Hemo test2 and coag
Specimen collected from an arm with a heparin lock or from a heparinized vascular access device (VAD). what do you do to correct this
Collect the blood from a vein rather than a VAD. If blood must be drawn from the VAD, flush it first with 5 mL of saline, and discard the first 5 mL of blood before collecting the specimen.
Which of the following may produce a falsely prolonged aPTT test result?
Collecting a specimen for aPTT testing from a heparinized vascular access device
The dilute Russell viper venom (dRVV) activated the coagulation cascade at factor X (FX), eliminating any interference in factors above the cascade. However the dRVV will be influenced by which of the following?
Deficiency of FV
increase in megakaryocytes, platelets
Essential thrombocytopenia
what is the most common type of acute myelogenous leukemia
FAB M2
which type of AML is often with DIC
Fab M3 (acute promyelocytic leukemia)
Bleeding in patients with lupus anticoagulants rarely occurs, but might be seen in patients with an inhibitor to which of the following factors?
Factor II
Which of these factors may be deficient if both the PT and aPTT are prolonged?
Factor II
In an elderly patient without any bleeding history, but has a prolonged aPTT and a normal PT, which of the following is the most common etiology?
Lupus inhibitor
All of the following activities are associated with platelets except
Lysis
Which of the following tests could be used to distinguish whether an abnormal screening coagulation test result (PT or aPTT) is caused by a factor deficiency or an inhibitor?.
Mixing Studies
Graded Question A pre-operative patient presents with a prolonged aPTT with a negative bleeding history. What test would be used in the next line of testing?
Mixing study
which age group has the highest WBC
Newborns
Cells show variation in morphology but no physiological impairment results from the variation.
Nonpathological
Which of the following statements is true regarding hyposegmented neutrophils?
Nucleus may be round, peanut-shaped or bilobed.
Cells show variations in morphology as a result of an abnormal response to a stimulus.
Pathological
Hyposegmented Polys normal function
Pegler-Huet
Patient has a hematocrit level above 55%. what corrective action should you take dealing with coag tubes
Prepare a specimen collection tube that contains less anticoagulant
This is a dry tap tear drop shape rbc, bone marrow fibrosis
Primary myelofibrosis
Warfarin therapy Liver disease Disseminated intravascular coagulation (DIC) Vitamin K deficiency Liver conditions such as cirrhosis or hepatitis Inadequate level of Factors I, II, V, VII, and/or X
Prolonged PT
Presence of heparin Liver disease, other liver conditions Vitamin K deficiency Hemophilias DIC von Willebrand disease Lupus anticoagulant Inadequate levels of Factors I, II, V, VIII, IX, X, XI, and/or XII
Prolonged aPTT
Cells show variation in morphology as a normal body response to invasion by a bacteria or virus.
Reactive
Blood collection tube is inadequately filled. what is the corrective action
Recollect specimen ensuring proper fill to achieve a blood to anticoagulant ratio of 9:1.
type of myelodysplastics syndrome has blast with sideroblast <5%
Refractory anemia
You have just performed stat PT and aPTT tests on your coagulation instrument. Your results are as follows: PT = 12 seconds (normal range 10-13 seconds) aPTT = 24 seconds (normal range 21-34 seconds)
Report the results
Which of the following mechanisms involve a series of interrelated chemical processes that lead to the formation of durable fibrin strands?
Secondary Hemostasis
What are myelodysplastic syndromes (MDS)
Sometimes known as pre-leukaemia. Group of malignant disorders with dysplastic changes and ineffective haemotopoiesis. Often progress to AML. Variably affects any of the blood cell lines.
what are causes of monocytosis
TB, subacute bacterial endocarditis, and tissue destructions
The difference between the coagulation disorders Hemophilia A, and Hemophilia B, lies in:
The deficient factor, and the products used in treatment.
All of the following are activities associated with platelets except:
The degradation of fibrin strands during fibrinolytic processes.
The ultimate goal of secondary hemostasis is:
The formation of a fibrin clot.
A patient with a suspected LA is tested in the routine laboratory and has an aPTT of 31 sec (Ref. Range = 25-35 sec). The physician is not satisfied and requests the sample be sent to the special coagulation laboratory. The test is repeated in the special coagulation laboratory with a result of 39 sec. (Ref. Range = 25-35 sec). The reason that caused these different results can be attributed to which of the following?
The reagent in the special coagulation laboratory is more sensitive than the reagent in the routine laboratory.
When performing your mixing study, you aliquot your sample plasma and the pooled normal plasma to create your "mix". You then place the mix in a water bath to incubate for 90 minutes before testing your new mixed sample. What is the problem with the steps involved in the procedure above?
You have not run a PT or aPTT on the new mix before incubating
name several conditions that can cause neutrophilia
bacteria infection, inflammation, malignancy
Name several conditions that can cause neutrophilia
bacterial infections, inflammation, and malignancy
How does the WHO classify acute leukemia
based on cytogenetics, molecular genetics, and immunological markers
where is the marginating pool of neutrophils located
blood vessel walls
what is primary myelofibrosis
bone marrow filled with fibrous tissue
Platelet adhesion involves the absorption of this factor between receptors on the exposed subendothelial tissue, and by receptors on the platelets themselves?
von Willebrands factor
normal bone scan increase igm, increase serum viscosity. heavy chains
waldenstrom macroglobulinemia
when does a myelocyte become a meta myelocyte
when the nucleus becomes to indent
Not all antiphospholipid antibodies can be detected by a clotting assay. Additional testing by ELISA should be performed to detect anticardiolipin antibodies and what other antibody?
β2 GP1
What is (PT) Normal Range?
11-13 seconds
What is the ratio of patient plasma to pooled normal plasma that is usually used in the performance of a mixing study?
1:1
what is the apptt normal range
21-34
what is the normal reference range for WBC in adults
4.5-11.5x10(9)L
What is the MINIMUM percentage of each coagulation factor that must be present in a patient's plasma to produce a normal PT and aPTT test result?
40%
describe the blood picture in chronic lymphocytic leukemia
80-90% of small lymphocytes with hypercondensed nuclear chromatin smudge cells are common
what is the normal WBC in newborn
9.0-37.0x10(9)L
A 3.2% NaCitrated tube is recieved for LA testing. What is the required ratio of blood to anticoagulant?
9:1
Which of the following statements about anticoagulant therapy is false?
Heparin dosage is monitored by the clinician using the PT test.
this has reed Sternberg cell, stepwise predictable spread, bi-model incidence
Hodgkin lymphoma
What laboratory test result is commonly used to monitor oral anticoagulant therapy?
INR
Which of the following is considered one of the most common coagulation inhibitors?
Lupus anticoagulant (anti-phospholipid antibody)
what is contained in the granules of basophils
heparin, histamines, and inflammatory response
What is Pelger-Huet anomaly?
hyposegmented neutrophil, benign condition no shift to left
What is immunophenotyping?
identification of specific cell markers using labeled bodies
Niemann-Pick disease
sphingomyelinase deficiency results in macrophages that have sea blue-bubble appearance.
What are myeloproliferative neoplasms?
stem cell disorder characterized by increase in one or more myeloid cell lines
when are non specific esterase stains used
to I dentify cell of monocytic origins
why is further immunophenotyping important in ALL
to determine if the leukemia is a T or B cell
in acute leukemia, what is the first step in immunophenotyping
to differentiate AML and ALL
what is the myeloperoxidase stain used for
to differentiate acute myelogenous leukemia and acute lymphocytic leukemia
when is sudan black stain used
to differentiate aml and all
WBC abnormalities is a shift. What is the shift
to the left
What are Auer rods?
toxic granuels, seen in infection, inflammation, due to rapid cell maturation
what are dark blue granules in the cytoplasm of mature neutrophils called
toxic granulation
A thrombin time will detect heparin in a patient's plasma so that heparin does not produce a false-positive aPTT mixing study result. true or false
true
What are neoplasms?
unregulated growth of a single transformed cell
Patient is receiving heparin therapy. what is the corrective action
use a heparin digesting enzyme as a pretreatment before testing the PT or aPTT.
what conditions are associated with reactive lymphocytes
viral infections, mononucleosis
Of the following, which is the most common cause of a qualitative or functional platelet defect?
Aspirin effect
What may cause the following mixing studies results? Initial aPTT = 133 seconds 1:1 Mix aPTT pre-incubation = 33 seconds 1:1 Mix aPTT post-incubation = 124 seconds Please select the single best answer
A slow acting coagulation inhibitor
Which gene rearrangement is present in APL
A t(15;17)
We know that hemostatic events are triggered by a break in the inert epithelial lining of the vasculature, but what specific product(s) act as initiators?
ADP and Serotonin
ACQUIRED hemophilia A may be the result of which of the following conditions?
Anti-factor VIII inhibitor
Which of the following coagulation disorders can be attributed to a genetic platelet disorder, where giant platelets are commonly seen in the peripheral smear of an affected patient?
Bernard-Soulier Syndrome
All of the following are considered part of the routine evaluation that screens for coagulation abnormalities except:
Bethesda assay
Which of the following tests is used to quantify a coagulation inhibitor?
Bethesda assay
what are the 4 common MPNs
CML, PV, essential thrombocythemia, and primary myelofibrosis
The lupus inhibitor...
Causes prolongation of the aPTT
Which of the following coagulation factor(s) are found only in the extrinsic pathway.
Factor VII
Which of the following factors is not involved in the intrinsic pathway?
Factor VII
Mixing studies may help to determine the presence of which of the following
Factor deficiencies that prolong a PT and/or aPTT test result Coagulation inhibitors that prolong a PT and/or aPTT test result
All of the following processes occur during primary hemostasis except:
Fibrin strands are added to the newly formed clot.
The term that describes the process by which fibrin strands are broken down, then removed from an established clot is:
Fibrinolysis
this leukemia is TRAP positive, pancytopenia, splenomegaly
Hairy cell leukemia
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 in the plasma sample
Which coagulation pathway is initiated when collagen is exposed, and involves the substances HMWK, Fletcher Factor, and Hageman Factor?
Intrinsic Pathway
The organ associated with the production of the vast majority of clotting factors is the:
Liver
Which of the following statements regarding hemophilia A is true?
The severity of the disease (bleeding) is related to the degree of deficiency
Which of the following statement is correct about the INR?
To calculate the INR, one needs to know the ISI, the PT of the patient, and the PT of the normal pooled plasma
Which of the following best represents the quantity of resultant bleed in order of smallest bleed to largest. (Assuming identical trauma)
Venuole -> Vein -> Artery
what is the typical WBC count in AML
WBC count is highest in M4
What is a leukamoid reaction?
a high WBC shift to the left due to infectious or inflammatory
Which of the following laboratory tests of hemostatic function is a screening test used to assess the functionality of both the intrinsic and common pathways?
aPTT
what is the major difference of acute and chronic leukemia
acute death is within months and deals with thrombocytopenia and anemia. Chronic may be years before diagnosis thrombocytopenia is rare and only adults
which is the most common leukemia in children
acute lymphoblastic anemia
cytochemical stains were ordered on the blood of a patient with acute leukemia. The results were myeloperoxidase positive, sudan black positive, napthol AS-D chloroacetate esterase positive alpha-napthyl acetate esterase negative. whi is the leukemia
acute myelogenous leukemia
the presence of aure rods and a positive myeloperoxidase stain are associated with which type of leukemia
acute myelogenous leukemia
this white cell disease has a large azurophilic granules what is the white cell disease
alder-reilly
what are the major groups of Fab
aml m0 to m7 and ALL is L1-L3
pre cursor b-cell are
cd 10, 19, 22, 24
Precursor T-cell ALL
cd 2, 4, 5, 8,
Large lysosomes, albinism, and an increased susceptibility to infection is indicative of what?
chediak-higashi
when does a band become a segmented neutrophil
chromatin connects the nuclear lobes
what is the type of leukemia in the elderly
chronic lymphocytic leukemia
this leukemia has mature lymphocytes , soccer ball nucleus
chronic lymphoid leukemia
increase myelocytic precursor from blast to mature neutrophil decrease Philadelphia chromosomes. what leukemia is this
chronic myelogenous leukemia
what are the conditions associated with absolute lymphocytosis
cmv, whooping cough toxoplasmosis
what are some causes of neutropenia
cytotoxic drugs, leukemia, vitamin b12 or folate deficiency
what are reactive atypical lymphocytes
differentiated T-cells responding to an antigen stimulus
what is terminal deoxynucleotidyl transferase
enzyme marker for primitive lymphoid cells
Having platelet poor plasma when testing for LA is important because platelets are a source of phospholipids and their presence will react with reagents resulting in a prolonged aPTT.
false
Which of the following would be acceptable as the "normal" plasma reagent to use in a mixing study?
for got the answer
which cell is not inhibited by tartaric acid 2
hair cell leukemia 2 Trap
at what stage do secondary granules first appear during granulocytes maturation
in the myelocyte
What is polycythemia vera?
increase production of RBC, granulocytes , platelets
what is essential thrombocythemia
increased production of platelets which leads to bleeding
when does a metamyelocyte become a band
indentation is half the diameter of the round nuclues
What is Waldenstrom Macroglobulinemia?
is a lymphocyte plasma cell proliferation disorder, high levels of IgM. high viscosity, rouleaux cryoglobulins are detected
what is the difference between leukemia and lymphoma
leukemia deals with unregulated proliferation of hematopoietic stem cells,. Lymphomas are malignant neoplasms of lymphoid cells in lymphatic tissue
What are F cells
leukemic promyelocytes in APL that bundles of Auer rods
what is the predominant WBC from 2 weeks to 4 years of age
lymphocytes
what are the hematologic findings in multiple myeloma
lymphocytosis and anemia is present. rouleaux Esr increased
what is the purpose of the diluent used when counting WBC in a hemacytometer
lyse the rbc , 2% acetic acid
what is the name of a tissue basophil
mast cell
large platelets low number , dohle bodies in seg, mono, lymphs, but does not affect leukocyte function what white cell disease is this
may-hegglin
which leukocytes are phagocytic
mono, neutrophils, eosinophils, basophils
this cell is 12-18 microns in diameter. The cytoplasm is voluminous, gray-blue, and filled with tiny pink granules and vacuoles. The nucleus is irregular in shape and convoluted.
monocyte
which is the largets wbc on a peripheral blood smear
monocytes
What are mononuclear cells?
monocytes and lymphocytes
what is hypersegmentation and what is its significances
more than 5 lobes, megaloblastic anemia
Name in order , the stages of development in the granulocytic series
myeloblast , promyelocyte, metamyelocyte, band, seg, neutrophil
neoplastic, clonal, stem cell disorders characterized by cytopenias what syndrome is this
myelodysplastic syndromes
If CD13, CD33, CD34 are found on cells from a patient with acute leukemia, what is the cell lineage
myeloid
meoplastic, clonal disorders, characterized by increases in the red cells, WBC and platelets
myeloproliferative neoplasm
what is the predominant WBC in adults
neutrophils
acute leukemia characteristics is microcytic, normocytic, macrocytic which one is it
normocytic, normochromic
why are plasma cell not seen on peripheral smear
not normally seen , may seen few in infection and multiple myeloma
this cell is round and 10-28 microns in diameter. The cytoplasm is deep blue and nongranular. The eccentric nucleus contains blocks of chromatin in a cartwheel configuration and is surrounded by a particular clear zone
plasma cell
this leukemia has 20% plasma cells in peripheral circulation
plasma cell leukemia
this myeloma gives you bone pain, sheets of plasma cells, rouleaux, and urinary secretion of bence jones protein.
plasma cell myeloma
this deals with janus kinase 2 mutations
polycythemia vera
what is the difference between primary and secondary granules
primary is non specific also known as azurophilic secondary deals with more specific contain lysozymes(neutro, lyso, eos)
Specimen is clotted. what corrective action do you take for coag
recollect
What are Dohle bodies?
remnants of RNA, pale blue inclusions
How is BCR/ABL1 dectected
reverse transcriptase polymerase chain reaction(RT-PCR
what is regenerative shift to the left
shift to left with high WBC count
