Hematology 126 Final Review

Picture: Identify the cell at the end of the pointer. a. Band neutrophil b. Metamyelocyte c. Promyelocyte d. Monocyte

Metamyelocyte

Which of the following statements does not correctly characterize the relationships among macrocytic anemia, megaloblastic anemia, and pernicious anemia? a. megaloblastic anemia is macrocytic b. pernicious anemia is macrocytic c. macrocytic anemias are megaloblastic d. pernicious anemia is megaloblastic

c. macrocytic anemias are megaloblastic

Which of the following is a common finding in aplastic anemia? a. a monoclonal disorder b. tumor infiltration c. peripheral blood pancytopenia d. defective BNA synthesis

c. peripheral blood pancytopenia

In myeloid cells, the stain that selsctively identifies phospholipid in the membranes of both primary and secondary granules is: a. PAS b. myeloperoxidase c. sudan black B stain d. terminal deoxnucleotidyl transferase (TdT)

c. sudan black B stain

Picture: The cell at the tip of the pointer is referred to as a: a. Stomatocyte b. Target cell c. Normal erythrocyte d. Spherocyte

d. Spherocyte

The maturational sequence of the erythrocyte series is: (1)rubriblast, prorubricyte, rubricyte, metarubricyte, reticulocyte, mature erythrocyte (2)basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, reticulocyte, mature erythrocyte (3)prorubricyte, rubricyte, metarubricyte, reticulocyte, mature erythrocyte (4)pronormoblast, basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, reticulocyte, mature erythrocyte. a. 1&2 b. 2&3 c. 3&4 d. 1&4

d. 1&4

The average life span of the rbc is ____ days. a. 7 b. 30 c. 60 d. 120

d. 120

A patient's hemoglobin is 13 g/dl. What would you expect the hematocrit to be? a. 40% b. 33% c. 42% d. 39% e. none of the above

d. 39%

Tyrosine kinase is an important mediator in leukocyte metabolic pathways because it suppresses: a. Opsonization b. Phagocytosis c. Leukoerythroblastosis d. Apoptosis

d. Apoptosis

All of the following may lead to deficiencies of clotting factors except: a. Renal disease b. Liver disease c. Autoimmune disease d. Cardiovascular disease

d. Cardiovascular disease

In adults, which of the following is the most common cause of iron deficiency anemia? a. Intestinal parasites b. Malabsorptive disorders c. Dietary content d. Chronic blood loss

d. Chronic blood loss

The best choice of anticoagulant for a CBC and differential is: a. Ammonium and potassium oxalate b. Trisodium citrate c. Heparin d. EDTA

d. EDTA

All of the following are symptoms of iron deficiency anemia except: a. Pallor b. Pica c. Vertigo d. Hair loss

d. Hair loss

Asynchrony in the bone marrow is defined as the: a. Presence of nucleoli throughout each maturation phase b. Presence of extremely basophilic cytoplasm in all precursors c. Lack of nuclear development in precursor cells d. Nuclear development and hemoglobin development that is unbalanced

d. Nuclear development and hemoglobin development that is unbalanced

All of the following are dysplastic changes of platelets frequently seen in MDS except: a. Abnormal granulation b. Micromega karyocytes c. Giant platelets d. Platelet satellitism

d. Platelet satellitism

The reticulocyte count is an expression of a. Red cell width b. Red cell hemoglobin concentration c. Red cells in suspension d. Red cell production

d. Red cell production

Lymphocyte concentrations in peripheral blood are greatest during what age interval? a. Immediately after birth b. Older adult (40 to 70 years) c. Young adult (16 to 40 years) d. Young child (up to 4 years)

d. Young child (up to 4 years)

Which of the following assays will be abnormal with hemophilia A? a. Platelet count b. Bleeding time c. PT d. aPTT

d. aPTT

Which of the following findings is not consistent with a diagnosis of megaloblastic anemia? a. absolute decrease of neutrophils b. increased RDW c. increased lactate dehydrogenase d. absolute increase in reticulocytes

d. absolute increase in reticulocytes

Tissue factor pathway inhibitor (TFPI): a. Prevents activation of factor X by VIIa b. Activates the common pathway c. Inhibits fibrinolysis d. Inhibits the kallikrein proteins

a. Prevents activation of factor X by VIIa

The CBC parameter that gives insight as to the amount of anisocytosis present in a specimen is: a. RDW b. MCHC c. MCV d. Hgb

a. RDW

Which of the following could show up in children due to lead poisoning? a. aplastic anemia b. anemia of chronic disorders c. hereditary sideroblastic anemia d. acquired sideroblastic anemia

d. acquired sideroblastic anemia

Signs of intravascular hemolysis include a. hemoglobinuria b. hemosiderinuria c. hemoglobinemia d. all of the above

d. all of the above

Target cells (codocytes) may be observed in a. obstructive liver diease b. Hb SC disease c. thalassemia d. all of the above

d. all of the above

Target cells are also called a. drepanocytes b. leptocytes c. schistocytes d. codocytes

d. codocytes

A delta check is a historical reference on samples run in the laboratories. Once a sample fails a delta check, the most obvious corrective action is to: a. Verify the identification of the patient sample b. Reestablish the parameters of the delta check c. Perform reflex testing d. Perform a manual method

a. Verify the identification of the patient sample

When the bone marrow temporarily ceases to produce cells in a sickle cell patient, a(n) _________ crisis has occurred. a. aplastic b. hemolytic c. vaso-occlusive d. cardiac

a. aplastic

The main site of erythropoiesis in the adult is the: a. bone marrow b. liver c. kidney d. yolk sac

a. bone marrow

The rbc organic phosphate 2,3 DPG a. controls hemoglobin affinity for oxygen b. catalyzes porphyrin synthesis c. prevents oxidative denaturation of hemoglobin d. converts methemoglobin to oxyhemoglobin

a. controls hemoglobin affinity for oxygen

The screening test for hemogloin S that uses a reducing agent, such as sodium dithionite, is based on the fact that hemogloins that sickle are a. less soluble than normal hemogloin b. more soluble than normal hemoglobin c. unstable and precipitate easily d. oxidize quickly and cause turbidity

a. less soluble than normal hemogloin

The presence of hyposegmented granulocytes a. might be of no clinical significance b. is always seen in bacterial infections c. may be associated with first-and second-degree burns d. always implies a poor prognosis

a. might be of no clinical significance

Reticulocytes may be seen in Wright's stained smears as a. polychromasia b. nucleated RBC's c. spherocytes d. siderocytes

a. polychromasia

In the following description of a bone marrow smear, find the statement that is inconsistent with the expected picture in megaloblastic anemia. The marrow appears hypercellular with an M:E of 1:1 due to prominent erythroid hyperplasia. Megakaryocytes appear normal in number and appearance. The white blood cell elements appear larger than normal with especially large metamyelocytes, though they otherwise appear morphologically normal. The red cell precursors also appear large. There is nuclear-cytoplasmic asynchrony, with the nucleus appearing more mature than expected for the color of the cytoplasm. a. red blood cell nucleus more mature than cytoplasm b. larger than normal white cell elements c. larger than normal red blood cells d. normal appearance of megakaryocytes

a. red blood cell nucleus more mature than cytoplasm

Which of the following tests best determines the adequacy of production of RBCs in the bone marrow? a. reticulocyte count b. RDW c. peripheral blood smear examination d. hematocrit

a. reticulocyte count

A blood smear from a patient with sickle cell crisis shows 65 nucleated red cells per 1000 RBCS. The total leukocyte count is 19.2 × 103/microliter (19,200). The corrected white cell count is: a. 19,200 b. 11,640 c. 12,480 d. 29,538

b. 11,640

Through routine screening, prospective parents discover that they are both heterozygous for hemoglobin S. What percentage of their children could potentially have sickle cell disease (HbSS)? a. 0 b. 25 c. 50 d. 100

b. 25

Picture: The cells at the tip of the pointer are most frequently associated with: a. CLL b. Hairy cell leukemia c. Sézary syndrome d. Multiple myeloma

b. Hairy cell leukemia

Which parameter of a CBC is indicative of the oxygen carrying capacity of the patient? a. White blood cell count b. Hemoglobin c. Platelet count d. RDW

b. Hemoglobin

G6PD is found in the: a. Embden-Meyerhof pathway. b. Hexose monophosphate shunt. c. Luebering-Rapoport pathway. d. Methemoglobin reductase pathway.

b. Hexose monophosphate shunt.

The pathophysiology of megaloblastic anemia is: a. defective RNA synthesis and abnormal cytoplasm maturation b. defective DNA synthesis and abnormal nuclear maturation c. defective RNA synthesis and abnormal nuclear maturation d. defective DNA synthesis and abnormal cytoplasm

d. defective DNA synthesis and abnormal cytoplasm

A typical blood picture in infectious mononucleosis is an absolute: a. Lymphocytosis and anemia with many reactive lymphocytes b. Lymphocytosis without anemia and many reactive lymphocytes c. Monocytosis and anemia with many atypical monocytes d. Monocytosis without anemia and many atypical monocytes

b. Lymphocytosis without anemia and many reactive lymphocytes

The RBC index that is used to describe average RBC size is the a. RDW b. MCV c. MCH d. MCHC

b. MCV

Which of the following morphological features is classic in the megaloblastic anemias? a. Polychromasia b. Macroovalocytes c. Basophilic stippling d. Hypochromia

b. Macroovalocytes

The hemoglobin molecule will either hold onto or release oxygen depending on the: a. Amount of alpha or beta chains b. Relationship between the pulmonary and venous circulations c. Viscosity of the blood d. M:E ratio

b. Relationship between the pulmonary and venous circulations

The presence of CD2, CD5, and CD7 and the absence of CD10 is seen in: a. B lymphocytes b. T lymphocytes c. Myeloblasts d. Monoblasts

b. T lymphocytes

Hemolytic disease of the newborn is caused by a. a genetic defect b. a blood incompatibility c. an acute aplastic anemia d. a renal disorder

b. a blood incompatibility

Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia? a. acute myeloid leukemia without maturation b. acute promyelocytic leukemia c. acute myelomonocytic leukemia d. acute monocytic leukemia

b. acute promyelocytic leukemia

Heparin therapy is monitored best by performing routine: a. PT/INRs b. anti-factor Xa c. Fibrinogen levels d. Bleeding time tests

b. anti-factor Xa

A deficiency in the hexose monophosphate shunt results in a. schistocytes b. denatured hemoglobin c. ferric iron aggregates d. decreased membrane permeability

b. denatured hemoglobin

Which of the following CBC findings would be most suggestive of a megaloblastic anemia? a. MCV of 103 fL b. hypersegmentation of neutrophils c. RDW of 16% d. hemoglobin of 9.1 g/dL

b. hypersegmentation of neutrophils

Of the following, which would be difficult to detect if only the red cell morphology was used? a. macrocytic, normochromic anemia b. normocytic, normochromic anemia c. microcytic, hypochromic anemia d. all of the above

b. normocytic, normochromic anemia

The substitution of valine for glutamic acid at the sixth position of the beta chain of hemoglobin results in hemoglobin that a. is unstabel and causes formation of Heinz bodies b. polymerizes to form tactoid crystals c. crystalizes in a tetragonal shape d. contain iron in the ferric (Fe3+) state

b. polymerizes to form tactoid crystals

Red cell morphology such as the one at the tip of the pointer are associated with: a. von Willebrand’s disease b. Glanzmann’s thrombasthenia c. Thrombotic thrombocytopenic purpura d. All of the above

c. Thrombotic thrombocytopenic purpura

What is polychromatophilia? a. a condition caused by a decreased production of membrane proteins b. a form of hereditary anemia c. a bluish coloration of RBCs due to residual RNA d. an observable decrease in RBC hemoglobin content

c. a bluish coloration of RBCs due to residual RNA

The numbers of this cell greatly increase in parasitic infections. a. neutrophils b. basophils c. eosinophils d. lymphocytes

c. eosinophils

Anemia develops in persons with sickle cell disease because: a. the production of erythroid precursors is impaired b. antibodies coat the erythrocyte membrane leading to cell lysis c. erythrocytes have a greatly shortened life span d. marrow stem cells are inhibited or crowded out.

c. erythrocytes have a greatly shortened life span

Hypersegmentation of the neutrophilic qranulocyte is seen in a. vitamin B12 deficiency or iron deficiency b. iron deficiency or viral infections c. folate deficiency or as an inherited anomaly d. as an inherited anomaly or as a result of third-degree burns

c. folate deficiency or as an inherited anomaly

According to the morphological classification of anemias, megaloblastic anemia is a: a. macrocytic, hypochromic anemia b. macroctic, hyperchromic anemia c. macroctic, normochromic anemia d. normocytic, normochromic anemia

c. macroctic, normochromic anemia

All of the following are clinical manifestations of both B12 deficiency and folate deficiency except: a. anemia and jaundice b. weakness and shortness of breath c. thrombocytopenia and bleeding d. hemoglobinuria

d. hemoglobinuria

The presence of many sickled erythrocytes on a peripheral blood smear is most likely to be found in a person who is: a. heterozygous for HbC b. homozygous for HbC c. heterozygous for HbS d. homozygous for HbS

d. homozygous for HbS

A left shift is a(n) a. decrease in immature granulocytes b. decrease in immature lymphocytes c. increase in immature lymphocytes d. increase in immature granulocytes

d. increase in immature granulocytes

The glycoprotein necessary for absorption of vitamin B12 is: a. albumin b. transcobalamin ll c. haptoglobin d. intrinsic factor

d. intrinsic factor

Which of the disorders below causes ineffective erythropoieis? a. G6PD deficiency b. liver disease c. Hgb C disease d. pernicious anemia

d. pernicious anemia

Oxygen delivery is the primary purpose of hemoglobin. True False

True

Patients with moderate anemias (7 to 10 g/dL) may be asymptomatic. True False

True

The normal value for a reticulocyte count is: a. .5-1.5% b. 3-5% c. .1-.5% d. 10-15%

a. .5-1.5%

What percentage of RBC catabolism normally occurs in the vascular system? a. 10 b. 20 c. 50 d. 90

a. 10

The adult hemoglobin reference range for adult whole blood is: a. 12.0-18.0 g/dl b. 16-20 g/dl c. 8-12 g/dl d. 10-14 g/dl e. none of the above

a. 12.0-18.0 g/dl

A high-risk factor for the diagnosis of essential thrombocythemia is: a. A platelet count of greater than 600,000 b. Extramedullary hematopoiesis c. The presence of BCR/ABL d. Fibrotic bone marrow

a. A platelet count of greater than 600,000

The CD markers associated with CLL include all of the following except: a. CD 4 b. CD 15 c. CD 19 d. CD 20

a. CD 4

Which of the following is characteristic of Auer rods? a. Composed of fused primary granules b. Predominantly seen in ALL c. Predominantly seen in HCL d. Composed of specific granules

a. Composed of fused primary granules

An excess of which of the following is indicative of the breakdown of fibrin products within the circulating blood? a. D-dimers b. Alpha-2-antiplasmin c. Protein C d. Plasmin

a. D-dimers

As the cell matures, nucleoli a. Disappear b. Become more prominent c. Remain the same

a. Disappear

The alpha thalassemias result from: a. Gene deletion b. Defective alpha genes c. Iron overload d. Excessive production of alpha chains

a. Gene deletion

Picture: The inclusions pictured below are seen with supravital staining only. Top is Wrights Giemsa and the bottom shows the inclusions with a supravital stain. These inclusions are most likely: a. Heinz bodies b. Howell-Jolly bodies c. Pappenheimer bodies d. Due to stain contamination

a. Heinz bodies

A patient who has a persist leukocytosis, Dohle bodies, and an elevated LAP score most likely has a (an): a. Leukemoid reaction b. Pelger-Huët anomaly c. Parasitic infection d. HIV infection

a. Leukemoid reaction

A patient whose RBC = 4.02 x 10 12/uL, Hgb = 12.5 g/dL, and HCT = 37.2% has the following RBC indices: a. MCV=92.5 fL, MCH= 31.1 pg, MCHC= 33.6 % b. MCV=92.5 fL, MCH=33.6 pg, MCHC= 31.1% c. MCV=107.8 fL, MCH=32.1 pg, MCHC=29.8% d. MCV=149.2, MCH=31.2 pg, MCHC= 33.5%

a. MCV=92.5 fL, MCH= 31.1 pg, MCHC= 33.6 %

When iron is present in an oxidized state, as Fe+3 or ferric iron, the resulting hemoglobin is known as: a. Methemoglobin b. Carboxyhemoglobin c. Sulfhemoglobin d. Deoxyhemoglobin

a. Methemoglobin

Intrinsic factor is secreted by the: a. Parietal cells of the stomach b. Ileum c. Thyroid d. Bone marrow

a. Parietal cells of the stomach

A variation in shape of RBCs is termed: a. Poikilocytosis b. Anisocytosis c. Polychromasia d. Hypochromasia

a. Poikilocytosis

A patient presents with mild normochromic, normocytic anemia. On the peripheral smear there are a few target cells, a rare nRBC, and tetragonal crystals both within and lying outside of the RBCs. Which of the following abnormalities in the hemoglobin molecule is most likely? a. decreased production of beta chains b. substitution of lysine for glutamic acid at the sixth position of the beta chain c. substitution of a tyrosine amino acid for the proximal histidine amino acid in the beta chain d. double substitution on the beta chain

b. substitution of lysine for glutamic acid at the sixth position of the beta chain

Another term for platelet is a. erythrocyte b. thrombocyte c. leukocyte d. none of the above

b. thrombocyte

The carrier protein that delivers iron to the RBC membrane is a. protoporphyrin b. transferrin c. ferritin d. hemosiderin

b. transferrin

An elevated MCV, along with a high RDW, suggests a. iron deficiency anemia b. vitamin B12 or folate deficiency c. sickle cell anemia d. normal blood picture

b. vitamin B12 or folate deficiency

Calculate the MCH based on the following parameters: hemoglobin = 12 g/dl, RBC count = 4.4 x 106 cu mm, hematocrit = 37% a. 30 pg b. 24 pg c. 27 pg d. 32 pg

c. 27 pg

One of the key morphological features of the nucleated red cell stages is: a. Basophilic cytoplasm through every stage of maturation b. Granules in the cytoplasm c. A round nucleus d. An increase in size as the cell matures

c. A round nucleus

_____ is predominantly a disease of children. a. AML b. CML c. ALL d. CLL

c. ALL

There are four phases in regards to platelet function. The correct order of occurrence from the beginning to end is: a. Adhesion, release, aggregation, stabilization b. Aggregation, adhesion, stabilization, release c. Adhesion, aggregation, release, stabilization d. Release, aggregation, adhesion, stabilization

c. Adhesion, aggregation, release, stabilization

A patient with DIC will have the following coagulation test results except: a. An increased PT/INR b. An increased aPTT c. An increased fibrinogen d. An increased D-dimer

c. An increased fibrinogen

The classic measure for hemoglobin is: a. Carboxyhemoglobin b. Sulfhemoglobin c. Cyanomethemoglobin d. Oxyhemoglobin

c. Cyanomethemoglobin

Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias? a. MCV 99 fl, MCH 28 pg, MCHC 31% b. MCV 62fl , MCH 27 pg, MCHC 30% c. MCV 125 fl, MCH 36 pg, MCHC 34% d. MCV 78 fl, MCH 23 pg, MCHC 30%

c. MCV 125 fl, MCH 36 pg, MCHC 34%

Hyperviscosity syndrome and paraproteinemia are associated with: a. Chediak-Higashi syndrome b. Wiskott-Aldrich syndrome c. Multiple myeloma and Waldenström’s macroglobulinemia d. ITP

c. Multiple myeloma and Waldenström’s macroglobulinemia

The most common hematological malignancy in the adult population is: a. Acute leukemia b. Multiple myeloma c. Myelodysplastic syndrome d. Chronic leukemias

c. Myelodysplastic syndrome

Heparin-induced thrombocytopenia (HIT) usually: a. Occurs as a result of protein C deficiency b. Will show an increase in platelets c. Occurs 5 to 14 days after heparin therapy d. Occurs only in males

c. Occurs 5 to 14 days after heparin therapy

Dohle bodies consist of: a. DNA b. Primary granules c. Ribosomes RNA d. Lipid deposits

c. Ribosomes RNA

Failure to thrive, facial structure abnormalities, severe anemia, and splenomegaly are signs of which of the following disorders? a. Thalassemia minor b. Alpha thalassemia trait c. Thalassemia major d. Thalassemia intermedia

c. Thalassemia major

In patients with sickle cell trait and no complicating disease: a. NRBCs and polychromasia are usually seen on the peripheral smear b. Sickle cells are prevalent in the peripheral blood c. There may be occasional hematuria d. There is a severe decrease in Hgb, Hct, and RBC count

c. There may be occasional hematuria