result in a patient with thalassemia major would most likely be: A. Increased B. Decreased C. Normal D. Decreased after incubation at 37°C

B. Decreased The osmotic fragility is decreased because numerous target cells are present and have increased surface volume in thalassemia major patients.

The erythrocytosis seen in relative polycythemia occurs because of: A. Decreased arterial oxygen saturation B. Decreased plasma volume of circulating blood C. Increased erythropoietin levels D. Increased erythropoiesis in the bone marrow

B. Decreased plasma volume of circulating blood Relative polycythemia is caused by a reduction of plasma rather than an increase in red blood cell volume or mass. Red cell mass is increased in both PV and secondary polycythemia, but erythropoietin levels are high only in secondary polycythemia.

Which of the following parameters may be similar for the anemia of inflammation and iron deficiency anemia? A. Normocytic indices B. Decreased serum iron concentration C. Ringed sideroblasts D. Pappenheimer bodies

B. Decreased serum iron concentration Thirty to fifty percent of the individuals with the anemia of chronic inflammation demonstrate a microcytic hypochromic blood picture with decreased serum iron. Serum iron is decreased because it is unable to escape from the RE cells to be delivered to the nucleated red cells in the bone marrow.

Which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant? A. Thrombin time test B. Diluted Russell's viper venom test (DRVVT) C. D-dimer test D. FDP test

B. Diluted Russell's viper venom test (DRVVT)

Which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant? A. Thrombin time test B. Diluted Russell's viper venom test (DRVVT) C. D-dimer test D. FDP test

B. Diluted Russell's viper venom test (DRVVT) Russell's viper venom (RVV) reagent contains factors X and V, activating enzymes that are strongly phospholipid dependent. The reagent also contains RVV, calcium ions, and phospholipid. In the presence of phospholipid autoantibodies such as lupus anticoagulant, the reagent phospholipid is partially neutralized causing prolongation of the clotting time. Thrombin time evaluates fibrinogen. FDP and D-dimer tests evaluate fibrinogen and fibrin degradation products.

All of the following are characteristics of megaloblastic anemia except: A. Pancytopenia B. Elevated reticulocyte count C. Hypersegmented neutrophils D. Macrocytic erythrocyte indices

B. Elevated reticulocyte count Megaloblastic anemias are associated with an ineffective erythropoiesis and therefore a decrease in the reticulocyte count.

A 45-year-old woman visited her doctor complaining of easy bruising and menorrhagia occurring for the past few weeks. The patient had no history of excessive bleeding during childbirth several years earlier nor during a tonsillectomy in childhood. Her family history was unremarkable. PT 45 sec (11-13 sec) APTT 125 sec (28-37 sec) Thrombin Time 14.0 sec (10-15 sec) Mixing studies (patient plasma + normal plasma): PT = 40 sec; APTT = 90 sec Platelet count and morphology = normal Liver function tests = normal These clinical manifestations and laboratory results are consistent with: A. Factor VIII inhibitor B. Factor V inhibitor C. Factor VIII deficiency D. Lupus anticoagulant

B. Factor V inhibitor The lack of a positive family history in this patient indicates the presence of an acquired coagulopathy. Because both PT and APTT tests are abnormal, the clotting factor involved is most probably in the common pathway. The lack of correction by mixing studies suggests the presence of an inhibitor. Factor V antibodies are the MOST COMMON ANTIBODIES among the clotting factors of the common pathway (I, II, V, and X). Factor V antibodies are reported to be associated with surgery, some antibiotics such as streptomycin, patients who are exposed to blood products, or the bovine form of "fibrin glue." Patients with antibodies to factor V may require long-term therapy with immunosuppressive drugs. Acute bleeding episodes may be treated by platelet transfusions. The PT test is normal in patients with factor VIII deficiency and factor VIII inhibitor. Lupus anticoagulant is not present with bleeding unless associated with coexisting thrombocytopenia.

The most suitable product for treatment of factor VIII deficiency is: A. Fresh frozen plasma B. Factor VIII concentrate C. Prothrombin complex concentrate (for VIII inhibitor) D. Factor V Leiden

B. Factor VIII concentrate Factor VIII concentrate (human or recombinant) is the treatment of choice for patients with factor VIII deficiency. Fresh frozen plasma contains factor VIII; however, it is no longer used as the primary treatment for factor VIII deficiency. Prothrombin complex concentrate is used to treat patients with factor VIII inhibitor.

When performing a factor VIII activity assay, a patient's plasma is mixed with: A. Normal patient's plasma B. Factor VIII deficient plasma C. Plasma with a high concentration of factor VIII D. Normal control plasma

B. Factor VIII deficient plasma Coagulation factor assays are based upon the ability of the patient's plasma to correct any specific factor-deficient plasma. To measure for factor VIII activity in a patient's plasma, diluted patient plasma is mixed with a factor VIII-deficient plasma. An APTT test is performed on the mixture. Each laboratory should calculate its own normal ranges based on patient population, reagents, and the instrument used. An approximate range of 50%-150% is considered normal.

The Bethesda assay is used for which determination? A. Lupus anticoagulant titer B. Factor VIII inhibitor titer C. Factor V Leiden titer D. Protein S deficiency

B. Factor VIII inhibitor titer The Bethesda assay is a quantitative assay for factor VIII inhibitor. In this assay, normal plasma is incubated with different dilutions of the patient's plasma or a normal control. The inhibitor inactivates factor VIII present in normal plasma following incubation for 2 hours at 37°C. The residual activities in the sample are determined, and the inhibitor titer is calculated.

The APTT is sensitive to a deficiency of which clotting factor? A. Factor VII B. Factor X C. PF3 D. Calcium

B. Factor X The APTT is sensitive to the deficiency of coagulation factors in the intrinsic pathway (factors XII, XI, IX, and VIII) and the common pathway (factors X, V, II, and I).

The morphological characteristic(s) associated with the Chédiak-Higashi syndrome is (are): A. Pale blue cytoplasmic inclusions B. Giant lysosomal granules C. Small, dark-staining granules and condensed nuclei D. Nuclear hyposegmentation

B. Giant lysosomal granules Chédiak-Higashi syndrome is a disorder of neutrophil phagocytic dysfunction caused by depressed chemotaxis and delayed degranulation. The degranulation disturbance is attributed to interference from the giant lysosomal granules characteristic of this disorder.

Two days after receiving the antimalarial drug primaquine, a 27-year old black man develops sudden intravascular hemolysis resulting in a decreased hematocrit, hemoglobinemia, and hemoglobinuria. Examination of the peripheral blood reveals erythrocytes with a membrane defect forming "bite" cells; when crystal violet stain is applied, many Heinz bodies are seen. The most likely diagnosis is: A. Hereditary spherocytosis B. Glucose-6-phosphate dehydrogenase deficiency C. Paroxysmal nocturnal hemoglobinuria D. Autoimmune hemolytic anemia E. Microangiopathic hemolytic anemia

B. Glucose-6-phosphate dehydrogenase deficiency

Normal platelet adhesion depends upon: A. Fibrinogen B. Glycoprotein Ib C. Glycoprotein IIb, IIIa complex D. Calcium

B. Glycoprotein Ib Glycoprotein Ib is a platelet receptor for VWF. Glycoprotein Ib and VWF are both necessary for a normal platelet adhesion. Other proteins that play a role in platelet adhesion are glycoproteins V and IX. PLATELET ADHESION: VWF VIII V IX

Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright's-stained blood smear? A. Basophilic stippling B. Heinz bodies C. Howell-Jolly bodies D. Siderotic granules

B. Heinz bodies Heinz bodies are irregular, refractile, purple inclusions that are not visible with Wright's stain but show up with supravital staining. The other three inclusions can be detected with Wright's stain.

Review the following CBC results: WBCs = 11.0 × 109/L RBCs = 3.52 × 1012/L Hgb = 10.0 g/dL Hct = 29.9 mL/dL 12 NRBCs/100 WBCs RBC Morphology: Moderate polychromasia, 3+ target cells, few schistocytes MCV = 85.0 fL MCH = 28.4 pg MCHC = 33.4% PLT = 155 × 109/L Which of the following additional laboratory tests would yield informative diagnostic information for this patient? A. Osmotic fragility B. Hgb electrophoresis C. Sugar water test D. Bone marrow examination

B. Hgb electrophoresis

Review the following CBC results: WBCs = 11.0 × 109/L RBCs = 3.52 × 1012/L Hgb = 10.0 g/dL Hct = 29.9 mL/dL MCV = 85.0 fL MCH = 28.4 pg MCHC = 33.4% PLT = 155 × 109/L 12 NRBCs/100 WBCs RBC morphology: Moderate polychromasia, 3+ target cells, Few schistocytes Which of the following additional laboratory tests would yield informative diagnostic information for this patient? A. Osmotic fragility B. Hgb electrophoresis C. Sugar water test D. Bone marrow examination

B. Hgb electrophoresis The findings of a moderate anemia, numerous TARGET CELLS seen on a peripheral blood smear, as well as the presence of NRBCs, are often associated with HEMOGLOBINOPATHIES. Hemoglobin electrophoresis at ALKALINE pH (8.6) is a commonly performed test to correctly diagnose the type of hemoglobinopathy.

What red cell inclusion may be seen in the peripheral blood smear of a patient postsplenectomy? A. Toxic granulation B. Howell-Jolly bodies C. Malarial parasites D. Siderotic granules

B. Howell-Jolly bodies As a result of splenectomy, Howell-Jolly bodies may be seen in great numbers. One of the main functions of the spleen is the pitting function, which allows inclusions to be removed from the red cell without destroying the cell membrane.

A patient has 80 nucleated red blood cells per 100 leukocytes. In addition to increased polychromasia on the peripheral smear, what other finding may be present on the CBC? A. Increased platelets B. Increased MCV C. Increased Hct D. Increased red blood cell count

B. Increased MCV The patient will have an increased MCV. One of the causes of a macrocytic anemia that is not megaloblastic is an increased reticulocyte count, here noted as increased polychromasia. Reticulocytes are polychromatic macrocytes; therefore, the MCV is slightly increased.

Thrombotic thrombocytopenic purpura (TTP) is characterized by: A. Prolonged PT B. Increased platelet aggregation C. Thrombocytosis D. Prolonged APTT

B. Increased platelet aggregation Thrombotic thrombocytopenic purpura (TTP) is a quantitative platelet disorder associated with increased intravascular platelet activation and aggregation resulting in thrombocytopenia. The PT and APTT results are normal in TTP.

Which of the following complications may occur as a result of decreased tissue factor pathway inhibitor (TFPI)? A. Increased hemorrhagic episodes B. Increased thrombotic risk C. Impaired platelet plug formation D. Immune thrombocytopenia

B. Increased thrombotic risk Tissue factor pathway inhibitor (TFPI) is released from the vasculature and is the MOST IMPORTANCE INHIBITOR OF THE EXTRINSIC PATHWAY. TFPI inhibits factors Xa and VIIa-TF complex. Therefore, the deficiency of TFPI is associated with thrombosis.

Which of the following is correct regarding the international normalized ratio (INR)? A. It uses the International Sensitivity Ratio (ISR) B. It standardizes PT results C. It standardizes APTT results D. It is used to monitor heparin therapy

B. It standardizes PT results INR is used to standardize PT results to adjust for the difference in thromboplastin reagents made by different manufacturers and used by various institutions. The INR calculation uses the International Sensitivity Index (ISI) value, and is used to monitor an oral anticoagulant such as WARFAIN/COUMADIN. INR is NOT used to standardize APTT testing.

What is the major type of leukocyte seen in the peripheral smear of a patient with aplastic anemia? A. Segmented neutrophil B. Lymphocyte C. Monocyte D. Eosinophil

B. Lymphocyte Lymphocytes constitute the majority of the nucleated cells seen. The bone marrow in aplastic anemia is spotty with patches of normal cellularity. Absolute granulocytopenia is usually present; however, lymphocyte production is less affected.

A falsely elevated Hct is obtained. Which of the following calculated values will not be affected? A. MCV B. MCH C. MCHC D. Red cell distribution width (RDW)

B. MCH Centrifugal force for microhematocrit determination should be 12,000 g for 5 min in order to avoid error caused by trapped plasma. The red cell distribution width (RDW) is calculated by electronic cell counters and reflects the variance in the size of the red cell population. Electronic cell counters calculate Hct from the MCV and RBC count. Therefore, the RDW would be affected by an erroneous MCV.

Which of the following may be seen in the peripheral blood smear of a patient with obstructive liver disease? A. Schistocytes B. Macrocytes C. Howell-Jolly bodies D. Microcytes

B. Macrocytes Patients with obstructive liver disease may have red blood cells that have an increased tendency toward the deposition of lipid on the surface of the red cell. Consequently, the red cells are larger or more macrocytic than normal red cells.

Sodium fluoride may be added to the naphthyl ASD acetate (NASDA) esterase reaction. The fluoride is added to inhibit a positive reaction with: A. Megakaryocytes B. Monocytes C. Erythrocytes D. Granulocytes

B. Monocytes NASDA stains monocytes (and monoblasts) and granulocytes (and myeloblasts). The addition of fluoride renders the monocytic cells (and blasts) negative, thus allowing for differentiation from the granulocytic cells, which remain positive.

Which of the following is contained in the primary granules of the neutrophil? A. Lactoferrin B. Myeloperoxidase C. Histamine D. Alkaline phosphatase

B. Myeloperoxidase Myeloperoxidase, lysozyme, and acid phosphatase are enzymes that are contained in the primary granules of neutrophils. The contents of secondary and tertiary granules include lactoferrin, collagenase, NADPH oxidase, and alkaline phosphatase.

Which coagulation test(s) would be abnormal in a vitamin K-deficient patient? A. PT only B. PT and APTT C. Fibrinogen level D. Thrombin time

B. PT and APTT Patients with vitamin K deficiency exhibit decreased production of functional prothrombin proteins (factors II, VII, IX, and X). Decreased levels of these factors prolong both the PT and APTT.

In PV, what is characteristically seen in the peripheral blood? A. Panmyelosis B. Pancytosis C. Pancytopenia D. Panhyperplasia

B. Pancytosis PV is a myeloproliferative disorder characterized by uncontrolled proliferation of erythroid precursors. However, production of all cell lines is usually increased. PANHYPERPLASIA is a term used to describe the cellularity of the BONE MARROW in PV.

Qualitative and quantitative neutrophil changes noted in response to infection include all of the following except: A. Neutrophilia B. Pelgeroid hyposegmentation C. Toxic granulation D. Vacuolization

B. Pelgeroid hyposegmentation Neutrophil changes associated with infection may include neutrophilia, shift to the left, toxic granulation, Döhle bodies, and vacuolization. Pelgeroid hyposegmentation is noted in neutrophils from individuals with the congenital Pelger-Huët anomaly and as an acquired anomaly induced by drug ingestion or secondary to conditions such as leukemia.

Lumi-aggregation measures: A. Platelet aggregation only B. Platelet aggregation and ATP release C. Platelet adhesion D. Platelet glycoprotein Ib

B. Platelet aggregation and ATP release Platelet aggregation: IMPEDANCE ATP release: LUCIFERIN Note: NO ATP RELEASE IN STORAGE POOL DEFICIENCIES Lumi-aggregation measures platelet aggregation and ATP release. It is performed on WHOLE BLOOD DILUTED WITH SALINE. Platelet aggregation is measured by IMPEDANCE, whereas ATP release is measured by addition of LUCIFERIN to a blood sample. There is NO ATP RELEASE in storage pool deficiencies.

Glanzmann thrombasthenia and essential athrombia: A. Platelet adhesion defect B. Primary platelet aggregation defect C. Secondary platelet aggregation defect D. Isolated platelet factor III deficicency

B. Primary platelet aggregation defect ADHESION DEFECTS Bernard-Soulier syndrome Impaired adhesion to collagen AGGREGATION DEFECTS: PRIMARY Glanzmann thrombasthenia Essential athrombia AGGREGATION DEFECTS: SECONDARY Storage pool diseases Aspirin-like defects Release reaction defects ISOLATED PLATELET FACTOR III DEFICIENCY SEVERE COAGULATION FACTOR DEFICIENCIES Afibrinogenemia Factor VIII: C deficiency Factor IX: C deficiency

Which of the following abnormalities is consistent with the presence of lupus anticoagulant? A. Decreased APTT/bleeding complications B. Prolonged APTT/thrombosis C. Prolonged APTT/thrombocytosis D. Thrombocytosis/thrombosis

B. Prolonged APTT/thrombosis Lupus anticoagulant interferes with phospholipids in the APTT reagent, resulting in prolongation of APTT. However, in vivo, lupus anticoagulant decreases fibrinolytic activity, causing an increased risk of thrombosis. Lupus anticoagulant does not result in a bleeding tendency UNLESS there is a coexisting thrombocytopenia or other coagulation abnormality.

A 50-year-old female was admitted to a hospital for hip replacement surgery. The preoperative tests were performed and the results showed an Hgb of 13.5 g/dL; Hct = 42%; PT = 12 sec; APTT = 36 sec The patient was bleeding during surgery and the postoperative test results revealed an Hgb = 5.0 g/dL; Hct = 16%; PT = 8 sec; and APTT = 25 sec What steps should be taken before releasing these results? A. No follow-up steps are needed; report the results as obtained B. Report Hgb and Hct results, adjust the anticoagulant volume, and redraw a new sample for PT and APTT C. Call the nurse and ask if the patient is receiving heparin D. Because the patient is severely anemic, multiply the PT and APTT results by two and report the results

B. Report Hgb and Hct results, adjust the anticoagulant volume, and redraw a new sample for PT and APTT The anticoagulant-to-blood ratio should be adjusted for PT and APTT tests in patients with a severe anemia. The standard anticoagulant volume (0.5 mL) is not sufficient for the large quantity of plasma in these patients, causing unreliable PT and APTT results. The low Hgb and Hct in this patient were due to severe bleeding during surgery. To get accurate PT and APTT results, the amount of anticoagulant is adjusted according to the following formula: (0.00185)(V)(100-H) = C, where V = blood volume in mL; H = patient's Hct; and C = volume of anticoagulant in mL. A new sample should be drawn to rerun the PT and APTT. There are other causes for decreased PT and APTT, such as increased fibrinogen and increased factor VIII; however, the preanalytical variables affecting unreliable results should be ruled out first. Heparin therapy would increase PT and APTT.

A Miller disk is an ocular device used to facilitate counting of: A. Platelets B. Reticulocytes C. Sickle cells D. Nucleated red blood cells (NRBCs)

B. Reticulocytes

Which of the following is associated with multiple factor deficiencies? A. An inherited disorder of coagulation B. Severe liver disease C. Dysfibrinogenemia D. Lupus anticoagulant

B. Severe liver disease Most of the clotting factors are made in the liver. Therefore, severe liver disease results in multiple factor deficiencies. An inherited disorder of coagulation is commonly associated with a single factor deficiency. Lupus anticoagulant is directed against the phospholipid-dependent coagulation factors. Dysfibrinogenemia results from an abnormal fibrinogen molecule.

The anticoagulant of choice for most routine coagulation studies is: A. Sodium oxalate B. Sodium citrate C. Heparin D. Ethylenediaminetetraacetic acid (EDTA)

B. Sodium citrate The anticoagulant of choice for most coagulation procedures is sodium citrate (3.2%). Because factors V and VIII are more labile in sodium oxalate, heparin neutralizes thrombin, and EDTA inhibits thrombin's action on fibrinogen, these anticoagulants are not used for routine coagulation studies.

The anticoagulant of choice for most routine coagulation studies is: A. Sodium oxalate B. Sodium citrate C. Heparin D. Ethylenediaminetetraacetic acid (EDTA)

B. Sodium citrate The anticoagulant of choice for most coagulation procedures is sodium citrate (3.2%). Because factors V and VIII are more LABILE in SODIUM OXALATE, HEPARIN neutralizes thrombin, and EDTA inhibits thrombin's action on fibrinogen, these anticoagulants are not used for routine coagulation studies.

Autoimmune hemolytic anemia is best characterized by which of the following? A. Increased levels of plasma C3 B. Spherocytic red cells C. Decreased osmotic fragility D. Decreased unconjugated bilirubin

B. Spherocytic red cells Spherocytes are characteristic of autoimmune hemolytic anemia and result in an increased osmotic fragility. In autoimmune hemolytic anemias (AIHAs), production of autoantibodies against one's own red cells causes hemolysis or phagocytic destruction of RBCs. A positive direct antiglobulin (DAT or Coombs') test identifies in vivo antibody-coated and complement-coated red cells. A positive DAT distinguishes AIHA from other types of hemolytic anemia that produce spherocytes.

Which of the following organs is responsible for the "pitting process" for RBCs? A. Liver B. Spleen C. Kidney D. Lymph nodes

B. Spleen The spleen is the supreme filter of the body, pitting imperfections from the erythrocyte without destroying the integrity of the membrane.

In primary fibrinolysis, the fibrinolytic activity results in response to: A. Increased fibrin formation B. Spontaneous activation of fibrinolysis C. Increased fibrin monomers D. DIC

B. Spontaneous activation of fibrinolysis Primary fibrinolysis is a rare pathological condition in which a spontaneous systemic fibrinolysis occurs. Plasmin is formed in the absence of coagulation activation and clot formation. Primary fibrinolysis is associated with INCREASED PRODUCTION OF PLASMINOGEN AND PLASMIN, decreased plasmin removal from the circulation, and spontaneous bleeding.

What staining method is used most frequently to stain and manually count reticulocytes? A. Immunofluorescence B. Supravital staining C. Romanowsky staining D. Cytochemical staining

B. Supravital staining The reticulum within the reticulocytes consists of ribonucleic acid (RNA), which cannot be stained with Wright's stain. Supravital staining with new methylene blue is used to identify the reticulocytes.

Neurological findings may be commonly associated with which of the following disorders? A. HUS B. TTP C. ITP D. PTP

B. TTP TTP is characterized by neurological problems, fever, thrombocytopenia, microangiopathic hemolytic anemia, and renal failure.

Which anemia has red cell morphology similar to that seen in iron deficiency anemia? A. Sickle cell anemia B. Thalassemia syndrome C. Pernicious anemia D. Hereditary spherocytosis

B. Thalassemia syndrome

Which anemia has red cell morphology similar to that seen in iron deficiency anemia? A. Sickle cell anemia B. Thalassemia syndrome C. Pernicious anemia D. Hereditary spherocytosis

B. Thalassemia syndrome Iron deficiency anemia and thalassemia are both classified as microcytic, hypochromic anemias. Iron deficiency anemia is caused by defective heme synthesis; whereas thalassemia is caused by decreased globin chain synthesis.

What influence does the Philadelphia (Ph1) chromosome have on the prognosis of patients with chronic myelocytic leukemia? A. It is not predictive B. The prognosis is better if Ph1 is present C. The prognosis is worse if Ph1 is present D. The disease usually transforms into AML when Ph1 is present

B. The prognosis is better if Ph1 is present Ninety percent of patients with CML have the Philadelphia chromosome. This appears as a long arm deletion of chromosome 22, but is actually a translocation between the long arms of chromosomes 22 and 9. The ABL oncogene from chromosome 9 forms a hybrid gene with the bcr region of chromosome 22. This results in production of a chimeric protein with tyrosine kinase activity that activates the cell cycle. The prognosis for CML is better if the Philadelphia chromosome is present. Often, a second chromosomal abnormality occurs in CML before blast crisis.

Which of the following is associated with antithrombin deficiency? A. Thrombocytosis B. Thrombosis C. Thrombocytopenia D. Bleeding

B. Thrombosis Antithrombin is a physiological anticoagulant. It inhibits factors IIa, Xa, IXa, XIa, and XIIa. Deficiency of antithrombin is associated with thrombosis. Thrombotic events may be primary (in the absence of a triggering factor) or may be associated with another risk factor such as pregnancy or surgery.

Fletcher factor (prekallikrein) deficiency may be associated with: A. Bleeding B. Thrombosis C. Thrombocytopenia D. Thrombocytosis

B. Thrombosis Fletcher factor (prekallikrein) is a contact factor. Activated prekallikrein is named kallikrein and is involved in activation of factor XII to XIIa. Like factor XII deficiency, Fletcher factor deficiency may be associated with thrombosis.

Plasminogen deficiency is associated with: A. Bleeding B. Thrombosis C. Increased fibrinolysis D. Increased coagulation

B. Thrombosis Plasminogen deficiency is associated with thrombosis. Plasminogen is an important component of the fibrinolytic system. Plasminogen is activated to plasmin, which is necessary for degradation of fibrin clots to prevent thrombosis. When plasminogen is deficient, plasmin is not formed, causing a defect in the clot lysing processes.

Which of the following is most commonly associated with activated protein C resistance (APCR)? A. Bleeding B. Thrombosis C. Epistaxis D. Menorrhagia

B. Thrombosis Activated protein C resistance is the single most common cause of inherited thrombosis. In 90% of individuals, the cause is gene mutation of factor V (factor V Leiden). Affected individuals are predisposed to thrombosis, mainly after age 40. Heterozygous individuals may not manifest thrombosis unless other clinical conditions coexist.

Which of the following initiates in vivo coagulation by activation of factor VII? A. Protein C B. Tissue factor C. Plasmin activator D. Thrombomodulin

B. Tissue factor In vivo, activation of coagulation occurs on the surface of activated platelets or cells that have tissue factor. Tissue factor is found on the surface of many cells outside the vascular system (extrinsic). Upon vascular injury, TF is exposed to the vascular system. TF has high affinity for factors VII and VIIa. TF activates factor VII to VIIa and forms TF-VIIa complex. TF-VIIa complex in the presence of Ca+2 and platelet phospholipid activates factors IX to IXa and X to Xa. Factor Xa forms a complex with cofactor Va (Xa-Va) on the surface of the activated platelets. Factor Xa-Va complex in the presence of Ca+2 and platelet phospholipid converts prothrombin (factor II) to thrombin (IIa). Thrombin acts on soluble plasma fibrinogen to form a fibrin clot, which is stabilizedby activated factor XIII (XIIIa). In addition, activated factor IX (IXa) forms a complex with activated cofactor VIII (VIIIa) on the surface of the activated platelets. Factor IXa-VIIIa complex in the presenceof Ca+2 and platelet phospholipid converts factor X to Xa with the end products of thrombin and fibrin clot as discussed previously. The classical description of intrinsic, extrinsic, and common pathways doesnot take place in vivo. The concept of these three pathways is used to explain clot formation in laboratory tests. The activated thromboplastin time (APTT) is determined by the intrinsic and common pathways, while the prothrombin time (PT) is determined by the extrinsic and common pathways. The extrinsic pathway is so named because the tissue factor is derived from extravascular cells.

Which of the following initiates in vivo coagulation by activation of factor VII? A. Protein C B. Tissue factor C. Plasmin activator D. Thrombomodulin

A prolonged APTT and PT are corrected when mixed with normal plasma. Which factor is most likely deficient? A. VIII B. V C. XI D. IX

B. V Factor V (common pathway factor) deficiency is most likely suspected, because both the PT and APTT are prolonged, and both are corrected when mixed with normal plasma.

Select the amino acid substitution that is responsible for sickle cell anemia. A. Lysine is substituted for glutamic acid at the sixth position of the α-chain B. Valine is substituted for glutamic acid at the sixth position of the β-chain C. Valine is substituted for glutamic acid at the sixth position of the α-chain D. Glutamine is substituted for glutamic acid at the sixth position of the β-chain

B. Valine is substituted for glutamic acid at the sixth position of the β-chain The structural mutation for Hgb S is the substitution of valine for glutamic acid at the sixth position of the β-chain. Because glutamic acid is negatively charged, this decreases its rate of migration toward the anode at pH 8.6.

Patient History A 12-year-old white male has the following symptoms: visible bruising on arms and legs, bruising after sports activities, and excessive postoperative hemorrhage following tonsillectomy 3 months ago. His family history revealed that his mother suffers from heavy menstrual bleeding, and his maternal grandfather had recurrent nosebleeds and bruising. Platelet Count: 350 × 103/μL (200-450 × 103/μL) PT: 11.0 sec (10-12 sec) APTT: 70 sec (28-37 sec) TT: 13 sec (10-15 sec) Platelet Aggregation Normal aggregation with collagen, epinephrine, ADP Abnormal aggregation with ristocetin VWF:Rco 25% (45%-140%) VIII:C 20% (50%-150%) WWF:antigen 10% (45%-185%) These clinical manifestations and laboratory results are consistent with which diagnosis? A. Factor VIII deficiency B. von Willebrand's disease C. Glanzmann's thrombasthenia D. Bernard-Soulier syndrome

B. von Willebrand's disease These clinical manifestations and laboratory results are consistent with von Willebrand's disease. Von Willebrand's disease is an inherited bleeding disorder caused by abnormal platelet adhesion. Platelet adhesion depends on VWF and glycoprotein Ib. In von Willebrand's disease, VWF is deficient or dysfunctional. VWF promotes secondary hemostasis by acting as a carrier for factor VIII. Deficient or dysfunctional VWF results in decreased factor VIII and therefore abnormal secondary hemostasis. The clinical manifestations associated with von Willebrand's disease are easy bruising, epistaxis, and bleeding after surgery. Abnormal laboratory test results are increased bleeding time and abnormal platelet aggregation to ristocetin, which is corrected on addition of normal plasma containing VWF. Activated partial thromboplastin time (APTT) is prolonged as a result of the deficiency of factor VIII. Factor VIII activity (VIII:C), VWF ristocetin cofactor activity (VWF:Rco), and VWF:antigenic activity (VWF:antigen) are all abnormal. The platelet count and prothrombin time are normal in von Willebrand's disease.

Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive chronic myelogenous leukemia? MYC/IGH BCR/ABL PML/RARA JAK2

BCR/ABL The Philadelphia chromosome, t(9;22), is detected in almost all cases of CML (depends on detection method) and results in a mutated BCR/ABL fusion gene.

Elongated and curved nucleus; very clumped chromatin: Myelocyte Metamyelocyte Band Segmenter neutrophil

Band

Granulocytic cell with a sausage-shaped nucleus: Promyelocyte Myelocyte Metamyelocyte Band

Band

Very clumped chromatin: Myelocyte Metamyelocyte Band Segmented neutrophil

Band

The promonocyte nucleus is deeply indented and should not be confused with a: Lymphocyte Erythrocyte Segmenter neutrophil Band neutrophil

Band neutrophil

Mast cells have an appearance similar to that of the blood: Monocyte Neutrophil Eosinophil Basophil

Basophil Mast cells (tissue basophils) are not observed in the blood of healthy persons. These cells have an appearance similar to that of the blood basophil. Mast cells have a round or oval nucleus. The granules of the mast cell do not overlie the nucleus as they do in basophils.

Chondroitin sulfates such as heparan: Neutrophil secondary granules Eosinophil secondary granules Basophil secondary granules

Basophil secondary granules

RBC inclusions representing granules composed of ribosomes and RNA that are precipitated during the process of staining of a blood smear; associated clinically with disturbed erythropoiesis (defective or accelerated heme synthesis),lead poisoning, and severe anemias. Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Basophilic stippling

What is the color of the cytoplasm of monocytes? Pink Green Purple Blue-grey

Blue-grey

Which of the following locations is not a site of extramedullary hematopoiesis? Bone marrow Liver Spleen Thymus

Bone marrow BONE MARROW - MEDULLARY SITE

A patient has a splenomegaly, and his CBC shows a left shift; bizarre RBCs, including dacryocytes; and notable platelet abnormalities. Which of the following would be the most helpful in determining the patient's diagnosis? Bone marrow biopsy LAP staining Karyotyping for the Philadelphia chromosome Spleen biopsy

Bone marrow biopsy A bone marrow biopsy would help in confirming a diagnosis of primary MYELOFIBROSIS, which is a possible diagnosis suggested by the DACRYOCYTES, left shift, and abnormal platelets. If the patient had primary myelofibrosis, the bone marrow would likely show areas of FIBROSIS, in addition to increases in megakaryocytes and abnormal platelets.

DIC is also known as: Defibrination syndrome Consumption coagulopathy Both of these None of these

Both of these

Which results would be expected for the PT and APTT in a patient with polycythemia? Both prolonged Both shortened Normal PT, prolonged APTT Both normal

Both prolonged

Which results would be expected for PT and APTT in patients with polycythemia? Both prolonged Both shortened Both normal Prolonged APTT, normal PT

Both prolonged More cells than plasma Excessive citrate in plasma, and will react with it Falsely prolonged PT and APTT Remedy: Reduce citrate volume

When a blood film is viewed through the microscope, the RBCs appear redder than normal, the neutrophils are barely visible, and the eosinophils are bright orange. What is the most likely cause? Slide was overstained Stain was too alkaline Buffer was too acidic Slide was not rinsed adequately

Buffer was too acidic EXCESSIVELY PINK STAIN Insufficient staining Prolonged washing time Mounting the coverslips before they are dry Too high acidity of the stain or buffer EXCESSIVELY BLUE STAIN Thick films Prolonged staining time Inadequate washing Too high an alkalinity of stain or diluent

PEANUT Clinical signs and symptoms commonly include low birth weight (<2,500 g), skin hyperpigmentation (café au lait spots), and short stature. Other manifestations can include skeletal disorders (aplasia or hypoplasia of the thumb), renal malformations, microcephaly, hypogonadism, mental retardation, and strabismus. A. Diamond Blackfan anemia B. Iron deficiency anemia C. Fanconi anemia D. Sideroblastic anemia

The familial condition of Pelger-Huët anomaly is important to recognize because this disorder must be differentiated from: A. Infectious mononucleosis B. May-Hegglin anomaly C. A shift-to-the-left increase in immature granulocytes D. G6PD deficiency

C. A shift-to-the-left increase in immature granulocytes Pelger-Huët anomaly is a benign familial condition reported in 1 out of 6,000 individuals. Care must be taken to differentiate Pelger-Huët cells from the numerous band neutrophils and metamyelocytes that may be observed during severe infection or a shift-to-the-left of immaturity in granulocyte stages.

What would be the most likely designation by the WHO for the FAB AML M2 by the French-American-British classification? A. AML with t(15;17) B. AML with mixed lineage C. AML with t(8;21) D. AML with inv(16)

C. AML with t(8;21)

Which of the following hemoglobins migrates to the same position as Hgb A2 at pH 8.6? A. Hgb H B. Hgb F C. Hgb C D. Hgb S

C. Hgb C At pH 8.6, several hemoglobins migrate together. These include Hgb A2, Hgb C, Hgb E, Hgb 0Arab, and Hgb CHarlem. These are located nearest the cathode at pH 8.6.

Typical dilution for manual platelet count: A. 1:10 B. 1:20 C. 1:100 D. 1:200

C. 1:100

Which ratio of anticoagulant to blood is correct for coagulation procedures? A. 1:4 B. 1:5 C. 1:9 D. 1:10

C. 1:9

Which ratio of anticoagulant-to-blood is correct for coagulation procedures? A. 1:4 B. 1:5 C. 1:9 D. 1:10

C. 1:9 1 part ANTICOAGULANT 9 parts BLOOD The optimum ratio of anticoagulant to blood is one part anticoagulant to nine parts of blood. The anticoagulant supplied in this amount is sufficient to bind all the available calcium, thereby preventing clotting.

What is the normal WBC differential lymphocyte percentage (range) in the adult population? A. 5%-10% B. 10%-20% C. 20%-44% D. 50%-70%

C. 20%-44% The normal adult percentage of lymphocytes in a white cell differential is between 20% and 44%, although normal ranges vary by institution, patient population, and testing methodology. This range is higher in the pediatric population.

A manual WBC count is performed. Eighty WBCs are counted in the four large corner squares of a Neubauer hemacytometer. The dilution is 1:100. What is the total WBC count? A. 4.0 × 109/L B. 8.0 × 109/L C. 20.0 × 109/L D. 200.0 × 109/L

C. 20.0 × 109/L The formula for calculating manual cell counts using a hemacytometer is: # cells counted × 10 (depth factor) × dilution factor divided by the area counted in mm2, or (80 × 10 × 100) ÷ 4 = 20,000/μL or 20.0 × 109/L

Abnormal rate of synthesis 1. Hb SS (sickle cell anemia) 2. Hb SA (sickle cell trait) 3. Hb C disease or trait 4. Alpha thalassemia 5. Beta thalassemia A. 1 and 2 B. 1, 2, and 3 C. 4 and 5 D. 1, 2, 3, 4, and 5

C. 4 and 5 ABNORMAL MOLECULAR STRUCTURE 1. Hb SS (sickle cell anemia) 2. Hb SA (sickle cell trait) 3. Hb C disease or trait ABNORMAL RATE OF SYNTHESIS 1. Alpha thalassemia 2. Beta thalassemia

C. AML with t(8;21) AML with t(8;21) is classified under the category of AML with Recurrent Genetic Abnormalities by the WHO. This translocation occurs in up to 15% of cases of AML and may be the MOST COMMON translocation. The AML1-ETO translocation occurs chiefly in younger patients and often in cases of acute myeloblastic leukemia with maturation, FAB M2. The translocation involves the fusion of the AML1 gene on chromosome 21 with the ETO gene on chromosome 8.

SITUATION: The following laboratory values are seen: WBCs = 6.0 × 109/L RBCs = 1.90 × 1012/L Platelets = 130 × 109/L Serum vitamin B12 and folic acid: normal Hgb = 6.0 g/dL Hct = 18.5% WBC Differential 6% PMNs 40% lymphocytes 4% monocytes 50% blasts Bone Marrow 40% myeloblasts 60% promegaloblasts 40 megaloblastoid NRBCs/100 WBCs These results are most characteristic of: A. Pernicious anemia B. Acute myeloid leukemia without maturation C. Acute erythroid leukemia D. Acute myelomonocytic leukemia

C. Acute erythroid leukemia In acute erythroid leukemia, more than 50% of nucleated bone marrow cells are erythroid and more than 30% nonerythroid cells are blasts. Pernicious anemia results in pancytopenia and low vitamin B12 concentrations.

What would be the most likely classification by the WHO for the FAB AML M7 by the French-American-British classification? A. Acute myeloid leukemias with recurrent genetic abnormalities B. Acute myeloid leukemia with multilineage dysplasia C. Acute myeloid leukemia not otherwise categorized D. Acute leukemias of ambiguous lineage

C. Acute myeloid leukemia not otherwise categorized Acute megakaryoblastic leukemia, which is equivalent to FAB M7, is a relatively uncommon form of leukemia characterized by neoplastic proliferation of megakaryoblasts and atypical megakaryocytes. Recognition of this entity was aided by the use of platelet peroxidase (PPO) ultrastructural studies. PPO, which is distinct from myeloperoxidase, is specific for the megakaryocytic cell line. Acute megakaryoblastic leukemia is defined as an acute leukemia in which greater than or equal to 50% of the blasts are of megakaryocytic lineage.

Which defect characterizes Gray's syndrome? A. Platelet adhesion defect B. Dense granule defect C. Alpha granule defect D. Coagulation defect

C. Alpha granule defect Gray's syndrome is a platelet granule defect associated with a decrease in alpha granules resulting in decreased production of alpha granule proteins such as platelet factor 4 and beta thromboglobulin. Alpha granule deficiency results in the appearanceof agranular platelets when viewed on a Wright's- stained blood smear.

Which test may be used to monitor LMWH therapy? A. APTT B. INR C. Anti-Xa heparin assay D. Activated clotting time

C. Anti-Xa heparin assay The anti-factor Xa heparin assay is used to monitor LMWH therapy when required because the APTT test is insensitive to LMWH. The assay can be performed by chromogenic end-point detection used on automated analyzers. The principle of the test is to measure the inhibition of Xa by heparin. The reagent is a mixture of a fixed concentration of factor Xa, a substrate which is specific for factor Xa, and a fixed concentration of antithrombin (AT). Some kits rely on the antithrombin in patient's plasma. Heparin forms a complex with AT and factor Xa (AT-heparin-Xa). Excess free factor Xa cleaves the chromogenic substrate and releases a yellow product. The color intensity of the product is inversely proportional to plasma heparin concentration, and is measured by a photodetector at 405 nm. LMWH therapy does not usually require monitoring; however, exceptions include pediatric, obese, and pregnant patients and those with renal failure.

Which of the following conditions may produce spherocytes in a peripheral smear? A. Pelger-Huët anomaly B. Pernicious anemia C. Autoimmune hemolytic anemia D. Sideroblastic anemia

C. Autoimmune hemolytic anemia Spherocytes are produced in autoimmune hemolytic anemia. Spherocytes may be produced by one of three mechanisms. First, they are anatural morphological phase of normal red cell senescence. Second, they are produced when the cell surface-to-volume ratio is decreased, as seen in hereditary spherocytosis. And third, they may be produced as a result of antibody coating of the red cells. As the antibody-coated red cells travel through the spleen, the antibodies and portions of the red cell membrane are removed by macrophages. The membrane repairs itself; hence, the red cell's morphology changes from a biconcave disk to a spherocyte.

Multiple myeloma is most difficult to distinguish from: A. Chronic lymphocytic leukemia B. Acute myelogenous leukemia C. Benign monoclonal gammopathy D. Benign adenoma

C. Benign monoclonal gammopathy Benign monoclonal gammopathies have peripheral blood findings similar to those in myeloma. However, a lower concentration of monoclonal protein is usually seen. There are no osteolytic lesions, and the plasma cells comprise less than 10% of nucleated cells in the bone marrow. About 30% become malignant, and therefore the term monoclonal gammopathy of undetermined significance (MGUS) is the designation used to describe this condition.

Which of the following tests is most likely to be abnormal in patients taking aspirin? A. Platelet morphology B. Platelet count C. Bleeding time D. Prothrombin time

C. Bleeding time Aspirin is an antiplatelet drug. It prevents platelet aggregation by inhibition of cyclo-oxygenase. Aspirin has no effect on the platelet count, platelet morphology, or prothrombin time.

A standard blue-top tube filled appropriately (with 4.5 mL blood) was submitted to the laboratory for preoperative PT and APTT testing. The results of both tests were elevated. The patient's PT and APTT from the previous day were within normal limits, and he is not on heparin therapy. Which is the most appropriate first step to investigate the abnormal results? A. Report the result as obtained B. Perform a mixing study C. Check the sample for a clot D. Report the APTT only

C. Check the sample for a clot A clot can form because of inadequate mixing ofthe sample after venipuncture, if the blood fills the evacuated tube at a slow rate, or with traumatic venipuncture. In vitro, blood clots result in consumption of the clotting factors and therefore prolongation of PT, APTT, and other clot-based assays. If the clotting factors have been activated but the clot formation is incomplete, it may result in shortening of the PT and APTT. Checking the sample for a clot is the most reasonable step in this case.

A 62-year-old female presents with jaundice and the following laboratory data: Peripheral blood smear: macrocytosis, target cells Platelet count: 355 × 109/L PT: 25 sec (reference range =10-14) APTT: 65 sec (reference range = 28-36) Transaminases: elevated (AST:ALT>1) Total and direct bilirubin: elevated These clinical presentations and laboratory results are consistent with: A. Inherited factor VII deficiency B. DIC C. Cirrhosis of the liver D. von Willebrand's disease

C. Cirrhosis of the liver The clinical presentation and laboratory results in this patient are indicative of cirrhosis of the liver. Most of the clotting factors are made in the liver. A decrease in multiple clotting factors is associated with a prolonged PT and APTT. Macrocytosis and target cells are present in liver disease. The liver changes the unconjugated bilirubin to conjugated bilirubin. Conjugated bilirubin is excreted into the intestines, where the bilirubin is then converted to urobilinogen and excreted into the stool. In cirrhosis of the liver, both necrosis and obstruction caused by scarring produce an increase in unconjugated and conjugated bilirubin, respectively. In addition, the liver enzymes are elevated (the AST:ALT ratio is <1 in necrotic liver diseases such as hepatitis but not in cirrhosis).

Which of the following statistical terms reflects the best index of precision when comparing two CBC parameters? A. Mean B. Median C. Coefficient of variation D. Standard deviation

C. Coefficient of variation Standard deviation(s) describes the distribution of a sample of observations. It depends upon both the mean (average value) and dispersion of results and is most influenced by reproducibility or precision. Because s is influenced by the mean and expressed as a percentage of the mean, the coefficient of variation ([s ÷ mean] × 100) can be used to compare precision of tests with different means (e.g., WBC and RBC counts or low vs. high controls).

Refer to the following results: PT = prolonged APTT = prolonged Platelet count = decreased Which disorder may be indicated? A. Factor VIII deficiency B. von Willebrand's disease C. DIC D. Factor IX deficiency

C. DIC In DIC, there is a diffuse intravascular generation of thrombin and fibrin. As a result, coagulation factors and platelets are consumed, resulting in decreased platelet count and increased PT and APTT.

All of the following are characteristic findings in a patient with iron deficiency anemia except: A. Microcytic, hypochromic red cell morphology B. Decreased serum iron and ferritin levels C. Decreased total iron-binding capacity (TIBC) D. Increased RBC protoporphyrin

C. Decreased total iron-binding capacity (TIBC)

Hemolytic uremic syndrome (HUS) is associated with: A. Fever, thrombocytosis, anemia, and renal failure B. Fever, granulocytosis, and thrombocytosis C. Escherichia coli 0157:H7 D. Leukocytosis and thrombocytosis

C. Escherichia coli 0157:H7 HUS is caused by E. coli 0157:H7. It is associated with ingestion of E. coli-contaminated foods and is commonly seen in children. The clinical manifestations in HUS are fever, diarrhea, THROMBOCYTOPENIA, microangiopathic hemolytic anemia, and renal failure.

"Bite cells" are usually seen in patients with: A. Rh null trait B. Chronic granulomatous disease C. G6PD deficiency D. PK deficiency

C. G6PD deficiency In patients with G6PD deficiency, the red cells are unable to reduce nicotinamide adenine dinucleotide phosphate (NADP) to NADPH; consequently, Hgb is denatured and Heinz bodies are formed. "Bite cells" appear in the peripheral circulation as a result of splenic pitting of Heinz bodies.

A 1-year-old infant was admitted to the hospital with recurrent epistaxis for the past 5 days. The past medical history revealed easy bruising and a severe nosebleed at 3 months of age, necessitating transfusion therapy. The mother had had a severe nosebleed 8 years ago. The father was reported to bleed easily after lacerations. The patient was transfused with 2 units of packed red cells upon admission. Hgb: 4.5 g/dL (13-15 g/dL) Platelet count: 249 × 109/L (150-450 × 109/L) PT: 11.2 sec (11-13 sec) APTT: 34 sec (28-37 sec) ADDITIONAL LABORATORY TESTS Factor VIII assay 70% (50%-150%) Platelet aggregation: Abnormal to ADP, epinephrine, and thrombin; normal to ristocetin These clinical manifestations and laboratory results are consistent with which condition? A. von Willebrand's disease B. Bernard-Soulier syndrome C. Glanzmann's thrombasthenia D. Factor VIII deficiency

C. Glanzmann's thrombasthenia These clinical manifestations and laboratory results are consistent with Glanzmann's thrombasthenia. Epistaxis and easy bruising are characteristics of platelet disorders. The positive family history is indicative of an inherited bleeding disorder. Laboratory tests reveal a low hemoglobin level due to epistaxis. The normal platelet count rules out any quantitative platelet disorder. The platelet count is typically low in Bernard-Soulier syndrome. The bleeding time test evaluates in vivo platelet function and number. Normal PT and APTT combined with a normal factor VIII assay rule out coagulation disorders. The laboratory tests that confirm an inherited platelet disorder are platelet aggregation studies. Platelet aggregation is normal to ristocetin and abnormal to ADP, epinephrine, and thrombin. These results are consistent with Glanzmann's thrombasthenia. Platelet aggregation is abnormal to ristocetin in von Willebrand's disease and Bernard-Soulier syndrome.

Cells that exhibit a positive stain with acid phosphatase and are not inhibited with tartaric acid are characteristically seen in: A. Infectious mononucleosis B. Infectious lymphocytosis C. Hairy cell leukemia D. T-cell acute lymphoblastic leukemia

C. Hairy cell leukemia A variable number of malignant cells in hairy cell leukemia (HCL) will stain positive with tartrate- resistant acid phosphatase (TRAP+). Although this cytochemical reaction is fairly specific for HCL, TRAP activity has occasionally been reported in B-cell and rarely T-cell leukemia.

A 7.0-mL ethylenediaminetetraacetic acid (EDTA) tube is received in the laboratory containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the following tests will most likely be erroneous? A. RBC count B. Hemoglobin (Hgb) C. Hct D. WBC count

C. Hct Excessive anticoagulant causes shrinkage of cells; thus, the Hct will be affected. RBC and WBC counts remain the same, as does the Hgb content.

Which of the following is an unusual complication that may occur in infectious mononucleosis? A. Splenic infarctions B. Dactylitis C. Hemolytic anemia D. Giant platelets

C. Hemolytic anemia Occasionally patients with infectious mononucleosis develop a potent cold agglutinin with anti-I specificity. This cold autoantibody can cause strong hemolysis and a hemolytic anemia.

More than half of the cases have been described in Ashkenazi Jews, but individuals of any ethnic group may be affected: A. Hemophilia A B. Hemophilia B C. Hemophilia C D. vWD

C. Hemophilia C

Patient History A 3-year-old male was admitted to a hospital with scattered petechiae and epistaxis. The patient had normal growth and had no other medical problems except for chickenpox 3 weeks earlier. His family history was unremarkable. PT: 11 sec (10-13 sec) APTT: 32 sec (28-37 sec) Platelet count: 18 × 103/μL (150-450 × 103/μL) These clinical manifestations and laboratory results are consistent with which condition? A. TTP B. DIC C. ITP D. HUS

C. ITP These clinical manifestations and laboratory results are consistent with ITP. ITP is an autoimmune thrombocytopenia. In children, acute ITP thrombocytopenia occurs following a viral infection, as is the case in this 3-year-old patient. Clinical manifestations are associated with petechiae, purpura, and mucous membrane bleedings such as epistaxis and gingival bleeding. Abnormal laboratory tests include a very low platelet count and a prolonged bleeding time. Other causes of thrombocytopenia should be ruled out in patients with ITP.

A prolonged APTT is corrected with factor VIII- deficient plasma but not with factor IX-deficient plasma. Which factor is deficient? A. V B. VIII C. IX D. X

C. IX Because the prolonged APTT is not corrected with a factor IX-deficient plasma, factor IX is suspected to be deficient in the test plasma.

A patient's peripheral smear reveals numerous NRBCs, marked variation of red cell morphology, and pronounced polychromasia. In addition to a decreased Hgb and decreased Hct values, what other CBC parameters may be anticipated? A. Reduced platelets B. Increased MCHC C. Increased MCV D. Decreased red-cell distribution width (RDW)

C. Increased MCV This patient's abnormal peripheral smear indicates marked red cell regeneration, causing many reticulocytes to be released from the marrow. Because reticulocytes are larger than mature RBCs, the MCV will be slightly elevated.

Which of the following is not associated with hereditary spherocytosis? A. Increased osmotic fragility B. An MCHC greater than 36% C. Intravascular hemolysis D. Extravascular hemolysis

C. Intravascular hemolysis Classic features of intravascular hemolysis such as hemoglobinemia, hemoglobinuria, or hemosiderinuria do not occur in hereditary spherocytosis. The hemolysis seen in hereditary spherocytosis is an extravascular rather than an intravascular process.

Repeated phlebotomy in patients with polycythemia vera (PV) may lead to the development of: A. Folic acid deficiency B. Sideroblastic anemia C. Iron deficiency anemia D. Hemolytic anemia

C. Iron deficiency anemia The most common treatment modality utilized in PV is phlebotomy. Reduction of blood volume (usually 1 unit of whole blood—450 cc), can be performed weekly or even twice weekly in younger patients to control symptoms. The Hct target range is less than 45% for men, less than 42% for women. Iron deficiency anemia is a predictable complication of therapeutic phlebotomy because approximately 250 mg of iron is removed with each unit of blood.

Which characteristic describes antithrombin (AT)? A. It is synthesized in megakaryocytes B. It is activated by protein C C. It is a cofactor of heparin D. It is a pathological inhibitor of coagulation

C. It is a cofactor of heparin Antithrombin is heparin cofactor and it is the most important naturally occurring physiological inhibitor of blood coagulation. It represents about 75% of antithrombotic activity and is an α2-globulin made by the liver.

Which of the following characterizes vitamin K? A. It is required for biological activity of fibrinolysis B. Its activity is enhanced by heparin therapy C. It is required for carboxylation of glutamate residues of some coagulation factors D. It is made by the endothelial cells

C. It is required for carboxylation of glutamate residues of some coagulation factors Vitamin K is necessary for activation of vitamin K- dependent clotting factors (II, VII, IX, and X). This activation is accomplished by carboxylation of glutamic acid residues of the inactive clotting factors. The activity of vitamin K is NOT ENHANCED BY HEPARIN therapy. Vitamin K is present in a variety of foods and is also the only vitamin made by the organisms living in the intestine.

C. It is required for carboxylation of glutamate residues of some coagulation factors Vitamin K is necessary for activation of vitamin K- dependent clotting factors (II, VII, IX, and X). This activation is accomplished by carboxylation of glutamic acid residues of the inactive clotting factors. The activity of vitamin K is NOT enhanced by heparin therapy. Vitamin K is present in a variety of foods and is also the only vitamin made by the organisms living in the intestine

In leukemia, which term describes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by nucleated red cells? A. Myelophthisis B. Dysplasia C. Leukoerythroblastosis D. Megaloblastosis

C. Leukoerythroblastosis The presence of immature leukocytes and nucleated red cells is called leukoerythroblastosis and frequently denotes a malignant or myeloproliferative process. Myelophthisis refers to replacement of bone marrow by a disease process such as a neoplasm. The development of abnormal tissue is called dysplasia.

Hypersplenism is characterized by: A. Polycythemia B. Pancytosis C. Leukopenia D. Myelodysplasia

C. Leukopenia Hypersplenic conditions are generally described by the following four criteria: (1) cytopenias of one or more peripheral cell lines, (2) splenomegaly, (3) bone marrow hyperplasia, and (4) resolution of cytopenia by splenectomy.

Mrs. Smith has the following laboratory results, and no bleeding history: APTT: prolonged APTT results on a 1:1 mixture of the patient's plasma with normal plasma: Preincubation: prolonged APTT 2-hour incubation: prolonged APTT These results are consistent with: A. Factor VIII deficiency B. Factor VIII inhibitor C. Lupus anticoagulant D. Protein C deficiency

C. Lupus anticoagulant Mixing studies differentiate factor deficiencies from factor inhibitors. Lupus anticoagulant is associated with thrombosis, and it is directed against phospholipid-dependent coagulation tests such as the APTT. In patients with lupus anticoagulant, the APTT after mixing patient's plasma with normal plasma remains prolonged immediately after mixing and following 2-hours incubation. Factor VIII deficiency and factor VIII inhibitor are associated with bleeding. Factor VIII inhibitor is time and temperature dependent. The prolonged APTT may be corrected immediately after mixing, and becomes prolonged following incubation. In factor VIII deficiency, the prolonged APTT would be corrected after mixing the patient's plasma with normal plasma.

Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias? A. MCV 99 fl, MCH 28 pg, MCHC 31% B. MCV 62 fL, MCH 27 pg, MCHC 30% C. MCV 125 fL, MCH 36 pg, MCHC 34% D. MCV 78 fL, MCH 23 pg, MCHC 30%

C. MCV 125 fL, MCH 36 pg, MCHC 34% The red cell indices in a patient with megaloblastic anemia are macrocytic and normochromic. The macrocytosis is prominent, with an MCV ranging from 100 to 130 fL.

Given the following values, which set of red blood cell indices suggests spherocytosis? A. MCV 76 μm3 ; MCH 19.9 pg ; MCHC 28.5% B. MCV 90 μm3 ; MCH 30.5 pg ; MCHC 32.5% C. MCV 80 μm3 ; MCH 36.5 pg ; MCHC 39.0% D. MCV 81 μm3 ; MCH 29.0 pg ; MCHC 34.8%

C. MCV 80 μm3 ; MCH 36.5 pg ; MCHC 39.0%

A patient has an Hct of 30%, a hemoglobin of 8 g/dL, and an RBC count of 4.0 × 1012/L. What is the morphological classification of this anemia? A. Normocytic normochromic B. Macrocytic hypochromic C. Microcytic hypochromic D. Normocytic hyperchromic

C. Microcytic hypochromic The indices will provide a morphological classification of this anemia. The MCV is 75 fL (reference range 80-100 fL), the MCH is 20.0 pg (reference range 27-31 pg), and the MCHC is 26.6% (reference range 32%-36%). Therefore, the anemia is microcytic hypochromic.

Which of the following is a characteristic of classic hemophilia A? A. Prolonged bleeding time B. Autosomal recessive inheritance C. Mild to severe bleeding episodes D. Prolonged PT

C. Mild to severe bleeding episodes Hemophilia A (factor VIII deficiency) is characterized by mild to severe bleeding episodes, depending upon the concentration of factor VIII:C. Hemophilia A is inherited as a sex-linked disease. Bleeding time and prothrombin time are both normal in hemophilia A.

Hereditary pyropoikilocytosis (HP) is a red cell membrane defect characterized by: A. Increased pencil-shaped cells B. Increased oval macrocytes C. Misshapen budding fragmented cells D. Bite cells

C. Misshapen budding fragmented cells HP is a membrane defect characterized by a spectrin abnormality and thermal instability. The MCV is decreased and the red cells appear to be budding and fragmented.

Which of the following results on an automated differential suggests that a peripheral smear should be reviewed manually? A. Segs = 70% B. Band = 6% C. Mono = 15% D. Eos = 2%

C. Mono = 15% A relative monocyte count of 15% is abnormal, given that the baseline monocyte count in a normal differential is between 1% and 8%. An increased monocyte count may signal a myeloproliferative process such as chronic myelomonocytic leukemia, an inflammatory response, or abnormal lymphocytes that may have been counted as monocytes by an automated cell counter.

Several hours after birth, a baby boy develops petechiae and purpura and a hemorrhagic diathesis. The platelet count is 18 × 109/L. What is the most likely explanation for the low platelet count? A. Drug-induced thrombocytopenia B. Secondary thrombocytopenia C. Neonatal alloimmune thrombocytopenia D. Neonatal DIC

C. Neonatal alloimmune thrombocytopenia Neonatal alloimmune thrombocytopenia is similar to the hemolytic disease of the fetus and newborn. It results from immunization of the mother by fetal platelet antigens. The offending antibodies are commonly anti HPA-1a alloantibodies that are directed against glycoproteins IIb/IIIa, Ib/IX, Ia/IIb, and CD 109. The maternal antibodies cross the placenta, resulting in thrombocytopenia in the fetus.

SITUATION: RBC indices obtained on an anemic patient are as follows: MCV 88 μm3 (fL); MCH 30 pg; MCHC 34% (.340). The RBCs on the peripheral smear would appear: A. Microcytic, hypochromic B. Microcytic, normochromic C. Normocytic, normochromic D. Normocytic, hypochromic

C. Normocytic, normochromic

The anemia seen in sickle cell disease is usually: A. Microcytic, normochromic B. Microcytic, hypochromic C. Normocytic, normochromic D. Normocytic, hypochromic

C. Normocytic, normochromic

Which type of anemia is usually present in a patient with acute leukemia? A. Microcytic, hyperchromic B. Microcytic, hypochromic C. Normocytic, normochromic D. Macrocytic, normochromic

C. Normocytic, normochromic Acute leukemia is usually associated with a normocytic normochromic anemia. Anemia in acute leukemia is usually present from the onset and may be severe; however, there is no inherent nutritional deficiency leading to either a microcytic, hypochromic, or megaloblastic process.

Which drug may be associated with deep venous thrombosis (DVT)? A. Aspirin B. tPA C. Oral contraceptives D. Plavix (clopidogrel)

C. Oral contraceptives Oral contraceptive drugs are acquired risk factors for thrombosis. Aspirin and Plavix are antiplatelet drugs and tPA is a fibrinolytic drug used for the treatment of thrombosis.

The macrocytes typically seen in megaloblastic processes are: A. Crescent-shaped B. Teardrop-shaped C. Ovalocytic D. Pencil-shaped

C. Ovalocytic Macrocytes in true megaloblastic conditions are oval macrocytes as opposed to the round macrocytes that are usually seen in alcoholism and obstructive liver disease.

Platelet phospholipid needed for proper platelet function and coagulation: A. PF1 B. PF2 C. PF3 D. PF4

C. PF3

Which of the following Hgb configurations is characteristic of Hgb H? A. γ4 B. α2-γ2 C. β4 D. α2-β2

C. β4 The structure of Hgb H is β4. Hgb H disease is a severe clinical expression of α-thalassemia in which only one α-gene out of four is functioning.

Which test would be abnormal in a patient with factor X deficiency? A. PT only B. APTT only C. PT and APTT D. Thrombin time

C. PT and APTT Factor X is involved in the common pathway of the coagulation cascade; therefore, its deficiency prolongs both the PT and APTT. Activated factor X along with factor V in the presence of calcium and platelet factor III (PF3) converts prothrombin (factor II) to the active enzyme thrombin (factor IIa).

Which of the following is a common finding in aplastic anemia? A. A monoclonal disorder B. Tumor infiltration C. Peripheral blood pancytopenia D. Defective DNA synthesis

C. Peripheral blood pancytopenia Aplastic anemia has many causes, such as chemical, drug, or radiation poisoning; congenital aplasia; and Fanconi's syndrome. All result in depletion of hematopoietic precursors of all cell lines, leading to peripheral blood pancytopenia.

A 30-year-old woman develops signs and symptoms of thrombosis in her left lower leg following 5 days of heparin therapy. The patient had open-heart surgery 3 days previously and has been on heparin ever since. Which of the following would be the most helpful in making the diagnosis? A. Fibrinogen assay B. Prothrombin time C. Platelet counts D. Increased heparin dose

C. Platelet counts The platelet count should be checked every other day in patients receiving heparin therapy. Heparin-induced thrombocytopenia (HIT) should be suspected in patients who are not responding to heparin therapy and/or are developing thrombocytopenia (50% below the baseline value) and thrombotic complications while on heparin therapy. Increase in heparin dose should be avoided in patients with the clinical symptoms of thrombosis while they are receiving heparin. Fibrinogen assay and PT are not the appropriate assays for monitoring heparin therapy, nor are they used to test for HIT.

Storage pool deficiencies are defects of: A. Platelet adhesion B. Platelet aggregation C. Platelet granules D. Platelet production

C. Platelet granules Storage pool deficiencies are defects of platelet granules. Most commonly, a decrease in platelet-DENSE granules is present with decreased release of ADP, ATP, calcium, and serotonin from platelet-dense granules.

A striking feature of the peripheral blood of a patient with CML is a: A. Profusion of bizarre blast cells B. Normal number of typical granulocytes C. Presence of granulocytes at different stages of development D. Pancytopenia

C. Presence of granulocytes at different stages of development The WBC count in CML is often higher than 100 × 109/L, and the peripheral smear shows a granulocyte progression from myeloblast to segmented neutrophil.

Which of the following prevents platelet aggregation? A. Thromboxane A2 B. Thromboxane B2 C. Prostacyclin D. Antithrombin

C. Prostacyclin Prostacyclin is released from the ENDOTHELIUM and is an INHIBITOR of platelet aggregation. Thromboxane A2 promotes platelet aggregation. Thromboxane B2 is an oxidized form of thromboxane A2 and is excreted in the urine. Antithrombin is a physiological anticoagulant.

In a patient with human immunodeficiency virus (HIV) infection, one should expect to see: A. Shift to the left in WBCs B. Target cells C. Reactive lymphocytes D. Pelgeroid cells

C. Reactive lymphocytes HIV infection brings about several hematological abnormalities seen on peripheral smear examination; most patients demonstrate reactive lymphocytes and have granulocytopenia.

What is the characteristic finding seen in the peripheral smear of a patient with multiple myeloma? A. Microcytic hypochromic cells B. Intracellular inclusion bodies C. Rouleaux D. Hypersegmented neutrophils

C. Rouleaux Rouleaux is observed in multiple myeloma patients as a result of increased viscosity and decreased albumin/globulin ratio. Multiple myeloma is a plasma cell dyscrasia that is characterized by an overproduction of monoclonal immunoglobulin.

In myeloid cells, the stain that selectively identifies phospholipid in the membranes of both primary and secondary granules is: A. PAS B. Myeloperoxidase C. Sudan Black B stain D. Terminal deoxynucleotidyl transferase (TdT)

C. Sudan Black B stain Phospholipids, neutral fats, and sterols are stained by Sudan Black B. The PAS reaction stains intracellular glycogen. Myeloperoxidase is an enzyme present in the primary granules of myeloid cells and to a lesser degree in monocytic cells. Terminal deoxynucleotidyl transferase is a DNA polymerase found in thymus- derived and some bone marrow-derived lymphocytes.

A 46-year-old female was admitted to the emergency department with complaints of headache, dizziness, lethargy, nausea, vomiting, and weakness. The patient had a gastrectomy procedure 4 months earlier to remove adenocarcinoma of the stomach. She was placed on mitomycin therapy. Diagnostic procedures indicated recurrence of the carcinoma. WBC 17.1 × 109/L (4.8-10.8 × 109/L) RBC 2.29 × 1012/L (3.80-5.50 × 1012/L) Hgb 8.1 g/dL (12.0-15.2 g/dL) Hct 23% (37%-46%) MCV 95.7 fL (79-101 fL) MCH 35.4 pg (27-33 pg) MCHC 35.0 g/dL (31-34 g/dL) RDW 18.5 (11.5-14.5) PLT 48.0 × 109/L (140-450 × 109/L) MPV 11.2 (7.4-9.4) Segmented neutrophils 79 (30%-70%) Band neutrophils 3 (0%-10%) Lymphocytes 11 (20%-50%) Monocytes 6 (2%-12%) Basophils 1 (0%-2%) NRBCs (/100 WBCs) 3 (0) Manual platelet count: 18 × 109/L (140-450 × 109/L) Marked anisocytosis none Marked RBC fragmentation none PT, APTT, and TT: Normal Urinalysis pH 5.0 (5-7) Protein 30.0 mg/dL (0-15 mg/dL) RBC 60-100/μL (0-5/μL) Casts 10/hpf granular/hyaline (Not detectable) Creatinine 3.1 mg/dL (0.7-1.3 mg/dL) BUN 39 mg/dL (8-22 mg/dL) Haptoglobin 5.0 mg/dL (50-150 mg/dL) These clinical manifestations and laboratory results are consistent with: A. ITP B. von Willebrand's disease C. TTP D. DIC

C. TTP The clinical manifestations and laboratory results in this patient are consistent with TTP. The clinical manifestations of TTP include microangiopathic hemolytic anemia (MAHA), thrombocytopenia, fever, renal failure, and neurological symptoms. The neurological symptoms in this patient are manifested by headache, dizziness, nausea, and vomiting. Weakness and lethargy are signs and symptoms of anemia. Low hemoglobin and hematocrit with normal MCV and MCHC indicate a normocytic/normochromic anemia. The presence of schistocytes on the peripheral blood with low platelet counts and low haptoglobin are consistent with microangiopathic hemolytic anemia. The high blood urea nitrogen and creatinine levels are characteristic of renal failure. The platelet count, performed on admission, was done on a hematology analyzer and was falsely elevated because of the presence of microcytes or fragmented red cells. The manual platelet count was much lower. The coagulation tests are normal in TTP. In von Willebrand's disease, the platelet count is normal and the APTT is usually abnormal. ITP is characterized by thrombocytopenia but not HA. Although DIC is associated with a low platelet count and HA, it is characterized by abnormal coagulation studies. The acute onset of symptoms may be related to mitomycin used for the treatment of gastric carcinoma in this patient.

In myelofibrosis, the characteristic abnormal red blood cell morphology is that of: A. Target cells B. Schistocytes C. Teardrop cells D. Ovalocytes

C. Teardrop cells The marked amount of fibrosis, both medullary and extramedullary, accounts for the irreversible red cell morphological change to a teardrop shape. The red cells are "teared" as they attempt to pass through the fibrotic tissue.

When performing a mixing study, the patient's APTT is corrected to 12% of normal. What is the most appropriate interpretation of these findings? A. The APTT is considered corrected B. The APTT is considered uncorrected C. The mixing study needs to be repeated D. A circulating anticoagulant can be ruled out

C. The mixing study needs to be repeated In mixing studies, correction occurs if a prolonged APTT result drops to within 10% of the result of normal human plasma. Only 50% factor activity is required for a normal PT or APTT. Clotting results >15% are not considered corrected, and results between 10%-15% should be repeated. A circulating anticoagulant typically results in failure to correct the APTT with normal plasma.

A modification of which procedure can be used to measure fibrinogen? A. PT B. APTT C. Thrombin time D. Fibrin degradation products

C. Thrombin time CLAUSS METHOD Fibrinogen can be quantitatively measured by a modification of the thrombin time by diluting the plasma, because the thrombin clotting time of diluted plasma is inversely proportional to the concentration of fibrinogen (principle of Clauss method).

A modification of which procedure can be used to measure fibrinogen? A. PT B. APTT C. Thrombin time D. Fibrin degradation products

C. Thrombin time Fibrinogen can be quantitatively measured by a modification of the thrombin time by DILUTING THE PLASMA, because the thrombin clotting time of diluted plasma is INVERSELY proportional to the concentration of fibrinogen (principle of Clauss method). "PRINCIPLE OF CLAUSS METHOD" Thrombin clotting time of diluted plasma is inversely related to concentration of fibrinogen.

Bernard-Soulier syndrome is associated with: A. Decreased bleeding time B. Decreased factor VIII assay C. Thrombocytopenia and giant platelets D. Abnormal platelet aggregation to ADP

C. Thrombocytopenia and giant platelets Bernard-Soulier syndrome is associated with thrombocytopenia and giant platelets. It is a qualitative platelet disorder caused by the deficiency of glycoprotein Ib. In Bernard-Soulier syndrome, platelet aggregation to ADP is normal. Aggregation in the platelet function assay is abnormal. Factor VIII assay is not indicated for this diagnosis.

What reagents are used in the PT test? A. Thromboplastin and sodium chloride B. Thromboplastin and potassium chloride C. Thromboplastin and calcium D. Actin and calcium chloride

C. Thromboplastin and calcium Thromboplastin and calcium (combined into a single reagent) replace the tissue thromboplastin and calcium necessary in vivo to activate factor VII to factor VIIa. This ultimately generates THROMBIN from prothrombin via the coagulation cascade.

What reagents are used in the PT test? A. Thromboplastin and sodium chloride B. Thromboplastin and potassium chloride C. Thromboplastin and calcium D. Actin and calcium chloride

C. Thromboplastin and calcium Thromboplastin and calcium (combined into a single reagent) replace the tissue thromboplastin and calcium necessary in vivo to activate factor VII to factor VIIa. This ultimately generates thrombin from prothrombin via the coagulation cascade.

Hyperhomocysteinemia may be a risk factor for: A. Bleeding B. Thrombocythemia C. Thrombosis D. Thrombocytopenia

C. Thrombosis Elevated plasma homocysteine is a risk factorfor the development of venous thrombosis. Homocystinemia may be inherited or acquired. Acquired homocystinemia is caused by the dietary deficiencies of vitamins B6, B12, and folic acid.

Aspirin resistance may be associated with: A. Bleeding B. Factor VIII deficiency C. Thrombosis D. Thrombocytosis

C. Thrombosis Up to 22% of patients taking aspirin become resistant to aspirin's antiplatelet effect. Patients who are aspirin resistant have a higher risk of thrombosis (heart attacks and strokes).

Clot retraction is a function of: A. Factor XIII B. Thromboplastin C. Thrombosthenin D. TXA2

C. Thrombosthenin Clot retraction is a function of platelets, particularly the platelet filaments ACTOMYOSIN (also called as Thrombosthenin).

Which of the following is referred to as an ENDOGENOUS activator of plasminogen? A. Streptokinase B. Transamidase C. Tissue plasminogen activator D. Tissue plasminogen activator inhibitor

C. Tissue plasminogen activator Tissue plasminogen activator (tPA) is an endogenous (produced in the body) activator of plasminogen. It is released from the endothelial cells by the action of protein C. It converts plasminogen to plasmin. STREPTOKINASE is an EXOGENOUS (not made in the body) activator of plasminogen.

Which drug promotes fibrinolysis? A. Warfarin B. Heparin C. Urokinase D. Aspirin

C. Urokinase Urokinase is a thrombolytic drug commonly used to treat acute arterial thrombosis. Urokinase can also be used for the treatment of venous thromboembolism, myocardial infarction, and clotted catheters. Warfarin and heparin are anticoagulant drugs, whereas aspirin prevents platelet aggregation by inhibiting cyclo-oxygenase.

Review the following automated CBC values. WBCs = 17.5 × 109/L (flagged) RBCs = 2.89 × 1012/L Hgb = 8.1 g/dL Hct = 25.2% MCV = 86.8 fL MCH = 28.0 pg MCHC = 32.3% PLT = 217 × 109/L Many sickle cells were observed upon review of the peripheral blood smear. Based on this finding and the results provided, what automated parameter of this patient is most likely inaccurate and what follow-up test should be done to accurately assess this parameter? A. MCV/perform reticulocyte count B. Hct/perform manual Hct C. WBC/perform manual WBC count D. Hgb/perform serum:saline replacement

C. WBC/perform manual WBC count When an automated WBC count is performed using a hematology analyzer, the RBCs are lysed to allow enumeration of the WBCs. SICKLE CELLS are often RESISTANT TO LYSIS within the limited time frame (less than 1 minute), during which the RBCs are exposed to the lysing reagent and the WBCs are subsequently counted. As a result, the nonlysed RBCs are counted along with the WBCs, thus falsely increasing the WBC count. When an automated cell counting analyzer indicates a review flag for the WBC count, and sickle cells are noted on peripheral smear analysis, a manual WBC count must be performed. The manual method allows optimal time for sickle cell lysis and accurate enumeration of the WBCs.

Which of the following clotting factors are measured by the APTT test? A. II, VII, IX, X B. VII, X, V, II, I C. XII, XI, IX, VIII, X, V, II, I D. XII, VII, X, V, II, I

C. XII, XI, IX, VIII, X, V, II, I The APTT test evaluates the clotting factors in the intrinsic pathway (XII, XI, IX, and VIII) as well as the common pathway (X, V, II, and I).

PEANUT Which of the following clotting factors plays a role in clot formation in vitro, but not in vivo? in vitro clot formation and not in vivo coagulation? A. VIIa B. IIa C. XIIa D. Xa

C. XIIa

Which of the following clotting factors plays a role in clot formation in vitro, but not in vivo? in vitro clot formation and NOT IN VIVO coagulation? A. VIIa B. IIa C. XIIa D. Xa

C. XIIa Factor XIIa does not play a role in coagulation in vivo; HOWEVER, in vitro, the deficiency of this factor causes a prolonged APTT result. IN VITRO, factor XII is activated by substances such as glass, Kaolin, and ellagic acid, and IN VIVO it may be activated by exposure to a negatively charged cell surface membrane such COLLAGEN as well as KALLIKREIN (an activated form of prekallikrein) and high molecular weight kininogen (HMWK). IN VIVO, factor XIIa plays an important role in the fibrinolytic system by activating plasminogen to plasmin. Plasmin degrades the fibrin clot at the site of injury. Deficiency of factor XII is associated with THROMBOSIS and NOT bleeding. Factors VIIa, Xa, and IIa play a role in vivo and in vitro.

Which of the following clotting factors plays a role in clot formation in vitro, but not in vivo? in vitro clot formation and not in vivo coagulation? A. VIIa B. IIa C. XIIa D. Xa

C. XIIa IN VIVO: Glass, Kaolin, and Ellagic acid IN VITRO: negatively charged Collagen, Kallikren, HMWK Factor XIIa does not play a role in coagulation in vivo; however, in vitro, the deficiency of this factor causes a prolonged APTT result. In vitro, factor XII is activated by substances such as GLASS, KAOLIN, and ELLAGIC ACID, and in vivo it may be activated by exposure to a negatively charged cell surface membrane such COLLAGEN as well as KALLIKREIN (an activated form of prekallikrein) and high molecular weight kininogen (HMWK). In vivo, factor XIIa plays an important role in the fibrinolytic system by activating plasminogen to plasmin. Plasmin degrades the fibrin clot at the site of injury. Deficiency of factor XII is associated with thrombosis and not bleeding. Factors VIIa, Xa, and IIa play a role in vivo and in vitro.

Refer to the following results: PT = normal APTT = prolonged Bleeding time= increased Platelet count = normal Platelet aggregation to ristocetin = abnormal Which of the following disorders may be indicated? A. Factor VIII deficiency B. DIC C. von Willebrand's disease D. Factor IX deficiency

C. von Willebrand's disease VWF is involved in both platelet adhesion and coagulation via complexing with factor VIII. Therefore, in von Willebrand's disease (deficiency or functional abnormality of VWF) factor VIII is also decreased, causing an abnormal APTT as well as abnormal platelet aggregation to ristocetin. The platelet count and the PT are not affected in VWF deficiency

Which protein is the primary inhibitor of the fibrinolytic system? A. Protein C B. Protein S C. α2-Antiplasmin D. α2-Macroglobulin

C. α2-Antiplasmin α2-Antiplasmin is the main inhibitor of plasmin. It inhibits plasmin by forming a 1:1 stoichiometric complex with any free plasmin in the plasma and, therefore, prevents the binding of plasmin to fibrin and fibrinogen.

What is the basic hematological defect seen in patients with thalassemia major? A. DNA synthetic defect B. Hgb structure C. β-Chain synthesis D. Hgb phosphorylation

C. β-Chain synthesis In thalassemia major, there is little or no production of the β-chain, resulting in severely depressed or no synthesis of Hgb A. Severe anemia is seen, along with skeletal abnormalities and marked splenomegaly. The patient is usually supported with transfusion therapy.

In which of the following conditions is Hgb A2 elevated? A. Hgb H B. Hgb SC disease C. β-Thalassemia minor D. Hgb S trait

C. β-Thalassemia minor Hgb A is part of the normal complement of adult 2 Hgb. This Hgb is elevated in β-thalassemia minor because the individual with this condition has only one normal β-gene; consequently, there is a slight elevation of Hgb A2 and Hgb F.

What are the INITIAL laboratory tests that are performed for the diagnosis of anemia? CBC, iron studies, and reticulocyte count CBC, reticulocyte count, and peripheral blood film examination Reticulocyte count and serum iron, vitamin B12 and folate assays Bone marrow study, iron studies, and peripheral blood film examination

CBC, reticulocyte count, and peripheral blood film examination

Platelet dense granule Fibrinogen Fibronectin Calcium B-thromboglobulin

Calcium "CAPAS" + Magnesium

A 60-year-old patient was admitted to a hospital for a liver biopsy. The biopsy was scheduled for 11:00 a.m. The coagulation results performed at the time of admission revealed a prolonged PT with an INR of 4.5. What is the physician's most appropriate course of action? Proceed with biopsy, because a prolonged PT is expected in liver disease Postpone the procedure for a couple of days Cancel the procedure and start the patient on vitamin K therapy Put patient on vitamin K and proceed with the procedure immediately

Cancel the procedure and start the patient on vitamin K therapy Liver biopsy in a patient with a prolonged PT and a high INR could be life threatening. In this patient, the prolonged PT is likely caused by liver disease. Vitamin K is stored in the liver and is essential for activation of factors II, VII, IX, and X. Vitamin K needs bile (secreted by the liver) for its absorption. In liver disease characterized by obstruction, bile is not secreted into the GI tract, and therefore, vitamin K is poorly absorbed. The most logical course of action is to recommend the following: Start the patient on vitamin K therapy, repeat the PT test 4 days after starting vitamin K administration, and cancel the biopsy until the patient's PT returns to normal.

An APTT test is performed on a patient and the result is 50 sec (reference range 27-37 sec). The instrument flags the result owing to failure of the delta check. The patient had an APTT of 35 sec the previous day. The technologist calls the nursing unit to check whether the patient is on heparin therapy. The patient is not receiving heparin. What is the next appropriate step? Check the family history for an inherited factor VIII deficiency Check to see if the patient has received any other anticoagulant medications Perform mixing studies Perform a factor VIII assay

Check to see if the patient has received any other anticoagulant medications Traditional anticoagulant drugs such as heparinand warfarin are well known. There are new anticoagulant drugs available for the treatment and prevention of thrombosis. Some of these new drugs have antithrombin effects and therefore increase PT, APTT, and TT results. Examples of these drugs are hirudin, which inhibits thrombin; and danaparoid, which inhibits factor Xa.

Most reliable way to differentiate a mature from an immature granulocyte: Size of the cell Color of the cytoplasm Size of the nucleus Chromatin pattern

Chromatin pattern

The nitroblue tetrazolium reduction test is used to assist in the diagnosis of: Leukocyte adhesion disorders (LADs) Chronic granulomatous disease (CGD) May-Hegglin anomaly Pelger-Huet anomaly

Chronic granulomatous disease (CGD)

A 75-year-old male patient visits his physician for an annual checkup. His CBC showed an elevated WBC count with numerous small lymphocytes and smudge cells, and a subsequent bone marrow biopsy and aspirate showed hypercellularity with increased lymphoid cells. What is a presumptive diagnosis based on this information? Acute lymphoblastic leukemia Chronic lymphocytic leukemia Hairy cell leukemia Therapy-related acute myelogenous leukemia

Chronic lymphocytic leukemia This smear and bone marrow picture is typical of chronic lymphocytic leukemia (CLL) with numerous mature small lymphocytes. CLUE: Presence of SMUDGE cells

Anticoagulant for the sugar water and sucrose hemolysis test: EDTA Citrate Heparin Oxalate

Citrate

The morphologic abnormality characteristically found in hemoglobinopathies: Elliptocytes Dacryocytes Codocytes Discocytes

Codocytes

Which of the following is NOT associated with causing a falsely low ESR? Column used is slanted EDTA tube is clotted EDTA tube is one-third full EDTA specimen is 24 hours old

Column used is slanted

Dendritic cells are derived from: Common lymphoid progenitor Common myeloid progenitor

Common lymphoid progenitor

Plasma thromboplastin or prothrombinase includes: Calcium ion only Complex of calcium ions and activated factor XI Complex of activated factor VII and calcium ions Complex of activated factors X and V, platelet factor 3 and calcium ions

Complex of activated factors X and V, platelet factor 3 and calcium ions

Hereditary hemorrhagic telangiectasia is a disorder of: Platelets Clotting proteins Fibrinolysis Connective tissue

Connective tissue Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) is a connective tissue disorder associated with telangiectases (dilated capillaries) of the mucous membranes and skin. Lesions may develop on the tongue, lips, palate, face, hands, nasal mucosa, and throughout the gastrointestinal tract. This disorder is an autosomal dominant condition that usually manifests in adolescence or early adulthood.

To increase accuracy of the WBC differential, it is advisable to count at least ___ cells when the WBC count is higher than 40 x 10 9th/L. Count 50 cells Count 100 cells Count 200 cells Count 300 or 400 cells

Count 200 cells 50 CELLS WBC <1.0 x 10^9/L 200 CELLS >10% Eosinophils >2% Basophils >11% Monocytes Lymphocytes > Neutrophils (except in children) WBC >40 x 10^9/L 300 OR 400 CELLS WBC > 100 x 10^9/L

In WBC differential, if the WBC count is 100 x 10 9th/L or greater, it would be more precise and accurate to count ____ cells. Count 50 cells Count 100 cells Count 200 cells Count 300 or 400 cells

Count 300 or 400 cells 50 CELLS WBC <1.0 x 10^9/L 200 CELLS >10% Eosinophils >2% Basophils >11% Monocytes Lymphocytes > Neutrophils (except in children) WBC >40 x 10^9/L 300 OR 400 CELLS WBC > 100 x 10^9/L

The preferred blood product for a bleeding patient with von Willebrand's disease is transfusion with: Factor II, VII, IX, X concentrates Platelet Concentrates Fresh Frozen Plasma and Platelets Cryoprecipitated AHF

Cryoprecipitated AHF

Reliable way to differentiate PLATELET PRECURSORS: Size of the cell Cytoplasmic appearance Nucleus Chromatin pattern

Cytoplasmic appearance

Side angle scatter in a laser-based cell counting system is used to measure: Cell size Cytoplasmic granularity Cell number Immunologic (antigenic) identification

Cytoplasmic granularity

PEANUT Once the metamyelocyte stage has been reached, cells have undergone ______ cell divisions and the proliferative phase comes to an end. A. 1 or 2 cell divisions B. 2 or 3 cell divisions C. 3 or 4 cell divisions D. 4 or 5 cell divisions

PEANUT A liver-produced peptide hormone and the master regulatory hormone of systemic iron metabolism: A. Transferrin B. Ferritin C. Hemosiderin D. Hepcidin

PEANUT Primary targets of G-CSF, except: A. Neutrophil precursors B. Fibroblasts C. Leukemic myeloblasts D. T and B cells

PEANUT 1. Densely packed chromatin: A. Myelocyte B. Metamyelocyte C. Band D. Segmenter 2. Clumped chromatin: A. Myelocyte B. Metamyelocyte C. Band D. Segmenter 3. Very clumped chromatin: A. Myelocyte B. Metamyelocyte C. Band D. Segmenter

D B C

In addition to the number of blasts, what other criterion is essential for the diagnosis of RARS? More than 15% ringed sideroblasts Dyshematopoiesis in all three lineages More than 5% ringed sideroblasts Pancytopenia

More than 15% ringed sideroblasts

In the French-American-British (FAB) classification, acute lymphocytic leukemia is divided into groups according to: Prognosis Immunology Cytochemistry Morphology

Morphology

The only abnormal test result in CHRONIC DIC: PT APTT Thrombin time D-dimer

D-dimer DIC, although characteristically identified through its hemorrhagic symptoms, is classified as a THROMBOTIC DISORDER 1. ACUTE DIC UNCOMPENSATED PT, PTT, and thrombin time are prolonged; the fibrinogen level is reduced to less than 100 mg/dL; and fibrin degradation products, including D-dimers, are significantly increased 2. CHRONIC DIC COMPENSATED Only elevated test result may be the D-dimer assay value, a hallmark of unregulated coagulation and fibrinolysis

Factor VIII inhibitors occur in ____________ of patients with factor VIII deficiency? A. 40%-50% B. 30%-40% C. 25%-30% D. 10%-20%

D. 10%-20% Factor VIII inhibitors (antibodies) occur in 10%-20% of patients with factor VIII deficiency receiving factor VIII replacement.

If more than 500 platelets are counted on each side, a ___ dilution should be made. A. 1:10 B. 1:20 C. 1:100 D. 1:200

D. 1:200

A manual RBC count is performed on a pleural fluid. The RBC count in the large center square of the Neubauer hemacytometer is 125, and the dilution is 1:200. What is the total RBC count? A. 27.8 × 109/L B. 62.5 × 109/L C. 125.0 × 109/L D. 250.0 × 109/L

D. 250.0 × 109/L Note: The RBC was counted in the LARGE CENTER SQUARE (25/25) = 1. Regardless of the cell or fluid type, the formula for calculating manual cell counts using a hemacytometer is: # cells counted × 10 (depth factor) × dilution factor divided by the area counted in mm2, or (125 × 10 × 200) ÷ 1 = 250,000/μL or 250.0 × 109/L

What is the typical range of relative lymphocyte percentage in the peripheral blood smear of a 1-year-old child? A. 1%-6% B. 27%-33% C. 35%-58% D. 50%-70%

D. 50%-70% The mean relative lymphocyte percentage for a 1-year-old child is 61% compared to the mean lymphocyte percentage of 35% for an adult.

Which AML cytogenetic abnormality is associated with acute myelomonocytic leukemia with marrow eosinophilia under the WHO classification of AML with recurrent genetic abnormalities? A. AML with t(15;17) B. AML with mixed lineage C. AML with t(8;21) D. AML with inv(16)

D. AML with inv(16) AML with inv(16) has pericentric inversion of chromosome 16, and is associated with acute myelomonocytic leukemia with marrow eosinophilia, M4eo under the FAB system. The inv(16) results in the fusion of the CBFβ gene on 16q22 with the MYH11 gene on 16p13.

PV is characterized by: A. Increased plasma volume B. Pancytopenia C. Decreased oxygen saturation D. Absolute increase in total red cell mass

D. Absolute increase in total red cell mass The diagnosis of PV requires the demonstration of an increase in red cell mass. Pancytosis may also be seen in about two thirds of PV cases. The plasma volume is normal or slightly reduced, and the arterial oxygen saturation is usually normal.

A patient's peripheral blood smear and bone marrow both show 70% blasts. These cells are negative for Sudan Black B stain. Given these data, which of the following is the most likely diagnosis? A. Acute myeloid leukemia B. Chronic lymphocytic leukemia C. Acute promyelocytic leukemia D. Acute lymphocytic leukemia

D. Acute lymphocytic leukemia

A 24-year-old man with Down syndrome presents with a fever, pallor, lymphadenopathy, and hepatosplenomegaly. His CBC results are as follows: WBCs = 10.8 × 109/L 8% PMNs 25% lymphocytes 67% PAS-positive blasts RBCs = 1.56 × 1012/L Hgb = 3.3 g/dL Hct = 11% Platelets = 2.5 × 109/L These findings are suggestive of: A. Hodgkin's lymphoma B. Myeloproliferative disorder C. Leukemoid reaction D. Acute lymphocytic leukemia

D. Acute lymphocytic leukemia Common signs of acute lymphocytic leukemia are hepatosplenomegaly (65%), lymphadenopathy (50%), and fever (60%). Anemia and thrombocytopenia are usually present and the WBC count is variable. The numerous lymphoblasts are generally PAS positive.

D. Acute lymphocytic leukemia Sudan Black B stains phospholipids and other neutral fats. It is the most sensitive stain for granulocytic precursors. Lymphoid cells rarely stain positive for it. Because 70% lymphoblasts would never be seen in CLL, the correct response is ALL.

Which of the following is considered a normal hemoglobin? A. Carboxyhemoglobin B. Methemoglobin C. Sulfhemoglobin D. Deoxyhemoglobin

D. Deoxyhemoglobin Deoxyhemoglobin is the physiological Hgb that results from the unloading of oxygen by Hgb. This is accompanied by the widening of the space between β-chains and the binding of 2,3-diphosphoglycerate (2,3-DPG) on a mole-for-mole basis.

Which type of acute myeloid leukemia is called the true monocytic leukemia and follows an acute or subacute course characterized by monoblasts, promonocytes, and monocytes? A. Acute myeloid leukemia, minimally differentiated B. Acute myeloid leukemia without maturation C. Acute myelomonocytic leukemia D. Acute monocytic leukemia

D. Acute monocytic leukemia Acute monocytic leukemia has an incidence of between 1%-8% of all acute leukemias. It has a distinctive clinical manifestation of monocytic involvement resulting in skin and gum hyperplasia. The WBC count is markedly elevated, and prognosis is poor.

Which of the following is associated with abnormal platelet aggregation test? A. Factor VIII deficiency B. Factor VIII inhibitor C. Lupus anticoagulant D. Afibrinogenemia

D. Afibrinogenemia Fibrinogen is a plasma protein that is essential for platelet aggregation and fibrin formation. In afibrinogenemia, platelet aggregation is abnormal.

Which of the following instruments can be used to evaluate platelet function? A. Platelet aggregometer B. VerifyNow C. PFA-100 D. All of the above

D. All of the above Platelet function testing is done to either determine the cause of bleeding in a patient with normal platelet count and normal coagulation tests, or to assess the efficacy of antiplatelet drugs. Platelet aggregometry is used for the diagnosis of inherited platelet disorders. A platelet aggregometer uses PLATELET-RICH PLASMA to measure platelet aggregation in response to different platelet aggregating agents by measuring the light transmission. A Lumi-aggregometer uses whole blood, and has the ability to measure dense-granule secretion (using a luminescent marker) in addition to platelet aggregation. The VerifyNow measures a patient's response to multiple antiplatelet drugs including aspirin, P2Y12 inhibitors, and glycoprotein IIb/IIIa inhibitors. The PFA-100 (Platelet Function ananlyzer-100) is used as a platelet function screen in place of the bleeding time. It uses CITRATED whole blood. A drop of venous blood is put into a test cartridge. Vacuum is used to move the blood through a very thin glass tube that has been coated with a membrane containing collagen and either epinephrine (EPI) or ADP. This coating activates the platelets in the moving sample, and promotes platelet adhesion and aggregation. The time it takes for the clot to form inside the glass tube and prevent further flow is measured as the closure time (CT). An initial screen is done with collagen/EPI. If the CT is normal, it is unlikely that platelet dysfunction exists. The collagen/ADP membrane is used to confirm an abnormal collagen/EPI test. If both tests are abnormal, it is likely that the patient has a platelet dysfunction, and further testing for inheritedand acquired bleeding disorders is indicated. If collagen/ADP is normal, then the abnormal collagen/EPI test is likely due to aspirin sensitivity.

Which of the following can shift the hemoglobin oxygen dissociation curve to the right? A. Increases in 2,3 DPG B. Acidosis C. Hypoxia D. All of these options

D. All of these options

Which of the following occurs in idiopathic myelofibrosis (IMF)? A. Myeloid metaplasia B. Leukoerythroblastosis C. Fibrosis of the bone marrow D. All of these options

D. All of these options Anemia, fibrosis, myeloid metaplasia, thrombocytosis, and leukoerythroblastosis occur in idiopathic myelofibrosis.

Autoagglutination of red cells at room temperature can cause which of the following abnormal test results? A. Low RBC count B. High MCV C. Low hematocrit D. All of these options

D. All of these options Autoagglutination at room temperature may cause a low RBC count and high MCV from an electronic counter. The Hct will be low because it is calculated from the RBC count. Low RBC count and low Hct cause falsely high calculations of MCH and MCHC, respectively.

Which of the morphological findings are characteristic of reactive lymphocytes? A. High nuclear:cytoplasmic ratio B. Prominent nucleoli C. Basophilic cytoplasm D. All of these options

D. All of these options Both reactive lymphocytes and blasts may have basophilic cytoplasm, a high N:C ratio, and the presence of prominent nucleoli. Blasts, however, have an extremely fine nuclear chromatin staining pattern as viewed on a Wright's-Giemsa's—stained smear.

The pathology of multiple myeloma includes which of the following? A. Expanding plasma cell mass B. Overproduction of monoclonal immunoglobulins C. Production of osteoclast activating factor (OAF) and other cytokines D. All of these options

D. All of these options Mutated plasmablasts in the bone marrow undergo clonal replication and expand the plasma cell mass. Normal bone marrow is gradually replaced by the malignant plasma cells leading to pancytopenia. Most malignant plasma cells actively produce immunoglobulins. In multiple myeloma, the normally controlled and purposeful production of antibodies is replaced by the inappropriate production of even larger amounts of USELESS immunoglobulin molecules. The normally equal production of light chains and heavy chains may be imbalanced. The result is the release of EXCESS FREE LIGHT CHAINS OR FREE HEAVY CHAINS. The immunoglobulins produced by a clone of myeloma cells are IDENTICAL. Any abnormal production of identical antibodies is referred to by the general name of monoclonal gammopathy. Osteoclasts are bone cells active in locally resorbing bone and releasing calcium into the blood. Nearby osteoblasts are equally active in utilizing calcium in the blood to form new bone. Multiple myeloma interrupts this balance by the secretion of at least two substances. These are interleukin-6 (IL-6) and osteoclast-activating factor (OAF). As its name implies, OAF stimulates osteoclasts to increase bone resorption and release of calcium, which leads to lytic lesions of the bone.

Which of the following leukemias are included in the 2008 World Health Organization classification of myeloproliferative neoplasms? A. Chronic myelogenous leukemia (CML) B. Chronic neutrophilic leukemia (CNL) C. Chronic eosinophilic leukemia (CEL) D. All of these options are classified as myeloproliferative neoplasms (MPN)

D. All of these options are classified as myeloproliferative neoplasms (MPN) The 2008 WHO classification system includes the following disorders under the myeloproliferative neoplasms (MPN): chronic myelogenous leukemia (CML), chronic neutrophilic leukemia (CNL), chronic eosinophilic leukemia (CEL), essential thrombocythemia (ET), polycythemia vera (PV), primary (idiopathetic) myelofibrosis, hypereosinophilic syndrome, mast cell disease, and MPNs unclassified.

Which of the following is (are) commonly found in CML? A. Many teardrop-shaped cells B. Intense LAP staining C. A decrease in granulocytes D. An increase in basophils

D. An increase in basophils

Which of the following is (are) commonly found in CML? A. Many teardrop-shaped cells B. Intense LAP staining C. A decrease in granulocytes D. An increase in basophils

D. An increase in basophils CML is marked by an elevated WBC count demonstrating various stages of maturation, hypermetabolism, and a minimal LAP staining. An increase in basophils and eosinophils is a common finding. Pseudo-Pelger-Huët cells and thrombocytosis may be present. The marrow is hypercellular with a high M:E ratio (e.g., 10:1).

Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)? A. Anti-I B. Anti-i C. Anti-M D. Anti-P

D. Anti-P PCH is caused by the anti-P antibody, a cold autoantibody that binds to the patient's RBCs at low temperatures and fixes complement. In the classic Donath-Landsteiner test, hemolysis is demonstrated in a sample placed at 4°C that is then warmed to 37°C.

Heparin-induced thrombocytopenia (HIT) results from: A. Antibodies to heparin B. Antibodies to platelets C. Antibodies to PF4 D. Antibodies to heparin-PF4 complex

D. Antibodies to heparin-PF4 complex Heparin-induced thrombocytopenia is an immune process caused by the production of antibodies to heparin-PF4 complex. This immune complex binds to platelet Fc receptors, causing platelet activation and formation of platelet microparticles that in turn induce hypercoagulability and thrombocytopenia.

In which of the following conditions does LAP show the least activity? A. Leukemoid reactions B. Idiopathic myelofibrosis C. PV D. CML

D. CML Chronic myelogenous leukemia shows the least LAP activity, whereas the LAP score is slightly to markedly increased in each of the other states.

The JAK2(V617F) mutation may be positive in all of the following chronic myeloproliferative disorders except: A. Essential thrombocythemia B. Idiopathic myelofibrosis C. PV D. CML

D. CML The JAK2(V617F) mutation is negative in patients with CML. It may be positive in patients with idiopathic myelofibrosis (35%-57%), polycythemia vera (65%-97%), and essential thrombocythemia (23%-57%). Mutation in CML involves ABL/BCR.

SITUATION: A differential shows reactive lymphocytes, and the physician suspects a viral infection is the cause. What is the expected laboratory finding in a patient with a cytomegalovirus (CMV) infection? A. Heterophile antibody: positive B. Epstein-Barr virus (EBV)-immunoglobulin (IgM): positive C. Direct antiglobulin test (DAT): positive D. CMV-IgM: positive

D. CMV-IgM: positive If both the heterophile antibody test and the EBV-IgM tests are negative in a patient with reactive lymphocytosis and a suspected viral infection, the serum should be analyzed for IgM antibodies to CMV. CMV belongs to the herpes virus family and is endemic worldwide. CMV infection is the most common cause of heterophile-negative infectious mononucleosis.

The P2Y12 ADP receptor agonist assay may be used to monitor platelet aggregation inhibition to which of the following drugs? A. Warfarin B. Heparin C. LMWH D. Clopidogrel (Plavix)

D. Clopidogrel (Plavix) CLOPIDOGREL (Plavix) PRASUGREL (Effient) ASPIRIN The VerifyNow P2Y12 test is used to assess a patient's response to antiplatelet drugs such as CLOPIDOGREL (Plavix) and PRASUGREL (Effient). These drugs are given orally for prevention of thrombosis along with ASPIRIN, or as alternative antiplatelet drugs for patients who cannot tolerate or are not sensitive to aspirin. Clopidogrel and prasugrel prevent platelet aggregation by irreversibly binding to P2Y12, which is a platelet membrane receptor for ADP. The VerifyNow P2Y12 test is a whole blood test and uses ADP as an aggregating agent to measure the level of platelet aggregation impaired by these medications. The baseline platelet aggregation is established. The percent (%) change from baseline aggregation is calculated and reported as % P2Y12 inhibition.

Leukemic lymphoblasts reacting with anti-CALLA are characteristically seen in: A. B-cell ALL B. T-cell ALL C. Null-cell ALL D. Common ALL

D. Common ALL The majority of non-T, non-B ALL blast cells display the common ALL antigen (CALLA) marker. Lymphoblasts of common ALL are TdT positive and CALLA positive but do not have surface membrane IgM or μ chains and are pre-B lymphoblasts. Common ALL has a lower relapse rate and better prognosis than other immunologic subtypes of B-cell ALL.

Hereditary hemorrhagic telangiectasia is a disorder of: A. Platelets B. Clotting proteins C. Fibrinolysis D. Connective tissue

D. Connective tissue Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) is a connective tissue disorder associated with telangiectases (dilated capillaries) of the mucous membranes and skin. Lesions may develop on the tongue, lips, palate, face, hands, nasal mucosa, and throughout the gastrointestinal tract. This disorder is an autosomal dominant condition that usually manifests in adolescence or early adulthood.

The following results are obtained from a patient who developed severe bleeding: Prolonged PT and APTT Platelet count = 100 × 109 /L Fibrinogen = 40 mg/dL Which of the following blood products should be recommended for transfusion? A. Factor VIII concentrate B. Platelets C. Fresh frozen plasma D. Cryoprecipitate

D. Cryoprecipitate Cryoprecipitate contains fibrinogen, factor VIII, and VWF. Fresh frozen plasma has all of the clotting factors; however, it is not the best choice if cryoprecipitate is available.

The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except: A. Replacement of normal marrow precursors by leukemic cells causing anemia B. Decrease in functional leukocytes causing infection C. Hemorrhage secondary to thrombocytopenia D. Decreased erythropoietin production

D. Decreased erythropoietin production A normal physiological response to anemia would be an increase in the kidney's production of erythropoietin. The accumulation of leukemic cells in the bone marrow leads to marrow failure, which is manifested by anemia, thrombocytopenia, and granulocytopenia.

What leukocyte cytoplasmic inclusion is composed of ribosomal RNA? Primary granules Toxic granules Dohle bodies Howell-Jolly bodies

Dohle bodies Inclusions in Dohle bodies are composed of lamellar rows of Rough Endoplasmic Reticulum (RER). Dohle bodies represent RIBOSOMAL RNA; seen in INFECTIONS and BURNS.

If a patient presents with a prolonged APTT that does not correct upon mixing, the next test performed should be: A. Factor II assay B. Factor VIII assay C. Platelet count D. Dilute Russell Viper Venom Time

D. Dilute Russell Viper Venom Time Circulating anticoagulants (ex: lupus inhibitors) should be determined through Dilute Russell Viper Venom Time or Platelet Neutralization tests.

The following laboratory results were obtained on a 25-year-old woman with menorrhagia after delivery of her second son. The patient has no previous bleeding history. Normal platelet count; normal bleeding time; normal PT; prolonged APTT Mixing of the patient's plasma with normal plasma corrected the prolonged APTT on immediate testing. However, mixing followed by 2-hour incubation at 37°C caused a prolonged APTT. What is the most probable cause of these laboratory results? A. Lupus anticoagulant B. Factor VIII deficiency C. Factor IX deficiency D. Factor VIII inhibitor

D. Factor VIII inhibitor Factor VIII inhibitor is found in 10%-20% of hemophilia patients receiving replacement therapy. It may also develop in patients with immunologic problems, women after childbirth, and patients with lymphoproliferative and plasma cell disorders, or it may develop in response to medications. Factor VIII inhibitor is an IgG immunoglobulin with an inhibitory effect that is time and temperature dependent. The presence of factor VIII inhibitor causes an elevated APTT in the face of a normal prothrombin time. Mixing studies in factors VIII and IX deficiencies will correct the prolonged APTT both at the immediate mixing stage and after incubation for 2 hours. The APTT would not be corrected by mixing studies if lupus anticoagulant was present. In addition, lupus anticoagulant is not associated with bleeding unless it coexists with thrombocytopenia.

Which clotting factor is not measured by PT and APTT tests? A. Factor VIII B. Factor IX C. Factor V D. Factor XIII

D. Factor XIII Factor XIII is not measured by the PT or APTT. Factor XIII (fibrin stabilizing factor) is a TRANSAMIDASE. It creates COVALENT bonds between fibrin monomers formed during the coagulation process to produce a stable fibrin clot. In the absence of factor XIII, the hydrogen bonded fibrin polymers are SOLUBLE in 5M urea or in 1% monochloroacetic acid.

Normal PT and APTT results in a patient with a poor wound healing may be associated with: A. Factor VII deficiency B. Factor VIII deficiency C. Factor XII deficiency D. Factor XIII deficiency

D. Factor XIII deficiency Factor XIII deficiency can lead to impaired wound healing and may cause severe bleeding problems. Factor XIII is a fibrin stabilizing factor that changes the fibrinogen bonds in fibrin polymers to stable covalent bonds. Factor XIII is not involved in the process of fibrin formation and, therefore, the PT and APTT are both normal.

All of the following are usually found in Hgb C disease except: A. Hgb C crystals B. Target cells C. Lysine substituted for glutamic acid at the sixth position of the β-chain D. Fast mobility of Hgb C at pH 8.6

D. Fast mobility of Hgb C at pH 8.6 Substitution of a positively charged amino acid for a negatively charged amino acid in Hgb C disease results in a slow electrophoretic mobility at pH 8.6.

A prolonged thrombin time is indicative of which of the following antithrombotic therapies? A. Prasugrel B. Clopidogrel C. Aspirin D. Heparin

D. Heparin Heparin is an antithrombin drug causing prolonged TT in patients who are on heparin therapy. Prasugrel, clopidogrel, and aspirin are antiplatelet drugs causing inhibition of platelet aggregation.

Which of the following disorders has an increase in osmotic fragility? A. Iron deficiency anemia B. Hereditary elliptocytosis C. Hereditary stomatocytosis D. Hereditary spherocytosis

D. Hereditary spherocytosis Spherocytic cells have decreased tolerance to swelling and, therefore, hemolyze at a higher concentration.

Which is the major Hgb found in the RBCs of patients with sickle cell trait? A. Hgb S B. Hgb F C. Hgb A2 D. Hgb A

D. Hgb A The major hemoglobin in sickle cell trait is Hgb A, which constitutes 50%-70% of the total. Hgb S comprises 20%-40%, and Hgb A2 and Hgb F are present in normal amounts.

Which of the following is the primary Hgb in patients with thalassemia major? A. Hgb D B. Hgb A C. Hgb C D. Hgb F

D. Hgb F Patients with thalassemia major are unable to synthesize the β-chain; hence, little or no Hgb A is produced. However, γ-chains continue to be synthesized and lead to variable elevations of Hgb F in these patients.

Ecarin clotting time may be used to monitor: A. Heparin therapy B. Warfarin therapy C. Fibrinolytic therapy D. Hirudin therapy

D. Hirudin therapy Ecarin clotting time, a snake venom-based clotting assay, may be used to monitor hirudin therapy in instances when the baseline APTT is prolonged due to lupus anticoagulant or factor deficiencies. The APTT is insensitive to hirudin levels above 0.6 mg/L, and this insensitivity may result in a drug overdose despite a monitoring protocol. Heparin therapy is monitored by the APTT; warfarin therapy is monitored by the INR. Fibrinolytic therapy may be monitored by D-dimer.

Thrombophilia may be associated with which of the following disorders? A. Afibrinogenemia B. Hypofibrinogenemia C. Factor VIII inhibitor D. Hyperfibrinogenemia

D. Hyperfibrinogenemia Hyperfibrinogenemia is a risk factor for thrombophilia. Fibrinogen is an acute phase reactant and may be increased in inflammation, stress, obesity, smoking, and medications such as oral contraceptives. Hypofibrinogenemia, afibrinogenemia, and factor VIII inhibitors are associated with bleeding.

Which morphological classification is characteristic of megaloblastic anemia? A. Normocytic, normochromic B. Microcytic, normochromic C. Macrocytic, hypochromic D. Macrocytic, normochromic

D. Macrocytic, normochromic Megaloblastic macrocytic anemia is normochromic because there is no defect in the Hgb synthesis. These anemias comprise a group of asynchronized anemias characterized by DEFECTIVE NUCLEAR MATURATION due to DEFECTIVE DNA SYNTHESIS. This abnormality accounts for the megaloblastic features in the bone marrow and the macrocytosis in the peripheral blood.

The following laboratory results were obtained from a 40-year-old woman: PT = 20 sec; APTT = 50 sec; thrombin time = 18 sec. What is the most probable diagnosis? A. Factor VII deficiency B. Factor VIII deficiency C. Factor X deficiency D. Hypofibrinogenemia

D. Hypofibrinogenemia Reference ranges: CLOTTING TIME Capillary blood (2-4 minutes) Whole blood/Lee and White (5-15 minutes) PROTHROMBIN TIME 10-12 seconds APTT 25-35 seconds STYPVEN/RUSSELL VIPER TIME 6-10 seconds THROMBIN TIME 10-14 seconds REPTILASE TEST 10-15 seconds Fibrinogen (factor I) is a clotting protein of the common pathway and is evaluated by the thrombin time. In hypofibrinogenemia (fibrinogen concentration <100 mg/dL), the PT, APTT, and TT are prolonged. In factor VII deficiency, the APTT is normal; in factor VIII deficiency, the PT is normal; and in factor X deficiency, the TT is normal.

Which test result would be normal in a patient with dysfibrinogenemia? A. Thrombin time B. APTT C. PT D. Immunologic fibrinogen level

D. Immunologic fibrinogen level The level of plasma fibrinogen determined immunologically is normal. In a patient with dysfibrinogenemia, fibrinogen is not polymerized properly, causing abnormal fibrinogen-dependent coagulation tests.

All of the following are associated with sideroblastic anemia except: A. Increased serum iron B. Ringed sideroblasts C. Dimorphic blood picture D. Increased RBC protoporphyrin

D. Increased RBC protoporphyrin Sideroblastic anemia has a decreased red cell protoporphyrin. The defect in sideroblastic anemia involves ineffective erythropoiesis. The failure to produce RBC protoporphyrin occurs because the nonheme iron is trapped in the mitochondria and is unavailable to be recycled.

Spherocytes differ from normal red cells in all of the following except: A. Decreased surface to volume B. No central pallor C. Decreased resistance to hypotonic saline D. Increased deformability

D. Increased deformability Spherocytes lose their deformability owing to the defect in spectrin, a membrane protein, and are therefore prone to splenic sequestration and hemolysis.

Factor XII deficiency is associated with: A. Bleeding episodes B. Epistaxis C. Decreased risk of thrombosis D. Increased risk of thrombosis

D. Increased risk of thrombosis Factor XII-deficient patients commonly have thrombotic episodes. Factor XII is the contact activator of the intrinsic pathway of coagulation. It also plays a major role in the fibrinolytic system by activating plasminogen to form plasmin. Hemorrhagic manifestations are NOT associated with factor XII deficiency because thrombin generated by the extrinsic pathway can activate factor XI to XIa, and factor VIIa/TF can activate factor IX to IXa.

Which statement about the fibrinogen/fibrin degradation product test is correct? A. It detects early degradation products (X and Y) B. It is decreased in disseminated intravascular coagulation (DIC) C. It evaluates the coagulation system D. It detects late degradation products (D and E)

D. It detects late degradation products (D and E) The fibrin degradation product (FDP) test detects the LATE degradation products (fragments D and E) and not the early ones (fragments X and Y).

Which statement regarding protein C is correct? A. It is a vitamin K-independent zymogen B. It is activated by fibrinogen C. It activates cofactors V and VIII D. Its activity is enhanced by protein S

D. Its activity is enhanced by protein S Protein S functions as a cofactor of protein C and as such enhances its activity. Activated protein C inactivates factors Va and VIIIa.

Which of the following anticoagulant drugs can be used in patients with HIT? A. Warfarin B. Heparin C. Aspirin D. Lepirudin

D. Lepirudin Lepirudin is a recombinant analogue of hirudin. It is an alternative anticoagulant drug used in patients with HIT who cannot tolerate heparin or LMWH therapy. Warfarin should NOT be used to anticoagulate persons with HIT because it causes a fall in protein C concentration prior to inducing a decrease in coagulation factors derived from vitamin K. The lower protein C predisposes HIT patients to leg thrombosis.

A 30-year-old female was referred to the hospital for evaluation for multiple spontaneous abortions and current complaint of pain and swelling in her right leg. Her family history is unremarkable. PT: 14.5 sec (11-13 sec) APTT: 63.0 sec (28-37 sec) Thrombin time: 12.0 sec (10-15 sec) Mixing Study Preincubation and after 2-hour incubation at 37°C APTT: 57.0 sec Platelet Neutralization Procedure: Patient plasma + freeze-thawed platelets APTT: 35.0 sec Patient plasma + saline APTT: 59.0 sec These clinical manifestations and laboratory results are consistent with: A. Factor VIII inhibitor B. Factor VIII deficiency C. Anticardiolipin antibodies D. Lupus anticoagulant

D. Lupus anticoagulant These clinical manifestations and laboratory results are consistent with lupus anticoagulant. Pain and swelling in her right leg may be indicative of thrombosis. As many as 48% of women with repeated spontaneous abortions have lupus anticoagulant or/and antibody to phospholipidsuch as anticardiolipin antibodies. The unremarkable family history in this patient rules out an inherited thrombotic disorder. A normal TT rules out fibrinogen disorders. A prolonged PT and APTT in the absence of bleeding history eliminate the diagnosis of factor deficiency, including factor VIII deficiency. The APTT performed on a mixture of patient plasma and normal plasma did not correct. This result is indicative of an inhibitor. However, because the patient is not bleeding, factor VIII inhibitor is not indicated. A negative anticardiolipin antibody result rules out the possibility of anticardiolipin antibodies being responsible for the patient's clinical symptoms. The laboratory test that confirms the presence of a lupus anticoagulant is a prolonged APTT that is not corrected when mixed with normal plasma and that is neutralized by preincubation with platelets (an excess of platelet phospholipid neutralizes the antibody, resulting in a normal APTT).

Leukemia, especially with chemotherapy: Decreased WBCs, increased platelets Increased WBCs, decreased platelets

Decreased WBCs, increased platelets RATIONALE Fragile WBCs, fragments counted as platelets CORRECTIVE ACTION Review film, perform phase platelet count or CD61 count

Which of the following disorders is associated with ineffective erythropoiesis? A. G6PD deficiency B. Liver disease C. Hgb C disease D. Megaloblastic anemia

D. Megaloblastic anemia Ineffective erythropoiesis is caused by destruction of erythroid precursor cells prior to their release from the bone marrow. Pernicious anemia results from defective DNA synthesis; it is suggested that the asynchronous development of red cells renders them more liable to intramedullary destruction.

Which of the following antibodies is used in the D-dimer assay? A. Polyclonal directed against X and Y fragments B. Polyclonal directed against D-dimer C. Monoclonal against D and E fragments D. Monoclonal against D-dimer

D. Monoclonal against D-dimer The D-dimer is the fibrin degradation product generated by the action of plasmin on cross-linked fibrin formed by XIIIa. The patient plasma is mixed with latex particles coated with MONOCLONAL antibodies against D-DOMAINS. The test can be automated or performed manually on a glass slide, looking macroscopically for agglutination. ELISA methods are also available. Normal D-dimer in plasma is less than 2 ng/mL (2 ng/mL). Increased levels of D-dimer are associated with DIC, thrombolytic therapy, venous thrombosis, and thromboembolic disorders. The D-dimer assay has a 90%-95% negative predictive value. (NPV), and has been used to rule out thrombosis and thromboembolic disorders.

What phagocytic cells produce lysozymes that are bacteriocidal? A. Eosinophils B. Lymphocytes C. Platelets D. Neutrophils

D. Neutrophils NEUTROPHILS are highly phagocytic and release lysozymes, peroxidase, and pyrogenic proteins. EOSINOPHILS migrate to sites where there is an allergic reaction or parasitic infestation, releasing peroxidase, pyrogens, and other enzymes, including an OXIDASE that neutralizes histamine. They are poorly phagocytic and do not release lysozyme.

Review the following CBC results on a 2-day-old infant: WBCs = 15.2 × 109/L RBCs = 5.30 × 1012/L Hgb = 18.5 g/dL Hct = 57.9% These results indicate: A. Macrocytic anemia B. Microcytic anemia C. Liver disease D. Normal values for a 2-day-old infant

D. Normal values for a 2-day-old infant During the first week of life, an infant has an average Hct of 55 mL/dL. This value drops to a mean of 43 mL/dL by the first month of life. The mean MCV of the first week is 108 fL; after 2 months, the average MCV is 96 fL. The mean WBC count during the first week is approximately 18 × 109/L, and this drops to an average of 10.8 × 109/L after the first month. The platelet count of newborns falls within the same normal range as adults.

An abnormal APTT caused by a pathological circulating anticoagulant is: A. Corrected with factor VIII-deficient plasma B. Corrected with factor IX-deficient plasma C. Corrected with normal plasma D. Not corrected with normal plasma

D. Not corrected with normal plasma In the presence of a pathological circulating anticoagulant, a mixing test using normal plasma does not correct the abnormal APTT. These anticoagulants are pathological substances and are endogenously produced. They are either directed against a specific clotting factor or against a group of factors. A prolonged APTT due to a factor deficiency is corrected when mixed with a normal plasma. Factors VIII and IX deficient plasmas are used for assaying factor VIII and IX activities, respectively.

A patient with a prolonged PT is given intravenous vitamin K. The PT corrects to normal after 24 hours. What clinical condition most likely caused these results? A. Necrotic liver disease B. Factor X deficiency C. Fibrinogen deficiency D. Obstructive jaundice

D. Obstructive jaundice Obstructive jaundice contributes to coagulation disorders by preventing vitamin K absorption. Vitamin K is fat soluble and requires bile salts for absorption. Parenteral administration of vitamin K bypasses the bowel; hence the need for bile salts.

Multiple myeloma and Waldenström's macroglobulinemia have all the following in common except: A. Monoclonal gammopathy B. Hyperviscosity of the blood C. Bence-Jones protein in the urine D. Osteolytic lesions

D. Osteolytic lesions OSTEOLYTIC LESIONS indicating destruction of the bone as evidenced by radiography are seen in MULTIPLE MYELOMA but not in Waldenström's macroglobulinemia. In addition, Waldenström's gives rise to a LYMPHOCYTOSIS that does not occur in multiple myeloma and differs in the morphology of the malignant cells.

Platelet factor that neutralizes heparin: A. PF1 B. PF2 C. PF3 D. PF4

D. PF4

A 50-year-old man has been on heparin for the past 7 days. Which combination of the tests is expected to be abnormal? A. PT and APTT only B. APTT, TT only C. APTT, TT, fibrinogen assay D. PT, APTT, TT

D. PT, APTT, TT Heparin is a therapeutic anticoagulant with an antithrombin activity. Heparin also inhibits factors XIIa, XIa, Xa, and IXa. In patients receiving heparin therapy, the PT, APTT, and TT are all prolonged. Quantitative fibrinogen assay, however, is not affected by heparin therapy.

An autohemolysis test is positive in all the following conditions except: A. Glucose-6-phosphate dehydrogenase (G6PD) deficiency B. Hereditary spherocytosis (HS) C. Pyruvate kinase (PK) deficiency D. Paroxysmal nocturnal hemoglobinuria (PNH)

D. Paroxysmal nocturnal hemoglobinuria (PNH) The autohemolysis test is positive in G6PD and PK deficiencies and in HS, but is normal in PNH because lysis in PNH requires SUCROSE to enhance complement binding. The addition of glucose, sucrose, or adenosine triphosphate (ATP) corrects the autohemolysis of HS. Autohemolysis of PK can be corrected by ATP.

Which anemia is characterized by a lack of intrinsic factor that prevents B12 absorption? A. Tropical sprue B. Transcobalamin deficiency C. Blind loop syndrome D. Pernicious anemia

D. Pernicious anemia

All of the following are associated with the diagnosis of multiple myeloma except: A. Marrow plasmacytosis B. Lytic bone lesions C. Serum and/or urine M component (monoclonal protein) D. Philadelphia chromosome

D. Philadelphia chromosome The Ph1 chromosome is a diagnostic marker for CML. Osteolytic lesions, monoclonal gammopathy, and bone marrow infiltration by plasma cells constitute the triad of diagnostic markers for multiple myeloma.

The lupus anticoagulant affects which of the following tests? A. Factor VIII assay B. Factor IX assay C. VWF assay D. Phospholipid-dependent assays

D. Phospholipid-dependent assays The lupus anticoagulant interferes with phospholipid-dependent coagulation assays such as the PT and APTT tests. The lupus anticoagulant does not inhibit clotting factor assays, and does not inhibit in vivo coagulation.

Which of the following laboratory tests is helpful in the diagnosis of aspirin resistance? A. APTT B. PT C. Platelet count and morphology D. Platelet aggregation

D. Platelet aggregation Currently, the platelet aggregation test is considered the GOLD STANDARD for evaluation of ASPIRIN RESISTANCE. In aspirin resistance, platelet aggregation is NOT inhibited by aspirin ingestion. Aspirin resistance has no effect on platelet count and morphology.

Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to the formation of hemoglobin? A. Reticulocyte B. Pronormoblast C. Basophilic normoblast D. Polychromatic normoblast

D. Polychromatic normoblast In normal erythrocytic maturation, Hgb formation in the late polychromatic normoblast stage gives the cytoplasm a prominent pink coloration. The red cell continues to produce Hgb throughout the reticulocyte stage of development.

Which of the following drugs inhibits ADP mediated platelet aggregation? A. Heparin B. Warfarin C. Aspirin D. Prasugrel

D. Prasugrel Prasugrel (Effient) is an antiplatelet drug that reduces platelet aggregation by irreversibly blocking the P2Y12 receptors on the platelet surface membrane, thereby inhibiting platelet aggregation to ADP. Aspirin is another antiplatelet drug that inhibits platelet aggregation by blocking the action of the enzyme cyclo-oxygenase. Warfarin and heparin are anticoagulant drugs that act against clotting factors.

A 50-year-old patient is suffering from pernicious anemia. Which of the following laboratory data are most likely for this patient? A. RBC = 2.5 × 1012/L; WBC =12,500/μL (12.5 × 109/L); PLT = 250,000/μL (250 × 109/L) B. RBC = 4.5 × 1012/L; WBC = 6,500/μL (6.5 × 109/L); PLT = 150,000/μL (150 × 109/L) C. RBC = 3.0 × 1012/L; WBC = 5,000/μL (5.0 × 109/L); PLT = 750,000/μL (750 × 109/L) D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L)

D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L) Patients with pernicious anemia demonstrate a pancytopenia with low WBC, PLT, and RBC counts. Because this is a megaloblastic process and a DNA maturation defect, all cell lines are affected. In the bone marrow, this results in abnormally large precursor cells, maturation asynchrony, hyperplasia of all cell lines, and a low M:E ratio.

A50-year-old patient is suffering from pernicious anemia. Which of the following laboratory data are most likely for this patient? A. RBC = 2.5 × 1012/L; WBC = 12,500/μL (12.5 × 109/L); PLT = 250,000/μL (250 × 109/L) B. RBC = 4.5 × 1012/L; WBC = 6,500/μL (6.5 × 109/L); PLT = 150,000/μL (150 × 109/L) C. RBC = 3.0 × 1012/L; WBC = 5,000/μL (5.0 × 109/L); PLT = 750,000/μL (750 × 109/L) D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L)

D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L)

Reticulocytosis usually indicates: A. Response to inflammation B. Neoplastic process C. Aplastic anemia D. Red cell regeneration

D. Red cell regeneration RETICULOCYTE COUNT: Index of bone marrow production of blood cells Adult: 0.5-1.5% (average 1%) Neonates: 2-6% Needs supravital stain (New Methylene Blue) INCREASED in Hemolysis and Hemorrhage DECREASED in Aplastic Anemia

Reticulocytosis usually indicates: A. Response to inflammation B. Neoplastic process C. Aplastic anemia D. Red cell regeneration

D. Red cell regeneration Reticulocytes are polychromatophilic macrocytes, and the presence of reticulocytes indicates red cell regeneration. The bone marrow's appropriate response to anemia is to deliver red cells prematurely to the peripheral circulation. In this way, reticulocytes and possibly nucleated red cells may be seen in the peripheral smear.

Which of the following cells is considered pathognomonic for Hodgkin's disease? A. Niemann-Pick cells B. Reactive lymphocytes C. Flame cells D. Reed-Sternberg cells

D. Reed-Sternberg cells The morphological common denominator in Hodgkin's lymphoma is the Reed-Sternberg (RS) cell. It is a large, binucleated cell with a dense nucleolus surrounded by clear space. These characteristics give the RS cell an "owl's eye" appearance. Niemann-Pick cells (foam cells) are histiocytes containing phagocytized sphingolipids that stain pale blue and impart a foamlike texture to the cytoplasm. FLAME CELLS are plasma cells with distinctive red cytoplasm. They are sometimes seen in the bone marrow of patients with MULTIPLE MYELOMA

True for PRECISION: A. Measure of agreement between an assay value and the theoretical "true value" of its analyte B. Magnitude of error separating the assay result from the true value C. Easy to define but difficult to establish and maintain D. Relatively easy to measure and maintain

D. Relatively easy to measure and maintain ACCRUACY is easy to define but difficult to establish and maintain. PRECISION is relatively easy to measure and maintain. It is the expression of reproducibility or dispersion about the mean, often expressed as SD or CV%.

Hemolytic uremic syndrome (HUS) is characterized by all of the following except: A. Hemorrhage B. Thrombocytopenia C. Hemoglobinuria D. Reticulocytopenia

D. Reticulocytopenia The hemolytic anemia of HUS is associated with reticulocytosis. The anemia seen in HUS is multifactorial, with characteristic schistocytes and polychromasia commensurate with the anemia.

Microangiopathic hemolytic anemia is characterized by: A. Target cells and Cabot rings B. Toxic granulation and Döhle bodies C. Pappenheimer bodies and basophilic stippling D. Schistocytes and nucleated RBCs

D. Schistocytes and nucleated RBCs Microangiopathic hemolytic anemia is a condition resulting from shear stress to the erythrocytes. Fibrin strands are laid down within the microcirculation, and red cells become fragmented as they contact fibrin through the circulation process, forming schistocytes.

Storage iron is usually best determined by: A. Serum transferrin levels B. Hgb values C. Myoglobin values D. Serum ferritin levels

D. Serum ferritin levels Ferritin enters the serum from all ferritin-producing tissues, and therefore is considered to be a good indicator of body storage iron. Because iron stores must be depleted before anemia develops, low serum ferritin levels precede the fall in serum iron associated with iron deficiency anemia.

In which of the following conditions will autosplenectomy most likely occur? A. Thalassemia major B. Hgb C disease C. Hgb SC disease D. Sickle cell disease

D. Sickle cell disease Autosplenectomy occurs in sickle cell anemia as a result of repeated infarcts to the spleen caused by the overwhelming sickling phenomenon.

When an erythrocyte containing iron granules is stained with Prussian blue, the cell is called a: A. Spherocyte B. Leptocyte C. Schistocyte D. Siderocyte

D. Siderocyte

Which of the following is often associated with CML but not with AML? A. Infections B. WBCs greater than 20.0 × 109/L C. Hemorrhage D. Splenomegaly

D. Splenomegaly

Which of the following is often associated with CML but not with AML? A. Infections B. WBCs greater than 20.0 × 109/L C. Hemorrhage D. Splenomegaly

D. Splenomegaly Splenomegaly is seen in more than 90% of CML patients, but it is not a characteristic finding in AML. Infections, hemorrhage, and elevated WBC counts may be seen in both CML and AML.

All of the following are major criteria for the 2008 WHO diagnostic criteria for essential thrombocythemia except: A. Platelet count >450 × 109/L B. Megakaryocyte proliferation with large and mature morphology, and no or little granulocyte or erythroid proliferation C. Demonstration of JAK2(V617F) or other clonal marker D. Sustained platelet count >600 × 109/L

D. Sustained platelet count >600 × 109/L The criterion for the 2001 WHO diagnosis of essential thrombocythemia (ET) was a platelet count ≥600 x 109/L. This was CHANGED in the 2008 WHO criteria to ≥450 x 109 /L. Diagnosis of essential thrombocythemia requires meeting all four major 2008 WHO diagnostic criteria, which also includes: • Megakaryocyte proliferation with large and mature morphology and no or little granulocyte or erythroid proliferation; • Not meeting WHO criteria for CML, PV, IMF, MDS, or other myeloid neoplasm; • and Demonstration of JAK2(V617F) mutation or other clonal marker, or no evidence of reactive thrombocytosis.

Which of the following statements is correct regarding the D-dimer test? A. Levels are decreased in DIC B. Test detects polypeptides A and B C. Test detects fragments D and E D. Test has a negative predictive value

D. Test has a negative predictive value The D-dimer assay evaluates fibrin degradation. It is a NONSPECIFIC screening test that is increased in many conditions in which fibrinolysis is increased, such as DIC and fibrinolytic therapy. The D-dimer test is widely used to RULE OUT THROMBOSIS and thrombotic activities. The negative predictive value of a test is the probability that a person with a negative result is free of the disease the test is meant to detect. Therefore, a NEGATIVE D-dimer test RULES OUT THROMBOSIS and hence further laboratory investigations are NOT REQUIRED.

Iron deficiency anemia may be distinguished from anemia of chronic infection by: A. Serum iron level B. Red cell morphology C. Red cell indices D. Total iron-binding capacity

D. Total iron-binding capacity In iron deficiency anemia, the serum iron and ferritin levels are decreased and the total iron-binding capacity and RBC protoporphyrin are increased. In chronic disease, serum iron and TIBC are both decreased because the iron is trapped in reticuloendothelial (RE) cells, and is unavailable to the red cells for hemoglobin production.

Acquired platelet function defects: A. Bernard-Soulier syndrome B. Bernard-Soulier and Glanzmann thrombasthenia C. Uremia, multiple myeloma D. Uremia, multiple myeloma, vitamin B12 or folate deficiency

D. Uremia, multiple myeloma, vitamin B12 or folate deficiency

Which of the following clotting factors are activated by thrombin that is generated by tissue pathway (TF-VIIa)? A. XII, XI B. XII, I C. I, II D. V, VIII

D. V, VIII Factors V and VIII are activated by the thrombin that is generated by the action of TF-VIIa on factor X to form factor Xa. Factor Xa forms a complex with factor Va on the platelet surfaces. FXa -Va complex in the presence of phospholipid and Ca+2 transform more prothrombin to thrombin.

A synthetic vasopressin analog that can stimulate release of vWF from vascular endothelium in type I patients

DDAVP Desmopressin (also known as DDAVP, which stands for 1-deamino-8-D-arginine vasopressin) is a synthetic medicine that boosts levels of factor VIII (FVIII) and von Willebrand factor (VWF) to prevent or control bleeding.

A positive protamine sulfate is suggestive of: vWD Primary fibrinolysis DIC Glanzmann's thrombasthenia

DIC

In which of the following diseases would you most likely find an abnormal prothrombin time: Hemophilia A Hemophilia B vWD DIC

DIC

Fibrin monomers are increased in which of the following conditions? Primary fibrinolysis DIC Fibrinogen deficiency Factor VIII deficiency

DIC Increased fibrin monomers result from coagulation activation. DIC is an acquired condition associated with spontaneous activation of coagulation and fibrinolysis. In primary fibrinolysis, the fibrinolytic system is activated and fibrin monomers are normal.

Howell-Jolly bodies are composed of: DNA Iron Reticulum RNA

DNA

Lack of vitamin B12 or folic acid hinders the erythroblast in manufacturing: Heme Globin DNA RNA

DNA Remember: MEGALOBLASTIC ANEMIA

Effect of excess anticoagulant to hematocrit: Increase Decrease No effect Cannot be determined

Decrease TOO MUCH anticoagulant = Destruction of cells = LOW packed cells volume

ESR of patient with leukocytosis: Decreased Increased Variable

Decreased

Fibrinogen concentration in primary fibrinolysis: Decreased Increased Variable

Decreased

Fibrinogen concentration in secondary fibrinolysis: Decreased Increased Variable

Decreased

Cold agglutinins: Decreased RBCs, increased MCV and MCHC, grainy appearance Increased RBCs, decreased MCV and MCHC, grainy appearance

Decreased RBCs, increased MCV and MCHC, grainy appearance RATIONALE: Agglutination of RBCsCORRECTIVE ACTION: Warm specimen to 37° C and rerun

The erythrocytosis seen in relative polycythemia occurs because of: Decreased arterial oxygen saturation Decreased plasma volume of circulating blood Increased erythropoietin levels Increased erythropoiesis in the bone marrow

Decreased plasma volume of circulating blood Relative polycythemia is caused by a reduction of plasma rather than an increase in red blood cell volume or mass. Red cell mass is increased in both PV and secondary polycythemia, but erythropoietin levels are high only in secondary polycythemia.

Effect of platelet clumps to automated cell counting: Decreased platelets and WBCs Increased platelets and WBCs Decreased platelets, increased WBCs Increased platelets, decreased WBCs

Decreased platelets, increased WBCs RATIONALE: Large clumps counted as WBCs and not platelets CORRECTIVE ACTION: Redraw specimen in sodium citrate, multiply result by 1.1

Which of the following is not a cause of ABSOLUTE secondary erythrocytosis? Defective cardiac or pulmonary function High-altitude adjustment Dehydration secondary to diuretic use Hemoglobins with increased oxygen affinity

Dehydration secondary to diuretic use Dehydration is a cause of relative (pseudo) erythrocytosis due to plasma loss.

Which type of patient is most likely to have an arteriovenous fistula or graft? Arthritic Dialysis Hospice Wheelchair-bound

Dialysis An arteriovenous (AV) shunt, fistula, or graft is the permanent surgical connection of an artery and vein by direct fusion (fistula), resulting in a bulging vein, or with a piece of vein or tubing (graft) that creates a loop under the skin. It is typically created to be used for dialysis, commonly joins the radial artery and cephalic vein above the wrist on the underside of the arm, and has a distinctive buzzing sensation called a "thrill" when palpated. A temporary shunt with tubing on the surface of the skin can also be created.

Congenital erythroid hypoplasia/pure red cell aplasia: Diamond-Blackfan anemia Fanconi's anemia Sideroblastic anemia Myelophthisi

Diamond-Blackfan anemia

The term for cell movement across the cellular membranes from the blood vessels to the tissues is called: Diapedesis Endocytosis Margination Chemotaxis

Diapedesis

Which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant? Thrombin time test Diluted Russell's viper venom test (DRVVT) D-dimer test FDP test

Diluted Russell's viper venom test (DRVVT)

Which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant? FDP test Thrombin time test Diluted Russell's viper venom test (DRVVT) D-dimer test

Diluted Russell's viper venom test (DRVVT) Russell's viper venom (RVV) reagent contains factors X and V, activating enzymes that are strongly phospholipid dependent. The reagent also contains RVV, calcium ions, and phospholipid. In the presence of phospholipid autoantibodies such as lupus anticoagulant, the reagent phospholipid is partially neutralized causing prolongation of the clotting time.

THE ESR IS ____ PROPORTIONAL TO THE RED BLOOD CELL MASS and _____proportional to plasma viscosity. Direct, direct Direct, inverse Inverse, direct Inverse, inverse

Direct, inverse

ESR and RBC mass: Directly proportional Inversely proportional Cannot be determined

Directly proportional The ESR is directly proportional to the red blood cell mass and inversely proportional to plasma viscosity.

A patient complains of extreme pain when you insert the needle during a venipuncture attempt. The pain does not subside, but the patient does not feel any numbness or burning sensation. You know the needle is in the vein because the blood is flowing into the tube. You have only two tubes to fill, and the first one is almost full. What should you do? A. Ask the patient if he or she wants you to continue the draw B. Discontinue the draw and attempt collection at another site C. Distract the patient with small talk and continue the draw D. Tell the patient to hang in there as you have only one tube left

Discontinue the draw and attempt collection at another site If marked or extreme pain occurs, or the patient asks you to remove the needle for any reason, the venipuncture should be terminated immediately, even if there are no other signs of nerve injury.

Immune thrombocytopenic purpura (ITP): Formerly known as disseminated intravascular coagulation (DIC) Absence of megakaryocytes in the bone marrow Widespread formation of platelet thrombi Due to platelet antibodies

Due to platelet antibodies

All but one are related: A. Eicosanoid synthesis pathway B. Prostaglandin pathway C. Cyclooxygenase pathway D. Thromboxane pathway E. IP3-DAG

E. IP3-DAG PLATELET ACTIVATION PATHWAYS 1. Eicosanoid synthesis pathway (alternatively called prostaglandin, cyclooxygenase, and thromboxane pathway) 2. Inositol Triphosphate-Diacylglycerol Activation (IP3-DAG) pathway

Most common complication encountered in obtaining a blood specimen: Ecchymosis (bruise) Hematoma Hemoconcentration Anemia

Ecchymosis (bruise)

In aplastic anemia, the bone marrow is: Empty Empty, hypoplastic Empty, hyperplastic Either hypoplastic or hyperplastic

Empty, hypoplastic

Falsely elevated automated platelet counts may result from: Platelet satellitism Platelet agglutinins Exceptionally large platelets Erythrocyte inclusion bodies

Erythrocyte inclusion bodies

Megaloblastic anemia: Alcoholism Aplastic anemia Chronic liver disease Erythroleukemia

Erythroleukemia NONMEGALOBLASTIC ANEMIA: Alcoholism Aplastic anemia Chronic liver disease MEGALOBLASTIC ANEMIA: Vitamin B12 Deficiency Folate Deficiency Myelodysplasia Erythroleukemia Some drugs

Portion of DNA that is ACTIVE in gene expression and stains lightly with Wright stain: Euchromatin Heterochromatin

Euchromatin

EDTA-induced pseudothrombocytopenia can be identified on blood smear by: Finding platelets pushed to the feathered end Finding platelets adhering to WBCs Finding no platelets at all on the smear Bluish discoloration to the macroscopic appearance of the slide

Finding platelets adhering to WBCs Platelet satellitosis (platelet encircling the peripheral borders of neutrophils) is seen in a rare patient whose blood is anticoagulated with EDTA. This phenomenon is thought to be due to a serum factor which reacts in the presence of EDTA.

Which of the following is NOT a source of error when measuring hemoglobin by the cyanmethemoglobin method? Excessive anticoagulant White blood cell count that exceeds linearity limits Lipemic plasma Scratched or dirty hemoglobin measuring cell

Excessive anticoagulant Excessive anticoagulant does not affect hemoglobin readings. Anything that causes an increase in absorbance will cause a hemoglobin that is read spectrophotometrically to be falsely high.

G6PD deficiency episodes are related to which of the following? Exposure to oxidant drugs Defective globin chains Antibodies to RBCs Abnormal protein structures

Exposure to oxidant drugs

Many microspherocytes and schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with: Hereditary spherocytosis Disseminated intravascular coagulation Autoimmune hemolytic anemia Extensive burns

Extensive burns POIKILOCYTES IN EXTENSIVE BURNS: Microspherocyte Spherocyte Schistocyte GRANULOCYTE ABNORMALITIES IN INFECTION AND BURNS: Toxic granules Toxic vacuoles Dohle bodies

Proconvertin FVII FIX FXI FXIII

FVII

A prolonged Stypven (Russell viper venom) time is associated with deficiency of the following factors EXCEPT: Factor I Factor II Factor X Factor VII

Factor VII

The Bethesda assay is used for which determination? Lupus anticoagulant titer Factor VIII inhibitor titer Factor V Leiden titer Protein S deficiency

Factor VIII inhibitor titer The Bethesda assay is a quantitative assay for factor VIII inhibitor. In this assay, normal plasma is incubated with different dilutions of the patient's plasma or a normal control. The inhibitor inactivates factor VIII present in normal plasma following incubation for 2 hours at 37°C. The residual activities in the sample are determined, and the inhibitor titer is calculated.

Normal PT and APTT results in a patient with a poor wound healing may be associated with: Factor VII deficiency Factor VIII deficiency Factor XII deficiency Factor XIII deficiency

Factor XIII deficiency Factor XIII deficiency can lead to impaired wound healing and may cause severe bleeding problems. Factor XIII is a fibrin stabilizing factor that changes the fibrinogen bonds in fibrin polymers to stable covalent bonds. Factor XIII is not involved in the process of fibrin formation and, therefore, the PT and APTT are both normal.

What effect does selecting the wrong gate have on results when cells are counted by flow cytometry? No effect Failure to count the desired cell population Falsely elevated results Impossible to determine

Failure to count the desired cell population

Anticoagulant therapy: Falsely decreased D-dimer values Falsely increased D-dimer values No effect Cannot be determined

Falsely decreased D-dimer values ALSELY DECREASED VALUES 1. Anticoagulant therapy 2. Smaller, older, nonprogressing thrombus FALSELY INCREASED VALUES 1. Various disease states 2. Post-therapeutic clinical procedures

Congenital pancytopenia/aplastic anemia: Diamond-Blackfan anemia Fanconi's anemia Sideroblastic anemia Myelophthisi

Fanconi's anemia

Primary substrate of thrombin: Fibrinogen Prothrombin Factor V Factor X

Fibrinogen

Primary substrate of thrombin Fibrinogen Prothrombin Factor V Factor X

Fibrinogen - Factor I is activated by thrombin to form fibrin clot.

An abnormal thrombin time is associated with: Factor X deficiency Excess plasminogen Fibrinogen deficiency Protein C deficiency

Fibrinogen deficiency

An enzyme deficiency associated with a moderate to severe hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions formed by denatured hemoglobin is: Lactate dehydrogenase deficiency G-6-PD deficiency Pyruvate kinase deficiency Hexokinase deficiency

G-6-PD deficiency CLUE: Denatured hemoglobin - Heinz bodies

In ____, the tetraploid DNA is checked for proper replication and damage, takes approximately 4 hours. G1 S G2 M

G2 G0 - Quiescence - Non-dividing G1 - Gap 1 - 10 hours - Cell growth S - DNA Synthesis - 8 hours - DNA Replication G2 - Gap 2 - 4 hours - Protein synthesis M - Mitosis - 1 hour - Mitosis followed by cytokinesis or cell division

Bite cells are usually seen in patients with: Rh null disease Chronic granulomatous disease G6PD deficiency Pyruvate kinase deficiency

G6PD deficiency

The process of selecting a population of interest as defined by one or more flow cytometric parameters Sorting Designating Gating Setting

Gating Gate - a set of filters placed around a population of interest to analyze various parameters (extrinsic and intrinsic) of the cells contained within the selected region

Which of the following is a characteristic of low molecular weight heparin (LMWH)? Generally requires monitoring Specifically acts on factor Va Has a longer half-life than unfractionated heparin Can be used as a fibrinolytic agent

Has a longer half-life than unfractionated heparin Low molecular weight heparin (LMWH) is a small glycosaminoglycan that is derived from unfractionated heparin (UFH). The LMWH has a low affinity for plasma proteins and endothelial cells and therefore has a longer half-life. The half-life of the drug does not depend on the dosage. LMWH has an inhibitory effect on factors Xa and IIa. It does not require routine monitoring except in patients with renal failure, obese patients, pediatric patients, and pregnant patients.

Proaccelerin Christmas factor Stuart-prower factor Stable factor Labile factor

Labile factor

The morphological characteristic(s) associated with the Chédiak-Higashi syndrome is (are): Pale blue cytoplasmic inclusions Giant lysosomal granules Small, dark-staining granules and condensed nuclei Nuclear hyposegmentation

Giant lysosomal granules Chédiak-Higashi syndrome is a disorder of neutrophil phagocytic dysfunction caused by depressed chemotaxis and delayed degranulation. The degranulation disturbance is attributed to interference from the giant lysosomal granules characteristic of this disorder.

Primary PLATELET AGGREGATION disorders: Bernard-Soulier syndrome Glanzmann's thrombasthenia Essential athrombia Glanzmann's thrombasthenia and essential athrombia

Glanzmann's thrombasthenia and essential athrombia

Normal platelet adhesion depends upon: Fibrinogen Glycoprotein Ib Glycoprotein IIb, IIIa complex Calcium

Glycoprotein Ib Glycoprotein Ib is a platelet receptor for VWF. Glycoprotein Ib and VWF are both necessary for a normal platelet adhesion. Other proteins that play a role in platelet adhesion are glycoproteins V and IX.

In ENTERIC ISOLATION, the technologist is required to wear Gown and gloves Gown, mask and gloves Gown, mask, gloves and shoe coverings Mask

Gown and gloves STRICT ISOLATION: Gown, mask and gloves ENTERIC ISOLATION: Gown and gloves RESPIRATORY ISOLATION: Mask, gloves WOUND AND SKIN ISOLATION: Gown and gloves PROTECTIVE ISOLATION: Gown, mask, gloves, shoe coverings

Naphthol AS-D chloroacetate esterase (specific) is usually positive in _____ cells, and alpha naphthyl acetate esterase (nonspecific)is useful for identifying blast cells of ______lineage. Granulocytic; monocytic Monocytic; granulocytic Granulocytic; lymphocytic Monocytic; lymphocytic

Granulocytic; monocytic Naphthol AS-D chloroacetate esterase (specific) reacts strongly in granulocytic cells, and alpha-naphthyl acetate esterase (nonspecific) stains positively in monocytic cells.

WBC COUNT that can cause turbidity in the cyanmethemoglobin method resulting to falsely high hemoglobin value: Greater than 5 x 10 9th/L Greater than 10 x 10 9th/L Greater than 15 x 10 9th/L Greater than 20 x 10 9th/L

Greater than 20 x 10 9th/L A high WBC count (greater than 20 x 10 9th/L) or a high platelet count (greater than 700 x 10 9th/L) can cause turbidity and a falsely high result. IN THIS CASE, THE REAGENT-SAMPLE SOLUTION CAN BE CENTRIFUGED AND THE SUPERNATANT MEASURED.

PLATELET COUNT that can cause turbidity in the cyanmethemoglobin method resulting to falsely high hemoglobin value: Greater than 150 x 10 9th/L Greater than 200 x 10 9th/L Greater than 500 x 10 9th/L Greater than 700 x 10 9th/L

Greater than 700 x 10 9th/L A high WBC count (greater than 20 x 10 9th/L) or a high platelet count (greater than 700 x 10 9th/L) can cause turbidity and a falsely high result. IN THIS CASE, THE REAGENT-SAMPLE SOLUTION CAN BE CENTRIFUGED AND THE SUPERNATANT MEASURED.

Cells that exhibit a positive stain with acid phosphatase and are not inhibited with tartaric acid are characteristically seen in: Infectious mononucleosis Infectious lymphocytosis Hairy cell leukemia T-cell acute lymphoblastic leukemia

Hairy cell leukemia

Leukemic reticuloendotheliosis: Prolymphocytoc leukemia Plasma cell leukemia Hairy cell leukemia Sezary syndrome

Hairy cell leukemia

Hairy cell leukemia A variable number of malignant cells in hairy cell leukemia (HCL) will stain positive with tartrate-resistant acid phosphatase (TRAP+).

RBCs inclusions, 0.2 to 2.0 mm in size, that can be seen with a stain such as crystal violet or brilliant cresyl blue; represent precipitated, denatured hemoglobin and are clinically associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such as phenacetin, and some hemoglobinopathies. Hemoglobin C crystals Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Heinz bodies

Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright's-stained blood smear? Basophilic stippling Heinz bodies Howell-Jolly bodies Siderotic granules

Heinz bodies

A 7.0 mL EDTA tube is received in the laboratory containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the following tests will most likely be erroneous? RBC count Hemoglobin Hematocrit WBC count

Hematocrit

Which is the major hemoglobin found in the RBCs of patients with SICKLE CELL TRAIT? Hemoglobin S Hemoglobin F Hemoglobin A2 Hemoglobin A1

Hemoglobin A1

Which of the following hemoglobins is composed of four beta globin chains? Hemoglobin F Hemoglobin C Bart's hemoglobin Hemoglobin H

Hemoglobin H

Hemoglobin SOLUBILITY TEST is a screening test for: Hemoglobin A2 Hemoglobin F Hemoglobin S Unstable hemoglobins

Hemoglobin S

Which laboratory test is best used for DEFINITIVE diagnosis of sickle cell anemia? Solubility testing Hemoglobin electrophoresis Peripheral smear review for sickle cells Bone marrow analysis

Hemoglobin electrophoresis

When blood is placed in a 0.25% solution of sodium chloride, the RBC: Shrinks Hemolyzes Crenates Remains the same

Hemolyzes NSS: 0.85% or 0.9% HYPOTONIC SOLUTION Swell, Hemolyze HYPERTONIC SOLUTION Shrink, Crenate

Portion of DNA that is INACTIVE during transcription to messenger RNA and stains deeply with Wright stain: Euchromatin Heterochromatin

Heterochromatin "HID" Inactive, Dark

Bilobed neutrophil nucleus (pince-nez) - common type of hyposegmentation: Homozygous Pelger-Huet anomaly Heterozygous Pelger-Huet anomaly

Heterozygous Pelger-Huet anomaly Homozygous Pelger-Huet - round neutrophil nucleus Heterozygous Pelger-Huet - bilobed neutrophil nucleus (pince-nez); common

Ecarin clotting time. may be used to monitor: Heparin therapy Warfarin therapy Fibrinolytic therapy Hirudin therapy

Hirudin therapy Hirudin is an anticoagulant produced in trace amounts by the medicinal LEECH (Hirudo medicinalis)

Thrombocytopenia may be associated with: Postsplenectomy Hypersplenism Acute blood loss Increased proliferation of pluripotential stem cells

Hypersplenism Hypersplenism is associated with thrombocytopenia. In this condition, up to 90% of platelets can be sequestered in the spleen, causing decreases in circulatory platelets. Postsplenectomy, acute blood loss, and increased proliferation of pluripotential stem cells are associated with thrombocytosis.

Acute disseminated intravascular coagulation is characterized by: Hypofibrinogenemia Thrombocytosis Negative D-dimer Shortened thrombin time

Hypofibrinogenemia

Nuclear remnants predominantly composed of DNA; believed to develop in periods of accelerated or abnormal erythropoiesis, because the spleen cannot keep upwith pitting these remnants from the cell. Its presence is associated with hemolytic anemias, pernicious anemia, and particularly post-splenectomy, physiologicalatrophy of the spleen. Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Howell-Jolly bodies

These erythrocyte inclusions are nuclear remnants predominantly composed of DNA Pappenheimer bodies Howell-Jolly body Basophilic stippling Heinz bodies

Howell-Jolly body

It is used by medical laboratories in developing their quality management systems and assessing their own competence and for use by accreditation bodies in confirming or recognizing the competence of medical laboratories: ISO 11166 ISO 11469 ISO 15189 ISO 15819

ISO 15189 ISO 15189:2007 is for use by medical laboratories in developing their quality management systems and assessing their own competence and for use by accreditation bodies in confirming or recognizing the competence of medical laboratories.

In the French-American-Bristish (FAB) classification, myelomonocytic leukemia would be: M1 and M2 M3 M4 M5

Alpha and dense granules of platelets: In peripheral zone In sol-gel zone In organelle zone In membranous system

In organelle zone PERIPHERAL ZONE: Glycocalyx Plasma membrane Sub-membranous area SOL-GEL ZONE: Microfilaments Microtubules ORGANELLE ZONE: Alpha granules Dense bodies Mitochondria Lysosomal granules MEMBRANOUS SYSTEM: Dense tubular system Surface connecting system (open canalicular system)

In essential thrombocythemia, the platelets are: Increased in number and functionally abnormal Normal in number and functionally abnormal Decreased in number and functional Decreased in number and functionally abnormal

Increased in number and functionally abnormal In essential thrombocythemia, the platelet count is extremely elevated. These platelets are abnormal in function, leading to both BLEEDING and THROMBOTIC DIATHESIS.

Holes all over the blood film indicates: RBC agglutination Markedly increased WBC and platelet counts Increased lipid levels Increased blood proteins as in multiple myeloma

Increased lipid levels MACROSCOPIC EXAMINATION OF BLOOD FILM 1. BLUER Increased blood proteins, as in plasma cell myeloma, and that ROULEAUX may be seen on the film 2. GRAINY RBC agglutination, as in cold hemagglutinin diseases 3. HOLES Increased lipid levels 4. BLUE SPECKS OUT AT THE FEATHER EDGE Markedly increased WBC counts and platelet counts

Megaloblastic anemia is characterized by all of the following, EXCEPT: Decreased WBCs and retics Hypersegmented neutrophils Oval macrocytes Increased platelets

Increased platelets MEGALOBLASTIC ANEMIA Remember: "OM/HJ/HN" OM - Oval Macrocytes HJ - Howell-Jolly bodies HN - Hypersegmented Neutrophils

Which of the following is associated with post-transfusion purpura (PTP)? Nonimmune thrombocytopenia/alloantibodies Immune-mediated thrombocytopenia/alloantibodies Immune-mediated thrombocytopenia/autoantibodies Nonimmune-mediated thrombocytopenia/autoantibodies

Immune-mediated thrombocytopenia/alloantibodies Post-transfusion purpura is a rare form of alloimmune thrombocytopenia characterized by severe thrombocytopenia following transfusion of blood or blood products. PTP is caused by antibody-related platelet destruction in previously immunized patients. In the majority of cases, the alloantibody produced is against platelet antigen A1 (PlA1), also referred to as HPA-1a.

Asynchronous development of hematopoietic cells within the bone marrow is the result of: Inadequate levels of RNA Decreased erythropoietin Defective stem cells Impaired DNA synthesis

Impaired DNA synthesis

ESR of patient with leukemia: Decreased Increased Variable

Increased

In thrombocythemia, the platelets are: Increased Decreased Normal Normal in number, abnormal morphology

Increased

Effect of dehydration to hematocrit reading: Decreased Increased Variable No effect

Increased The fluid loss associated with dehydration causes a decrease in plasma volume and falsely increases the hematocrit reading.

A patient on therapeutic warfarin will most likely have a(an): Normal PT/INR, increased APTT, prolonged bleeding time, low platelet count Increased PT/INR, increased APTT, normal bleeding time, normal platelet count Normal PT/INR, normal APTT, normal bleeding time, normal platelet count Increased PT/INR, normal APTT, prolonged bleeding time, low platelet count

Increased PT/INR, increased APTT, normal bleeding time, normal platelet count

Nucleated RBCs, megakaryocyte fragments, or micromegakaryoblasts: Decreased WBCs in newer instruments Increased WBCs in older instruments

Increased WBCs in older instruments

Which of the following is NOT a characteristic finding in polycythemia vera? Blood pancytosis Increased red cell mass Increased erythropoietin level Increased blood viscosity

Increased erythropoietin level

All of the following are associated with hemolytic anemia except: Methemoglobinemia Hemoglobinuria Hemoglobinemia Increased haptoglobin

Increased haptoglobin Should be decreased haptoglobin

Dehydration: Decreased hematocrit Increased hematocrit Variable hematocrit Hematocrit cannot be determined

Increased hematocrit The fluid loss associated with dehydration causes a decrease in plasma volume and falsely INCREASES the hematocrit reading.

Lipemia and icterus: Decreased hemoglobin and MCH Increased hemoglobin and MCH

Increased hemoglobin and MCH RATIONALE: Turbidity affects spectrophotometric reading for hemoglobin CORRECTIVE ACTION: Plasma replacement

Effect of lipemia to to AUTOMATED hemoglobin determination: Decreased hemoglobin, inaccurate Decreased hemoglobin, imprecise Increased hemoglobin, inaccurate Increased hemoglobin, imprecise

Increased hemoglobin, inaccurate

Effect of lipemia to to MANUAL hemoglobin determination: Decreased hemoglobin, inaccurate Decreased hemoglobin, imprecise Increased hemoglobin, inaccurate Increased hemoglobin, imprecise

Increased hemoglobin, inaccurate

WBC > 100,000/µL: Decreased hemoglobin, decreased RBCs, incorrect hematocrit Increased hemoglobin, increased RBCs, incorrect hematocrit

Increased hemoglobin, increased RBCs, incorrect hematocrit RATIONALE: Turbidity affects spectrophotometric reading for hemoglobin, WBCs counted with RBC count CORRECTIVE ACTION: Manual HCT; perform manual HGB (spin/read supernatant), correct RBC count, recalculate indices; if above linearity, dilute for correct WBC count

In addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera? Decreased platelets, decreased granulocytes, decreased erythropoietin level Decreased platelets, decreased granulocytes, increased erythropoietin level Increased platelets, increased granulocytes, increased erythropoietin level Increased platelets, increased granulocytes, decreased erythropoietin level

Increased platelets, increased granulocytes, decreased erythropoietin level PV is not due to the activity of erythropoietin. The production of erythropoietin is almost completely suppressed in this malignant condition.

In which of the following would an absolute monocytosis not be seen? Tuberculosis Recovery stage of acute bacterial infection Collagen disorders Infectious mononucleosis

Infectious mononucleosis IM - LYMPHOCYTOSIS

What kind of light is used to visualize veins during phlebotomy? Infrared light UV light LED light Incandescent lights

Infrared light AccuVein is a handheld medical device that helps medical staff visualize veins before phlebotomy. The device emits infrared light and is held about 7 inches over the potential phlebotomy site.

What is the second stage of phagocytosis? Ingestion Killing and Digestion Formation of Neutrophil Extracellular Traps Recognition and Attachment

Ingestion PHAGOCYTOSIS (RODAK) 1. Recognition and Attachment 2. Ingestion 3. Killing and Digestion 4. Formation of Neutrophil Extracellular Traps

A patient has macrocytic anemia, the physician suspects pernicious anemia. Which tests would best rule in a definitive diagnosis of pernicious anemia? Homocysteine Intrinsic factor antibodies Ova and parasite examination for D. latum Bone marrow examination

Intrinsic factor antibodies

Perl's Prussian blue is a stain used to detect: DNA RNA Iron Glycogen

Iron When stained with a mixture of POTASSIUM FERRICYANIDE and HYDROCHLORIC ACID, nonheme iron stains bright blue. This is the most common stain used for storage iron. It can be used on bone marrow to identify SIDEROBLASTS, peripheral blood to identify the presence of siderocytes, or urine to perform hemosiderin testing.

The Coulter principle for counting of cells is based upon the fact that: Isotonic solutions conduct electricity better than cells do Conductivity varies proportionally to the number of cells Cells conduct electricity better than saline does Isotonic solutions cannot conduct electricity

Isotonic solutions conduct electricity better than cells do

Which of the following is considered to be an advantage of the MECHANICAL end-point detection methodology? It is not affected by lipemia in the test sample It has the ability to provide a graph of clot formation It can incorporate multiple wavelengths into a single testing sequence

It is not affected by lipemia in the test sample A hemostasis laboratory manager may choose to maintain a separate mechanical end-point coagulometer to substitute for the optical instrument if the specimen is too cloudy for optical determinations.

Which statement about Coumadin (warfarin) is accurate? It is a vitamin B antagonist It is not recommended for pregnant and lactating women It needs antithrombin as a cofactor APTT test is used to monitor its dosage

It is not recommended for pregnant and lactating women Coumadin (warfarin) crosses the placenta and is present in human milk; it is not recommended for pregnant and lactating women. Warfarin is a vitamin K antagonist drug that retards synthesis of the active form of vitamin K-dependent factors (II, VII, IX, and X). Antithrombin is a heparin (not warfarin) cofactor. The International Normalized Ratio (INR) is used to monitor warfarin dosage.

Which mutation is shared by a large percentage of patients with polycythemia vera, essential thrombocythemia, and primary myelofibrosis? BCR/ABL JAK2 V617F PDGFR RUNX1

JAK2 V617F The JAK2 V617F mutation is present in numerous cases of myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia, and primary myelofibrosis. BCR/ABL mutations are seen in CML, and PDGFR mutations are seen in neoplasms with eosinophilia. RUNX mutations may be seen in some cases of acute leukemias.

The ESR of patients with severe anemia is of ______ diagnostic value, because it will be falsely _____.

LITTLE, ELEVATED They are expected to have ELEVATED ESR.

A patient has a CBC and peripheral smear with an elevated WBC count and left shift, suggestive of a diagnosis of CML. Which of the following tests would be the most helpful in CONFIRMING the suspected diagnosis? Cytochemical staining for myeloperoxidase and LAP Karyotyping for the Philadelphia chromosome Flow cytometry for myeloid cell markers Lymph node biopsies for metastasis

Karyotyping for the Philadelphia chromosome Although leukocyte alkaline phosphatase (LAP) scores tend to be decreased in chronic myelogenous leukemia (CML) and myeloid cells are present, karyotyping for the presence of the Philadelphia chromosome (9;22 translocation) is required for the confirmation of a diagnosis of CML.

The FAB classification of ALL seen most commonly in children is: L1 L2 L3 Burkitt's type

L1 L1 Small Homogenous Most common type of CHILDHOOD ALL Best prognosis L2 Large Heterogenous Adult-type ALL L3 Large Homogenous Vacuoles Burkitt-type Rarest subtype Poor prognosis "Starry-sky pattern"

The megakaryocyte progenitor that undergoes endomitosis is: MK-I BFU-Meg CFU-Meg LD-CFU-Meg

LD-CFU-Meg

Microhematocrit tube: Length 75 mm, inner bore of 1.2 mm Length 115 mm, bore of 3 mm Length of 300 mm, bore of 2.5 mm Length of 11.5 cm, bore of 3 mm

Length 75 mm, inner bore of 1.2 mm Speed of centrifugation: RCF 10,000 to 15,000 g for 5 minutes BETTER packing of cells Meanwhile, in macrohematocrit WINTROBE Length: 11.5 cm Bore: 3 mm Anticoagulant: Double oxalate, EDTA Centrifugation: 2,000 to 2,300 g for 30 minutes

It can be used to clean the objective lenses: Normal saline Formalin Xylene Lens cleaner or 70% isopropyl alcohol

Lens cleaner or 70% isopropyl alcohol The use of xylene is discouraged, because it contains a carcinogenic component (benzene). Xylene is also a poor cleaning agent, leaving an oily film on the lens.

The difference between the total cells counted on each side should be less than ___%. A greater variation could indicate an uneven distribution, which requires that the procedure be repeated. Less than 10% Less than 15% Less than 20% Less than 30%

Less than 10%

In end-stage liver disease, the fibrinogen level may fall to less than ___mg/dL, which is a mark of liver failure. Less than 100 mg/dL Less than 200 mg/dL Less than 300 mg/dL

Less than 100 mg/dL In end-stage liver disease, the fibrinogen level may fall to less than 100 mg/dL, which is a mark of liver failure.

What is the key diagnostic test for Hodgkin lymphoma? Bone marrow biopsy Lymph node biopsy Spinal tap Skin biopsy

Lymph node biopsy

Which of the following appearances describes the types of cells seen in Sezary syndrome? Plasma cells containing immunoglobulin deposits Large circulating micromegakaryocytes Lymphocytes with convoluted, cerebriform nuclei Prolymphocytes with prominent azurophilic granules

Lymphocytes with convoluted, cerebriform nuclei

Solid tumor counterpart of acute lymphoblastic leukemia: Lymphoma, undifferentiated Lymphoma, poorly-differentiated Lymphoma, well-differentiated Myeloma

Lymphoma, poorly-differentiated LEUKEMIA TYPE SOLID TUMOR COUNTERPART STEM CELL LEUKEMIA: Lymphoma, undifferentiated ACUTE LYMPHOBLASTIC: Lymphoma, poorly leukemia differentiated; lymphocytic CHRONIC LYMPHOCYTIC: Lymphoma, well leukemia differentiated; lymphocytic MONOCYTIC LEUKEMIA: Reticulum cell sarcoma ACUTE MYELOGENOUS: Chloroma granulocytic leukemia PLASMA CELL LEUKEMIA: Myeloma

In hemoglobin C, glutamic acid on the 6th position of beta chain is replaced by which amino acid? Lysine Valine Arginine Glutamine

Lysine

Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage: M0 myeloid M1 myeloid M2 myeloid M3 myeloid

M2 myeloid

A cytogenic abnormality is found in almost 50% of the patients with which of the following classifications of acute nonlymphocytic leukemia? M1 M3 M5 M6

DIC is most often associated with which of the following FAB designation of acute leukemia? M1 M3 M4 M5

M3 Chromosome 15, 17

Basophilic and granular cytoplasm MK-I MK-II MK-III

MK-II

Moderately condensed chromatin: MK-I MK-II MK-III

MK-II

Deeply and variably condensed chromatin: MK-I MK-II MK-III

MK-III

Multilobed nucleus: MK-I MK-II MK-III

MK-III

The fish tapeworm Diphyllobothrium latum is associated with the development of: Microcytic anemia Macrocytic anemia Hemolytic anemia Hypoproliferative anemia

Macrocytic anemia The fish tapeworm competes for vitamin B12, and a macrocytic (megaloblastic) anemia may develop. Hookworm infestation causes chronic blood loss and a microcytic anemia due to iron deficiency.

Which morphological classification is characteristic of megaloblastic anemia? Normocytic, normochromic Microcytic, normochromic Macrocytic, hypochromic Macrocytic, normochromic

Macrocytic, normochromic

FAB type M6 is characterized by increased: Promyelocytes and lysozyme activity Marrow megakaryocytes and thrombocytosis Marrow erythroblasts and multinucleated red cells Marrow monoblasts and immature monocytes

Marrow erythroblasts and multinucleated red cells

Color of blood in the irreversible sulfhemoglobinemia: Chocolate brown Cherry red Mauve lavender Bright red

Mauve lavender

Which of the following inherited leukocyte disorders is one of a group disorders with mutations in nonmuscle myosin heavy-chain IIA? Pelger-Huet anomaly Chediak-Higashi disease Alder-Reilly anomaly May-Hegglin anomaly

May-Hegglin anomaly Inclusions in May-Hegglin anomaly are composed of PRECIPITATED MYOSIN HEAVY CHAINS.

The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia, and large platelets is called: May-Hegglin anomaly Chediak-Higashi syndrome Pelger-Huet anomaly Alder-Reilly anomaly

May-Hegglin anomaly Remember: "MD" M - May-Hegglin anomaly D - Dohle bodies May-Hegglin anomaly is an autosomal dominant disorder in which large blue cytoplasmic structures that resemble Dohle bodies are found in the granulocytes and possibly the monocytes.

The mean platelet volume (MPV): Analogous to the MCHC Direct measure of the platelet count Measurement of the average volume of platelets Comparison of the patient's value to the normal value

Measurement of the average volume of platelets

Begins to develop most of its cytoplasmic ultrastructure, including procoagulant-laden alpha-granules, dense granules (dense bodies),and the demarcation system (DMS): Megakaryoblast Promegakaryocyte Megakaryocyte Metamegakaryocyte

Megakaryoblast Please refer to Rodak: MEGAKARYOBLAST PLEASE The megakaryoblast begins to develop most of its cytoplasmic ultrastructure, including procoagulant-laden alpha-granules, dense granules (dense bodies), and the demarcation system (DMS). Note: First appearance of DMS: MEGAKARYOBLAST (MK-I) Presence of DMS: MK-I, MK-II and MK-III

The RDW and MCV are both quantitative descriptors of erythrocyte size. If both are increased, the most probable erythrocytic abnormality would be: Iron deficiency anemia Acquired aplastic anemia Megaloblastic anemia Hemoglobinopathy

Megaloblastic anemia

Hereditary stomatocytosis is manifested physiologically by changes in: Hemoglobin oxygen affinity Membrane cation permeability Efficiency of hemoglobin reduction Glycolytic ATP production

Membrane cation permeability The major defect in hereditary stomatocytosis is altered permeability of the red cell membrane to Na+ and K+ ions. Higher permeability to Na+ instead of K+. Seen in cases of Rh null patients.

Granulocytic precursor with an indented or kidney-shaped nucleus: Promyelocyte Myelocyte Metamyelocyte Band

Metamyelocyte

Indented nucleus, clumped chromatin: Promyelocyte Myelocyte Metamyelocyte Band

Metamyelocyte

Tertiary granules of the neutrophils are formed during the: Promyelocyte stage Myelocyte and metamyelocyte stage Metamyelocyte and band stage Band and segmented neutrophil stage

Metamyelocyte and band stage Primary (Azurophilic) Granules Formed during the promyelocyte stage Last to be released (exocytosis) Secondary (Specific) Granules Formed during myelocyte and metamyelocyte stages Third to be released Tertiary Granules Formed during metamyelocyte and band stages Second to be released Secretory Granules (Secretory Vesicles) Formed during band and segmented neutrophil stages First to be released (fuse to plasma membrane)

Sister chromatids move to the equatorial plate. Prophase Metaphase Anaphase Telophase

Metaphase PROPHASE The chromatin becomes tightly coiled. Nucleolus and nuclear envelope disintegrate. Centrioles move to opposite poles of the cell. METAPHASE Sister chromatids move to the equatorial plate. ANAPHASE Sister chromatids separate and move to opposite poles. TELOPHASE Chromosomes arrive at opposite poles. Nucleolus and nuclear membrane reappear. The chromatin pattern reappears.

What is the last nucleated stage in development of erythrocyte? Prorubricyte Rubricyte Metarubricyte Reticulocyte

Metarubricyte

The components of Wright's stain include: Crystal violet and safranin Brilliant green and neutral red New methylene blue and carbolfuchsin Methylene blue and eosin

Methylene blue and eosin One type of Romanowsky stain is the Wright's stain. It is a polychrome stain consisting of methylene blue and eosin.

Where do early and late stages of heme synthesis occur? Ribosomes Cytoplasm Mitochondria Nucleoli

Mitochondria

Which laboratory test is used to screen for activated protein C resistance? Mixing studies with normal plasma Mixing studies with factor-deficient plasma Modified APTT with and without activated protein C Modified PT with and without activated protein C

Modified APTT with and without activated protein C Activated protein C resistance can be evaluated by a two-part APTT test. The APTT is measured on the patient's plasma with and without the addition of activated protein C (APC). The result is expressed as the ratio of the APTT with APC to the APTT without APC. The normal ratio is 2:5. Patients with APCR have a lower ratio than the reference range. A positive screening test should be followed by a confirmatory test such as polymerase chain reaction (PCR) for factor V Leiden.

Which of the following is a proper way to clean up a small blood spill that has dried on a countertop? Moisten it with a disinfectant and carefully absorb it with a paper towel Rub it with an alcohol pad, then wipe the area with a clean alcohol pad Scrape it into a biohazard bag and wash the surface with soap and water Use a disinfectant wipe and scrub it in ever increasing concentric circles

Moisten it with a disinfectant and carefully absorb it with a paper towel

Indented or twisted nucleus, lacy chromatin and gray-blue cytoplasm: Segmented neutrophil Band neutrophil Monocyte Lymphocyte

Monocyte

Sodium fluoride maybe added to naphthyl ASD (NASDA) esterase reaction. The fluoride is added to inhibit a positive reaction with: Megakaryocytes Monocytes Erythrocytes Granulocytes

Monocytes

Which section of the scatterplot denotes the number of monocytes?

Monocytes account for the dots in section A, neutrophils are represented in section B, eosinophils in section C, and lymphocytes are denoted in section D.

Which of the following is associated with Alder-Reilly inclusions? Membrane defect of lysosomes Dohle bodies and giant platelets Two-lobed neutrophils Mucopolysaccharidosis

Mucopolysaccharidosis

A distinctive feature of the megakaryocyte: Multinucleated Multilobular Multinucleated and multilobular None of these

Multilobular A distinctive feature of the megakaryocyte is that it is MULTILOBAR, not multinucleated. The fully mature lobes of the megakaryocyte shed platelets from the cytoplasm on completion of maturation.

Solid tumor counterpart of plasma cell leukemia: Chloroma Multiple myeloma Lymphoma, poorly-differentiated Lymphoma, well-differentiated

Multiple myeloma

Which of the following is NOT classified as a myeloproliferative disorder? Polycythemia vera Essential thrombocythemia Multiple myeloma Chronic myelogenous leukemia

Multiple myeloma Multiple myeloma is a malignant lymphoproliferative disorder characterized by a clonal proliferation of plasma cells and multiple bone tumors.

What does the granulocyte MITOTIC pool in the bone marrow contain? Myeloblasts and Promyelocytes Band and Segmented forms Majority of marrow granulocytes Myelocytes and Metamyelocytes

Myeloblasts and Promyelocytes

The most mature cell that can undergo mitosis is the: Promyelocyte Myelocyte Metamyelocyte Band

Myelocyte

Solid tumor counterpart of plasma cell leukemia: Reticulum cell sarcoma Chloroma granulocytic leukemia Myeloma Lymphoma, undifferentiated

Myeloma

Solid tumor counterpart of plasma cell leukemia: Lymphoma, undifferentiated Reticulum cell sarcoma Chloroma Myeloma

Myeloma STEM CELL LEUKEMIA: Lymphoma, undifferentiated ACUTE LYMPHOBLASTIC: Lymphoma, poorly leukemia differentiated; lymphocytic CHRONIC LYMPHOCYTIC: Lymphoma, well leukemia differentiated; lymphocytic MONOCYTIC LEUKEMIA: Reticulum cell sarcoma ACUTE MYELOGENOUS: Chloroma granulocytic leukemia PLASMA CELL LEUKEMIA: Myeloma

Primary granules of neutrophils Collagenase, Gelatinase, Lactoferrin Lysozyme, Gelatinase, B2 microglobulin Myeloperoxidase, Defensins, Elastase Heparin, Esterase, Acid phosphatase

Myeloperoxidase, Defensins, Elastase

Which of the following will stain the GRANULOCYTES only? Naphthol AS-D chloroacetate Alpha-naphthyl acetate esterase Alpha-naphthyl butyrate esterase All of these

Naphthol AS-D chloroacetate AKA Specific Esterase

Paroxysmal nocturnal hemoglobinuria is characterized by flow cytometry results that are: Negative for CD55 and CD59 Positive for CD55 and CD59 Negative for CD4 and CD8 Positive for all normal CD markers

Negative for CD55 and CD59 CD55 - DAF CD59 - MIRL

Diagnosis of lupus anticoagulant is confirmed by which of the following criteria? Decreased APTT Correction of the APPT by mixing studies Neutralization of the antibody by high concentration of platelets Confirmation that abnormal coagulation tests are time and temperature dependent

Neutralization of the antibody by high concentration of platelets The International Society of Hemostasis and Thrombosis has recommended four criteria for the diagnosis of lupus anticoagulant: (1) a prolongation of one or more of the phospholipid-dependent clotting tests such as APTT or DRVVT; (2) the presence of an inhibitor confirmed by mixing studies (not corrected); (3) evidence that the inhibitor is directed against phospholipids by neutralizing the antibodies with a high concentration of platelets (platelet neutralization test or DRVVT with platelet-rich plasma); (4) lack of any other causes for thrombosis. Lupus inhibitor is not commonly time or temperature dependent.

WBC Count: 3x10^9/L Neutrophil: 2% Lymphocyte: 92% Monocyte: 4% Eosinophil: 2% Basophil: 0% Neutropenia Lymphocytosis Eosinophilia Monocytopenia

Neutropenia

When performing platelet aggregation studies, which set of platelet aggregation results would most likely be associated with Bernard-Soulier syndrome? Normal platelet aggregation to collagen, ADP, and ristocetin Normal platelet aggregation to collagen, ADP, and epinephrine; decreased aggregation to ristocetin Normal platelet aggregation to epinephrine and ristocetin; decreased aggregation to collagen and ADP Normal platelet aggregation to epinephrine, ristocetin, and collagen; decreased aggregation to ADP

Normal platelet aggregation to collagen, ADP, and epinephrine; decreased aggregation to ristocetin Bernard-Soulier syndrome is a disorder of platelet adhesion caused by deficiency of glycoprotein Ib. Platelet aggregation is normal in response to collagen, ADP, and epinephrine but abnormal in response to ristocetin.

Which set of platelet responses would be most likely associated with Glanzmann's thrombasthenia? Normal platelet aggregation to ADP and ristocetin; decreased aggregation to collagen Normal platelet aggregation to collagen; decreased aggregation to ADP and ristocetin Normal platelet aggregation to ristocetin; decreased aggregation to collagen, ADP, and epinephrine Normal platelet aggregation to ADP; decreased aggregation to collagen and ristocetin

Normal platelet aggregation to ristocetin; decreased aggregation to collagen, ADP, and epinephrine Glanzmann's thrombasthenia is a disorder of platelet aggregation. Platelet aggregation is normal in response to ristocetin, but abnormal in response to collagen, ADP, and epinephrine.

Which type of anemia is usually present in a patient with acute leukemia? Microcytic, hyperchromic Microcytic, hypochromic Normocytic, normochromic Macrocytic, normochromic

Normocytic, normochromic

An abnormal APTT caused by a pathological circulating anticoagulant is: Corrected with factor VIII-deficient plasma Corrected with factor X-deficient plasma Corrected with normal plasma Not corrected with normal plasma

Not corrected with normal plasma LUPUS ANTICOAGULANT/THROMBOSIS against PHOSPHOLIPID Screening test: Dilute RVVT Confirmatory test: Platelet Neutralization Test

If a patient adamantly refuses to have blood drawn, you should: Convince the patient to be cooperative Notify the patient's nurse or physician Restrain the patient and draw the blood Write a note to the patient's physician

Notify the patient's nurse or physician

Apoptosis is morphologically identified by: Cellular swelling Nuclear condensation Rupture of the cytoplasm Rupture of the nucleus

Nuclear condensation APOPTOSIS CELL SIZE: reduced due to shrinkage NUCLEUS: condensation and fragmentation between nucleosomes NECROSIS CELL SIZE: enlarged due to swelling NUCLEUS: random breaks and lysis (karylolysis)

Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow? Progressive decrease in overall cell size Increasing basophilia of cytoplasm Nuclear division without cytoplasmic division Fusion of the nuclear lobes

Nuclear division without cytoplasmic division

A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because: The WBC count would be falsely lower The RBC count is too low Nucleated RBCs are counted as leukocytes Nucleated RBCs are confused with giant platelets

Nucleated RBCs are counted as leukocytes The automated hematology analyzers enumerate all nucleated cells. NRBCs are counted along with WBCs, falsely elevating the WBC count. To correct the WBC count, determine the number of NRBCs per 100 WBCs. Corrected WBC count = (uncorrected WBC count ÷ [NRBC's + 100]) × 100.

The ESR of patients with severe anemia is: Critical Of diagnostic significance Of little diagnostic value

Of little diagnostic value The ESR of patients with severe anemia is of little diagnostic value, because it will be falsely elevated.

The macrocytes typically seen in megaloblastic processes are: Crescent-shaped Teardrop-shaped Ovalocytic Pencil-shaped

Ovalocytic Macrocytes in true megaloblastic conditions are oval macrocytes as opposed to the round macrocytes that are usually seen in alcoholism and obstructive liver disease.

Which of the following represents the principal defect in chronic granulomatous disease (CGD)? Chemotactic migration Phagocytosis Lysosomal formation and function Oxidative respiratory burst

Oxidative respiratory burst Chronic granulomatous disease (CGD) is a hereditary disorder in which neutrophils are incapable of killing most ingested microbes. The disease is usually fatal because of defective generation of oxidative metabolism products, such as superoxide anions and hydrogen peroxide, which are essential for killing.

Irregular clusters of small, light to dark blue granules, often near periphery of cells Cabot ring Heinz body Howell-Jolly body Pappenheimer bodies

Pappenheimer bodies

RBC inclusions that are aggregates of mitochondria, ribosomes, and iron particles. Clinically, they are associated with iron-loading anemias, hyposplenism, and hemolytic anemias. Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Pappenheimer bodies

Which of the following red cell inclusions stain with both Perl's Prussian blue and Wright's stain? Howell-Jolly bodies Basophilic stippling Pappenheimer bodies Heinz bodies

Pappenheimer bodies Pappenheimer bodies are iron deposits associated with mitochondria, and they stain with both Perl's Prussian blue and Wright's stain.

Myeloperoxidase (MPO) and Sudan Black B (SBB) staining results: Opposite Parallel Undetermined Variable

Parallel

A patient's differential count shows an elevated eosinophil count. This is consistent with which of the following? Aplastic anemia Bacterial infection Parasitic infection Viral infection

Parasitic infection

Screening tests for thrombophilia should be performed on: All pregnant women because of the thrombotic risk Patients with a negative family history Patients with thrombotic events occurring at a young age Patients who are receiving anticoagulant therapy

Patients with thrombotic events occurring at a young age Laboratory tests for evaluation of thrombophilia are justified in young patients with thrombotic events, in patients with a positive family history after a single thrombotic event, in those with recurrent spontaneous thrombosis, and in pregnancies associated with thrombosis.

Of the following, the disease most closely associated with granulocyte hyposegmentation is: May-Hegglin anomaly Pelger-Huet anomaly Chediak-Higashi syndrome Gaucher's disease

Pelger-Huet anomaly

Which of the following inherited leukocyte disorders is caused by a mutation in the lamin B receptor? Pelger-Huet anomaly Chediak-Higashi disease Alder-Reilly anomaly May-Hegglin anomaly

Pelger-Huet anomaly

Detects lymphocytic cells and certain abnormal erythrocytic cells by staining of cytoplasmic glycogen: Periodic acid Schiff (PAS) Peroxidase Sudan black B (SBB) Toluidine blue

Periodic acid Schiff (PAS)

Which of the following stains is helpful in the diagnosis of suspected erythroleukemia? Peroxidase Periodic acid-Schiff Nonspecific esterase Acid phosphatase

Periodic acid-Schiff

The outermost zone of platelet is called: Peripheral zone Sol-gel zone Alpha zone Organelle zone

Peripheral zone

Which anemia is characterized by a lack of intrinsic factor that prevents B12 absorption? Tropical sprue Transcobalamin deficiency Blind loop syndrome Pernicious anemia

Pernicious anemia

Which of the following conditions is not usually associated with marked reticulocytosis? Four days after a major hemorrhage Drug-induced autoimmune hemolytic anemia Sickle cell anemia Pernicious anemia

Pernicious anemia The reticulocyte count is not usually elevated in pernicious anemia even though increased marrow erythropoiesis occurs. The defective cellular maturation that occurs in megaloblastic anemias results in the death of many red cells in the bone marrow (ineffective erythropoiesis).

The activity of the lupus anticoagulant and anticardiolipin antibodies appears to be directed against: Factor V Factor VIII Factor IX Phospholipid

Phospholipid

Compare the volume of plasma to serum obtained from a given volume of whole blood: Plasma greater volume than serum Plasma lesser volume than serum Same volume Variable

Plasma greater volume than serum

The D-dimer test is a specific test for: Plasminogen activation Plasmin degradation of fibrinogen Plasmin degradation of fibrin Factor XIII

Plasmin degradation of fibrin

Which of the following coagulation test results is normal in patient with classic vWD? Bleeding time APTT Platelet count Factor VIII:C and vWF

Platelet count

Which of the following test results is normal in a patient with classic von Willebrand's disease? Bleeding time Activated partial thromboplastin time Platelet count Factor VIII:C and von Willebrand's factor (VWF) levels

Platelet count Von Willebrand's disease is an inherited, qualitative platelet disorder resulting in increased bleeding, prolonged APTT, and decreased factor VIII:C and VWF levels. The platelet count and morphology are generally NORMAL in von Willebrand's disease, but aggregation in the platelet function assay is ABNORMAL.

Measure of the uniformity of platelet size in a blood specimen: Platelet adhesion Platelet aggregation Mean platelet volume (MPV) Platelet distribution width (PDW)

Platelet distribution width (PDW) NV: <20% The PDW is a measure of the uniformity of platelet size in a blood specimen. This parameter serves as a validity check and monitors false results. A normal PDW is less than 20%.

Storage pool deficiencies are defects of: Platelet adhesion Platelet aggregation Platelet granules Platelet production

Platelet granules Storage pool deficiencies are defects of platelet granules. Most commonly, a decrease in platelet-dense granules is present with decreased release of ADP, ATP, calcium, and serotonin from platelet-dense granules.

In which stage of erythrocytic maturation does hemoglobin formation begin? Reticulocyte Pronormoblast Basophilic normoblast Polychromatophilic normoblast

Polychromatophilic normoblast

Which of the following red blood cell precursors is the LAST STAGE TO UNDERGO MITOSIS? Pronormoblast Basophilic normoblast Polychromatophilic normoblast Orthochromic normoblast

Polychromatophilic normoblast

Which is not an embryonic hemoglobin Gower-1 Gower-2 Portland-1 Portland-2

Portland-2 Hemoglobin in RBCs: 34 g/dL Each gram of hemoglobin: 1.34 mL oxygen Each gram of hemoglobin: 3.47 mg of iron Additional: In the human gene, there is ONE COPY of each globin gene per chromatid, for a total of 2 genes per diploid cell, with exception of alpha and gamma. There are two copies of the alpha and gamma globin genes per chromatid, for a total of four genes per diploid cell.

What combination of reagents is used to measure hemoglobin? Hydrochloric acid and p-dimethylaminobenzaldehyde Potassium ferricyanide and potassium cyanide Sodium bisulfite and sodium metabisulfite Sodium citrate and hydrogen peroxide

Potassium ferricyanide and potassium cyanide The standard assay for hemoglobin utilizes potassium ferricyanide. This solution, formerly called Drabkin's reagent, is now called cyanmethemoglobin (HiCN) reagent. The FERRICYANIDE oxidizes hemoglobin iron from ferrous (Fe2+) to ferric (Fe3+), and the POTASSIUM CYANIDE stabilizes the pigment as cyanmethemoglobin for spectrophotometric measurement.

Which results are associated with hemophilia A? Prolonged APTT, normal PT Prolonged PT and APTT Prolonged PT, normal APTT Normal PT and APTT

Prolonged APTT, normal PT Hemophilia A is associated with factor VIII deficiency. Factor VIII is a factor in the intrinsic coagulation pathway that is evaluated by the APTT and not the PT test. The PT test evaluates the extrinsic and common pathways.

The observation of a normal reptilase time and a prolonged thrombin time is indicative of: Presence of fibrin degradation products Hypoplasminogenemia Dysfibrinogenemia Presence of heparin

Presence of heparin

It describes the total number of events or conditions in a broadly defined population, for instance, the total number of patients with chronic heart disease in the Philippines. Incidence Prevalence False negative False positive

Prevalence 1. Prevalence describes the total number of events or conditions in a broadly defined population, for instance, the total number of patients with chronic heart disease in the United States. 2. Incidence describes the number of events occurring within a randomly selected number of subjects representing a population, over a defined time, for instance, the number of new cases of heart disease per 100,000 U.S. residents per year. Scientists use INCIDENCE, not prevalence, to select laboratory assays for specific applications such as screening or confirmation.

Reversal of heparin overdose can be achieved by administration of: Vitamin K Anti-thrombin Protamine sulfate Warfarin

Protamine sulfate

Reversal of heparin overdose can be achieved by administration of: Vitamin K Protamine sulfate Antithrombin Warfarin

Protamine sulfate - Neutralizer

A patient on Warfarin therapy will be deficient in a functional amount of: Fibrinogen and prothrombin Stable and labile factors Protein C and protein S Fletcher and Fitzgerald factors

Protein C and protein S Vitamin K dependent factors: PROTHROMBIN group X, IX, VII, II Aside from these factors, proteins C and S are also vitamin K dependent.

The automated platelet count on an EDTA specimen is 58 x 10 9th/L. The platelet estimate on the blood smear appears normal, but it was noted that the platelets were surrounding the neutrophils. The next step should be to: Report the automated platelet count since it is more accurate than a platelet estimate Warm the EDTA tube and repeat the automated platelet count Rerun the original specimen since the platelet count and blood smear estimate do not match Recollect a specimen for a platelet count using a different anticoagulant

Recollect a specimen for a platelet count using a different anticoagulant Use citrate

Which therapy and resulting mode of action are appropriate for the treatment of a patient with a high titer of factor VIII inhibitors? Factor VIII concentrate to neutralize the antibodies Recombinant factor VIIa (rVIIa) to activate factor X Factor X concentrate to activate the common pathway Fresh frozen plasma to replace factor VIII

Recombinant factor VIIa (rVIIa) to activate factor X Recombinant factor VII (rVIIa) is effective for the treatment of a high titer factor VIII inhibitor. Factor VIIa can directly activate factor X to Xa in the absence of factors VIII and IX. Recombinant factor VIIa does not stimulate anamnestic responses in patients with factor VIII inhibitor. Factor VIII concentrate is used for a low titer factor VIII inhibitor. Factor X concentrate and FFP are not the treatments of choice for factor VIII inhibitor.

Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria? Autosomal dominant inheritance Red cell membrane defects Positive direct antiglobulin test Measured platelet count

Red cell membrane defects

What effect would using a buffer at pH 6.0 have on a Wright's-stained smear? Red cells would be stained too pink White cell cytoplasm would be stained too blue Red cells would be stained too blue Red cells would lyse on the slide

Red cells would be stained too pink The pH of the buffer is critical in Romanowsky stains. When the pH is too low (<6.4), the red cells take up more acid dye (eosin), becoming too pink. Leukocytes also show poor nuclear detail when the pH is decreased. Additional: pH 6.8 - for blood and bone marrow staining pH 7.2 - malarial parasites EXCESSIVELY BLUE STAIN Thick films Prolonged staining time Inadequate washing Too high ALKALINITY of stain DILUENT tends to cause excessive basophilia EXCESSIVELY PINK STAIN Insufficient staining Prolong washing MOUNTING the coverslips before they are DRY Too high ACIDITY of stain BUFFER may cause excessive acidophilia

Which of the following cells is considered pathognomonic for Hodgkin's disease? Niemann-Pick cells Reactive lymphocytes Flame cells Reed-Sternberg cells

Reed-Sternberg cells The morphological common denominator in Hodgkin's lymphoma is the Reed-Sternberg (RS) cell. It is a large, binucleated cell with a dense nucleolus surrounded by clear space. These characteristics give the RS cell an "owl's eye" appearance. LARGE CELL WITH LARGE NUCLEOLI

A standard 4.5-mL blue-top tube filled with 3.0 mL of blood was submitted to the laboratory for PT and APTT tests. The sample is from a patient undergoing surgery the following morning for a tonsillectomy. Which of the following is the necessary course of action by the technologist? Run both tests in duplicate and report the average result Reject the sample and request a new sample Report the PT result Report the APTT result

Reject the sample and request a new sample A 4.5-mL blue-top tube contains 4.5 mL blood + 0.5 mL sodium citrate. The tube should be 90% full. A tube with 3.0 mL blood should be rejected as quantity not sufficient (QNS). QNS samples alter the necessary blood to an anticoagulant ratio of 9:1. The excess anticoagulant in a QNS sample binds to the reagent calcium, thereby resulting in FALSE PROLONGATION of the PT and APTT.

All of the following tests are affected by heparin therapy except: Thrombin time Whole blood clotting time APTT Reptilase time

Reptilase time

A fresh blood sample was sent to the laboratory at 8:00 a.m. for a PT test. At 4:00 p.m., the doctor requested an APTT test to be done on the same sample. What should the technologist do? Rerun APTT on the 8:00 a.m. sample and report the result Request a new sample for APTT Run APTT in duplicate and report the average Mix the patient plasma with normal plasma and run the APTT

Request a new sample for APTT According to Clinical Laboratory Standards Institute (CLSI) guidelines, samples for APTT should be centrifuged and tested within 2 hours after collection. However, the sample is stable for 4 hours if stored at 4C. APTT evaluates the clotting factors in the intrinsic and common coagulation pathways, including factor VIII (intrinsic) and factor V (common). Factors VIII and V are cofactors necessary for fibrin formation. However, they are both labile. Storage beyond 4 hours causes falsely elevated APTT results. The technologist should request a new sample for the APTT.

The degree of effective erythropoiesis is best assessed by: Serum iron levels Serial hemoglobin determinations Reticulocyte count Ferrokinetic studies

Reticulocyte count NV Adults: 0.5-1.5% (Ave. 1%) Neonates: 2-6%

A Miller disk is an ocular device used to facilitate counting of: Platelets Reticulocytes Sickle cells Nucleated RBCs

Reticulocytes

The process of replacing the active marrow by adipocytes (yellow marrow) during development is Hematopoiesis Progression Regression Retrogression

Retrogression The process of replacing the active marrow by adipocytes (yellow marrow) during development is called retrogression and eventually results in restriction of the active marrow in the adult to the sternum, vertebrae, scapulae, pelvis, ribs, skull, and proximal portion of the long bones.

In an erythrocyte histogram, the erythrocytes that are larger than normal will be to the _____ of the normal distribution curve. Right Left In the middle

Right

What is the characteristic finding seen in the peripheral smear of a patient with multiple myeloma? Microcytic hypochromic cells Intracellular inclusion bodies Rouleaux Hypersegmented neutrophils

Rouleaux

A stained blood film is held up to the light and observed to be bluer than normal. What microscopic abnormality might be expected on this film? Rouleaux Spherocytosis Reactive lymphocytosis Toxic granulation

Rouleaux MACROSCOPIC EXAMINATION OF BLOOD FILM 1. BLUER Increased blood proteins, as in plasma cell myeloma, and that ROULEAUX may be seen on the film 2. GRAINY RBC agglutination, as in cold hemagglutinin diseases 3. HOLES Increased lipid levels 4. BLUE SPECKS OUT AT THE FEATHER EDGE Markedly increased WBC counts and platelet counts

The following test orders for different patient shave been received at the same time. Which test would you collect first? Fasting glucose STAT glucose in the ER STAT hemoglobin in ICU ASAP CBC in ICU

STAT glucose in the ER ER stats typically have priority over other stats.

The presence of excessive rouleaux formation on a blood smear is often accompanied by an increased: Reticulocyte count Sedimentation rate Hematocrit Erythrocyte count

Sedimentation rate

Densely packed chromatin: Myelocyte Metamyelocyte Band Segmented neutrophil

Segmented neutrophil

Storage iron is usually best determined by: Serum transferrin levels Hgb values Myoglobin values Serum ferritin levels

Serum ferritin levels Ferritin enters the serum from all ferritin-producing tissues, and therefore is considered to be a good indicator of body storage iron. Because iron stores must be depleted before anemia develops, low serum ferritin levels precede the fall in serum iron associated with iron deficiency anemia.

Which of the following is associated with multiple factor deficiencies? An inherited disorder of coagulation Severe liver disease Dysfibrinogenemia Lupus anticoagulant

Severe liver disease Most of the clotting factors are made in the liver. Therefore, severe liver disease results in multiple factor deficiencies.

The morphologic manifestation of APOPTOSIS is _______ of the cell. Shrinkage of the cell Swelling of the cell

Shrinkage of the cell

A decreased osmotic fragility test would be associated which of the following conditions? Sickle cell anemia Hereditary spherocytosis HDN Acquired hemolytic anemia

Sickle cell anemia

Prothrombin G20210A is characterized by which of the following causes and conditions? Single mutation of prothrombin molecule/bleeding Single mutation of prothrombin molecule/thrombosis Decreased levels of prothrombin in plasma/thrombosis Increased levels of prothrombin in plasma/bleeding

Single mutation of prothrombin molecule/thrombosis Prothrombin G20210A is defined as a single-point mutation of the prothrombin gene, resulting in increased concentration of plasma prothrombin and thereby a risk factor for THROMBOSIS. Prothrombin G20210A is the second most common cause of inherited hypercoagulability (behind FACTOR V LEIDEN). It has the highest incidence in whites from southern Europe. The thrombotic episodes generally occur before age 40.

All of the following are causes of spurious increase in WBCs, except: Cryoglobulin Cryofibrinogen Monoclonal proteins Smudge cells

Smudge cells SPURIOUS INCREASE IN WBC Cryoglobulin, cryofibrinogen Heparin, monoclonal proteins Nucleated RBCs, unlysed RBCs Platelet clumping SPURIOUS DECREASE IN WBC Clotting, smudge cells Uremia plus immunosuppressants

The presence of more than four times the number of cells per field at the edges or feather compared with the monolayer area of the film Rouleaux Snowplow effect Agglutination All of the above

Snowplow effect This is unacceptable, and the film should be remade.

All of the following are components of the modified Drabkin's reagent EXCEPT: Potassium cyanide, potassium ferricyanide Dihydrogen potassium phosphate Nonionic detergent Sodium chloride

Sodium chloride COMPONENTS OF DRABKIN'S REAGENT 1) Potassium ferricyanide - converts ferrous to ferric state to form methemoglobin (Hi) 2) Potassium cyanide - combines with methemoglobin to form stable pigment, cyanmethemoglobin (HiCN) 3) Non-ionic detergent/Saponin - improves lysis of RBCs and decreases amount of turbidity 4) Dihydrogen potassium phosphate (Modified) - allows test to be read after 3 minutes 5) Sodium bicarbonate (Original) - allows test to be read after 15 minutes

Reagent for the solubility test: Hydrochloric acid Ferric cyanide and detergent 2% sodium metabisulfite Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)

Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)

Reagent for the solubility test: Ferric cyanide and detergent 2% sodium metabisulfite Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin) 1% sodium hydroxide

Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin) 2% sodium metabisulfite - SICKLING TEST 1% sodium hydroxide - BETKE TEST (for Hb F)

The reagent used in the traditional sickle cell screening test is: Sodium chloride Sodium citrate Sodium metabisulfite Sodium-potassium oxalate

Sodium metabisulfite

The red blood cell protein that is responsible for deformability and flexibility of the red blood cell is: Spectrin Glycophorin Glycine Erythropoietin

Spectrin

The largest lymphoid organ in the body: Bone marrow Thymus Liver Spleen

Spleen It is vital but not essential for life and functions as an indiscriminate filter of the circulating blood. In a healthy individual, the spleen contains about 350 mL of blood.

Which statement is correct regarding sample storage for the prothrombin time test? Stable for 24 hours if the sample is capped Stable for 24 hours if the sample is refrigerated at 4°C Stable for 4 hours if the sample is stored at 4°C Should be run within 8 hours

Stable for 24 hours if the sample is capped According to Clinical Laboratory Standards Institute (CLSI, formerly NCCLS) guidelines, plasma samples for PT testing are stable for 24 hours at ROOM TEMPERATURE IF CAPPED. Refrigerating the sample causes cold activation of factor VII and, therefore, SHORTENED PT results. The APTT samples are stable for 4 hours if stored at 4°C.

If the sugar water test is positive, _____ procedure should be performed before a diagnosis of PNH is made. Autohemolysis test Hemoglobin electrophoresis Osmotic fragility test Sucrose hemolysis test

Sucrose hemolysis test

In myeloid cells, the stain that selectively identifies PHOSPHOLIPIDS in the membranes of both primary and secondary granules is: PAS Myeloperoxidase Sudan black B Tdt

Sudan black B PAS is for M6 (Erythroblasts)

The first morphologic manifestation of NECROSIS is _______ of the cell. Shrinkage of the cell Swelling of the cell

Swelling of the cell

In myelofibrosis, the characteristic abnormal red cell morphology is: Target cells Schistocytes Teardrop cells Ovalocytes

Teardrop cells

In myelofibrosis, the characteristic abnormal red blood cell morphology is that of: Target cells Schistocytes Teardrop cells Ovalocytes

Teardrop cells The marked amount of fibrosis, both medullary and extramedullary, accounts for the irreversible red cell morphological change to a teardrop shape. The red cells are "teared" as they attempt to pass through the fibrotic tissue.

Which anemia has red cell morphology similar to that seen in iron deficiency anemia? Sickle cell anemia Thalassemia Pernicious anemia Hereditary spherocytosis

Thalassemia

A patient was put on heparin therapy postoperatively for prevention of thrombosis. The patient had the following laboratory results on admission: Platelet count = 350 × 109/L; PT = 12 sec (reference: 10-13 sec); APTT = 35 sec (reference: 28-37). After 6 days of heparin therapy, the patient complained of pain and swelling in her left leg. Her platelet count dropped to 85 × 109/L and her APTT result was 36 sec. The physician suspected heparin-induced thrombocytopenia (HIT) and ordered a platelet aggregation test to be performed immediately. The heparin-induced platelet aggregation test result was negative. Heparin therapy was continued. Several days later, the patient developed a massive clot in her left leg that necessitated amputation. Which of the following should have been recognized or initiated? The patient should have been placed on LMWH The heparin dose should have been increased The negative platelet aggregation does not rule out HIT The patient should have been placed on warfarin therapy

The negative platelet aggregation does not rule out HIT Heparin therapy should be stopped immediately when clinical symptoms indicate HIT. The blood sample should be tested at least 4 hours after heparin therapy is discontinued. Early sampling for HIT testing may give a false-negative result due to the neutralization of antibody by heparin. LMWH should not be used in patients who develop HIT, because LMWH drugs can also cause HIT. Warfarin therapy can be started in patients who respond to heparin therapy as soon as the APTT is increased to 1.5 times the baseline APTT. Heparin therapy must overlap warfarin therapy until the INR reaches a stable therapeutic range (2.0-3.0). Warfarin therapy could not be used in this patient because she did not respond to heparin therapy. The first step in the treatment of HIT is discontinuation of heparin, including intravenous catheter flushes, heparin- coated indwelling catheters, unfractionated heparin, and LMWH.

In disseminated intravascular coagulation (DIC) and immune thrombocytopenic purpura (ITP): There is decreased production of platelets There is increased destruction of platelets There is a defect of platelet membrane There is defect of platelet release reaction

There is increased destruction of platelets

Also known as siderophilin Hemosiderin Ferritin Transferrin Hemoglobin

Transferrin

Iron is TRANSPORTED IN PLASMA via: Hemosiderin Ferritin Transferrin Hemoglobin

Transferrin

What reagents are used in PT test? Thromboplastin and sodium chloride Thromboplastin and potassium chloride Thromboplastin and calcium Actin and calcium chloride

Thromboplastin and calcium PT: Thromboplastin - activates factor VII Calcium chloride - begin timing upon addition of this APTT: Activator: KAOLIN, CELITE, ELLAGIC ACID - activate factor XII Phospholipids - substitute for platelets Calcium chloride - begin timing upon addition of this

Which initiates in vivo coagulation by activation of factor VII? Protein C Tissue factor Plasmin activator Thrombomodulin

Tissue factor - Factor III (Tissue Thromboplastin)

Iron deficiency anemia may be distinguished from anemia of chronic infection by: Serum iron level Red cell morphology Red cell indices Total iron-binding capacity

Total iron-binding capacity In iron deficiency anemia, the serum iron and ferritin levels are decreased and the total iron-binding capacity and RBC protoporphyrin are increased. In chronic disease, serum iron and TIBC are both decreased because the iron is trapped in reticuloendothelial (RE) cells, and is unavailable to the red cells for hemoglobin production.

The most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus: Multipotential stem cell Pluripotential stem cell Totipotential stem cell

Totipotential stem cell 1. Totipotential stem cells These cells are present in the first few hours after an ovum is fertilized. Totipotential stem cells, the most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus. 2. Pluripotential stem cells These cells are present several days after fertilization. Pluripotent stem cells can develop into any cell type, except they CANNOT develop into a fetus. 3. Multipotential stem cells These cells are derived from pluripotent stem cells. They can be found in adults, but they are limited to specific types of cells to form tissues. For example, bone marrow stem cells can produce all types of blood cells, bone cartilage, and adipose (fat) cells.

CYTOPLASMIC INCLUSIONS seen in INFECTIONS and BURNS

Toxic granules Toxic vacuoles Dohle bodies

One chromosome breaks off and becomes attached to a different chromosome: Addition Deletion Inversion Translocation

Translocation TRANSLOCATIONS Most common type of DNA change that can lead to leukemia. A translocation means that a part of one chromosome breaks off and becomes attached to a different chromosome. The point at which the break occurs can affect nearby genes—for example, it can turn on oncogenes or turn off genes that would normally help a cell to mature. DELETIONS Occur when part of a chromosome is lost. This may result in the cell losing a gene that helped keep its growth in check, for example, a tumor suppressor gene. INVERSIONS Occur when part of a chromosome gets turned around, so it is now in reverse order. This can result in the loss of a gene (or genes) because the cell can no longer read its instructions in protein translation. ADDITION An extra chromosome or part of a chromosome is gained. This can lead to too many copies of certain genes within the cell. This can be a problem if one or more of these genes are oncogenes.

Positive result in the solubility test (sodium dithionite test for hemoglobin S): Normal looking RBCs or slightly crenated RBCs Sickle cells or 'holly leaf' form of RBCs Clear solution, black lines of the reader scale are visible through the solution Turbid solution, reader scale is not visible through the test solution

Turbid solution, reader scale is not visible through the test solution If the solubility test is positive, hemoglobin electrophoresis should be performed on the specimen.

The IMPEDANCE PRINCIPLE OF CELL COUNTING is based on the detection and measurement of CHANGES IN ELECTRICAL RESISTANCE produced by cells as they traverse a small aperture. Electrical resistance between the ___ electrodes, or impedance in the current, occurs as the cells pass through the sensing aperture, causing voltage pulses that are measurable. Two (2) electrodes Three (3) electrodes Four (4) electrodes Ten (10) electrodes

Two (2) electrodes

The most common subtype of classic vWF disease: Type 1 Type 2A Type 2B Type 3

Type 1 Type 1 - most common (70-80%), mild bleeding Type 3 - total absence of vWF molecule, severe bleeding Type 2A and 2B - deficiency of intermediate and/or high molecular weight portions of vWF molecule

Type of immersion oil with high viscosity and is used in brightfield and standard clinical microscopy. In hematology, this oil is routinely used. Type A Type B Type C

Type B 1. TYPE A has VERY LOW viscosity and is used in fluorescence and darkfield studies. 2. TYPE B has HIGH viscosity and is used in brightfield and standard clinical microscopy. In hematology, this oil is ROUTINELY used. 3. TYPE C has VERY HIGH viscosity and is used with inclined microscopes with long-focus objective lenses and wide condenser gaps.

Nuclear chromatin is coarse and clumped; dark blue (basophilic) cytoplasm around the periphery or in a radial pattern and few cytoplasmic vacuoles: Type I Downey cells Type II Downey cells Type III Downey cells

Type II Downey cells Type I Nucleus May be irregularly shaped Cytoplasm Usually many cytoplasmic vacuoles, dark blue (basophilic) Type II Nucleus Chromatin is coarse and clumped Cytoplasm Increased amount, dark blue (basophilic) around the periphery or in a radial pattern, a few cytoplasmic vacuoles Type IIIa Nucleus Nucleoli usually visible, enlarged in size Cytoplasm Dark blue (basophilic)

Type 1 This is the most common and mildest form of VWD, in which a person has lower-than-normal levels of VWF. A person with Type 1 VWD also might have low levels of factor VIII (8), another type of blood-clotting protein. About 85% of people treated for VWD have Type 1. Type 2 With this type of VWD, although the body makes normal amounts of the VWF, the factor does not work the way it should.. Type IA Type IIB Type IIC, IID Type III

Type III Type 1 This is the most common and mildest form of VWD, in which a person has lower-than-normal levels of VWF. Type 2 With this type of VWD, although the body makes normal amounts of the VWF, the factor does not work the way it should. Type 3 This is the most severe form of VWD, in which a person has very little or no VWF and low levels of factor VIII. This is the rarest type of VWD. Only 3% of people with VWD have Type 3.

What clotting factors (cofactors) are inhibited by protein S? V and X Va and VIIIa VIII and IX VIII and X

Va and VIIIa

What clotting factors (cofactors) are inhibited by protein S? V and X Va and VIIIa VIII and IX VIII and X

Va and VIIIa Factors Va and VIIIa are deactivated by protein S and activated protein C.

If the RBC distribution on a histogram demonstrates a homogeneous pattern and a small SD, the peripheral blood smear would probably exhibit: Extreme anisocytosis Very little anisocytosis A single population of spherocytes A single population of macrocytes

Very little anisocytosis

In automated cell counters, these parameters are directly measured: WBC and RBC WBC, RBC, and hemoglobin WBC and hemoglobin RBC only

WBC, RBC, and hemoglobin

To improve accuracy of the reticulocyte count, have another laboratorian count the other film; counts should agree within: Within 1% Within 5% Within 10% Within 20%

Within 20%

Which of the following plays a role in clot formation IN VITRO, but not in vivo? VIIa IIa XIIa Xa

XIIa Glass factor

All of the following statements refers to APOPTOSIS, except: a. Enlarged cell size due to swelling b. Reduced cell size due to shrinkage c. Condensation and fragmentation of the nucleus between nucleosomes d. Mostly physiologic to remove unwanted cells

a. Enlarged cell size due to swelling APOPTOSIS Reduced due to shrinkage Condensation and fragmentation between nucleosomes Mostly physiologic to remove unwanted cells; pathologic in response to cell injury ---- NECROSIS Enlarged due to swelling Random breaks and lysis (karyolysis) Pathologic; results from cell injury

Part of the INITIAL VON WILLEBRAND DISEASE WORKUP: a. BT, PT and APTT b. CBC, PT and APTT c. CBC, BT, PT and APTT d. CBC, BT, PT, APTT and automated functional platelet assays e. Decreased vWF activity and personal/family history of mucocutaneous bleeding

b. CBC, PT and APTT A CBC is necessary to rule out thrombocytopenia as the cause of mucocutaneous bleeding, and PT and PTT, which assess the coagulation system, are part of the initial VWD workup. No longer recommended are the bleeding time test and the PFA-100 or other automated functional platelet assays. These traditional screening tests generate "conflicting" sensitivity and specificity data.

This pathway prevents denaturation of globin of the hemoglobin molecule by oxidation: a. Embden-Meyerhof pathway b. Hexose-monophosphate shunt c. Methemoglobin reductase pathway d. Luebering-Rapoport pathway

b. Hexose-monophosphate shunt Embden-Meyerhof Pathway Maintains cellular energy by generating ATP Oxidative pathway or hexose-monophosphate shunt Prevents denaturation of globin of the hemoglobin molecule by oxidation Methemoglobin reductase pathway Prevents oxidation of heme iron Luebering-Rapaport pathway Regulates oxygen affinity of hemoglobin

Second step in phagocytosis: a. Recognition and attachement b. Ingestion c. Killing and digestion d. Formation of neutrophil extracellular trap

b. Ingestion PHAGOCYTOSIS (RODAK) 1. Recognition and attachment 2. Ingestion 3. Killing and digestion 4. Formation of neutrophil extracellular trap

Lipemia, icterus: a. Increased Hb b. Increased Hb, decreased MCH c. Increased Hb and MCH d. Decreased Hb and MCH

c. Increased Hb and MCH Turbidity affects spectrophotometric reading for hemoglobin (Hb). Hb value is needed to compute for MCH.

Possible solution when specimen is icteric or lipemic for a clot-based test: a. PT falsely shortened; recollect specimen. b. PT falsely prolonged; recollect specimen. c. Measure PT using a mechanical coagulometer d. Adjust anticoagulant volume

c. Measure PT using a mechanical coagulometer

Hemoglobin appears for the first time: a. Rubriblast (pronormoblast) b. Prorubricyte (basophilic normoblast) c. Rubricyte (polychromatophilic normoblast) d. Metarubricyte (orthochromic normoblast)

c. Rubricyte (polychromatophilic normoblast)

Parameters affected when the WBC count > 100,000/uL: a. Increased RBCs, decreased hemoglobin b. Decreased RBCs, increased hemoglobin c. Decreased RBCs and hemoglobin d. Increased RBcs and hemoglobin, incorrect hematocrit

d. Increased RBcs and hemoglobin, incorrect hematocrit

In Coulter instruments, which parameters are directly measured: a. RBC count and hemoglobin b. RBC and WBC counts c. RBC count and hematocrit d. RBC and WBC counts, hemoglobin

d. RBC and WBC counts, hemoglobin

Cytokine(s) that function to stimulate megakaryocytopoiesis: a. Thrombopoietin (TPO) b. TPO and IL-3 c. TPO, IL-3 and IL-6 d. TPO, IL-3, IL-6 and IL-11

d. TPO, IL-3, IL-6 and IL-11 IL-3 seems to act in synergy with TPO to induce the early differentiation of stem cells, whereas IL-6 and IL-11 act in the presence of TPO to enhance the later phenomena of endomitosis, megakaryocyte maturation, and thrombocytopoiesis.

The following results were obtained on a patient: prolonged bleeding time, normal platelet count, normal PT, and prolonged APTT. Which of the following disorders is most consistent with these results? Hemophilia A Glanzmann's thrombasthenia Hemophilia B vWD

vWD

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