Hematology Review
A manual WBC count was performed. A total of 36 cells were counted in all 9 squares of a hemacytometer. A 1:10 dilution was used. What is the WBC count?
0.4 x 10^9/L
What is the approximate normal mean platelet volume (MPV) expressed in femtoliters (fL)?
10
Normal platelets have a circulating life span of
10 days
The following numbers were obtained in evaluating LAP activity in neutrophils. What is the score? 0 1 2 3 4 32 24 21 15 8
143
An increase in what factor will result in an immediate increase of oxygen delivery to the tissues
2,3-BPG levels
Which of the following would be an unexpected finding in chronic myeloid leukemia (CML)? A) increased eosinophils and basophils in the peripheral blood B) 20% blasts in the peripheral blood C) hypercellular bone marrow with granulopoiesis D) white blood count of 100 X 109/L
20% blasts in the peripheral blood
A manual WBC count is performed on a hemacytometer. 80 WBCs are counted in 4 large squares. The dilution is 1:100. What is the total WBC count?
20.0 x 10^9/L
A manual RBC count is performed on a hemacytometer. The RBC count in the large center square is 125, and the dilution is 1:200. What is the total RBC count?
250.0 x 10^9/L
Given the following data: WBC 8.5 x 103/µL Segs 56% Bands 2% Lymphs 30% Monos 6% Eos 6% What is the absolute lymphocyte count
2550
A 1:200 dilution of a patient's sample was made and 336 RBCs were counted in an area of 0.2 mm2. What is the RBC count
3.36 x 10^12/L
Calculate the mean cell hemoglobin concentration (MCHC) using the following values: Hgb: 15 g/dL; RBC: 4.50 x 106/µL; Hct: 47%
31.9 g/dL
What is the normal ratio of myeloid to erythroid precursors in the bone marrow
4:1
List the factors in the Prothrombin time test
7,1,2,5,10
To evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets should be observed per oil immersion field?
8-20
The Philadelphia chromosome is a reciprocal translocation of material between chromosomes
9 and 22
The ratio of anticoagulant to blood for coagulation procedures should be 1 to
9.0 (1:9)
Hairy cell leukemia is
A chronic leukemia of lymphocytic origin
Prothrombin is:
A protein formed by the liver in the presence of vitamin K
Terminal deoxyribonucleotidyl transferase (TdT) is found in 90% of the cases of
ALL
Coarse PAS positivity is found most often in the leukemic cells of
ALL, L1
Which of the following conditions has >30% blasts in bone marrow? A) AML B) RA-EBt C) RARS D) CMML
AML
ll of the following are included in the chronic myeloproliferative disorders (MPDs) except: A) acute myeloid leukemia (AML) B) chronic myeloid leukemia (CML) C) polycythemia vera (PV) D) essential thrombocythemia (ET)
AML
Which form of acute myeloid (AML) is most often associated with disseminated intravascular coagulation?
AML with t(15;17)(q22:q12)
TTP differs from DIC in that
APTT is normal in TTP but prolonged in DIC
Hemoglobin H disease results from
Absence of 3 of 4 alpha genes
Which of the following is associated with Glanzmann's thrombasthenia? A) Normal bleeding time B) Normal ADP aggregation C) Abnormal ristocetin aggregation D) Absence of clot retraction
Absence of clot retraction
Which condition will shift oxyhemoglobin dissociation curve to the right?
Acidosis
When thrombin binds with thrombomodulin on the endothelial cell surface, thrombin can
Activate protein C
How does Coumadin therapy work as a blood thinner
Acts as a vitamin K antagonist
50-90% myeloblasts in a peripheral blood sample is typical of which of the following? A) Chronic granulocytic leukemia B) Myelofibrosis with myeloid metaplasia C) Erythroleukemia D) Acute granulocytic leukemia
Acute granulocytic leukemia
Auer rods are most likely present in which of the following? A) Chronic granulocytic leukemia B) Myelofibrosis with myeloid metaplasia C) Erythroleukemia D) Acute granulocytic leukemia
Acute granulocytic leukemia
Which of the following conditions is least likely in an elderly individual? A) Acute lymphoblastic leukemia B) Multiple myeloma C) Myelodysplasia D) Chronic lymphocyte leukemia
Acute lymphoblastic leukemia
The most common form of childhood leukemia is:
Acute lymphocytic
A 50-year-old woman who has been receiving busulfan for 3 years for chronic myelogenous leukemia becomes anemic. Laboratory tests reveal: Thrombocytopenia Many peroxidase negative blast cells in the peripheral blood Bone marrow hypercellular in blast transformation Markedly increased bone marrow TdT Which of the following complications is this patient most likely to have? A) Acute lymphocytic leukemia B) Acute myelocytic leukemia C) Acute myelomonocytic leukemia D) Busulfan toxicity
Acute lymphocytic leukemia
Which form of acute myeloid leukemia (AML) has megakaryoblasts and antibodies to platelet glycoprotein IIb/IIIa?
Acute megakaryocytic leukemia
Into what other hematologic disease does MDS often convert?
Acute myelogenous leukemia
The strongest risk factor for development of a lymphoproliferative disorder is
Altered immune function
A leukemoid reaction is an increase in peripheral blood cells associated with
An extreme infectious response
Erythrocytes that vary in size from the normal 6-8 µm are described as exhibiting
Anisocytosis
Using a Coulter counter analyzer, an increased RDW should correlate with:
Anisocytosis
What antibody is associated with paroxysmal cold hemoglobinuria
Anti-P
Platelet activity is affected by
Aspirin
Which therapeutic agent affects platelet function?
Aspirin
Which of the following statements is correct? Hypersegmented neutrophils have greater than 6 nuclear lobes Auer rods are composed of fused primary granules Toxic granules are prominent secondary granules Dohle bodies are agranular patches of DNA
Auer rods are composed of fused primary granules
Which of the following corresponds to CD10? A) T Cell B) B Cell C) Megakaryocyte D) Granulocyte
B cell
Which of the following corresponds to CD19? A) T Cell B) B Cell C) Megakaryocyte D) Granulocyte
B cell
Which of the following corresponds to TdT? A) T Cell B) B Cell C) Blast Cell D) Granulocyte
B cell
what is the basic hematological defect seen in patients with thalassemia major
B-chain synthesis
In what condition is Hgb A2 elevated
B-thalassemia minor
Abnormal platelet function is the suspected cause of the bleeding problem in a patient who has a normal platelet count. Which of the following laboratory procedures gives information with regard to platelet function and, therefore, could provide information as to the cause of the bleeding problem
BT
Lab results on a patient with a severe bleeding problem are as follows: Platelet count 125 x 109/L MPV 16.0 fL (ref. range = 8-10 fL) Bleeding time >15 min (ref. range = 2-10 min) PT 12 sec APTT 32 sec Platelet Aggregation Normal response to ADP, collagen, epinephrine; no response with ristocetin These results are consistent with:
Bernard-Soulier syndrome
Congenital dyserythropoietic anemias are characterized by
Bizarre multinucleated erythroblasts
Which of the following corresponds to CD34? A) T Cell B) B Cell C) Blast Cell D) Granulocyte
Blast cell
A patient has been taking aspirin regularly for arthritic pain. Which one of the following tests is most likely to be abnormal in this patient?
Bleeding time
may influence the erythrocyte sedimentation rate (ESR) except:
Blood drawn into a sodium citrate tube
Viruses have been found as an etiologic agent for which of the following hematologic malignancies?
Burkitt Lymphoma
The starry sky pattern due to numerous macrophages can be seen in which of the following: A) Mantle cell lymphoma B) Burkitt lymphoma C) Follicular lymphoma D) Sezary Syndrome
Burkitt lymphoma
Viruses have been found as an etiologic agent for which of the following hematologic malignancies?
Burkitt lymphoma
Neoplastic lymphocytes with noncleaved clumped nuclei and very basophilic cytoplasm with prominent vacuoles describes:
Burkitt lymphoma cells
The RBCs seen in Color Plate 6 were noted in a patient with renal insufficiency. What are these cells known as?
Burr cells
The phenotype antigen that indicates a favorable prognosis in ALL is
CALLa (CD10)
Which of the following are mature pan-B cell markers? A) CD2 and CD8 B) CD33 and CD45 C) CD19 and CD20 D) CD33 and CD59
CD19 & CD20
The peripheral blood shown below is from a 69-year-old female. Her WBC count is 83 x 109/L and her platelet count was normal. Based on the smear morphology and this information, what is the most likely diagnosis? (smudge cell)
CLL
The Philadelphia chromosome is present in approximately 90% of patients with
CML
Which of the following conditions has 5-20% blasts in bone marrow with an absolute monocytosis?
CMML
Why is Burkitt lymphoma such an aggressive malignancy
Cells have a high proliferative rate
Of the following, the disease most closely associated with cytoplasmic granule fusion is: A) Chediak-Higashi B) Pelger-Huet C) May-Hegglin D) Alder-Reilly
Chediak-Higashi
Which substrate is used for the detection of specific esterase?
Chloroacetate
Increased numbers of basophils are often seen in:
Chronic granulocytic leukemia
The following results were obtained on a 35-year-old woman complaining of fatigue and weight loss: WBC 1.8 x 103/µL Differential RBC 4.6 x 106/µL Segs 30% Platelets 903 x 103/µL Bands 17% Uric acid 6.4 ng/dL Lymphs 13% Monos 3% Eos 4% Basos 6% Metamyelos 3% Myelos 20% Promyelos 3% Blasts 1% LAP 0 Philadelphia chromosome Positive These results are consistent with: A) Neutrophilic leukemoid reactio B) Idiopathic thrombocythemia C) Chronic granulocytic leukemia D) Leukoerythroblastosis in myelofibrosis
Chronic granulocytic leukemia
In what condition would a LAP score of 10 most likely be found?
Chronic myelocytic leukemia
Which of the following laboratory findings is associated with Factor XIII deficiency? A) Prolonged APTT B) Clot solubility in a 5 molar urea solution C) Prolonged TT D) Prolonged PT
Clot solubility in a 5 molar urea solution
statistical terms reflects the best index of precision
Coefficient of Variation
A prolonged APTT is obtained on a patient diagnoses as having acute DIC. The patient has not yet been treated for this syndrome. How can the prolonged APTT be explained?
Continuous activation of the coagulation system uses some factors more rapidly than the liver can make them
A prolonged APTT result is obtained on a patient diagnosed with acute DIC. The patient has not yet been treated for this syndrome. How can the prolonged APTT be explained?
Continuous activation of the coagulation system uses some factors more rapidly than the liver can synthesize them
Eosinophils are increased in all the following except
Cushing's disease ( Cushings is about cortisol)
Right-angle scatter in a laser-based cell counting system is used to measure
Cytoplasmic granularity
A 25-year-old obstetrical patient at 35 weeks gestation is admitted through the ER. She has bleeding in the genitourinary tract and there are visible petechiae and ecchymoses. The following lab results are obtained: Platelet count Decreased PT Prolonged APTT Prolonged Fibrinogen Decreased Thrombin Time Prolonged D-Dimer Positive RBC morphology Schistocytes present These lab results are consistent with: Primary fibrinolysis DIC Factor II deficiency Heparin therapy
DIC
A patient develops unexpected bleeding and the following test results were obtained: Prolonged PT and APTT Decreased fibrinogen Increased fibrin split products Decreased platelets What is the most probable cause of these results? A) Familial afibrinogenemia B) Primary fibrinolysis C) DIC D) Liver disease
DIC
Howell-Jolly bodies are composed of
DNA
When viewing Color Plate 7, the RBC with the elongated projection is known as a(n) ________ and may be seen in _________.
Dacrocyte, myelofibrosis
Which of the following platelet responses is most likely associated with Bernard Soulier Syndrome? A) Decreased platelet aggregation to ristocetin B) Defective ADP release, normal response to ADP C) Decreased amount of ADP in platelets D) Markedly decreased aggregation to epinephrine, ADP, and collagen
Decreased platelet aggregation to ristocetin
Which of the following platelet responses is most likely associated with von Willebrand's disease? A) Decreased platelet aggregation to ristocetin B) Normal platelet aggregation to ristocetin C) Absent aggregation to epinephrine, ADP, and collagen D) Decreased amount of ADP in platelets
Decreased platelet aggregation to ristocetin
Thalassemias are characterized by
Decreased rate of globin synthesis
Which of the following is considered a normal hemoglobin Carboxyhemoglobin Methemoglobin Sulfhemoglobin Deoxyhemoglobin
Deoxyhemoglobin
Is a true red blood cell aplasia
Diamond-Blackfan
What is the term for cell movement through blood vessels to a tissue site
Diapedesis
What is the major indication of MDS in the peripheral blood and bone marrow
Dyspoiesis
A patient has a platelet count of 1200 X 109/L. Many platelets are giant and have abnormal shapes. A mild anemia is present. The bone marrow has increased megakaryocytes in clusters; iron stores are present. Which of the following is most likely?
ET
Counting the number and size of electrical interferences created by blood cells as they pass through a small aperture is a description of which of the following principles?
Electronic impedance
In polycythemia vera, the hemoglobin, hematocrit, and red blood cell count are: A) Elevated B) Normal C) Decreased
Elevated
Hemolytic uremic syndrome (HUS) is associated with
Escherichia coli 0157:H7
A patient with normal hemoglobin and WBC values, a persistently elevated platelet count (>1000 x 109/L), increased marrow megakaryocytes, and a history of frequent bleeding and clotting episodes most likely has
Essential thrombocythemia
The prothrombin time will detect deficiencies in the _______ pathway(s) when calcium and an extract of tissue such as brain are added to plasma
Extrinsic and common
The thrombin time will be prolonged in the presence of all the following except A) Elevated fibrinogen degradation products B) Heparin C) Factor I deficiency D) Factor II deficiency
Factor II deficiency
The thrombin time will be prolonged in the presence of all the following except Elevated fibrinogen degradation products Heparin Factor I deficiency Factor II deficiency
Factor II deficiency
What is the coagulation factor that has a sex-linked recessive inheritance pattern?
Factor IX
The following data were obtained on a patient: PT 20 sec TT 13 sec (Ref range 9-13 sec) APTT 55 sec APTT plus aged serum Corrected APTT plus adsorbed plasma Not corrected Which of the following coagulation factors is deficient? A) Factor V B) Factor VIII C) Factor X D) Factor XI
Factor X
Fibrin strands are cross-linked and the fibrin clot stabilized by the activity of
Factor XIIIa
Aliquots of plasma with a prolonged PT and prolonged APTT are mixed using various ratios of patient plasma and normal plasma. All samples are incubated at 37°C and tested at 10, 30, and 60 minute intervals. The PT and APTT results on all of the mixtures are corrected. The results would indicate the presence of:
Factor deficiency
All of the following are usually found in Hgb C disease except Hgb C crystals Target cells Lysine substituted for glutamic acid at the 6th position of the β-chain Fast mobility of Hgb C at pH 8.6
Fast mobility of Hgb C at pH 8.6
A severe vitamin K deficiency will affect all the following except Fibrinogen Stable factor Christmas factor Protein C
Fibrinogen
Measurement of time required for fibrin formation when thrombin is added to plasma evaluates the
Fibrinogen concentration
Impaired DNA metabolism is characteristic of
Folic acid deficiency
Bite cells" are usually seen in patients with:
G6PD deficiency
Precipitation of hemoglobin is associated with
G6PD deficiency
What is the growth factor primarily responsible for regulating granulocyte and monocyte production?
GM-CSF
Of the following, the disease most closely associated with glucocerebrosidase deficiency is: A) Gaucher's disease B) May-Hegglin anomaly C) Niemann-Pick disease D) Di Guglielmo disease
Gaucher's Disease
Which of the following is characteristic of Bernard-Soulier Syndrome? A) Giant platelets B) Normal bleeding time C) Abnormal aggregation with ADP D) Increased platelet count
Giant platelets
The following results are obtained on a patient with a severe bleeding problem: Platelet count 256 x 109/L Bleeding time >15 min Clot retraction Deficient Platelet Normal response to ristocetin; weak Aggregation response to ADP, collagen, epinephrine These results are consistent with
Glanzmann's thrombasthenia
Which of the following corresponds to CD33? A) T Cell B) B Cell C) Megakaryocyte D) Granulocyte
Granulocyte
Naphthol AS-D chloroacetate esterase (specific) is usually positive in ______ cells and alpha-naphthyl acetate esterase (nonspecific) is useful for identifying blast cells of _______ lineage
Granulocytic, monocytic
Fitzgerald factor is another name for
HMWK
Which of the following statements about hairy cell leukemia is true? It is an acute disease, primarily affecting young adults Splenomegaly is an unusual finding Hairy cells contain tartrate resistant acid phosphatase Hairy cells are abnormal T lymphocytes
Hairy cells contain tartrate resistant acid phosphatase
List the factors seen in adsorbed plasma.
Has I, V, VIII, XI, XII (1,5,8,11, 12)
Mean cell volume (MCV) is calculated using the following formula
Hct x 10/ RBC [fL]
Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright's-stained smear?
Heinz bodies
Which of the following would be an unusual finding in the blood smear of an adult with Sickle Cell Disease (SCD) crisis? A) Heinz bodies B) Target cells C) Howell-Jolly bodies D) Drepanocytes
Heinz bodies
what inclusions is not seen on wright's stained smears
Heinz bodies
The majority of iron in an adult is a constituent of
Hemoglobin
A cellulose acetate electrophoresis revealed a large band of hemoglobin in the hemoglobin S position. This band quantified as 95%. The peripheral smear revealed 70% target cells and the solubility test was negative. Based on this information, what is the hemoglobin?
Hemoglobin D
A 25-year old male student was seen in the clinic complaining of abdominal pain for 3 days. A CBC revealed the following:WBC: 7.0 x 109/L MCV: 86.2 fL RBC: 2.90 x 1012/L MCH: 29.3 pg Hgb: 8.5 g/dL MCHC: 34.0 g/dL Hct: 25% RDW: 21% The peripheral smear revealed the red blood cell morphology seen in Color Plate 5. Of what condition is this suggestive?
Hemoglobin S-C disease
The following results are obtained on a 3-year-old boy with sudden severe hemorrhagic problems: Bleeding time Normal PT Normal APTT Prolonged APTT 1:1 Mixing Study Corrected Platelet aggregation Normal with ristocetin, ADP, collagen, and epinephrine These clinical manifestations and lab results are consistent with
Hemophilia A
A prolonged thrombin time and a normal reptilase time are characteristic of:
Heparin therapy
what is the major Hgb found in the RBCs of patients with sickle cell trait
Hgb A
Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait? Hgb A: 40%; Hgb S: 35%; Hgb F: 5% Hgb A: 60%; Hgb S: 40%; Hgb A2: 2% Hgb A: 0%; Hgb A2: 5%; Hgb F: 95% Hgb A: 80%; Hgb S: 10%; Hgb A2: 10%
Hgb A: 60%; Hgb S: 40%; Hgb A2: 2%
Which of the following hemoglobins migrates to the same position as Hgb A2 at pH 8.6?
Hgb C
what is the primary Hgb in patients with thalassemia major
Hgb F
What red cell inclusion may be seen in peripheral blood smear of a patient postsplenectomy?
Howell-Jolly Bodies
A patient with an MCV of 107 fL, hypersegmented neutrophils, and markedly decreased intrinsic factor, would most likely have what red cell inclusions?
Howell-Jolly bodies
All of the following are associated with thrombosis except A) Factor V Leiden mutation B) Hypofibrinogenemia C) Lupus anticoagulant D) Anticardiolipin antibody
Hypofibrinogenemia
All the following are associated with thrombosis except
Hypofibrinogenemia
Which factors are consumed in clotting and, therefore, absent in serum
I, II, V, VIII, XIII (1,2,5, 8, 13)
Which coagulation factors are referred to as "vitamin K dependent"?
II, VII, IX, X (2,7,9, 10)
Coagulation factors affected by Coumadin (warfarin) drugs are
II, VII, IX, and X (2,7,9,10)
All the following are true of the INR except INR is dependent on reagents and instrumentation used INR is calculated using the PT ratio taken to the power of ISI value WHO recommends reporting of the INR on patients with long-term oral anticoagulant therapy Desired INR on a patient on coumadin is between 2.0 and 2.5 but may be higher depending on the cause of the patient's hypercoagulable state
INR is dependent on reagents and instrumentation used
A 4-year-old child is seen in the ER with petechiae and a platelet count of 15 x 109/L. She has no previous history of bleeding problems. 3 weeks earlier she had chicken pox. The physician advises the parents to keep the child off the playground to avoid injury and the child will recover within several weeks to a month with no further treatment. What condition does this child most likely have
ITP
What is the diagnosis of a child who has an onset of bleeding signs and symptoms, a normal physical examination, a CBC that reveals thrombocytopenia with normal RBC and WBC morphology, and no family history of hemorrhagic abnormalities?
ITP
Multiple myeloma is characterized by the presence in urine of large amounts of
IgG light chains
Which of the following is increased in Waldenstrom's macroglobulinemia?
IgM
Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult?
Iliac crest
A child has monotonous blasts in the peripheral blood that have scant blue cytoplasm. They are CALLa (CD10) positive. Which form of acute lymphoid leukemia is most likely?
Immature B cell
The term "shift to the left" refers to:
Immature cell forms in the peripheral blood
What is the basis for the Coulter principle of electronic particle counting?
Impedance of an electrical current by the particles
A "shift to the left" when used to describe a cell population refers to
Increase in immature blood cells following release of bone marrow pools
Usual findings in Polycythemia Vera include all the following except Pancytosis Increased red cell mass Increased erythropoietin Increased blood viscosity
Increased erythropoietin
Which of the following is typical of polycythemia vera? A) Increased serum iron concentration B) Decreased thrombocytes count C) Increased erythropoietin D) Increased leukocyte alkaline phosphatase activity
Increased leukocyte alkaline phosphatase activity
Which of the following can shift hemoglobin oxygen dissociation curve to the right?
Increases in 2,3-DPG, Acidosis Hypoxia
Which of the following is characteristic of metamyelocytes?
Indentation of nucleus
Heparin acts by
Inhibiting thrombin
The activated partial thromboplastin time will detect deficiencies in the __________ pathway
Intrinsic and common
Which of the following is the most specific laboratory test to diagnose chronic myeloid leukemia (CML)? A) increased bone marrow fibrosis and reticulin fibers B) increased eosinophils and basophils in peripheral blood C) 5% blasts in the bone marrow D) leukocyte alkaline phosphatase (LAP)
LAP
Which may be the cause of defective clot retraction
Lack of platelet receptor GP IIb/IIIa for fibrinogen
What condition is not usuually associated with the presence of schistocytes on the peripheral smear
Lead poisoning
Which of the following tests can be useful in differentiating leukemoid reaction from chronic granulocytic leukemias? A) Myeloperoxidase stain B) Sudan Black B stain C) TRAP D) Leukocyte alkaline phosphatase
Leukocyte alkaline phosphatase
Which stain should be used to differentiate a neutrophilic leukemoid reaction from chronic myelogenous leukemia?
Leukocyte alkaline phosphatase
Neutrophilia accompanied by immature granulocytes and nucleated red cells is what kind of reaction?
Leukoerythroblastic
The presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately called a
Leukoerythroblastic reaction
WBC 5.0 x 103/µL Differential RBC 1.7 x 106/µL Segs 16% MCV 84 fL Bands 22% Platelets 89 x 103/µL Lymphs 28% Monos 16% Eos 1% LAP 142 Basos 1% Philadelphia chromosome Negative Metamyelos 4% Myelos 3% Promyelos 4% Blasts 5% 1 megakaryoblast 30 nRBCs Teardrops Schistocytes Polychromasia Giant, bizarre platelets A) Idiopathic thrombocythemia B) Polycythemia vera C) Chronic granulocytic leukemia D) Leukoerythroblastosis in myelofibrosis
Leukoerythroblastosis in myelofibrosis
In the Sudan Black B stain, what is specifically being stained in the cell
Lipids
The Sudan Black B stain is a stain for
Lipids
Where does conjugation of bilirubin occur
Liver
Which of the following cells is not produced in the bone marrow of normal adults
Lymphocyte
What is the amino acid substitution of in Hemoglobin C
Lysine for glutamic acid
The FAB type of AML most often associated with DIC is
M3
In the FAB classification, myelomonocytic leukemia would be
M4
The blast cells shown below are CD14 and CD33 positive, Sudan Black B positive, specific esterase positive, and nonspecific esterase positive. Which FAB classification of acute leukemia is most consistent with these results?
M4
A falsely elevated hct is obtained what calculated values will not be affected
MCH
Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias MCV 99 fL; MCH 28 pg; MCHC 31 g/dL MCV 62 fL; MCH 27 pg; MCHC 30 g/dL MCV 125 fL; MCH 36 pg; MCHC 34 g/dL MCV 78 fL; MCH 23 pg; MCHC 30 g/dL
MCV 125 fL; MCH 36 pg; MCHC 34 g/dL
Given the following values, which set of RBC indices suggest spherocytosis MCV 76 fL; MCH 19.9 pg; MCHC 28.5%. MCV 90 fL; MCH 30.5 pg; MCHC 32.5% MCV 80 fL; MCH 36.5 pg; MCHC 39.0% MCV 81 fL; MCH 29.0 pg; MCHC 34.8%
MCV 80 fL; MCH 36.5 pg; MCHC 39.0%
Which of the following platelet responses is most likely associated with Glanzmann's thrombasthenia? A) Decreased platelet aggregation to ristocetin B) Defective ADP release, normal response to ADP C) Decreased amount of ADP in platelets D) Markedly decreased aggregation to epinephrine, ADP, and collagen
Markedly decreased aggregation to epinephrine, ADP, and collagen
Di Guglielmo's syndrome or FAB acute leukemia type M6 is characterized by increased
Marrow erythroblasts and multinucleated red cells
Thrombocytopenia is a characteristic of: A) Classic von Willebrand's disease B) Hemophilia A C) Glanzmann's thrombasthenia D) May-Hegglin Anomaly
May-Hegglin
Which of the following anomalies is an autosomal dominant disorder characterized by irregularly sized inclusions in polymorphonuclear neutrophils, abnormal giant platelets, and often thrombocytopenia?
May-Hegglin
The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia, and large platelets is called
May-Hegglin anomaly
Of the following cells, which is never found in the peripheral circulation in its mature form? Myeloblast Promyelocyte Promonocyte Megakaryoctye
Megakaryoctye
Which of the following corresponds to CD61? A) Granulocyte B) Monocyte C) Megakaryocyte D) T cell
Megakaryocyte
Which of the following is a significant feature of erythroleukemia? A) Persistently increased M:E ratio B) Megaloblastoid erythropoiesis C) Marked thrombocytosis D) Decreased stainable iron in the marrow
Megaloblastoid erythropoiesis
All of the following are associated with hemolytic anemia
Methemoglbinemia, hemooglobinuria, hemoglbinemia ( Is NOT Increased haptoglobin)
A patient has a Hct of 30%, Hgb of 8 g/dL, and RBC count of 4.0 x 1012/L. What is the morphological classification of this anemia?
Microcytic, Hypochromic
All the following are normal maturation stages of platelets except Megakaryoblast Promegakaryocyte Micromegakaryocyte Megakaryocyte
Micromegakaryocyte
Which of the following corresponds to CD14? A) Granulocyte B) Monocyte C) Megakaryocyte D) T cell
Monocyte
In the French-America-British (FAB) classification, acute lymphocytic leukemia is divided into groups according to:
Morphology
Alder-Reilly anomaly is an abnormality of
Mucopolysaccharide metabolism
Which of the following is associated with Alder-Reilly inclusions? A) Membrane defect of lysosomes B) Dohle-like bodies and giant platelets C) Two-lobed neutrophils D) Mucopolysaccharidosis
Mucopolysaccharidosis
Which of the following is characteristic of platelet disorders? A) Deep muscle hemorrhages B) Retroperitoneal hemorrhages C) Mucous membrane hemorrhages D) Severely prolonged clotting times
Mucous membrane hemorrhages
Which of the following is not usually classified as a myeloproliferative disorder? Polycythemia vera Essential thrombocythemia Multiple myeloma Chronic myelocytic leukemia
Multiple myeloma
An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC count, and an LAP score of 170. The blood smear shows teardrop erythrocytes and leukoerythroblastosis. In addition, the bone marrow aspirate was a "dry tap". These findings are most consistent with
Myelofibrosis with myeloid metaplasia
Which of the following is associated with pseudo-Pelger Huet anomaly? A) Aplastic anemia B) Iron deficiency anemia C) Myelogenous leukemia D) Chediak-Higashi syndrome
Myelogenous leukemia
All the following test results are characteristic of DIC except A) Decreased fibrinogen concentration B) Negative test for degradation products C) Decreased platelet count D) Prolonged PT
Negative test for degradation products
All the following test results are characteristic of DIC except Decreased fibrinogen concentration Negative test for degradation products Decreased platelet count Prolonged prothrombin time test
Negative test for degradation products
A bone marrow slide shows foam cells ranging from 20 to 100 µm in size with vacuolated cytoplasm containing sphingomyelin and is faintly PAS positive. This cell type is most characteristic of:
Niemann-Pick disease
Bone marrow of a patient with acute leukemia is stained with the periodic acid-Schiff (PAS) stain. When this stain is evaluated, segmented neutrophils show diffuse pink staining. Select the correct interpretation.
No conclusion can be reached; blast cells must be examined
When performing platelet aggregation studies, which set of platelet aggregation results would most likely be associated with Bernard-Soulier syndrome?
Normal platelet aggregation to collagen, ADP, and epinephrine; decreased aggregation to ristocetin
RBC indices obtained on a patient are as follows MCV 88 fL; MCH 30 pg; MCHC 34 g/dL The RBCs on the peripheral smear would appear
Normocytic, normochromic
A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because
Nucleated RBCs are counted as leukocytes
What is the etiology of myelodysplastic syndromes (MDSs)
Oval macrocytes, Dimorphic, Hypochromic, microcytic
What would be the expected screening test results for a patient with a fibrin stabilizing factor deficiency
PT and APTT normal
What would be the expected screening test results for a patient with a fibrin stabilizing factor deficiency?
PT and APTT normal
Thrombocytosis is a characteristic of
PV
The acid serum lysis (Ham) test is used to screen patients for which disorder
Paroxysmal nocturnal hemoglbinuria
What RBC membrane defect that results in increased complement deposition
Paroxysmal nocturnal hemoglboinuria
Leukocyte alkaline phosphatase activity is decreased in
Paroxysmal nocturnal hemoglobinuria
A differential was performed on an asymptomatic patient. The differential included 60% neutrophils: 55 of which had 2 lobes and 5 had 3 lobes. There were no other abnormalities. This is consistent with which of the following anomalies?
Pelger-Huet
In which anomaly is a failure of granulocytes to divide beyond the band or two-lobed stage observed
Pelger-Huet
Which of the following stains is helpful in the diagnosis of suspected erythroleukemia? A) Myeloperoxidase B) Nonspecific esterase C) Periodic acid-schiff D) Acid phosphatase
Periodic acid-schiff
is a common finding in aplastic anemia
Peripheral blood pancytopenia
The activity of the lupus anticoagulant appears to be directed against
Phospholipid
Which of the following cell types is characteristic of Pelger-Huet anomaly? A) Band form B) Pince-nez form C) Normal neutrophil D) Myelocyte
Pince-nez form
Cells that produce immunoglobulins in response to antigenic stimulation are designated
Plasma cells
What is von Willebrand's factor?
Plasma protein that binds platelets to exposed subendothelium
Which of the following enzymatically degrades the stabilized fibrin clot?
Plasmin
A bleeding time is used to evaluate the activity of:
Platelets
What term describes the change in shape of erythrocytes on a Wright's-stained peripheral blood smear
Poikilocytosis
In which stage of erythrocytic maturation does Hgb formation begin
Polychromatic normoblast
In Hemoglobin SC disease, what would the result of the hemoglobin solubility test be
Positive
Thrombocytopenia may be caused by all the following except\ Post-splenectomy Chemotherapy Decreased thrombopoietin Aplastic anemia
Post-splenectomy
Results on a patient presenting with sudden severe hemorrhagic problems are as follows: Bleeding time Normal PT Normal APTT Prolonged APTT 1:1 Mixing Study No correction These clinical manifestations and lab results are consistent with
Presence of a circulating inhibitor
Results on a patient presenting with sudden severe hemorrhagic problems are as follows: Bleeding time Normal PT Normal APTT Prolonged APTT 1:1 mixing study No correction These clinical manifestations and lab results are consistent with
Presence of a circulating inhibitor
Which of the following suggests a diagnosis of Hodgkin's disease rather than other lymphoproliferative disorders
Presence of giant Reed-Sternberg cells binucleated with prominent nucleoli
In myelopoiesis, which is the first developmental stage to present with primary granules
Promyelocyte
Pure erythroid leukemia is a disorder involving
Pronormoblasts and basophilic normoblasts
A failure to generate sufficient ATP is characteristic of RBCs with
Pyruvate kinase deficiency
Which of the following is the most common cause of an abnormality in hemostasis? A) Decreased fibrinogen level B) Decreased factor VIII level C) Decreased factor IX level D) Quantitative abnormality of platelets
Quantitative abnormality of platelets
Which of the following conditions has <1% blasts in blood, <5% bone marrow blasts, and <15% ringed sideroblasts?
RA
Which of the following conditions has 5-20% blasts in bone marrow? A) AML B) RA-EBt C) RARS D) CMML
RA-EBt
A 60-year-old patient presents with extreme fatigue. Her blood and bone marrow findings are as follows: severe anemia with a dual RBC population, 3% marrow blasts, and numerous ringed sideroblasts. This information is mostly consistent with
RARS
Which of the following conditions has <1% peripheral blood blasts, >15% ringed sideroblasts, and a dimorphic RBC population?
RARS
A 50-year old patient is suffering from pernicious anemia. Which of the following lab data are most likely for this patient? RBC 2.5 x 1012/L; WBC 12.5 x 109/L; Plt 250 x 109/L RBC 4.5 x 1012/L; WBC 6.5 x 109/L; Plt 150 x 109/L RBC 3.0 x 1012/L; WBC 5.0 x 109/L; Plt 750 x 109/L RBC 2.5 x 1012/L; WBC 2.5 x 109/L; Plt 50 x 109/L
RBC 2.5 x 10^12/L; WBC 2.5 x 10^9/L; Plt 50 x 10^9/L
The morphological classification of anemias is based on which of the following?
RBC indices
Explain how a sickle cell is formed
RBCs containing Hb S are exposed to low oxygen tension, hemoglobin polymerization occurs causing the sickle shape
Reticulocytosis usually indicates
Red cell regeneration
What is the diagnostic c`ell, found in involved lymph nodes, for Hodgkin's lymphoma?
Reed-Sternberg cell
Microangiopathic hemolytic anemia (MAHA) is characterized by
Schistocytes and nucleated RBCs
Which cells specifically are being scored using Leukocyte Alkaline Phosphatase stain
Segmented neutrophils and bands
Mature T cell with cerebriform, clefted nuclei found in the skin and peripheral blood describe
Sezary cells
Which of the following bone marrow findings favors the diagnosis of multiple myeloma? A) Presence of Reed-Sternberg cells B) Sheaths of immature plasma cells C) Presence of flame cells and Russell bodies D) Presence of plasmacytic satellitosis
Sheaths of immature plasma cells
When an erythrocyte containing iron granules is stained with Prussian blue, the cell is called a:
Siderocyte
What is the specimen of choice for routine coagulation testing?
Sodium citrate
Which of the following organs is responsible for the "pitting process" for RBCs?
Spleen
Which of the following is a true statement about acute idiopathic thrombocytopenic purpura (ITP)?
Spontaneous remission usually occurs within several weeks.
Which of the following is a characteristic of acute idiopathic thrombocytopenic purpura
Spontaneous remission within a few weeks
The cytoplasmic inclusion present below (contains auer rods)
Stains positive with myeloperoxidase
The qualitative hemoglobinopathies cause disease by producing hemoglobin chains that are
Structurally altered
Which of the following may be used to stain neutral fats, phospholipids, and sterols? A) Myeloperoxidase B) Sudan Black B C) Periodic acid-schiff (PAS) D) Prussian blue
Sudan Black B
What staining method is used most frequently to stain and count reticulocytes?
Supravital staining
T lymphocytes are characterized by all the following except
Synthesize antibody
Which of the following corresponds to CD2? A) T Cell B) B Cell C) Blast Cell D) Granulocyte
T cell
Which of the following corresponds to CD4? A) T Cell B) B Cell C) Megakaryocyte D) Granulocyte
T cell
Which of the following corresponds to CD5? A) T Cell B) B Cell C) Blast Cell D) Granulocyte
T cell
The presence of CD2, CD5, CD7 and the absence of CD10 (CALLA) are associated with
T-cell acute lymphocytic leukemia
Iron deficiency anemia may be distinguished from anemia of chronic infection by
TIBC
Neurological findings may be commonly associated with which of the following disorders
TTP
Which of the following patterns is characteristic of the peripheral blood in patients with CIMF? A) Teardrop-shaped erythrocytes, nRBCs, immature granulocytes B) Abnormal platelets only C) Hypochromic erythrocytes, immature granulocytes, and normal platelets D) Spherocytes, immature granulocytes, and increased platelets
Teardrop-shaped erythrocytes, nRBCs, immature granulocytes
A 15-month-old was seen in the ER with a femur fracture. History revealed that the break had occurred from a fall down the stairs. The physician noted hepatosplenomegaly, extreme pallor, and a slight arrhythmia. A CBC revealed the following: WBC 10.2 x 109/L RBC 3.05 x 1012/L Hgb 6.1 g/dL Hct 17% MCV 55.7 fL MCH 20 pg MCHC 35.9 g/dL RDW 21% Hemoglobin electrophoresis results were obtained as follows: Hgb F 97% Hgb A2 3% Hgb A 0% Which condition is most likely causing the hematologic abnormalities?
Thalassemia major
An adult has a total WBC count of 4.0 x 109/L. The differential count is as follows: PMN 25%, Bands 5%, lymphs 65%, and monos 5%.
There is a relative lymphocytosis
Cells involved in hemostasis are
Thrombocytes
Bernard-Soulier syndrome is associated with
Thrombocytopenia and giant platelets
Which of the following is an expected finding in polycythemia vera (PV)? A) Thrombocytosis B) Anemia C) low leukocyte alkaline phosphatase (LAP) D) normal white count
Thrombocytosis
are indicators of a neutrophilic response to tissue damage or inflammatory stimuli?
Toxic granules and Dohle bodies in the neutrophils
Which of the following coagulation factors is considered to be labile? A) II B) V C) VII D) X
V
The coagulation factor associated with hemophilia A is
VIII (8)
What is the clinical hallmark feature of Sickle Cell Anemia
Vaso-occlusion
An absolute lymphocytosis with reactive lymphocytes suggests which of the following conditions?
Viral infection
Lab results on a patient with a severe bleeding problem are as follows: Platelet count 193 x 109/L Bleeding time >15 minutes PT 12.0 sec APTT 92.0 sec Plt aggregation Normal response to ADP, collagen, epinephrine; no response with ristocetin These results are consistent with
Von Willebrand's disease
Which of the following is a component of platelet alpha granules
Von Willebrand's factor
The following lab results were obtained for a patient with an inherited autosomal dominant trait: Bleeding time Prolonged Platelet adhesiveness Abnormal PT Normal APTT Normal These findings are most consistent with: A) Hemophilia A B) Factor X deficiency C) Factor XI deficiency D) Von Willebrand's disease
Von Willebrands disease
A Gaucher's cell is best described as a macrophage with
Wrinkled cytoplasm due to an accumulation of glucocerebroside
An APTT on a 46-year-old male patient admitted for minor surgery is markedly abnormal, whereas the PT is within normal range. The patient has no clinical manifestations of a bleeding problem and has no personal or family history of bleeding problems. Several family members have been treated for thrombotic episodes. The prolonged APTT is corrected with a 1:1 mixing study using normal plasma. Based on these lab results and clinical history, what factor deficiency would be expected?
XII
What factors are a part of the contact group?
XII, HMWK, PreK, XI (12, HMWK, PreK, 11)
Lymphocyte concentrations in the peripheral blood are greatest during what age interval?
Young child (1-4 years)
what is characteristically seen in abetalipoproteinemia
acanthocytes
Neutrophilia and a left shift are most often found in patients with
acute bacterial infection
The patient, whose peripheral blood is shown below, most likely has a(n) (blasts)
acute leukemia
Periodic Acid-Schiff (PAS) is used to distinguish which type of leukemia
acute monocytic leukemia
Sudan black is used to distinguish which types of leukemia
acute myeloid from acute lymphoid
A patient has a very high white blood count with many blasts in the blood and bone marrow. Esterase stains using both naphthol AS-D chloroacetate and alpha-naphthyl acetate esterase as substrates are both positive. What condition is likely?
acute myelomonocytic leukemia
Basophilic stippling of RBCs represents
aggregated ribosomes
During the hemostatic process, platelets interacting with and binding to other platelets is referred to as
aggregation
which defect characterizes Gray's syndrome
alpha granule defect
Valine is substituted for glutamic acid at the 6th position of the β-chain
amino acid substitution that is responsible for sickle cell anemia
what would stain most strongly for myeloperoxidase
auer rods
conditions may produce spherocytes in a peripheral smear?
autoimmune hemolytic anemia
Toxic granulation, Döhle bodies, and vacuolization in neutrophils are often found together in
bacterial infection
what red cell inclusion is characteristically found in lead poisoning
basophilic stippling
lthough found in most chronic myeloproliferative disorders (MPDs), increased fibrosis detected by the silver techniques and trichrome stain is the key feature of:
chronic idiopathic myelofibrosis
Which of the following diseases is activated with the fusing of BCR-ABL genes? A) Burkitt lymphoma B) chronic myeloid leukemia C) hairy cell leukemia D) acute myeloid leukemia
chronic myeloid leukemia
Hereditary hemorrhagic telangiectasia is a disorder of:
connective tissue
In what area of the bone marrow does hematopoiesis take place
cords
characteristic findings in a patient with iron deficiency anemia except
decreased TIBC
what is associated with a shift to the left in the oxygen dissociation curve
decreased oxygen delivery
Iron deficiency anemia is characterized by
decreased plasma iron, decreased % saturation, increased TIBC
what parameters may be similar for the anemia of inflammation and iron deficiency anemia
decreased serum iron concentration
Cytochemical procedures stain what cellular elements
enzymes, lipids & glycogen
What is the coagulation factor that has a sex-linked recessive inheritance pattern
factor IX (9)
what does methemoglobin contain
ferric form of iron
Hemoglobin F is composed of 2 alpha globin chains and 2 ____
gamma globin chains
Tartrate-resistant acid phosphatase is strongly positive in which of the following cells
hairy cell
what protein is primarily responsible for transport of hemoglobin dimers resulting from intravascular hemolysis
haptoglobin
what is an excess of storage iron called
hemochromatosis
Hemolytic uremic syndrome (HUS) is characterized by
hemorrhage, thrombocytopenia hemoglbinuria (NOT reticulocytopenia)
What disorder has an increase in osmotic fraility
hereditary spherocytosis
Sickle cell disorders are
hereditary, intracorpuscular RBC defects
where do early and late stages of heme synthesis occur
in mitochondria
what is the function of reduced glutathione in the RBC
inactivates intracellular oxidants that accumulate
A patient has 80 nucleated RBCs per 100 leukocytes. In addition to increased polychromasia on the peripheral smear, what other findings may be present on the CBC?
increased MCV
A patient's peripheral smear reveals many nRBCs, marked variation of red cell morphology, and pronounced polychromasia. In addition to a decreased Hgb and decreased Hct values, what other CBC parameters may be anticipated?
increased MCV
Spherocytes differ from normal red cells in all of the following except Decreased surface to volume No central pallor Decreased resistance to hypotonic saline Increased deformability
increased deformability
Pernicious anemia causes _____ erythropoiesis
ineffective
The Na-K pump is an important mechanism in keeping the red blood cell intact. Its function is to maintain a high level of
intracellular K
What is most true of Paroxysmal nocturnal hemoglbinuria
it is an acquired hemolytic anemia
the mechanism that relays information about oxygen levels to the erythropoietin-producing tissue is thought to be located in the
kidney
In children, pica is most commonly associated with what condition
lead poisoning
a senescent red blood cell is one that has
lived its life span
In the third month of gestation, what is the primary site of heatopoiesis
liver
what morphological classification is characteristic of megaloblastic anemia
macrocytic, normochromic
Pancytopenia, Hypersegmented neutrophils, Macrocytic erythrocyte indices are characteristics of
megaloblastic anemia (remember increased retic count is NOT)
Hereditary stomatocytosis is manifested physiolgically be changes in
membrane cation permeability
Which of the following is associated with Chediak-Higashi syndrome? A) Membrane defect of lysosomes B) Dohle-like bodies and giant platelets C) Two-lobed neutrophils D) Mucopolysaccharidosis
membrane defect of lysosomes
Hereditary pyropikilocytosis is a red cell membrane defect characterized by
misshapen budding fragmented cells
Normally, what is the largest white blood cell found in the peripheral blood?
monocyte
Production of primary granules ceases and production of secondary granules commences with what cell stage
myelocyte
What is the most mature cell that can undergo mitosis?
myelocyte
What substances in segmented neutrophils are important for intracellular killing of bacteria? A) alkaline phosphatase and halides
myeloperoxidase
Which of the following is least likely to contribute to death for patients with MDS? A) Neutropenia B) Thrombocytopenia C) Organ failure D) Neuropathy
neuropathy
What is the major phagocytic cell involved in the initial defense against pathogens such as bacteria
neutrophil
A patient has 45% hemoglobin S, 55% hemoglobin A, and a positive tube solubility. Which of the following would likely be found?
normal blood smear and no disease
The anemia seen in sickle cell disease is usually
normocytic, normocytic
what is the most mature red blood cell seen in color plate 2
orthochromic normoblast
the macrocytes typically seen in megaloblastic processes re
ovalocytic
A schilling test gives the following results Part 1: 2% excretion of vitamin B12 (normal 5-35%) Part 2: 8% excretion of vitamin B12 after intrinsic factor was given with (normal 7-10%)
pernicious anemia
what red cell precursors is the last stage to undergo mitosis
polychromatophilic normoblast
What condition is seen with a LAP score of 125
polycythemia vera
what would most likely be associated with the inclusion body seen in color plate 1
post splenectomy
In an adult what are two best areas for obtaining active bone marrow by aspiration
posterior iliac crest, sternum
What is an auer rod composed of
primary granules
Spectrin is a protein that occupies a major role in
red blood cell membrane structure
What effect would using a buffer at pH 6.0 have on a wright's-stained smear
red cells would b stained too pink
what describes the process known as culling
removal of abnormal red cells by the spleen
With which of the following is an absolute neutrophil count of 1.0 x 109/L associated?
risk of infection
storage iron is usually best determined by
serum ferritin levels
A patient has a white blood count of 35 x 109/L with a left shift. The leukocyte alkaline phosphatase (LAP) stain is 220. Which of the following is most likely
severe bacterial infection
A decreased osmotic fragility test would be associated with which of the following conditions?
sickle cell anemia
what condition will autosplenectomy most likely occur
sickle cell disease
Increased serum iron, ringed sideroblasts, dimorphic blood picture are associated with
sideroblastic anemia (remember increased RBC protoprphyrin is NOT)
what term describes a mature red blood cell that contains nonhemoglobin iron granules
siderocyte
Autoimmune hemolytic anemia is best characterized by which of the following?
spherocytic red cells
Serum ferritin is a good indicator of the amount of
storage iron
Premature release of erythrocytes in the circulation due to increased erythropoietin stimulation results in
stress reticulocytes
Which of the following is seen most often in thalassemia? A) Chronic blood loss B) Target cells C) Basophilic stippling D) Ringed sideroblasts
target cells
Results from decreased globin chain synthesis
thalassemia
what anemia has red cell morphology similar to that seen in iron deficiency anemia
thalassemia syndrome
A patient with the previous diagnosis of CML presents with circulating blasts and promyelocytes that total 30%. The disease is considered to be in what phase?
transformation to acute leukemia
Hemoglobin Barts is composed of
y4
