Clinical Hematology

How is the Mean Cell Volume calculated?

(Hematocrit %/ Red blood cells) X 10

How many large hemacytometer squares contain a total volume of 1 µL (microliter) of fluid?

10

Which of the following is a clinical finding of Myelodysplastic Syndrome with Excess Blasts subtype 2 (MDS-EB-2)?

10 to 19% blasts in the bone marrow

What is the corrected WBC if a differential count shows 20 nucleated erythrocytes per 100 leukocytes and the uncorrected leukocyte count is 12.0 X 109

10.0 X 10^9/L

What is the ratio of patient plasma to pooled normal plasma (PNP) that is usually used in the performance of a mixing study?

1:1

A serum ferritin above what level would be suggestive of iron overload and possibly hereditary hemochromatosis (HH) in a pre-menopausal woman?

200 ng/mL

The normal size of an erythrocyte is:

7 to 8 microns

How long are healthy neutrophils expected to reside in the peripheral blood of an adult?

7-8 hours

When performing a manual white blood cell count, 236 cells were counted on side number one of the hemacytometer, 224 cells on side number two. A 1/20 dilution of 1% HC1 was used, and the area counted on each side was 4 sq. mm. Twenty-five nucleated red blood cells in the differential were observed per 100 white blood cells. What is the CORRECT WBC/µL?

9,200

Adult (normal) Hemoglobin is made up of the following composition:

>95% HbA, <3.5% HbA2, <1-2% HbF

An SDS-agarose gel electrophoresis for determining different multimer sizes of von Willebrand factor (vWF) is performed on a group of patients. Which of the following would indicate a patient who does not have von Willebrand Disease (vWD)?

A column which has 11 heavy-staining bands.

The most common forms of hereditary sideroblastic anemia (SA) are due to which of the following?

A defective X-linked recessive gene.

Which of the following laboratory results is characteristic for a patient with Von Willebrand disease?

Abnormal platelet aggregation response to ristocetin

A test used to evaluate the abnormalities in the intrinsic coagulation pathway and to monitor heparin therapy is called:

Activated partial thrombloplastin time (aPTT or PTT)

Which of the following terms refers to a deficiency of red blood cells (RBCs) or hemoglobin?

Anemia

When monitoring the use of low-molecular-weight heparins becomes necessary, which of the following laboratory tests is recommended?

Anti-Xa

Acquired hemophilia A (not classic hemophilia A) may result from which of the following conditions?

Anti-factor VIII inhibitor

In most cases of Fanconi anemia, which of the following types of anemia develops?

Aplastic

The mediator cell type that binds to IgE antibodies is the:

Basophil

Which of the following erythrocyte inclusions is indicated by the arrow in the image on this page?

Basophilic stippling

A young child is brought in for a clinic visit for bleeding and bruising tendencies. Coagulation screening tests revealed normal PT and APTT levels. The CBC was overall normal with the exception of a low platelet count and giant platelets. Platelet aggregation studies were then ordered with normal responses to all agents except ristocetin which had no response. Which of the following is the disease that correlates with these findings?

Bernard Soulier Syndrome

These test results are most consistent with which of the following types of beta thalassemia?

Beta thalassemia minor

Which of the following globin genes are found on Chromosome 11?

Beta, gamma, epsilon

"Xanthochromic" CSF means that the color of the CSF can be any of the following EXCEPT:

Blue

Which lymphocytes produce surface immunoglobulins?

B lymphocytes

Which one of the following drugs/drug classes is the MOST COMMON cause of drug-induced immune hemolytic anemia?

Cephalosporins

A representative congenital neutrophil functional disorder is:

Chédiak-Higashi syndrome

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

Coagulation deficiencies

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

Crenated cell

An India Ink preparation is used to identify:

Cryptococcus neoformans in CSF

All of the cells listed below function as a phagocyte, EXCEPT?

Eosinophil

Identify the arrowed cells in the image to the right from the Wright-Giemsa stained blood smear slide.

Eosinophilic Myelocyte

If one finds excessive rouleaux formation on a blood smear examination, then which of the following parameters might also be increased?

Erythrocyte sedimentation rate

The prothrombin time test will detect deficiencies in which pathways?

Extrinsic and common pathways

Which of the following factors is known as Hageman factor?

Factor XII

Platelet satellitism is most likely to cause which of the following erroneous results?

Falsely decreased platelet count

All of the following are associated with Hgb C disease, EXCEPT?

Fast mobility of Hgb C at pH 8.6

Which of the following will give the best overall picture of a patient's iron stores:

Ferritin (storage form of iron)

Which of the following is found in plasma but absent in serum?

Fibrinogen

The D-dimer is useful in detecting activity in which aspect of hemostasis?

Fibrinolysis

An isolated crenated erythrocyte with spicules is seen on an otherwise normocytic normochromic peripheral blood smear. Which of the following statements is true?

Finding is most likely an artifact caused by poor smear preparation

Which of the following laboratory tests would be most helpful in determining the number of T cells in circulation?

Flow cytometry

Regarding hemoglobin synthesis, which of the following constitutes the alpha globin chain coding?

Four gene loci; two each on chromosome 16

A ten-year-old boy came to a physician's attention because of recent jaundice and icteric sclera after taking the medication Primaquine before a trip to Africa. The immediate laboratory work revealed: Hct 24% (normal 36%-47%), MCV 79.5 fL (normal 78-95fL), RDW 13% (normal 11.5-15.0%). His blood smear findings are reflected in the images to the right. The upper image is a Wright-Giemsa stained smear, while the lower is a supravital-stained smear. Which condition should be considered for this patient when analyzing his symptoms, history, and laboratory results?

G6PD deficiency

No platelet aggregation response to ristocetin occurs in both Von Willebrand Disease and in Bernard Soulier Syndrome. In VWD, it is a cofactor for Von Willebrand Factor and as a result of deficiency of VWF, ristocetin becomes deficient as well. What is deficient in Bernard Soulier Syndrome to cause no response to ristocetin?

GP Ib/IX/V

Which of the following conditions/findings is most likely associated with the peripheral blood picture in the photomicrograph?

Transfusion dimorphism

To obtain accurate aPTT times in patients who have hemophilia and have blood drawn from implanted venous access devices, it is important to:

Treat patient plasma with heparin neutralizers and then do the aPTT

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

Which of the following conditions is hypersegmentation of granulocytes most commonly associated with?

Vitamin B12 or Folate deficiency

What cell population is gated in this peripheral blood sample case analyzed by flow cytometry?

lymphocytes

Which chromosome abnormality is most commonly associated with CML?

t(9;22)

A peripheral smear with red blood cells photographed in a typical field was submitted for review. All of the following conditions are most likely associated with the red blood cell population found here, EXCEPT:

Hereditary Hemochromatosis

Which HFE genotype is most common in patients with hereditary hemochromatosis (HH)?

Homozygous for C282Y

Which of the following inclusions may be observed on a Wright-stained peripheral blood smear if a patient has had a splenectomy?

Howell-jolly bodies

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:

Hypocellular

The INR (international normalized ratio) is calculated using the following formula:

INR=(PT patient / PT normal) raised to the ISI.

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?

Inaccurate result, only blast cells are to be examined for reaction

All of the following cells are considered granulocytes EXCEPT?

Lymphocytes

What are the smallest nucleated cells seen in normal peripheral blood?

Lymphocytes

The large blue staining cells represented in the photomicrographs comprise 50% of the total white blood cell count. Which of the following conditions is this peripheral blood picture most consistent with?

Infectious mononucleosis

Hemoglobin H bodies can directly alter which of the following?

Integrity of the RBC membrane

All of the following are associated with hereditary spherocytosis, EXCEPT?

Intravascular hemolysis

Which of the following is necessary for the absorption of Vitamin B12:

Intrinsic factor

All of the following are usually increased in alpha thalassemia EXCEPT?

Iron binding capacity

During phagocytosis by a neutrophil, the granules which fuse with the phagosome (phagocytic vacuole) can contain all of the following EXCEPT:

Lactase

Coarse basophilic stippling is usually seen in patients who have which of the following conditions?

Lead poisoning

The image is a stained smear of cerebrospinal fluid. The cells present in this field may indicate what condition?

Leukemia with CNS involvement

All of the following are sites of active hematopoiesis in the adult EXCEPT

Liver

Which of the following set of results would be consistent for a patient with the following findings: macrocytosis, anemia, leukopenia, and thrombocytopenia?

MCV 115 fL; Hgb 7.5 g/dL; WBC 2.5 x 103/µL; Platelets 75,000/µL

All of the following are terms associated with segmented neutrophils EXCEPT?

Macrophage

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:

Mix one part patient plasma and one part normal pooled plasma and repeat the aPTT

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 finding

How would you describe the red blood cell morphology of this image if it is a representative field of a Wright stained peripheral blood smear?

Normocytic / normochromic

All of the following would be represented in the usual classification of anemia EXCEPT:

Normocytic, hyperchromic

A known case of hemolytic disease of the newborn (HDN) is presented in the image on the right. Many different cellular morphologies are present. Apart from the obvious anisocytosis (microcytes and macrocytes), which additional red blood cell morphologies are worth reporting?

Nucleated red blood cells, spherocytes, polychromatophilic cells, Howell-Jolly bodies

Identify the nucleated cell in the image.

Orthochromic normoblast

What is the nucleated cell present in the following image?

Osteoblast

Laboratory tests which can contribute toward the diagnosis of Glanzmann Thrombasthenia include all of the following EXCEPT:

PT and aPTT

Which of the following cells are of lymphoid lineage?

Plasma cell

The cell in this image is known as a MOTT cell. What is the condition in which these cells are associated?

Plasma cell myeloma

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 laboratory result is the most critical in recognizing heparin-induced thrombocytopenia (HIT)?

Platelet count

The cells which release von Willebrand's Factor (vWF) are:

Platelets and endothelial cells

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

Polychromatophilic

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

Polychromatophilic RBCs

The image is a Wright-Giemsa stained smear (1000x) of cerebrospinal fluid (CSF). What is the identification of the cells that are indicated by the arrows?

Presumptive malignant cells

All of the following characteristics describe T lymphocytes EXCEPT?

Production of surface immunoglobulins

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

Identify the cell in this image:

Promyelocyte

Which of the following laboratory tests is commonly used to monitor oral anticoagulant therapy?

Prothrombin time (PT)/INR

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 these methods could be used to differentiate between Howell-Jolly bodies and Pappenheimer bodies and what results would be noted?

Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do not stain blue

In order for a cell to be classified as a ring sideroblast, which of the following must be true?

RBC precursor with at least 5 iron granules circling at least 1/3 of the nucleus

The reticulocyte count is used to assess which of the following?

RBC production by bone marrow

What characteristic is common to all of these conditions: hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?

Red cell membrane defects

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) What would be your next step?

Report the results.

Which one of the following hematological determinations is MOST reliable for evaluating bone marrow erythropoietic activity?

Reticulocyte count

What physiological factor causes sedimentation in the Erythrocyte Sedimentation Rate (ESR)?

Rouleaux formation

What are the globular inclusions in this cell?

Russell bodies

Which of the following is true of the nuclear appendage seen in this image?

Seen only in women

All of the following are true of lab results of patients with Glanzmann thrombasthenia EXCEPT?

Severe thrombocytopenia

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

What is the characteristic RBC that is uniquely associated with HbSS?

Sickle cell (drepanocyte)

Which of the following cells is characterized by a thin rim of cytoplasm around the nucleus?

Small lymphocyte

A WBC differential count on CSF should be performed using the following technique:

Stained smear of a cytocentrifuged specimen

Which of the following is LEAST likely to stimulate the production of reactive lymphocytes?

Staphylococcus aureus

The fibrinolytic system may be activated by which one of the following?

Streptokinase

What is an appropriate use for molecular (DNA) tests for mutations of the HFE gene, the gene found in the majority of patients diagnosed with hereditary hemochromatosis (HH)?

Testing family members of persons with HH

All of the following are associated with RBC macrocytosis EXCEPT?

Thalassemia

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

ADAMTS13 deficiency

A 41-year-old male arrived at the clinic with complaints of fatigue, malaise, and overall discomfort. Upon testing, the patient's CBC results were notably abnormal with 30% blasts present along with anemia and thrombocytopenia. Bone marrow and cytochemical staining were subsequently performed. The cytochemical stains noted negative reactions to Myeloperoxidase and Sudan Black B but a positive reaction to alpha-naphthyl acetate. Which of the following conditions is most likely seen?

Acute Monocytic Leukemia

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)

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. Which condition is this patient most likely suffering from?

Acute myeloid leukemia (AML)

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

Agglutination

This drawing depicts which alpha chain genotype?

Alpha thalassemia intermedia (Hemoglobin H Disease)

All of the following are true in terms of platelet characteristics, EXCEPT?

Are normally found circulating in their inactive, spiny form.

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

Ascorbic acid

All of the following are likely the causes of an abnormal thrombin time (TT) EXCEPT:

Aspirin

Which of the following mutations is most commonly found in hereditary hemochromatosis (HH)?

C282Y

Which of the following markers is associated with normal mature B cell expression?

CD19

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 endothelial cells, ultimately leading to vaso-occlusion?

CD36

Identify the inclusion indicated by the arrow:

Cabot ring

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

All of the following tests are useful in the diagnosis of heparin induced thrombocytopenia (HIT) EXCEPT:

Dilute partial thromboplastin time (DTT)

A blood smear represented by the photograph was submitted for hematologic review. Based on the erythrocyte morphology and the accompanying histogram, which of the following choices is the most likely situation or condition?

Dimorphic red cell population

The light blue-gray inclusions observed in the cytoplasm of many of the bands and segmented neutrophils of a burn patient are most likely?

Dohle bodies

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?

Draw and discard a waste light-blue top tube before the tube that will be used for coagulation studies.

Which of the following red blood cell morphologies are frequently artifactual?

Echinocytes, stomatocytes

In which disorder do neonates demonstrate the presence of Bart's hemoglobin that changes to beta chain tetramers in adults?

Hemoglobin H disease

Identify the bi-nucleate cell (see arrow) in the pericardial fluid sample shown here.

Mesothelial

The following image is from a cytocentrifuged preparation of serous fluid. The arrow is pointing to which of the following:

Mesothelial cell

Which of the following statements about monocyte function is INCORRECT?

Monocytes are white blood cells that are actively phagocytic in the peripheral blood.

What causes the hemolysis associated with malarial infections?

Multiplication of merozoites within erythrocytes

In which of the following cells are Auer rods most likely to be seen?

Myeloblast

What does the M:E ratio in a bone marrow evaluation represent?

Myeloid cells to erythroid cells

The mutational status of Janus kinase 2 (JAK2) is most commonly used for the diagnosis of which of the following?

Myeloproliferative neoplasms

What type of lymphocyte appears as a large cell with abundant cytoplasm and a few azurophilic granules?

Natural killer lymphocyte

Which of the following viruses is MOST often reported as the cause of infection leading to aplastic crisis in a patient with sickle cell disease?

Parvovirus B19

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 considered a macrocytic anemia?

Pernicious anemia

The image is a stained smear of cerebrospinal fluid. Which of the following statements is true about the cells shown at the right?

They line the arachnoid space.

This assay would be used to help rule-out heparin contamination in a coagulation sample:

Thrombin time

Disseminated intravascular coagulation (DIC) is associated with all of the following clinical conditions EXCEPT:

Thrombocytosis

Decrease platelet production can be caused by a lack of or decreased amount of which of the following?

Thrombopoietin

Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample?

Within one hour

Which of the following smear techniques has the advantage of providing the best WBC distribution when performed correctly?

coverslip technique