Hematology Media Lab Exam
What is the approximate percentage of individuals in the US who are heterozygous for HFE mutations for hereditary hemochromatosis?
10 to 12%
Approximately what percentage of pulmonary emboli originate from deep veins of the legs?
95%
Adult (normal) Hemoglobin is made up of the following composition:
>95% HbA, <3.5% HbA2, <1-2% HbF
Which is the MOST accurate definition for an orthochromic normoblast or nucleated red blood cell (NRBC)?
A cell with a low nuclear-to-cytoplasmic ratio with pink cytoplasm and a heavily condensed chromatin pattern
An alpha thalassemia patient is diagnosed as having three of their four genes deleted which code for alpha hemoglobin chains. Which one of the following types of hemoglobin is abnormal and would be found in such a patient?
Hb H
The hemoglobin electrophoresis patterns shown include 2 controls labeled AF and ASC above (lanes 1 and 2) and below (lanes 9 and 10) the patient results on the alkaline electrophoresis (on the left), and above (lanes 1 and 2) the patient results on the acid electrophoresis (on the right). Note that the labels AF and ASC are simply labels for the controls and do not indicate order of migration. The patient sample was tested in duplicate, and the results are in lanes 4 and 6. The patient lanes displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?
HbSC
If the red cell count is known, which of the following MUST also be known in order to calculate the mean corpuscular volume (MCV)?
Hematocrit
A 55-year-old white male had the following lab data: RBC 3.7 X 1012/L Serum iron 220 µg/dL (N: 60-80 µg/dL) TIBC 300 µg/dL (N: 260-400 µg/dL) Hct 32% Serum Ferritin 2,800 ng/mL (N: 10-200 ng/mL) WBC 5.8 x 109/L MCV 86 fL MCH 26 pg MCHC 32% Prussian Blue stain of bone marrow aspirate indicates markedly elevated iron stores. These laboratory results are MOST consistent with which of the following conditions?
Hemochromatosis
Which of the following tests are necessary to confirm the condition suggested by the morphology shown in this image?
Hemoglobin electrophoresis for the presence of Hb S
A prothrombin time (PT) specimen was collected at an outpatient clinic and will not be picked up by the testing laboratory's courier until several hours later. How should the specimen be stored until it is picked up by the courier?
The tube should remain unopened and be kept at room temperature (20°-25° C).
Which of the following statements is correct regarding the bone marrow compartments?
The two main compartments of the bone marrow are the vascular sinuses and hematopoietic cords
What characteristic is common to all of these conditions: hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?
red cell membrane defects
Considering the red cell distribution width (RDW) in alpha thalassemia, how would you expect the red blood cell histogram to look?
shifted to the left
Which one of the following anticoagulants is used most commonly for most coagulation studies?
sodium citrate
T lymphocytes are characterized by all of the following functions EXCEPT which?
synthesize antibody
Which of the following gene translocations is associated with Acute Promyelocytic Leukemia (APL)?
t(15;17)
All of the following characteristics describe T lymphocytes EXCEPT?
production of surface immunoglobulins
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
Which of the following is the cause of thrombotic thrombocytopenic purpura (TTP)?
ADAMTS13 deficiency
What is the normal myeloid to erythroid (M:E) ratio in the bone marrow?
2:1-4:1
What is the lower reference limit for progressive motility of spermatozoa when performing a semen analysis?
32%
Which of the following represents the White Blood Cell (WBC) count reference range for adults?
4.4 - 11.0 x 109/L
The appropriate magnification for a manual RBC cell count using a hemocytometer is which of the following?
4o X dry
Which of the following laboratory results is characteristic for a patient with Von Willebrand disease?
Abnormal platelet aggregation response to ristocetin
Which of the following leukemias can be excluded as a possible diagnosis if Auer rods are seen in blasts on the peripheral blood smear?
Acute lymphoblastic leukemia
Which morphologic term describes this slide?
Alder-Reilly neutrophils
Using an automated cell counter analyzer, an increased Red Cell Distribution Width (RDW) should correlate with which of the following?
Anisocytosis
Which of the following is responsible for the humoral immune response:
B lymphocytes
Which of the following is a genetic platelet disorder characterized by giant platelets, abnormal screening tests for platelet function and moderate to severe thrombocytopenia?
Bernard-Soulier syndrome
The diagram above represents which of the following beta thalassemias?
Beta thelassemia intermedia
How would you describe the appearance of a mature monocyte seen in a Wright's stained peripheral blood smear?
Blue gray opaque cytoplasm. Nucleus may have convolutions.
Which of the following conditions is associated with the Epstein-Barr Virus?
Burkitt's lymphoma
Image C represents which of the following?
Cabot rings
A population of small lymphocytes is gated for further evaluation in the flow cytometry laboratory. The scatterplot for one of the evaluations is shown on the right. How would you interpret this scatterplot?
Cells in the gated population are co-expressing CD5 and CD20.
Which one of the following drugs/drug classes is the MOST COMMON cause of drug-induced immune hemolytic anemia?
Cephalosporins
Which of the following tests could be used to determine whether an abnormal screening coagulation test result (PT or aPTT) is caused by a factor deficiency or an inhibitor?
mixing studies
Which chromosome demonstrates a partial or full gene loci deletion in various forms of beta thalassemia?
Chromosome 11
This image is from a patient with beta thalassemia. Though not diagnostic for this condition, what abnormal RBC morphology is present that would lead you to consider thalassemia?
Codocytes (target cells)
Cytomegalovirus (CMV) appears to suppress cell-mediated immune functions. Which of the following is a characteristic finding in persons infected with CMV?
Decreased CD4+ cells; increased CD8+ cells
Which one of the following sets of laboratory results is consistent with hemolytic anemia?
Decreased erythrocyte survival; increased catabolism of heme; decreased haptoglobin levels
A cell count is ordered on a CSF sample that is bloody. Which of the following procedures would improve count accuracy?
Dilute the sample to minimize the number of red blood cells in the squares being counted
When performing controls for the morning run in coagulation, the normal control is within acceptable limits for both the PT and APTT, but the abnormal control is out of range for both procedures. Which of the following would be an appropriate action to take?
Document QC, repeat the abnormal control, troubleshoot if necessary; report patient results only when both controls are within acceptable ranges
All of the following are true concerning the Erythrocyte Sedimentation Rate (ESR) EXCEPT:
ESR is decreased during inflammatory conditions
Identify the arrowed cells in the image to the right from the Wright-Giemsa stained blood smear slide.
Eosinophilic Myelocyte
Which one of the following factors, if deficient, would cause a prolongation of the PT assay without prolonging the aPTT?
Factor VII
Which of the following inclusions are composed of DNA?
Howell-Jolly bodies
The INR (international normalized ratio) is calculated using the following formula:
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 return to a normal biconcave shape
Erythropoietin is mainly produced in:
Kidneys
Which of the following conditions might give rise to the red cell abnormality depicted here:
Lead poisoning
Identify the cell in this illustration indicated by the arrow:
Lymphocyte
Identify the illustrated leukocyte.
Lymphocyte
Identify the nucleated blood cell:
Lymphocyte
The image on the right is a cytospin preparation of cerebrospinal fluid viewed at 1000X magnification. What is the identity of the primary blood cell type observed in this microscopic field?
Lymphocytes
Select from the choices below the best report that reflects this pleural fluid cytospin image from a patient with refractory Non-Hodgkin lymphoma.
Lymphocytes, lymphoma cells, neutrophils, macrophages, hemophagocytosis
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/L4.0-10.0 x109/L Red blood cells (RBC)3.9 x1012/L4.2-5.9 x1012/L Hemoglobin14.4 g/dL12-16 g/dL Hematocrit41%37-48% MCV105 fL80-100 fL RDW-CV16.5%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)
What description applies to the cells that are indicated by the arrows?
Macrocytosis
Which of the marrow cells from the list below has highly granular basophilic cytoplasm but does not show nuclear lobules?
Mast cell
What condition would the following abnormal RBCs, such as those shown by the arrow, be seen in?
Megaloblastic anemia
An example of a neoplastic proliferative disease of the plasma cells is:
Multiple Myeloma
Identify the nucleated blood cell:
Neutrophil
What abnormality is present in this slide?
None
The small club-shaped, "drumstick" nuclear appendage attached to one lobe of a neutrophil (marked by the blue arrow in the image) may be found in:
Normal female
How would the RBCs appear on the peripheral blood smear if the red cell indices obtained on a patient are as follows: MCV 88.5 f1 MCH 30.2 pg MCHC 33.1 %
Normocytic, normochromic
Which of the following red blood cell inclusions, marked by arrows, is seen on this peripheral blood smear?
Pappenheimer bodies
A manual differential shows 72% hyposegmented neutrophils, which of the following is most likely?
Pelger-Huet Anomaly
Which of the following conditions would produce the results listed below in an anemic patient? MCV = 115 fL MCH = 30 pg MCHC = 34 %
Pernicious anemia
Which of the following is a common clinical symptom that is directly related to thrombocytopenia?
Petechiae
A patient with suspected intraabdominal malignancy had a paracentesis procedure performed. The fluid was then sent to the laboratory for examination and fluid differential. Which cells predominate in this cytospin field from the patient's sample?
Plasma cells
Which parasite demonstrates the following findings on a blood smear from a patient with suspected malaria? Enlarged RBCs, some with fine brownish granules > 12 parasites in some cells Amoeboid structures Schüffner's dots
Plasmodium vivax
Which laboratory result is the most critical in recognizing heparin-induced thrombocytopenia (HIT)?
Platelet count
Identify the cells at the arrows.
Polychromatophillic erythrocytes
Which finding best distinguishes immune hemolytic anemia from other hemolytic anemias?
Positive DAT
Which of the following is responsible for inhibiting the tissue plasminogen activator?
Protein C
In addition to a Romanowsky stain, which one of the following would be useful in the routine evaluation of a bone marrow?
Prussian blue
Which of the following abnormal white blood cells is most commonly found in a peripheral smear of a patient with infectious mononucleosis?
Reactive lymphocytes
What would be the next step when an EDTA specimen had an automated platelet count of 61,000/mm3 and the platelets were surrounding the neutrophils on the differential?
Recollect a specimen for a platelet count without using EDTA
The photograph here is of a peripheral smear sent for hematologic review. No clinical information for the patient was sent with the slide. What is the first course of action that the reviewer should take to assist him/her in interpreting the findings on this blood smear?
Request additional medical information
All of the following methods are used in the diagnosis and classification of acute leukemia, EXCEPT?
Reticulocyte count
What is the cell indicated by the arrow in this illustration?
Smudge cell
What are the cells that are indicated by the arrows in this peripheral blood smear image?
Spherocytes
This peripheral smear is demonstrating:
Rouleaux
The image is of a peripheral blood smear stained with Prussion blue stain.
Siderotic granules
The fibrinolytic system may be activated by which one of the following?
Streptokinase
The red cells in this illustration exhibit which of the following abnormal erythrocyte shapes:
Teardrop cells
Which of the following conditions is characterized by small clots made up of platelets and large forms of von Willebrand factor?
Thrombotic thrombocytopenic purpura (TTP)
In which organ or tissue do T-lymphocytes mature?
Thymus
Which of the following conditions/findings is most likely associated with the peripheral blood picture in the photomicrograph?
Transfusion dimorphism
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?
normal findings
If present, how many Howell-Jolly bodies are usually seen within a given erythrocyte?
one
What stain is most commonly used in the hematology laboratory?
Wright stain
Hemoglobin D (HbD) is elevated in all of the following EXCEPT?
alpha thalassemia
Which of the following terms refers to a deficiency of red blood cells (RBCs) or hemoglobin?
anemia
What characteristics are most often associated with alpha thalassemia intermedia?
anemia, splenomegaly
A manual white blood cell count was performed by the hematology technologist. The cell counts for both sides were 99 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?
cannot report
Which of the following statements regarding coagulation disorders is correct?
clotting factors II, VI, IX, and X are vitamin K dependent
The arrangement of erythrocytes on this peripheral blood smear may be seen in each of the following conditions EXCEPT?
cold agglutinin disorders
Which of the following processes can lead to the formation of microclots in a patient specimen that is collected in a tube containing EDTA anticoagulant?
failing to invert the tube after specimen collection
Which of the following analytes will be falsely decreased due to hemolysis?
hemoglobin, hematocrit, RBC count
A technologist decides to make a 1:20 dilution of cerebrospinal fluid (CSF) after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of observed cells in each of the large squares of the hemocytometer is >100. What should the technologist do to obtain the most accurate count?
make a larger dilution
