LabCE Quiz 9

A patient that has 2% peripheral blood blasts, absolute monocytosis, and 10% bone marrow blasts would be classified as which Myelodysplastic Syndrome? a) Refractory Anemia b) Chronic Myelomonocytic Leukemia c) Refractory Anemia with Excess Blasts d) Refractory Anemia with Excess Blasts in Transformation

b) Chronic Myelomonocytic Leukemia

Which of the following would be true of the myeloid to erythroid (M:E) ratio in a case of chronic myelocytic leukemia (CML)? a) Normal (2:1 - 4:1) b) High (>4:1) c) Low (<2:1) d) Variable

b) High (>4:1)

In almost all cases of polycythemia vera, which of the following genetic abnormalities is present? a) Philadelphia chromosome b) JAK2 mutation c) BCR/ABL1 d) t(15:17)(q22;q12)

b) JAK2 mutation

The analysis of a differential blood smear and laboratory results produced the following results: WBC: 47,000/µL 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

In which stain will auer rods have the most intense reaction? a) Sudan Black B b) Myeloperoxidase c) Chloroacetate Esterase d) Periodic Acid-Schiff

b) Myeloperoxidase

All of the following methods are used in the diagnosis and classification of acute leukemia, EXCEPT? a) Immunophenotyping b) Reticulocyte count c) Cytochemical Analysis d) Cytogenetics

b) Reticulocyte count

Which of the following gene translocations is associated with Acute Promyelocytic Leukemia (APL)? a) t(8;21) b) t(15;17) c) t(9;11) d) t(6;9)

b) t(15;17)

Which of the following is a clinical finding of Myelodysplastic Syndrome with Excess Blasts subtype 2 (MDS-EB-2)? a) 5 to 15% ring sideroblasts b) Isolated deletion of the long arm of chromosome 5 (del 5q) c) 10 to 19% blasts in the Bone Marrow d) No cytopenia in the peripheral blood

c) 10 to 19% blasts in the Bone Marrow

A 72-year-old patient has a routine check-up and CBC. The CBC shows a high absolute neutrophil count of 28,000/µl, with slightly elevated bands, a few immature myeloid cells, and slight toxic granulation. Upon further examination of the patient, hepatomegaly and splenomegaly are noted. Because of the splenomegaly and the lack of obvious infection, a bone marrow exam is performed which shows hypercellularity of the granulocytes. Molecular testing yields a CSF3R mutation. The most likely diagnosis is: a) Pelger-Huet anomaly b) Chronic Myelogenous Leukemia (CML) c) Chronic Neutrophilic Leukemia (CNL) d) Primary Myelofibrosis (PMF)

c) Chronic Neutrophilic Leukemia (CNL)

Myelodysplastic Syndromes are characterized by cytopenias with at least one cell line decreased as well as this: a) Left shift b) Leukoerythroblastosis c) Dyspoiesis d) Leukemoid Reaction

c) Dyspoiesis

A CBC is done on a patient admitted for a severe hemorrhage. The patient has a high platelet count and the blood smear can be seen on the right. A bone marrow exam is performed and a proliferation of megakaryocytes is noted. Molecular analysis shows a JAK 2 mutation. This patient most likely has: a) Reactive thrombocytosis b) Iron deficiency anemia c) Essential Thrombocythemia d) Chronic Myelogenous Leukemia

c) Essential Thrombocythemia

Which of the following is the cause of cytopenia in Myelodysplastic syndromes (MDS)? a) Unchecked clonal hematopoiesis b) Inability to incorporate iron into developing erythrocytes c) Excess apoptosis d) Myelofibrosis

c) Excess apoptosis

Diseases associated with a dysfunction of polymorphonuclear neutrophils (PMNs) include all of the following with the exception of: a) Chediak-Higashi syndrome (CH) b) Chronic granulomatous diseases (CGDs) c) Gaucher 's Disease d) Myeloperoxidase deficiency (MPO)

c) Gaucher 's Disease

If a patient's WBC is 50,000/mm3, what test should be ordered to determine if this is a leukemoid reaction or a chronic myelocytic leukemia? a) Peroxidase stain b) Sternheimer stain c) Leukocyte alkaline phosphatase stain d) Sudan Black B stain

c) Leukocyte alkaline phosphatase stain

The most striking laboratory finding of this myeloproliferative neoplasms is an absolute erythrocytosis and hemoglobin concentrations of greater than 18.5 g/dL? a) Chronic myelogenous leukemia (CML) b) Essential thrombocythemia (ET) c) Polycythemia vera (PV) d) Primary myelofibrosis (PMF)

c) Polycythemia vera (PV)

Which of the following best describes Myelodysplastic syndromes? a) A myeloproliferative disorder b) An acute leukemia that is in remission c) A leukemia that typically progresses to thrombocytopenia and lymphocytic leukemia d) A qualitative disorder of erythroid, myeloid and/or megakaryocytic cell series

d) A qualitative disorder of erythroid, myeloid and/or megakaryocytic cell series

Auer rods are most commonly present in which of the following conditions? a) Acute lymphocytic leukemia (ALL) b) Plasma cell leukemia c) Erythroleukemia d) Acute myelocytic leukemia (AML)

d) Acute myelocytic leukemia (AML)

What is the name of the cells that are indicated by the arrows on this slide? a) Acanthocytes b) Burr cells c) Codocytes d) Dacrocytes

d) Dacrocytes

Laboratory tests which distinguish Polycythemia Vera (PV) from Chronic Myelogenous Leukemia (CML) include all of the following EXCEPT: a) The JAK 2 mutation b) Nucleated red blood cells c) Elevated LAP score d) Hypercellular bone marrow

d) Hypercellular bone marrow

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)? a) Wright's stain b) Peroxidase (i.e. Myeloperoxidase) c) Alpha-naphthyl acetate d) Leukocyte alkaline phosphatase (LAP)

d) Leukocyte alkaline phosphatase (LAP)

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 (PAS) c) Acid phosphatase with tartrate d) Leukocyte alkaline phosphatase (LAP)

d) Leukocyte alkaline phosphatase (LAP)

A patient has a high absolute eosinophil count of 2000/µl; organ biopsies show infiltration of eosinophils. The patient is diagnosed as having Chronic Eosinophilic Leukemia. Other causes for high eosinophil counts include all of the following EXCEPT: a) Infections of parasitic helminths b) Allergic reactions c) Chronic Myelogenous Leukemia d) Mycosis Fungoides

d) Mycosis Fungoides

Which chromosome abnormality is most commonly associated with CML? a) t(8;21) b) t(5;17) c) t(11;17) d) t(9;22)

d) t(9;22)

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? a) Acute Myeloid Leukemia (AML) b) Acute Lymphoid Leukemia (ALL) c) Chronic Lymphocytic Leukemia (CLL) d) Polycythemia Vera (PV)

a) Acute Myeloid Leukemia (AML)

Fifty percent blasts are found on a peripheral blood smear. The cells are large (3-5x the size of a lymphocyte) with a nucleus that contains fine homogeneous chromatin and two to three nucleoli. There is moderate blue-grey cytoplasm with Auer rods. What leukemia is most likely? a) Acute myelogenous leukemia (AML) b) Hairy cell leukemia (HCL) c) Acute lymphoblastic leukemia (ALL) d) Chronic lymphocytic leukemia (CLL)

a) Acute myelogenous leukemia (AML)

A 41-year-old male arrived at the clinic with complaints of fatigue, malaise, and overall discomfort. Upon testing, the patient's CBC results were notably abnormal with 30% blasts present along with anemia and thrombocytopenia. Bone marrow and cytochemical staining were subsequently performed. The cytochemical stains noted negative reactions to Myeloperoxidase and Sudan Black B but a positive reaction to alpha-naphthyl acetate. Which of the following conditions is most likely seen? a) Acute Erythroleukemia b) Acute Monocytic Leukemia c) Acute Promyelocytic Leukemia d) Acute Lymphocytic Leukemia

b) Acute Monocytic Leukemia

The Philadelphia chromosome is consistently associated with which of the following blood disorders? a) Chronic myelocytic leukemia (CML) b) Chronic lymphocytic leukemia (CLL) c) Acute myelocytic leukemia (AML) d) Acute lymphocytic leukemia (ALL)

a) Chronic myelocytic leukemia (CML)

Which of the following is NOT classified as a Myelodysplastic Syndrome? a) MDS with Philadelphia Chromosome (MDS-PC) b) MDS with Ring Sideroblasts (MDS-RS) c) MDS with Single Lineage Dysplasia (MDS-SLD) d) MDS with Excess Blasts (MDS-EB)

a) MDS with Philadelphia Chromosome (MDS-PC)

The following results correlate with which of the following myelodysplastic syndromes? 2 cyotpenias in the peripheral blood 11% blasts in the peripheral blood 18% 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

A patient that has >15% ringed sideroblasts present would be categorized as which myelodysplastic syndrome? a) MDS-RS b) MDS-MLD c) CMML d) MDS-EB

a) MDS-RS

Which of the following is a sign of dyserythropoiesis that occurs in Myelodysplastic Syndromes? a) Oval macrocytes b) Schistocytes c) Basophilic stippling d) Sickle cells

a) Oval macrocytes

A patient has a hypercellular bone marrow and is suspected of having a myeloproliferative disorder. Laboratory features include: excess megakaryocyte proliferation and atypia, marked marrow fibrosis, and the JAK2 mutation. The most likely diagnosis is: a) Primary Myelofibrosis (PMF) b) Chronic Myelogenous Leukemia (CML) c) Chronic Neutrophilic Leukemia (CNL) d) Essential Thrombocythemia (ET)

a) Primary Myelofibrosis (PMF)

In order for a cell to be classified as a ring sideroblast, which of the following must be true? a) RBC precursor with at least 5 iron granules circling at least 1/3 of the nucleus b) RBC precursor with at least 4 iron granules circling at least 1/4 of the nucleus c) RBC precursor with at least 3 iron granules circling at least 1/4 of the nucleus d) RBC precursor with at least 8 iron granules circling at least 1/2 of the nucleus

a) RBC precursor with at least 5 iron granules circling at least 1/3 of the nucleus

What is the cell that is indicated by the arrow in this Prussian-blue stained bone marrow smear? a) Ringed sideroblast b) Reticulocyte c) Megakaryocyte d) Plasma cell

a) Ringed sideroblast

Classification of acute leukemia in the United States relies on two main systems, the FAB (French American British) and the WHO (World Health Organization) classifications. In order to diagnose acute leukemia, the FAB system requires ______% of non-erythroid blasts to be present in the bone marrow/peripheral blood, while the WHO system requires the presence of ________% non-erythroid blasts. a) 40%, 20% b) 30%, 20% c) 20%, 30% d) 20%, 40%

b) 30%, 20%

What are the white blood cell inclusions that are indicated by the arrows in this image? a) Dohle bodies b) Auer rods c )Toxic granules d) Bacteria

b) Auer rods