Hema/ Coag/ Urinalysis Practicum Quiz 2

This image is of a peripheral blood smear from a patient with what condition? A. Toxic granulation caused by bacterial infection B. Pelger Huet anomaly C. Acute myeloid leukemia with an Auer rod. d. May-Hegglin anomaly

d. May-Hegglin anomaly This image represents a blood smear from a patient with May-Hegglin anomaly, an inherited disorder. The blood picture of such patients includes Dõhle body-like inclusions in the granulocytes (seen at the arrow), thrombocytopenia, and abnormally large platelets. The image exhibits all three of these abnormal findings.

How long are healthy neutrophils expected to reside in the peripheral blood of an adult? A. 3 days B. 1 day C. 7-8 hours D. 12-14 hours

C. 7-8 hours

Which morphologic term describes this slide? A. Alder-Reilly neutrophils B. Auer rods C. Döhle bodies, bacteria, toxic granulation D. Pelgeroid neutrophils

A. Alder-Reilly neutrophils Alder-Reilly anomaly is inherited through an autosomal recessive mechanism. With this condition, white blood cells are characterized by the accumulation of cytoplasmic granules containing mucopolysaccharides. When the slide is stained with a Wright stain, these granules often appear dark purple/blue. In contrast, on this stain the granules appear red. Patients with Alder-Reilly anomaly have neutrophils with qualitative changes that resemble toxic granulation.

Which disease/condition can be indicated by the morphology displayed in the white blood cell to the right? A. Chediak-Higashi syndrome B. Pelger-Huet anomaly C. Dohle bodies D. Toxic granulation

A. Chediak-Higashi syndrome Chediak-Higashi syndrome is a rare autosomal recessive condition. It is characterized by the presence of large peroxidase positive lysosomes in most cells of the body, including neutrophils.

The Philadelphia chromosome is consistently associated with which of the following blood disorders? A. Chronic myelocytic leukemia (CML) B. Chronic lymphocytic leukemia (CLL) C. Acute myelocytic leukemia (AML) D. Acute lymphocytic leukemia (ALL)

A. Chronic myelocytic leukemia (CML) The Philadelphia chromosome is characterized by a translocation between chromosome 9 and 22 and is strongly associated with chronic myelogenous leukemia, or CML.

Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample? A. Within one hour B. Within four hours C. Within eight hours D. Within 24 hours

A. Within one hour

How would you describe the appearance of a mature monocyte seen in a Wright's stained peripheral blood smear? A. Pale blue cytoplasm. Nucleus may be oval or round. B. Blue-gray opaque cytoplasm. Nucleus may have convolutions. C. Light pink cytoplasm with fine granules. Nucleus with 2-5 lobes. D. Colorless cytoplasm with large red refractile granules

B. Blue-gray opaque cytoplasm. Nucleus may have convolutions. A monocyte has a blue-gray, often abundant cytoplasm, with few or no granules. Occasionally vacuoles can be seen. It is mononuclear, and the nucleus often has a folded, convoluted appearance.

Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be the breakdown products of: A. Neutrophils B. Eosinophils C. Monocytes D. Lymphocytes

B. Eosinophils Charcot-Leyden crystals in stool are thought to be created from damaged eosinophil byproducts. These crystals have a strong association, although they are rare, with parasitic infections or allergic reactions.

Toxic granulation is seen most frequently in: A. Viral infections B. Parasitic infections C. Bacterial infections D. Allergic reactions

C. Bacterial infections Toxic granulation is most commonly observed in patients with severe bacterial infections. Toxic granulation, vacuoles, and Döhle bodies may be observed in the same patient's neutrophils during severe bacterial infection.

What morphological change is present in the image indicated by the arrow? A. Barr bodies B. Slight toxic granulation C. Hypersegmented nucleus D. Hyposegmented

C. Hypersegmented nucleus

Which of the following best describes Myelodysplastic syndromes? A. A myeloproliferative disorder B. An acute leukemia that is in remission C. A leukemia that typically progresses to thrombocytopenia and lymphocytic leukemia D. A qualitative disorder of erythroid, myeloid and/or megakaryocytic cell series

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

Auer rods are most commonly present in which of the following conditions? A. Acute lymphocytic leukemia (ALL) B. Plasma cell leukemia C. Erythroleukemia D. Acute myelocytic leukemia (AML)

D. Acute myelocytic leukemia (AML) Auer rods are key diagnostic indicators of acute myelocytic (myelogenous) leukemia or AML. Auer rods are most commonly found in the cytoplasm of AML blasts but can less commonly be found in promyelocytes as well.

All of the following tests are included in a complete blood count (CBC), EXCEPT? A. White blood cell count B. Hemoglobin C. Platelet count D. Blood culture

D. Blood culture

Laboratory tests which distinguish Polycythemia Vera (PV) from Chronic Myelogenous Leukemia (CML) include all of the following EXCEPT: A. The JAK 2 mutation B. Nucleated red blood cells C. Elevated LAP score D. Hypercellular bone marrow

D. Hypercellular bone marrow Both CML and PV are characterized by hypercellular bone marrow due to unchecked proliferation, so this is not a distinguishing test

Which of the following stains is used to differentiate a neutrophilic leukemoid reaction from chronic myelogenous leukemia (CML)? A. Sudan black B B. Periodic acid-Schiff reagent (PAS) C. Acid phosphatase with tartrate D. Leukocyte alkaline phosphatase (LAP)

D. Leukocyte alkaline phosphatase (LAP) The leukocyte alkaline phosphatase stain, also known as LAP is the correct stain to differentiate between chronic myelogenous leukemia and a leukemoid reaction.

All of the following methods are used to detect and differentiate white blood cells in most hematology analyzers, EXCEPT? A. Disruption of electrical current B. Conductivity measurement using high frequency electromagnetic probe C. Forward angle light scatter D. Lysis of white cells with subsequent conversion to cyanmethemoglobin followed by spectrophotometric determination

D. Lysis of white cells with subsequent conversion to cyanmethemoglobin followed by spectrophotometric determination Distribution of electrical current, conductivity, and light scatter are all used to quantitate and differentiate white blood cells. The cyanmethemoglobin method is used to measure hemoglobin, not white cells.

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? A. Report the automated platelet count since it is more accurate than a platelet estimate B. Warm the EDTA tube and repeat the automated platelet count C. Rerun the original specimen since the platelet count and blood smear estimate do not match D. Recollect a specimen for a platelet count without using EDTA

D. Recollect a specimen for a platelet count without using EDTA Occasionally platelet satellitosis can occur in some patient samples when collected in EDTA. The solution for this problem is to recollect in a different type of anticoagulated tube, usually a sodium citrate tube, to prevent the platelets from adhering to the neutrophils. The platelet count would be multiplied by 1.11 to account for the dilution of the blood sample with sodium citrate (9:1).

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. Although monocytes are phagocytic cells, they function in the tissues and organs and rarely, if ever, in the peripheral blood. Driven by chemokines and cell adhesion molecules, monocytes exit the vessels and migrate to tissues and organs throughout the body, where they are phagocytic and secrete cytokines.

A peripheral blood smear with many myeloid cells was presented for morphology review (see image on the right). Toxic granulation and vacuoles in the neutrophil most likely represent which of the following conditions? A. Septicemia B. Viral infection C. Tuberculosis D. Active allergies

A. Septicemia The intended response is septicemia. Cytoplasmic vacuoles in monocytes and granulocytes correlate with septicemia with a sensitivity >95%.

When three tubes of cerebrospinal fluid are received in the laboratory they should be distributed to the various laboratory sections as follows: A. #1 Hematology, #2 Chemistry, #3 Microbiology B. #1 Chemistry, #2 Microbiology, #3 Hematology C. #1 Microbiology, #2 Hematology, #3 Chemistry D. #1 Chemistry, #2 Hematology, #3 Microbiology

B. #1 Chemistry, #2 Microbiology, #3 Hematology

What are the white blood cell inclusions that are indicated by the arrows in this image? A. Dohle bodies B. Auer rods C. Toxic granules D. Bacteria

B. Auer rods

A 3-year old girl was brought to the ER with a temperature of 103ºF, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed: WBC: 4,500/µL Differential: 88% neutrophils Glucose: 15 mg/dL 12% lymphocytes Protein: 140 mg/dL Gram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider? A. Brain tumor B. Bacterial meningitis C. Viral meningitis D. Subdural hematoma

B. Bacterial meningitis Due to the elevated white blood cell count along with a strong percentage of neutrophils, a bacterial infection should be suspected. Though there are no organisms seen on the gram stain, a bacterial infection is still very possible as the bacterial count in the spinal fluid may be low.

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) Pelger-Huet anomaly is an autosomal dominant condition characterized by failure of normal neutrophilic segmentation and the presence of bilobed neutrophils. It is of no clinical significance.

What condition would be suspected in an asymptomatic patient with greater than 20% atypical (reactive) lymphocytes on their peripheral blood smear? A. Herpes simplex virus infection B. Epstein-Barr virus infection C. Bacterial meningitis D. Acute leukemia

B. Epstein-Barr virus infection Epstein-Barr virus causes infectious mononucleosis, which is associated with atypical (reactive) lymphocytosis. The peripheral blood smear may show 5%to 30% atypical lymphocytes. Patients are often asymptomatic, however, they can present with fatigue, malaise, fever, sore throat and cervical lymphadenopathy.

Which of the following morphologic characteristics is associated with the Chédiak-Higashi syndrome? A. Pale blue cytoplasmic inclusions in neutrophils B. Giant lysosomal granules in granulocytes C. Neutrophils with many small granules and vacuoles D. Nuclear hypo-segmentation of neutrophils

B. Giant lysosomal granules in granulocytes Giant lysosomal granules (abnormal) are associated with Chédiak-Higashi syndrome. It is a rare but fatal disease where dysfunctional lysosomes contribute to recurrent pyogenic infections.

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? A. RBCs are fairly far apart showing a "cobblestone effect." B. RBCs are lying singly, barely touching, with occasional overlapping. C. RBCs are stacked like coins with the majority of cells overlapping. D. RBCs are aggregated.

B. RBCs are lying singly, barely touching, with occasional overlapping. The correct area for RBC evaluation on a peripheral blood smear is one in which RBCs lie singly with only occasional overlapping.

Which of the following descriptions best describes the term absolute value as it would relate to leukocyte differential counts. A. Relative % of each cell type B. Relative % of each cell type multiplied by total white count C. Relative % of each cell type divided by total white count D. Specific number of each cell type divided by total white count

B. Relative % of each cell type multiplied by total white count

All of the following methods are used in the diagnosis and classification of acute leukemia, EXCEPT? A. Immunophenotyping B. Reticulocyte count C. Cytochemical Analysis D. Cytogenetics

B. Reticulocyte count Reticulocyte counts are a measure of immature erythrocytes, which can be present in many forms of hematologic disorders. While this procedure can be useful in monitoring a leukemic patient's status, it is not useful in the diagnosis of acute leukemia

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.

Which of the following gene translocations is associated with Acute Promyelocytic Leukemia (APL)? A. t(8;21) B. t(15;17) C. t(9;11) D. t(6;9)

B. t(15;17) Acute Promyelocytic Leukemia (APL), known by WHO classification as Acute Myelocytic Leukemia (AML) with t(15;17)(q22;q12), is the correct answer. APL makes up 5-8% of all AML cases. Promyelocytes are the predominant cells type found in the peripheral blood of patients with APL.

Alder-Reilly inclusions may be found in which cell type(s)? A. Neutrophils only B. Granulocytes only C. All types of mature white blood cells D. Erythrocytes

C. All types of mature white blood cells Alder's anomaly or Alder-Reilly inclusions may be seen in all types of mature white blood cells, including neutrophils, eosinophils, basophils, monocytes, and occasionally lymphocytes. In some cases, only one cell line may be affected. 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.

Which type of granulocyte has water soluble granules which may fade during the rinsing phase of the staining process using the Wright's stain? A. Neutrophilic segs B. Eosinophils C. Basophils D. Neutrophilic bands

C. Basophils Basophils contain substances such as histamine and heparin which are important in inflammatory and allergic responses. Many of the basophil's granules are water-soluble, and thus could wash out or get lighter if the rinsing step during the staining process is prolonged

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? A. Peroxidase stain B. Sternheimer stain C. Leukocyte alkaline phosphatase stain D. Sudan Black B stain

C. Leukocyte alkaline phosphatase stain Leukocyte alkaline phosphatase (LAP) stain is used to differentiate chronic myelocytic (myelogenous) leukemia (CML) from leukemoid reactions. The LAP score is calculated and is high in reactive states, such as leukemoid reactions, but is low in CML.

Agranulocytes include the following types of white blood cells (leukocytes): A. Monocytes and neutrophils B. Monocytes and eosinophils C. Lymphocytes and monocytes D. Lymphocytes and neutrophils

C. Lymphocytes and monocytes Leukocytes are divided into two groups, granulocytes and agranulocytes. Granulocytes include the neutrophils, eosinophils, and basophils, while the agranulocytes include monocytes and lymphocytes.

The WBC anomaly indicated by the arrow in this illustration is: A. Alder-Reilly anomaly B. Pelger-Huet anomaly C. May-Hegglin anomaly D. Toxic granulation

C. May-Hegglin anomaly May-Hegglin anomaly is a rare autosomal dominant condition in which patients are at risk for bleeding and infections. It is characterized by large Dohle body-like inclusions within neutrophils, eosinophils, basophils, and monocytes.

Eosinophilia is commonly found in which of the following disorder? A. Pernicious anemia B. Liver disease C. Parasitic infections D. Infectious mononucleosis

C. Parasitic infections Eosinophilia is most commonly seen as a result of allergic reactions, medication reactions, and parasitic infections.

Approximately 80 - 90% of the neutrophils on the peripheral blood smear of a young man are similar to those in the image. This peripheral smear most likely represents which condition? A. Infection, with a shift to the left B. Folic acid deficiency C. Pelger-Huet anomaly D. Leukemoid reaction

C. Pelger-Huet anomaly The WBCs seen in the image are neutrophils, each with a bi-lobed nucleus. Hyposegmentation of the nucleus in granulocytes is associated with "Pelger-Huet anomaly.

Which of the following represents the best match of cell type with function? A. Eosinophils - humoral immunity B. Neutrophils - mediate inflammatory responses C. T lymphocytes - cell mediated immunity D. Monocytes - protect against parasitic infections

C. T lymphocytes - cell mediated immunity T lymphocytes are key to cell-mediated immune responses through the work of T helper and T cytotoxic cells.

Which of the following formulas would you use to calculate absolute cell counts? A. Cells counted / total cells B. 10 x cells counted / total cells C. Total count X % of cells counted D. Cells counted X total cells

C. Total count X % of cells counted The absolute cell count is the percentage of a single leukocyte type multiplied by the total WBC count.

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? A. Pelger-Huet anomaly B. Alder-Reilly C. Toxic granulation D. Chediak-Hegashi syndrome

D. Chediak-Hegashi syndrome Chediak-Higashi syndrome is defined as the abnormal fusion of cytoplasmic lysozymes in granulocytes and occasionally monocytes. This condition is associated with albino characteristics, photophobia, and frequent infections (as the granules are dysfunctional and cannot fight infection appropriately).