Hematology Exam Simulator Questions
The nucleus of a small lymphocyte is about the same size as a: A) Normal erythrocyte B) Monocyte C) large platelet D) band neutrophil
A) Normal erythrocyte
What should be added to the cytocentrifuge chamber when preparing slides on serous fluid to aid in adhesion of cells to the slide and preserve cellular morphology? A) hylauronidase B) 22% Albumin C) 10% acetic acid D) sterile saline
B) 22% albumin helps preserve cellular morphology and improves adhesion to the slide
A defect in which of the following factors causes impaired platelet adhesion and aggregation? A) Stuart-Prower factor B) Von Willebrand Factor C) Hageman Factor D) Fletcher factor
B) Von Willebrand Factor
Dohle bodies
Round-oval pale grayish-blue inclusions that are found in the periphery of the cytoplasm of neutrophils, accompanies toxic granulation
Polychromasia
increased reticulocyte count
CD5 antigen is normally found on which of the following lymphocyte populations?
mature T cells
What is the precursor of the platelet which is commonly found in the bone marrow?
megakaryocytes
Corrected WBC count formula
uncorrected WBC count x (100/NRBCs +100)
Auer rods - diagnosis?
AML
Chediak-Higashi syndrome
AR - Giant granules in neutrophils, infections, oculocutaneous albinism - Caused by defect in microtubule polymerization associated with albino characteristics, photophobia, and frequent infections
An abnormality in which assays would be most likely to be associated with thrombotic tendency?
AT III Protein C Protein S
A peripheral blood smear with many myeloid cells was presented for morphology review. Toxic granulation and vacuoles in the neutrophil most likely represent which of the following conditions? A) septicemia B) viral infection C) tuberculosis D) active allergies
A) septicemia
The diameter of a normal RBC is similar in size to the nucleus of a ________? A) small lymphocyte B) normal platelet C) segmented neutrophil D) monocyte
A) small lymphocyte
Which of the following is currently considered to be a good test for screening persons for hereditary hemochromatosis (HH) due to its sensitivity and specificity for iron overload? A) transferrin saturation B) liver biopsy C) phlebotomy D) serum iron alone
A) transferrin saturation
The light blue-gray inclusions observed in the cytoplasm of many of the bands and segmented neutrophils of a burn patient are MOST likely? A) auer rods B) dohle bodies C) toxic granules D) may-hegglin bodies
B) dohle bodies - are associated with the peripheral smear of burn patients, severe infections, and cancer as a result of toxic drugs used on the patient
All of the cells listed below function as a phagocyte, EXCEPT: A) neutrophil B) eosinophil C) monocyte D) macrophage
B) eosinophil
Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be breakdown products of: A) neutrophils B) eosinophils C) monocytes D) lymphocytes
B) eosinophils
Which coagulation pathways is factor VII part of? A) intrinsic B) extrinsic C) common D) intrinsic and extrinsic
B) extrinsic
Which of the following processes does NOT occur during primary hemostasis? A) physical decrease in the size of damaged vessels (vasoconstriction) B) fibrin strands added to the newly formed clot C) blood flow rerouted around the damaged vessel D) platelet adhere to exposed collagen at the site of the breach
B) fibrin strands added to the newly formed clot
What is the most common early abnormality observed in the lymph nodes of AIDs patients?
reactive lymphadenopathy
What best describes the absolute value of leukocyte differential counts?
relative percent of each cell type multiplied by the total white count
Basophilic stippling
relatively evenly distributed fine or coarse granules throughout the red cell
What are methods used in diagnosis and classification of acute leukemias?
immunophenotyping cytochemical analysis cytogenetics
Platelet characteristics
produced in the bone marrow by megakaryocytes possess an inherent sticky property that aids in adhesion and aggregation have a normal lifespan of 9-12 days
A specimen drawn from an indwelling catheter that was contaminated by heparin would be indicated by:
prolonged aPTT and normal reptilase time test
What is the main function of the hexose monophosphate shunt in the RBCs?
provide NADPH and reduced glutathione to prevent oxidation of hemoglobin
A patient's coagulation mixing study results are shown below after an initially prolonged aPTT result. Initial aPTT - 63 sec (21-34 sec) Immediate aPTT mixing study - 26 sec Incubated aPTT mixing study - 65 sec A) corrected, factor deficiency B) corrected coagulation inhibitor C) not corrected factor deficiency D) not corrected coagulation inhibitor
D) not corrected coagulation inhibitor
What would the following Schilling test result indicate: Part I - 2% excretion of radioactive vitamin B12 (normal 5-35%) Part II - 8% excretion of radioactive vitamin B12 after intrinsic factor was given with vitamin B12 (normal 7-10%) A) tropical sprue B) transcobalamin deficiency C) folic acid deficiency D) pernicious anemia
D) pernicious anemia
In an adult, the hematopoiesis occurs in which of the following listed sites? A) liver B) spleen C) pancreas D) proximal ends of long bones
D) proximal ends of long bones
What is a corrective action that can be used to obtain a valid platelet count from a patient specimen that exhibits platelet satellitism on the manual differentials? A) redraw the patient specimen in another EDTA collection tube and wait 20 minutes before sampling B) refrigerate the patient sample for 30 minutes prior to sampling C) invert the EDTA tube several times prior to sampling D) recollect the blood specimen in a blue top tube containing sodium citrate
D) recollect the blood specimen in a blue top tube containing sodium citrate
Coarse basophilic stippling is usually seen in patients who have which of the following conditions? A) lead poisoning B) bacterial infection C) leukemia D) lymphocytosis
A) lead poisoning
What MINIMUM level of a particular factor will cause the aPTT test to become prolonged? A) less than 40% B) less than 50% C) less than 60% D) less than 70%
A) less than 40%
In which of the following cells are Auer rods most likely to be seen? A) myeloblast B) lymphoblast C) erythroblast D) megakaryocytes
A) myeloblast
What is the typical regimen for long-term maintenance therapy of individuals with hereditary hemochromatosis (HH)? A) removal of 2 to 6 units of blood yearly B) dietary restriction of iron intake only C) treatment with desferrioxamine D) removal of one unit of blood once per week
A) removal of 2 to 6 units of blood yearly
Which of the following cells is characterized by a thin rim of cytoplasm around the nucleus? A) small lymphocyte B) large lymphocyte C) monocyte D) segmented neutrophil
A) small lymphocyte
Where is the main site of action for monocytes after diapedesis? A) peripheral blood B) body tissues C) bone marrow D) digestive tract
B) body tissues
The reticulocyte count is used to assess which of the following? A) increase blood loss B) microcytic anemia C) macrocytic anemia D) RBC production by the bone marrow
D) RBC production of the bone marrow
The gene loci for the alpha globin chains are adjacent to the locus for which other globin chain? A) Beta B) Delta C) Epsilon D) Zeta
D) Zeta
Depanocytes
sickle cells are half moon shaped cells with pointy ends
What is the total magnification produced when using a 10X ocular lens and a 40X objective lens on a bright field microscope? A) 4000x B) 800x C) 400x D) cannot be determine without additional information
C) 400x
The appropriate magnification for a manual RBC cell count using a hemocytometer is which of the following? A) 10X B) 100X (oil) C) 40X dry D) 4x
C) 40X dry
What is the CORRECT blood to anticoagulant ratio in blue top (sodium citrate) tubes used for coagulation tests? A) 4:1 B) 5:1 C) 9:1 D) 10:1
C) 9:1
EDTA and Sodium citrate combine with _____________ to inhibit coagulation in blood samples. A) Potassium B) Calcium C) Magnesium D) Sodium
B) Calcium
Which of the following leukemias can be excluded as a possible diagnosis if Auer Rods are seen in blasts on the peripheral blood smear? A) Acute myelomonocytic leukemia B) acute lymphoblastic leukemia C) acute myeloid leukemia without maturation D) acute promyelocytic leukemia
B) acute lymphoblastic leukemia
Traditional coagulation assays are based almost solely on this technique: A) chromogenic assays B) clot-based assays C) RIA assays D) ELISA assays
B) clot-based assays
MCHC calculation
(HgB x 100)/ Hct %
MCH calculation
(Hgb x 10)/RBC
INR calculation
(PT patient/PT normal) raised to the ISI
RDW calculation
(SD of RBC volume x 100)/mean MCV
Calculate Absolute cell count
(total count)(% of cells counted)
Beta thalassemia intermedia
- develops later in life - little or no need for transfusions - patients vary in clinical symptoms based on genetic inheritance patterns
Beta thalassemia intermedia
1. Normal HbF 2. No transfusion dependence
What is the approximate percentage of individuals in the US who are heterozygous for HFE mutations for hereditary hemochromatosis?
10-12%
What is the ratio of patient plasma to pooled normal plasma (PNP) that is usually used in the performance of a mixing study?
1:1
What is the normal ratio of erythroid to myeloid cells found in normal bone marrow?
1:3
What factors does warfarin inhibit?
2, 7, 9, 10
What should be added to the cytocentrifuge chamber when preparing slides on serous fluid to aid in adhesion of cells to the slide and preserve cellular morphology?
22% Albumin
Normal Myeloid-to-erythroid (M:E) ratio
2:1 - 4:1
The laboratorian completed the mixing study ordered for John Doe. The results are as follows: Initial aPTT result - 167 sec Initial 1:1 Mix with normal pooled plasma - 158 secs Incubated 1:1 Mix with normal pooled plasma - 150 secs Which of the choices below would most likely explain the results for this patient? A) factor VIII deficiency B) Immediate-actin coagulation inhibitor C) time/temperature-dependent coagulation inhibitor D) Factor VII deficiency
B) Immediate-actin coagulation inhibitor
What is the normal cellularity of of iliac crest bone marrow biopsy in a 50 year old male?
50%
factors in extrinsic pathway
7
Which of the following conditions would be associated with an increased osmotic fragility test result? A) hereditary spherocytosis B) iron deficiency anemia C) sickle cell anemia D) thalassemia
A) hereditary spherocytosis
Which coagulation pathway is initiated when collage is expose, and involves the substances high-molecular-weight kininogen (HK) prekallikrein (PK), and factor XII? A) intrinsic B) extrinsic C) common D) fibrinolysis
A) intrinsic
All of the following are usually increased in alpha thalassemia EXCEPT? A) iron binding capacity B) percent iron saturation C) lactate dehydrongenase D) bilirubin
A) iron binding capacity - because iron may remain in excess as inadequate amounts of hemoglobin are being formed
What morphologically abnormal red blood cell is associated with "hyperchromia"? A) spherocyte B) macrocytes C) microcytes D) target cell
A) spherocytes - only truly "hyperchromic" red blood cell
What leukemia is most common in children?
ALL
What hemoglobin is replaced by hemoglobin H after birth in individual with HbH disease?
bart's hemoglobin
What type of granulocytes has water soluble granules which may fade during the rinsing phase of the staining process using the Wright's stain?
basophils
Hemoglobin H bodies are tetrameters of what globin chain?
beta globin
What describes a beta thalassemia genotype B+/B?
beta thalassemia minor
Target cells appear in what conditions?
beta thalassemia minor beta thalassemia intermedia beta thalassemia major
erythroleukemia
bizarre red blood cell morphology, etrhyroid hyperplasia in bone marrow, a variant of acute myelogenous leukemia with anemia
What condition is associated with EBV?
burkitt's lymphoma
Hereditary Hemochromatosis
caused by a missense mutation in the HFE gene impairs hepcidin regulation of ferroportin activity
What drug/drug class is MOST COMMON cause of drug-induced immune hemolytic anemia?
cephalosporins
Myelopthisic Anemia
characterized by the bone marrow being invaded by fibrotic, granulomatous, or neoplastic cells
Acute Immune Thrombocytopenic Purpura is MOST OFTEN associated with which population?
children 2-6 years of age
A normal hemoglobin molecules is comprised of what?
four heme and four globin chains
The bone marrow begins producing cells in the _______ month of fetal life?
fourth
toxic granulation
general measure of the degree of inflammation
Essential thrombocythemia
myeloproliferative disorder characterized by increase in abnormal platelets increased in number and functionally abnormal
Dohle bodies are found in what type of blood cell?
neutrophil highly associated with severe infection, burns, and cancer (due to toxic drugs)
Elliptocyte
oval red blood cells
Increased number of lymphocytes is associated with bacterial or viral meningitis?
viral meningitis
In reference to semen analysis microscopic examination, differentiation and enumeration of "round cells" which are often present in semen count are referred as:
white blood cells
What is the most commonly used stain in hematology?
wright stain
pappenheimer bodies in erythrocytes can be detected using what stains?
wright stain prussian blue stain
Are monocytes phagocytic?
yes
When performing your mixing study, you aliquot your sample plasma and the pooled normal plasma to create your "mix". You then place the sample in a water bath to incubate for 90 minutes before running your new mixed sample. What is the problem with the steps involved in the procedure above?
you don't have to run a PT or aPTT on the new mix before incubating
What condition/situation is associated with the peripheral blood picture? A) hereditary spherocytosis B) lead poisoning C) transfusion dimorphism D) folic acid deficiency
C) transfusion dimorphism
Complaints of pain from a patient with sickle cell disease are most likely associated with which of the following conditions/events? A) hemolytic anemia B) infection C) vaso-occlusive crisis D) aplastic crisis
C) vaso-occlusive
Which form of hemoglobin cannot be measured using the cyanmethemoglobin method? A) sulfhemoglobin B) carboxyhemoglobin C) oxyhemoglobin D) hemoglobin
A) sulfhemoglobin
If a sodium citrate sample drawn for coagulation is noted to be filled an inch below the fill line (blank line), then the specimen is considered: A) unacceptable for coagulation studies B) acceptable for coagulation studies C) acceptable if the tube can be filled with additional blood D) acceptable if only the PT test is to be performed
A) unacceptable for coagulation studies
What does the red cell distribution width (RDW) indicate on the peripheral blood smear? A) variability of RBC volume B) poikilocytosis C) macrocytosis D) microcytosis
A) variability of RBC volume
A yellow coloration found in fresh cerebrospinal fluid supernatant is termed: A) xanthochromia B) hemolysis C) jaundice D) hyperlipidemia
A) xanthochromia
How many large hemacytometer squares contain a total volume of 1uL of fluid? A) 5 B) 10 C) 15 D) 18
B) 10
Which of the following tests may be used to confirm screening test results for a lupus anticoagulant (or antiphospholipid antibody)? A) activated partial thromboplastin time B) prothrombin time C) factor assays D) Russel Viper Venom Test
Russell Viper Venom Test - used to confirm the presence of lupus anticoagulant
What is May-Hegglin anomaly?
an inherited condition that causes large Dohle-like inclusion bodies primarily in neutrophils. Platelets are affected making them abnormally large and sometimes bizarre shapes. About half of the cases will be asymptomatic while those with decreased platelet counts may experience bleeding.
What is lymphocytosis?
increase in the number of lymphocytes in the blood
What causes basophilic stippling?
lead poisoning, some anemias, and thalassemia
What are Howell-Jolly bodies?
nuclear remnants of the RBCs which are generally removed by a functional spleen; therefore, presence in a peripheral smear suggests functional asplenia in sickle cell pts
Which of the following may result in a platelet count of 230.0 x10^9/L with a bleeding time of 15 minutes. A) defective platelet function B) decreased platelet production C) increased platelet production D) increased platelet destruction
A) defective platelet function
The presence of erythrocytes with altered morphology (see photo): A) excessive burns B) babesiosis C) sickle cell disease D) type I VwD
A) excessive burns
What is the anticoagulant most commonly used for routine coagulation testing? A) EDTA B) Lithium Heparin C) Sodium Citrate D) Sodium Heparin
C) Sodium Citrate
Which of the following processes can lead to the formation of microclots in a patient specimen that is colelcted in a tube containing EDTA anticoagulant? A) failing to invert the tube after specimen collection B) filling the tube as full as the vacuum in the tube allows C) inverting the tube 5-10 times after specimen collection D) using the EDTA tube for an automated platelet count
A) failing to invert the tube after specimen collection
The predominant cell seen in CSF from a twelve-year-old female exhibiting fever, lethargy, and a stiff neck. The WBC count on the sample was 2,000/microliter. The finding most likely indicates: A) normal cytocentrifuged smear B) viral meningitis C) bacterial meningitis D) Alzheimer's disease
B) viral meningitis
Hemoglobin D (HbD) is elevated in all of the following EXCEPT? A) Hemoglobin D disease B) Hemoglobin SD disease C) Hb D/beta-thalassemia D) Alpha thalassemia
D) Alpha thalassemia
Which of the following is NOT considered necessary for making a diagnosis of hereditary hemochromatosis (HH)? A) laboratory evidence of iron overload B) genetic mutations associated with HH C) clinical signs and symptoms consistent with HH D) a positive family history
D) a positive family history
All of the following activities are associated with platelets EXCEPT: A) aggregation B) adhesion C) lysis D) release of granules
C) lysis
What mutation is most commonly found in hereditary hemochromatosis?
C282Y
An adult patient presents with a temperature of 103F. A CBC is ordered and the whole blood cell (WBC) count is 15 x 10^9 (reference interval = 4-11) with 10% band neutrophils and 2% metamyelocytes. What can be concluded at this point with these clinical and laboratory results? A) this is most likely a parasitic infection B) this is most likely normal for this patient C) this is most likely a bacterial infection or inflammatory response D) this is most likely a viral infection
C) this is mostly a bacterial infection or inflammatory response
A 27 year-old man with Down syndrome has the following CBC results which are MOST suggestive of what condition? WBC: 27 x10^3 HGB: 8.5 g/dl HCT: 25% PLT: 30x10^9 Differential Blood Smear Results: 8% segmented neutrophil 25% lymphocytes 67% TdT-positive blasts A) acute myelogenous leukemia B) myeloproliferative disorder C) leukemoid reaction D) acute lymphocytic leukemia
D) acute lymphocytc leukemia
Which of the following is a genetic platelet disorder characterized by giant platelets, abnormal screening tests for platelet function and moderate to severe thrombocytopenia? A) Glanzmann's thrombasthenia B) Gray platelet syndrome C) delta storage pool disease D) bernard-soulier syndrome
D) bernard-soulier syndrome
All of the following are associated with Hgb C disease, EXCEPT? A) Hgb C crystal B) target cells C) lysine substituted for glutamic acid at the sixth position of the beta chain D) fast mobility of Hgb C at pH 8.6
D) fast mobility of Hgb C at pH 8.6
What principle(s) of flow cytometry is employed when performing immunophenotyping? A) diffraction grating B) impedence C) diffraction grating and impedance D) fluorescent antibody tagging and light scatter
D) fluorescent antibody tagging and light scatter
Erythropoietin is mainly produced in: A) bone marrow B) bones C) lymphocytes D) kidneys
D) kidneys
ependymal cells
produce cerebrospinal fluid in CNS lines the arachnoid space (central nervous system)
Which one of the following conditions is associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency? A) microcytic red cells B) precipitation of hemoglobin C) faulty heme synthesis D) hemoglobins with low oxygen affinities
B) precipitation of hemoglobin
Which of the following characteristics can be seen in the microcytes present in some hemolytic disorders? A) diameter 7.5 um B) spherocytosis C) MCV 90 fL D) hypochromasia
B) spherocytosis
Pluripotential stem cells are capable of producing which of the following? A) only T-lymphocyte and B-lymphocyte subsets B) erythropoietin, thrombopoietin, and leukopoietin C) lymphoid and myeloid stem cells D) daughter cells from only a single cell line
C) lymphoid and myeloid stem cells
In which organ or tissue do T-lymphocytes mature? A) bone marrow B) thymus C) lymph nodes D) spleen
B) thymus
polycythemia vera
general increase in red blood cells myeloproliferative neoplasms erythrocytosis
Cell that stain positive with acid phosphatase, and are NOT inhibited with tartate are characteristically seen in?
hairy cell leukemia
Exposure to what chemicals can cause hemolytic anemia?
heavy metals lead naphthalene
MCV calculation
hematocrit x 10 / # of red blood cells in sample
What are causes of death in patients with hereditary hemochromatosis (HH)?
hepatocellular carcinoma cirrhosis cardiomyopathy
What condition is associated with an increased osmotic fragility test result?
hereditary spherocytosis
What cellular inclusions are composed of DNA?
howell jolly bodies
Neutrophil granules contain
hydrolytic enzymes or defensins lysozymes myeloperoxidase lactoferrin
myelocyte
immature cell that comes from a myeloblast in the red marrow and develops into either a neutrophil, eosinophil, or basophil
What morphologically abnormal red blood cell is associated with hyperchromia?
spherocytes
Acanthocytes
spur cells
What is the predominant abnormal erythrocyte morphology associated with idiopathic myelofibrosis?
tear drop cells
How long should therapy continue for patient with hereditary hemochromatosis (HH)?
therapy should be continue throughout the lifetime
Laboratory Findings of Hemolytic Uremic Syndrome
thrombocytopenia increased serum bilirubin decreased haptoglobin
Decreased platelet production can be caused by a lack of or decreased amount of what?
thrombopoietin
Aspirin ingestion prevents the synthesis of this signaling molecule in the platelet?
thromboxane A2
What organ or tissue do T-lymphocytes mature?
thymus
multinucleated histiocyte
tissue macrophages
What bone marrow processing procedure is best suited for a patient who had a dry tap?
touch preparation
Smudge cell
Created by the mechanical spreading of blood during the creation of the smear CLL
What RBC indice is measured in femtoliters?
MCV
Warfarin (Coumadin) is monitored by what test?
PT/INR
alpha globin chain loci
chromosome 16
How long are healthy neutrophils expected to reside in the peripheral blood of an adult?
7-8 hours
Factors of intrinsic pathway
8, 9, 11, 12
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%
A 1:20 dilution is made for a manual WBC count. The four corner squares on both sides of a hemocytometer are counted. A TOTAL of 100 cells are counted (eight total squares). What is the white blood cell count in terms of a liter? A) 2.5 x 10^9 B) 25 x 10^9 C) 2500/L D) 25000/L
A) 2.5 x 10^9
Which of the following markers is associated with normal mature B cell expression? A) CD19 B) CD8 C) CD14 D) C42
A) CD19
Which coagulation factor is found ONLY in the extrinsic pathway? A) Factor VII B) Factor VIII C) Factor IX D) Factor X
A) Factor VII
Which abnormal hemoglobin may be formed in alpha thalassemia? A) Hb Bart's B) Hb Lepore C) Hb E D) Hb S
A) Hb Bart's
Which of the following inclusions are composed of DNA? A) Howell-Jolly Bodies B) Heinz Bodies C) Pappenheimer Bodies D) Dohle Bodies
A) Howell-Jolly Bodies
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? A) L-arginine B) L-glutamine C) L-lysine D) L-tyrosine
A) L-arginine substrate needed to produce nitric oxide
Which of the following is LEAST likely to stimulate the production of reactive lymphocytes? A) Staphylococcus aureus B) cytomegalovirus (CMV) C) Epstein-Barr virus D) Toxoplasma gondii
A) Staphylococcus aureus
Which of the following statements best describes a normal mature erythrocyte? A) a biconcave disc, 6-8um in diameter, that stains pinkish-orange (salmon) in color B) a biconcave disc, 7um in diameter, with a salmon-colored cytoplasm and condensed nucleus C) a biconcave disc, 6-8um in diameter, containing ribosomes and mitochondria D) a biconcave disc, 7um in diameter, responsible for transporting myoglobin
A) a biconcave disc, 6-8um in diameter, that stains pinkish-orange (salmon) in color
What is one of the main characteristics of secondary granules in the neutrophilic granulocyte cytoplasm? A) appear first at the myelocyte stage B) dissolve in mature granulocytes C) are formed on the mitochondria D) are derived from azurophil (primary) granules
A) appear first at the myelocyte stage
Which beta thalassemia shows no anemia and may not be detected using hemoglobin electrophoresis? A) beta thalassemia minima B) beta thalassemia minor C) beta thalassemia intermedia D) beta thalassemia major
A) beta thalassemia minima - shows no anemia and may not be detected using hemoglobin electrophoresis; silent carrier state of beta thalassemia involves one minor beta chain deletion or mutation
During data analysis in flow cytometry, how are cells gated? A) by placing a gate around cells with the same light-scattering B) by placing a gate around cells with different light-scattering C) by placing a gate around cells with different fluorescent properties D) by placing a gate around cells that have no fluorescence
A) by placing a gate around cells with the same light-scattering
Which ethnic group has the highest incidence of hereditary hemochromatosis in the United States? A) caucasians B) african americans C) asians D) hispanics
A) caucasians
When using a flow cytometer, forward scatter measures which of the following parameters? A) cell size B) clonality C) cytoplasmic complexity (granularity) D) fluorescence
A) cell size
CSF lymphocytosis is associated with all of the following EXCEPT: A) cerebral abscess B) viral meningitis C) chronic fungal meningitis D) chronic tuberculous meningitis
A) cerebral abscess
For which of these conditions or procedures there may be an increased number of megakaryocytes in the bone marrow, but a decreased number of circulating platelets? A) folic acid deficiency B) aplastic anemia C) radiation therapy D) Wiskott-Aldrich syndrome
A) folic acid deficiency
Which of the following disorders or diseases is associated with coarse basophilic stippling? A) lead poisoning B) bacterial infection C) leukemia D) lymphocytosis
A) lead poisoning
In which of the following conditions are Cabot Rings most likely to be observed on a Wright-Stained peripheral blood smear? A) megaloblastic anemia B) moderate iron deficiency anemia C) sickle cell trait D) plasma cell myeloma
A) megaloblastic anemia
After briefly circulating in the peripheral blood, which of the following cells becomes a tissue macrophage (or histiocyte) whose main function is phagocytosis? A) monocyte B) basophil C) neutrophil D) plasma cell
A) monocyte
How many 1mm x 1mm square is the Neubauer hemacytometer counting grid composed of? A) nine per side B) ten per side C) twenty-two between both sides D) thirty between both sides
A) nine per side
The diagnostic value of the reticulocyte count in the evaluation of anemia is that it determines the: A) response and ability of the bone marrow to compensate for anemia B) nutritional status of the patient C) real cause of the anemia D) true red blood cell count
A) response and ability of the bone marrow to compensate for anemia
Which of the following sets of results is indicative of stage 3 iron deficiency (iron deficiency anemia)? A) decreased ferritin, normal soluble transferrin receptor (sTfR), slightly increased total iron-binding capacity (TIBC) B) decreased ferritin, increased sTfR, increased TIBC) C) decreased ferritin, increased sTfR, decreased TIBC D) increased ferritin, normal sTfR, increased TIBC
B) decreased ferritin, increased sTfR, increased TIBC)
Adult (normal) hemoglobin is made up of the following composition: A) >90% HbA, 1% HbA2, 5%HbF B) >95% HbA, <3.5% HbA2, <1-2%HbF C) <90% HbA, 10% HbA2, 5%HbF D) >90% HbA, 1% HbA2, 5%HbF
B) >95% HbA, <3.5% HbA2, <1-2%HbF
Hemoglobin H (HbH) bodies are tetramers of which globin chain? A) Alpha B) Beta C) Delta D) Gamma
B) Beta seen in alpha thalassemia intermedia or Hemoglobin H disease
A deficiency in which of the following coagulation factors will produce an abnormal prothrombin time (PT) test result, but will not affect the activated partial thromboplastin time (APTT) test results? A) Factor X B) Factor VII C) Factor V D) Factor II
B) Factor VII
Which of the following factors require Vitamin K for their synthesis in the liver? A) Factor XIII B) Factor VII C) Factor VIII D) Factor I
B) Factor VII
The fibrin clot begins to form when fibrinogen is cleaved resulting in a fibrin monomer, fibrinopeptide A, and fibrinopeptide B. The fibrin monomers sponaneously polymerize due to hydrogen bonding, and then are covalently linked into fibrin polymers by which factor? A) Plasmin B) Factor XIII C) Factor V D) Thrombin
B) Factor XIII
Which of the following set of results would be consistent . for a patient with the following findings: macrocytosis, anemia, leukopenia, and thrombocytopenia? A) MCV 115fL; Hgb 9.5 g/dL; WBC 6.5x10^3; Platelet 75000/uL B) MCV 115fL; Hgb 7.5 g/dL; WBC 2.5x10^3; Platelet 75000/uL C) MCV 75fL; Hgb 7.5 g/dL; WBC 2.5x10^3; Platelet 75000/uL D) MCV 75fL; Hgb 9.5 g/dL; WBC 6.5x10^3; Platelet 175000/uL
B) MCV 115fL; Hgb 7.5 g/dL; WBC 2.5x10^3; Platelet 75000/uL
Using an automated cell counter analyzer, an increased red cell distribution width (RDW) should correlate with which of the following? A) leukocytosis B) anisocytosis C) spherocytosis D) macrocytosis
B) anisocytosis
All of the following methods can be used to transport carbon dioxide to the lungs EXCEPT: A) blood plasma B) attached to neutrophils C) bound to hemoglobin in the RBC D) in solution within the RBC
B) attached to neutrophils
What abnormal red blood cell inclusion is composed of multiple small, dark blue aggregates of ribosome (RNA) that are distributed throughout the RBC? A) Pappenheimer bodies B) basophilic stippling C) Heinz bodies D) Howell-Jolly Bodies
B) basophilic stippling
The erythrocyte inclusions which are thin, red-purple staining strands, usually found in figure-eight shapes are called: A) basophilic stippling B) cabot rings C) pappenheimer bodies D) heinz bodies
B) cabot rings
A monoclonal B-cell population (Kappa or Lambda predominant) with expression of CD19, CD20, CD23, and co-expression of CD5 is consistent with which of the following? A) A normal B cell B) chronic lymphocytic leukemia C) mantle cell lymphoma D) A mature T cell
B) chronic lymphocytic leukemia
A 68 year old woman presents with pressure under the lower left ribs from a swollen spleen, but s not complaining of any other symptoms. her laboratory data showed the following: Hgb - 13.5g/dl Hct - 40% Platelets - 240x10^9 WBC - 46x10^9 Differential - 45% Neutrophils, 2% lymphocytes, 6% Eosinophils, 2% Basophils, 35% myelocytes, 10% metamyelocytes LAP Score - 11 What is the potential diagnosis? A) Leukemoid reaction B) chronic myelogenous leukemia C) acute myelogenous leukemia D) polycythemia vera
B) chronic myelogenous leukemia
A 36-year-old woman visits her physician after experiencing fevers, night sweats, and overall fatigue over the past 3 months. Upon physical examination she displays lymphadenopathy. When a lymph node biopsy is performed, Reed-Sternberg cells, bands of fibrosis, and various-sized lymphocytes are noted. Which of the following conditions is the most likely diagnosis? A) mantle cell lymphoma B) hodgkin lymphoma C) follicular cell lymphoma D) burkitt lymphoma
B) hodgkin lymphoma
Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called: A) heinz bodies B) howell-jolly bodies C) basophilic stippling D) pappenheimer bodies
B) howell-jolly bodies
All of the following are causes of hemolytic anemia EXCEPT? A) thermal injury B) iron deficiency anemia C) brown recluse spider bite D) plasmodium infection
B) iron deficiency anemia
The analysis of a differential blood smear and laboratory results produced the following results: WBC: 47000/uL Hgb: 10.9 g/dL Hct: 34% Differential: 4% monocytes 20% lymphocytes 4% myelocytes 2% promyelocytes 15% metamyelocytes 25% segmented neutrophils 30% bands Leukocyte Alkaline Phosphatase (LAP) - increased What is the MOST likely disease/condition associated with these results? A) myelofibrosis B) leukemoid reaction C) chronic myelogenous leukemia D) acute myelogenous leukemia
B) leukemoid reaction - presents with increased white blood cell counts due to a physiologic response to stress or infection. LAP score is high in leukemoid reactions but NOT CML
What does the M:E ratio in a bone marrow evaluation represent? A) monocytes to erythrocytes B) myeloid cells to erythroid cells C) myelocytes to erythrocytes D) megakaryocytes to erythrocytes
B) myeloid cells to erythroid cells
By utilizing a Prussian Blue stain, which of the following red blood cell inclusions would be identifiable if present? A) cabot rings B) pappenheimer (siderotic) bodies C) howell jolly bodies D) malarial parasites
B) pappenheimer (siderotic) bodies
Mott Cell What is the condition in which these cells are associated? A) Chronic lymphocytic leukemia B) plasma cell myeloma C) Chediak-Higashi anomaly D) severe pyogenic infection
B) plasma cell myeloma
An assessment of the myeloid to erythroid (M:E) ratio is part of every bone marrow evaluation. Which of the following does not apply to the M:E ratio? A) the erythroid total used tin calculating the M:E ratio is the sum of all of the nucleated red cell precursors B) the myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow C) white blood cells used in the myeloid tally/total used to calculate the M:E ratio include neutrophil precursors D) the M:E should always be interpreted in context with the overall bone marrow cellularity
B) the myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow normal ratio 2:1 - 4:1
Xanthochromic CSF means that the color of the CSF can be any of the following EXCEPT: A) pale orange B) pale pink C) yellow D) blue
D) blue
What is the approximate percentage of individuals in the US who are heterozygous for HFE mutations for hereditary hemochromatosis? A) 0.05% to 0.10% B) 1% to 2% C) 10% to 12% D) 20% to 25%
C) 10% to 12%
An abnormality of which of the following assays would be LEAST likely to be associated with thrombotic tendency? A) AT III B) Protein C C) APTT D) Protein S
C) APTT - used to evaluate the intrinsic pathway and the common pathway of the coagulation cascade, reflects the activity of prekallikrein, HMWK, and factors XII, XI, IX, VIII, X, V, II and I Deficiencies of protein C. protein S, and AT III all cause hypercoagulability
Which of the following statements regarding coagulation disorders is correct? A) Hemophilia A and B are usually acquired disorders B) Damage to the kidneys can cause hemostatic dysfunction as the kidneys are the primary site for clotting factor production C) Clotting Factor II, VII, IX, and X are vitamin K-dependent D) Factor IX deficiency is the most common inherited coagulation factor deficiency
C) Clotting Factor II, VII, IX, and X are vitamin K-dependent
A woman in labor is bleeding, has a very high fever, and is in danger of losing the fetus. Laboratory results include a platelet count of 15x10^9, ( normal platelet count of 150-450), prolonged PT and aPTT, decreased fibrinogen, and increased D-dimer. Her automated blood count flagged for blood smear review, and the cells (schistocytes) were seen on her peripheral smear along with a decrease in the number of platelets present. What condition is suggested by these results? A) Thrombotic thrombocytopenic purpura (TTP) B) hemolytic uremic syndrome (HUS) C) disseminated intravascular coagulation (DIC) D) glanzmann thrombasthenia
C) Disseminated intravascular coagulation
Which of the following options best describes how hemophilia A differs from hemophilia B? A) the clinical presentation is drastically different B) Hemophilia A is an inherited disorder and hemophilia B is an acquired disorder C) Factor VIII is deficient in hemophilia A and factor IX is deficient in hemophilia B D) hemophilia A is a disorder of secondary hemostasis and hemophilia B is a disorder of primary hemostasis
C) Factor VIII is deficient in hemophilia A and factor IX is deficient in hemophilia B
Which hemoglobin, when elevated, acts as a protection against sickling in patients with HbS? A) Hemoglobin E B) Hemoglobin C C) Hemoglobin F D) Hemoglobin D
C) Hemoglobin F
In which disorder do neonates demonstrate the presence of Bart's hemoglobin that changes to beta chain tetramers in adults? A) Alpha thalassemia major B) Alpha thalassemia minor C) Hemoglobin H disease D) hydrops fetalis
C) Hemoglobin H disease
Laser light can be described by all of the following characteristics EXCEPT: A) intensity and concentration B) used in flow cytometry for cell sorting and identification of cells C) LASER is an acronym for light amplified by stimulated energy radiation D) monochromaticity
C) LASER is an acronym for light amplified by stimulated energy radiation
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? A) Adenovirus B) Epstein-Barr Virus C) Parvovirus B19 D) Zoster-simplex virus
C) Parvovirus B19
CSF specimens are usually collected by lumbar puncture and placed in numbered tubes starting with the first tube collected. If tubes are collected, which tube would be used for a cell count and differential? A) Tube 1 B) Tube 2 C) Tube 3 D) Tube 4
C) Tube 3
Which group of conditions increases the risk of HbS polymerization? A) acid pH, dehydration, decreased levels of 2,3 DPG B) alkaline pH, dehydration, increased levels of 2,3 DPG C) acid pH, dehydration, increased levels of 2,3 DPG D) alkaline pH, dehydration, decreased levels of 2,3 DPG
C) acid pH, dehydration, increased levels of 2,3 DPG risk of HbS polymerization is enhanced in low pH
All of the following factors would cause an increase erythrocyte sedimentation rate (ESR) values EXCEPT: A) severe anemia B) abnormal protein (rouleaux) C) blood drawn into sodium citrate anticoagulant D) a slanted (not perpendicular tube)
C) blood drawn into sodium citrate anticoagulant
The hemoglobin electrophoresis patter for patient #2 shows an increase in HbF and a decrease in both HbA and HbA2. These results correlate best with which of these thalassemias? A) beta thalassemia minor B) beta thalassemia major C) delta-beta thalassemia minor D) alpha thalassemia major
C) delta-beta thalassemia minor
In the hemoglobin methodology using potassium ferricyanide the following measurable reaction occurs A) carboxyhemoglobin is formed B) iron remains in the ferrous state C) ferrous iron is oxidized to ferric iron to form methemoglobin D) acid hematin is formed
C) ferrous iron is oxidized to ferric iron to form methemoglobin
Which white blood cell population would have the MOST side scatter when analyzed using flow cytometry? A) monocytes B) lymphocytes C) granulocytes D) erythrocytes
C) granulocytes side scatter is the measurement of cell complexity (granularity)
Which of the following stains is used to differentiate a neutrophilic leukemoid reaction from chronic myelogenous leukemia (CML)? A) Sudan Black B B) periodic acid-schiff reagent C) acid phosphate with tartrate D) leukocyte alkaline phosphatase (LAP)
D) leukocyte alkaline phosphatase (LAP)
The cells found in the peripheral blood smear of a patient with the following results: Total WBC - 21.5x10^9/L Differential Count: metamyelocyte 4 band neutrophils 16 segmented neutrophils 48 monocytes 6 eosinophil 1 basophils 1 lymphocytes 24 This hematologic picture is most consistent with: A) Leukemoid reaction B) chromic myeloid leukemia C) left shift D) leukoerythroblastosis
C) left shift
Which of the following . major cellular elements does not develop solely in the bone marrow? A) monocyte B) neutrophil C) lymphocyte D) macrophages
C) lymphocyte
Which of the following cells are capable of producing antibodies? A) thrombocytes B) macrocytes C) lymphocytes D) neutrophils
C) lymphocytes
A technologist decides to make a 1:20 dilution of CSF after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of cells that are observed in each of the large squares of the hemocytometer is > 100. What should the technologist doe to obtain the most accurate count? A) count all four corner squares B) make a smaller dilution C) make a larger dilution D) no dilution necessary
C) make a larger dilution
What procedure(s) would be acceptable to run on an EDTA specimen containing a small clot? A) Platelet count only B) ESR only C) no procedures will be accurate D) hemoglobin by cyanmet method
C) no procedures will be accurate
Hematocrit is: A) percentage of blood made up of serum B) concentration of serum x 100 C) percentage of blood made up of red blood cells D) concentration of red cells x 100
C) percentage of blood made up of red blood cells
What is the correct order of erythrocyte maturation in the bone marrow? A) polychromatophilic normoblast, basophilic normoblast, polychromatophilic erythrocyte, orthochromic normoblast, pronormoblast B) orthochromic normoblast, basophilic normoblast, polychromatophilic normoblast, polychromatophilic erythrocyte, pronormoblast C) pronormoblast, basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, polychromatophilic erythrocyte D) pronormoblast, basophilic normoblast, polychromatophilic erythrocyte, orthochromatic normoblast, polychromatophilic normoblast
C) pronormoblast, basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, polychromatophilic erythrocyte
In addition to the Romanowsky stain, which one of the following would be useful in the routine evaluation of a bone marrow? A) Chloroacetate esterase B) periodic acid-schiff (PAS) C) prussian blue D) sudan black B
C) prussian blue
All of the following are decreased in beta thalassemia major EXCEPT: A) mean corpuscular hemoglobin concentration (MCHC) B) mean corpuscular volume (MCV) C) red cell distribution width (RDW) D) red blood cell (RBC) count
C) red cell distribution width (RDW) - due to anisocytosis and poikilocytosis
All of the following factors offer a protective effect, delaying symptoms in persons with hereditary hemochromatosis (HH) EXCEPT? A) regular blood donation B) pregnancy C) regular use of multivitamins with iron D) menstruation
C) regular use of multivitamins with iron
For which determination is the brillant cresyl lue stain used MOST often? A) malaria -ring forms B) plasma cells C) reticulocytes D) basophilic stippling
C) reticulocytes
In the flow cytometric analysis, which of the following data can be collected? A) anisocytosis due to presence of microcytes or macrocytes B) hemoglobin and hematocrit levels C) size and granularity of the cell by forward/side scatters D) presence of abnormal erythrocyte inclusions
C) size and granularity of the cell by forward/side scatters
The removal of which of these organs may be a last resort treatment for a patient whose platelet count is less than 30 x 10^9/L as a result of chronic idiopathic thrombocytopenic purpura (ITP)? A) gall bladder B) pancreas C) spleen D) a kidney
C) spleen
Which red cell morphological classification is characteristic of megaloblastic anemia? A) Normocytic B) Microcytic C) Hypochromic D) Macrocytic
D) macrocytic
Which of the following cells is the most common nucleated cells in normal adult bone marrow? A) myeloblast B) promyelocyte C) myelocyte D) metamyelocyte
D) metamyelocyte
CD markers for normal mature T cells
CD3 CD5 CD7
Low LAP score
CML
What is the BEST type of microscopy for performing manual platelet counts? A) electron B) dark-field C) light D) phase contrast
D) phase contrast
Which of the following cells is indicative of Hodgkin's disease? A) Niemann-Pick cells B) reactive lymphocytes C) flame cells D) reed-sternberg (RS) cells
D) reed-sternberg (RS) cells
Which of the following blood smear observation would support the diagnosis of Multiple Myeloma if a patient demonstrated plasma cells in his bone marrow and had an elevated serum IgG? A) Anisocytosis B) Target Cells C) Microcytic RBCs D) Rouleaux formation
D) rouleaux formation
In the process of thrombopoiesis, which is arranged from least mature to more mature? A) Thrombocyte, metamegakaryocyte, megakaryocyte, promegakarocyte, megakaryoblast, stem cell B) Stem cell, megakaryoblast, megakaryocyte, promegakaryocyte, thrombocyte, metamegakaryocyte C) megakaryocyte, promegakaryocyte, megakarocyte, thrombocyte D) stem cell, megakaryoblast, promegakaryocyte, megakaryocyte, thrombocyte
D) stem cell, megakaryoblast, promegakaryocyte, megakaryocyte, thrombocyte
All of the following would be considered a part of the body's cellular immune system EXCEPT? A) macrophages B) mast cells C) neutrophils D) thrombocytes
D) thrombocytes
Hyposegmented neutrophils
Defect in chromatin synthesis (myelodysplasia) nucleus may be round, peanut shaped or bilobed
At an alkaline pH, what hemoglobins cannot be separated from hemoglobin S during hemoglobin electrophoresis?
Hb D Hb G
With the exception of beta thalassemia minima, which hemoglobin is decreased in beta thalassemia?
HbA
If a patient has three inactive alpha globin genes, which of the four alpha (a) thalassemia classifications would he/she have?
HbH disease
Russell Bodies
Multiple myeloma Mott cell - globular inclusions are immunoglobulin accumulations representing the accumulation of excessive mucopholysaccharides and globulins with endoplasmic reticulum
What can interfere with the measurement of hemoglobin?
Icteric plasma lipemia leukocytosis
A manual white blood cell count was performed by the hematology technologist. The cell count for each of two sides was 38 and 42 respectively. All nine large squares were counted on each side. The dilution fo this kit was pre-measured at 1:10. What should the technology report as the white cell count? A) 4.8 x 10^9/L B) 4.4 x 10^9/L C) 0.48 x 10^9/L D) 0.44 x 10^9/L
D) 0.44 x 10^9/L
The central pallor in a red blood cell is about __________ the diameter of the cell. A) 1/4 B) 1/2 C) 1/8 D) 1/3
D) 1/3
Which of the following sites is used most often for the CSF collection? A) ventricles B) L1-L2 C) subarachnoid D) L3-L4
D) L3-L4
If a Mycobacterium sp. infection is suspected on a bone marrow or body fluid, what stain should be used to detect these bacteria? A) Wright's stain B) new methylene blue stain C) hematoxylin and eosin (H&E) stain D) acid fast stain
D) acid fast stain acid allow the stain to penetrate the cell wall
General formula for hemocytometer
Count = [(Dilution Factor) x (Total cell count in # squares)] x volume correction factor
Anemia of Chronic Disease
EPO production inhibitied by cytokines direct cytokine inhibition of erythropoiesis shortened erythrocyte survival
What FAB designation is called the "true" monocytic leukemia and is characterized by monoblasts, promonocytes, and monocytes?
FAB M5
Hemophilia B (Christmas disease)
Factor IX deficiency
Hemophilia A
Factor VIII deficiency
What blood cell inclusions cannot be detected on a Wright's stained blood smear?
Heinz bodies
What are important protein regulators of iron metabolism?
Hepcidin Transferrin receptor Ferroportin
Pappenheimer bodies
Iron inclusions in red blood cells that appear as pale blue granules with Wright's stain
Pappenheimer bodies
Iron inclusions in red blood cells that appear as pale blue granules with Wright's stain can also been seen n Prussian Blue Stain
If a patient has a white blood count of 40,000/µL, what would be the MOST useful staining procedure to distinguish between bacterial infection and chronic myelogenous leukemia (CML)?
LAP
G6PD deficiency
Low NADPH leads to hemolytic anemia (free radicals) with bite cells and heinz bodies Fava beans, sulfonamides, primiquine, dapsone X-linked recessive
G6PD deficiency
Low NADPH leads to hemolytic anemia (free radicals) with bite cells and heinz bodies Fava beans, sulfonamides, primiquine, dapsone X-linked recessive schistocytes
What are the usual results of the MCV and RDW in alpha thalassemia?
MCV decreased RDW usually increased
Beta thalassemia major
No B-globin production Growth retardation, developmental delays Increase in Hemoglobin A2 and F Patients die in childhood without transfusions
Orthochromic Normoblast (Metarubricyte)
Stage 4-Last stage where nucleus is present Cell size: 8-12 N/C Ratio: 1:1 Cytoplasm: Pink-orange color due to hemoglobin production, Moderate amount Nucleus: Small and pyknotic (a homogenous blue-black mass with no structure), Coarse and condensed chromatin pattern, Bluish-purple Location: Mostly found in bone marrow, May migrate to peripheral blood during times of increased production
What two inclusions can sometimes be seen in segmented neutrophils?
Toxic granulation and dohle bodies
Pelger-Huet anomaly
WBC disorder in which neutrophils, eosinophils, and basophils are not segmented properly, but function normally Mimics a left shift HYPOSEGMENTATION
Are neutrophils normally the most numerous cell type found in peripheral blood of an otherwise healthy adult?
Yes - segmented neutrophils (40-80%)
What hormone is produced by the kidney and influences erythrocyte production?
erythropoietin
Beta Thalassemia
a decrease in the rate of production of beat chains due to a partial or total deletion of loci from chromosome 11 that code for the beta chain
What test is used to monitor therapy with unfractionated heparin?
aPTT
What are laboratory characteristics of patient with von willibrand disease?
abnormal platelet aggregation response to ristocetin
What conditions are associated with RBC macrocytosis?
alcoholism hypothyroidism B12 deficiency
What is the primary role of basophils?
allergic reactions
What disorder may a mild anemia be present even with an increased RBC count and normal adult hemoglobin electrophoresis?
alpha thalassemia minor
Promyelocyte
an immature, developing form of blood cell
Abetalipoproteinemia
an inherited inability to synthesize apolipoprotien B, thus lipids absorbed in the small intestine cannot be transported by chylomicrons and therefore it builds up in enterocytes.
What characteristics are most often associated with alpha thalassemia intermedia?
anemia splenomegaly
What conditions cause coarse basophilic stippling?
anemias of abnormal hemoglobin synthesis thalassemia lead poisoning
Acquired Hemophilia A may be the result of what condition?
anti-factor VIII inhibitor
Howell-Jolly bodies
appear as round, smooth, almost pyknotic, dark-purple staining bodies
May-Hegglin Anomaly
autosomal dominant trait disorder where neutrophils have blue-staining inclusions that resemble Dohle bodies; thrombocytopenia is also present with giant abnormal platelets
Alder-Reilly Anomaly
autosomal recessive trait associated with disorders that prevent normal breakdown of mucopolysaccharides, characterized by presence of prominent, dark staining, coarse cytoplasmic granules
A deficiency in plasminogen activator inhibitor-1 can lead to a serious bleeding disorder due to what?
excessive and unregulated fibrinolysis
What is the function of ADAMTS13 enzyme?
cleaving ultra-large von willebrand factor to keep them out of circulation
What are the functions of platelets?
clotting plug formation release of serotonin repair of the injured tissues
Fresh Frozen Plasma should be used for what?
coagulation deficiencies
What smear technique has the advantage of providing the best WBC distribution when performed correctly?
coverslip technique
Cytomegalovirus (CMV) appears to suppress cell-mediated immune functions. What are characteristic findings in persons affected?
decreased CD4+ cells increased CD8+ cells
What lab results are consistent with hemolytic anemia?
decreased erythrocyte survival increased catabolism of heme decreased haptoglobin levels
Hypochromia
decreased hemoglobin concentration in RBCs
Sickle dex test
decreased solubility of deoxygenated HbS in solution produces visible turbidity
Abnormal platelet function seen in patient with Bernard Soulier Syndrome is caused by which of the following platelet components?
defective glycoprotein Ib/IX
What other hemoglobin gene loci occur on the same chromosome as the beta chain loci?
delta and gamma
A hemoglobin F concentration of 100% is seen in which beta thalassemia?
delta-beta thalassemia major
What coag factors are Vitamin K dependent?
factors 2, 7, 9, 10
Storage Pool Iron
ferritin and hemosiderin
What is likely to cause an abnormal thrombin time (TT)?
fibrin split products heparin dysfibrinogenemia
What is associated with macrocytic anemia?
fish tapeworm (absorbs vitamin B12)
What laboratory tests would be most helpful in determining the number of T cells in circulation?
flow cytometry
What assays are more sensitive and specific for the diagnosis of paroxysmal nocturnal hemoglobinuria (PNH)?
flow cytometry for GPI-anchored proteins
What are conditions associated with hereditary spherocytosis?
increased osmotic fragility MCHC greater than 37% extravascular hemolysis
What may prevent the detection of lupus anticoagulant in a plasma sample if the blood used for testing is not centrifuged for a sufficient time?
increased platelets in the plasma sample
How does hydroxyurea aid in the treatment of sickle cell disease?
induces increased production of HbF
Bacterial Meningitis
inflammation of the protective membranes covering the brain and spinal cord caused by various types of bacteria
What conditions would you NOT expect to see howell jolly bodies?
iron deficiency anemia
What would you predict is the effect of iron absorption if erythropoietic activity is increased over a prolonged period of time?
it would increase
What cells have a blue-gray cytoplasm with a "ground glass" appearance and vacuoles in the cytoplasms?
monocytes
Hepcidin function
key regulator of the entry of iron into circulation via ferroportin
Sideroblastic anemia
lead toxicity, Etoh -- iron accumulation -mitochondria dx: hct 20-30%, lead= basophilic stippling of RBCs tx: chelation therapy; transfusion
Bone marrow examination may be used to aid in the diagnosis of what condition?
leukemia
High LAP score
leukemoid reaction
What organ is associated with the production of the majority of clotting factors?
liver
What condition is most commonly associated with nonmegaloblastic macrocytic anemia?
liver disease
What lab assays are useful in diagnosing Hereditary Hemochromatosis?
liver function tests genetic studies iron studies
acute leukemia
presence of undifferentiated or immature cells, usually blast cells occurs more often in children
What cells have pale blue cytoplasm with a few azurophilic granules and an oval or indented nucleus?
lymphocytes
CD45 is present on what cells?
lymphocytes monocytes granulocytes
The peroxidase stain is useful in differentiating between which cells?
lymphocytic and granulocytic cells
What lineage are plasma cells from?
lymphoid lineage
During the "staining" process prior to flow cytometry analysis of white blood cells, how are the erythrocytes treated?
lysed
The presence of an increased number of hypersegmented neutrophils in the peripheral blood is an indication of what condition?
megaloblastic anemia
Characteristic findings in patients with iron deficiency anemia
microcytic, hypochromic red cell morphology decreased serum iron level decreased ferritin
What age group is Type I Hereditary Hemochromatosis most likely to be initially detected based on clinical symptoms?
middle age adults
neutrophilic granulocyte maturation
myeloblast promyelocyte myelocyte metamyelocyte band neutrophil
Tear Drop Cells are seen in what conditions?
myelofibrosis myelophthisic anemia thalassemia
What is the most immature neutrophil found in normal peripheral blood?
neutrophil bands
If present, how many Howell Jolly bodies are usually seen within a given erythrocyte?
one
What red cell inclusions are found in a patient with sideroblastic anemia?
pappenheimer bodies
What bones contain active hematopoietic bone marrow in a normal adult?
pelvis sternum vertebrae
Hematocrit
percentage of blood volume occupied by red blood cells
What is a clinical symptom associated with thrombocytopenia?
petechiae
What is a common clinical symptom that is directly related to thrombocytopenia?
petechiae
A white blood cell stained with Wright's stain has the following characteristics: Round eccentric nucleus with clumped chromatin pattern 1:1 nucleus to cytoplasm ratio Basophilic cytoplasm Crescent-shaped clear area next to nucleus What is the MOST likely identification of this cell?
plasma cell
Hb H inclusions
precipitate with brilliant cresyl blue
Osteoblast
resemble plasma cells
A smear that is prepared from equal parts of new methylene blue and whole blood is used for what count?
reticulocyte count
What hematological determinations is most reliable for evaluating bone marrow erythropoietic activity?
reticulocyte count
What physiological factor causes sedimentation in ESR?
rouleaux formation
How are T lymphocytes characterized?
secrete cytokines compromise majority of cells in blood lymphocyte pool help regulate immune response
What conditions is DIC associated with?
septicemia obstetric emergencies intravascular hemolysis
Spherocytes
small, spherically shaped erythrocytes immune hemolytic anemia increased osmotic fragility
What stain must be used to visualize Heinz bodies?
supravital stain
Transfusion Dimorphism
two population of red blood cells present
What inclusions are frequently seen on the same peripheral blood smear along with toxic granulation?
vacuoles
