Lab CE heme part 2
This image depicts a brilliant cresyl blue-stained blood smear. What inclusion bodies are shown in the erythrocyte indicated by the arrow (B)? Howell-Jolly bodies Hb H inclusions Pappenheimer bodies Siderotic granules
Hb H inclusions
The abnormal RBC shape seen in the center of this illustration is a: Burr cell Target cell Helmet cell Stomatocyte
Helmet cell
Which of the following would be true of the myeloid to erythroid (M:E) ratio in a case of chronic myelocytic leukemia (CML)? Normal (2:1 - 4:1) High (>4:1) Low (<2:1) Variable
High (>4:1)
When performing a bone marrow analysis, all of the following cells types are included in the differential, EXCEPT? Nucleated Red Blood Cells Mature White Blood Cells Non-nucleated Red Blood Cells Immature White Blood Cells
Non-nucleated Red Blood Cells
How long are healthy neutrophils expected to reside in the peripheral blood of an adult? 3 days 1 day 7-8 hours 12-14 hours
7-8 hours
If a Mycobacterium sp. infection is suspected on a bone marrow or body fluid, what stain should be used to detect these bacteria? Wright's stain New methylene blue stain Hematoxylin and Eosin (H&E) stain Acid fast stain
Acid fast stain
Which of the following laboratory tests of hemostatic function is a screening test used to assess the functionality of both the intrinsic and common pathways? Bleeding time Activated partial thromboplastin time (aPTT) Prothrombin time (PT) Factor assays
Activated partial thromboplastin time (aPTT)
Which of the following tests is used to monitor therapy with unfractionated heparin? Prothrombin time (PT) Activated partial thromboplastin time (aPTT) Fibrinogen assay Platelet function assay
Activated partial thromboplastin time (aPTT)
What are the cells that are indicated by the red arrows in the image on the right? Normal lymphocytes Hematogones Plasma cells Monocytes
Plasma cells
Which of the following red blood cell inclusions is seen in this photomicrograph (arrow)? Plasmodium species intracellular ring form Cabot ring Howell-Jolly body Pappenheimer bodies
Plasmodium species intracellular ring form
Which of the following tests would be most affected by microclots in an EDTA tube drawn for a CBC? RBC Hematocrit Hemoglobin Platelet count
Platelet count
Which of the following mechanisms involves a series of interrelated chemical processess that lead to the formation of durable fibrin strands? Fibrinolysis Primary hemostasis Secondary hemostasis Vasoconstriction
Secondary hemostasis
Considering the red cell distribution width (RDW) in alpha thalassemia, how would you expect the red blood cell histogram to look? Shifted to the right Shifted to the left Bimodal Normal
Shifted to the left
Gastrointestinal infections of which of the following a organisms are associated with hemolytic uremic syndrome? Shiga toxin producing E. coli Salmonella Proteus mirabilis Clostridium difficile
Shiga toxin producing E. coli
What cellular characteristic of red blood cells is described by the term poikilocytosis? Variability in size Variability in shape Presence of nuclear material Concentration of hemoglobin
Variability in shape
Complaints of pain from a patient with sickle cell disease are most likely associated with which of the following conditions/events? Hemolytic anemia Infection Vaso-occlusive crisis Aplastic crisis
Vaso-occlusive crisis
All of the following can cause erroneously decreased automated platelet counts EXCEPT? Platelet clumping Platelet satellitosis Clotting WBC fragmentation
WBC fragmentation
What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis? 12% 22% 32% 40%
32%
During capillary collection from a young child, which of the following lab results may be falsely increased due to excessive crying? Hemoglobin Hematocrit White blood cell count Red blood cell count
White blood cell count
Which of the following ranges is the reference range for hematocrit for an adult male? 14 - 18 g/dL 12 -16 g/dL 35 - 47% 40 - 52%
40 - 52% 35 - 47% represents the reference range for hematocrit for an adult female.
Whole blood if composed of approximately: 75% formed elements and 25% plasma 60% formed elements and 40% plasma 45% formed elements and 55% plasma 30% formed elements and 70% plasma
45% formed elements and 55% plasma
What is the normal cellularity of an iliac crest bone marrow biopsy in a 50-year-old male: 20% 35% 50% 65%
50%
Blood is diluted at 1:100 and charged on the hemocytometer counting chambers on both sides. If the average platelet count from a counting chamber in one mm2 (one large square) is 68, what is the calculated platelet count? 680,000/mm3 6,800/mm3 68,000/mm3 34,000/mm3
68,000/mm3
How would you describe the appearance of a mature monocyte seen in a Wright's stained peripheral blood smear? A. Pale blue cytoplasm. Nucleus may be oval or round. B. Blue-gray opaque cytoplasm. Nucleus may have convolutions. C. Light pink cytoplasm with fine granules. Nucleus with 2-5 lobes. D. Colorless cytoplasm with large red refractile granules.
B. Blue-gray opaque cytoplasm. Nucleus may have convolutions.
What is the characteristic RBC that is uniquely associated with HbSS? Target cell (codocyte) Sickle cell (drepanocyte) Polychromatophilic cell Spherocyte
Sickle cell (drepanocyte)
In flow cytometry, the granularity of a cell is indicated by which of the following? Side scatter Forward scatter Hydrodynamic focusing Fluorochromes
Side scatter
Note the iron-stained bone marrow preparation in the image to the right. The cells as shown can be associated with which type of anemia? Iron deficiency anemia Sickle cell anemia Sideroblastic anemia Megaloblastic anemia
Sideroblastic anemia
Which of the following cells is characterized by a thin rim of cytoplasm around the nucleus? Small lymphocyte Large lymphocyte Monocyte Segmented neutrophil
Small lymphocyte
What is the anticoagulant most commonly used for routine coagulation testing? EDTA Lithium Heparin Sodium citrate Sodium heparin
Sodium citrate
Methods of identifying many of the major hemoglobin variants such as Hb A, Hb F, Hb S, etc. include all of the following EXCEPT: Sodium metabisulfite solubility test High performance liquid chromatography (HPLC) Citrate agar electrophoresis Alkaline electrophoresis
Sodium metabisulfite solubility test
Varied red blood cell morphologies due to pitting, culling, filtering, and the persistence of abnormal red blood cells in the peripheral blood is most likely due to what? Cirrhosis of the liver Splenectomy Incompatible blood transfusion Autosomal recessive trait
Splenectomy
Which abnormal gene is inherited with Chediak-Higashi syndrome resulting in dysfunctional cells causing greater susceptibility to infections? CHS1 LYST JAK2 TET2 ADAMTS13
CHS1 LYST
Identify the large multinucleated cell found in this cerebrospinal fluid cytospin field. Mesothelial cell Tumor cell Multinucleate histiocyte Macrophage
Multinucleate histiocyte
The upper image of a peripheral blood smear reveals RBC rouleaux formation. Several blood cells that are similar to the one indicated by the arrow in the bottom image are also seen on the smear. Which of the following conditions is associated with both of these findings? Multiple myeloma Infectious mononucleosis Chronic lymphocytic leukemia Normal peripheral blood smear findings
Multiple myeloma
Which of the following cells is seen in the photomicrograph? Myeloblast Myelocyte Metamyelocyte Monocyte
Myeloblast
Which of the following is characterized by the bone marrow being invaded by fibrotic, granulomatous, or neoplastic cells? Fanconi anemia Megaloblastic anemia Myelophthisic anemia Diamond-Blackfan anemia
Myelophthisic anemia
Which of the following lymphoid cells have the capability of spontaneous cytotoxicity of various target cells? Cytotoxic T cells (TC) Helper T cells (TH) Natural killer cells (NK) B cells
Natural killer cells (NK)
The most immature neutrophil found in normal peripheral blood is which of the following? Segmented neutrophil Neutrophil band Metamyelocyte Myeloctye
Neutrophil band
Identify the white blood cell in the center of this smear. Metamyelocyte Monocyte Neutrophilic band Segmented neutrophil
Neutrophilic band
Which of the following abnormal CBC tests typically occurs in patients with chronic pulmonary disease ? Increased MCV Increased hematocrit Decreased MCHC Decreased hemoglobin
Increased hematocrit
What is another name used to designate a fully committed B-lymphocyte: T-lymphocyte Reactive lymphocyte Large lymphocyte Plasma cell
Plasma cell
The abnormalities that are seen on this slide are probably associated with which of the following conditions? Lead poisoning Increased red cell production There are no abnormalities on this slide Decreased red blood cell production
Increased red cell production
Which coagulation pathway is initiated when collagen is exposed, and involves the substances high-molecular-weight kininogen (HK), prekallikrein (PK), and factor XII? Intrinsic Extrinsic Common Fibrinolysis
Intrinsic
A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemacytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter? 527 758 833 1500
1500 Cells/µL = 150 x 10/ 10 x 0.1 µL
A dilution commonly used for a routine sperm count is: 1:2 1:20 1:200 1:400
1:20
The normal Myeloid-to-erythroid ratio (M:E ratio) ranges from: 2:1 to 7:1 1.2:1 to 5:1 2:1 to 4:1 0.5:1 to 1:1
2:1 to 4:1
What is the expected life span of a normal red blood cell? 3-4 months 1-2 months 3-6 weeks 1-3 weeks
3-4 months
What may cause the following mixing studies results? Initial aPTT = 133 seconds 1:1 Mix aPTT pre-incubation = 33 seconds 1:1 Mix aPTT post-incubation = 124 seconds Factor IX deficiency Factor XI deficiency A slow acting coagulation inhibitor Factor VII deficiency
A slow acting coagulation inhibitor
The following describes a clot-based test to assess Protein C function, as well as the results of someone's test who has a protein C deficiency. A. A parital thromboplastin time (PTT) is performed using C-depleted normal plasma, a venom activator of protein C (such as Protac), and a heparin neutralizer. The clotting time would not be prolonged in someone with a protein C deficiency. B. A parital thromboplastin time (PTT) is performed using C-depleted normal plasma, a venom activator of protein C (such as Protac), and a heparin neutralizer. The clotting time would be prolonged (above reference range) in someone with a protein c deficiency
A. A parital thromboplastin time (PTT) is performed using C-depleted normal plasma, a venom activator of protein C (such as Protac), and a heparin neutralizer. The clotting time would not be prolonged in someone with a protein C deficiency.
Which alpha thalassemia shows no anemia or evidence of disease, although a slight decrease in the MCV and MCHC may be seen? A. Alpha thalassemia silent carrier B. Alpha thalassemia minor C. Alpha thalassemia intermedia (Hemoglobin H disease) D. Alpha thalassemia major (Hydrops fetalis)
A. Alpha thalassemia silent carrier
In essential thrombocythemia, the platelets are usually: A. Increased in number and functionally abnormal B. Normal in number and functionally abnormal C. Decreased in number and functionally normal D. Decreased in number and functionally abnormal
A. Increased in number and functionally abnormal
Why is hereditary hemochromatosis (HH) thought to be underdiagnosed? A. Its early symptoms are nonspecific and vague, and generally do not get serious until later in life. B. It is an extremely rare disease. C. It appears shortly after birth, but then symptoms rapidly subside. D. It is a mild disorder and has no severe implications for one's health.
A. Its early symptoms are nonspecific and vague, and generally do not get serious until later in life.
Upon centrifugation, a cerebrospinal fluid (CSF) sample supernatant exhibited xanthochromia. The image is a Wright-Giemsa stained smear that was made from that CSF sample. What condition is probably related to these macroscopic and microscopic findings? A. Previous subarachnoid hemorrhage B. Traumatic tap C. Leukemia D. This is a normal microscopic finding for a CSF specimen
A. Previous subarachnoid hemorrhage
The diagnostic value of the reticulocyte count in the evaluation of anemia is that it determines the: A. Response and ability of the bone marrow to compensate for the anemia B. Nutritional status of the patient C. Real cause of the anemia D. True red blood cell count
A. Response and ability of the bone marrow to compensate for the anemia
Which of the following statements characterize a reticulocyte? A. Reticulum visible with a supravital stain, such as new methylene blue B. Reticulum visible with Wright stain C. Contains some organelles used for hemoglobin production D. Pyknotic nucleus still present in the cell
A. Reticulum visible with a supravital stain, such as new methylene blue
how long should therapy continue for patients with hereditary hemochromatosis A. Therapy should continue throughout the lifetime B. Therapy should continue only until ferritin levels have returned to normal C. Therapy should continue for one year only D. The length of therapy is variable for each patient
A. Therapy should continue throughout the lifetime
Which of the following statements best describes the appearance of Cabot rings? A. Thin, reddish-violet-staining strands in the shapes of figure eights, or the letter B B. Irregular magenta inclusions seen along the periphery of red cells C. Fine or coarse dark blue granules spread evenly throughout the erythrocyte in the reticulocyte stage D. Small, dark purples round inclusions composed of DNA that are located eccentrically in the erythrocyte
A. Thin, reddish-violet-staining strands in the shapes of figure eights, or the letter B
An 8-year-old boy presents with a 2 week history of high fevers and lethargy. He has shown petechiae and bleeding gums for approximately 3 weeks. Upon physical examination, the following was noted:Enlarged cervical lymph nodes, Pale and febrile, Enlarged spleenHis laboratory results were the following: Hgb = 6.3g/dL Hct = 18.9% RBC count = 2.89 x 109/L WBC Count = 96 x 109/L Platelet count = 23 x 109/L Differential: 90% blasts, 5% bands, 5% neutrophils BM aspirate > 90% blastsWhat is this patient most likely suffering from? Polycythemia vera Chronic leukemia Acute leukemia Infectious mononucleosis
Acute leukemia
Which of the following chemical substances induces platelet adhesion when there is a break in the inert epithelial lining of the vasculature? Epinephrine Factors IX and XIII Adenosine diphosphate (ADP) Thrombin
Adenosine diphosphate (ADP)
Which disorder exhibits a genetic code that is incompatible with life? Heterozygous alpha thalassemia minor Homozygous alpha thalassemia minor Hemoglobin H disease Alpha thalassemia major
Alpha thalassemia major
The principle behind point-of-care devices to measure hematocrit is: A. Counting the RBCs and determining the MCV; then, multiplying the MCV x RBC/10 B. Calculating the conductance of the blood sample and correcting for temperature, conductivity of the plasma, and size of the fluid segment C. Detecting cumulative pulse height D. Centrifuging the sample at a standard speed and time, then measuring the RBC column vs. whole blood.
B. Calculating the conductance of the blood sample and correcting for temperature, conductivity of the plasma, and size of the fluid segment
All of the following are true concerning the Erythrocyte Sedimentation Rate (ESR) EXCEPT: A. ESR can be used to follow the course of a disease B. ESR is decreased during inflammatory conditions C. Highest ESR values are usually seen in multiple myeloma D. ESR values are increased in rheumatoid conditions
B. ESR is decreased during inflammatory conditions
Which of the following morphologic characteristics is associated with the Chédiak-Higashi syndrome? A. Pale blue cytoplasmic inclusions in neutrophils B. Giant lysosomal granules in granulocytes C. Neutrophils with many small granules and vacuoles D. Nuclear hypo-segmentation of neutrophils
B. Giant lysosomal granules in granulocytes
Which of the following tests are necessary to confirm the condition suggested by the morphology shown in this image? A. Serum vitamin B12 and folate assay B. Hemoglobin electrophoresis for the presence of Hb S C. Hemoglobin electrophoresis for the presence of Hb Bart's D. Column chromatography for elevated Hb A2
B. Hemoglobin electrophoresis for the presence of Hb S
The laboratorian completed the mixing study ordered for John Doe. The results are as follows: Initial aPTT result: 167 seconds Initial 1:1 Mix with Normal Pooled Plasma: 158 seconds Incubated 1:1 Mix with Normal Pooled Plasma: 150 seconds Which of the choices below would most likely explain the results for this patient? A. Factor VIII deficiency B. Immediate-acting coagulation inhibitor C. Time/temperature-dependent coagulation inhibitor D. Factor VII deficiency
B. Immediate-acting coagulation inhibitor
When preparing a slide for morphologic examination, what is the reason for adding a drop of albumin to the cerebrospinal fluid (CSF) sample prior to cytocentrifugation? A. Enhance staining of the elements. B. Preserve the integrity of the cells. C. Increases the fluid volume so that cells will form a monolayer on the slide. D. Dilute the sample
B. Preserve the integrity of the cells.
Patients who undergo urologic procedures, as well as those with genitourinary tract diseases such as prostate cancer can sometimes be prone to diffuse hemorrhage. A possible cause of this could be which of the following? A. Dysfunction of platelets B. Release of urokinases C. Initiation of tissue factor released from endothelial cells D. Release of PGL (a prostacyclin) from endothelial cells
B. Release of urokinases
All of the following are true of lab results of patients with Glanzmann thrombasthenia EXCEPT? A. Deficient GPIIb/IIIa B. Severe thrombocytopenia C. Increased bleeding time D. Abnormal platelet aggregation with ADP, collagen, and epinephrine
B. Severe thrombocytopenia
T lymphocytes are characterized by all of the following functions EXCEPT which? A. Secrete cytokines B. Synthesize antibody C. Comprise majority of cells in blood lymphocyte pool D. Help regulate immune response
B. Synthesize antibody
The mediator cell type that binds to IgE antibodies is the: Basophil Eosinophil Polymorphonuclear neutrophil (PMN) Macrophage
Basophil
Which type of granulocyte has water soluble granules which may fade during the rinsing phase of the staining process using the Wright's stain? Neutrophilic segs Eosinophils Basophils Neutrophilic bands
Basophils
Hemoglobin H (HbH) bodies are tetramers of which globin chain? Alpha Beta Delta Gamma
Beta Tetramers of gamma globin is called Hb Bart, which is seen in alpha thalassemia major. Tetramers of alpha and delta gobins not seen.
Skeletal deformations are most commonly present in which of the following beta thalassemias? Beta thalassemia minor Beta thalassemia intermedia Beta thalassemia major All of the beta thalassemias equally
Beta thalassemia major
A patient has an increased RBC count with a decreased Hb and normal Hct. The MCV is microcytic and the RDW is within normal limits. Many codocytes are present on the peripheral smear. Serum iron is 165 µg/dL (normal = 60 -150 µg/dL), and the TIBC is 230 µg/dL (normal = 250 - 400 µg/dL). Consider also the findings on alkaline hemoglobin electrophoresis, which show an increased level of hemoglobin A2 of 5% (normal values are less than 3.5%).What is this patient's most likely diagnosis? Beta thalassemia silent carrier Beta thalassemia minor Beta thalassemia intermedia Beta thalassemia major
Beta thalassemia minor
All of the following CD markers are present on a normal mature T cell, EXCEPT? CD20 CD7 CD3 CD5
CD20 CD is expressed by B cells
Which of the following is a clinical finding of Myelodysplastic Syndrome with Excess Blasts subtype 2 (MDS-EB-2)? A. 5 to 15% ring sideroblasts B. Isolated deletion of the long arm of chromosome 5 (del 5q) C. 10 to 19% blasts in the Bone Marrow D. No cytopenia in the peripheral blood
C. 10 to 19% blasts in the Bone Marrow MDS-EB-2 is characterized by 10 to 19% blasts in the bone marrow (BM) and 5 to 19% blasts in the peripheral blood (PB). Auer Rods may be present
After the physician orders a follow up for abnormal coagulation screening tests, the laboratorian completes a mixing study with the following results: Initial aPTT result: 98 seconds Initial 1:1 Mix with Normal Pooled Plasma: 28 seconds Incubated 1:1 Mix with Normal Pooled Plasma: 30 seconds Which of the choices below would most likely explain the results for this patient? A. Immediate-acting coagulation inhibitor B. Time/temperature-dependent coagulation inhibitor C. Factor VIII deficiency D. Factor VII deficiency
C. Factor VIII deficiency
Platelets are: A. The smallest nucleated cells seen in normal peripheral blood. B. The largest nucleated cells seen in normal peripheral blood. C. Fragments of megakaryocyte cytoplasm and do not contain nuclei D. Fragments of neutrophils
C. Fragments of megakaryocyte cytoplasm and do not contain nuclei
The descriptions below refer to the appearance of inclusions found in Wright-stained or supravital-stained peripheral blood smears. Which best describes basophilic stippling? A. Round and smooth and usually one per erythrocyte B. Variable in size and aggregated near cell periphery C. Relatively evenly distributed fine or coarse granules throughout the red cell D. Reddish figure-eight strand within the red cell
C. Relatively evenly distributed fine or coarse granules throughout the red cell
Ristocetin is used in certain von Willebrand Factor (vWF) functional assays. The reason it is used is because: A. Ristocetin can prevent bacterial contamination of the specimen. B. Ristocetin can break down the vWF multimers into monomers, and then be assayed. C. Ristocetin enhances binding of vWF to platelet GPIba. D. Ristocetin prevents interference by other coagulation factors.
C. Ristocetin enhances binding of vWF to platelet GPIba.
Which of the following markers is associated with normal mature B cell expression? CD19 CD8 CD14 C42
CD19
What is the most likely clinical condition in which the cell in the image A would be present in increased numbers? Chediak-Higashi May-Hegglin Pelger-Huet Alder-Reilly
Chediak-Higashi
When distinguishing megaloblastic from nonmegaloblastic macrocytic anemia, which of the following is a key difference in red blood cell morphology? A. The presence of target cells in nonmegaloblastic macrocytic anemia B. The presence of oval macrocytes in nonmegaloblastic anemia C. The presence of round macrocytes in megaloblastic anemia D. The presence of round macrocytes in nonmegaloblastic anemia.
D. The presence of round macrocytes in nonmegaloblastic anemia.
What are Howell-Jolly bodies composed of? Hemoglobin DNA Iron RNA
DNA
Traditional coagulation assays are based almost solely on this technique: Chromogenic assays Clot-based assays RIA assays ELISA assays
Clot-based assays
The arrangement of erythrocytes on this peripheral blood smear can be associated with each of the following conditions EXCEPT: Multiple myeloma Cold agglutinin disorders Chronic inflammatory disorders Lymphoplasmacytic lymphoma
Cold agglutinin disorders Multiple myeloma, chronic inflammatory disorders, and lymphoplasmacytic lymphoma are each responsible for increasing the concentration of these positively charged proteins leading to rouleaux.
Which of the following smear techniques has the advantage of providing the best WBC distribution when performed correctly? Coverslip technique Spun technique Manual wedge technique Semi-automated wedge technique
Coverslip technique
Which of the following hemoglobins is known to migrate with HbS during electrophoresis when an alkaline gel, such as cellulose acetate, is used? A2 C D F
D
An isolated crenated erythrocyte with spicules is seen on an otherwise normocytic normochromic peripheral blood smear. Which of the following statements is true? A. Finding is indicative of possible abeta-lipoproteinemia B. Morphology suggests likelihood of disseminated intravascular coagulation C. Morphology indicates hemoglobinopathy such as thalassemia D. Finding is most likely an artifact caused by poor smear preparation
D. Finding is most likely an artifact caused by poor smear preparation
Plasma exchange is the current treatment for all of these conditions, EXCEPT: A. Warm autoimmune hemolytic anemia (WAIHA) B. Diarrhea-associated hemolytic uremic syndrome (HUS) C. Thrombotic thrombocytopenic purpura (TTP) D. Pernicious anemia
D. Pernicious anemia Pernicious anemia is treated with monthly parenteral does of hydroxycobalamin not by plasma exchange.
Which of these methods could be used to differentiate between Howell-Jolly bodies and Pappenheimer bodies and what results would be noted? A. Wright-Giemsa stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue B. Wright-Giemsa stain: Howell-Jolly bodies stain blue but Pappenheimer bodies do not stain blue C. Prussian blue stain: Howell-Jolly bodies stain blue but Pappenheimer bodies do not stain blue D. Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue
D. Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue
Which of the following may result in a platelet count of 230.0 X 109/L with a bleeding time of 15 minutes. Defective platelet function Decreased platelet production Increased platelet production Increased platelet destruction
Defective platelet function
An example of a cause of a "relative erythrocytosis" is: Dehydration Increased erythropoietin production High oxygen affinity hemoglobinopathy Genetic polycythemia
Dehydration
The hemoglobin electrophoresis pattern for patient #2 shows an increase in Hb F and a decrease in both Hb A and Hb A2. These results correlate best with which of these thalassemias? Beta thalassemia minor Beta thalassemia major Delta-beta thalassemia minor Alpha thalassemia major
Delta-beta thalassemia minor Decreases in both Hb A and A2 and an increase in Hb F correlate with delta-beta thalassemia minor
A two-year old male patient has the following hemogram results: Hgb = 6.7g/dL Hct = 20% Platelets = 355 x 109/L RBC = 3.0 x1012/L WBC = 8.75 x 109/L Differential = 6% eos, 20% segs, 68% lymphs, 6% monos Which of the following is the MOST likely diagnosis? Dietary iron deficiency Idiopathic thrombocytopenia Lymphocytic leukemia Lead poisoning
Dietary iron deficiency
A blood smear represented by the photograph was submitted for hematologic review. Based on the erythrocyte morphology and the accompanying histogram, which of the following choices is the most likely situation or condition? Normal smear Iron deficiency anemia Aplastic anemia Dimorphic red cell population
Dimorphic red cell population
What is the identification of this cellular clump found in CSF? Note the presence of many similar-appearing nuclei without distinct lines of demarcation between cells. Cartilage cell Tumor cell clump Ependymal clump Lymphoblast clump
Ependymal clump
A woman in labor is bleeding, has a very high fever, and is in danger of losing the fetus. Laboratory results include a platelet count of 15 x 109/L (normal platelet count = 150 - 450 x 109/L), prolonged PT and aPTT, decreased fibrinogen, and increased D-dimer. Her automated blood count flagged for blood smear review and the cells indicated by the arrows were seen on her peripheral smear along with a decrease in the number of platelets present. What condition is suggested by these results? Thrombotic thrombocytopenic purpura (TTP) Hemolytic uremic syndrome (HUS) Disseminated intravascular coagulation (DIC) Glanzmann thrombasthenia (GT)
Disseminated intravascular coagulation (DIC)
The light blue-gray inclusions observed in the cytoplasm of many of the bands and segmented neutrophils of a burn patient are most likely? Auer rods Dohle bodies Toxic granules May-Hegglin bodies
Dohle bodies
Which of the following types of anemia can be described as an inherited bone marrow failure syndrome with patients developing dystrophic nails and white patches in the mouth? Fanconi anemia Dyskeratosis congenita Chronic aquired pure red cell aplasia Diamond-Blackfan anemia
Dyskeratosis congenita
Which of the following red blood cell morphologies are frequently artifactual? Drepanocytes, echinocytes, dacryocytes Drepanocytes, dacryocytes Echinocytes, stomatocytes Stomatocytes, acanthocytes, elliptocytes
Echinocytes, stomatocytes
All of the following are associated with HELLP syndrome EXCEPT: Hemolysis Elevated liver enzymes Low platelet count Elevated lipid levels
Elevated lipid levels
All of the cells listed below function as a phagocyte, EXCEPT? Neutrophil Eosinophil Monocyte Macrophage
Eosinophil
Which coagulation pathway is factor VII part of? Intrinsic Extrinsic Common Intrinsic and extrinsic
Extrinsic
The prothrombin time test will detect deficiencies in which pathways? Extrinsic and intrinsic pathways Extrinsic and common pathways Intrinsic pathway and common pathways Intrinsic pathway only
Extrinsic and common pathways
Which of these factors may be deficient if both the PT and aptt are prolonged Factor II Factor VII Factor VIII Factor XI
Factor II
Which of the following factors is Vitamin K-dependent? Factor I Factor VIII Factor IX Factor XI
Factor IX
A patient has a prolonged non-therapeutic PT and a normal aPTT. The physician orders a PT mixing study. The results are as follows: Original PT test- 32 seconds 1:1 Mix (room temp immediate) - 22 seconds 1:1 Mix (incubated for 90 minutes) - 23 seconds Which factor may be present in abnormally low levels and causing the prolongation? Factor XI Factor VII Factor IX Factor VIII
Factor VII
Which of the following conditions will show an increased prothrombin time (PT) with a normal activated thromboplastin time (aPTT)? Factor IX deficiency Factor VII deficiency Factor VIII deficiency Factor X deficiency
Factor VII deficiency
The dissolution of a clot with 5M urea indicates which one of the following factor deficiencies? Factor II Factor XIII von Willebrand disease Factor IX
Factor XIII
Thromboelastography (TEG) is a methodology used to assess blood coagulation. The prothrombin time (PT) and activated partial thromboplastin time (APTT) are more commonly used. All of the following are things that TEG can assess that the PT and APTT cannot assess EXCEPT? Platelet function Clot strength Fibrinolysis Factor deficiencies
Factor deficiencies
Platelet satellitism is most likely to cause which of the following erroneous results? Falsely increased WBC count Falsely decreased RBC count Falsely decreased platelet count Falsely decreased hemoglobin level
Falsely decreased platelet count
Which of the following is MOST responsible for increasing the erythrocyte sedimentation rate (ESR)? Fibrinogen Albumin Alpha-2-globulins and beta-globulins Gamma-globulins
Fibrinogen
Dysfibrinogenemia can be caused by many different structural mutations of the fibrinogen genes, and can result in bleeding, thrombosis, or in some patients, no symptoms. A lab test which differentiates dysfibrinogenemia from afibrinogenemia is: PT aPTT Thrombin time (TT) Fibrinogen antigen assay
Fibrinogen antigen assay
Which of the following is associated with macrocytic anemia? Iron deficiency Fish tapeworm Sickle cell disease Beta thalassemia minor
Fish tapeworm
A laboratory test which can detect the specific decrease in the platelet surface membrane receptor glycoprotein Ib and thus lead to a diagnosis of Bernard Soulier Syndrome (BSS) is: Platelet count Ristocetin induced platelet aggregation studies Flow cytometry ELISA
Flow cytometry
Regarding hemoglobin synthesis, which of the following constitutes the alpha globin chain coding? Two gene loci; one each on chromosome 11. Four gene loci; two each on chromosome 11. Two gene loci; one each on chromosome 16. Four gene loci; two each on chromosome 16.
Four gene loci; two each on chromosome 16.
A ten-year-old boy came to a physician's attention because of recent jaundice and icteric sclera after taking the medication Primaquine before a trip to Africa. The immediate laboratory work revealed: Hct 24% (normal 36%-47%), MCV 79.5 fL (normal 78-95fL), RDW 13% (normal 11.5-15.0%). His blood smear findings are reflected in the images to the right. The upper image is a Wright-Giemsa stained smear, while the lower is a supravital-stained smear. Which condition should be considered for this patient when analyzing his symptoms, history, and laboratory results? G6PD deficiency Pyruvate kinase deficiency Iron deficiency anemia Megaloblastic anemia
G6PD deficiency
A deficiency of platelet receptor IIb/IIIa can be found in which of the following? Glanzmann Thrombasthenia Von Willebrand Disease Aspirin therapy Bernard Soulier Syndrome
Glanzmann Thrombasthenia
Which of the following categories includes mature neutrophils, eosinophils, and basophils? Granulocytes Hematopoietic stem cells Lymphoid cells Mononuclear cells
Granulocytes
With the exception of beta thalassemia minima, which hemoglobin is decreased in beta thalassemia? Hb A Hb A2 Hb F Hb S
Hb A
A 55-year-old white male had the following lab data: RBC 3.7 X 1012/L Serum iron 220 µg/dL (N: 60-80 µg/dL) TIBC 300 µg/dL (N: 260-400 µg/dL) Hct 32% Serum Ferritin 2,800 ng/mL (N: 10-200 ng/mL) WBC 5.8 x 109/L MCV 86 fL MCH 26 pg MCHC 32% Prussian Blue stain of bone marrow aspirate indicates markedly elevated iron stores. These laboratory results are MOST consistent with which of the following conditions? Sideroblastic anemia Anemia of chronic disease Hemochromatosis Megaloblastic anemia
Hemochromatosis
A quick mathematical check which can be applied to verify that the hemoglobin and hematocrit values on a complete blood count correspond with each other would be: Hematocrit X 3 = hemoglobin Hemoglobin X 3 = hematocrit Hemoglobin / hematocrit = 3 Hemoglobin + hematocrit = 3
Hemoglobin X 3 = hematocrit
Which of the following analytes will be falsely decreased due to hemolysis? Potassium, Magnesium, Hemoglobin Potassium, Magnesium, Iron, Total Protein Hematocrit, Red Blood Cell Count, Potassium Hemoglobin, Hematocrit, Red Blood Cell Count
Hemoglobin, Hematocrit, Red Blood Cell Count
All of the following are considered to be important protein regulators of iron metabolism, EXCEPT? Hemosiderin Hepcidin Transferrin receptor Ferroportin
Hemosiderin
Which of the following is a negative regulator of intestinal iron absorption? Hepcidin Ferroportin 1 Erythroferron Hephaestin
Hepcidin
Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called: Heinz bodies Howell-Jolly bodies Basophilic stippling Pappenheimer bodies
Howell-Jolly bodies
What is the condition most likely associated with the peripheral blood picture shown in the image on the right? Artifact of staining Congenital spherocytosis Iron deficiency anemia Autoimmune hemolytic anemia
Iron deficiency anemia
In which of the following conditions would you NOT expect to find Howell-Jolly bodies? Sickle cell anemia Iron deficiency anemia Post splenectomy Megaloblastic anemia
Iron deficiency anemiaj
In which of the following disorders would you probably observe coarse basophilic stippling on a Wright-stained peripheral blood smear? Hemolytic anemia Sideroblastic anemia Multiple myeloma Lead poisoning
Lead poisoning
What MINIMUM level of a particular factor will cause the aPTT test to become prolonged? Less than 40% Less than 50% Less than 60% Less than 70%
Less than 40%
The analysis of a differential blood smear and laboratory results produced the following results: WBC: 47,000/µL Hgb: 10.9 g/dL Hct: 34% Differential: 4% Monocytes 20% Lymphocytes 4% Myelocytes 2% Promyelocytes 15% Metamyelocytes 25% Segmented Neutrophils 30% Bands Leukocyte Alkaline Phosphatase (LAP) - increased What is the MOST likely disease/condition associated with these results? Myelofibrosis Leukemoid reaction Chronic myelogenous leukemia Acute myelogenous leukemia
Leukemoid reaction A leukemoid reaction presents with increased white blood cell counts due to a physiologic response to stress or infection. Usually, a leukocyte count that exceeds 50,000 WBC/mm3 with an increase in early neutrophil precursors is referred to as a leukemoid reaction. The peripheral blood smear typically shows myelocytes, metamyelocytes, and bands, and in some cases, promyelocytes and myeloblasts
A variety of additives are used in blood collection tubes. Which of the following additives prevents clotting by inhibiting thrombin and thromboplastin? EDTA Gel Lithium or sodium heparin Sodium fluoride
Lithium or sodium heparin
The white blood cell that can vary MOST in size and shape on a Wright-stained smear is: Basophil Eosinophil Neutrophil Lymphocyte
Lymphocyte
All of the following cells are considered granulocytes EXCEPT? Neutrophils Lymphocytes Basophils Eosinophils
Lymphocytes
Which of the following cells are capable of producing antibodies? Thrombocytes Macrophages Lymphocytes Neutrophils
Lymphocytes
A patient that has >15% ringed sideroblasts present would be categorized as which myelodysplastic syndrome? MDS-RS MDS-MLD CMML MDS-EB
MDS-RS
The peroxidase stain is useful in differentiating between which cells? Lymphocytic and granulocytic cells Monoblastic and myeloblastic cells Leukemoid reaction and myelocytic leukemia Eosinophils and neutrophils
Lymphocytic and granulocytic cells Peroxidase stain is an enzymatic stain based on the principle that peroxidase granules in some neutrophils and in eosinophils will stain positive. Lymphocytes stain negative with peroxidase stains.
All of the following are granulocytes EXCEPT: Neutrophilic band Basophil Mott cell Mast cell
Mott cell
The presence of an increased number of hypersegmented neutrophils in the peripheral blood, as shown in this image, is an indication of which of the following conditions? Preleukemia Megaloblastic anemia Aplastic anemia Myeloproliferative disorder
Megaloblastic anemia
Anticoagulant drugs, which are direct thrombin inhibitors (such as argatroban and bivalirudin), can prolong which of the following clot-based assay/s? Ecarin clotting time only (ECT) Activated thromboplastin time (aPTT) only PT and aPTT PT, aPTT and Ecarin clotting time
PT, aPTT and Ecarin clotting time
On this alkaline electrophoresis gel, which patient most likely has alpha thalassemia? Lanes 5 and 6 represent controls. Patient 1 Patient 2 Patient 3 Patient 4
Patient 3
A manual differential shows 72% hyposegmented neutrophils, which of the following is most likely? Chediak Higashi Alder Reilly Anomaly May-Hegglin Anomaly Pelger-Huet Anomaly
Pelger-Huet Anomaly
In which developmental stage do red blood cells begin forming hemoglobin in amounts large enough to be visualized on a Wright-stained bone marrow aspirate smear? Reticulocyte Pronormoblast Basophilic normoblast Polychromatic normoblast
Polychromatic normoblast
Which finding best distinguishes immune hemolytic anemia from other hemolytic anemias? Rouleaux Positive DAT Splenomegaly Increased erythrocyte count
Positive DAT
Note the view of a peripheral blood smear in the photograph. Pictured are scattered acanthocytes, echinocytes, target cells, spherocytes, schistocytes and a Howell-Jolly Body. The condition in which each of these atypical RBC's may be found in the same patient's peripheral blood smear is: Hemolytic anemia Postsplenectomy syndrome Disseminated intravascular coagulation Thalassemia minor
Postsplenectomy syndrome
All of the following factors offer a protective effect, delaying symptoms in persons with hereditary hemochromatosis (HH) EXCEPT? Regular blood donation Pregnancy Regular use of multivitamins with iron Menstruation
Regular use of multivitamins with iron
For which determination is the brilliant cresyl blue stain used MOST often? Malaria - ring forms Plasma Cells Reticulocytes Basophilic stippling
Reticulocytes
All of the following are present in normal bone marrow EXCEPT? Siderocyte Sideroblast Ringed sideroblast Hemosiderin
Ringed sideroblast
What is the cell indicated by the arrow in this Prussian blue stain? Ringed sideroblast Siderocyte Segmented Neutrophil Myelocyte
Ringed sideroblast
What physiological factor causes sedimentation in the erythrocyte sedimentation rate (ESR)? Elevated levels of immunoglobulins Increased concentration of fibrinogen Rouleaux formation Tilted tube, varying from the vertical
Rouleaux formation
What is the predominant abnormal erythrocyte morphology associated with idiopathic myelofibrosis? Target cells Elliptocytes Teardrop cells Ovalocytes
Teardrop cells
All of the following are associated with RBC macrocytosis EXCEPT? Alcoholism Hypothyroidism B12 deficiency Thalassemia
Thalassemia
which of the following converts fibrinogen into firbrin monomer? Heparin Calcium 2+ ions Tissue factor Thrombin
Thrombin
The clot-based assay that is most specific for measuring fibrinogen function is the: Prothrombin Time (PT) Activated Partial Thromboplastin TIme (aPTT) Thrombin Time (TT) Immunoassay for fibrinogen
Thrombin Time (TT)
Which of the following bone marrow processing procedures is best suited for a patient who had a dry tap Direct differential smear Touch preparations Concentrate (buffy coat) smears Crush smear
Touch preparations
Which two inclusions can sometimes be seen in segmented neutrophils? Basophilic stippling and Dðhle bodies Auer rods and toxic granulation Toxic granulation and Dðhle bodies Auer rods and basophilic stippling
Toxic granulation and Dðhle bodies
