Lab CE heme part 1
In the Kleihauer-Betke test, a maternal blood smear is treated with acid and then stained with counterstain. The fetal cells contain fetal hemoglobin, which is resistant to acid and will remain pink. Since the calculated volume of fetomaternal hemorrhage is an estimate, how many additional RhIg vials need to be added for the dose? 1 1.5 2 3
1 One vial is added to the calculated answer
A laboratory professional will perform a mixing study to differentiate between a factor deficiency and a coagulation inhibitor as the cause of a prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT) test result. The mixing study should be performed within what time frame following collection of the specimen? 4 hours 8 hours 24 hours 48 hours
4 hours
The appropriate magnification for a manual RBC cell count using a hemocytometer is which of the following? 10X 100X (Oil) 40X (Dry) 4X
40X (Dry)
The radioactive method used to measure red cell survival uses which of the following isotopes? I125 51Cr P31 14C
51Cr
Which of the following best describes a hemoglobinopathy? Any problem involving hemoglobin destruction. Any problem associated with hemoglobin production. A deletion of the loci of one or more hemoglobin chains. A substitution of an amino acid in the hemoglobin chain.
A substitution of an amino acid in the hemoglobin chain.
Hemoglobin S (HbS) is MOST common in which of the following countries? African countries Mediterranean countries Middle Eastern countries North American countries
African countries
What is the composition of the granules associated with basophilic stippling? Aggregates of iron Aggregates of hemoglobin Aggregates of ribosomes Aggregates of DNA
Aggregates of ribosomes
Red blood cell (RBC) count : 5.6 x 10^12/L (4.1 - 5.1 x 1012/L) Hemoglobin (Hb) 11.2 g/dL (12.3 - 15.3) g/dL Hematocrit (HCT) 34.5% (35.9 - 44.6%) RDW 14.0<14.5 RBC morphology- Microcytes, basophilic stippling, codocytes (target) present. Beta thalassemia minima Beta thalassemia minor Beta thalassemia intermedia Beta thalassemia major
Beta thalassemia minor
Which of the following describes a beta thalassemia genotype ß+/ß? Beta thalassemia silent carrier Beta thalassemia minor Beta thalassemia intermedia Beta thalassemia major
Beta thalassemia minor
Where is the main site of action for monocytes after diapedesis? Peripheral blood Body tissues Bone marrow Digestive tract
Body tissues
Acute immune thrombocytopenic purpura (ITP) is MOST OFTEN associated with which of these populations? Newborns Children 2 - 6 years of age Adults 20 - 40 years of age Seniors over the age of 65
Children 2 - 6 years of age
Which of the following non-HbS hemoglobins can also sickle and show a positive solubility test? HbC Harlem HbD LosAngeles HbG Philadelphia HbO Arab
HbC Harlem
Which of the following stages of neutrophilic granulocyte cellular development is at the second stage from the least mature stage? Band neutrohiil Promyelocyte Metamyelocyte Myeloblast
Promyelocyte
Which potent inhibitor of platelet aggregation is released by endothelial cells? Epinephrine Prostacyclin Ristocetin Thromboxane A2
Prostacyclin
Which of the following disorders or diseases is associated with coarse basophilic stippling? Lead poisoning Bacterial infection Leukemia Lymphocytosis
Lead poisoning
What organ is associated with the production of the majority of clotting factors? Thymus Duodenum Liver Kidney
Liver
Which of the following major cellular elements does not develop solely in the bone marrow? Monocyte Neutrophil Lymphocyte Macrophage
Lymphocyte
What are the smallest nucleated cells seen in normal peripheral blood? Lymphocytes Segmented neutrophils Monocytes Platelets
Lymphocytes
Which of the following cells would be increased if the cerebrospinal fluid (CSF) of a patient suspected of having multiple sclerosis? Neutrophils Lymphocytes Macrophages Monocytes
Lymphocytes
A white blood cell stained with Wright's stain has the following characteristics: Round eccentric nucleus with clumped chromatin pattern 1:1 nucleus to cytoplasm ratio Basophilic cytoplasm Crescent-shaped clear area next to nucleus What is the MOST likely identification of this cell? Myeloblast Plasma cell Reactive lymphocyte Polychromatic normoblast
Plasma cell
Which laboratory result is the most critical in recognizing heparin-induced thrombocytopenia (HIT)? Fibrinogen level Prothrombin time D-dimer Platelet count
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? Factor VIII assay Mixing studies with factor-deficient plasmas Antinuclear antibody test Platelet neutralization test
Platelet neutralization test
The most striking laboratory finding of this myeloproliferative neoplasms is an absolute erythrocytosis and hemoglobin concentrations of greater than 18.5 g/dL? Chronic myelogenous leukemia (CML) Essential thrombocythemia (ET) Polycythemia vera (PV) Primary myelofibrosis (PMF)
Polycythemia vera (PV)
Which of the following is an expected or common laboratory finding in patients with hereditary hemochromatosis (HH)? Elevated hemoglobin and hematocrit Decreased transferrin saturation Presence of HFE mutation Decreased serum ferritin
Presence of HFE mutation
The gene loci for the alpha-globin chains are adjacent to the locus for which other globin chain? Beta Delta Epsilon Zeta
Zeta The order of globin gene loci on chromosome 16 is Zeta, Alpha 2, and Alpha 1. Beta globin gene, delta globin gene, and epsilon globin genes are found on chromosome 11.
Cytomegalovirus (CMV) appears to suppress cell-mediated immune functions. Which of the following is a characteristic finding in persons infected with CMV? Increased CD4+ cells; decreased CD8+ cells Increased CD4+ cells; increased CD8+ cells Decreased CD4+ cells; increased CD8+ cells Decreased CD4+ cells; decreased CD8+ cells
Decreased CD4+ cells; increased CD8+ cells
Anemia of chronic inflammation, also known as anemia of chronic disease, can be caused by all of the following mechanisms EXCEPT: EPO production inhibited by cytokines Direct cytokine inhibition of erythropoiesis Decreased ferritin Shortened erythrocyte survival
Decreased ferritin
Which of the following would describe hypochromia? Decreased size of RBC's. Variation in the shape of RBC's. Increased variation of size of RBC's. Decreased hemoglobin concentration in RBCs.
Decreased hemoglobin concentration in RBCs.
Which of the following laboratory test results indicates that a sickle cell patient may be in aplastic crisis? Decreased reticulocyte count Decreased haptoglobin level Increased bilirubin level Increased lactate dehydrogenase (LDH)
Decreased reticulocyte count
What is the Kleihauer-Betke test used for? Screen for sickle cell anemia Screen for fetal hemoglobin Differentiate between maternal and fetal red cells Screen for hemoglobin A1c
Differentiate between maternal and fetal red cells Fetal cells X maternal blood volume* / Total cells counted = Fetomaternal hemorrhage (mL of whole blood) Maternal blood volume is estimated at 5000 mL
In patients who have developed heparin-induced thrombocytopenia with thrombosis (HIT), which of the following should be used to prevent ischemic stroke? Unfractionated heparin Direct thrombin inhibitors Oral anticoagulant Vitamin K
Direct thrombin inhibitors
Diseases associated with a dysfunction of polymorphonuclear neutrophils (PMNs) include all of the following with the exception of: Chediak-Higashi syndrome (CH) Chronic granulomatous diseases (CGDs) Gaucher 's Disease Myeloperoxidase deficiency (MPO)
Gaucher 's Disease Gaucher's disease is a monocyte-macrophage disorder caused by a rare genetic defect.
What is a potentially negative aspect to molecular (DNA) testing for mutations of the HFE gene, the gene found in the majority of patients diagnosed with hereditary hemochromatosis (HH)? Genetic discrimination based on knowledge of test results Interference from preanalytical and physiologic variables Inaccuracy of test results Insensitivity of test methods
Genetic discrimination based on knowledge of test results
Which of the following options best describes how hemophilia A differs from hemophilia B? A. The clinical presentation is drastically different. B. Hemophilia A is an inherited disorder and hemophilia B is an acquired disorder. C. Factor VIII is deficient in hemophilia A and factor IX is deficient in hemophilia B. D. Hemophilia A is a disorder of secondary hemostasis and hemophilia B is a disorder of primary hemostasis.
C. Factor VIII is deficient in hemophilia A and factor IX is deficient in hemophilia B.
Which of the following RBC inclusions can be visualized with Supravital stain but CANNOT be detected on a Wright stained blood smear? Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies
Heinz bodies
Which of the following formulas will provide the value that reflects the average cell volume in a blood sample? Hemoglobin (g/dL) x 10/RBC count (1012/L) Hematocrit (%) x 10/RBC count (1012/L) Hemoglobin (g/dL) x 100/Hematocrit (%) Hemoglobin x 3
Hematocrit (%) x 10/RBC count (1012/L)
Relative polycythemia is a mild form of polycythemia that can be the result of all of the following EXCEPT? Dehydration Hemoconcentration Gaisböck's syndrome Low thrombopoietin levels
Low thrombopoietin levels
A 52 year old male with a history of alcoholism is admitted to the hospital with severe abdominal pain. A CBC reveals the following results: White blood cells (WBC) 15.7 x109/L (4.0-10.0 x109/L) Red blood cells (RBC) 3.9 x1012/L (4.2-5.9 x1012/L) Hemoglobin1 4.4 g/dL (12-16 g/dL) Hematocrit 41% (37-48%) MCV105 fL (80-100 fL) RDW-CV 16.5% (11.0-14.0%) Considering the information that is provided, which of the following would be an appropriate description this patients RBC population? Macrocytic, heterogenous (i.e., more variable) Macrocytic, homogenous (i.e., not as variable) Normocytic, homogenous Microcytic, heterogenous
Macrocytic, heterogenous (i.e., more variable) RDW is above the reference interval and indicative of a heterogenous cell population (variation in RBC size)
What is the precursor of the platelet which is, in most cases, only found in the bone marrow? Myeloblast Promegakarocyte Megakaryocyte Erythroblast
Megakaryocyte
The condition which is highly associated with the oval-macrocytes and hypersegmented neutrophils found in this image is? Sideroblastic Anemia Megaloblastic Anemia Iron Deficiency Anemia Malarial Infection
Megaloblastic Anemia
In which of the following conditions are Cabot rings most likely to be observed on a Wright-stained peripheral blood smear? Megaloblastic anemia Moderate iron deficiency anemia Sickle cell trait Plasma cell myeloma
Megaloblastic anemia
Each of the cells below can be found in all types of body fluids EXCEPT: Neutrophils Macrophage/monocytes Lymphocytes Mesothelial cells
Mesothelial cells
In which age group is Type I Hereditary Hemochromatosis (HH - the most common form) most likely to be initially detected based on clinical symptoms? Middle aged adults Young adults School age children Infants
Middle aged adults
The mutational status of Janus kinase 2 (JAK2) is most commonly used for the diagnosis of which of the following? Paroxysmal Nocturnal Hemoglobinuria (PNH) Myeloproliferative neoplasms Anemias due to nutritional deficiencies Hypoproliferative conditions
Myeloproliferative neoplasms
Hematocrit is: Percentage of blood made up of serum Concentration of serum X 100 Percentage of blood made up of red blood cells Concentration of red cells X 100
Percentage of blood made up of red blood cells
Which of the following is a clinical symptom that is associated with thrombocytopenia? Edema Petechiae Hair loss Dry skin
Petechiae
A patient has a hypercellular bone marrow and is suspected of having a myeloproliferative disorder. Laboratory features include: excess megakaryocyte proliferation and atypia, marked marrow fibrosis, and the JAK2 mutation. The most likely diagnosis is: Primary Myelofibrosis (PMF) Chronic Myelogenous Leukemia (CML) Chronic Neutrophilic Leukemia (CNL) Essential Thrombocythemia (ET)
Primary Myelofibrosis (PMF)
The vascular system contributes to hemostasis in all of the following ways EXCEPT: Production of tissue factor Diversion of blood flow around the damaged vessel Contraction of vessels Providing smooth endothelial surface
Providing smooth endothelial surface
When scanning a Wright's stained blood smear, which of the following would describe the optimum area to begin your blood smear analysis and differential white blood cell count? RBCs are fairly far apart showing a "cobblestone effect." RBCs are lying singly, barely touching, with occasional overlapping. RBCs are stacked like coins with the majority of cells overlapping. RBCs are aggregated.
RBCs are lying singly, barely touching, with occasional overlapping.
Von Willebrand Factor (vWF) multimer analyses of patient's plasma can be performed by: Ristocetin induced platelet aggregation tests (RIPA) ELISA antigen assays SDS agarose gel electrophoresis Latex agglutination tests
SDS agarose gel electrophoresis
Which of the following alpha thalassemia syndromes has the genotype -a/aa ? Silent carrier Alpha thalassemia minor Hemoglobin H disease Alpha thalassemia major
Silent carrier
The cell diameter of a normal RBC is similar in size to the nucleus of a __________________. Small lymphocyte Normal platelet Segmented neutrophil Monocyte
Small lymphocyte
A substance secreted by the vascular endothelial cells that can help to initiate fibrinolysis is: Tissue factor (TF) Tissue factor pathway inhibitors (TFPI) Tissue plasminogen activator (t-PA) Von Willebrand factor (vWF)
Tissue plasminogen activator (t-PA)
To produce hemoglobin S (HbS), glutamic acid normally present in the sixth position on the beta-globin chain is substituted with which of the following? Cystine Guanine Thyamine Valine
Valine
yellow coloration found in fresh cerebrospinal fluid supernatant is termed: Xanthochromia Hemolysis Jaundice Hyperlipidemia
Xanthochromia
These 3 tubes of cerebrospinal fluid (CSF) are delivered to the laboratory for analysis. The tube labeled #1 was the first tube collected. Which one of the tubes should be used by the hematology department for cell count and differential? Tube #1 Tube #2 Tube #3 Any one of the tubes can be used
Tube #3 Typically performed on last tube collected to ensure that any peripheral blood that may have contaminated the sample during the lumbar puncture has cleared.
An abnormality of which of the following assays would be LEAST likely to be associated with thrombotic tendency? AT III Protein C APTT Protein S
APTT Deficiencies of Protein C, Protein S, and Antithrombin III all cause hypercoagulability.
Which of the following is LEAST useful in differentiating hemophilia A from hemophilia B? Factor VIII and IX assays Clinical history Activated Partial thromboplastin time (aPTT) Mixing studies (correction studies)
Activated Partial thromboplastin time (aPTT) aPTT will be abnormal in both hemophilia A and B
Blast cells found in a spinal fluid differential are most likely associated with which of the following? Bacterial meningitis Acute Leukemia Viral meningitis Metastatic carcinomas
Acute Leukemia
The following stain reactions were resulted on a suspected case of leukemia: Myeloperoxidase + Sudan Black B + Chloroacetate Esterase + Nonspecific Esterases - Which of the following is the correct interpretation? Acute Myelocytic Leukemia Acute Monocytic Leukemia Acute Megakaryoblastic Leukemia Acute Lymphocytic Leukemia
Acute Myelocytic Leukemia
Alder-Reilly inclusions may be found in which cell type(s)? Neutrophils only Granulocytes only All types of mature white blood cells Erythrocytes
All types of mature white blood cells Alder-Reilly inclusions are composed of precipitated mucopolysaccharides and are seen in Hunter's and Hurler's syndromes, as well as other disorders of mucopolysaccharidosis. Alder-Reilly inclusions are dark-staining, coarse cytoplasmic granules that are larger in size and stain positive with metachromatic stains.
Basophils' primary role involves: Phagocytosis Allergic reactions Long term immunity Fighting parasitic infections
Allergic reactions
Hemoglobin D (HbD) is elevated in all of the following EXCEPT? Hemoglobin D disease Hemoglobin SD disease Hb D/beta-thalassemia Alpha thalassemia
Alpha thalassemia
Which of the following terms refers to a deficiency of red blood cells (RBCs) or hemoglobin? Anemia Erythropoiesis Leukocytopenia Hypoxia
Anemia
Using an automated cell counter analyzer, an increased Red Cell Distribution Width (RDW) should correlate with which of the following? Leukocytosis Anisocytosis Spherocytosis Macrocytosis
Anisocytosis
What is one of the main characteristics of secondary granules in the neutrophilic granulocyte cytoplasm? Appear first at the myelocyte stage Dissolve in mature granulocytes Are formed on the mitochondria Are derived from azurophil (primary) granules
Appear first at the myelocyte stage
All of the following are likely the causes of an abnormal thrombin time (TT) EXCEPT: Fibrin split products Heparin Aspirin Dysfibrinogenemia
Aspirin
Which of the following is NOT a cause of death in patients with hereditary hemochromatosis (HH)? Autoimmune disease Hepatocellular carcinoma Cirrhosis Cardiomyopathy
Autoimmune disease Hereditary hemochromatosis is a recessive genetic disorder that causes a gradual accumulation of iron in the tissues. This accumulated iron leads to chronic liver disease, arthritis, diabetes, pituitary damage, congestive heart failure, and cardiac arrhythmias. Death is due to iron overload with organ damage and cirrhosis.
Which of the following leukocytes is most directly associated with antibody production? B-Cell T-Cell Neutrophil NK Cell
B-Cell
Toxic granulation is seen most frequently in: Viral infections Parasitic infections Bacterial infections Allergic reactions
Bacterial infections
Which ethnic group has the highest incidence of hereditary hemochromatosis in the United States? Caucasians African Americans Asians Hispanics
Caucasians
When using a flow cytometer, forward scatter measures which of the following parameters? Cell size Clonality Cytoplasmic complexity (granularity) Fluorescence
Cell size
A small child has albino characteristics, photophobia, frequent pyogenic infections, and her blood smear shows giant dark granules in her monocytes and granulocytes. What is the probable diagnosis? Pelger-Huet anomaly Alder-Reilly Toxic granulation Chediak-Hegashi syndrome
Chediak-Hegashi syndrome
Which chromosome demonstrates a partial or full gene loci deletion in various forms of beta thalassemia? Chromosome 16 Chromosome 8 Chromosome 11 Chromosome 9
Chromosome 11 Chromsome 16 = alpha thalassemia
Which of the following is least likely to interfere with the measurement of hemoglobin? Icteric plasma Lipemia Cold agglutinin Leukocytosis
Cold agglutinin
An India Ink preparation is used to identify: Crystals in synovial fluid Cryptococcus neoformans in CSF Bacteria in CSF WBCs in synovial fluid
Cryptococcus neoformans in CSF
Which of the following is the recommended method for preparing a cerebrospinal fluid (CSF) sample for a differential count? Cytocentrifugation The concentration of cells by traditional centrifugation Manual smear methods Use of hemocytometer
Cytocentrifugation
Which of the following will cause a falsely increased erythrocyte sedimentation rate? ESR tube is slanted EDTA tube is clotted EDTA tube is one-third full EDTA specimen is 24 hours old
ESR tube is slanted
If one finds excessive rouleaux formation on a blood smear examination, then which of the following parameters might also be increased? Leukocyte count Erythrocyte sedimentation rate Hematocrit Osmotic fragility
Erythrocyte sedimentation rate
A 90-year-old patient is admitted to the hospital with the following laboratory data: WBC: 9,000/mm3 PLT: 190,000/mm3 Hgb: 6.1 g/dL Differential:11% Neutrophils40% Lymphocytes4% Monocytes45% Myeloblasts45 NRBC's / 100 WBCBone Marrow: 45% Myeloblasts & 55% Megaloblastoid Erythroblasts Serum Vitamin B12 and Folic Acid: Normal The MOST likely diagnosis is: Pernicious anemia Polycythemia vera Erythroleukemia Myelomonocytic leukemia
Erythroleukemia
Which hormone is produced by the kidney and influences erythrocyte production? Growth hormone Erythropoietin Interleukin 3 ALA synthetase
Erythropoietin
Which of the following is the cause of cytopenia in Myelodysplastic syndromes (MDS)? Unchecked clonal hematopoiesis Inability to incorporate iron into developing erythrocytes Excess apoptosis Myelofibrosis
Excess apoptosis Excess apoptosis of abnormal (dysplastic) cells results in fewer cells being released into the circulation, which leads to cytopenia.
Which of the following coagulation pathways includes Factor VII? Common pathway Extrinsic pathway Intrinsic pathway Fibrinolysis
Extrinsic pathway
Plasmin is known to degrade Factors Va, VIIIa, and GPIb. What other substance is it known to digest? Fibrin Thrombin Plasminogen Hageman Factor
Fibrin
What principle(s) of flow cytometry is employed when performing immuno-phenotyping? Diffraction grating Impedance Diffraction grating and impedance Fluorescent antibody tagging and light scatter
Fluorescent antibody tagging and light scatter
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 Aplastic anemia Radiation Therapy Wiskott-Aldrich syndrome
Folic acid deficiency
The anemia seen in anemia of chronic disease (also known as anemia of chronic infection) is characterized by low serum iron levels. Which of the following contributes to the low serum iron levels seen in persons with anemia of chronic disease? Decreased erythropoietin Hepcidin Decreased dietary intake Decreased ferritin levels
Hepcidin Decreased serum iron levels seen in anemia of chronic disease are due to increased hepcidin, which is responsible for blocking the release of iron from macrophages Erythropoietin (EPO) levels can be decreased in anemia of chronic disease, but the level of EPO would not contribute to the level of serum iron.
Which of the formulas given below is used to calculate MCHC- mean cell (corpuscular) hemoglobin (Hgb) concentration? Hgb (g/dL) x 10/ red blood cell (RBC) count Hematocrit (%) x 10/ red blood cell (RBC) count Red blood cell (RBC) count / Hgb (g/dL) x 10 Hgb (g/dL) x 100/ Hematocrit (%)
Hgb (g/dL) x 100/ Hematocrit (%)
A 36-year-old woman visits her physician after experiencing fevers, night sweats, and overall fatigue over the past 3 months. Upon physical examination, she displays lymphadenopathy. When a lymph node biopsy is performed, Reed-Sternberg cells, bands of fibrosis, and various-sized lymphocytes are noted. Which of the following conditions is the most likely diagnosis? Mantle cell lymphoma Hodgkin lymphoma Follicular lymphoma Burkitt lymphoma
Hodgkin lymphoma
What is the site used MOST frequently in the adult patient when performing a bone marrow biopsy? Vertebrae Sternum Clavicle Iliac crest
Iliac crest
Which test result will be normal in a patient with dysfibrinogenemia? Thrombin time Reptilase test Clot based - fibrinogen assay Immunologic fibrinogen level
Immunologic fibrinogen level
How does hydroxyurea aid in the treatment of sickle cell disease? Acts as an analgesic in pain management. Prevents sickle cells from clumping together. Induces increased production of HbF. Reduces the number of sickle cells that form.
Induces increased production of HbF.
Basophils' primary role involves: Phagocytosis Initiation of allergic inflammation Long term immunity Antibody production
Initiation of allergic inflammation
What would you predict is the effect on iron absorption if erythopoietic activity is increased over a prolonged period of time? It would increase. It would decrease. It would remain the same. It is impossible to predict.
It would increase.
During the 'staining' process prior to flow cytometry analysis of white blood cells, how are the erythrocytes treated? Lysed Bound Counted Stained
Lysed
Blood samples for complete blood counts are collected on morning rounds and stored in a rack in the phlebotomist's basket. When the phlebotomist delivers the samples to your workstation, the cells and plasma in the samples have separated. As a result, one of the samples has lipemic plasma. Which of the following parameters may be affected by the lipemia? RDW MCV MCHC None of the parameters would be affected.
MCHC The MCHC may be affected by lipemia as well as hemolysis and red cell agglutination. In addition, the photometric measurement of the hemoglobin may be affected by the lipemia, which would then impact the MCHC calculation.
Which of the following RBC indices is expressed in femtoliters? RDW MCHC MCH MCV
MCV
The following results correlate with which of the following myelodysplastic syndromes?2 cyotpenias in the peripheral blood11% blasts in the peripheral blood18% blasts in the bone marrowAuer rods present MDS-EB-2 MDS-SLD MDS-MLD MDS-U
MDS-EB-2 MDS with excess blasts subtype 2
A patient is admitted to the emergency room with lethargy and pallor. The CBC results are as follows: RBC = 4.1 x 1012/L Hemoglobin = 7.9 g/dL Hematocrit = 29% How would you classify this anemia? Microcytic, hypochromic Normocytic, normochromic Macrocytic, normochromic Microcytic, hyperchromic
Microcytic, hypochromic
A peripheral smear demonstrates a population of red cells that are mostly 5 - 5.5 µm in diameter. The CBC data shows RDW of 13% (reference range 11.5-14.5%). Which of the following morphologies is consistent with these findings? Macrocytosis, low variation of cell volume Normocytic cell, low variation of cell volume Microcytosis, low variation of cell volume Normocytic cell, high variation of cell volume
Microcytosis, low variation of cell volume Normal RBC diameter is 7.5 microm.
In which of the following cells are Auer rods most likely to be seen? Myeloblast Lymphoblast Erythroblast Megakaryocyte
Myeloblast
When a few small, purple inclusions are found in erythrocytes, they can be confirmed as containing iron by: Describing them very carefully Performing a crystal violet stain Performing a new methylene blue stain Performing a Prussian blue stain
Performing a Prussian blue stain
Which of the following is considered a macrocytic anemia? Cooley's anemia Iron deficiency anemia Pernicious anemia Polycythemia vera
Pernicious anemia
If greater than 50% lymphocytes were found on the peripheral blood smear of a 5-month-old child you would suspect which of the following conditions? Immune deficiency syndrome Acute viral infection Normal finding Infectious hepatitis
Normal finding
A semen sample for semen analysis should generally be received at the testing site within what period of time? One hour Two hours Three hours Four hours
One hour
The central pallor in a red blood cell is about _________ the diameter of the cell. One fourth One half One eighth One third
One third
Degenerated erythrocyte cytoplasmic organelles that contain iron are called: Cabot rings Howell-Jolly bodies Heinz bodies Pappenheimer bodies
Pappenheimer bodies
Which of the following red cell inclusions are often found in peripheral blood smears of patients with sideroblastic anemia? Howell-Jolly bodies Pappenheimer bodies Heinz bodies Cabot rings
Pappenheimer bodies
Which of the following laboratory tests is commonly used to monitor oral anticoagulant therapy? Activated partial thromboplastin time (APTT) Thrombin time (TT) Prothrombin time (PT)/INR Fibrinogen assay
Prothrombin time (PT)/INR
The primary purpose of neutrophil granules is to: Facilitate nuclear maturation. Help distinguish neutrophils from lymphocytes. Prepare cells for removal from circulation. Provide microbicidal action.
Provide microbicidal action.
MCV is calculated using which of the following parameters? Hgb and RBC Hct and Hgb RBC and Hct RBC and MCHC
RBC and Hct
All of the following methods are used in the diagnosis and classification of acute leukemia, EXCEPT? Immunophenotyping Reticulocyte count Cytochemical Analysis Cytogenetics
Reticulocyte count
All of the following erythrocyte alterations are always associated with pathological conditions EXCEPT: Rouleaux Basophylic stippling Howell Jolly bodies Pappenheimer bodies.
Rouleaux
Which of the following tests may be used to confirm screening test results for a lupus anticoagulant (or antiphospholipid antibody)? Activated partial thromboplastin time Prothrombin time Factor assays Russell Viper Venom test
Russell Viper Venom test
The bone marrow becomes the main site of hematopoiesis in the ________ month of gestation. First Second Fourth Seventh
Seventh
Which of the following cells demonstrate an increase in osmotic fragility? Target cells Reticulocytes Spherocytes Macrocytes
Spherocytes
In which of the following conditions would one see Pappenheimer bodies on the peripheral blood smear? Iron deficiency anemia Malarial infections G6PD deficiency Splenectomies
Splenectomies
What is the principle of the New Methylene Blue test? Reflecting ultra-violet light Inhibit lipids and proteins Staining hemoglobin components Staining cytoplasmic RNA, mitochondria, and ribosomes
Staining cytoplasmic RNA, mitochondria, and ribosomes
Which of the following is LEAST likely to stimulate the production of reactive lymphocytes? Staphylococcus aureus Cytomegalovirus (CMV) Epstein-Barr virus Toxoplasma gondii
Staphylococcus aureus
Four tubes of CSF on the same patient were received in the laboratory. It was noted on the report that all four tubes contained visible blood. Which of the following is the best explanation for this finding? Traumatic tap Subarachnoid hemorrhage Meningitis WAHA
Subarachnoid hemorrhage
Which form of hemoglobin cannot be measured using the cyanmethemoglobin method? Sulfhemoglobin Carboxyhemoglobin Oxyhemoglobin Hemoglobin
Sulfhemoglobin
which image most likely corresponds with the blood smear that would be found from a patient with myelofibrosis? Tear drop cells Burr cells Schistocytes Acanthocytes
Tear drop cells
Which of the following best describes a segmented neutrophil? Nucleus contains greater than 5 lobes. The nucleus contains 2-5 lobes connected by a thin filament. Nucleus is kidney bean shaped. Cytoplasm of the cell contains large primary granules.
The nucleus contains 2-5 lobes connected by a thin filament.
As an RBC ages, all of the following are true EXCEPT: The membrane becomes less flexible. The cellular hemoglobin concentration increases. Glycolysis and other enzyme activity decrease. They become less prone to phagocytosis.
They become less prone to phagocytosis.
This assay would be used to help rule-out heparin contamination in a coagulation sample: Protein C assay Thrombin time PT APTT
Thrombin time
All of the following would be considered a part of the body's cellular immune system EXCEPT? Macrophages Mast cells Neutrophils Thrombocytes
Thrombocytes
Disseminated intravascular coagulation (DIC) is associated with all of the following clinical conditions EXCEPT: Septicemia Obstetric emergencies Intravascular hemolysis Thrombocytosis
Thrombocytosis
Obstruction of a blood vessel caused by a stationary blood clot is called: Phlebitis Embolism Thrombosis Aneurysm
Thrombosis
Aspirin ingestion prevents the synthesis of this signaling molecule in the platelet? Thromboxane A2 Calcium Collagen ADP
Thromboxane A2
Which of the following best represents the quantity of resultant bleeding in order of smallest bleed to largest (assuming identical trauma)? Artery, Arteriole, Vein Venule, Artery, Vein Venule, Vein, Artery Artery, Vein, Arteriole
Venule, Vein, Artery
A patient has anemia with an elevated mean corpuscular volume (MCV) of 104 fL (reference range 80-100 fL). All of the following could be likely causes EXCEPT: Vitamin B12 deficiency Alcoholism Acute blood loss Liver disease
Vitamin B12 deficiency
Which of the following conditions is hypersegmentation of granulocytes most commonly associated with? Inherited trait or lipid storage disease Iron deficiency Viral infection Vitamin B12 or Folate deficiency
Vitamin B12 or Folate deficiency
Which of the following best describes a resting lymphocyte? A. Cytoplasm is light blue and nucleus is about the size of an erythrocyte. B. Delicate chromatin with cytoplasm that has a "ground glass" appearance. C. Light pink cytoplasm with many fine specific granules. D. Clear cytoplasm with large red-orange specific granules.
A. Cytoplasm is light blue and nucleus is about the size of an erythrocyte.
Laboratory tests which can contribute toward the diagnosis of Glanzmann Thrombasthenia include all of the following EXCEPT: A. PT and aPTT B. Non-anticoagulated blood films (e.g. smears from a finger stick) C. Platelet aggregation tests D. Flow cytometry
A. PT and aPTT
Which of the following statements is true regarding macrophages (histiocytes)? A. It is a form of lymphocyte that is capable of cell lysis. B. It is a type of monocyte that has entered the tissues via diapedesis. C. It is a cell found in tissues with numerous basophilic granules in the cytoplasm. D. It is a type of eosinophil that has immunoglobulins on the surface to recognize invading parasites.
B. It is a type of monocyte that has entered the tissues via diapedesis.
A 76-year-old patient experiences frequent infections and bleeding episodes. She is also complaining of pain in her bones and joints. Upon routine exam, her physician orders a complete blood count and differential. The hematology technologist notices many cells appearing similar to the cell in the image to the right, Blasts with auer rods in it. Which condition is this patient most likely suffering from? Acute Myeloid Leukemia (AML) Acute Lymphoid Leukemia (ALL) Chronic Lymphocytic Leukemia (CLL) Polycythemia Vera (PV)
Acute Myeloid Leukemia (AML)
What is a correct characteristic of Alpha Thalassemia? A. Decreased or absent alpha chain production results in excess gamma chain production during and shortly after birth, followed by excess beta chains later. B. The typical haplotype for alpha thalassemia is (+a/+a). C. Alpha thalassemia does not manifest in utero, it is acquired later in life. D. Increased alpha chain production results in decreased or absent gamma and beta chain production.
A. Decreased or absent alpha chain production results in excess gamma chain production during and shortly after birth, followed by excess beta chains later.
To determine if an elevated aPTT is caused by a factor deficiency or a factor inhibitor when the PT is normal, the FIRST step would be: A. Mix one part patient plasma and one part normal pooled plasma and repeat the aPTT B. Mix one part patient plasma and one part normal aged plasma and repeat the aPTT C. Perform a Factor IX assay to see if it is a Factor IX deficiency D. Perform a test for a lupus anticoagulant
A. Mix one part patient plasma and one part normal pooled plasma and repeat the aPTT
Which of the following statements about monocyte function is INCORRECT? A. Monocytes are white blood cells that are actively phagocytic in the peripheral blood. B. Monocytes are white blood cells that are actively phagocytic in the body tissues. C. Monocytes are white blood cells that can continue to develop into macrophages. D. Monocytes are white blood cells that play an important role in inflammatory diseases.
A. Monocytes are white blood cells that are actively phagocytic in the peripheral blood.
A manual white blood cell count was performed by the hematology technologist. The cell counts for both sides were 152 and 164 respectively. All nine large squares were counted on each side. The dilution for this kit was pre-measured at 1:100. What should the technologist report as the white cell count? 177.5 x 109/L 17.5 x 109/L 1.75 x 109/L 175 x 109/L
17.5 x 109/L in this case the average of both sides) X dilution factor (in this case 100) / # of squares counted (in this case 9) X area of each square (1 mm2) X 0.1 mm (depth factor) 158 x 100 / 9 x 1 x 0.1 mm = 17555.55/mm3
Twenty microliters (20 µL) of blood are diluted with 1.98 mL of diluent. Both sides of the hemocytometer are charged with the diluted sample and the entire ruled area of the center square is counted on both sides. A total of 356 platelets are counted (combined total of the two large squares). What is the platelet count per liter? 100 x 109/L 178 x 109/L 356 x 109/L 712 x 109/L
178 x 109/L 20 uL = 0.02 mL. total volume of dilution is 2.00 mL and dilution is 1:100 # of platelets counted x the dilution = platelets/µLnumber of squares counted x 0.1
Given the following information, what is the CORRECTED white count? Initial White count = 35,000/µL92 nucleated red blood cells are noted per 100 WBC's counted on the manual differential 3,500/µL 10,300/µL 16,700/µL 18,229/µL
18,229/µL
A sample of cerebrospinal fluid is diluted 1:100; the standard 9 squares of a hemocytometer are counted on each side for a total of 18 large squares. Side 1-- 186 nucleated cells counted Side 2-- 184 nucleated cells counted Total nucleated cells = 370 cells/ul = (#of cells counted x dilution / #of large squares counted x 0.1) Using the standard hemocytometer formula shown on the right, what is the nucleated cell count per microliter (µL)? 1.03 x 104 2.06 x 104 4.12 x 104 8.24 x 104
2.06 x 104
What is the normal myeloid to erythroid (M:E) ratio in the bone marrow? 2:1 - 4:1 1:2 - 1:4 3:1 - 5:1 5:1 -10:1
2:1 - 4:1
A manual WBC count was performed. A TOTAL of 72 cells were counted in 4 large mm squares of a Neubauer-ruled hemacytometer. A 1:20 dilution was used. What is the calculated WBC count? 0.4 x 103/µL 1.8 x 103/µL 3.6 x 103/µL 4.0 x 103/µL
3.6 x 103/µL (dilution ratio x # of cells counted x 10) / (# mm2 area counted)
What is the optimal time to begin initial microscopic examination of a semen specimen, assuming liquefaction is complete? 30 minutes 2 hours 4 hours 8 hours
30 minutes
Calculate the mean corpuscular hemoglobin content (MCHC) when Hgb = 15 g/dL (150 g/L), RBC count = 4.50 x 106/µL (4.50 x 1012/L), and Hct = 47% (0.47). 34.7 g/dL 10.4 g/dL 31.9 g/dL 33.9 g/dL
31.9 g/dL MCHC is (Hemoglobin (g/dL) / Hematocrit (%)) x 100
What is the corrected white blood cell count if the WBC is 14,460, and there were 47 nucleated red blood cells per 100 white blood cells noted on the differential count? 6,796 9,837 10,165 21,256
9,837 Corrected WBC count = uncorrected WBC count x (100 / NRBCs +100)
The ratio of whole blood to anticoagulant is very important in the PT assay; at which hematocrit level should the standard anticoagulant volume be adjusted? < 50% > 75% > 55% < 35 %
> 55% Volume of sodium citrate = (1.85 X 10-3) X (100 - patient hematocrit) X volume of whole blood drawn
Fifty percent blasts are found on a peripheral blood smear. The cells are large (3-5x the size of a lymphocyte) with a nucleus that contains fine homogeneous chromatin and two to three nucleoli. There is moderate blue-grey cytoplasm with Auer rods. What leukemia is most likely? Acute myelogenous leukemia (AML) Hairy cell leukemia (HCL) Acute lymphoblastic leukemia (ALL) Chronic lymphocytic leukemia (CLL)
Acute myelogenous leukemia (AML) HCL, ALL, and CLL are all leukemias affecting the lymphocytic cell line, and the presence of Auer rods would not be seen in the blasts of these conditions.
Each of the following has been shown to induce platelet aggregation EXCEPT? Epinephrine ADP Aspirin Collagen
Aspirin
Pelger-Huet anomaly is characterized by which of the following? A. Giant gray-green bodies and giant lysosomes in the cytoplasm of neutrophils B. Bilobed or round nuclei in neutrophils (hyposegmented) C. Dohle-like-bodies in the cytoplasm of neutrophils D. Large purplish granules in the cytoplasm of all leukocytes
B. Bilobed or round nuclei in neutrophils (hyposegmented)
Which of the following statements is correct regarding bone marrow evaluation? A. Bone marrow cellularity increases with age. B. Bone marrow cellularity is highest in young children compared to adults. C. In a healthy person, the expected myeloid : erythroid ratio is less than 1 (one). D. As we age, the amount of adipose tissue (fat) decreases.
B. Bone marrow cellularity is highest in young children compared to adults.
Which one of the following sets of laboratory results is consistent with hemolytic anemia? A. Increased concentration of haptoglobin; negative hemoglobinuria B. Decreased erythrocyte survival; increased catabolism of heme; decreased haptoglobin levels C. Decreased serum LDH activity; normal catabolism of heme D. Normal concentration of haptoglobin; marked hemoglobinuria
B. Decreased erythrocyte survival; increased catabolism of heme; decreased haptoglobin levels
What is the correct procedure when using a winged collection device (butterfly) to draw a light-blue top tube intended for a coagulation test if this is the first tube that will be collected in the draw? A. Draw and discard a red-top tube that only contains an additive for clot activation before collecting the light-blue top tube that will be used for coagulation studies. B. Draw and discard a waste light-blue top tube before the tube that will be used for coagulation studies. C. Draw only the light-blue top tube that will be used for coagulation studies and then perform a second venipuncture for additional tubes. D. There is no correct procedure because a winged collection device cannot be used for collecting specimens for coagulation studies.
B. Draw and discard a waste light-blue top tube before the tube that will be used for coagulation studies.
What is the principle of the Kleihauer-Betke test? A. Fetal cells present in the mother's blood smear contain fetal hemoglobin (Hgb F). When treated with acid the fetal cells are sensitive and become ghost cells. B. Fetal cells present in the mother's blood smear contain fetal hemoglobin (Hgb F). When treated with acid the fetal cells are resistant and will stain pink with the counter stain. C. Maternal red blood cells contain fetal hemoglobin (Hgb F). When treated with acid the maternal cells are resistant and will stain pink with the counter stain. D. Paternal cells present in the mother's blood smear are stained pink with an acid treatment.
B. Fetal cells present in the mother's blood smear contain fetal hemoglobin (Hgb F). When treated with acid the fetal cells are resistant and will stain pink with the counter stain.
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? A. Residual red blood cells in the plasma sample B. Increased platelets in the plasma sample C. Residual white blood cells in the plasma sample D. Centrifugation time would not affect the detection of lupus anticoagulant in a plasma sample
B. Increased platelets in the plasma sample
Methylene blue stain works by: A. Staining cellular components that have a neutral pH, such as neutrophilic granules B. Staining cellular components that have an acidic pH such as ribosomes, DNA, and RNA C. Staining cellular components that have a basic pH such as cytoplasmic proteins D. Staining cellular components regardless of the pH
B. Staining cellular components that have an acidic pH such as ribosomes, DNA, and RNA
An assessment of the myeloid to erythroid (M:E) ratio is part of every bone marrow evaluation. Which of the following does not apply to the M:E ratio? A. The erythroid total used in calculating the M:E ratio is the sum of all the nucleated red cell precursors. B. The myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow. C. White blood cells used in the myeloid tally/total used to calculate the M:E ratio include neutrophil precursors as well as eosinophil precursors and basophil precursors. D. The M:E should always be interpreted in context with the overall bone marrow cellularity.
B. The myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow. The M:E ratio is calculated from the total granulocyte precursors and the total erythroid precursors. It does not include non-myeloid nucleated cells such as lymphocytes, monocytes etc. It should always be interpreted in context with the overall bone marrow cellularity. Although laboratories may have slightly different reference ranges, the typical reference range for the M:E ratio is 2:1 - 4:1.
Newborns who will develop Hemoglobin H disease may demonstrate up to 30% of which type of hemoglobin? Bart's Fetal Lepore Sickle
Bart's
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? Sickle cells Pappenheimer bodies Howell-Jolly bodies Basophilic stippling
Basophilic stippling
A red blood cell on the smear that was stained with Wright stain shows numerous fine purple-blue inclusions that are distributed throughout the cell. It should be reported as: Howell-Jolly bodies Basophilic stippling Heinz bodies Siderotic granules
Basophilic stippling
What abnormal red blood cell inclusion is composed of multiple small, dark blue aggregates of ribosomes (RNA) that are distributed throughout the RBC? Pappenheimer bodies Basophilic stippling Heinz bodies Howell-Jolly bodies
Basophilic stippling
Nucleated RBCs are most likely to be seen in the peripheral blood of which type of beta thalassemia? Beta thalassemia minima Beta thalassemia minor Beta thalassemia intermedia Beta thalassemia major
Beta thalassemia major
Which of the following tests is used to quantify a coagulation inhibitor? Prothrombin time Thrombin time Mixing study Bethesda assay
Bethesda assay
Which of the following is characteristic of Alder-Reilly anomaly? A. Giant, dysfunctional lysosomal cytoplasmic granules B. Döhle body-like inclusions composed of precipitated myosin heavy chains C. Large, darkly staining cytoplasmic granules composed of partially digested mucopolysaccharides D. Decreased nuclear segmentation and coarse chromatin in leukocytes
C. Large, darkly staining cytoplasmic granules composed of partially digested mucopolysaccharides
To obtain accurate aPTT times in patients who have hemophilia and have blood drawn from implanted venous access devices, it is important to: A. Run the activated thromboplastin time (aPTT) in triplicate B. Compare the patient's current aPTT with previous results C. Treat patient plasma with heparin neutralizers and then do the aPTT D. Perform the aPTT on plasma from a green top tube, rather than a blue top.
C. Treat patient plasma with heparin neutralizers and then do the aPTT
The principle behind the diagnosis of Paroxysmal Nocturnal Hemoglobinuria (PNH) by flow cytometry is: A. Incubation of patient blood in sucrose solutions, thus promoting hemolysis of PNH blood by complement. B. Evaluating the patient's lymphocytes for CD4 and CD8 markers. C. Using a fluorescein labeled proaerolysin variant to selectively bind to GPI anchor proteins D. Evaluating red blood cell histograms for variation in size.
C. Using a fluorescein labeled proaerolysin variant to selectively bind to GPI anchor proteins
The principle of most commercially available d-dimer assays is: A. Measuring the time it takes a patient's clot to lyse and form d-dimers B. Measuring plasminogen levels C. Using specific antisera to detect d-dimers' neo-epitopes D. Adding thrombin to patient plasma and measuring the time it takes to clot
C. Using specific antisera to detect d-dimers' neo-epitopes
All helper cells are T cells. Consequently, in a normal lymphocyte population, it is reasonable to expect all CD4-positive cells to also be positive for which of the following CD markers? CD3 CD20 CD33 CD41 and CD42
CD3
In HbSS blood, an increased amount of which of the following surface antigens on young sickle cells (reticulocytes) may allow platelets to form a bridge between the reticulocytes and CD3 CD4 CD8 CD36
CD36 CD 3,4,8 all associated with T-lymphs
Which of the following is the proper designation for the pluripotential stem cell that is a precursor for both myeloid and lymphoid cell lines? CFU-S CFU-GEMM G-CSF CFU-GM
CFU-S CFU-S stands for colony-forming unit spleen - it is the pluripotential stem cell that gives rise to all cell lines.
Fresh frozen plasma should be used for which of the following? Platelet replacement Coagulation deficiencies Volume replacement Albumin replacement
Coagulation deficiencies
In the heterozygous state of HbS, referred to as sickle cell trait, which of the following hemoglobins appear in combination with HbS? HbE HbA HbC HbD
HbA
All of the following are true in terms of platelet characteristics, EXCEPT? A. Produced in the bone marrow by megakaryocytes. B. Possess an inherent sticky property that aids in adhesion and aggregation. C. Have a lifespan of roughly 9-12 days. D. Are normally found circulating in their inactive, spiny form.
D. Are normally found circulating in their inactive, spiny form.
Which of the following statements is TRUE regarding lymphocyte cytoplasmic granules? A. Lymohocytes never contain granules in the cytoplasm. B. Lymphocytes contain fine primary or non-specific granules in the cytoplasm. C. Lymphocytes contain large secondary or specific granules in the cytoplasm. D. Lymphocytes may contain a few azurophilic granules in the cytoplasm.
D. Lymphocytes may contain a few azurophilic granules in the cytoplasm.
Which of the following statements is true regarding primary hemostatic process resulting from vascular damage? A. Inhibition of platelet function by interaction with collagen. B. Platelet adhesion through Weibel-Palade bodies. C. Platelet aggregation through interaction of von Willebrand factor and glycoprotein IIb/IIIa. D. Rapid and immediate vasoconstriction by contraction of smooth muscles.
D. Rapid and immediate vasoconstriction by contraction of smooth muscles.
What is a corrective action that can be used to obtain a valid platelet count from a patient specimen that exhibits platelet satellitism on the manual differential? A. Redraw the patient specimen in another EDTA collection tube and wait 20 minutes before sampling. B. Refrigerate the patient sample for 30 minutes prior to sampling. C. Invert the EDTA tube several times prior to sampling. D. Recollect the blood specimen in a blue top tube containing sodium citrate.
D. Recollect the blood specimen in a blue top tube containing sodium citrate. use of EDTA as the anticoagulant will not be effective because the presence of EDTA is causing the satellitism to occur.
In the process of thrombopoiesis, which is arranged from least mature to most mature? A. Thrombocyte, metamegakarocyte, megakarocyte, promegakarocyte, megakaryoblast, stem cell B. Stem cell, megakaryoblast, megakarocyte, promegakarocyte, thrombocyte, metamegakarocyte C. Megakarocyte, promegakarocyte, megakaryoblast, thrombocyte D. Stem cell, megakaryoblast, promegakarocyte, megakarocyte, thrombocyte
D. Stem cell, megakaryoblast, promegakarocyte, megakarocyte, thrombocyte
Abnormal platelet function seen in patients with Bernard-Soulier Syndrome is caused by which of the following platelet components? Defective glycoprotein Ib/IX Dense granule deficiency a-granule deficiency Defective glycoprotein IIb/IIIa
Defective glycoprotein Ib/IX
A hemoglobin F concentration of 100% may be seen in which beta thalassemia? Beta thalassemia minor (ß0/ß) Beta thalassemia major (ß0/ß0) Delta-beta thalassemia minor (dß0/ß) Delta-beta thalassemia major (dß0/dß0)
Delta-beta thalassemia major (dß0/dß0)
Treatment of "sequestration crisis," often seen in infants and young children with sickle cell disease, involves which of the following? Exchange transfusions, and/or splenectomy. Bone marrow transplantation. Antibiotic treatment, for example with penicillin. Treatment with hydroxyurea (hydroxy carbamide).
Exchange transfusions, and/or splenectomy.
Which of the following assays is commonly used to confirm the diagnosis of Activated Protein C resistance? Factor V Leiden Mutation Assay Antithrombin Activity Assay Antithrombin Antigen Assay Anticardiolipin Antibody Immunoassay
Factor V Leiden Mutation Assay
A newly admitted patient has the following coagulation results:PT: 12.9 seconds (N = 12-14 seconds)aPTT: 84 seconds (N = 25-35 seconds)Platelet Count: 200 x 109/L (N = 150-450 x 109/L) A mixing study was performed due to the abnormal aPTT test results. The mixing study demonstrated the following:aPTT was corrected by normal plasma, factor IX deficient plasma, but not by factor VIII deficient plasma. What factor assay should be performed next? None; a platelet disorder is indicated Factor V assay Factor VIII assay Factor IX assay
Factor VIII assay
Which of the following inclusions are composed of DNA? Howell-Jolly bodies Heinz bodies Pappenheimer bodies Döhle bodies
Howell-Jolly bodies
Which of the following is an FDA-approved therapeutic agent for treating sickle cell patients? Butyric acid Erythropoietin Hydroxyurea Nitric oxide
Hydroxyurea It elevates hemoglobin F (HbF) in most cells containing HgS by activating genes that control gamma-globin chain production. HbF consists of 2 alpha-globin chains and 2 gamma-globin chains.
A bone marrow biopsy from a 50-year-old patient that has an overall cellularity of 20% (i.e., 80% fat and 20% hematopoietic cells) is considered: Normocellular Hypocellular Hypercellular Monocellular
Hypocellular A general estimate of the expected normal cellularity range in an adult can be determined by first subtracting the age of the patient from 100%. The range is then +/- 10 of that number. Therefore, a normal, healthy 50-year-old should have an overall cellularity between 40% and 60%. At age 50, cellular elements to fat cells in the bone marrow are about 1:1; meaning that adults should have approximately 50% fat and 50% hematopoietic cells in the bone marrow. If there is an increased amount of fat with a decreased percentage of cells, this is considered to be hypocellular.
The INR (international normalized ratio) is calculated using the following formula: INR=(PT patient / PT normal) raised to the ISI. INR=(PT patient / PT normal). INR=(PT patient / PT control) raised to the ISI. INR=(PT control / PT normal) raised to the ISI.
INR=(PT patient / PT normal) raised to the ISI.
The first time a cell containing HbSS is deoxygenated, it forms a sickle cell. Upon reoxygenation, which of the following is true for the sickle cell? It will remain sickled. It will return to a normal biconcave shape. It will turn into a codocyte (target cell). It will appear as an echinocyte (burr cell).
It will return to a normal biconcave shape.
In almost all cases of polycythemia vera, which of the following genetic abnormalities is present? Philadelphia chromosome JAK2 mutation BCR/ABL1 t(15:17)(q22;q12)
JAK2 mutation
Nitric oxide is associated with the prevention of vaso-occlusion by decreasing cellular adherence to endothelium. Which amino acid is decreased in patients with sickle cell disease and is needed as a substrate to produce nitric oxide? L-arginine L-glutamine L-lysine L-tyrosine
L-arginine
Which laboratory procedure may be used to assist in differentiating chronic myelocytic leukemia (CML) from a leukemoid reaction? Absolute platelet count Prussian blue stain LAP stain Peroxidase stain
LAP stain
A defective clot retraction might be caused by which one of these? Lack of or defect of platelet receptor glycoprotein Ib/IX/V Lack of or defect of platelet receptor IIb/IIIa Insufficient storage of ADP in platelet granules Absence or defect of von Willebrand's Factor
Lack of or defect of platelet receptor IIb/IIIa
If a patient has a white blood count of 40,000/µL, what would be the MOST useful staining procedure to distinguish between bacterial infection and chronic myelogenous leukemia (CML)? Wright's stain Peroxidase (i.e. Myeloperoxidase) Alpha-naphthyl acetate Leukocyte alkaline phosphatase (LAP)
Leukocyte alkaline phosphatase (LAP) LAP stain is used to determine if an increase of cells is due to chronic myelogenous leukemia or a leukemoid reaction due to infection or similar conditions
Which of the following conditions would have macrocytic red cells? Liver disease and Vitamin B12 deficiency Iron deficiency and thalassemia Hereditary spherocytosis and hereditary elliptocytosis G6PD deficiency and malaria
Liver disease and Vitamin B12 deficiency
You are evaluating a potentially malignant effusion (e.g. peritoneal or pleural fluid) and you note cells that appear to be some type of tumor cells. How would you follow up/report this? A. Assume that they are probably just mesothelial cells and report them as such. B. Ignore the cells since that is not part of a laboratory scientist's role in body fluid analysis. C. Consult a pathologist and confirm that the specimen has been sent to cytology for analysis. D. Consult with other laboratory scientists, then identify and report the cells.
C. Consult a pathologist and confirm that the specimen has been sent to cytology for analysis.
Abnormal granulation can be seen in the cytoplasm of leukocytes in which of the following conditions? Pelger-Huët anomaly Pseudo-Pelger-Huët anomaly May-Hegglin anomaly Chediak-Higashi syndrome
Chediak-Higashi syndrome
A patient that has 2% peripheral blood blasts, absolute monocytosis, and 10% bone marrow blasts would be classified as which Myelodysplastic Syndrome? Refractory Anemia Chronic Myelomonocytic Leukemia Refractory Anemia with Excess Blasts Refractory Anemia with Excess Blasts in Transformation
Chronic Myelomonocytic Leukemia
A 72-year-old patient has a routine check-up and CBC. The CBC shows a high absolute neutrophil count of 28,000/µl, with slightly elevated bands, a few immature myeloid cells, and slight toxic granulation. Upon further examination of the patient, hepatomegaly and splenomegaly are noted. Because of the splenomegaly and the lack of obvious infection, a bone marrow exam is performed which shows hypercellularity of the granulocytes. Molecular testing yields a CSF3R mutation. The most likely diagnosis is: Pelger-Huet anomaly Chronic Myelogenous Leukemia (CML) Chronic Neutrophilic Leukemia (CNL) Primary Myelofibrosis (PMF)
Chronic Neutrophilic Leukemia (CNL)
A representative congenital neutrophil functional disorder is: Chédiak-Higashi syndrome Gaucher's disease Niemann-Pick Disease Systemic inflammatory response syndrome (SIRS)
Chédiak-Higashi syndrome
Which one of the following factors, if deficient, would cause a prolongation of the PT assay without prolonging the aPTT? Factor XI Factor VII Factor VIII Factor IX
Factor VII Is an extrinsic factor and is assessed by the PT assay only The other factors listed are in the intrinsic pathway and would each prolong the aPTT if deficient
If a patient's WBC is 50,000/mm3, what test should be ordered to determine if this is a leukemoid reaction or a chronic myelocytic leukemia? Peroxidase stain Sternheimer stain Leukocyte alkaline phosphatase stain Sudan Black B stain
Leukocyte alkaline phosphatase stain
Which is the MOST accurate definition for an orthochromic normoblast or nucleated red blood cell (NRBC)? A. A cell with irregular lobulated or puckered shape containing residual RNA and mitochondria in the cytoplasm. B. A cell with a high nuclear-to-cytoplasmic ratio with a lacy, fine linear chromatin pattern. C. A cell with deeply basophilic cytoplasm, a perinuclear halo and a wheel spoke chromatin pattern. D. A cell with a low nuclear-to-cytoplasmic ratio with pink cytoplasm and a heavily condensed chromatin pattern.
D. A cell with a low nuclear-to-cytoplasmic ratio with pink cytoplasm and a heavily condensed chromatin pattern.
A medical laboratory scientist working in Hematology was performing Myeloperoxidase staining on a suspected AML case. They found positive reactions of the segmented neutrophils. What would be the next step? A. Report result, patient is confirmed for AML B. Report result and perform Sudan Black B and Esterase stains to further confirm AML C. Inaccurate result, Myeloperoxdase stain confirms ALL and not AML D. Inaccurate result, only blast cells are to be examined for reaction
D. Inaccurate result, only blast cells are to be examined for reaction
Whereas von Willebrand's Disease (vWD) and Bernard-Soulier Syndrome (BSS) are both disorders of platelet adhesion, differences between the two include all of the following except: A. In BSS the abnormality is in the platelet GPIb-IX-V complex, where as in vWD this defect is in some aspect of vWF. B. In BSS, the platelets are decreased in in number but increased in size, whereas in vWD they appear normal. C. In BSS, the addition of normal vWF from cryoprecipitate fractions does not restore ristoetin-induced agglutination of platelets but in vWD it does. D. VWD is a rare inherited disorder, whereas BSS is a relatively common inherited disorder.
D. VWD is a rare inherited disorder, whereas BSS is a relatively common inherited disorder.
Disorders affecting the thyroid, pituitary, and adrenal glands can all lead to anemia (mild to moderate). This is most often associated to which of the following? Increase in direct effector hormones Increase in tropic hormones Decrease in erythropoietin (EPO) Decrease in tropic hormones
Decrease in erythropoietin (EPO)
