ASCP Hematology Review Mode

A 40-year-old man patient presents with non-specific physical complaints which include abdominal pain. Based on symptoms and family history the physician suspects Hereditary Hemochromatosis. Which of the following laboratory tests would be the LEAST diagnostic?

Complete blood count

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?

Consult a pathologist and confirm that the specimen has been sent to cytology for analysis.

What is the term used to describe the abnormal RBC shape seen in this illustration?

Crenated cell

Which of the following phrases best describes a segmented neutrophil?

Cytoplasm appears pink-purple due to small specific granules.

The hemoglobin electrophoresis pattern for patient #2 shows an increase in Hb F and a decrease in both Hb A and Hb A2. These results correlate best with which of these thalassemias?

Delta-beta thalassemia minor

Which abnormal morphologic term(s) describes this slide?

Dohle bodies, bacteria, toxic granulation

What cytoplasmic inclusion is indicated by the arrow in this image?

Döhle body

All of the following are associated with HELLP syndrome EXCEPT:

Elevated lipid levels

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 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

You are running quality control for Hemoglobin A1C by high-pressure liquid chromatography (HPLC). The high control was 2.5 standard deviations above the mean. The low control was 2.2 standard deviations below the mean. Should you continue to run patient samples?

No. These QC values indicate a violation of the Westgard R4S rule and are therefore cause for rejection.

Which of the following is a sign of dyserythropoiesis that occurs in Myelodysplastic Syndromes?

Oval macrocytes

After several incidences of deep vein thrombosis (DVT), a patient is to be assessed for hypercoagulability. The following would be an appropriate panel for hypercoagulability screening:

PT, aPTT. Lupus Anticoagulamt (LA) screening, Activated Protein C resistance (APC) , d-dimer screening

Degenerated erythrocyte cytoplasmic organelles that contain iron are called:

Pappenheimer bodies

This image was taken from a patient suffering from severe organism-related anemia. Which organism could be responsible for this patient's anemia?

Plasmodium sp.

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

This image represents a field of red blood cells (RBCs) stained using a supravital stain. How would these cells appear if viewed on a Wright-stained smear?

Polychromatophilic RBCs

Which of the following is an expected or common laboratory finding in patients with hereditary hemochromatosis (HH)?

Presence of HFE mutation

Which of the following laboratory results would be seen in a patient with acute Disseminated Intravascular Coagulation (DIC)?

Prolonged PT, decreased fibrinogen, decreased platelet count, increased FDP

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?

Recollect the blood specimen in a blue top tube containing sodium citrate

Which of the following cells is indicative of Hodgkin's disease?

Reed-Sternberg (RS) cells

Patients who undergo urologic procedures, as well as those with genitourinary tract diseases such as prostate cancer can sometimes be prone to diffuse hemorrhage. A possible cause of this could be which of the following?

Release of urokinases

What is a typical regimen for long-term maintenance therapy of individuals with hereditary hemochromatosis (HH)?

Removal of 2 to 6 units of blood yearly

Which of the following statements are true for the hematopoietic cords?

Reticular cells (adventitial cells) provide support for developing hematopoietic cells within the hematopoietic cords

Neoplastic T lymphocytes with irregular, convoluted (cerebriform) nuclear outlines best describe which of the following?

Sezary Cells

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 of the following statements about macrocytes is true?

The cells are typically larger than a resting lymphocyte.

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?

The myeloid total used in calculating the M:E ratio is the sum of all non-RBC cell types found in the marrow.

The buffy coat includes which of the following constituents of the blood?

White blood cells and platelets

In a moderately bloody specimen, 250 cells are counted in 1 primary square. The dilution is 1:100. What is the count/µL?

2.5 x 105

Which of the following ranges is the reference range for hematocrit for an adult male?

40 - 52%

What is the CORRECT blood-to-anticoagulant ratio in blue top (sodium citrate) tubes used for coagulation tests?

9:1

Which of the following statements best describes a normal mature erythrocyte?

A biconcave disc, 6-8 µm in diameter, that stains pinkish-orange (salmon) in color

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

The abnormal RBC shape seen in the center of this illustration is

Helmet cell

All of the following are considered to be important protein regulators of iron metabolism, EXCEPT?

Hemosiderin

Which of the following is a negative regulator of intestinal iron absorption?

Hepcidin

What morphological change is present in the image indicated by the arrow?

Hypersegmented nucleus

What morphological change is present in this image?

Hyposegmentation of the nucleus

Which of the following is least likely to interfere with the measurement of hemoglobin?

Cold agglutinin

Which of the following best describes Myelodysplastic syndromes?

A qualitative disorder of erythroid, myeloid and/or megakaryocytic cell series

Which of the following is the cause of thrombotic thrombocytopenic purpura (TTP)?

ADAMTS13 deficiency

In all of the following conditions, the red blood cell morphology seen in the photomicrograph would be an expected finding, EXCEPT?

Abetalipoproteinemia

What is the most likely clinical condition responsible for the red cell morphology indicated by the arrow?

Abetalipoproteinemia

The arrangement of the erythrocytes shown by the blue arrows in this peripheral smear should be reported out as

Agglutination

In which disorder may a mild anemia be present even with an increased red blood cell (RBC) count and normal adult hemoglobin electrophoresis?

Alpha thalassemia minor

What characteristics are most often associated with alpha thalassemia intermedia?

Anemia, splenomegaly

What is one of the main characteristics of secondary granules in the neutrophilic granulocyte cytoplasm?

Appear first at the myelocyte stage

Exposure to all of the following chemicals may cause hemolytic anemia, EXCEPT?

Ascorbic acid

What abnormal red blood cell inclusion is composed of multiple small, dark blue aggregates of ribosomes (RNA) that are distributed throughout the RBC?

Basophilic stippling

Hemoglobin H (HbH) bodies are tetramers of which globin chain?

Beta

A 5-year-old African American child with hepato-splenomegaly and skeletal abnormalities has the following laboratory results: WBC = 8.8 X 109/L RBC = 4.70 X 1012/L HGB = 6.2 g/dL 40 NRBC/100 WBC Many target cells Marked microcytosis, hypochromasia, anisocytosis & poikilocytosis were present. Serum Iron = 200 µg/dL (elevated) Sickle Solubility = negative Hemoglobin F = elevated

Beta-thalassemia major

Pelger-Huet anomaly is characterized by which of the following?

Bilobed or round nuclei in neutrophils (hyposegmented)

The hematology analyzer reported an elevated white blood cell count and flagged for manual review due to the suspected presence of immature cells. What is the arrowed cell's identity, and what name is given to its inclusion?

Blast with Auer rod

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 tests will be abnormal in a patient with Fibrin Stabilizing factor deficiency?

Both 5 M urea clot solubility test and Factor XIII assay

What type of red cells are indicated by the arrows in this image?

Burr cells (echinocytes)

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

When using a flow cytometer, forward scatter measures which of the following parameters?

Cell size

Which of the following statement is INCORRECT regarding the bone marrow biopsy specimen?

Cellular morphologic detail can be determined.

The inclusions that are seen in the white cell indicated by the arrow in this image are characteristic of which of the following conditions?

Chediak-Higashi syndrome

Detecting the BCR/ABL1 mutation by molecular techniques is useful in the diagnosis of which of the following diseases/conditions?

Chronic myelogenous leukemia (CML)

Fresh frozen plasma should be used for which of the following?

Coagulation deficiencies

Which of the following factors is Vitamin K-dependent?

Factor IX

Which of these coagulation factors are referred to as "vitamin-K dependent"?

Factors II, VII, IX, X

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

Fibrinolysis

A laboratory test which can detect the specific decrease in the platelet surface membrane receptor glycoprotein Ib and thus lead to a diagnosis of Bernard Soulier Syndrome (BSS) is:

Flow cytometry

What principle(s) of flow cytometry is employed when performing immuno-phenotyping?

Fluorescent antibody tagging and light scatter

Which of the following methods for long-term diabetic monitoring is recommended for patients with sickle cell anemia?

Fructosamine

In serum protein electrophoresis all of the following proteins reside in the band closest to the anodal end EXCEPT:

Haptoglobin

Which of the following non-HbS hemoglobins can also sickle and show a positive solubility test?

HbC Harlem

Spherocytes are associated with which of the following conditions?

Immune hemolytic anemia

In essential thrombocythemia, the platelets are usually:

Increased in number and functionally abnormal

The abnormalities that are seen on this slide are probably associated with which of the following conditions?

Increased red cell production

All of the following are laboratory findings in cases of hemolytic uremic syndrome (HUS) EXCEPT: a.Thrombocytopenia b.Increased serum c.bilirubin d.Decreased haptoglobin e.Increased uric acid

Increased uric acid

A D-dimer test is collected in which color test tube?

Light blue

What organ is associated with the production of the majority of clotting factors?

Liver

Which of the following is the most common condition associated with a nonmegaloblastic macrocytic anemia?

Liver disease

You are analyzing a patient sample in the hematology laboratory when the instrument you use for automatic CBC flags your specimen for having a low platelet count. Upon performing a visual differential of the slide, you notice that there are indeed very few platelets on the slide. You also notice numerous, fragmented red blood cells.

Thrombotic Thrombocytopenic Purpura (TTP)

Which two inclusions can sometimes be seen in segmented neutrophils?

Toxic granulation and Dðhle bodies

All of the following are ways hemoglobin functions EXCEPT:

Transport Haptoglobin

Eosinophils are increased in all of the following conditions EXCEPT?

Viral infections

When performing your mixing study, you aliquot your sample plasma and the pooled normal plasma to create your "mix." You then place the sample in a water bath to incubate for 90 minutes before running 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.