Heme EXAM 2-4
critical values
life threatening results that require immediate notification of the healthcare provider
2nd trimester, protein, vitamins, minerals, bilirubin, Kupffer cells
role of the liver in hematopoiesis: - primary site of hematopoiesis during ___ ____ - ___ synthesis - storage of ___ and ___ - conjugation of ___ - ___ ___ remove damaged or old RBCs
c
Cholesterol is: a) hydrophilic b) hydrophobic c) both
Levey Jennings chart
a quality control chart used to record daily quality control values
secondary lymphoid tissues
spleen, lymph nodes, MALT
b
A clinical laboratory scientist performs 30 replicate hemoglobin determinations on a single blood sample. When statistics are used to determine the precision of the method, the mean is 13.8 g/dL and 1 SD is 0.1 g/dL. This means that 95.5% of the results on this specimen lie between: a) 13.4 and 14.2 g/dL b) 13.6 and 14.0 g/dL c) 13.5 and 14.1 g/dL d) 13.7 and 13.9 g/dL
c
A laboratory comparing its results to those of other laboratories on the same specimen is an example of: a) precision monitoring. b) internal quality control. c) external quality control. d) delta checks.
a
A laboratory gets numerous complaints regarding the length of time it takes hematology results to get to the emergency department. What would be an appropriate response? a) Make this a quality assurance project. b) Ignore the complaints. c) Explain why it takes so long. d) Tell the employees to work faster.
c
A patient's white blood cells are counted on an automated cell counter 10 times. The mean white count is 8000/mL and the SD is 300. What is the coefficient of variation? a) 0.04% b) 2.6% c) 3.8% d) 26%
American Proficiency Institute
API: lab proficiency testing and QA programs
a
All of the following are functions of macrophages in the bone marrow except: a) activate adipose cells. b) secrete cytokines. c) store iron. d) phagocytize senescent cells.
b
Apoptosis is: a) enhanced red cell production. b) programmed cell death. c) directed exit of cells from the bone marrow. d) accidental cell death from trauma.
College of American Pathologists
CAP: lab accreditation, proficiency testing, etc
Clinical Laboratory Improvement Amendments (of 1988)
CLIA
Amendments
CLI___
Clinical and Laboratory Standards Institute
CLSI: international guidelines and standards for lab practice
Improvement
CL___A
Centers for Medicare and Medicaid Services
CMS: administer laws and rules developed from the CLIA
c
Colony stimulating factors: a) have poor affinity for their target cells. b) require high concentrations to be effective. c) are produced by many cells. d) are all lineage specific.
12S
Control level is > 2 SD but < 3 SD; indicts warning
13S
Control level is > 3 SD; out of control
b
Enlarged lymph nodes are commonly found in all of the following except: a) viral infections. b) liver cirrhosis. c) bacterial infections. d) metastatic malignancy.
liver
Extramedullary hematopoiesis occurs in the ___.
b
Fatty acid chains of the phospholipids and the steroid nucleus of cholesterol are: a) hydrophilic b) hydrophobic c) both
s/mean x 100
Formula for coefficient of variation
[sum (xd-mean)^2]/n-1
Formula for variance
cell membrane
Functions of the ___ ___ - Restrict/facilitate permeability - Detect signals in intercellular communication - Display surface markers for cell identity
barrier, permeability, intercellular communication, surface markers
Functions of the cell membrane - Provide physical ___ for the cell - Restrict/facilitate ___ - Detect signals in ___ ___ - Display ___ ___ for cell identity
a
Germinal centers in lymph nodes contain primarily: a) B cells. b) macrophages. c) neutrophils. d) T cells.
bone marrow
Hematopoiesis occurs predominantly in the ___ from the third trimester of fetal life through adulthood.
d
How do cells get from the bone marrow into peripheral circulation? a) Stem cells escape the bone marrow and mature in peripheral circulation. b) Mature cells attach to a carrier protein for transport. c) Capillaries flow into the marrow and pluck out precursor cells. d) Mature cells squeeze through spaces in the vessel endothelial lining.
d
How does the genetically active portion of the nuclear chromatin look when stained with Wright stain? a) condensed, darkly stained b) clumped, dark purple c) rope-like, pink or red d) diffuse, uncondensed and pale blue
d
How many blood cells are made each day in the bone marrow of a normal adult? a) thousands b) millions c) about 1 billion d) hundreds of billions
b
If the cytoplasm of a cell is very basophilic or blue when stained with Wright's stain it contains: a) low concentration of lysosomes. b) large number of ribosomes. c) small number of ribosomes. d) high concentration of lysosomes.
Joint Commission on Accreditation of Healthcare Organizations
JCAHO
Healthcare
JCA___O
Accreditation
JC___HO
Commission
J___AHO
b
Kupffer cells, found in the liver, are: a) adipose cells. b) macrophages. c) immature red cells. d) immature granulocytes (neutrophils).
41S
Last four control runs are > 1 SD on the same side of the mean; out of control
R4S
Last two control runs are > 4 SD apart; out of control
22S
Last two control runs were > 2 SD on the same side of the mean; out of control
membrane, cytoplasm, nucleus
List the three basic parts of all cells.
b
Lysosomes are found in the cytoplasm of many cells and contain: a) cholesterol. b) hydrolytic enzymes. c) glycoproteins. d) RNA.
a
More mature cells have more ___ because they are less transcriptionally active. a) heterochromatin b) euchromatin
Occupational Safety and Health Administration
OSHA
Health
OS___A
Safety
O___HA
b
One of two controls that have been evaluated over the last 28 days gives a result on day 29 between 2 and 3 standard deviations of the mean; the other control is within 2 SDs of its mean. What is the correct procedure to follow? a) Ignore the result unless it happens again the next day. b) Rerun the control and if acceptable continue with patients. c) Recalibrate the instrument. d) Open new vials of controls and repeat both controls.
iliac crest, sternum
Primary sites for bone marrow collection
b
Proper specimen collection and patient satisfaction are components of: a) quality control b) quality assurance c) reliability d) precision
a
Protein synthesis occurs in what part of a cell? a) ribosomes b) nucleus c) mitochondria d) lysosomes
quality control
Refers to the control and monitoring of the testing process to ensure that the results are valid and reproducible
Peripheral proteins
a group of biologically active molecules formed from amino acids which interact with the surface of the lipid bilayer of cell membranes
2
Results for a control must fall within predetermined dispersion limits, typically +/- ___ SD.
reagent lot, fitting, light source
Some common causes of shift include: - Change in ___ ___ - Change of instrument ___ - Change of ____ ___
Deterioration, Dimming, pump fittings
Some common causes of trend include: - ___ of reagents - ___ light sources - Deteriorating ___ ___
T
T/F: There are approximately equal amounts of red and yellow marrow in the adult body.
F
T/F: Yellow marrow cannot revert back to red marrow in cases of increased demand, such as in cases of excessive blood loss or hemolysis.
negative predictive value
TN/(TN+FN) x 100
specificity
TN/(TN+FP) x 100
sensitivity
TP/(TP+FN) x 100
positive predictive value
TP/(TP+FP) x 100
a
The antinuclear antibody test (ANA) is positive in almost all people who have systemic lupus erythematosus (SLE). It is also positive in some patients who do not have SLE. The anti-DNA is positive only in people with SLE but not in all who do. Which of the following is true? a) ANA is a good screening test and anti-DNA is a good confirmatory test. b) Anti-DNA is a good screening test and ANA is a good confirmatory test. c) Both are good screening tests for SLE. d) Neither of these tests is valid.
b
The best way to prevent errors in the laboratory is to ensure: a) purchasing quality instruments from reputable vendors. b) hiring only well-trained, conscientious workers. c) having quality management. d) performing external quality control procedures.
b
The following hemoglobin results, reported in g/dL, are obtained on a hospitalized patient on 3 consecutive days: Day 1: 14.3 Day 2: 11.5 Day 3: 14.4 The SD for this hemoglobin method is 0.1. A delta check was obtained on day 2. Controls were run as appropriate each day and were all within limits for this procedure. What is the most probable reason for the day 2 result when compared to those for days 1 and 3? a) It is within the 95.5% confidence levels for this test. b) It may represent an error in patient identification. c) The patient had a major blood loss between days 1 and 2. d) It is within the 99% confidence levels for this test.
c
The nucleolus of a cell is composed of: a) hydrolytic enzymes. b) glycoproteins. c) RNA. d) DNA.
a
The phophate end of the phospholipid and hydroxyl radical of cholesterol are: a) hydrophilic b) hydrophobic c) both
b
The precision limits of a method are defined by: a) the mean. b) the standard deviation. c) sensitivity. d) specificity.
b
The thymus is responsible for the initial development of: a) macrophages. b) T cells. c) B cells. d) neutrophils.
c
The tubing that brings the lyse reagent to the hemoglobin cuvette on an automated cell counter is pinched and not delivering any reagent. All hemoglobin values are greater than 20 g/dL. This represents what type of error? a) random b) imprecision c) constant systematic d) proportional systematic
d
When hematopoiesis occurs in the liver in an adult, it is called: a) intramedullary. b) intermedullary. c) normal. d) extramedullary.
b
What are the major hematopoietic sites in the fetus and in the adult? (fetus/adult) a) lymph nodes/spleen b) liver/bone marrow c) liver/spleen d) bone marrow/liver
d
What bone marrow cells can differentiate into all of the blood cells? a) BFU-E b) CFU-GM c) CFU-GEMM d) hematopoietic stem cells (HSCs)
c
What cellular component "directs traffic" for smooth functioning? a) mitochondria b) ribosomes c) Golgi complex d) nucleoli
c
What cellular component is responsible for energy production and metabolic processes? a) ribosomes b) nucleus c) mitochondria d) lysosomes
c
What cellular component of the erythrocyte is its control center? a) heterochromatin b) Golgi complex c) nucleus d) cytoplasm
b
What component of the erythrocyte is most responsible for its cytoskeleton and cellular integrity? a) integral protein b) peripheral protein c) nucleus d) Golgi complex
c
What condition is most associated with autosplenectomy? a) abdominal trauma b) thrombocytopenia c) sickle cell anemia d) iron deficiency
d
What does the coefficient of variation describe about white cell counts? a) accuracy b) reliability c) proper calibration d) precision
c
What is the primary mechanism for the anemia associated with kidney disease? a) hemolysis b) hemorrhage c) inadequate synthesis of erythropoietin d) inadequate synthesis of interleukins
a
Where are developing red cells located in the bone marrow? a) adjacent to the outer surfaces of the vascular sinuses b) outside the vascular walls of the sinusoids c) deep in the cords d) randomly spaced throughout the cords
a
Where are surface markers that help in cell identification found? a) cell membrane b) Golgi complex c) rough endoplasmic reticulum d) nucleus
a
Which of the following groups of patients shouldn't be included in establishing moving averages using red cell indices? a) chemotherapy patients b) females c) obstetrical patients d) surgical patients
Occupational
___SHA
linearity
ability to generate results proportional to the calculated concentration or activity of the analyte
limits
acceptable range where results are considered valid and accurate
b
all of the following functions are performed by cytokines except: a) stimulate production of blood cells. b) induce macrophages to attack senescent cells. c) regulate cell differentiation. d) monitor trafficking of mature blood cells.
osteoblasts
bone forming cells
primary lymphoid tissues
bone marrow, thymus
osteoclasts
bone resorbing cells
precision
bullseye analogy: values do not hit the center of the target, but are all gathered in the same area
accuracy
bullseye analogy: values hit the center of the target
heterochromatin
chromatin that is more darkly stained, with a condensed clumping pattern. Is the transcriptionally inactive area of the nucleus.
trend
continuous movement of values in one direction over six or more analytical runs
internal control
control that is made by the tester or the individual lab. Is specific to lab demographics and more economic but is more laborious.
external control
control that is purchased. Yields quicker, more accurate results, and can be used to compare with other labs.
erythropoietin
glycoprotein hormone synthesized primarily in the kidneys and released into the blood in response to hypoxia
red marrow
hematopoietically active marrow composed of developing blood cells and their progenitors
yellow marrow
hematopoietically inactive marrow composed primarily of adipocytes with undifferenciated mesechymal cells and macrophages
thrombopoietin
hormone produced primarily by the liver that promotes hematopoietic stem cells to differentiate into the megakaryocyte lineage
accuracy
how close a measurement or result is to the true value
precision
how close the reproduction of results are to each other
endoplasmic reticulum
membrane-bound, interconnected network of flattened sacs and tubes that is located adjacent to the nucleus and extends throughout the cytoplasm
TN/(TN+FN) x 100
negative predictive value
TP/(TP+FP) x 100
positive predictive value
bone marrow, thymus
primary lymphoid tissues
calibration
procedure used to adjust or revalidate instrumentation or to develop a calibration curve
hematopoiesis
process by which all blood cells are formed, develop, and specialize
endothelial cells
regulate particle flow in and out of hematopoietic spaces in vascular sinuses
adipocytes
regulate volume of marrow in which active hematopoiesis occurs. Also secrete cytokines and growth factors to positively stimulate HSCs and bone homeostasis.
platelets, blood supply, primary, pathogens, macrophages
role of spleen in hematopoiesis: - contains ___ (30% found in spleen) - has rich ___ ___ - involved in ___ immune response to blood-borne ___ - ___ remove damaged/old RBCs
coefficient of variation
s/mean x 100
5th, 2, liver, A, F, A2, extra
stages of hematopoiesis: HEPATIC - ___ week - ___ weeks after birth - occurs in the ___ - Hgb ___, Hgb ___, Hgb ___ - ___vascular
5th month, bone marrow, A, F, A2, extra
stages of hematopoiesis: MEDULLARY - ___ ___ - death - occurs in the ___ ___ - Hgb ___, Hgb ____, Hgb ___ - ___vascular
0-8, yolk sac, aorta, Portland, Gower1, Gower2, intra
stages of hematopoiesis: MESOBLASTIC - ___ weeks - occurs in the ___ ___ and ___ - ___, ___ and ___ - ___vascular
macrophages, lymphocytes
two types of cells that secrete cytokines to regulate hematopoiesis
T lymphocytes, cortex, negative, positive, medulla, peripheral
role of the thymus in hematopoiesis: - differentiation of ___ ___ - ___ holds T cell progenitors as they mature to form double ___ T cells to double ___ T cells, then to mature T cells that express either CD4+ or CD8+ - ___ holds 15% of naive mature T cells until they are needed in ___ lymphoid tissues
spleen, lymph nodes, MALT
secondary lymphoid tissues
TP/(TP+FN) x 100
sensitivity
TN/(TN+FP) x 100
specificity
mesoblastic
stages of hematopoiesis: ____ - 0-8 weeks - yolk sac and aorta - Portland, Gower1, Gower2 - intravascular
medullary
stages of hematopoiesis: ____ - 5th month - death - occurs in the bone marrow - Hgb A, Hgb F, Hgb A2 - extravascular
hepatic
stages of hematopoiesis: ____ - 5th week - 2 weeks after birth - occurs in the liver - Hgb A, Hgb F, Hgb A2 - extravascular
control
substance that provides known values and is sampled alongside patient specimens to accomplish internal assay validation
shift
sudden change of values from one level of the control chart to another
delta check
system that compares a current analyte result with the result from the most recent previous analysis for the same patient
a
A cell that is actively synthesizing protein has: a) more nucleoli. b) more heterochromatin. c) fewer ribosomes. d) fewer mitochondria.
d
A patient specimen is analyzed on an instrument known to be in control from previous assays performed on a calibrated instrument and gives a hemoglobin result of 13.2 g/dL. Two hours later it is evaluated on another instrument that is being evaluated for purchase by the laboratory. The result is 11.8 g/dL. This result, when compared to the first is: a) acceptable agreement. b) reportable. c) precise agreement. d) inaccurate.
d
A purchased hemoglobin standard is used to adjust a hemoglobinometer. This standard is being used as a: a) control. b) precision check. c) delta check. d) calibrator.
a
A test that is positive in all patients who have the disease but also in some who do not have the disease is: a) sensitive. b) specific. c) precise. d) reliable.
c
If the lysosomal membrane ruptures, what is the consequence to the cell? a) activates cell nucleus to replicate DNA b) enhances protein synthesis by ribosomes c) damages internal cell structures d) facilitates rearrangement of intracellular organelles
a
The control values for both controls for the prothrombin test were ranging between the mean and 1 SD for the first 19 days of use. Starting on day 20, the values for both were consistently between +1 and +2 SDs. This is an example of a: a) shift. b) trend. c) random error. d) predictable error.
d
What is the purpose of the granules in phagocytic cells? a) maintain cell shape b) manufacture enzymes c) provide surface receptor sites d) digest foreign material such as microorganisms
a
Which of the following is a hematopoietic growth factor? a) interleukin b) BFU-E c) fibroblast d) hematopoietic stem cell
a
Which of the following is a morphologically identifiable precursor cell using Wright stain? a) promyelocyte b) CFU-E c) CSF-GM d) hematopoietic stem cell (HSC)
d
Which of the following is true regarding reference ranges? a) should be derived from reference books b) need to be determined only for adults c) can be established by running the test procedure on 10 healthy people d) are ranges of values for an analyte in normal healthy people
d
Which of the following would most likely be associated with a shift? a) operator error b) fading light source c) instrument miscalibrated d) starting a new lot number of thromboplastin reagent
c
Which of the following, using Wright stain, is a feature of normal cells as they mature? a) overall size increases b) nucleoli become more prominent c) nuclear chromatin becomes more condensed d) cytoplasmic basophilia increases
d
Why are erythrocyte cellular inclusions such as Howell-Jolly bodies found after surgical removal of the spleen? a) Blood loss from surgery increases erythrocyte production. b) Necessary hematopoiesis growth factors produced in the spleen are lost. c) Removal of the spleen induces the formation of inclusions. d) The absent spleen cannot "pit" or remove the normally formed inclusions.
b
Why does surgical removal of the spleen cause people to have an increased platelet count? a) The bone marrow makes more platelets when there is no spleen. b) The 30% of platelets normally stored in the spleen are freely circulating. c) Antibodies produced after splenectomy attack platelets. d) Surgery stimulates platelet growth factors.
variance
[sum (xd-mean)^2]/n-1
lymphoid
___ progenitors differentiate into T and B lymphocyte, NK cell, and dendritic cell lineages.
myeloid
___ progenitors differentiate into granulocyte, erythrocyte, monocyte, and megakaryocyte lineages.
Integral protein
any protein which has a special functional region of the purpose of securing its position within the cellular membrane
euchromatin
chromatin which has a diffuse, uncondensed, open chromatin pattern and is the genetically active area of the nucleus where DNA transcription into messenger RNA occurs.
chromatin
consists of one long molecule of double stranded DNA in each chromosome that is tightly folded with histone and nonhistone proteins
fibroblasts
form an incomplete layer of cells on the surface of vascular sinuses to form supporting lattice for developing hematopoietic cells
95% confidence interval
includes 95% of all values of a parameter measured in a normal population, which corresponds closely to +/- 2 SD.
retrogression
process of replacing red bone marrow with yellow bone marrow (occurs after ages 5-7 years)
lymphocytes, immunoglobulins, filtering
role of the lymph node in hematopoiesis: - formation of new ___ - processing specific ___ - ___ debris, bacteria, and particulate matter
