BOC Hematology (MLT only)

110) Which of the following is the formula for MCHC? a) (Hgb x 100)/Hct b) Hgb/RBC c) RBC/Hct d) (Hct x 1000)/RBC

a) (Hgb x 100)/Hct Calculating RBC indicies.

220) Which of the following is the formula for manual white cell count? a) (number of cells x dilution x 10)/number of squares counted b) (number of cells x dilution)/10 x number of squares counted c) number of cells x dilution d) number of cells x number of squares counted

a) (number of cells counted x dilution x 10)/number of squares counted Hemocytometer calculation.

108) What is the MCH if the Hct is 20%, the RBC is 2.4 and the Hgb is 5 g/dL? a) 21 b) 23 c) 25 d) 84

a) 21 MCH = Hgb x 10 / RBC Calculation of RBC indicies.

223) An automated leukocyte count is 22.5. The differential reveals 200 normoblasts/100 leukocytes. What is the actual leukocyte count per microliter? a) 7,500/uL b) 11,500/uL c) 14,400/uL d) 22,300/uL

a) 7,500/uL Corrected WBC count = WBCs x 100 / nRBCs + 100 22.5 x 100 = 2,250 / 300 (200 nRBCs + 100) = 7.5 or 7,500/uL

201) Of the following, the disease most closely associtaed with cytoplasmic granule fusion is: a) Chediak-Higashi syndrome b) Pelger-Huet anomaly c) May-Hegglin anomaly d) Alder-Reilly anomaly

a) Chediak-Higashi syndrome Identification of condition with morphologic alteration in neutrophils, representing giant fused lysosomes.

381) The specimen of choice for preparation of blood films for manual differential leukocyte counts is whole blood collected in: a)EDTA b) oxalate c) citrate d) heparin

a) EDTA High-quality blood smears can be made from the EDTA tube within 2-3 hours of collecting the specimen.

38) A patient has a congenital nonspherocytic hemolytic anemia. After exposure to anti-malarial drugs the patient experiences a severe hemolytic episode. This episode is characterized by red cell inclusions caused by hemoglobin denaturation. Which of the following conditions is MOST consistent with these findings? a) G-6-PD deficiency b) thalassemia major c) pyruvate kinase deficiency d) paroxysmal nocturnal hemoglobinuria

a) G-6-PD G-6-PD deficiency - anti-malarial drugs

211) Of the following, the disease most closely associated with glucocerebrosidase deficiency is: a) Gaucher disease b) Chediak-Higashi syndrome c) Pelger-Huet anomaly d) May-Hegglin anomaly

a) Gaucher disease Differentiation of lipid storage disease from other anomalies of leukocytes.

208) A differential was performed on an asymptomatic patient. The differential included 60% neutrophils: 55 of which had 2 lobes and 5 had 3 lobes. There were no other abnormalities. This is consistent with which of the following anomolies? a) Pelger-Huet b) May-Hegglin c) Alder-Reilly d) Chediak-Higashi

a) Pelger-Huet Morphologic alteration of neutrophils -- primary feature is hyposegmentation.

154) Which of the following cells is the atypical lymphocyte seen on the peripheral smear of patients with infectious mono? a) T lymphocytes b) B lymphocytes c) monocytes d) mast cells

a) T lymphocytes T-cell activation follows during second week of IM in response to the EBV induced B-cell infection and activation.

326) Plasma from a patient with lupus coagulation inhibitor can show: a) a prolonged APTT and normal PT b) a prolonged thrombin time c) no change with platelet neutralization d) complete correction when incubated with normal plasma

a) a prolonged APTT and normal PT Patients suspected of a lupus anticoagulant present with a prolonged APTT. Lab assays to detect lupus anticoagulants are the APTT, dilute Russel viper venom test, and Kaolin clotting time. In the presence of LA, the mixing study doesn't correct.

310) Prothrombin is: a) a protein formed by the liver in the presence of Vitamin K b) an enzyme that converts fibrinogen into fibrin threads c) the end product of the reaction between fibrinogen and thrombin d) a protein released by platelets during coagulation

a) a protein formed by the liver in the presence of Vitamin K Prothrombin is produced by the liver cells dependent on Vitamin K as a coenzyme for its functionality. It is released into the blood as a zymogen as a precursor for its active form thrombin.

350) A bedside test that can be used to monitor heparin activity is the: a) activated clotting time b) stypven time c) reptilase time d) partial thromboplastin time

a) activated clotting time The ACT monitors high-dose heparin therapy at clinics, bedside, cardiac catheterization or at a surgical site. The Stypven time is a test using snake venom for testing for lupus. The reptilase time is used to distinguish between heparin contamination and a decreased fibrinogen level.

193) The most common form of childhood leukemia is: a) acute lymphocytic b) acute granulocytic c) acute monocytic d) chronic granulocytic

a) acute lymphocytic Recognized ALL as most common malignancy of children.

192) A 50-yr-old woman who has been receiving busulfan for 3 years for chronic myelogenous leukemia becomes anemic. Lab tests reveal: Thrombocytopenia Many peroxidase-negative blast cells in peripheral blood Bone marrow hypercellular in blast transformation Markedly increased bone marrow TdT Which of the following complications is this patient most likely to have? a) acute lymphocytic leukemia b) acute myelocytic leukemia c) acute myelomonocytic leukemia d) busulfan toxicity

a) acute lymphocytic leukemia Recognized ALL as possible progression for 1/3 of CML cases

287) The chamber counting method of platelet enumeration: a) allows direct visualization of the particles being counted b) has a high degree of precision c) has a high degree of reproducibility d) is the method of choice for the performance of 50-60 counts per day

a) allows direct visualization of the particles being counted Manual chamber counts do not have a high degree of precision or reproducibility, and require a significant amount of time.

228) An unexplained elevation of the prothrombin time (PT) in a 72-yr-old smoker who has been diagnosed with COPD is most likely due to: a) an elevated Hct b) a decreased Hct c) vitamin K deficiency d) decreased thrombin activity

a) an elevated Hct An elevated Hct decreases the amount of plasma in whole blood, and causes an effective increase in the amount of citrate added to the plasma. Recalcification incompletely overcomes the additional citrate, and prolongations in clotting time tests can be expected, unless the amount of citrate is adjusted for the abnormal Hct.

65) The RDW-CV and RDW-SD performed by the automated cell counters are calculations that provide: a) an index of the distribution of RBC volumes b) a calculated mean RBC hemoglobin concentration c) a calculated mean cell hemoglobin d) the mean RBC volume

a) an index of the distribution of RBC volumes RDW-CV is a new parameter available from automated instruments.

353) Low molecular weight heparin is monitored by a: a) anti-Xa assay b) APTT c) PT d) anti-IIa assay

a) anti-Xa assay The chromogenic anti-Xa assay is the only assay available to monitor LMWH; it may also be used to measure UFH. The APTT can not be used to monitor low molecular-weight heparin therapy.

132) Specific (secondary) granules of the neutrophilic granulocyte: a) appear first at the myelocyte stage b) contain lysosomal enzymes c) are formed on the mitochrondria d) are derived from azurophil (primary) granules

a) appear first at the myelocyte stage Secondary granule appearance in neutrophils.

74) Evidence of active red cell regeneration may be indicated on a blood smear by: a) basophilic stippling, nucleated RBCs and polychromasia b) hypochromia, macrocytes and nucleated RBCs c) hypochromia, basophilic stippling and nucleated RBCs d) Howell-Jolly bodies, Cabot rings and basophilic stippling

a) basophilic stippling, nucleated RBCs and polychromasia Polychromatophilic RBCs and basophilic stippling can be associated with accelerated heme synthesis.

297) Which of the following detects or measures platelet function? a) bleeding time b) prothrombin time c) thrombin time d) partial thromboplastin time

a) bleeding time BT assesses platelet function; PT, TT & APTT do not assess platelet function.

298) Platelet aggregation is dependent in vitro on the presence of: a) calcium ions b) sodium citrate c) thrombin d) potassium

a) calcium ions Calcium is required for platelet aggregation.

240) In synovial fluid, the most characteristic finding in pseudogout is: a) calcium pyrophosphate dihydrate crystals b) cartilage debris c) monosodium urate crystals d) hemosiderin-laden macrophages

a) calcium pyrophosphate dihydrate crystals Association of pseudogout with calcium pyrophosphate crystals.

373) The photo-optical method of endpoint detection is described as: a) change in optical density as a result of a fibrin clot b) measurement of turbidity of antigen-antibody formation c) decreased motion of a mechanical ball d) color-producing chromophor

a) change in optical density as a result of a fibrin clot Photo-optical endpoint is a change in optical density. Nephelometry is an immunometric method for measuring proteins. Chromogenic methods employs a color-producing substance called a chromophor. Immunologic assays are based on antigen-antibody reactions.

214) An oncology patient has the following results: Day 1 Day 3 WBC 8.0 2.0 RBC 3.50 3.45 Hgb 10.0 9.9 Hct 29.8 29.5 Plt 180 150 The most probable explanation is: a) chemotherapy b) cold antibody c) clotted specimen d) inadequate mixing

a) chemotherapy Effect of conventional chemotherapy on WBC count.

178) All stages of neutrophils are most likely seen in the peripheral blood of a patient with: a) chronic myelocytic leukemia b) myelofibrosis with myeloid metaplasia c) erythroleukemia d) acute myelocytic leukemia

a) chronic myelocytic leukemia Demonstrates difference between acute vs chronic leukemias; intermediate cell maturity seen in chronic myelogenous, but would not predominate in erythroleukemia.

237) The most characteristic morphologic features of atypical lymphocytes include: a) course nuclear chromatin & basophilic cytoplasm b) blue-grey cytoplasm, fine nuclear chromatin c) nucleoli and deep blue RNA-rich cytoplasm d) a stretched nucleus & cytoplasmic indentations

a) course nuclear chromatin & basophilic cytoplasm Morphology of reactive lymphocytes.

348) D-dimers are produced from: a) cross-linked and stabilized fibrin clots b) decreased fibrinogen and platelets c) plasminogen converting to plasmin d) generation of thrombin from endothelial cells

a) cross-linked and stabilized fibrin clots D-dimers are produced from cross-linked and stabilized fibrin clots. These clots are dissolved by plasma and D-dimers are released. Therefore, D-dimers suggest a breakdown of fibrin clots, and indicate that clots have been formed at the site of injury.

52) Lab findings in hereditary spherocytosis do NOT include: a) decreased osmotic fragility b) increased autohemolysis corrected by glucose c) reticulocytosis d) shortened erythrocyte survival

a) decreased osmotic fragility Hereditary spherocytosis - lab results

106) In polycythemia vera (PV) the leukocyte alkaline phosphatase (LAP) activity is: a) elevated b) normal c) decreased

a) elevated LAP activity may be increased in polycythemia vera

279) In polycythemia vera, the platelet count is: a) elevated b) normal c) decreased d) variable

a) elevated Polycythemia vera is characterized by increased WBC, RBC, and platelet counts.

78) In polycythemia vera, the Hgb, Hct, RBC count and red cell mass are: a) elevated b) normal c) decreased

a) elevated The nation PV Study group criteria for the diagnosis of PV include increased red cell mass, increased platelet count, increased LAP score.

17) Cells for the transport of O2 and CO2 are: a) erythrocytes b) granulocytes c) lymphocytes d) thrombocytes

a) erythrocytes Primary functions of red blood cells

385) On a smear made directly from a finger stick, no platelets were found in the counting area. The first thing to do is: a) examine the slide for clumping b) obtain another smear c) perform a total platelet count d) request another finger stick

a) examine the slide for clumping Platelet clumping is expected if smears are made directly from the finger. Smears must be made promptly before any clotting begins.

320) A hemophiliac male and a normal female can produce a: a) female carrier b) male carrier c) male hemophiliac d) normal female

a) female carrier All daughters of hemophiliac men are carriers of the disease; all sons are normal. The gene for Factor VIII lies on the X chromosome.

45) The most likely cause of the macrocytosis that often accompanies anemia of myelofibrosis is: a) folic acid deficiency b) increased reticulocyte count c) inadequate B12 absorption d) pyroxidine deficiency

a) folic acid deficiency Myelofibrosis is often accompanied by folate deficiency, which causes macrocytic anemia.

283) Which of the following is characteristic of Bernard-Soulier syndrome? a) giant platelets b) normal bleeding times c) abnormal aggregation with ADP d) increased platelet count

a) giant platelets Giant platelets, abnormal bleeding time, normal aggregation with ADP, decreased platelet count are characteristic of Bernard-Soulier.

236) A patient is diagnosed as having bacterial septicemia. Which of the following would best describe the expected change in his peripheral blood? a) granulocytic leukemoid reaction b) lymphocytic leukemoid reaction c) neutropenia d) eosinophilia

a) granulocytic leukemoid reaction Correlation of sepsis with a leukemoid reaction.

3) The majority of iron in an adult is found as a constituent of: a) hemoglobin b) hemosiderin c) myoglobin d) transferrin

a) hemoglobin 2/3 iron in body bound to Hgb

332) Acute disseminated intravascular coagulation is characterized by: a) hypofibrinogenemia b) thrombocytosis c) negative D-dimer d) shortened thrombin time

a) hypofibrinogenemia The lab profile for a patient with acute DIC is: increased PT, APTT and D-dimers, with decreased fibrinogen and platelets.

380) Blood collected in EDTA undergoes which of the following changes if kept at room temperature for 6-24 hours? a) increased Hct and MCV b) increased ESR and MCV c) increased MCHC and MCV d) decreased reticulocyte count and Hct

a) increased Hct and MCV Tubes that remain at room temperature for >5 hours have unacceptable blood cell artifacts. This will affect the Hct and the MCV.

105) When using an electronic cell counter, which of the following results can occur in the presence of a cold agglutinin? a) increased MCV and decreased RBC b) increased MCV and normal RBC c) decreased MCV and increased MCHC d) decreased MCV and RBC

a) increased MCV and decreased RBC

168) Biochemical abnormalities characteristic of polycythemia vera include: a) increased serum B12 binding capacity b) hypouricemia c) hypohitaminemia d) decreased leukocyte alkaline phosphatase activity

a) increased serum B12 binding capacity Lab findings are reflective of erythroid rather than myeloid metaplasia.

84) A 56-year-old man was admitted to the hospital for treatment of a bleeding ulcer. The following laboratory data were obtained: RBC: 4.2 WBC: 5.0 Hct: 30 Hgb: 8.5 serum iron: 40 TIBC: 460 serum ferritin: 12 Examination of the bone marrow revealed the absence of iron stores. This data is most consistent with which of the following conditions? a) iron deficiency anemia b) anemia of chronic disease c) hemochromatosis d) acute blood loss

a) iron deficiency anemia Lab findings in iron deficiency anemia include decreased serum iron, serum ferritin, % transferrin saturation and increased TIBC, FED, and serum soluble transferrin receptor levels.

312) The most potent plasminogen activator in the contact phase of coagulation is: a) kallikrein b) streptokinase c) HMWK d) fibrinogen

a) kallikrein A clot is degraded by plasmin in the fibrinolytic system. Plasminogen is the zymogen producted when Factor XIIa and kallikrein are produced by contact activation.

140) The Philadelphia chromosome is formed by a translocation between the: a) long arm of chromosome 22 & long arm chromosome 9 b) long arm chromosome 21 & long arm chromosome 9 c) long arm chromosome 21 & short arm chromosome 6 d) long arm chromosome 22 & short arm chromosome 6

a) long arm of chromosome 22 & long arm of chromosome 9 Philadelphia chromosome composition.

43) The characteristic morphologic feature in folic acid deficiency is: a) macrocytosis b) target cells c) basophilic stippling d) rouleaux formation

a) macrocytosis Folate deficiency - peripheral smear will show abnormally large RBCs.

382) A platelet determination was performed on an automated instrument and a very low value was obatined. The platelets appeared adquate when estimated from the stained blood film. The best explanation for this discrepancy is: a) many platelets are abnormally large b) blood sample is hemolyzed c) white cell fragments are present in the blood d) red cell fragments are present in the blood

a) many platelets are abnormally large Instruments count particles within defined size limits. The upper limit is to separate large platelets from erythrocytes. Large platelets may be counted as erythrocytes.

265) Which of the following cells is the largest cell in the bone marrow? a) megakaryocyte b) histiocyte c) osteoblast d) mast cell

a) megakaryocyte Megakaryocytes are the largest cell in the bone marrow.

205) Which of the following is associated with Chediak-Higashi syndrome? a) membrane defect of lysosomes b) Dohle bodies and giant platelets c) 2-lobed neutrophils d) mucopolysaccharidosis

a) membrane defect of lysosomes Giant granulocyte inclusions due to fusion of lysosomes.

100) The lab findings on a patient are as follows: MCV: 55 MCHC: 25 MCH: 17 A stained blood film of this patient would most likely reveal a red cell picture that is: a) microcytic, hypochromic b) macrocytic, hypochromic c) normocytic, normochromic d) microcytic, normochromic

a) microcytic, hypochromic Using RBC indicies to classify anemia

314) Which of the following is a characteristic of Factor XII deficiency? a) negative bleeding history b) normal clotting times c) decreased risk of thrombosis d) epistaxis

a) negative bleeding history See explanation in question 313 *same*

151) The following results were obtained on a 45-year-old man complaining of chills and fever: WBC: 23 LAP: 200 Philadelphia chromosome: negative Differential: Segs: 60% Bands: 21% Lymphs: 11% Monos: 3% Metamyelos: 2% Myelos: 3% Toxic granulation, Dohle bodies and vacuoles These results are consistent with: a) neutrophilic leukemoid reaction b) polycythemia vera c) chronic myelocytic leukemia d) leukoerythroblastosis in myelofibrosis

a) neutrophilic leukemoid reaction Lab findings: increased WBC but with increased LAP; negative Philadelphia chromosome differentiates leukemoid response from leukemia.

79) The M:E ratio in polycythemia vera is usually: a) normal b) high c) low d) variable

a) normal Increase in both myeloid and erythroid precursers

117) The principle confirmatory test for hereditary spherocytosis is: a) osmotic fragility b) sucrose hemolysis c) heat instability test d) Kleihauer-Betke

a) osmotic fragility The principle screening test would be peripheral smear and RBC indicies. The confirmatory osmotic fragility is frequently a reference lab test only.

40) Peripheral blood smears from patients with untreated pernicious anemia are characterized by: a) pancytopenia and macrocytosis b) leukocytosis and elliptocytosis c) leukocytosis and ovalocytosis d) pancytopenia and microcytosis

a) pancytopenia and macrocytosis Patients with pernicious anemia have fewer of all types of blood cells, but they are abnormally large.

250) Which of the following stains is closely associated with the lysosomal enzyme in primary (azurophilic) granules? a) peroxidase b) Sudan Black B c) periodic acid-Schiff (PAS) d) Prussian blue

a) peroxidase Myeloperoxidase as a marker of primary granules in granulocytes.

184) A patient is diagnosed with polycythemia vera 5 years ago now has a normal Hct, decreased Hgb and microcytic, hypochromic red cells. What is the most probable cause for the current blood situation? a) phlebotomy b) myelofibrosis c) preleukemia d) aplastic anemia

a) phlebotomy Hypochromic, microcytic RBCs is most commonly associated with iron deficiency, which would most likely result from therapeutic phlebotomies.

294) A bleeding time is used to evaluate the activity of: a) platelets b) prothrombin c) labile factor d) Factor XIII

a) platelets Bleeding time (BT) assesses platelet activity.

340) A patient is taking 10 mg per day of Coumadin (warfarin). The results of which of the following lab tests will be most impacted? a) protein C level b) antithrombin III level c) Factor V Leiden mutation d) Factor VIII level

a) protein C level Protein C is a Vitamin K dependent protein; hence warfarin therapy will lower levels of this protein.

137) Elevation of the lymphocyte percentage above 47% is termed: a) relative lymphocytosis b) absolute lymphocytosis c) leukocytosis d) absolute neutrophilic leukocytosis

a) relative lymphocytosis

120) Supravital staining is important for reticulocytes since the cells must be living in order to stain the: a) remaining RNA in the cell b) iron before it precipitates c) cell membrane before it dries out d) denatured hemoglobin in the cell

a) remaining RNA in the cell Using a supravital stain, residual ribosomal RNA is precipitated within the reticulocytes.

289) A phase-platelet count was performed and the total platelet count was 356. 10 fields on the stained blood smear were examined for platelets and the results per field were: 16, 18, 15, 20, 19, 17, 19, 18, 20, 16 The next step would be to: a) report the platelet-phase count since it correlated well with the slide b) repeat the phase-platelet count on a recollected specimen and check for clumping c) check ten additional fields on the blood smear d) repeat the platelet count using a different method

a) report the platelet-phase count since it correlated well with the slide Platelet count matches estimate well (avg of 17.8 platelets per oil immersion field x 20,000)

81) Which of the following is most closely associated with erythroleukemia? a) ringed sideroblasts, nuclear budding and Howell-Jolly bodies b) disseminated intravascular coagulation c) micromegakaryocytes d) lysozymuria

a) ringed sideroblasts, nuclear budding and Howell-Jolly bodies RBC morphology of erythroleukemia include nuclear budding/fragmentation, cytoplasmic vacuoles, Howell-Jolly bodies, ringed sideroblasts & megaloblastic changes.

72) A red blood cell about 5 um in diameter that stains bright red and shows no central palor is a: a) spherocyte b) leptocyte c) microcyte d) macrocyte

a) spherocyte Recognize spherocytes on a blood smear.

66) The erythrocyte sedimentation rate (ESR) can be falsely elevated by: a) tilting the tube b) refrigerated blood c) air bubbles in the column d) specimen being too old

a) tilting of the tube Tilting of the tube accelerates the fall of the red blood cells.

256) In flow cytometry analysis, low angle or forward scatter of a laser light beam provides information that pertain to a cell's: a) volume b) viability c) granularity d) lineage

a) volume In flow cytometry, forward scatter provides an estimate of cell volume or size.

221) If a WBC count is performed on a 1:10 dilution and the number of cells counted in 8 squares is 120, the total WBC count is: a) 1,200/uL b) 1,500/uL c) 12,000/uL d) 15,000/uL

b) 1,500/uL Hemocytometer calculation.

266) Normal platelets have a circulating life-span of approximately: a) 5 days b) 10 days c) 20 days d) 30 days

b) 10 days Average life span of platelets in peripheral blood is 9.5 days.

2) The following are compounds formed in the synthesis of heme: 1 coproporphyrinogen 2 porphobilinogen 3 uroporphyrinogen 4 protoporphyrinogen Which of the following responses lists these compounds in the order in which they are formed? a) 4, 3, 1, 2 b) 2, 3, 1, 4 c) 4, 2, 3, 1 d) 2, 1, 3, 4

b) 2, 3, 1, 4 Porphobilinogen, uroporphyrinogen, coproporphyrinogen, protoporphyrinogen Correct order of Heme synthesis

111) What is the MCHC if the Hct is 20%, the RBC is 2.4 and the Hgb is 5 g/dL? a) 21% b) 25% c) 30% d) 34%

b) 25% MCHC = Hgb x 100/Hct Calculating RBC indicies.

112) What is the MCHC if the Hct is 20%, the RBC is 1.5 and the Hgb is 6 g/dL? a) 28% b) 30% c) 40% d) 75%

b) 30% MCHC = Hgb x 100/Hct Calculating RBC indicies.

219) Given the following data: WBC: 8.5 Differential: Segs: 56% Bands: 2% Lymphs: 30% Monos: 6% Eos: 6% What is the absolute eosinophil count? a) 170/uL b) 510/uL c) 2,550/uL d) 4,760/uL

b) 501/uL Calculation of absolute eosinophil count.

222) If a WBC count is performed on a 1:100 dilution and the number of cells counted in 8 squares is 50, the total WBC count is: a) 5,000/uL b) 6,250/uL c) 50,000/uL d) 62,500/uL

b) 6,250/uL Hemocytometer calculation.

224) A total leukocyte count is 10.0 and 25 nRBCs are seen per 100 leukocytes on the differential. What is the corrected leukocyte count? a) 2,000/uL b) 8,000/uL c) 10,000/uL d) 12,000/uL

b) 8,000/uL 10 x 100 / 125 (25 nRBCs + 100) = 8.0 or 8,000/uL

115) What is the MCV if the Hct is 20%, the RBC is 2.4 and the Hgb is 5 g/dL? a) 68 b) 83 c) 100 d) 120

b) 83 MCV = Hct x 10 / RBC Calculating RBC indicies.

153) The atypical lymphocyte seen in the peripheral smear of patients with infectious mono is probably derived from which of the following? a) T lymphocytes b) B lymphocytes c) monocytes d) mast cells

b) B lymphocytes Delineates pathophysiology of initial B-cell proliferation in EBV infection.

207) Which of the following is associated with May-Hegglin anomaly? a) membrane defect of lysosomes b) Dohle bodies and giant platelets c) 2-lobed neutrophils d) mucopolysaccharidosis

b) Dohle bodies and giant platelets Morphologic alteration of neutrophils -- differentiated from Chediak-Higashi; Pelger-Huet and Alder-Reilly anomolies.

316) Which one of the following factors typically shows an increase in liver disease? a) Factor VII b) Factor VIII c) Factor IX d) Factor X

b) Factor VIII Liver disease affects all Vitamin K dependent factors ( II, VII, IX and X) which will be decreased. Factor VIII is an acute phase reactant that may be elevated in liver disease.

313) Which of the following factor deficiencies is associated with either no bleeding or only a minor bleeding tendency, even after a trauma or surgery? a) Factor X b) Factor XII c) Factor XIII d) Factor V

b) Factor XII Patients with deficiency of Factor XII tend to have thrombotic complications. They do not have bleeding problems most likely due to the lack of activation of fibrin lysis, also due to pathway activation of IX by VIIa/TF complex as well as the activation of Factor XI by thrombin.

325) Patient presents with bleeding 48 hours post tooth extraction. Results are as follows: PT 11.5 sec (ref. range: 10-13 sec) APTT 32.5 sec (ref. range: 23-35 sec) fibrinogen 345 mg/dL (ref. range: 200-400 mg/dL) platelets 324 (ref. range: 150-450) Possible causes are a deficiency in: a) plasminogen b) Factor XIII c) alpha2 anti-plasmin d) Factor XII

b) Factor XIII Factor XIII activity is <5% in congenital or acquired disorders. In adults, bleeding is slow and delayed. The PT, APTT, fibrinogen and platelets will be normal.

36) 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: a) lactate dehyrogenase deficiency b) G-6-PD deficiency c) pyruvate kinase deficiency d) hexokinase deficiency

b) G-6-PD deficiency

149) Neutropenia is NOT usually associated with: a) viral infections b) Hodgkin disease c) select antibiotics d) chemotherapy

b) Hodgkin disease Recognizes multiple causes impacting granulocyte production.

203) Of the following, the disease most closely associated with granulocyte hyposegmentation is: a) May-Hegglin b) Pelger-Huet c) Chediak-Higashi d) Gaucher disease

b) Pelger-Huet Morphologic alteration of neutrophils; majority of nuclei are bilobed and rounded.

123) Which of the following stains can be used to differentiate siderotic granules (Pappenheimer bodies) from basophilic stippling? a) Wright b) Prussian blue c) crystal violet d) periodic acid-Schiff

b) Prussian blue Prussian blue stain is used to differentiate siderotic granules (Pappenheimer bodies) from basophilic stippling.

311) Which of the following coagulation factors is considered labile? a) II b) V c) VII d) X

b) V Factor V is called labile factor, because its activity diminishes quickly at room temperature. Factor II: prothrombin, VII: stable factors, X: Stuart-Prower.

356) The electrical resistance method of cell counting requires: a) equal-sized particles b) a conductive liquid c) 2 internal electrodes for current d) 3 apertures for counting

b) a conductive liquid Coulter principle of particle counting.

32) Evidence indicates that the genetic defect in thalassemia usually results in: a) the production of abnormal globin chains b) a quantitative deficiency in RNA resulting in decreased globin chain production c) a structural change in the heme portion of the Hgb d) an abnormality in the alpha or beta-chain binding or affinity

b) a quantitiative deficiency in RNA resulting in decreased globin chain production Mechanism of genetic abnormality in thalassemia reduces globin chain production

269) Platelet activity is affected by: a) calcium b) aspirin c) hyperglycemia d) hypoglycemia

b) aspirin Aspirin interferes with prostaglandin metabolism in the platelet.

160) Increased numbers of basophils are often seen in: a) acute infections b) chronic myelocytic leukemia c) chronic lymphocytic leukemia d) erythroblastosis fetalis (HDN)

b) chronic myelocytic leukemia Identifies classic cellular findings in CML.

351) Which of the following lab findings is associated with Factor XIII deficiency? a) prolonged activated partial thromboplastin time b) clot solubility in a 5 molar urea solution c) prolonged thrombin time d) prolonged prothrombin time

b) clot solubility in a 5 molar urea solution Fibrin stabilizing factor is needed to polymerize a clot. Primary screening tests are normal in Factor XIII deficiency. A screening test is based on the solubility of a fibrin clot in 5M urea.

378) If a blood smear is dried too slowly, the RBCs are often: a) clumped b) crenated c) lysed d) destroyed

b) crenated Prolonged drying of slides will produce erythrocyte distortion (crenated) on microscopic examination.

155) The disease most frequently present in patients with atypical lymphocytosis and persistently negative tests is: a) toxoplasmosis b) cytomegalovirus (CMV) infection c) herpes virus infection d) viral hepatitis

b) cytomegalovirus (CMV) infection Differentiates CMV as most common of viral diseases that lacks serological evidence of infection.

127) An increased amount of cytoplasmic basophilia in a blood cell indicates: a) increased cytoplasmic maturation b) decreased cytoplasmic maturation c) reduction in size of the cell d) decreased nuclear maturation

b) decreased cytoplasmic maturation An increased amount of cytoplasmic basophilia in a blood cell indicates decreased cytoplasmic maturation.

363) Which of the following will not cause erroneous results when using a phase optical system for enumerating platelets: a) incipient clotting b) decreased hematocrit c) Howell-Jolly bodies d) leukocyte cytoplasmic fragments

b) decreased hematocrit Howell-Jolly bodies and WBC fragments may be mistaken for platelets; clotting may affect platelet numbers; decreased Hct would have no effect on a phase platelet count.

90) The most appropriate screening test for Hgb S is: a) Kleihauer-Betke b) dithionite solubility c) osmotic fragility d) sucrose hemolysis

b) dithionite solubility The solubility test is a rapid test for Hgb S. This should not be used for screening newborns, needs to be corrected in severe anemia and is not specific for Hgb S as there are other Hgbs that will sickle. The presence of Hgb S is confirmed by Hgb electrophoresis.

339) Aliquots of plasma with a prolonged PT and APTT are mixed using various ratios of patient plasma and normal plasma. All samples are incubated at 37°C and tested at 10, 30, and 60-min intervals. The PT and APTT results on all of the mixtures are corrected. These results would indicate the presence of: a) circulating anticoagulant b) factor deficiency c) contaminated reagent d) antibodies

b) factor deficiency A mixing study, when corrected, indicates a factor deficiency. Lack of correction indicates an inhibitor. Some inhibitors may only become evident after the patient's plasma is allowed to interact with normal plasma after incubation. In this case, correction occurred immediately, as well as after incubation, confirming a factor deficiency.

141) Phagocytosis is a function of: a) erythrocytes b) granulocytes c) lymphocytes d) thrombocytes

b) granulocytes Phagocytosis is performed by granulocytes.

146) The M:E ratio in chronic myelocytic leukemia is usually: a) normal b) high c) low d) variable

b) high Demonstrates CML as having predominant myeloid cell line.

171) The M:E ratio in acute myelocytic leukemia is usually: a) normal b) high c) low d) variable

b) high Recognizes myeloid predominance in AML, would increase (from 2:1 to 4:1) myeloid:erythroid ratio.

128) The term "shift to the left" refers to: a) a microscopic adjustment b) immature cell forms in the peripheral blood c) a trend on the Levy-Jennings chart d) a calibration adjustment on an instrument

b) immature cell forms in the peripheral blood Definition of a left shift.

364) The most common cause of an error when using automated cell counters is: a) contamination of the diluent b) inadequate mixing of the sample prior to testing c) variation in voltage of the current supply d) a calibration error

b) inadequate mixing of the sample prior to testing Problems with diluent contamination, voltage variation and calibration errors are not common and are detected by daily quality control.

14) After the removal of red blood cells from the circulation, hemoglobin is broken down into: a) iron, porphyrin, and amino acids b) iron, protoporphyrin, and globin c) heme, protoporphyrin, and amino acids d) heme, hemosiderin, and globin

b) iron, protoporphyrin, and globin Normal degredation products of red blood cells

152) In an uncomplicated case of infectious mono, which of the following cells are affected? a) erythrocytes b) lymphocytes c) monocytes d) thrombocytes

b) lymphocytes Identifies predominant cell line impacted in viral response.

179) All of the following conditions are myeloproliferative disorders EXCEPT: a) myelocytic leukemia b) lymphocytic leukemia c) polycythemia vera d) idiopathic thrombocythemia

b) lymphocytic leukemia Discriminates between conditions due to granulocytic precursor, which would exclude lymphocytic leukemia.

209) The cytoplasmic abnormality of the white blood cell of Alder-Reilly anomaly is found in the: a) endoplasmic reticulum b) lysosomes c) mitochondria d) ribosomes

b) lysosomes Identification of cellular structure where accumulation of partially degraded mucopolysaccharides occurs.

354) In an automated cell counter, the WBC printed result is "+++". The next step is to: a) repeat after warming the sample to 37°C b) make an appropriate dilution of the sample c) recalibrate the machine from pooled samples d) request a new sample immediately

b) make an appropriate dilution of the sample "+++" is an indicator that the WBC count exceeds the upper reportable limit.

204) Which of the following cell types is characteristic of Pelger-Huet anomaly? a) band form b) pince-nez form c) normal neutrophil d) myelocyte

b) pince-nez form Morphologic alteration of neutrophils, majority of nuclei are bilobed, rounded and dumbbell-shaped.

180) The following results were obtained on a 55-year-old man complaining of headaches and blurred vision: WBC: 19.0 RBC: 7.2 Plt: 1,056 Uric acid: 13.0 O2 saturation: 93% Rh1: negative Red Cell Volume: 3,911 (normal = 1,600) Differential: Segs: 84% Bands: 10% Lymphs: 3% Monos: 2% Eos: 1% These results are consistent with: a) neutrophilic leukemoid reaction b) polycythemia vera c) chronic myelocytic leukemia d) leukoerythroblastosis in myelofibrosis

b) polycythemia vera Recognized results reflect polycythemia vera's excessive proliferation of multiphasic cell lines (megakaryocytes, erythroid and myelocytoid).

182) Which of the following types of polycythemia is most often associated with emphysema? a) polycythemia vera b) polycythemia, secondary to hypoxia c) relative polycythemia associated with dehydration d) polycythemia associated with renal disease

b) polycythemia, secondary to hypoxia RBC production is inversely regulated by O2 levels - O2 would decrease in emphysema (hypoxia); therefore, RBC levels would compensate, ie, increase.

4) The main function of the hexose monophosphate shunt in the erythrocyte is to: a) regulate the level of 2,3-DPG b) provide reduced glutathione to prevent oxidation of hemoglobin c) prevent the reduction of heme iron d) provide energy for membrane maintenance

b) provide reduced glutathione to prevent oxidation of hemoglobin Maintains in Fe++ form by way of reduced glutathione

27) Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and PNH? a) autosomal dominant inheritance b) red cell membrane defects c) positive direct antiglobulin test d) measured platelet count

b) red cell membrane defects RBC membrane defects are common to PNH, HS and HE.

379) A citrated blood specimen for coagulation studies is to be collected from a polycythemic patient. The anticoagulant should be: a) the standard volume b) reduced in volume c) changed to EDTA d) changed to oxalate

b) reduced in volume In polycythemia, the decrease in plasma volume relative to whole blood alters the 9 part blood to 1 part anticoagulant ratio, falsely prolonging results. Therefore, a tube with a reduced volume of anticoagulant is needed when the Hct is >55%.

286) A phase-platelet count is performed using a platelet Unopette (dilution = 1:100). 155 platelets are counted on one side of the hemocytometer in the center square mm, and 145 are counted on the other side in the same area. After making the appropriate calculations, the next step would be to: a) repeat the procedure, using a 1:20 dilution with acetic acid b) report the calculated value c) collect a new specimen d) repeat the procedure, using a 1:200 dilution with saline

b) report the calculated value There is no indication that any part of the procedure has been done incorrectly.

77) The characteristic peripheral blood morphologic feature in multiple myeloma is: a) cytotoxic T cells b) rouleaux formation c) spherocytosis d) macrocytosis

b) rouleaux formation The peripheral smear allows microscopic examination of the blood cells. The most characteristic finding in multiple myeloma is rouleaux formation of the red cells.

76) The presence of excessive rouleaux formation on a blood smear is often accompanied by an increased: a) reticulocyte count b) sedimentation rate c) hematocrit d) erythrocyte count

b) sedimentation rate Rouleaux and an increased sed rate are caused by increased fibrinogen and/or with increased immunoglobulin.

119) The prussian blue staining of peripheral blood identifies: a) howell-jolly bodies b) siderotic granules c) reticulocytes d) basophilic stippling

b) siderotic granules Sideroblasts and siderocytes may be identified with Perl Prussian blue iron stain.

63) Which of the following technical factors will cause a decreased erythrocyte sedimentation rate? a) gross hemolysis b) small fibrin clots in the sample c) increased room temperature d) tilting of the tube

b) small fibrin clots in the sample When the shape or size of the RBC prevents rouleaux formation a decreased or low ESR is expected. This is observed with sickle cells, acanthocytes, and spherocytes.

386) The anticoagulant of choice for routine coagulation procedures is: a) sodium oxalate b) sodium citrate c) heparin d) sodium fluoride

b) sodium citrate Sodium citrate is the only anticoagulant used for hemostasis testing. Sodium citrate binds free calcium ions. EDTA inhibits the thrombin-mediated conversion of fibrinogen to fibrin and binds reagent calcium added to initiate clot based tests. Heparin inhibits IIa, Xa, XIIa, XIa and IXa.

18) Erythropoietin acts to: a) shorten the replication time of the granulocytes b) stimulate RNA synthesis of erythroid cells c) increase colony-stimulating factors produced by the B-lymphocytes d) decrease the release of marrow reticulocytes

b) stimulate RNA synthesis of erythroid cells Erythropoietin action.

118) A screening test for paroxysmal nocturnal hemoglobinuria is: a) heat instability test b) sucrose hemolysis c) osmotic fragility d) dithionite solubility

b) sucrose hemolysis The sucrose hemolysis test is still sometimes used for screening; however, the most accurate measurement is immunophenotyping.

124) A patient has pancytopenia, decreased total serum iron, decreased serum iron binding capacity, and shows a homogeneous fluorescence pattern with a high titer on a fluorescent anti-nuclear antibody test. This is suggestive of: a) polycythemia vera b) systemic lupus erythematosus c) iron deficiency anemia d) hemoglobin SC disease

b) systemic lupus erythematosus Systemic lupus erythematosus (SLE) is an autoimmune disease. The ANA procedure is a screening tool for SLE.

295) A patient has been taking aspirin regularly for arthritic pain. Which one of the following tests is most likely to be abnormal in this patient? a) platelet count b) template bleeding time c) prothrombin time d) activated partial thromboplastin time

b) template bleeding time BT assesses platelet number and function; platelet count only assesses platelet number; PT & APTT do not assess platelet number or function.

345) In a Clauss fibrinogen method, the time to clot formation in plasma is measured after the addition of: a) calcium b) thrombin c) phospholipids d) kaolin

b) thrombin In a Clauss fibrinogen, a standard amount of thrombin is added to diluted plasma, and the time required for clot formation is recorded.

344) The best test to determine if a sample is contaminated with heparin is: a) fibrinogen b) thrombin time c) prothrombin time d) stypven time

b) thrombin time A prolonged thrombin time may be considered evident of diminished or abnormal fibrinogen; however, the presence of AT activity such as heparin, must be ruled out.

86) A common source of interference in the cyanmethemoglobin method is: a) hemolysis b) very high WBC count c) hemochromatosis d) acute blood loss

b) very high WBC count A very high WBC count causes turbidity in cyanmethemoglobin reagent-patient specimen that will result in falsely elevated hgb values.

41) Lab tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? a) anemia of chronic disorder b) vitamin B12 deficiency c) iron deficiency d) acute hemorrhage

b) vitamin B12 deficiency Anemia differentiation - vitamin B12 deficiency results in pernicious anemia(pancytopenia, macrocytosis)

113) Which of the following is the formula for mean corpuscular volume (MCV)? a) (Hgb x 10)/RBC b) Hgb/Hct c) (Hct x 10)/RBC d) RBC/Hct

c) (Hct x 10)/RBC Calculating RBC indicies.

226) A blood smear shows 80 nRBCs per 100 leukocytes. The total leukocyte count is 18. The true white cell count expressed in SI units is: a) 17.2 b) 9.0 c) 10.0 d) 13.4

c) 10.0 18 x 100 / 180 (80 nRBCs + 100) = 10.0

101) A patient has the following lab results: RBC: 2.00 Hct: 24 Hgb: 6.8 Retics: 0.8 The mean corpuscular volume (MCV) of the patient is: a) 35 b) 83 c) 120 d) 150

c) 120 MCV = Hct x 10 / RBC Calculating the RBC indicies.

225) If the total leukocyte count is 20.0 and 50 nRBCs are seen per 100 luekocytes on the differential, what is the corrected leukocyte count? a) 6,666/uL b) 10,000/uL c) 13,333/uL d) 26,666/uL

c) 13,333/uL 20 x 100 / 150 (50 nRBCs + 100) = 13.333/uL

218) Given the following data: WBC: 8.5 Differential: Segs: 56% Bands: 2% Lymphs: 30% Monos: 6% Eos: 6% What is the absolute lymphocyte count? a) 170/uL b) 510/uL c) 2,550 uL d) 4,760 uL

c) 2,550 uL Calculation of absolute from relative % and WBC.

288) Blood is diluted 1:200, and a platelet count is performed. 180 platelets were counted in the center square mm on one side and 186 on the other side. The total platelet count is: a) 146 b) 183 c) 366 d) 732

c) 366 Standard calculation for hemocytometer cell count.

109) What is the MCH if the Hct is 20%, the RBC is 1.5 and the Hgb is 6 g/dL? a) 28 b) 30 c) 40 d) 75

c) 40 MCH = Hgb x 10 / RBC Calculation of RBC indicies.

71) The mean value of a reticulocyte count on specimens of cord blood from healthy, full-term newborns is approximately: a) 0.5% b) 2.0% c) 5.0% d) 8.0%

c) 5.0% Newborn infants have elevated reticulocyte counts

334) Patient results are as follows: PT 17.5 sec (ref. range: 10-13 sec) APTT 56.7 sec (ref. range: 23-35 sec) D-dimer 698 ng/mL (<250 ng/mL)( fibrinogen 123 mg/dL (200 - 400 mg/dL) platelet count 102 (150 - 450) This workup suggests: a) blood clot b) hemorrhage c) DIC d) HUS

c) DIC The lab profile for a DIC workup includes increased PT, APTT and D-dimers, with decreased fibrinogen and platelets.

317) A patient has a normal prothrombin time and a prolonged activated partial thromboplastin time using a kaolin activator. The APTT corrects to normal when the incubation time is increased. These results suggest that the patient has: a) hemophilia A (Factor VIII deficiency) b) Hageman Factor (XII) deficiency c) Fletcher Factor deficiency (prekalikrein) d) Factor V deficiency

c) Fletcher Factor deficiency (prekalikrein) A prolonged APTT with a normal PT denotes a problem with the intrinsic pathway, so Factors VIII, IX, XI would be looked at, these deficiencies would correct in a mixing study. A characteristic of prekalikrein deficiency is the correction of the PTT when incubated for 10 minutes with kaolin, Celite, silica or ellagic acid.

305) Coagulation factors affected by warfarin (Coumadin) drugs are: a) VIII, IX and X b) I, II, V and VII c) II, VII, IX and X d) II, V and VII

c) II, VII, IX and X Warfarin interferes with the carboxylation of vitamin K factors by interrupting the enzymatic phase of the reaction. Factors are inhibited according to their half life, VII having the shortest (4-5 hours) and II the longest (2-3 days).

89) The most appropriate screening test for detecting Hemoglobin F is: a) osmotic fragility b) dithionite solubility c) Kleihauer-Betke d) heat instability test

c) Kleihauer-Betke The Kleihauer-Betke procedure is commonly used as a screening test to determine the amount of fetal blood that has mixed with maternal blood.

213) Of the following, the disease most closely associated with pale blue inclusions in granulocytes and giant platelets is: a) Gaucher disease b) Alder-Reilly anomaly c) May-Hegglin anomaly d) Pelger-Huet anomaly

c) May-Hegglin anomaly Primary characteristic distinguishing May-Hegglin from other neutrophil and lipid storage anomalies.

308) Which of the following factors is used only in the extrinsic coagulation pathway? a) II b) V c) VII d) VIII

c) VII The extrinsic pathway is initiated by the release of tissue thromboplastin that has been expressed after damage to a vessel. Factor VII forms a complex with tissue thromboplastin and calcium. Factors II and VII are found in the common pathway, and Factor VIII is in the intrinsic pathway.

83) Values below were obtained on an automated blood count system performed on a blood sample from a 25-year-old man: Patient Normal WBC: 5.1 5.0 - 10.0 RBC: 2.94 4.6 - 6.2 Hgb: 13.8 14 - 18 Hct: 35.4 40 - 54 MCV: 128 82 - 90 MCH: 46.7 27 - 31 MCHC: 40 32 - 36 These results are most consistent with which of the following? a) megaloblastic anemia b) hereditary spherocytosis c) a high titer of cold agglutinins d) an elevated reticulocyte count

c) a high titer of cold agglutinins In patients with cold agglutinins, the automated cell counters show an erroneously elevated MCV and an erroneously decreased red blood cell count due to clumping of the red cells.

296) A platelet count done by phase microscopy is 200. A standardized template bleeding time on the same person is 15 min. (ref. range 4.5 + 1.5 min). This indicates that: a) the Duke method should have been used for the bleeding time b) the manual platelet count is in error c) abnormal platelet function should be suspected d) the results are expected

c) abnormal platelet function should be suspected

215) A leukocyte count and differential on a 40-yr-old Caucasian man revealed: WBC: 5.4 Differential: Segs: 20% Lymphs: 58% Monos: 20% Eos: 2% The data represents: a) absolute lymphocytosis b) relative neutrophilia c) absolute neutropenia d) leukopenia

c) absolute neutropenia Definition of absolute neutropenia.

54) Which of the following is most likely to be seen in lead poisoning? a) iron overload in tissue b) codocytes c) basophilic stippling d) ringed sideroblasts

c) basophilic stippling Lead poisoning - basophilic stippling

58) The characteristic morphologic feature in lead poisoning is: a) macrocytosis b) target cells (codocytes) c) basophilic stippling d) rouleaux formation

c) basophilic stippling RBC morphology in lead poisoning.

165) The following results were obtained on a 35-year-old woman complaining of fatigue and weight loss: WBC: 1.8 RBC 4.6 Plt: 903 uric acid: 6.4 LAP: 0 Philadelphia chromosome: positive Differential: Segs: 30% Bands: 17% Lymphs: 13% Monos: 3% Eos: 4% Basos: 6% Metamyelos: 3% Promyelos: 3% Blasts: 1% These results are consistent with: a) neutrophilic leukemoid reaction b) idiopathic thrombocythemia c) chronic myelocytic leukemia d) leukoerythroblastosis in myelofibrosis

c) chronic myelocytic leukemia Leukopenia with immature granulocytes in all stages, including blasts with markedly decreased LAP and philadelphia chromosome, positively identify CML. Leukopenia is consistent with engorged marrow space.

359) On an electrical particle counter, if the RBC is erroneously increased, how will other parameters be affected? a) increased MCHC b) increased Hgb c) decreased MCH d) increased MCV

c) decreased MCH Formulas for calculation of the indicies; falsely increased RBC should not affect Hgb.

347) Excess D-dimer indicate that clots have been: a) converted to fibrin monomers b) released into circulation c) formed and are being excessively lysed d) stimulated to activate platelets

c) formed and are being excessively lysed D-dimers are produced from crosslinked and stabilized fibrin clots. These clots are dissolved by plasma and D-dimers suggest a breakdown of fibrin clots, and indicate that clots have been formed at the site of injury.

257) In flow cytometry analysis, right angle (90°) or side scatter of a laser light beam provides information that pertains to a cell's: a) volume b) viability c) granularity d) lineage

c) granularity In flow cytometry, side scatter provides an estimate of cell complexity or granularity.

306) Which of the following statements concerning Vitamin K is NOT true? a) there are 2 sources of Vitamin K; vegetable & bacterial b) Vitamin K converts precursor molecules into functional coagulation factors c) heparin inhibits the action of Vitamin K d) Vitamin K is fat soluble.

c) heparin inhibits the action of Vitamin K Vitamin K is present in green vegetables, fish, liver & tobacco and synthesized by bacteria in the intestine. Naturally occurring vitamin K is fat soluble. Warfarin is the most popular vitamin K antagonist. Heparin inhibits Factor Xa and thrombin.

264) Which of the following cells contain hemosiderin? a) megakaryocyte b) osteoclast c) histiocyte d) mast cell

c) histiocyte Bone marrow and splenic macrophages contain hemosiderin; histiocyte is a collective term for macrophages.

144) The white cell feature most characteristic of pernicious anemia is: a) eosinophilia b) toxic granulation c) hypersegmentation d) atypical lymphocytes

c) hypersegmentation Hypersegmented neutrophils in pernicious anemia.

174) The absence of intermediate maturing cells between the blast and mature neutrophils commonly seen in acute myelocytic leukemia and myelodysplastic syndrome is called: a) subleukemia b) aleukemic leukemia c) leukemia hiatus d) leukemoid reaction

c) leukemia hiatus Definition of 'hiatus' as opening or break demonstrates the absence of intermediate maturing cells.

135) Elevation of the total white cell count above 12 is termed: a) relative lymphocytosis b) absolute lymphocytosis c) leukocytosis d) relative neutrophilic leukocytosis

c) leukocytosis

129) A term that means varying degrees of leukocytosis with a shift to the left and occasional nucleated red cells in the peripheral blood is: a) polycythemia vera b) erythroleukemia c) leukoerythroblastosis d) megaloblastoid

c) leukoerythroblastosis Definition of leukoerythroblastosis

130) Cells that produce antibodies and lymphokines are: a) erythrocytes b) granulocytes c) lymphocytes d) thrombocytes

c) lymphocytes Lymphocyte function.

191) Which of the following is true of acute lymphoblastic leukemia (ALL)? a) occurs most commonly in children 1-2 years of age b) patient is asymptomatic c) massive accumulation of primitive lymphoid-appearing cells in bone marrow occurs d) children under 1 year of age have a good prognosis

c) massive accumulation of primitive lymphoid-appearing cells in bone marrow occurs Characteristics of ALL; onset highest 1-5 yrs of age with peak at 2-3 yrs of age; presents with lethargy, fever, bone pain, with poor prognosis under 1 yr. of age.

148) Abnormalities in erythroleukemia include: a) rapid DNA synthesis b) marrow fibrosis c) megaloblastoid development d) increased erythrocyte survival

c) megaloblastoid development Differentiates this from other myeloid leukemias or other red cell abnormalities.

217) In synovial fluid, the most characteristic microscopic finding in gout it: a) calcium pyrophosphate crystals b) cartilage debris c) monosodium urate crystals d) hemosiderin-laden macrophages

c) monosodium urate crystals Correlation of gout with sodium urate crystals.

282) Which of the following is characteristic of platelet disorders? a) deep muscle hemorrhages b) retroperitoneal hemorrhages c) mucous membrane hemorrhages d) severely prolonged clotting times

c) mucous membrane hemorrhages MM hemorrhage is typical of platelet disorders; remaining choices are typical of coagulation factor disorders.

157) Which of the following is associated with pseudo-Pelger-Huet anomaly? a) aplastic anemia b) iron deficiency anemia c) myelogenous leukemia d) Chediak-Higashi syndrome

c) myelogenous leukemia Differentiates leukemia with classic granulocyte anomaly.

121) Which of the following is used for staining reticulocytes? a) Giemsa stain b) Wright stain c) new methylene blue d) Prussian blue

c) new methylene blue Using a supravital stain (new methylene blue), residual ribosomal RNA is precipitated within the reticulocytes.

73) The following results were obtained on a patient's blood: Hgb: 11.5 Hct: 40 MCV: 89 MCH: 26 MCHC: 29 Examination of a Wright-stained smear of the same sample would most likely show: a) macrocytic, normochromic erythrocytes b) microcytic, hypochromic erythrocytes c) normocytic, hypochromic erythrocytes d) normocytic, normochromic erythrocytes

c) normocytic, hypochromic erythrocytes Use knowledge of RBC indicies to classify anemia

263) Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow? a) progressive decrease in overall cell size b) increasing basophilia of cytoplasm c) nuclear division without cytoplasmic division d) fusion of the nuclear lobes

c) nuclear division without cytoplasmic division Nuclear maturation and division occurs first, and is largely complete before cytoplasmic maturation begins.

167) In chronic myelocytic leukemia, blood histamine concentrations tend to reflect the: a) number of platelets present b) serum uric acid concentrations c) number of basophils present d) the total number of granulocytes

c) number of basophils present Demonstrates nature of basophils

337) In the APTT test, the patient's plasma is mixed with: a) ADP and calcium b) tissue thromboplastin and collagen c) phospholipid and calcium d) tissue thromboplastin and calcium

c) phospholipid and calcium The APTT reagent contains phospholipid and a negatively-charged particulate activator such as kaolin, ellagic acid, or Celite. Ionic calcium and phospholipid are supplied as reagents.

376) The ideal capillary blood collection site on a newborn is: a) tip of the thumb b) ear lobe c) plantar surface of the heel d) the great toe

c) plantar surface of the heel The heel is the preferred site for drawing capillary blood from the newborn. The posterior curvature of the heel should never be used.

136) Elevation of the granulocyte percentage above 75% is termed: a) absolute lymphocytosis b) leukocytosis c) relative neutrophilic leukocytosis d) absolute neutrophilic leukocytosis

c) relative neutrophilic leukocytosis

53) Which of the following types of polycythemia is a severely burned patient MOST likely to have? a) polycythemia vera b) polycythemia, secondary to hypoxia c) relative polycythemia associated with dehydration d) polycythemia associated with renal disease

c) relative polycythemia associated with dehydration Polycythemia, in burn patient

29) A patient is admitted with a history of chronic bleeding secondary to peptic ulcer. Hematology work-up reveals a severe microcytic, hypochromic anemia. Iron studies were requested. Which of the following would be expected in this case? Serum Iron TIBC Storage Iron result A decreased increased increased result B increased decreased increased result C decreased increased decreased result D increased normal decreased a) result A b) result B c) result C d) result D

c) result C Iron Studies: microcytic hypochromic anemia results in a decrease in serum and storage iron, but an increase in TIBC.

355) A specimen run on an automatic cell counter has a platelet count of 19. The first thing a tech should do is: a) report the count after the batch run is complete b) request a new specimen c) review the stained blood smear d) notify the laboratory manager

c) review the stained blood smear Low platelet count values should be verified with a slide estimate.

19) What cell shape is MOST commonly associated with an increased MCHC? a) teardrop cells b) target cells c) spherocytes d) sickle cells

c) spherocytes May be referred to as hyperchromic because of decreased MCHC.

70) The lab tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? a) iron deficiency b) hereditary spherocytosis c) vitamin B12 deficiency d) acute hemorrhage

c) vitamin B12 deficiency Recognize the lab findings in megaloblastic anemia

68) Which of the following is the formula for absolute cell count? a) number of cells counted/total count b) total count/number of cells counted c) 10 x total count d) % of cells counted x total count

d) % of cells counted x total count The absolute concentration of each type of cell in a WBC differential is important for determining an increase or decrease.

107) Which of the following is the formula for mean corpuscular hemoglobin (MCH)? a) Hct/(RBC x 100) b) Hgb/Hct c) RBC/Hct d) (Hgb x 10)/RBC

d) (Hgb x 10)/RBC Calculation of RBC indicies

116) What is the MCV if the Hct is 20%, the RBC is 1.5 and the Hgb is 5 g/dL? a) 68 b) 75 c) 115 d) 133

d) 133 MCV = Hct x 10 / RBC Calculating RBC indicies

280) Thrombocytosis would be indicated by a platelet count of: a) 100 b) 200 c) 300 d) 600

d) 600 Definition of increased platelet count.

114) Given the following data: Hgb: 8 g/dL Hct: 28% RBC: 3.6 The MCV is: a) 28 b) 35 c) 40 d) 77

d) 77 MCV = Hct x 10 / RBC Calculating RBC indicies.

210) Of the following, the disease most closely associated with mucopolysaccharidosis is: a) Pelger-Huet anomaly b) Chediak-Higashi syndrome c) Gaucher disease d) Alder-Reilly anomaly

d) Alder-Reilly anomaly Discrimination of anomaly from others involving nuclear hyposegmentation; large granules in leukocytes; lipid storage disease.

336) The prothrombin time test requires that the patient's citrated plasma be combined with: a) platelet lipids b) thromboplastin c) Ca++ and platelet lipids d) Ca++ and thromboplastin

d) Ca++ and thromboplastin PT thromboplastin reagents are prepared from recombinant or affinity purified tissue factor suspended in phospholipid mixed with a buffered 0.025M solution of calcium chloride.

307) Which of the following is Vitamin-K dependent? a) Factor XII b) fibrinogen c) antithrombin III d) Factor VII

d) Factor VII Factor VII (proconvertin) is a single-chain glycoprotein that is Vitamin K dependent and remains stable for 4-5 hours in blood. Produced in the liver, it has the shortest half-life; therefore, it is the first factor affected when a Vitamin K antagonist such as Warfarin is administered.

197) Morphologic variants of plasma cells do NOT include: a) flame cells b) morula cells c) grape cells d) Gaucher cells

d) Gaucher cells Recognition that Gaucher cells are from lipid storage disease, not plasma cell variance.

1) The light-colored zone adjacent to the nucleus in a plasmacyte is the: a) ribosome b) chromatin c) mitochondria d) Golgi area

d) Golgi area Morhphological identifiable perinuclear halo.

64) Which of the RBC indicies is a measure of the amount of hemoglobin in individual red blood cells? a) MCHC b) MCV c) Hct d) MCH

d) MCH Patients unable to synthesize normal amounts of hemoglobin show reduction in the MCH.

104) A blood sample from a patient with high-titer cold agglutinin, analyzed at room temperature, with an electronic particle counter would cause an error in the: a) Hgb and MCV b) MCHC and WBC c) WBC and RBC d) MCV and MCHC

d) MCV and MCHC

202) Which of the following anomalies is an autosomal dominant disorder characterized by irregularly-sized inclusions in polymorphonuclear neutrophils, abnormal giant platelets and often thrombocytopenia? a) Pelger-Huet b) Chediak-Higashi c) Alder-Reilly d) May-Hegglin

d) May-Hegglin Description of MH anomaly.

175) Which of the following is most closely associated with chronic myelogenous leukemia? a) ringed sideroblasts b) disseminated intravascular coagulation c) micromegakaryocytes d) Philadelphia chromosome

d) Philadelphia chromosome Classic discrimination between CML vs other hematological conditions: sideroblastic anemia, PML, myelofibrosis.

122) Which of the following stains is used to demonstrate iron, ferritin and hemosiderin? a) peroxidase b) Sudan black B c) periodic acid-Schiff (PAS) d) Prussian blue

d) Prussian blue Prussian blue stain is used for assessing iron stores in bone marrow.

315) The 2 factors that differentiate liver disease from Vitamin K deficiency are: a) II and VII b) IX and VII c) VIII and IX d) V and VII

d) V and VII Factors V and VII are helpful in distinguishing between liver disease and Vitamin K deficiency. Factor VII is a Vitamin K dependent factor; however, Factor V is not and will not be decreased. Both factors will be decreased in liver disease.

319) A 4-yr-old boy presents with chronic ear infections and is on prophylactic antibiotics. He presents with bleeding. Factor assays reveal: Factor VIII 100% (ref. range: 50 - 150%) Factor V 75% (ref. range: 50 - 150%) Factor IX 38% (ref. range: 50 - 150%) Factor II 22% (ref. range: 50 - 150%) Possible causes are: a) Factor II deficiency b) lupus anticoagulant c) hemophilia d) Vitamin K deficiency

d) Vitamin K deficiency Long-term antibiotic therapy disrupts normal flora, which provides a source of Vitamin K synthesis. This results in a Vitamin K deficiency.

183) Hemorrhage in polycythemia vera is the result of: a) increased plasma viscosity b) persistent thrombocytosis c) splenic sequestration of platelets d) abnormal platelet function

d) abnormal platelet function Discriminates between faulty function of platelets, which would inhibit clotting and other PCV characteristics.

134) Elevation of the total granulocyte count above 7.7 is termed: a) relative lymphocytosis b) leukocytosis c) relative neutrophilic leukocytosis d) absolute neutrophilic leukocytosis

d) absolute neutrophilic leukocytosis

194) Chronic lymphocytic leukemia is defined as a(n): a) malignancy of the thymus b) accumulation of prolymphocytes c) accumulation of hairy cells in the spleen d) accumulation of monoclonal B cells with a block in cell maturation

d) accumulation of monoclonal B cells with a block in cell maturation Discrimination of CLL from other major mature B cell neoplasms.

150) Auer rods are MOST likely present in which of the following? a) chronic myelocytic leukemia b) myelofibrosis with myeloid metaplasia c) erythroleukemia d) acute myelocytic leukemia

d) acute myelocytic leukemia Classic feature discriminates AML from other types of erythroid/myeloid metaplasia.

170) 50 - 90% myeloblasts in a peripheral blood smear is typical of which of the following? a) chronic myelocytic leukemia b) myelofibrosis with myeloid metaplasia c) erythroleukemia d) acute myelocytic leukemia

d) acute myelocytic leukemia >20% myeloblasts without other immature stages differentiates AML from CML and myeloid metaplasia; erythroleukemia requires at least 50% erythroid precursors in marrow.

177) A block in the differentiation or maturation of, and an accreation of immature hematopoietic progenitors is a hallmark of: a) chronic lymphocytic leukemia b) myeloproliferative diseases c) polycythemia vera d) acute myelogenous leukemia

d) acute myelogenous leukemia Acute leukemia is characterized by a maturation defect, whereby immature hematopoietic progenitors cannot overcome a block in differentiation, also known as leukemic hiatus.

227) A mean cellular Hgb concentration (MCHC) over 36 g/dL is frequently found in: a) hereditary spherocytosis b) lipemia c) active cold agglutinin disease d) all of the above

d) all of the above An elevation in the MCHC occurs in 50% of individuals with hereditary spherocytosis. Elevation in the MCHC above the upper normal limit should prompt investigation of the sample for autoantibodies that agglutinate RBCs, or on older instruments when the Hgb concentration is artifactually elevated by lipemia.

187) In comparison to malignant lymphoma cells, reactive lymphocytes: a) have a denser nuclear chromatin b) are known to be T cells c) have more cytoplasm and more mitochondria d) are morphologically more variable throughout the smear

d) are morphologically more variable throughout the smear Discriminates between reactive cell lines and more homogenous malignant cell lines.

16) Hemolysis in paroxysmal nocturnal hemoglobinuria (PNH) is: a) termperature-dependent b) complement-dependent c) antibody-mediated d) caused by a red cell membrane defect

d) caused by a red cell membrane defect RBC membrane defect increases susceptibility to complement mediated lysis.

91) Hematology standards include: a) stabilized red blood cell suspension b) latex particles c) stabilized avian red blood cells d) certified cyanmethemoglobin solution

d) certified cyanmethemoglobin solution Hgb concentration is calibrated using commercially available HiCN solutions of known content.

185) A patient has been treated for polycythemia vera for several years. His blood smear now shows: Oval macrocytes Howell-Jolly bodies Hypersegmented neutrophils Large, agranular platelets The most probable cause of this blood picture is: a) iron deficiency b) alcoholism c) dietary B12 deficiency d) chemotherapy

d) chemotherapy Smear findings demonstrate drug impact: megaloblastic changes due to interference with DNA synthesis (oval macrocytes) as well as other toxic nuclear effects (Howell-Jolly; hypersegmentation).

30) Which of the following is MOST closely associated with iron deficiency anemia? a) iron overload in tissue b) target cells c) basophilic stippling d) chronic blood loss

d) chronic blood loss Chronic blood loss frequently results in iron deficiency anemia.

96) When using the turbidity (solubility) method for detecting the presence of Hgb S, an incorrect interpretation may be made when there is a(n): a) concentration of less than 7 g/dL Hgb b) glucose concentration greater than 150 mg/dL c) blood specimen greater than 2 hours old d) decreased Hgb

d) decreased Hgb The low Hgb can result in a false-negative result

50) Thalassemias are characterized by: a) structural abnormalities in the hemoglobin molecule b) absence of iron in hemoglobin c) decreased rate of heme synthesis d) decreased rate of globin synthesis

d) decreased rate of globin synthesis Thalassemia cause

15) Heinz bodies are: a) readily identifiable with polychrome stains b) rarely found in glucose-6-phosphate dehydrogenase deficient erythrocytes c) closely associated with spherocytes d) denatured hemoglobin inclusions that are readily removed by the spleed

d) denatured hemoglobin inclusions that are readily removed by the spleen Formed with oxidization of Fe and formation of methemoglobin

361) The following results were obtained on an electronic particle counter: WBC: ++++ RBC: 2.01 Hgb: 7.7 Hct: 28.2% MCV: 141 MCH: 38.5 MCHC: 23.3 What steps should be taken before recycling the sample? a) clean the aperture b) warm the specimen c) replace the lysing agent d) dilute the specimen

d) dilute the specimen "++++" indicates a WBC that is above the reportable range of the instrument; dilute the sample and rerun.

186) In infectious mononucleosis, lymphocytes tend to be: a) small with little cytoplasm b) normal c) decreased in number d) enlarged and indented by surrounding structures

d) enlarged and indented by surrounding structures Differentiates morphologic features of IM.

80) Many microspherocytes, schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with: a) hereditary spherocytosis b) disseminated intravascular coagulation (DIC) c) acquired autoimmune hemolytic anemia d) extensive burns

d) extensive burns Patients who have suffered severe burns to more than 15% of their body generally show evidence of intravascular hemolysis. RBCs show changes including fragmentation, budding & microspherocyte formation.

387) A blue top tube is drawn for coagulation studies, the sample is a short draw, results may be: a) falsely shortened b) correct c) unable to be obtained d) falsely prolonged

d) falsely prolonged Falsely prolonged results will occur if there is too much anticoagulant for the plasma; this also occurs with an increased Hct. Conversely, if a tube is overdrawn, there may be too little anticoagulant, resulting in a clot.

241) In synovial fluid, the most characteristic finding in traumatic arthritis is: a) monosodium urate crystals b) cartilage debris c) calcium pyrophosphate crystals d) hemosiderin-laden macrophages

d) hemosiderin-laden macrophages Association of traumatic arthritis with macrophages containing hemosiderin.

10) In order for hemoglobin to combine reversibly with oxygen, the iron must be: a) complexed with haptoglobin b) freely circulating in the cytoplasm c) attached to transferrin d) in the ferrous state

d) in the ferrous state Functional form of Fe (reduced).

196) Which of the following is NOT a characteristic usually associated with hairy cell leukemia? a) pancytopenia b) mononuclear cells with ruffled edges c) splenomegaly d) increased resistance to infection

d) increased resistance to infection Characteristic features of hairy cell leukemia include all answers listed as well as decreased resistance to infection.

62) A 14-year-old boy is seen in the ER complaining of a sore throat, swollen glands and fatigue. The CBC results are: WBC: 16.0 RBC: 4.37 Hgb: 12.8 Hct : 38.4 Plt: 180 Differential: absolute neutrophils: 3.9 absolute lymphs: 6.0 absolute monos: 0.5 absolute atypical lymphs: 3.2 What is the most likely diagnosis? a) acute lymphocytic leukemia b) chronic lymphocytic leukemia c) viral hepatitis d) infectious mononeucleosis

d) infectious mononucleosis Infectious mononucleosis, the leukocyte is usually increased due to an absolute lymphocytosis. The platelet count is often mildly decreased.

352) Heparin acts by: a) precipitating fibrinogen b) binding calcium c) activating plasmin d) inhibiting thrombin

d) inhibiting thrombin Heparin acts by inhibiting thrombin and Factor Xa. Anticoagulants, such as sodium citrate, act by binding calcium to prevent a blood sample from clotting.

102) The following results were obtained from a post-surgical patient receiving total parenteral nutrition: Hospital Day 17 18 19 Hgb 12.1 11.6 9.4 Hct 29.2 29.4 28.8 The most consistent explanation for the above data is: a) acute surgical bleeder b) specimen on day 19 from wrong patient c) improperly mixed specimen on day 19 d) lipid interference on days 17 and 18

d) lipid interference on days 17 and 18 Any turbidity in the cyanmethemoglobin reagent-patient specimen will result in falsely elevated values.

138) Terminal deoxynucleotidyl transferase (TdT) is a marker found on: a) hairy cells b) myeloblasts c) monoblasts d) lymphoblasts

d) lymphoblasts TdT staining in lymphoblasts

139) Multipotent stem cells are capable of producing: a) daughter cells of only one cell line b) only T-lymphocytes and B-lymphocytes c) erythropoietin, thrombopoietin, and leukopoietin d) lymphoid and myeloid stem cells

d) lymphoid and myeloid stem cells Definition of multipotent stem cells.

173) Which of the following is most closely associated with chronic myelomonocytic leukemia? a) Philadelphia chromosome b) disseminated intravascular coagulation c) micromegakaryocytes d) lysozymuria

d) lysozymuria Findings differentiate between CMML vs. CML, PML and myelofibrosis.

262) vWF antigen can be found in which of the following? a) myeloblast b) monoblast c) lymphoblast d) megakaryoblast

d) megakaryoblast vWF is a constituent of platelet alpha granules, and is synthesized in the megakaryocyte as it develops

145) Which of the following conditions is NOT associated with a high incidence of leukemia? a) paroxysmal nocturnal hemoglobinuria b) Fanconi anemia c) aplastic anemia d) megaloblastic anemia

d) megaloblastic anemia Differentiates anemia due to conditioned nutritional deficiency from those of bone marrow dysfunction.

133) In normal adult bone marrow, the most common granuloctye is the: a) basophil b) myeloblast c) eosinophil d) metamyelocyte

d) metamyelocyte Normal bone marrow differential.

338) The APTT: a) tests the extrinsic coagulation pathway b) monitors Coumadin therapy c) requires tissue thromboplastin d) monitors heparin therapy

d) monitors heparin therapy The APTT is performed to monitor the effects of unfractionated heparin, to detect factor deficiencies, and the presence of inhibitors. The PT tests the extrinsic pathway and requires thromboplastin. It is also used to monitor warfarin (Coumadin) therapy.

233) Cell description: Size: 12 to 16 um Nucleus: oval, notched, folded over horseshoe shape Chromatin: fine lacy, stains light purple-pink Nucleoli: none present Cytoplasm: abundant, slate gray, fine lilac-colored granules This cell is a: a) promyelocyte b) lymphocyte c) neutrophil d) monocyte

d) monocyte Morphological description of a monocyte.

206) Which of the following is associated with Alder-Reilly inclusions? a) membrane defect of lysosomes b) Dohle bodies and giant platelets c) 2-lobed neutrophils d) mucopolysaccharidosis

d) mucopolysaccharidosis Morphologic alteration of neutrophils -- differentiated from Chediak-Higashi; May-Hegglin and Pelger-Huet anomalies.

11) In which of the following disease states are teardrop cells and abnormal platelets most characteristically seen? a) hemolytic anemia b) multiple myeloma c_) G-6-PD deficiency d) myeloid metaplasia

d) myeloid metaplasia RBC morphology; disease state identification

181) A patient has a tumor that concentrates erythropoietin. He is most likely to have which of the following types of polycythemia? a) polycythemia vera b) polycythemia, secondary to hypoxia c) benign familial polycythemia d) polycythemia associated with renal disease

d) polycythemia assoicated with renal disease Recognized red cell increase secondary to stimulation of excessive erythropoietin produced in the kidneys.

383) When platelets concentrate at the edges and feathered end of a blood smear, it is usually due to: a) abnormal proteins b) inadequate mixing of blood an anticoagulant c) hemorrhage d) poorly made wedge smear

d) poorly made wedge smear Platelet clumping is expected if smears are made directly from the finger. Smears must be made promptly before any clotting begins. It is important to examine the edges for platelet clumping.

291) The automated platelet count on an EDTA specimen is 58. 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: a) report the automated platelet count since it is more accurate than a platelet estimate. b) warm the EDTA tube and repeat the automated platelet count c) rerun the original specimen since the platelet count and blood smear estimate do not match d) recollect a specimen using a different anticoagulant

d) recollect a specimen using a different anticoagulant Platelet satellitism is reduced by collecting sample in sodium citrate.

290) An automated platelet count indicates platelet clumping, which is confirmed by examining the smear. The technician should: a) repeat the count on the same sample b) report the automated count c) perform a manual count d) recollect in sodium citrate

d) recollect in sodium citrate Platelet clumping is reduced by collecting sample in sodium citrate.

13) In the normal adult, the spleen acts as a site for: a) storage of red blood cells b) production of red blood cells c) synthesis of erythropoietin d) removal of imperfect and aging cells

d) removal of imperfect and aging cells Major site of destruction of senescent red blood cells

360) On setting up the electronic particle counter in the morning, one of the controls is slightly below the range for the MCV. Which of the following is indicated? a) call for service b) adjust the MCV up slightly c) shut down the instrument d) repeat the control

d) repeat the control Repeat the out-of-range control is the first appropriate course of action.

103) A patient has a high cold agglutinin titer. Automated cell counter results reveal an elevated MCV, MCH and MCHC. Individual erythrocytes appear normal on a stained smear, but agglutinates are noted. The appropriate course of action would be to: a) perform the RBC, Hgb, and Hct determinations using manual methods b) perform the RBC determination by a manual method; the the automated results for the Hgb and Hct c) repeat the determinations using a microsample of diluted blood d) repeat the determination using a pre-warmed microsample of the diluted blood

d) repeat the determination using a pre-warmed microsample of the diluted blood Autoagglutination of anticoagulated blood can occur at room temp in patient with cold autoagg. The MCV will be falsely elevated and the RBC count falsely decreased, resulting in elevated MCHC. The blood sample should be warmed to 37° and rerun.

48) Which of the following represents characteristic features of iron metabolism in patients with anemia of chronic disorder? Serum Iron Transferrin saturation TIBC result A normal normal normal result B increased increased norm/slight incr. result C normal markedly incr. normal result D decreased decreased norm/decreased a) result A b) result B c) result C d) result D

d) result D Iron studies in anemia of chronic disease show decreased serum iron and transferrin saturation; TIBC may be decreased as well or normal.

82) The most characteristic peripheral blood smear finding in multiple myeloma is: a) plasmacytic satellitosis in the bone marrow b) many plasma cells in the peripheral blood c) many Mott cells in the peripheral blood d) rouleaux formation of the red cells

d) rouleaux formation Rouleaux is the stacking of red cells like coins and is caused by increased amounts of immunoglobulins in the blood causing RBCs to adhere to each other.

388) The ISI in the INR represents the reagents: a) activator b) specificity c) phospholipids d) sensitivity

d) sensitivity The ISI represents the International Sensitivity Index. The most responsive reagents have an ISI of 1.

37) Patients with A(-) type G-6-PD deficiency are LEAST likely to have hemolytic episodes in which of the following situations? a) following the administration of oxidizing drugs b) following the ingestion of fava beans c) during infections d) spontaneously

d) spontaneously G-6-PD deficiency - hemolytic stimulus

49) A characteristic morphologic feature in Hgb C disease is: a) macrocytosis b) spherocytosis c) rouleaux formation d) target cells

d) target cells Morphology in Hgb C disease

377) When evaluating a smear for a reticulocyte count, the tech observes that the RBCs are overlapping throughout the entire slide. The most likely explanation is: a) grease on the slide prevented even spreading b) improper proportions of blood and stain were used c) the slide was dried too quickly d) the drop used for the slide preparation was too large

d) the drop used for the slide preparation was too large Too large of a drop will produce a thick smear; slowly pushing the blood will affect the distribution of the cells.

342) A prolonged thrombin time and normal reptilase-R time are characteristic of: a) dysfibrinogenemia b) increased D-dimer c) fibrin monomer-split product complexes d) therapeutic heparinization

d) therapeutic herparinization A prolonged thrombin time can indicate diminished or abnormal fibrinogen, the presence of FDPs, paraproteins, and heparin. Reptilase is insensitive to the effects of herparin, and sensitive to dysfibrinogenemia. Therefore, when the TT is prolonged and the reptilase test is normal, this confirms the presence of heparin.

394) On Monday a patient's Hgb determination was 11.3 g/dL, and on Tuesday it measured 11.8 g/dL. The standard deviation of the method used is + 0.2 g/dL. Which of the following can be concluded about the Hgb values given? a) one value probably resulted from lab error b) there is poor precision; daily QC charts should be checked c) the second value is out of range and should be repeated d) there is no significant change in the patient's Hgb concentration

d) there is no significant change in the patient's Hgb concentration The distribution of data around the mean is the standard deviation. Using a specific confidence interval of 95.5%, or 2 SD, the results fall between +0.2 (1SD) or +0.4 (2SD).

270) Cells involved in hemostasis are: a) erythrocytes b) granulocytes c) lymphocytes d) thrombocytes

d) thrombocytes Thrombocytes (platelets) participate in several aspects of hemostasis.

309) Hageman Factor (XII) is involved in each of the following reactions EXCEPT: a) activation of C1 to C1 esterase b) activation of plasminogen c) activation of Factor XI d) transformation of fibrinogen to fibrin

d) transformation of fibrinogen to fibrin Factor XII is a contact factor, which is activated to Factor XIIa. It is responsible for the activation of Factor XI to Factor XIa. Fibrinogen is converted to fibrin by the action of thrombin.

318) The results on a patient are: PT 18.5 sec (ref. range: 11.0-13.5) APTT 47.5 sec (ref. range: 24-35) thrombin time 14.0 sec (ref. range: 12-19) ATIII 82% (70-130%) protein C 54% (77-167%) protein S 48% (65-140%) activated protein C resistance 2.6 (>2.1) These results reflect: a) thrombophila b) Factor IX deficiency c) heparin d) warfarin

d) warfarin Warfarin is a Vitamin K antagonist; coagulation Factors II, VII, IX, X, Protein C, and S are reduced as nonfunctional molecules are produced. The rate of reduction is based on the half-life of the factors.