BOC Hematology

Light blue-grey inclusions found in a burn patient?

Dohle bodies

What is the genotype associated with alpha thalassemia minor?

-a/-a

Normal M/E ratio for adults when assessing bone marrow aspirate smear?

2.5:1

Correct blood-to-coagulant ratio in blue top tubes for coagulation test?

9:1

Most common form of childhood leukemia?

ALL

Newborns who will develop Hb H disease may demonstrate up to 30% of what type of Hb?

Bart's

What hemoglobin is replaced by HbH after birth in individuals with HbH disease?

Bart's

What would not affect the results of a PT?

Factor VIII deficiency

Name a disease not associated with a dysfunction of PMNs.

Gaucher's disease

Hemoglobin decreased in beta thalassemia?

Hb A

A 36-year old woman has fever, night sweats, and over all fatigue over the past 3 months. Upon examination she displays lymphadenopathy. When a lymph node bipsy is performed, Reed-Sternberg cell, bands of fibrosis, and various-sized lymphocytes are noted. Diagnosis?

Hodgkin Lymphoma

What info can you provide from the RBC indices if an instrument is down?

MCHC only

What are the usual results of the MCV and RDW in alpha thalassemia?

MCV decreased, RDW increased

Abnormal gene associated with Chekiak Higashi resulting in abnormal cell and susceptible to infections?

LYST

Nitric oxide is associated with the prevention of vaso-occlusion by decreasing cellular adherence to endothelium. Which amino acid in decreased in patients with sickle cell disease and is needed as a substrate to produce nitric oxide?

L-arginine

What lab test is used to monitor oral anticoagulant therapy?

PT/INR

A patient that has >15% ringed sideroblasts present would be categorized as which Myelodysplastic Syndrome?

RARS

Which subset of effector lymphocytes is predominantly responsible for regulation of antibody production?

TH2

What are the primary reagents used aPTT?

activated partial thromboplastin and Ca

Composition of basophilic stippling?

aggregation of ribosomes?

Toxic granulation is seen most frequently in?

bacterial infections

Granulocyte that has water soluble granule that can fade during rinsing phase of Wright's stain?

basophil

What describes a beta thalassemia genotype b+/b?

beta thalassemia minor

Pelger-Huet anomaly is characterized by what?

bilobed or round nuclei in neutrophils(hypersegmented)

What doesn't cause and increased ESR?

blood drawn in sodium citrate anticoagulant

A low platelet count, along with a low WBC count and RBC count is caused by:

bone marrow hypoplasia

What test will be abnormal in patient with Fibrin Stabilizing factor deficiency?

both 5 M urea clot solubility and factor XIII assay

What is the most common cause of drug-induced immune hemolytic anemia?

cephalosporins

A small child has albino characteristics, photophobia, frequent pyogenic infections, and blood smear show giant dark granules in the monocytes and granulocytes. Probable diagnosis?

chediak-hegashi syndrome

FFP is used for?

coag deficiencies

Which of the following smear techniques has the advantage of providing the best WBC distribution when performed correctly?

coverslip technique

Alpha thalassemia:

decrease in rate of production of alpha chains due to a partial or total deletion of genetic code

Lab results consistent with hemolytic anemia?

decreased erythrocytic survival increased catablolism of heme decreased haptoblobin levels

What set of results is indicative of stage 3 iron deficiency?

decreased ferritin increased sTfR increased TIBC

Abnormal platelet function seen in patients with Bernard-Soulier Syndrome is caused by which of the following platelet components?

defective glycoprotein ib/IX

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

delta-beta thalassemia major

HgB=6.7 Hct= 20% Platelets=355 x 10 9 RBC=3.0 x 10 12 WBC=8.75 x 10 9

dietary iron deficiency

Afibrinogenemia results:

elevated: PT, aPTT, TT, & reptilase time

Which coag pathway is factor VII part of?

extrinsic

What factor may be deficient if both the PT and aPTT are prolonged?

factor II

Possible caused of initial aPTT prolongation?

factor IX defeciency

Regarding hemoblobin synthesis, what constitute the alpha globin chain coding?

four gene loci; two each on chromosome 16

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 is plasma sample

Which of the following observations would best explain why a blood smear is exhibiting polychromasia?

increased retic count

Most common early lab marker of HH?

increased serum ferrtin

How does hydroxyurea aid in the treatment of sickle cell anemia?

induces increased production of HbF

Hemoglobin H antibodies can directly alter what?

integrity of the RBC membrane

Not asso. with hereditary spherocytosis?

intravascular hemolysis

What condition could result in microsytic anemia?

iron deficiency

What is cause of hemolytic anemia?

iron deficiency anemia

The first time a cell containing HbSS is deoxygenated, it forms a sickle cell. Upon reoxygenation, what is true of the sickle cell?

it will return to a normal biconcave shape

What would you predict is the effect on iron absorption if erthopoietic activity is increased over a prolonged period of time?

it would increase

A defective clot retraction might be caused by what?

lack of/defect of platelet receptor llb/llla

Coarse basophilic stippling is usually seen in patients who have what?

lead poisoning

Patient with fever results: RBC=3.56 x 10 12 WBC=57.5 x 10 9 Platelet=375,000 Diff: 3 blast 10 myelo 6 meta 12 bands 64 segs 4 lymphs 1 mono LAP=155

leukemoid rxn

If a patient's WBC is 50,000/mm3, what test should be ordered to determine if this is a leukemoid rxn or a chronic myelocytic leukemia?

leukocyte alkaline phosphatase stain

A patient has a prolonged PT. Intravenous vitamin K is then administered. The repeat PT results are normal after 24 hrs of vitamin K therapy. What clinical condition is this?

liver disease

Abnormal TT isn't caused by what?

low platelet count

Platelets don't aid coagulation by?

lower bp by releasing heparin

Which of the following is considered one of the most common coagulation inhibitors?

lupus anticoagulant

RBC morphology characteristic of megaloblastic anemia?

macrocytic

The presence of an increased number of hypersegmented neutrophils in the peripheral blood is an indication of what condition?

megaloblastic anemia

The mutational status of JAK2 is most commonly used for diagnosis of what?

meyloproliferative neoplasms

HgB= 8.1 Hct=31 RBC=4.0 x 10 12

microcytic, hypochromic

In which age group is Type 1 HH most likely to be initially detected based on clinical symptoms?

middle aged adults

To determine if an elevated aPTT is caused by a factor deficiency or a factor inhibitor when the PT is normal, the 1st step would be?

mix one part patient plasma and one part normal pooled plasma and repeat the aPTT

Esterase stains are used to help differentiate what from what?

monoblast from myeloblast

After briefly circulating in the peripheral blood, what cell becomes a tissue macrophage whose main function is phagocytosis?

monocyte

What is not a granulocyte?

mott cell

Degenerated erythrocyte cytoplasmic organelles that contain iron:

pappenheimer bodies

Most reported virus as the cause of infection leading to aplastic crisis in person the sickle cell disease?

parvovirus b19

What is associated with thrombocytopenia?

petechiae

Inflammation of vein?

phelbitis

What procedure utilizes luekaphereisis to collect the buffy coat from whole blood?

photopheresis

Another name for fully committed B-lymph?

plasma cell

What cell is found in plasma cell leukemia?

plasma cell

3-year old has recurring conjunctivitis along with woody growths on mucous membranes. Which deficiency is this?

plasminogen

The TT complex is known to aid in the activation of what?

plasminogen

What most affected by microclots in EDTA drawn for CBC?

platelet count

A patient has a history of repeated spontaneous abortion. Coagulation studies reveal an elevated APTT, normal PT, normal platelet function, and normal thrombin time. Schistocytes were seen on the peripheral blood smear. Which test should be performed to determine if the patient has lupus anticoagulant?

platelet neutralization test

What can cause and automated platelet count to appear lower than it is?

platelet satellitism and platelet clumping

What is the best method for examination of synovial crystals?

polarized light

Disnorders in which coarse basophilic stippling can't be seen in what disorder?

polycythemia

Which potent inhibitor of platelet aggregation is released by endothelial cells?

prostacyclin

The vascular system does not contribute to what in homeostasis?

proving smooth endothelial cells

What is secondary hypercoagulable not caused by?

rapid weight loss

What cell is found in infectious mononucleosis?

reactive/variant lymph

How should a PT specimen be stored until a courier can pick it up?

remained unopened at room temp

What test system can be used to evaluate the adequacy of fibrinogen in heparinized patients?

reptilase time

Ristocetin is used in certain vWF functional assays. Reason is:

restocetin enhances binding of vWF to platelet GPlba

What 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?

rouleaux formation

Difference between megaloblasitc and nonmegaloblastic anemia in RBC morphology:

round macrocytes in nonmegaloblastic anemia

When assessing the RBC morphology, which would you expect finding on a patient with TTP?

schistocytes

Glanzmann doesn't have what result?

sever thrombocytopenia

Anemia formed due to the inability to incorporate in into the protoporphyrin ring?

sideroblastic anemia

What test is not included in many of the major HgB variants?

sodium metabisulfate solubility test

What abnormal RBC is associated with hyperchromia?

spherocyte

Principle of New Methylene Blue:

stain RNA, mitochondria, and ribosomes

What stain is used to confirm presence of Heinz bodies?

supravital stain

Gene formation associated with APL?

t(15:17)

What inclusions are frequently seen on the same peripheral smear along with toxic granulation?

vacuoles

12-year old girl exhibited a fever, lethargy, and a stiff neck. WBC count was 2000/microliter.

viral meningitis

A yellow coloration found in fresh cerebrospinal fluid supernatant is termed:

xanthochromia

A semen sample for analysis should generally be received at the testing site within what period of time?

1 hr

What is the most approx. % of individuals in the US who are heterozygous for HFE mutations for HH?

10-12%

What objective is used and how many cells are counted for a bone marrow differential?

100x, 200 cells

Best dilution for a slightly hazy spinal fluid?

1:10

Best dilution for routine sperm count?

1:20

M:E ratios ranges

2:1-4:1

Ref range for Hct for adult male?

40-52%

The appropriate magnification for a manual RBC cell count using a hemocytometer is what?

40X (dry)

Whole blood aprrox. composed of?

45% formed elements and 55% plasma

What is the normal cellularity of an iliac crest bone marrow biopsy in a 50-year old male?

50%

What minimum level of a particular factor will caused the aPTT test to become prolonged?

<40%

Fab designation called the true moncytic leukemia and characterized by monoblast, promonocytes, and monocytes?

M5

May be affected by lipemia?

MCHC

What test results might be consistent for a patient with the following findings: macrocytosis, anemia, leukopenia, and thrombocytopenia?

MCV 115 fL Hgb 7.5 g/dL WBC 2.5x10 3/uL Platelets 75,000/uL

Calculate data set: RBC count: 5,22 x 10 12/L HbG: 17.5 g/dL Hct: 53%

MCV=102fL MCH=34 pg MCHC=33g/dL

Lymphocyte w/ abundant cytoplasm and few granules?

NKC

Has enlarged RBCs, w/ possible brownish granules >12 parasites amoeboid structures Schuffner's dots

P. vivax

INR formula

PT patient/PT normal raised to the ISI

Results for DIC?

PT&aPTT prolonged Fibrinogen&platelet count low

What can anticoaggulant drugs prolong?

PT, aPTT, Ecarin clotting time

What is known to cause platelet satellitosis?

Ab directed against platelet membrane

What antigen marker is best associated with stem cells?

CD34

After several incidneces of deep vein thrombosis, a patient is assessed for hypercoagulability. What would an appropriate panel for hypercoaglability screening?

PT, aPTT, LA screeing, APC, d-dimer screening

Beta thalassemia major also known as?

Cooley's anemia

What is not useful in diagnosis of HIT?

DTT

What condition might have symptoms of lethargy, glossitis, and muscle dysfunction?

Fe deficiency anemia

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

Hb H

Normal adult HbG composition?

HbA >90% HbA2 <3,5% HbF <1-2%

RBC inclusion that can be visualized with Supravital stain, be not on Wright stain?

Heinz bodies

Formulas for MCHC and HgB concentration?

HgB (g/dL) x100/Hct (%)

Hbg% in sickle cell patient:

HgB A=60% HgB S=38% HgB A2=2% HgB F=0@

Splenectomy smear may have what?

Howell-Jolly bodies

What is responsible for inhibiting the tissue plasminogen acitvator?

Protein C

Best stain for differentiate between Howell-Jolly bodies & Pappenheimer bodies?

Prussian blue: P. bodies stain blue not H-J bodies

A defect in which factor causes impaired platelet adhesion and aggregation?

Von Willebrand factor

In reference to semen analysis examination, differentiation and enumeration of round cell which are often present in semen count are referred as:

WBCs

Glanzmann Thrombasthenia is caused by:

a defect in GPIIb/GbIIIa receptors leading to impaired platelet aggregation

A lab test to determine heparin levels in a patient's plasma is?

antii-FXa

In most cases of Fanconi anemia, what type of anemia develops?

aplastic

Increased retic not found in:

aplastic anemia

What is not a cause of an abnormal TT?

aspirin

What is not a method to transport CO2 to the lungs?

attatched to neutrophils

What is not a cause of death in patients with HH?

autoimmune disease

Why would a bone marrow aspirate and biopsy most likely recommended to aid in diagnosis?

evaluation of unexplained cytopenias

Hemophilia B or Christmas disease is the result of a hereditary deficiency in which coagulation factor?

factor IX

What assay is commonly used to confirm the diagnosis of activated protein C resistance?

factor V Leiden Mutation Assay

A factor that may be low, resulting in prolongation for a PT test?

factor VII

What factor requires vitamin K for synthesis in liver?

factor VII

Which of the following factors doesn't affect the result of the aPTT assay?

factor VII

What condition shows increased PT with a normal aPTT?

factor VII deficiency

What does warfarin not inhibit?

factor XI

The fibrin clot begins to form when fibrinogen is cleaved resulting in a fibrin monomer, fibrinopeptideb A, B fragments. The fibirn monmers spontaneously polymerize due to H bonding, and then are covalently linked to fibrin polymers by which factors?

factor XIII

Sundan III confirms presence of:

fat

Plasmin is knkown to degrade factors Va, VIIIa, and GPIb. what other substance is it known to digest?

fibrin

What process does not occur during primary homeostasis?

fibrin strands added to the newly formed clot

What can impact platelet aggragation when it becomes deficient?

fibrinogen

What is the most responsible for increasing the ESR?

fibrinogen

Which test is not abnormal with Stuart-Prower Factor deficiency?

fibrinogen

D-dimer is useful in detecting which aspect of homeostasis?

fibrinolysis

What is associated with macrosytic anemia?

fish tapeworm

What would be most helpful in determining the number of T cells in circulation?

flow cytometry

What is the most sensitive and specific for diagnosis of PNH?

flow cytometry for GPI-anchored proteins

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?

folic acid deficiency

What is the term that describes the process by which fibrin strands are broken down and the removed form an established clot?

fribrinolysis

Patient with a history of mucocutaneous bleeding: PT 12 sec APTT 26 sec BT 18 min ADP abnormal Thrombin abnormal Collagen abonormal Ristocetin normal

glanzmann thromasthenia

Absence of this clotting factor causes no bleeding tendencies?

hageman factor

Cells that stain positive with acid phosphatase, and are not inhibited with titrate?

hairy cell leukemia

What is not an important protein regulator of Fe metabolism?

hemosiderin

What contribute to low serum iron levels seen in persons with anemia of chronic disease?

hepcidin

The autohemolysis test is most useful in the diagnosis of?

hereditary spherocytosis

What genetic description will not contain Bart's hemoglobin at birth?

heterozyhous alpha thalassemia-2

Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are called:

holley-jolly bodies

A completely sickled cell is most commonly seen in what condition?

homozygous HbSS

What lab test isn't used to distinguish CML from PV?

hypercellular bone marrow

Bone marrow in alpha thalassemia usually demonstrates?

hyperplasia

Which test result will be normal in a patient with dysvibrinogenemia?

immunologic fribrinogen level

RAEB is classified under which category?

myelodysplastic syndromes

In which stain will auer rods have most intense rxn?

myeloperoxidase

What test results are inconsistent with DIC?

negative test for D-dimers

The most immature neutrophil found in normal peripheral blood is what?

neutrophil band

How many 1mmx1mm is the Neubauer hemacytometer counting grid composed of?

nine per side

You are running QC for HA1C by HPLC. The high control was 2.5 SD above the mean. The low control was 2.2 SD below the mean. Should you continue to run patient samples?

no, QC values indicate a violation of the R4S rule and should be rejected

How are Barr bodies usually classified?

non-pathogenical

What kind of aPTT does factor VII produce?

normal

The nucleus of a small lymphocyte is about the same size as a:

normal erythrocyte

MCV=88.5 MCH=30.2 MCHC=33.1

normocytic, normochromic

Not a characteristic of monocytes?

nuclear chromatin appears very condensed

What cell is found in numerous numbers in primary myelofibrosis?

nucleated RBCs

What is true regarding hypersegemented neutrophils?

nucleus may be round, peanut-shaped or biliobed

Corrected WBC count

uncorrected WBC x (100/NRBCs+100)

Principle for most d-dimer assays?

using specific antisera to detect d-dimer neo-epitopes

The following describes a clot-based test to assess Protein C function, as well as the results of someone's test who has a protein C deficiency:

A PTT is performed using C-depleted normal plasma, a venom activator of protein C, and a heparin neutralizer. The clotting time would not be prolonged in someone with a protein C deficiency.

Screening test used to assess functionality of both intrinsic and extrinsic and common pathways?

aPTT

What lab result is characteristic for a patient with Von Willebrand disease?

abnormal platelet aggregation response to ristocetin

Absence of beta-lipoproteins?

acanthocytes

Which group of conditions increases the risk of Hbs polymerization?

acid pH, dehydration, increased level of 2,3-DGP

Following stain rxns were resulted on a suspected case of leaukemia: Myeloperoxidase: + Sudan Black B: + Chloroacetate Esterase: + Nonspecific Esterase: -

acute myelocytic leukemia

Alder-Reilly inclusions may be found in which cell types?

all types of mature white blood cells

Disorder that exhibits code incompatible with live?

alpha thalassemia major

Disorder with mild anemia, increased RBC count, and normal HgB?

alpha thalassemia minor

Acquired hemophilia A may be the result of what?

anti-factor VIII inhibitor

During data analysis in flow cytometry, how are cells gated?

by placing a gate around cells with the same light-scattering

In patients who have developed HIT with thrombosis, what should be used to prevent ischemic stroke?

direct throbmin inhibitors

A substance secreted by the vascular endothelial cells that can help to initiate fibrinalysis is:

t-PA

What chemical test is useful for the diagnosis of hairy cell leukemia?

tartrate-resistant acid phosphatase test

What is an appropriate use for molecular test for mutations of the HFE gene, the gene found in the majority of patients with HH?

testing the family members of person with HH

Aspirin ingestion prevents the synthesis of this signaling molecule in the platelet?

thromboxane A2

What bone marrow procedure is best suited for patient who had a dry tap?

touch preparations

CSF specimens are usually collected by lumbar punture and placed in numbered tubes starting with the 1st tube collected. If four tubes are collected, which tube would be used for a cell count and differential?

tube #3