Hematology lab testing- Hemoglobin

A 17-year old African-American male had the following laboratory results: Sickle cell screen = positiveHemoglobin Electrophoresis:Hb S = 45%Hb A = 53%HbA2 = 2% Which of the following is the PROBABLE hemoglobin genotype?

AS

Hemoglobin D (HbD) is elevated in all of the following EXCEPT?

Alpha thalassemia

All of the following tests are included in a complete blood count (CBC), EXCEPT?

Blood culture

Identify the hemoglobin bands present, from cathode (negative) to anode (positive), in the sample shown in lane 5 of this alkaline hemoglobin electrophoresis.

C, S, A

Which of the following is least likely to interfere with the measurement of hemoglobin?

Cold agglutinin

What substance is measured in a spectrophotometer when Drabkin's solution is used for hemoglobin determinations?

Cyanmethemoglobin

Which of the following hemoglobins is known to migrate with HbS during electrophoresis when an alkaline gel, such as cellulose acetate, is used?

D

The most common screening test for Hb S, the hemoglobin solubility test, is based on which of the following principles?

Decreased solubility of deoxygenated Hb S in solution produces visible turbidity.

A hemoglobin F concentration of 100% may be seen in which beta thalassemia?

Delta-beta thalassemia major (dß0/dß0)

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

A two-year old male patient has the following hemogram results: Hgb = 6.7g/dLHct = 20%Platelets = 355 x 109/LRBC = 3.0 x1012/LWBC = 8.75 x 109/L Differential = 6% eos, 20% segs, 68% lymphs, 6% monos Which of the following is the MOST likely diagnosis?

Dietary iron deficiency

All of the following are associated with Hgb C disease, EXCEPT?

Fast mobility of Hgb C at pH 8.6

In the hemoglobin methodology using potassium ferricyanide the following measurable reaction occurs:

Ferrous iron is oxidized to ferric iron to form methemoglobin

At an alkaline pH, which of the following hemoglobins cannot be separated from hemoglobin S during hemoglobin electrophoresis?

Hb D

An alpha thalassemia patient is diagnosed as having three of their four genes deleted which code for alpha hemoglobin chains. Which one of the following types of hemoglobin is abnormal and would be found in such a patient?

Hb H

In the heterozygous state of HbS, referred to as sickle cell trait, which of the following hemoglobins appear in combination with HbS?

HbA

The hemoglobin electrophoresis patterns that are shown include controls labeled AF and ASC above and below the patient results on the alkaline electrophoresis (on the left), and above the patient results on the acid electrophoresis (on the right). Note that labels AF and ASC are simply labels for the controls and do not indicate order of migration. The patient was tested in duplicate and the results are in lanes 4 and 6. The patient samples displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?

HbAS

Which of the following non-HbS hemoglobins can also sickle and show a positive solubility test?

HbC Harlem

The gel electrophoresis pattern for hemoglobin S (HbS) shows which of the following migration patterns?

HbS migrates with HbD in alkaline and alone in acid electrophoresis.

The alkaline hemoglobin electrophoresis pattern that is shown on the right includes controls for A, S, and C; and A and F above and below the patient results. (NOTE: ASC and AF are simply labels for the controls and do not indicate order of migration.) The patient was tested in duplicate and the results are in lanes 3 and 4. The patient lanes (3 and 4) displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?

HbS/HPFH

The hemoglobin electrophoresis patterns shown include 2 controls labeled AF and ASC above (lanes 1 and 2) and below (lanes 9 and 10) the patient results on the alkaline electrophoresis (on the left), and above (lanes 1 and 2) the patient results on the acid electrophoresis (on the right). Note that the labels AF and ASC are simply labels for the controls and do not indicate order of migration. The patient sample was tested in duplicate, and the results are in lanes 4 and 6. The patient lanes displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?

HbSC

The hemoglobin electrophoresis patterns that are shown on the right include controls for A, S, and C; and A and F above and below the patient results. (NOTE: ASC and AF are simply labels for the controls and do not indicate order of migration.) The patient was tested in duplicate and the results are in lanes 5 and 6. The patterns on the left are from an alkaline hemoglobin electrophoresis and the patterns on the right are from an acid electrophoresis. These are results from the same patient. The patient lanes displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?

HbSS

When red blood cells hemolyze, what is the molecule released that will give the plasma its reddish appearance?

Hemoglobin

Which compound normally contains the majority of the body's total iron?

Hemoglobin

Which of the following hematology tests is used to indicate anemic conditions?

Hemoglobin

A 29-year-old female of Philippine descent is seen by her physician for fatigue. The patient states that a relative told her that their family has a long history of anemia.She presents with sclera icterus and her spleen is palpable. Routine blood work was initially ordered and these results were obtained: WBC6.1 X 10 9/L4.0 - 10.5 X 109/L RBC4.84 X 1012/L3.50 - 5.50 X 1012/L Hemoglobin8.4 g/dL12.0 - 16.0 g/dL Hematocrit28.8%36.0 - 48.0% MCV59 fL80.0 - 100.0 fL MCH17.4 pg26.0 - 34.0 pg MCHC29.3 g/dL32.0 - 36.0 g/dL RDW19.5 %11.0 - 15.0 % Platelets591 X 109/L150 - 400 X 109/L A peripheral blood smear is reviewed, revealing many codocytes (target cells) and a few schistocytes (fragmented RBCs). The majority of the RBCs that were seen in this smear were also microcytic and hypochromic. What additional laboratory tests should be performed to aid in the diagnosis of this disorder and associated anemia?

Hemoglobin electrophoresis

Which of the following analytes will be falsely decreased due to hemolysis?

Hemoglobin, Hematocrit, Red Blood Cell Count

A 5-year-old girl was brought to the emergency department with bloody diarrhea and severe abdominal pain. A complete blood count produced these results:CBC ParameterPatient ResultReference IntervalWBC9.6 x 109/L4.3 - 10.8 x 109/LHemoglobin9.1 g/dL11.5 - 13.5 g/dLHCT28%37 - 48%MCV80 fL86 - 98 fLRDW13.111 - 15Platelets90.1 x 109/L150 - 450 x 109/L The peripheral blood smear is represented in the image to the right. Which of the following condition(s) could be present in this patient when considering the information above and the cells indicated by the arrows on the peripheral smear?

Hemolytic uremic syndrome (HUS)

A peripheral smear with red blood cells photographed in a typical field was submitted for review. All of the following conditions are most likely associated with the red blood cell population found here, EXCEPT:

Hereditary Hemochromatosis

A known sickle cell trait patient has a hemoglobin electrophoresis test performed. Which of the following hemoglobin percentage sets would most closely match this patient's diagnostic state?

Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0%

Which of the following is most likely to interfere with the measurement of hemoglobin?

Lipemia

Case Study The image on the right is representative of the peripheral blood smear from a five-month-old immigrant from Asia. Her mother was concerned that the child was not eating well. Her spleen was palpable. These blood count results were reported: ParameterPatient ResultReference IntervalRBC5.5 x 1012/L3.1 - 4.5 x 1012/LHgb9.6 g/dL9.5 - 13.5 g/dLHCT30.4%29- 41%MCV55.4 fL74 - 108 fLMCH17.5 pg25 - 35 pgMCHC31.6 g/dL30 - 36 g/dLRDW34.9%11 - 15%Reticulocyte10.9%0.5 - 4.0% Knowing that the family is from a region of Thailand where HbE carriers are prevalent, the physician ordered a hemoglobin electrophoresis. The hemoglobin electrophoresis detected HbE. Based on the blood count results and this representative microscopic field, which of the following peripheral blood findings should be reported?

Microcytes (microspherocytes), target cells, nucleated red blood cells

You are running quality control for Hemoglobin A1C by high-pressure liquid chromatography (HPLC). The high control was 2.5 standard deviations above the mean. The low control was 2.2 standard deviations below the mean. Should you continue to run patient samples?

No. These QC values indicate a violation of the Westgard R4S rule and are therefore cause for rejection

On this alkaline electrophoresis gel, which patient most likely has alpha thalassemia? Lanes 5 and 6 represent controls.

Patient 3

Patient A and patient B both had hemoglobin migrating in the S position on an alkaline hemoglobin electrophoresis. Which of the following interpretations is appropriate for the sodium metabisulfite tests shown here?

Patient A has a positive solubility test.

What is the characteristic RBC that is uniquely associated with HbSS?

Sickle cell (drepanocyte)

An 8-year-old girl's peripheral blood smear is shown in the image on the right. Based on the peripheral blood image, what is a likely diagnosis?

Sickle cell disease

Methods of identifying many of the major hemoglobin variants such as Hb A, Hb F, Hb S, etc. include all of the following EXCEPT:

Sodium metabisulfite solubility test

Which form of hemoglobin cannot be measured using the cyanmethemoglobin method?

Sulfhemoglobin

Which of the following forms of hemoglobin cannot be detected by routine hemoglobin methods?

Sulfhemoglobin

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?

Transferrin saturation