Hematology
A 76-year-old patient experiences frequent infections and bleeding episodes. She is also complaining of pain in her bones and joints. Upon routine exam, her physician orders a complete blood count and differential. The hematology technologist notices many cells appearing similar to the cell in the image to the right. Which condition is this patient most likely suffering from?
Acute Myeloid Leukemia The presence of Auer rods are highly indicative of myeloid blasts. Auer rods are not present within lymphoblasts, but can occasionally be found in monoblasts. In this case, the only condition that matches the symptoms and blood cells out of the choices above would be Acute Myeloid Leukemia.
Auer rods may be seen in blasts of all the following conditions EXCEPT:
Acute lymphocytic leukemia (Ll, L2, L3) Auer rods are typically only found in myeloblasts. Therefore in lymphocytic leukemia with lymphoblasts, Auer rods would not be seen.
Sites of active hematopoiesis in the adult are:
skull sternum scapula pelvis Each of the sites listed above are areas where hematopoiesis occurs in adults.
In which organ or tissue do T-lymphocytes mature?
thymus T-lymphocytes are created in the bone marrow, but develop in the thymus (hence their name- "T" lymphocytes). B-lymphocytes are created and matured in the bone marrow.
Which of the following represents the percent population of T-helper cells in this sample data? absolute lymphocyte count= 2.4 x 109/L %CD3 = 60 %CD4 = 40 %CD8 = 20
40% Feedback T-helper cells are CD4 positive. The flow results reflected 40% CD4. CD3 is a pan T cell marker (and should reflect CD4 plus CD8). CD8 is the cytotoxic/suppressor T cell marker. Question Difficulty: Level 3
The ratio of whole blood to anticoagulant is very important in the PT assay; at which hematocrit level should the standard anticoagulant volume be adjusted:
> 55% The effect of anticoagulant is too great to be ignored if the hematocrit value is greater than 55%.
Which of the following best describes a hemoglobinopathy ?
A substitution of an amino acid in the hemoglobin chain. A hemoglobinopathy is a substitution of an amino acid in the hemoglobin chain. When an amino acid substitution occurs, a new protein is formed. Hemoglobin destruction or problems with hemoglobin production are not exclusive to hemoglobinopathies. Other anemias that are not considered hemoglobinopathies may also involve increased hemoglobin destruction or problems with hemoglobin production. However, other anemias demonstrating hemoglobin production problems do not form an abnormal hemoglobin protein. Deletion of a hemoglobin chain loci results in decreased production of that chain (thalassemia), and not production of a different hemoglogin protein.
Match the names of the inclusions with their corresponding diagrams.
A= Pappenheimer bodies B= Basophilic stippling C= Cabot rings D= Howell-Jolly bodies
EDTA and Sodium citrate combine with _________ to inhibit coagulation in blood samples.
Calcium Calcium is bound by EDTA and Sodium citrate to inhibit coagulation processes from occuring in the tube. When the sample is being tested in the coagulation laboratory, the anticoagulant complexes with calcium are overcome by adding small amounts of calcium back until anticoagulant is overcome and the clotting endpoint can be formed for measurement purposes.
These test results are most consistent with which of the following types of beta thalassemia? Test Patient Result Reference Intervals (Adult female) Red blood cell (RBC) count 5.6 x 1012/L 4.1 - 5.1 x 1012/L Hemoglobin (Hb) 11.2 g/dL 12.3 - 15.3 g/dL Hematocrit (HCT) 34.5% 35.9 - 44.6% RDW 14.0 <14.5 RBC morphology- Microcytes, basophilic stippling, codocytes present.
Beta thalassemia minor These test results are most consistent with beta thalassemia minor. RBC count is increased, hemoglobin may be decreased or normal, but is relatively decreased for the number of RBCs that are present. There is also a marked decrease in the MCV and the MCHC, but the RDW is usually normal. Codocytes and microcytes are common and basophilic stippling is possible.
What characteristic is common to all of these conditions: hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?
red cell membrane defects Feedback Red cell membrane defects are present in each of the choices above. Question Difficulty: Level 4
Which of the following laboratory assays would be most helpful in determining the number of T cell lymphocytes in circulation?
Flow cytometry Feedback Flow cytometry detects different cell types by evaluating cell markers or evaluating chemical properties of the cell after they are labeled with a fluorescent dye. Then the cells are analyzed using a laser that detects fluorescence. T cells can be identified using flow cytometry by detecting the CD4 and CD8 markers on these cells. The other choices may be able to identify lymphocytes, but not specifically T lymphocytes. Question Difficulty: Level 3
What is the MOST likely cause of a patient who developed a severe hemolytic episode after taking anti-malarial drugs, and red cell inclusions caused by denatured hemoglobin were seen on the differential smear?
G-6-PD deficiency Feedback Individuals with G6PD deficiency develop a nonimmune hemolytic anemia in response to antimalarial drugs, most commonly primaquine. Question Difficulty: Level 4
An India Ink preparation is used to identify:
Cryptococcus neoformans in CSF Feedback India ink preparation performed on spinal fluid is used to demonstrate the polysaccharide capsule of Cryptococcus neoformans by negative staining. Direct detection of capsular antigen by agglutination or immunoassay techniques is much more sensitive, and has largely replaced the India Ink stain for clinical specimens. Question Difficulty: Level 2
Which one of the following sets of laboratory results is consistent with hemolytic anemia?
Decreased erythrocyte survival; increased catabolism of heme; decreased haptoglobin levels Hemolysis is the process of rbc destruction, which leads to decreased erthryocyte survival. Increased catabolism of heme is also associated with rbc destruction. Finally, haptoglobin is decreased since most of it binds to the free hemoglobin released with a red cell is destroyed.
The light blue-gray inclusions observed in the cytoplasm of many of the bands and segmented neutrophils of a burn patient are MOST likely?
Dohle bodies Feedback Dohle bodies are associated with the peripheral smears of burn patients. Auer rods are found in myeloblasts, toxic granules can be found in many conditions, especially infections. May-Hegglin bodies are found in May-Hegglin anomaly- a white cell disorder. Question Difficulty: Level 4
What cytoplasmic inclusion is indicated by the arrow in this image?
Döhle body Feedback The arrow is pointing to a Döhle body. Döhle bodies are small, blue-staining inclusions seen in the cytoplasm of mature and immature neutrophils in the presence of bacterial infections, drug intoxication, burns, cytokine therapy, surgery, or pregnancy. They may be seen in cells that also contain toxic granules and/or vacuoles. Question Difficulty: Level 4
Identify the cell in this illustration indicated by the arrow:
Eosinophil Eosinophils have characteristic large prominent orange granules.
Match the clotting factor with its commonly associated name:
Factor I- Fibrinogen Factor II- Prothrombin Factor V- Proaccelerin
Which of the following factors does not affect the result of the aPTT assay?
Factor VII The aPTT is prolonged secondary to deficiency of factors of the intrinsic pathway, specifically: prekallekrein, high-molecular-weight kininogen, Factors XII, XI, IX, VIII, X, V, II, and I.
Match clotting factor with its commonly associated name:
Factor XII- Hageman factor Factor XIII- Fibrin stabilizing factor Fletcher factor- Prekallikrein Fitzgerald factor- High-molecular-weight kininogen
Match the disease conditions on the left with appropriate red cell size classification on the right:
G6PD deficiency, Malaria Normocytic Iron deficiency, Thalassemia Microcytic Chronic Liver Disease, Vitamin B12 deficiency Macrocytic Feedback Normocytic- G6PD deficiency, Malaria Microcytic- Iron deficiency, Thalassemia Macrocytic- Chronic Liver Disease, Vitamin B12 deficiency Question Difficulty: Level 4
At an alkaline pH, which hemoglobin cannot be separated from hemoglobin S during hemoglobin electrophoresis?
Hb D Hemoglobin S and hemoglobin D both migrate to the same position at an alkaline pH during hemoglobin electrophoresis. Both hemoglobin A and F migrate to their own positions during electrophoresis.
Found frequently in a newborn's blood the cells indicated by arrow in this illustration are:
Nucleated red cells Feedback Not normally seen in the peripheral blood of adults, but are often seen in the blood of newborns. Question Difficulty: Level 1
What clinical characteristics might a person with beta thalassemia intermedia exhibit?
Some splenomegaly Growth and development in children with beta thalassemia intermedia is usually normal and most patients have a normal life span. However, they can demonstrate splenomegaly and some facial bone deformity.
Basophils' primary role involves:
Allergic reactions Feedback When an allergen enters the immune system, the antigen binds to these IgE receptors on the surface of the cells where IgE is able to bind to that allergen. This binding causes the degranulation of basophils. As degranulation occurs, basophils release a series of granular components that orchestrate the allergic reaction. Question Difficulty: Level 3
What is the mechanism of heparin-induced thrombocytopenia (HIT)?
Antibodies directed against platelet factor 4 (PF-4) and heparin complex HIT is a complication that may occur in some patients receiving heparin therapy. When heparin is administered to these patients, it forms an immune complex with platelet factor 4 (PF-4) that is released from the alpha granules in platelets. The body's immune system recognizes this complex as a foreign substance and forms an antibody against it. The antibody binds to this complex and the platelets are destroyed. HIT is not the result of administration of toxic doses of heparin. The dosing is correct; the thrombocytopenia is the result of the patient's immune response to the heparin. Abrupt cessation of heparin therapy will not cause thrombocytopenia. If a patient is diagnosed with HIT, heparin therapy should be stopped immediately and replaced with a different anticoagulant therapy if necessary.
Match the following cells with their corresponding characteristics:
Antibody production - B-Cell Associated with the thymus, cellular immunity - T-Cell Classified as a phagocyte - Neither T-Cell nor B-Cell
The predominant cells seen on the CSF smear in this illustration are indicative of:
Bacterial meningitis Feedback Intracellular bacteria within neutrophils are indicative of bacterial infection. Question Difficulty: Level 3
Identify the neutrophil nuclear projection in this image.
Barr body The neutrophil in this image has a tiny projection off of one of its lobes called a barr body. A barr body is a structure composed of condensed X chromosome that is found in nondividing nuclei of female mammals.
Identify the white blood cell seen in this illustration:
Basophil Basophils have characteristic large prominent dark granules.
Nucleated RBCs are most likely to be seen in the peripheral blood of which of these beta thalassemias?
Beta thalassemia major Nucleated RBCs may be seen in the peripheral blood in cases of beta thalassemia major. Nucleated RBCs are usually not found in peripheral blood in cases of beta thalassemia minor and beta thalassemia intermedia, and would not be a finding in beta thalassemia minima.
The Epstein-Barr Virus is associated with which of the following conditions:
Burkitt's lymphoma Though the Epstein-Barr virus is usually associated with infectious mononucleosis, it can also cause human cancer, including Burkitt's lymphoma. The virus combines with acquired genetic mutations to produce disease.
Identify the hemoglobin bands present, from cathode to anode, in the sample shown in row 5 of this hemoglobin alkaline electrophoresis.
C, S, A Feedback The correct answer from cathode (-) to anode (+) is CSA. Hemoglobins migrate from cathode (-) to anode (+) in alkaline electrophoresis, with hemoglobin C being the slowest, then hemoglobin S, and finally hemoglobin A, which is the fastest of the three. Question Difficulty: Level 4
What is the primary function of hemoglobin :
Carry Oxygen to tissues Hemoglobin serves to carry inspired oxygen from the lungs to tissues, and carbon dioxide from tissues back to the lungs, where it is expired.
A population of small lymphocytes is gated for further evaluation in the flow cytometry laboratory. The scatterplot for one of the evaluations is shown on the right. How would you interpret this scatterplot?
Cells in the gated population are coexpressing CD5 and CD20. Feedback The scatterplot represents coexpression of CD5 and CD20. Q2 of the scatterplot contains CD5/CD20 + cells. Question Difficulty: Level 4
The beta hemoglobin chain loci are found on which chromosome?
Chromosome 11 The beta hemoglobin chain loci are found on chromosome 11. Alpha and zeta hemoglobin loci are found on chromosome 16.
Which of the following statements regarding coagulation disorders is correct?
Clotting factors II, VII, IX and X are vitamin K-dependent. Clotting factors II, VII, IX and X are vitamin K-dependent. Vitamin K plays an important role in coagulation factor synthesis. A lack of vitamin K affects coagulation function. Hemophilia A and B are inherited disorders. The liver is the primary site for clotting factor production. Liver damage can cause hemostatic dysfunction.
A hemoglobin F concentration of 100% may be seen in which beta thalassemia?
Delta-beta thalassemia major Delta-beta thalassemia major, Delta-beta 0/ Delta-beta0, exists when both gene loci for beta and delta chains are completely deleted or inactive on both chromosomes. In this state, only Hb F can be made.
The hemoglobin electrophoresis pattern for patient #2 shows an increase in Hb F and a decrease in both Hb A and Hb A2. These results correlate best with which of these thalassemias?
Delta-beta thalassemia minor Decreases in both Hb A and A2 and an increase in Hb F correlates with delta-beta thalassemia minor. Delta-Beta Thalassemia results from a deletion in both the delta and beta genes on chromosome 11, preventing the appropriate production of hemoglobins A2 and A respectively. The gamma genes on the affected chromosome increase their production of gamma globin thereby increasing the amount of HbF.
A two-year old male patient has the following hemogram results: Hgb = 6.7gms/dl Hct = 20% Platelets = 355,000/ mm3 RBC = 3.0mil/cmm WBC = 8750/cmm Differential = 6 eos 20 segs 68 lymphs 6 monos Which of the following is the MOST likely diagnosis?
Dietary iron deficiency We can rule out answer Idiopathic thrombocytopenia since the platelet count is normal. We can also exclude lymphocytic leukemia because the WBC is normal. Thalassemia minor can be excluded because thalassemia patients usually have only mild anemia. Finally, lead poisoning cannot be the answer since this condition does not usually cause severe anemia. The RBC, Hct, and Hgb are all very low, and this fits the picture of iron deficiency anemia.
Match the functions listed below with the corresponding cell types.
Eosinophil Involved in some parasitic infection response Lymphocyte Involved in immune response; especially viral Platelet Involed in Hemostasis Feedback Eosinophils: Involved in parasitic infection response; allergic response Lymphocytes: Involved in immune response; especially viral Platelets: Involved in hemostasis Question Difficulty: Level 1
Identify the nucleated blood cell:
Eosinophils are granulocytic white blood cells which are identified by their large orange/red granules and a dark purple nucleus usually segmented into two lobes. Lymphocytes are nongranular white cells with a large dark staining nucleus and very little cytoplasm which stains light blue. They are the smallest white cells by size and typically second most numerous after neutrophils. Neutrophils are the most numerous granulocytic white blood cells. The neutrophils' cytoplasm stains pink, with bluish/lavender granules, and they have multilobulated nuclei which stains dark blue/purple. Monocytes are nongranular and the largest white blood cell by size. They have a folded nucleus and an irregular cellular shape. The cytoplasm stains gray-blue and often contains vacuoles.
With which of these conditions or procedures may there be an increased number of megakaryocytes in the bone marrow, but a decreased number of circulating platelets?
Folic acid deficiency Pancytopenia is often seen with megaloblastic anemias that are caused by folic acid or vitamin B12 deficiency. Thrombopoiesis (as well as erythropoiesis and granulopoiesis) is ineffective. The bone marrow will contain normal, or even increased megakaryocytes, but the number of platelets entering the peripheral circulation is decreased. In aplastic anemia, megakaryocytes are decreased in number in the bone marrow, leading to a decreased number of circulating platelets. Radiation therapy causes bone marrow hypoplasia. Platelets as well as all other cell lines are depressed. The effect is transient; once the therapy has ended, the marrow will regenerate. Massive blood transfusion may also cause a transient thrombocytopenia, but megakaryocytes will not be increased in the bone marrow.
In which disorder do neonates demonstrate the presence of Bart's hemoglobin that changes to beta chain tetramers in adults?
Hemoglobin H disease When insufficient alpha chains are produced, the remaining globin chains often form tetramers. This condition is seen in alpha thalassemia intermedia or Hemoglobin H disease. In neonates the gamma chain is present in high amounts, forming tetramers known as Bart's hemoglobin. As gamma chain production decreases, beta chain production increases. Adults form beta chain tetramers (Hemoglobin H).
Which of the following conditions might give rise to the red cell abnormality depicted here:
Hemolytic anemia The fine basophilic stippling seen here may be due to reticulocytosis secondary to hemolytic anemia. Coarse basophilic stippling is usually associated with megaloblastic anemia, thalassemias, and lead poisoning.
A completely sickled cell (drepanocyte) is most commonly seen in which of these conditions?
Homozygous HbSS Truly sickled cells are a result of a homozygous HbSS state.
Considering the peripheral blood smear image to the right, which condition(s) would most likely fit the white cell morphology present?
Severe infection Burns The image in this question shows Dohle bodies in the cytoplasm of the neutrophils. Dohle bodies are highly associated with severe infections, burns, and cancer (due to toxic drugs). Dohle bodies can also be found in conjunction with toxic granulation and toxic vacuolization.
The RBC inclusions shown in the photograph represent which of the following?
Howell-Jolly bodies Feedback The correct response is Howell-Jolly bodies. These intra-erythrocyte inclusions represent DNA nuclear fragments which are composed of chromosome-material separated from their mitotic spindles. Howell-Jolly bodies are usually single, round, and tend to be positioned at the periphery of the red blood cell. These inclusions are rarely found on a routine peripheral blood smear, as they are usually removed by a functioning spleen. Howell-Jolly bodies appear after splenectomy, in hereditary asplenia, and in splenic dysfunction as splenic fibrosis. The blood smear represented by the photograph was from a twenty-five-year-old man with disseminated lymphoma whose spleen was removed. Question Difficulty: Level 2
What are the erythrocyte inclusions that are indicated by the arrows on this blood smear?
Howell-Jolly bodies The small, spherical, dark blue-staining, non-refractile inclusions are known as Howell-Jolly bodies. They may represent chromosomal remnants, and may be found in pernicious anemia, hemolytic anemias, and after splenectomy.
Most of the red blood cells in this field could be described as:
Hypochromic This peripheral smears depicts many hypochromic red blood cells. The central pallor of a red cell should typically not exceed more than one-third of the red cell diameter. In these cells, the central pallor takes up most of the cell, indicating a decreased amount of hemoglobin inside of the cells. Patients displaying this morphology are often classified as anemic.
What morphological change is present in this image?
Hyposegmentation of the nucleus The morphology indicated by the cell in this image is hyposegmentation. This neutrophil, would normally have 3-5 lobes; however, in this case the nucleus has not segmented. This morphology is typical of a homozygous-inherited Pelger-Huet anomaly.
Which of these coagulation factors are referred to as "vitamin-K dependent?"
II, VII, IX, X Vitamin K dependent factors are those that require Vitamin K for their synthesis in the liver. Vitamin K is an important factor to gamma-glutamyl carboxylase which adds a carboxyl group to glutamic acid residues on factors II, VII, IX and X, as well as Protein S, Protein C. In adding the gamma-carboxyl group to glutamate residues on the immature clotting factors Vitamin K is itself oxidized. Deficiency of Vitamin K due to malabsorption, liver disease, etc. may contribute to bleeding disorders because clotting factor maturation depends on Vitamin K.
Which of the following is necessary for the absorption of Vitamin B12:
Intrinsic factor Feedback Intrinsic factor is necessary for the proper absorption of vitamin B12. With a deficiency of intrinsic factor, individuals can develop a megaloblastic anemia if their bodies become deficient in vitamin B12, which plays a large role in cellular nuclear development. Question Difficulty: Level 5
Why might serum ferritin (SF) alone be considered a less than optimal screening test for hereditary hemochromatosis (HH)?
It is an acute phase reactant that is frequently elevated in a variety of clinical conditions. SF is an acute phase reactant that is frequently elevated in a variety of clinical conditions, therefore it lacks the specificity needed for a good screening test.
Erythropoietin is produced in:
Kidneys Erythropoietin, which is produced in the kidneys, stimulates the production of red blood cells.
Nitric oxide is associated with the prevention of vaso-occlusion by decreasing cellular adherence to endothelium. Which amino acid is DECREASED in patients with sickle cell disease and is needed as a substrate to produce nitric oxide?
L-arginine The amino acid, L-arginine is a substrate needed to produce nitric oxide.
Please identify the illustrated leukocyte.
Lymphocyte The cell illustrated in the image on the right is a lymphocyte. Lymphocytes are nongranular white cells with a large dark staining nucleus and very little cytoplasm which stains light blue. They are the smallest white cells by size and typically second most numerous after neutrophils. Neutrophils are the most numerous granulocytic white blood cells. The neutrophils' cytoplasm stains pink, with bluish/lavender granules, and they have multilobulated nuclei which stains dark blue/purple. Monocytes are nongranular and the largest white blood cell by size. They have a folded nucleus and an irregular cellular shape. The cytoplasm stains gray-blue and often contains vacuoles. Basophils are the least numerous granulocytic white blood cells. They can be identified by their large dark blue/purple staining granules and a S shaped nucleus.
All of the following activities are associated with platelets EXCEPT:
Lysis lysis is not an activity associated with platelets. However, activation, aggregation and release of granules are associated with platelet function.
CD5 antigen is normally found on which of the following lymphocyte populations?
Mature T cells CD5 is present on mature T cells, but is not present on normal B cells. The presence of CD5 on B cells may indicate a B cell malignant process.
A patient has a WBC count of 4.0 x 109/L. Giant platelets, such as the one indicated by the red arrow in the image, are observed on the Wright stained peripheral smear. Blue-staining inclusions are also observed in several of the neutrophils. Considering the morphologies noted by the black and red arrows, what is the identity of this patient's blue-staining WBC inclusions?
May-Hegglin anomaly inclusion The black arrow points to a May-Hegglin anomaly inclusion. This inclusion resembles a Döhle body. However, toxic changes are not present as they would be if this were a Döhle body. The giant platelets that are observed in the field also help to identify this as May-Hegglin anomaly, the condition that is producing these inclusions.
In which age group is hereditary hemochromatosis (HH) most likely to be initially detected based on clinical symptoms?
Middle aged adults Most patients with HH become symptomatic during middle age.
Identify the cell in this illustration:
Myeloblast The cell in the image is a myeloblast. The myeloblast typically has a high nuclear to cytoplasm ratio, meaning that the nucleus size is increased compared to the amount of cytoplasm present. This cell can be defined as a myeloblast and not another type of blast, due to the presence of the auer rod in the cytoplasm. This is a key feature only found in myeloblasts.
Identify the nucleated blood cell:
Neutrophil Feedback Neutrophils are the most numerous granulocytic white blood cells. The neutrophils' cytoplasm stains pink, with bluish/lavender granules, and they have multilobulated nuclei which stains dark blue/purple. Lymphocytes are nongranular white cells with a large dark staining nucleus and very little cytoplasm which stains light blue. They are the smallest white cells by size and typically second most numerous after neutrophils. Basophils are the least numerous granulocytic white blood cells. They can be identified by their large dark blue/purple staining granules and a S shaped nucleus. Monocytes are nongranular and the largest white blood cell by size. They have a folded nucleus and an irregular cellular shape. The cytoplasm stains gray-blue and often contains vacuoles. Question Difficulty: Level 1
When evaluating a potentially malignant effusion, select all of the following choices which would apply.
Note presence of blasts or tumor clumps on report after confirmation by pathologist. Send cytospin preparation for hematology or pathology review. Notify clinician of suspected malignant cells according to hospital protocol. It is very important to send abnormal cytospins for hematology or pathology review, and notify clinician of suspected malignant cells according to hospital protocol. However, a technologist should neither identify a specific blast type or ignore any identifiable cells, as these practices can cause erroneous results and could adversely affect patient care.
Warfarin-based (coumarin derivative) oral anti-coagulant therapy is commonly monitored with :
PT/INR Feedback Coumarin derivatives inhibit the vitamin K dependent Factors (II, VII, X) which can be measured with the PT and monitored frequently with the INR assay. Question Difficulty: Level 3
Which of the following viruses is MOST often reported as the cause of infection leading to aplastic crisis in a patient with sickle cell disease?
Parvovirus B19 Parvovirus B19 is the most common causitive agent of aplastic crisis in sickle cell disease.
Which potent inhibitor of platelet aggregation is released by endothelial cells?
Prostacyclin Prostacyclin is produced by endothelial cells and prevents formation of the platelet plug involved in primary hemostasis by preventing platelet activation and aggregation as well as enducing vasodilation. Ristocetin, Thromboxane A2, and Epinephrine are not produced by the endothelial cells.
What tests will be abnormal in a patient with Stuart-Prower Factor deficiency?
Prothrombin Time (PT) Activated Partial Thromboplastin Time (APTT) Russel Viper Venom Test (dRVVT) a & b & c Stuart Prower factor, or factor X, would cause abnormal PT, aPTT, and dRVVT test results as factor X is part of the common coagulation pathway and therefore measured in both the PT and aPTT test. In the dRVVT test, factor X is directly activated in the test principle; therefore an abnormal result would be expected in this test as well if there was a deficiency in factor X.
In addition to a Romanowsky stain, which one of the following would be useful in the routine evaluation of a bone marrow?
Prussian blue Prussian blue stains can be used in bone marrow smears to evaluate for iron storage in the normoblasts.
Which of these methods could be used to differentiate between Howell-Jolly bodies and Pappenheimer bodies and what results would be noted?
Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue. Prussian blue stain would help to differentiate between Pappenheimer bodies and Howell-Jolly bodies. Prussian blue stains iron. Pappenheimer bodies, which contain iron, will stain blue. Howell-Jolly bodies will not stain with Prussian blue because they do not contain iron. Both Howell-Jolly bodies and Pappenheimer bodies will stain with Wright-Giemsa stain.
MCV is calculated using which of the following parameters:
RBC and Hct To calculate the MCV, expressed in femtoliters (fl, or 10-15L), the following formula is used:
What would be the next step when an EDTA specimen had an automated platelet count of 61,000 mm3 and the platelets were surrounding the neutrophils on the differential?
Recollect a specimen for a platelet count without using EDTA Occasionally platelet satellitism can occur in some patient samples when collected in EDTA. The solution for this problem is to recollect in a different type of anticoagulated tube, usually a sodium citrate tube to prevent the platelets from adhering to the neutrophils.
What is the cell that is indicated by the arrow in this field?
Red cell fragment This cell is a red cell fragment. In some institutions it may also be referred to as a helmet cell or horn cell, or a schistocyte.
A patient with multiple myeloma is admitted to the hospital due to a flare up of symptoms. Her physician orders a complete blood count with differential. The peripheral blood smear is shown below. Which morphology is consistent with the findings in this case?
Rouleaux The red blood cells present in this image have "stacked coins" formation. This is known as rouleaux formation, which is highly associated with conditions where increased serum proteins, particularly fibrinogen and globulins., are present. This stacking is also the mechanism for increased sedimentation rates, as associated with multiple myeloma and other inflammatory conditions. Plasma cell disorders such as multiple myeloma are characterized by a clonal population of plasma cells that produce a monoclonal protein (M protein, or paraprotein), causing the red blood cells to stick together and form rouleaux.
Which of the following tests may be used to confirm screening test results for a lupus anticoagulant (or antiphospholipid antibody)?
Russell Viper Venom test Hexagonal Phase phospholipid tests, Platelet Neutralization tests, Thrombin Time tests, Kaolin clotting time, tissue thromboplastin inhibition tests, dRVVT (Russell viper venom test), and the detection of cardiolipin antibodies are all tests that can be utilized to confirm the presence of lupus anticoagulant.
A hemocytometer is generally not used for which of the following:
Synovial fluid crystal counts Synovial fluid crystals are best examined fresh using only a slide and coverslip, and a polarizing microscope.
Alpha thalassemia is defined as:
The decrease in the rate of production of alpha chains due to a partial or total deletion of the genetic code. Feedback Thalassemia in general is the decrease in the rate of production of a globin chain due to a partial or total deletion of the genetic code. In alpha thalassemia this deletion affects at least one of four gene loci.
Alpha thalassemia is defined as:
The decrease in the rate of production of alpha chains due to a partial or total deletion of the genetic code. Thalassemia in general is the decrease in the rate of production of a globin chain due to a partial or total deletion of the genetic code. In alpha thalassemia this deletion affects at least one of four gene loci.
What is a typical finding for determining the endpoint for the initial or iron-depletion phase of treatment for hereditary hemochromatosis (HH)?
The serum ferritin decreases to between 20 and 50 ng/mL The end of the initial phase of HH treatment is considered when the serum ferritin decreases to between 20 and 50 ng/mL.
Which of the following statements best describes the appearance of Cabot rings?
Thin, reddish-violet-staining strands in the shapes of rings, figure eights, or the letter B Feedback Cabot rings are thin, reddish-violet-staining strands in the shapes of rings, figure eights, or the letter B. Question Difficulty: Level 1
Which of the following formulas would you use to calculate absolute cell counts
Total count X % of cells counted The absolute cell count is the product of the percentage of a single leukocyte type multiplied by the total WBC count.
Prominent vacuolation involving the cytoplasm of abnormal lymphoblast-like cells seen in a body fluid preparation is a distinctive feature of Burkitt Lymphoma.
True Feedback Prominent cytoplasmic vacuolation of Burkitt lymphoma cells helps laboratorians identify these cells in a cytospin preparation of body fluids. Question Difficulty: Level 2
The two main compartments of the bone marrow are the venous sinuses/blood vessels and hematopoietic cords.
True This statement is true. The two main compartments of the bone marrow are the venous sinuses/blood vessels and hematopoietic cords.
The peripheral blood picture shown in the image below is most consistent with an artifact of smear preparation.
True When echinocytes dominate, as presented in this photograph, an artifact of smear preparation should be considered. Artifactual burr cells are more commonly found in the center of the smear, as the increased surface tension at the feather edges tend to flatten the RBC's and round off the projections. If burr cells still predominate on a new preparation, further investigation of their presence may be necessary.
Which of the following statements are true for the hematopoietic cords?
adventitial cells provide support for developing hematopoietic cells fat cells make up 50% of volume in an adult Both B and D are correct for this question. Adventitial cells provide support for developing hematopoietic cells and the average adult has about 50% fat cells (adipose cells) that make up the volume of their bone marrow.
All of the following factor(s) may increase erythrocyte sedimentation rate (ESR) values EXCEPT:
blood drawn into sodium citrate anticoagulant Either sodium citrate or EDTA are used for ESR testing since neither will have a positive or negative effect on the rate of red blood cell sedimentation. All of the other conditions listed above can affect the ESR results.
What other hemoglobin gene loci occur on the same chromosome as the beta chain loci?
delta gamma Globin chain loci are found on: chromosome 11 (beta, delta, epsilon, and gamma) chromosome 16 (alpha, and zeta)
When performing controls for the morning run in coagulation, the normal control is within acceptable limits for both PT and APTT, but the abnormal control is out of range for both procedures. Appropriate action would be to:
document the out of range QC, repeat the abnormal control, troubleshoot if necessary; report patient results only when both controls are within acceptable ranges. When coagulation controls are out of range, the technologist must document the situation first. Then the problem must be resolved by repeating, opening a new lot, calibration, etc. Only when the issue has been resolved and the coagulation controls are BOTH within range, can the patient samples be analyzed and resulted.
Reviewing a stained blood smear with the 10x objective is beneficial for which of the following?
evaluating the overall picture of the blood cells evaluating the quality of the blood smear assessing the quality of the Wright's stain all of the above
Which substance(s) is/are considered iron storage compounds?
hemosiderin ferritin Ferritin and hemosiderin are considered storage forms of iron.
In essential thrombocythemia, the platelets are usually:
increased in number and functionally abnormal In essential thrombocythemia, or ET, platelet counts are usually greater than 600 x 109/L. In ET, it is common for these platelets to be functionally abnormal.
Coarse basophilic stippling is usually seen in patients who have:
lead poisoning Coarse basophilic stippling is strongly associated with lead intoxication.
Bone marrow examinations may aid in the diagnosis of:
leukemia anemias thrombocytopenia Bone marrow examinations can help detect various types of anemias, leukemias, thrombocytopenias, etc. Bone marrow examinations CANNOT help to identify mental disorders.
The peroxidase stain is useful in differentiating between which cells?
lymphocytic and granulocytic cells Peroxidase stain is an enzymatic stain based on the principle that peroxidase granules in some neutrophils and in eosinophils will stain positive. Lymphocytes stain negative with peroxidase stains.
To determine if an elevated APTT is caused by a factor deficiency or a factor inhibitor when the PT is normal, the FIRST step would be:
mix 1 part patient plasma and 1 part normal reagent (pooled) plasma and repeat the APTT Feedback The first step in this case is to begin the mixing study protocol where the patient sample is mixed with normal reagent (pooled) plasma to determine whether or not there is a correction of the aPTT result upon re-running. If the specimen "corrects", a factor deficiency should be suspected. If the specimen does not "correct", a circulating factor inhibitor should be suspected. Question Difficulty: Level 3
Which of the following is LEAST useful in differentiating hemophilia A from hemophilia B?
partial thromboplastin time (aPTT) The aPTT test will be abnormal in both hemophilia A and B, so this test does not provide clinical differentiation between the two. Factor assays, clinical history and mixing studies can help to differentiate between hemophilia A and B. Factor VIII and IX assays are the most helpful.
A patient has a history of repeated spontaneous abortion. Coagulation studies reveal an elevated APTT, normal PT, normal platelet function, and normal clotting time. Schistocytes were seen on the peripheral blood smear.
platelet neutralization test Platelet neutralization tests are one of the confirmatory tests that can be used to determine if a patient has a circulating lupus antibody, or lupus anticoagulant. The principle in this test involved the use of a freeze-thawed platelet suspension that, when mixed with the patient plasma, will neutralize the anti-phospholipid antibodies (lupus anticoagulant) present and allow for a corrected aPTT result upon re-testing.
What is the MOST common early abnormality observed in the lymph nodes of AIDS patients?
reactive lymphadenopathy "Lymphadenopathy syndrome" has been used to describe the first symptomatic stage of HIV progression, preceding a diagnosis of AIDS. Generalized lymphadenopathy is an early sign of infection with human immunodeficiency virus (HIV).
The diagnostic value of the reticulocyte count in the evaluation of anemia is that it determines the:
response and potential of the bone marrow Feedback Reticulocytes counts can help determine how well the bone marrow is responding and its potential to make new RBCs. For example, an increased retic count could show the physician that the medication given to a patient to treat his/her anemia is working since the bone marrow is releasing new, young RBCs (reticulocytes). Question Difficulty: Level 2
Match the following characteristics below with their corresponding cells
Neutrophil Phagocytosis in tissues Neutrophil Digestive enzymes in granules Eosinophil Present in allergic and parasitic reactions Red blood cell Transport of O2 & CO2 Neutrophils = Phagocytosis in tissues, Digestive enzymes in granules Eosinophils = Present in allergic and parasitic reactions Red blood cells = Transport of O2 & CO2
