heme week 2 review
Lymphocyte concentrations in peripheral blood are greatest during what age interval?
0-6 months of age
The adult reference interval for peripheral blood lymphocytes is:
1.0-4.8x10^9/mcL
What is the RI for platelets in the peripheral blood?
150-400x10^9/L
what is the life span of a platelet?
8-10 days
A CBC is performed for a patient who has been treated for anemia. the laboratory professional notes an increase in polychromatophilic macrocytes. Which of the following is speculated about the patient from the peripheral blood smear?
Is responding to the treatment for the anemia
What effect does thrombopoietin have on megakaryocytes?
It increases size, DNA ploidy level and rate of maturation
What is the association with a significant number of giant platelets resulting in an increased MPV on peripheral blood platelet count?
It would generally be associated with a decreased platelet count
Wha is the RBC indies that indicates how filled the average RBC is with hemoglobin in term of weight per unit volume?
MCH
A CBC is ordered on a 3-day-old infant with a fever of 100F. The laboratory professional notes nucleated RBCs on the peripheral blood smear but is not alarmed by the findings. Why not?
Nucleated RBCs are commonly observed in the first 7 days of life
What is a description that best fits the plasma cell?
Nucleus eccentric, chromatin in a chartwheel arrangement, deeply basophilic cytoplasm
What is the order of megakaryocyte development
BFU-MK--> CFU-MK--> megakaryoblast--> granular megakaryocyte
Pre-B cells are characterized by the presence of
CD19
What substance is measured in a spectrophotometer when Drabkin's solution is used for hemoglobin determinations?
Cyanmethemoglobin
the main function of NK ccells is
Cytotoxicity in innate immunity
What are some functions of platelets
Forming a hemostatic plug, vascular wall repair, and assist in the immune response
Which erythrocyte inclusion are composed of DNA ad stain blue on Romanowsky stains?
Howell-Jolly bodies
basophils and mast cells have receptors for which immunoglobin?
IgE
Primary granules first appear in the
Promyelocyte
If there is an increase in macrocytic, polychromatophilic erythrocytes on the Romanowsky-stained blood smear, which laboratory test result would correlate with this
Reticulocyte count
A Blood smear reveals uneven distribution of RBC, and The RBCs appear to be stacked together like a stack of coins. How would you describe this distribution?
Rouleaux
Define endomitosis
Rounds of DNA synthesis without nuclear division or cellular division
The hallmark of differentiating myelocytes from promyelocytes morphologically is the visual identification of what in the myelocytes?
Secondary granules
CD surface markers including CD2, CD3, CD5, and CD7 are associated with which subclass of lymphocytes?
T lymphocytes
The major role of cytokines responsible for regulating both megakaryocytes and platelet production is
TPO
during a sever bacterial infection, the concentration of neutrophils will decrease in which of the following locations?
The storage pool
How would you describe a platelet?
They are small with azurophilic granules
How would you describe a megakaryocyte
They have abundant acidophilic cytoplasm filled with azurophilic granules and a single, large, lobulated nucleus
KIR molecules are found on which type of lymphocyte
Treg cells
What is the mechanism of heparin-induced thrombocytopenia (HIT)? a. Antibodies directed against platelet factor 4 (PF-4) and heparin complex. b. Administration of toxic doses of heparin that destroy platelets. c. Abrupt cessation of heparin therapy. d. Purposeful destruction of platelets by heparin administration.
a. Antibodies directed against platelet factor 4 (PF-4) and heparin complex.
What is the prominent red blood cell (RBC) morphologic feature found in lead poisoning (plumbism)? a. Basophilic stippling b. Hypersegmentation c. Macrocytosis d. Target cell
a. Basophilic stippling
What crystal protein play a role in cytotoxic and proinflammatory properties of eosinophils. a. Charcot-leyden b. IgD and IgG c. NETs d. Esterases
a. Charcot-leyden
"A rare congenital red cell aplasia" without leukopenia or thrombocytopenia" best describes which of the following disorders? a. Diamond-Blackfan syndrome (DBA) b. Fanconi anemia c. Myelophthisic anemia d. Dyskeratosis congenita
a. Diamond-Blackfan syndrome (DBA)
Which of the following is MOST responsible for increasing the erythrocyte sedimentation rate (ESR)? a. Fibrinogen b. Albumin b. Alpha-2-globulins and beta-globulins d. Gamma-globulins
a. Fibrinogen (Increased fibrinogen is most responsible for increasing the ESR. Fibrinogen and other similar proteins decrease the zeta potential or negative charge of red cells, allowing them to come closer together and sediment more rapidly.)
What is a common early laboratory marker of hereditary hemochromatosis (HH)? a. Increased serum ferritin b. Decreased serum iron c. Decreased transferrin saturation d. Increased hemoglobin
a. Increased serum ferritin
The following results correlate with which of the following myelodysplastic syndromes?2 cyotpenias in the peripheral blood11% blasts in the peripheral blood18% blasts in the bone marrow Auer rods present a. MDS-EB-2 b. MDS-SLD c. MDS-MLD d. MDS-U
a. MDS-EB-2
The fibrinolytic system may be activated by which one of the following? a. Streptokinase b. Streptolysin c. Fibrin d. EDTA
a. Streptokinase
Which of the following poikilocytoses are frequently artifacts, not pathologic findings? a. Drepanocytes b. Echinocytes c. spherocytes d. schistocytes
b. Echinocytes
All of the following factors are involved in the intrinsic pathway, EXCEPT? a. Factor XII b. Factor VII c. Factor IX d. Factor XI
b. Factor VII
Which of the following is associated with macrocytic anemia? a. Iron deficiency b. Fish tapeworm c. Sickle cell disease d. Beta thalassemia minor
b. Fish tapeworm
Which of the following formulas will provide the value that reflects the average cell volume in a blood sample? a. Hemoglobin (g/dL) x 10/RBC count (10^12/L) b. Hematocrit (%) x 10/RBC count (10^12/L) c. Hemoglobin (g/dL) x 100/Hematocrit (%) d. Hemoglobin x 3
b. Hematocrit (%) x 10/RBC count (1012/L)
The laboratorian completed the mixing study ordered for John Doe. The results are as follows: Initial aPTT result: 167 seconds Initial 1:1 Mix with Normal Pooled Plasma: 158 seconds Incubated 1:1 Mix with Normal Pooled Plasma: 150 seconds Which of the choices below would most likely explain the results for this patient? a. Factor VIII deficiency b. Immediate-acting coagulation inhibitor c. Time/temperature-dependent coagulation inhibitor d. Factor VII deficiency
b. Immediate-acting coagulation inhibitor
On a Cytospin preparation from a pleural fluid specimen, 50% of the cells have the following characteristics: - uniform, regular arrangement- some cells resemble a "fried egg"- multiple nuclei- smooth nuclear outline and homogeneous chromatin- when present in clumps, there are clear spaces between the cells ("windows") How should these cells be classified? a. Atypical cancer cells b. Mesothelial cells c. Tumor cells d. Ependymal cells
b. Mesothelial cells
Which of the following are cells of the innate immune system? a. plasma cells b. NK cells c. B lymphocytes d. T lymphocytes
b. NK cells
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
All of the following are true of lab results of patients with Glanzmann thrombasthenia EXCEPT? a. Deficient GPIIb/IIIa b. Severe thrombocytopenia c. Increased bleeding time d. Abnormal platelet aggregation with ADP, collagen, and epinephrine
b. Severe thrombocytopenia (Patients with Glanzmann thrombasthenia typically have normal platelet counts. The issue for patients with Glanzmann thrombasthenia is abnormal platelet function, not low platelet counts.)
What are the usual results of the mean corpuscular volume (MCV) and the red cell distribution width (RDW) in alpha thalassemia? a. Both within normal range b. The MCV is decreased but the RDW is usually increased c. The MCV is increased but the RDW is normal d. Both the MCV and RDW are decreased.
b. The MCV is decreased but the RDW is usually increased
The MCHC result is extremely elevated in a patient's CBC results. Which of the following is likely cause of this results? a. microcytic RBCs b. agglutination of the RBCs c. increased hemoglobin and RBC count d. High RDW
b. agglutination of the RBCs
The function of the lymphocyte is to a. phagocytosis b. antigen recognition c. hypersensitivity d. allergic response
b. antigen recognition
patients with chronic granulomatous disease lack the ability to produce a neutrophilic respiratory burst and often die of bacterial infections. which phase of phagocytosis is disrupted? a. ingestion of bacteria b. bacterial cell killing c. neutrophilic degranulation d. bacterial cell recognition
b. bacterial cell killing
A wright's stain peripheral blood smear was observed with a stretched or irregular nucleus; occasional nucleoli were present. The cytoplasm was abundant and scalloped around the erythrocytes. this description best fits the: a. plasma cell b. lymphoblast c. reactive lymphocytes d. monocytes
c. reactive lymphocytes
Which of the following leukocytes are most likely to resemble the morphology of a monocyte ? a. neutrophil b. basophil c. reactive lymphocytes d. eosinophil
c. reactive lymphocytes
What is the mechanism of platelet formation and release by megakaryocytes ?
formation of proplatelet process, which subsequently segments into individual platelets
An absence of the E- and P-selectin receptors on neutrophils results in:
inability of the neutrophil to interact with VEC
leukocytes migration to the tissues is regulated by leukocyte-endothelial cell recognition that requires
interaction of adhesion molecules and their receptors
megakaryocyte
large platelet precursor cell found in the bone marrow
How would you classify the red cell pop with the following indices: MCV 110, MCH 38, MCHCC 33?
macrocytic, normochromic
If a neutrophil lacked the ability to produce L-selectin, which of its functions or abilities would be disrupted?
margination
Segmented neutrophils are more capable of egressing from the bone marrow into the peripheral blood than myelocytes because:
mature neutrophils more easily deform through the small pore dimeter in endothelial cells lining the marrow sinusoids
MPV (mean platelet volume) is used for what ?
may contribute to the differential diagnosis of platelet disorders
A gene defect that reduces the ability of M-CSF to be produced in sufficient quantity would result in a:
monocytopenia
An adult mall present to the emergency department after experiencing nausea and vomiting. The Total WBC count for the patient is 7.8x10^3/mcl with a differential count that reveal 10% monocytes. The data for this patient represent a:
normal monocyte count
some of the RBCs on a patient's smear contain numerous small blue inclusions. what should be done next to determine what to report about the inclusions?
perform an iron stain for identification siderocytes
Monocytes function in the innate immune response by the ability to ________ and function in the adaptive immune response by ________ and ________.
phagocytose; antigen prestation and cytokine secretion
A patient with infectious mononucleosis would most likely produce
polyclonal antibodies
Monocytes contribute to a proper functioning adaptive immune response by:
processing and presenting foreign antigens to lymphocytes
The eosinophil's primary function is to
protect the host from parasites
A routine CBC is to be performed on a blood sample that arrives in the lab from an outside clinic 4 hours after it is drawn. The sample is frozen. the sample is:
unacceptable due to improper sample temperatures
What is the correct units for reporting in absolute RBC count using the SI system.
x X10^12/L
You are analyzing a patient sample in the hematology laboratory when the instrument you use for automatic CBC flags your specimen for having a low platelet count. Upon performing a visual differential of the slide, you notice that there are indeed very few platelets on the slide. You also notice numerous, fragmented red blood cells. Which of the following choices could be associated with the low platelet count and fragmented red blood cells found in this case? a. Thrombotic Thrombocytopenic Purpura (TTP) b. The patient has bone marrow failure c. The patient is undergoing chemotherapy for multiple myeloma d. Myelodysplastic Syndrome
a. Thrombotic Thrombocytopenic Purpura (TTP)
Which of the following bone marrow sampling methods would be advisable if the quantity is inadequate for an aspirate smear? a. Touch imprint b. Bone marrow core biopsy c. Direct aspirate smear d. Clot section
a. Touch imprint
The most likely explanation for a patient who has a WBC count of 16x10^9/mcL with many reactive lymphocytes and a few immunoblast present is ? a. a heightened immune response b. early leukemia or lymphoma c. the presence of immunodeficiency d. qualitatively abnormal lymphocytes
a. a heightened immune response
The average cell turnover rate for granulocytes and monocytes in the peripheral blood is? a. hours b. 24 hrs c. 8-10 days d.10 years
a. hours
routine hematogoical analysis was performed on a 1 day old. the WBC count was 21.3x10^3/mcL. This finding represents an? a. normal leukocyte count b. absolute leukocytosis c. relative leukopenia d. absolute leukopenia
a. normal leukocyte count
A genetic alteration that produces improperly formed Fc receptors on the surface of neutrophils would have which of the following effects? a. the neutrophils would not recognize IgG-coated bacterial cells b. the neutrophil would not be able to phagocytize viral particles c. activated complement could not bind to the neutrophil receptors d. phagocytosis could not take place at all
a. the neutrophils would not recognize IgG-coated bacterial cells
While neutrophils predominantly function in the tissues they can function as phagocytic cells in the blood stream during which of the following? a. when bacteria are present in the blood b. during time of intense physical activity c. during an allergic response d. during a viral infection
a. when bacteria are present in the blood
Leukocytosis is defined as
an increase in WBCs
The RDW is found to be 19.5% on a patient. which of the following should you find increased on the smear?
anisocytosis
a peripheral blood smear that has an erythrocyte mixture of macrocytes, microcytes and normocytes present can best be described as:
anisocytosis
A patient has lymphocytic leukemia with 60% lymphoblast in the Peripheral blood. the best way for the clinical lab to determine whether these are T or B cells. a. do a Tdt stain on the blood b. determine the CD surface markers on the blast by flow cytometry c. do a molecular analysis to find oncogenes d. send the peripheral blood specimen to cytogenetics
b. determine the CD surface markers on the blast by flow cytometry
what would be the major effect on the body of severe monocytopenia? a. increased risk of parasitic infections b. increased risk of bacterial infections c. increased risk of viral infections d. decreased risk of allergic reactions
b. increased erisk of bacterial infections
A 53-year-old patient had a hemoglobin of 7.0g/dl. the reticulocyte count is 15%. Which of the following would you expect on the blood smear? a. poikilocytoses b. polychromatophilia c. agglutination d. howell-jolly bodies
b. polychromatophilia
a patient was seen in the ER for symptoms of appendicitis. A CBC was ordered. The WBC count was 20x 10^3/ mcLa and the differential revealed 60% segmented neutrophils 15% bands, 20% lymphocytes, 4 % monocytes and 1 % eosinophils. all other parameters were in the RI. These results are most likely due to: a. release of neutrophils from the bone marrow proliferating/mitotic compartment b. release of neutrophils from the bone marrow maturation/ nitoitc compartment c. a shift in the marginated pool of neutrophils in the peripheral blood d. a shift in the circulated pool of neutrophils in the peripheral blood compartment
b. release of neutrophils from the bone marrow maturation/ nitoitc compartment
Which of the following is a characteristic of B lymphocytes a. regulate immune response b. synthesize antibody c. secrete cytokine d. are majority of peripheral blood lymphocytes
b. synthesize antibody
An absolute neutrophilia is most likely to be associated with a
bacterial infection
Neutrophil extracellular traps (NETs) use what two substances to ensnare and kill microorganisms a. actin and cytokines b. plasm membrane and cd proteins c. DNA and granule contents d. collagen and antibodies
c. DNA and granule contents
A 90-year-old patient is admitted to the hospital with the following laboratory data: WBC: 9,000/mm3 PLT: 190,000/mm3 Hgb: 6.1 g/dL Differential:11% Neutrophils 40% Lymphocytes 4% Monocytes 45% Myeloblasts45% NRBC's / 100 WBC Bone Marrow: 45% Myeloblasts & 55% Megaloblastoid Erythroblasts Serum Vitamin B12 and Folic Acid: Normal The MOST likely diagnosis is: a. Pernicious anemia b. Polycythemia vera c. Erythroleukemia d. Myelomonocytic leukemia
c. Erythroleukemia (is also known as Acute Myelogenous Leukemia type M6. This type is associated with either the presence of both erythroid and myeloid precursors OR strictly erythroid precursors. In the case above, there are both erythroid and myeloid precursors present in the peripheral smear.)
Platelet satellitism is most likely to cause which of the following erroneous results? a. Falsely increased WBC count b. Falsely decreased RBC count c. Falsely decreased platelet count d. Falsely decreased hemoglobin level
c. Falsely decreased platelet count
The gel electrophoresis pattern for hemoglobin S (HbS) shows which of the following migration patterns? a. HbS migrates alone in alkaline and with HbD in acid electrophoresis. b. HbS migrates with HbD in alkaline and with HbA in acid electrophoresis. c. HbS migrates with HbD in alkaline and alone in acid electrophoresis. d. HbS migrates with HbA in alkaline and HbD in acid electrophoresis.
c. HbS migrates with HbD in alkaline and alone in acid electrophoresis.
Which of the following erythrocytes inclusions cannot be stained and visualized with Romanowsky stains? a. Pappenheimer bodies b. Howell-Jolly bodies c. Heinz bodies d. Basophilc stippling
c. Heinz 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
c. L-lysine
total WBC of 21.5 x 109/L. Differential count: metamyelocytes 4 band neutrophils 16 segmented neutrophils 48 monocytes 6 eosinophils 1 basophils 1 lymphocytes 24 This hematologic picture is most consistent with: a. Leukemoid reaction b. Chronic myeloid leukemia c. Left shift d. Leukoerythroblastosis
c. Left shift
A prothrombin time (PT) specimen was collected at an outpatient clinic and will not be picked up by the testing laboratory's courier until several hours later. How should the specimen be stored until it is picked up by the courier? a. The specimen should be centrifuged right away and stored in the refrigerator at 4° C until is picked up the the courier. b. The specimen should be frozen immediately and kept there until is tested. c. The tube should remain unopened and be kept at room temperature (20°-25° C). d. The specimen should be protected from light
c. The tube should remain unopened and be kept at room temperature (20°-25° C).
a patient who is immunocompromised would likely have a. an increase in CD4 cells b. lymphocytosis and eosinophilia c. a decrease in CD4 cells d. an increase in the T cell to be cell ratio
c. a decrease in CD4 cells
An individual who has a muntation in the CD18 gene that results in absence of the B2-integrinn on the leukocyte membrane will likely have? a. allergic reactions b. leukocytosis with neutrophilia c. life-threatening bacterial infections d. a defect in phagocytosis
c. life-threatening bacterial infections
The first immunoglobulin heavy chain produced in the maturing b lymphocyte is. a. alpha b. beta c. mu d. upsilon
c. mu
A major function of CD4+ lymphocytes is
cell-mediated immunity
Which is not a antigen presenting cell? a. dendritic cell b. neutrophil c. macrophages d. B lymphocytes
d. B lymphocytes
In serum protein electrophoresis all of the following proteins reside in the band closest to the anodal end EXCEPT: a. Retinol-binding protein (RBP) b. Transthyretin c. Albumin d. Haptoglobin
d. Haptoglobin
Which one of the following is a true statement about Lupus Anticoagulant (LA)? a. LA is a specific inhibitor found mainly in patients with the autoimmune disease, Systemic Lupus Erythematosus (SLE), b. LA is common in hemophiliacs c. LA prolongs coagulation leading to bleeding problems in patients. d. LA is an immunoglobulin.
d. LA is an immunoglobulin.
Which of the following conditions would produce the results listed below in an anemic patient? MCV = 115 fL MCH = 30 pg MCHC = 34 % a. Sickle cell anemia b. Aplastic anemia c. Iron deficiency anemia d. Pernicious anemia
d. Pernicious anemia
The presence of dacrocytes on a peripheral blood smear is most likely suggestive of which of the following? a. Artifact b. young RBCs c. RBC destruction d. Splenic removal of TBC inclusion
d. Splenic removal of RBC inclusions
A______ has cytoplasm with ground glass appearance while a ______ contains cytoplasm that is pinkish to clear in color. a. eosinophil, neutrophil b. monocyte, lymphocytes c. lymphocyte, basophil d. monocyte, neutrophil
d. monocyte, neutrophil
The following cells are found in the granulocytic proliferating pool (mitotic pool) of the marrow: a. Multipotential stem cells b. unipotential progenitor cells c. monoblast, myeloblasts and macrophages d. myeloblast, promyelocytes and myelocytes
d. myeloblast, promyelocytes and myelocytes
The total WBC count for an adult is 13.1x10^3/mcL with a differential count that reveals 20% eosinophils this represents a?
relative and absolute eosinophilia
An 80% lymphocyte count with a total WBC count of 4.4x10^9/mcL on an adult indicates a:
relative increase in lymphocyte but an absolute number within the reference interval
interleukin 4 plays a role in.
stimulating proliferation of B lymphocytes
Rouleaux is found on a smear of a patient with multiple myeloma. How will this affect the CBC results?
there will be no effect
