Quiz: Hematology - Red Cells

30. 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

4. Pernicious anemia refers to cobalamin deficiency that results from a lack of which of the following? A. Vitamin B12 B. Intrinsic Factor C. Folate D. Vitamin C

A. Vitamin B12

19.Which of the following cell markers are useful in the diagnosis of paroxysmal nocturnal hemoglobinuria (PNH)? A. CD4 and CD8 B. CD55 and CD59 C. CD56 and CD57 D. CD14 and CD15

B. CD55 and CD59

9. If one finds excessive rouleaux formation on a blood smear examination, then which of the following parameters might also be increased? A. Leukocyte count B. Erythrocyte sedimentation rate C. Hematocrit D. Osmotic fragility

B. Erythrocyte sedimentation rate

33. In examining a Wright's stained blood smear of a patient who has had a splenectomy, one would most likely also find: A. Heinz bodies B. Howell-Jolly bodies C. Auer rods D. Dohle bodies

B. Howell-Jolly bodies

13. Which of the following disorders is characterized by a stem cell mutation due to the PIGA gene that leads to clones of cells that bind abnormally large amounts of complement? A. Spur cell anemia B. Paroxysmal nocturnal hemoglobinuria C. Hereditary acanthocytosis (aka Abetalipoproteinemia) D. Hereditary pyropoikilocytosis

B. Paroxysmal nocturnal hemoglobinuria

23. Which finding best distinguishes immune hemolytic anemia from other hemolytic anemias? A. Rouleaux B. Positive DAT C. Splenomegaly D. Increased erythrocyte count

B. Positive DAT

5. Considering the red cell distribution width (RDW) in alpha thalassemia, how would you expect the red blood cell histogram to look? A. Shifted to the right B. Shifted to the left C. Bimodal D. Normal

B. Shifted to the left

12.What is the characteristic RBC that is uniquely associated with HbSS? A.Target cell (codocyte) B. Sickle cell (drepanocyte) C. Polychromatophilic cell D. Spherocyte

B. Sickle cell (drepanocyte)

40. What cellular characteristic of red blood cells is described by the term poikilocytosis? A. Variability in size B. Variability in shape C. Presence of nuclear material D. Concentration of hemoglobin

B. Variability in shape

8. Which form of hemoglobin cannot be measured using the cyanmethemoglobin method? A. Sulfhemoglobin B. Carboxyhemoglobin C. Oxyhemoglobin D. Hemoglobin

A. Sulfhemoglobin

15. This photo shows the bone marrow aspirate of a patient with a history of fatigue and petechiae. The CBC from the peripheral blood would confirm: A. Decreased RBCs, platelets, and WBCs B. Decreased RBCs C. Decreased WBCs D. Decreased platelets Feedback

A. Decreased RBCs, platelets, and WBCs

35. The presence of erythrocytes with altered morphology as indicated by the arrows in the image has a close association with which of the following conditions? A. Extensive burns B. Babesiosis C. Sickle cell disease D. Type I von Willebrand's disease

A. Extensive burns

46. With the exception of beta thalassemia minima, which hemoglobin is decreased in beta thalassemia? A. Hb A B. Hb A2 C. Hb F D. Hb S

A. Hb A

44. Which of the following is a negative regulator of intestinal iron absorption? A. Hepcidin B. Ferroportin 1 C. Erythroferron D. Hephaestin

A. Hepcidin

31. 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

18. What best describes the cells seen in this illustration? A. Ovalocytes B. Burr cells V. Sickle cells D. Elliptocytes

B. Burr cells

26. The life span of RBCs containing Hemoglobin H is typically: A. Less than 120 days B. 100-120 days C. 120-140 days D. Greater than 140 days

A. Less than 120 days

7. 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

10.This image represents a field of red blood cells (RBCs) stained using a supravital stain. How would these cells appear if viewed on a Wright-stained smear? A. Polychromatophilic RBCs B. RBCs containing basophilic stippling C. RBCs containing Cabot's rings D. RBCs containing Pappenheimer bodies

A. Polychromatophilic RBCs

21. When assessing the RBC morphology on a peripheral blood smear, which would be an expected finding on a patient with thrombotic thrombocytopenic purpura (TTP)? A. Schistocytes B. Target cells C. Acanthocytes D. Echinocytes

A. Schistocytes

What is the expected life span of a normal red blood cell? A. 3-4 months B. 1-2 months C. 3-6 weeks D. 1-3 weeks

A. 3-4 months

34. Hemoglobin S (HbS) is MOST common in which of the following countries? A. African countries B. Mediterranean countries C. Middle Eastern countries D. North American countries

A. African countries

38.In most cases of Fanconi anemia, which of the following types of anemia develops? A. Aplastic B. Microcytic C. Hemolytic D. Drug-induced

A. Aplastic

42. When three tubes of cerebrospinal fluid are received in the laboratory they should be distributed to the various laboratory sections as follows: A. #1 Hematology, #2 Chemistry, #3 Microbiology B. #1 Chemistry, #2 Microbiology, #3 Hematology C. #1 Microbiology, #2 Hematology, #3 Chemistry D. #1 Chemistry, #2 Hematology, #3 Microbiology

B. #1 Chemistry, #2 Microbiology, #3 Hematology

47.Which of the following microcytic anemia's is the most common anemia other than Iron Deficiency Anemia (IDA) and accounts for more than one-third of anemia in hospitalized patients without blood loss? A. Pernicious anemia B. Megaloblastic anemia C. Anemia of chronic disease/inflammation D. Immune hemolytic anemia

C. Anemia of chronic disease/inflammation

14. Which of the following can cause an automated platelet count to appear to be lower than it actually is? A. Platelet satellitism B. Platelet clumping C. Both platelet satellitism and platelet clumping D. Neither platelet satellitism and platelet clumping

C. Both platelet satellitism and platelet clumping

2.A white blood cell (WBC) count is performed on a blood specimen from a newborn using a hematology analyzer that does not have the capability to detect and quantify nucleated red blood cells (NRBCs). The WBC count that is reported by the analyzer is 28.2 x 109/L, and it is flagged for a manual differential. Upon review of the blood film, more than 6 nucleated cells that resemble the cells shown in the image were identified in the 100 WBC differential. What action should be taken? A. Report the automated white blood cell count and the manual differential results immediately to the physician. B. Count the number of cells that resemble the cells in this image (per 100 WBCs) and subtract that number from the WBC count that was reported by the analyzer. C. Count the number of cells that resemble the cells in this image (per 100 WBCs) and compute for the corrected WBC count using the formula, Total WBCs x100 / 100+ number of NRBCs. D. Add the NRBCs to the WBC count.

C. Count the number of cells that resemble the cells in this image (per 100 WBCs) and compute for the corrected WBC count using the formula, Total WBCs x100 / 100+ number of NRBCs.

45. Which of the following is an FDA-approved therapeutic agent for treating sickle cell patients? A. Butyric acid B. Erythropoietin C. Hydroxyurea D. Nitric oxide

C. Hydroxyurea

22. What morphological change is present in the image indicated by the arrow? A. Barr bodies B. Slight toxic granulation C. Hypersegmented nucleus D. Hyposegmented

C. Hypersegmented nucleus

27. The complete blood count was obtained from a patient recently admitted to the emergency room. The red blood cell indices obtained revealed an MCV of 115 femtoliters (fL) (normal range 80 - 90 fL). The patient met the criteria for a peripheral blood smear examination. A representative field is shown on the right. All of the following conditions would be indicated by the results seen on this peripheral blood smear EXCEPT? A. Hemolytic anemia B. Myelodysplasia C. Iron deficiency D. Liver disease

C. Iron deficiency

1.A variety of additives are used in blood collection tubes. Which of the following additives prevents clotting by inhibiting thrombin and thromboplastin? A. EDTA B. Gel C. Lithium or sodium heparinSodium D. fluoride

C. Lithium or sodium heparinSodium 2.

11. What morphologically abnormal red blood cell is associated with "hyperchromia"? A.Spherocyte B. Macrocyte C. Microcyte D. Target cell

C. Microcyte

17. A smear that is prepared from equal parts of new methylene blue and whole blood is used for which of the following? A. WBC differential B. Platelet estimate C. Reticulocyte count D. Manual RBC count

C. Reticulocyte count

39.Note the iron-stained bone marrow preparation in the image to the right. The cells as shown can be associated with which type of anemia? A. Iron deficiency anemia B. Sickle cell anemia C. Sideroblastic anemia D. Megaloblastic anemia

C. Sideroblastic anemia

6. Which of the following statements about macrocytes is true? A. MCV is within normal limits. B. The appearance of the cell is due to exaggerated flattening. C. The cells are typically larger than a resting lymphocyte. D. Macrocytic cells are generally hypochromic.

C. The cells are typically larger than a resting lymphocyte.

37.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 crisis

20.Identify each of the white blood cells that are shown in this image of a Wright-Giemsa stained peripheral blood smear, 1000x magnification. A. #1 - monocyte; #2 - monocyte B. #1 - lymphocyte; #2 - monocyte C. #1 - plasma cell; #2 - monocyte D. #1 - lymphocyte; #2 - reactive (atypical) lymphocyte

D. #1 - lymphocyte; #2 - reactive (atypical) lymphocyte

25. A mother brings in her 6-year-old son to the clinic with concerns of learning difficulties from his school and also states he seems very tired all the time. The family has been staying in an old, run-down motel recently as they try to find housing with no other significant family history. Testing was ordered to include a CBC. The CBC shows a microcytic anemia but otherwise normal results. Which of the following may be present upon manual differential review? A. Sickle cells B. Pappenheimer bodies C. Howell-Jolly bodies D. Basophilic stippling

D. Basophilic stippling

36. Identify the inclusion indicated by the arrow: A. Auer rod B. Döhle bodies C. Heinz bodies D. Cabot ring

D. Cabot ring

28. A blood smear represented by the photograph was submitted for hematologic review. Based on the erythrocyte morphology and the accompanying histogram, which of the following choices is the most likely situation or condition? A. Normal smear B. Iron deficiency anemia C. Aplastic anemia D. Dimorphic red cell population

D. Dimorphic red cell population

49. Which of the following will give the best overall picture of a patient's iron stores: A. Albumin B. Transferrin C. Haptoglobin D. Ferritin

D. Ferritin

16. Which of these blood levels will decrease during intravascular hemolysis? A. Serum (plasma) B. LDHSerum (plasma) bilirubin C. Reticulocytes D. Haptoglobin

D. Haptoglobin

48. The alkaline hemoglobin electrophoresis pattern 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 labeled for the controls and do not indicate the migration order.) 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? A. HbSA B. HbSC C. HbSD D. HbS/HPFH

D. HbS/HPFH

43. The bone marrow in alpha thalassemia major usually demonstrates: A. Normoplasia B. Hypoplasia C. Aplasia D. Hyperplasia

D. Hyperplasia

24. Erythropoietin is mainly produced in: A. Bone marrow B. Bones C. Lymphocytes D. Kidneys

D. Kidneys

29. What is the identifty of this nucleated blood cell? A. Lymphocyte B. Neutrophil C. Basophil D. Monocyte

D. Monocyte

32. The two nucleated cells in this peripheral blood smear image can be identified as (left image-right image): A. Myelocyte - lymphocyte B. Monocyte- nucleated red blood cell C. Monocyte - lymphocyte D. Myelocyte - nucleated red blood cell

D. Myelocyte - nucleated red blood cell

3. 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

41. A 49-year-old male with pneumonia was treated with high-dose intravenous penicillin. He became jaundiced with yellow sclera. The image on the right is typical of other fields that were observed on his peripheral blood smear. Since penicillin may, in some individuals, cause autoimmune hemolytic anemia, the clinician requested a direct antiglobulin test (DAT) be performed. The DAT was positive, indicating that antibodies to the drug were produced, which were then attached to the drug on the surface of the red cells. Hemolysis occurred due to the drug-induced antibody attachment, leaving the patient with various abnormal red blood cell morphologies. Which of the following cell types would you report for this patient? A. Acanthocytes, nucleated red blood cells, polychromatophylic red blood cells B. Burr cells, spherocytes, polychromatophylic red blood cells C. Target cells, acanthocytes, polychromatophylic red blood cells D. Spherocytes, nucleated red blood cells, polychromatophylic red blood cells

D. Spherocytes, nucleated red blood cells, polychromatophylic red blood cells