Hematology Midterm Review
How many total genes does a person possess for the production of alpha chains?
Four
A hemoglobin molecule is composed of?
Four heme molecules and four globin chains
Neutrophils and monocytes and direct descendants of a common progenitor known as?
GMP
What platelet organelle sequesters ionic calcium and binds a series of enzymes of the eicosanoid pathway?
GP IIb/IIIa
Which of the following is an example of a transmembrane or integral membrane protein?
Glycophorin A
Receptors found on the platelets are called?
Glycoproteins
The glycocalyx is composed of membrane?
Glycoproteins and glycolipids
The organelle involved in packaging and trafficking of cellular products is?
Golgi apparatus
Biological hazards include all but one of the following?
Hair
Hematopoietic stem cells produce all lineages of blood cells in sufficient quantities over the lifetime of an individual because they?
Have the ability of self-renewal by asymmetric division
Which of the following erythrocytes inclusions can be visualized with supravital stain but cannot be deleted on a Wright's-stain blood smear?
Heinz Bodies
Which red blood cell inclusions originate as a result of denatured hemoglobin?
Heinz Bodies
Why is the mature erythrocyte unable to synthesize proteins or lipids?
It has no nucleus
What is the fate of transferrin receptor when it has completed its role in the delivery of iron into the cell?
It is recycled to the plasma membrane, where it can bind to ligand again
Erythropoietin is produced by the?
Kidneys
When tissues become hypoxic, which of the following organs is stimulated to release erythropoietin?
Kidneys
The megakaryocyte progenitor that undergoes endomitosis is?
LD-CFU-Meg
When a hemolytic event occurs, which of the following enzymes is increased?
LDH
Which of the following is considered personal protective equipment?
Laboratory coats
Functions of the cell membrane include all of the following except?
Lipid production and oxidation
When a coagulated blood sample is separated by centrifugation, the liquid component separated from the cells. This "serum" is the?
Liquid component with no clotting factors in it
During the 2nd trimester of fetal development, the primary site of blood cell production is the?
Liver
Which organs are involved in extramedullary hematopoiesis?
Liver and Spleen
Intramedullary Hematopoiesis in adults occur in all these sites except?
Liver and spleen
The key organs involved in extramedullary hematopoiesis include the?
Liver and spleen
What single feature of normal RBCs is most responsible for limiting their life span?
Loss of the nucleus
The _________ is one of the most stable parameters in a CBC?
MCV
Kupffer cells found in the liver are?
Macrophages
Kupffer cells, found in the liver are?
Macrophages
A laboratory get multiple complaints regarding the length of time it take hematology results to get to the emergency department. What would be an appropriate response?
Make this a quality assurance project
A peripheral blood smear stained with Prussion Blue demonstrates siderocytes. On a Wright stained smear, what would be expected?
Pappenheimer Bodies
What mechanism is responsible for the destruction of the majority of normal senescent erythrocytes?
Phagocytosis by splenic macrophages
What platelet membrane phospholipid flips from the inner surface to the plasma surface on activation and serves as the assembly point for coagulation factors?
Phosphatidylserine
Which splenic process removes inclusions from circulating red blood cells?
Pitting
Which of the following behaviors is a violation of standard precautions?
Placing beverages on the laboratory work area
RBC membrane cholesterol is replenished from the?
Plasma
Which of the following is the final stage of B cell maturation after activation by antigen?
Plasma cell
In the quaternary structure of hemoglobin, the globin chains associate into?
Two alpha beta dimers
Following are several of the many steps in the process from absorption and transport of iron to incorporation into heme. Place them in proper order. i. Transferrin picks up ferric iron ii. Iron is transferred to the mitochondria iii. DMT1 transports ferrous iron into enterocyte iv. Ferroportin transports iron from enterocyte to plasma v. The transferrin receptor transports iron into the cell
iii, iv, i, v, ii
Mean cell volume (MCV) is calculated using the following formula:
(Hct / RBC) X 10
What is the percent transferrin saturation for a patient with total serum iron of 63ug/dL and TIBC of 420ug/dL?
15%
When hand washing after a patient contact, the soap application process should last at least?
20 seconds
Calculate the mean cell hemoglobin concentration (MCHC) using the following values: Hgb: 15g/dL Hct: 47 mL/dL RBC: 4.50X10^6 uL (4.50X10^12/L)
31.9%
A patients hemoglobin is 12.3 g/dL. On the peripheral smear, the red cells appear normochromic and normocytic. The hematocrit value that correlates with these data is?
37%
When viewing a slide with the 50 X objective lens, the total magnification being used is?
500 X
The life span of a platelet is?
7 to 10 days
Which correctly describes a normal mature erythrocyte?
A 7-to-8-um biconcave disc that lives 120 days
Which of the following RBC pathways is responsible for providing 90% of the cellular ATP for red cell metabolism?
Embden-Meyerhof pathway
Which is true concerning 2,3-BPG?
Enhances O2 release from hemoglobin
Which one of the following features distinguishes a monocyte from a lymphocyte?
Abundant gray-blue cytoplasm
Autoagglutination of red cells at room temperature can cause which of the following abnormal tests results?
All of the above
Safety training is part of new employees training in health care and includes?
All of the choices
Which of the following is involved in the study of hematology and used to determine sickness and health?
All of the choices
A key rate-limiting step in heme synthesis in suppression of?
Aminolevulinate synthase
Standards and calibrators differ from control materials because
An exact amount of analyte is present in a standard or calibrator
Variation in red cell size observed on the peripheral smear is described as?
Anisocytosis
Physiologic programmed cell death is termed?
Apoptosis
White clots?
Are largely composed of platelets and von Willebrand factor
When compared with mature erythrocytes, reticulocytes?
Are larger and bluer on Wright stain from remnant ribonucleic acid (RNA)
Which is true regarding reference ranges?
Are ranges of values for an analyte in normal healthy people
A key morphological feature of the uncleared red blood cell stages is?
Baseball round nucleus
Normal red blood cell life span depends on all of the following except?
Baseball round nucleus
What type of erythrocyte inclusion are present?
Basophilic Stippling
Standard precautions involve?
Behavior that prevents direct contact with bodily fluids or contaminated surfaces
The nature of the interaction between 2,3-BPG and hemoglobin is that 2,3-BPG?
Binds to amino acids of the globin chain, contributing to a conformational change that inhibits oxygen from binding to heme
What types of samples are used primarily in the clinical laboratory?
Blood and bodily fluids
Hematology is the study of?
Blood cells
The primary lymphoid organs are the?
Bone marrow and thymus
Mature blood cells leave the bone marrow and enter the circulation via the?
Bone marrow sinuses
Mature red blood cells leave the bone marrow and enter the circulation via the?
Bone marrow sinuses
Microparticles?
Bud off of platelets after their exposure to strong agonists
Upon centrifugation of a blood specimen, the layer between the red blood cells and plasma is called the?
Buffy coat
Which CD marker is specific for monocytes?
CD14
The CD markers for HSC includes?
CD34+
Which of the following CD markers is more appropriately associated with the T cell?
CD4, CD8
Which of the following is an erythroid progenitor?
CFU-E
Carbon monoxide poisoning results from ___________ intake?
Carboxyhemoglobin
The glycolipids of the RBC membrane?
Carry RBC antigens
Which parts on the microscope is used for focusing?
Coarse and fine adjustment
Resemble a target with bulls eye in the center
Codocytes
Delta checks are used in the hematology laboratory to?
Compare past patient results with the current result
Which one of the following morphologic changes occurs during normal blood cell maturation?
Condensation of nuclear chromatin
Which chemical substances are responsible for differentiation and replication of the pluripotent stem cell?
Cytokines
Which of the following helps maintain RBC shape?
Cytoskeletal proteins
What pathway anerobically generates energy in the form of ATP?
Embden - Meyerhof pathway
What membrane-associated protein in enterocytes transports iron from the intestinal lumen into the enterocyte?
DMT1
The nucleus is composed largely of?
DNA
What is the composition of Howell-Jolly bodies?
DNA
Erythrocytes are elongated at one end to make a tear drop shape
Dacryocytes
Hypochromia is used to define?
Decrease in hemoglobin content of the red blood cells
Macrophages aid in adaptive immunity by?
Degrading antigen and presenting it to lymphocytes
Spleen functions include all except?
Detoxification
Spleen functions includes all except?
Detoxification
When referring to the microscope the tube length is the?
Distance from the eyepiece to the objective
All of the following are characteristics of the red blood cell in stages of development except?
Distinct granulation is in the cytoplasm
Erythrocytes are elongated with pointed ends
Drepanocytes
Basophils and mast cells have high-affinity surface receptors for which immunoglobulin?
E
What growth factor is produced in the kidneys and is used to treat anemia associated with kidney disease?
EPO
Erythrocytes with regularly distributed projections around the cell membrane
Echinocytes
Which of the following cells are important in immune regulation, allergic inflammation, and destruction of tissue invading helminths?
Eosinophils and basophils
Which of the following cells critical to iron trafficking in the body does NOT possess ferroportin?
Erythroblasts
Developing erythroblasts in the bone marrow affect the supply of body iron, both absorption and recycling, by secreting which of the following hormones?
Erythroferrone
A hormone released from the kidney that is unique for erythrocyte regeneration is?
Erythropoietin
The hormone responsible for red blood cell development in the bone marrow is?
Erythropoietin
When a patient has severe anemia and the bone marrow is unable to effectively produce red blood cells to meet the increased demand, one of the bodys responses is?
Extramedullary hematopoiesis in the liver and spleen
The predominant hemoglobin found in healthy newborn is?
F
Which one of the following cytokines is required very early in the differentiation of a hematopoietic stem cell?
FLT3 ligand
Progenitor cells are capable of self renewal?
False
True or False? A normal distribution curve will have 99.7% of the measured value fall with in 2SD
False
True or False? The higher the N:C ratio is, the more mature the cell?
False
What is the majority metabolically available storage form of iron in the body?
Ferritin
Iron is transported out of macrophages, hepatocytes, and enterocytes by what membrane protein?
Ferroportin
A 7.0 ml ethylenediaminetetraacetic acid (EDTA) tube is received in the laboratory containing only 2.0 ml blood. If the laboratory is using manual techniques which of the following tests will most likely be erroneous?
Hematocrit
The process of formation and development of blood cells is termed?
Hematopoiesis
What bone marrow cells can differentiate into all of the blood cells
Hematopoietic stem cells (HSCs)
What bone marrow cells can differentiate into all of the blood cells?
Hematopoietic stem cells (HSCs)
The basic components of the hemoglobin molecule include?
Heme, globin chains, and 2,3-DPG
Which of the following is a description of the structure of oxidized hemoglobin?
Hemoglobin with iron in the ferric state (methemoglobin) and not able to carry oxygen
Which of the following indications can distinguish intravascular from extravascular lysis?
Hemoglobinuria
The transfer of iron from the enterocyte into the plasma is REGULATED by?
Hepcidin
Which of the following hemoglobins is an embryonic hemoglobin?
Hgb Gower
Of the following formulas, which formula indicates the correction check between hemoglobin and hematocrit?
Hgb X 3 = Hct
What red cell inclusion may be seen in the peripheral blood smear of a post-splenectomy patient?
Howell-Jolly Bodies
The best source of active bone marrow from a 20 year old would be?
Iliac crest
Which of the following sites is the most preferable for bone marrow aspiration and biopsy in adults?
Iliac crest
Lymphocyte concentrations in peripheral blood are greatest during what age interval?
Immediately after birth
RBC membrane phospholipids are arranged?
In two layers whose composition is asymmetric
What is the primary mechanism for the anemia associated with kidney disease?
Inadequate synthesis of erythropoietin
Reticulated platelets can be enumerated in peripheral blood to detect?
Increased platelet production in response to need
Name one condition that may shift the OD curve to the left?
Inheriting a high oxygen affinity hemoglobin
Which of the following conditions produces micro cystic red blood cells?
Iron deficiency
In which condition can you see elliptocytes?
Iron deficiency anemia
Which of the following statements regarding 2,3-DPG is correct?
It controls hemoglobin affinity for oxygen
Which of the following determines the timing of egress of RBCs from the bone marrow?
Maturing normoblasts slowly lose receptors for adhesive molecules that bind them to stromal cells
The average of a group of data points is defined as the?
Mean
Who is ultimately responsible for determining specimen integrity before analysis?
Medical Laboratory Professional
What is responsible for erythrocyte deformability and maintaining cell shape?
Membrane protein
The stage in neutrophilic development in which the nucleus is indented in a kidney bean shape and the cytoplasm has secondary granules that are lavender in color is the?
Metamyelocyte
When the iron in the hemoglobin molecule is in the ferric (Fe3+) state, hemoglobin is termed?
Methemoglobin
Hemoglobin iron may become oxidized to Fe3+ by several pathologic mechanisms. What protein of the Embden-Meyerhof pathway reduces iron to Fe2+?
Methemoglobin reductase pathway
The shape of a cell is maintained by which of the following?
Microtubules
The energy source for cells is the?
Mitochondrion
Which of the following cell types is capable of differentiating into osteoclasts, macrophages, or dendritic cells?
Monocyte
In which stage of neutrophilic maturation are specific secondary granules first seen?
Myelocyte
What hexose-monophosphate shunt products participate in the detoxification of peroxides?
NADPH and reduced glutathione
Which one of the following is a function of neutrophils?
Nonspecific destruction of foreign organisms
What abnormality IF any present in this slide?
Normochromic normocytic (normal)
A correction is necessary for the WBC counts when Nucleated RBC's are seen on the peripheral blood smear because?
Nucleated RBC's are counted as leukocytes
The "control center" of the cell is the?
Nucleus
The marinating pool of neutrophils is located?
On the blood vessel walls
What is the most useful corrective action for the microscope when fine details cannot be visualized in immature cells?
Open up the diaphragm for maximum light
Which of the following cells is in the last nucleated stage of erythrocytic maturation? (using CAP terminology)
Orthochromic normoblast
Which of the following is the most mature normoblast?
Orthochromic normoblast
Which RBC process does not require energy?
Oxygen transportation
Which one of the following values is a critical value?
Platelet count of 10,000
What erythroid precursor can be described as follows: The cell is of medium size compared with other normoblasts, with an N:C ratio of nearly 1:1. The nuclear chromatin is condensed and chunky throughout the nucleus. No nucleoli are seen. The cytoplasm is gray-blue.
Polychromatic normoblast
Which of the following electrolytes maintains its highest concentration within the red blood cell cytoplasm as opposed to circulating in the plasma?
Potassium
Proper mixing of samples and timely delivery of samples to the laboratory are both examples of?
Preanalytic variables
A lab technologist identified a cell on peripheral cell smear- It has approximately a 20 um diameter, basophilic cytoplasm, a large purple to blue nucleus with nucleoli and an N:C ratio of 8:1. The cell is?
Pro or oblast - Rubriblast
How does the bone marrow respond to anemic stress?
Production is expanded, and red blood cells are released to the circulation prematurely
Erythropoietin can increase the production of RBCs by?
Promoting early release of reticulocytes from bone marrow
At which normoblastic stage does globin production begin?
Pronormoblast
Choose the correct order of Normoblastic maturation from least mature to most mature?
Pronormoblast, Basophilic normoblast, Polychromatic normoblast, Orthochromatic normoblast, Reticulocyte, Erythrocyte
Which of the following is not considered a Analytical variable?
Proper anticoagulant used
Which of the following is not considered a postanalytical variable?
Proper anticoagulant used
What is the name of the eicosanoid metabolite produced from endothelial cells that suppresses platelet activity?
Prostacyclin
Error analysis standard protocols, and turnaround time are all part of the?
Quality assurance system
Error analysis, standard protocols, and turnaround time all are part of the?
Quality assurance system
The CBC parameter that gives insight into the amount on anisocytosis present in a specimen is?
RDW
The following is unique to both B and T lymphocytes and occurs during their early development?
Rearrangement of antigen receptor genes
Which of the following forms of hemoglobin molecule has the lowest affinity for oxygen?
Tense
Which of these assays is the best test to assess the bone marrows response to anemic stress?
Reticulocyte count
The site of protein synthesis is the?
Ribosomes
RBC membranes block passage of most large molecules, such as proteins, but allow passage of small molecules such as the cations Na+, K+, and CA2+. What is the term for this membrane property?
Semipermeable
Which of the following molecules is stored in platelet dense granules?
Serotonin
Abnormalities in the horizontal and vertical linkages of the transmembrane and cytoskeletal RBC membrane proteins may be seen as?
Shape changes
Using the normal hemoglobin-oxygen dissociation curve, predict the position of the curve when there is a decrease in pH?
Shifted to the right of normal with decreased oxygen affinity
For a patient with screening iron study values that are equivocal for iron deficiency, which of the following tests would be most helpful in determining whether iron deficiency is present or not?
Soluble transferrin receptor
The proper definition of a standard is?
Solutions with a known amount of the analyte
The red blood cell protein that is responsible for deformability and flexibility of the red blood cell is?
Spectrin
Which red cell protein is responsible for deformability and flexibility of the red cell?
Spectrin
Erythrocytes with no central pallor and smaller than normal shape?
Spherocytes
Which organ is the site of sequestrations of platelets?
Spleen
Extravascular hemolysis occurs when?
Splenic macrophages ingest senescent RBCs
The primary function of erythropoietin is to?
Stimulate red blood cell production and maturation
Hypoxia stimulates RBC production by?
Stimulating EPO production by the kidney
The bone marrow, erythroid precursors are located?
Surrounding macrophages in erythroid islands
Which subpopulation of T cells alters the cell membrane?
T cytotoxic
Which one of the following cells is a product of the common lymphoid progenitor?
T lymphocyte
Which red blood cell morphology may form as a result of excess cholesterol taken on the red blood cell membrane?
Target cells
The M:E ratio describes?
The amount of myeloid elements in relation to erythrocyte elements in the marrow
Type II myeloblasts are characterized by?
The presence of fewer than 20 primary granules per cell
Upon activation, platelets secrete their alpha-granule contents via?
The surface connected canalicular system
The growth factor that is produced in the kidney and induces growth and differentiation of committed megakaryocyte progenitors is?
Thrombopoietin
Which one of the following organs is responsible for the maturation of T lymphocytes and regulation of their expression of CD4 and CD8?
Thymus
One of the primary glands in an infant responsible for lymphocyte origination is the?
Thymus gland
Iron is transported in plasma via?
Transferrin
The total iron-binding capacity (TIBC) of the serum is an indirect measure of which iron-related protein?
Transferrin
Which of the following plays a role in iron sensing so as to adjust iron absorption and recycling?
Transferrin receptor 2
Red pulp is composed of RBCs platelets and phagocytic cells
True
True or False? Accuracy is a measurement of the true value of an analyte
True
True or False? Red pulp is composed of RBCs platelets and phagocytic cells
True
True or False? Standard deviation is a measurement of precision
True
What plasma protein is essential for platelet adhesion?
VWF
Which of the following is the definition of a reference interval?
Values established for a particular analyte, given a method, instrument, or patient population
A delta check is a historical reference on samples run in the laboratories. Once a sample fails a delta check, the most obvious corrective action is to?
Verify the identification of the patient sample
All of the following represents an example of a safety violation in the laboratory except?
Wearing closed toe shoes
The morphology of blood cells is important to evaluate?
When a profiling instrument result is abnormal
How are the globin chain genes arranged?
With alpha genes and beta genes on separate chromosomes, including two alpha genes on one chromosome and one beta gene on a different chromosome
Fetal hemoglobin consists of which of the following chains?
a2, y2
Normal adult Hb A contains which polypeptide chains?
alpha and beta
The spleen harbors __________ of the circulatory platelet mass
one-third