HHHH
Which form of acute myeloid leukemia (AML) is most often associated with disseminated intravascular coagulation (DIC)?
AML with t(15;16)(q22:q12)
A 47 year old male patient has gingival hypertrophy and a white blood cell count of 108. He has a moderate anemia and is thrombocytopenic. The differential consists primarily of a combination of mature monocytes, promonocytes, and CD14 prositive blasts. Which of the following forms of acute myeloid leukemia (AML) is most likely?
AML with t(15;17)(q22:q12)
What leukemia is most likely in a patient whose bone marrow is composed of predominantly large, multinucleated, dysplastic erythroid precursors?
Acute erythroleukemia
What is the most common leukemia in children between the ages of 2 and 10 years?
Acute lymphoid
Which form of acute myeloid leukemia (AML) has megakaryoblasts and antibodies to platelet glycoprotein IIb/IIIa?
Acute megakaryocytic leukemia
An adult patient has a white blood count of 80. The differential has 92% Sudan Black B positive lasts and 8% lymphocytes. Which of the following is most likely?
Acute myeloid leukemia without maturation
A 27 year old woman presents with acute bleeding to the emergency department and is found to have a white count of 25.7 with pancytopenia: hematocrit 27%, platelet count 35, and absolute neutrophil count 0.8. She has a combination of 97% blasts and abnormal promyelocytes in her peripheral blood; some of these cells contain stacked Auer rods. What form of leukemia does she most likely have?
Acute myeloid with t(15;17)(q22:q12)
How to correct smudge cells
Add drop of albumin and re-smear
Compared to manual methods, automated reticulocyte counting improved which of the following?
All of the above: -Distribution error -Statistical sampling error -Inter-observer error
The strongest risk factor for development of a lymphoproliferative disorder is:
Altered immune function
At what age is it normal for bone marrow cellularity o be 80%-90%? (ie has very little fat)
At birth
When the electronic impedance principle is used to count blood cells, what is done to increase platelet counting sensitivity?
Decrease the size of the red blood cell/platelet aperture
How do CELL-DYN instruments differentiate red cells and platelets from one another?
Differences in volume (fL) using electrical impedance principle
How do Beckman Coulter and Abbott instruments count red cells and platelets?
Electrical impedance
Counting the number and size of electrical interferences created by blood cells as they pass through a small aperture is a description of which of the following principles?
Electronic impedance
ALL affects males and females
Equally
Which of the following is true of plasma cells?
Express cytoplasmic immunoglobulin
All of the following are functions of normal lymph nodes except:
Granulopoiesis
HCL
Hairy cell leukemia Use stain: TRAP (Tartrate Resistant Acid Phosphatase)
Which of the following is determined by light transmission between 525 and 555 nm?
Hemoglobin
A CBC is requested on a full-term newborn girl and the following results are obtained: ... What conclusion can be made regarding this data for this infant?
Hemoglobin, Hematocrit, and MCV are all decreased
What technology minimizes the problems of a rigid aperture including protein buildup, coincidence, and a single cell being counted twice?
Hydrodynamic focusing
A child has monotonous blasts in the peripheral blood that have scant blue cytoplasm. They are CALLa (CD10) positive. Which form of acute lymphoid leukemia (ALL) is most likely?
Immature B cell
The most useful classification system for acute lymphoid leukemia (ALL) based is based on:
Immunophenotyping
What is the mechanism for the three part differential found in older Coulter machines or those designed for smaller laboratories?
Impedance after cytoplasm shrinkage
Which of the following is true regarding classic Hodgkin lymphoma?
It is seen in young adults and present with enlarged mediastinal lymph nodes
Which of the following uses a peroxidase stain channel?
Bayer ADIVA 2120
Iron deficiency anemia in the elderly is most often a result of
Bleeding in the gastrointestinal tract
What are the marlignant plasma cells found in multiple myeloma?
Bone marrow and sometimes in the peripheral blood
An elevated immature reticulocyte fraction (IRF) is associated with:
Bone marrow response to anemia
Why are patients with multiple myeloma susceptible to infection?
Both B and C B. Neutropenia C. Suppressed normal immunoglobulin levels
What lymphoproliferative disorder has a very favorable response to highly aggressive chemotherapy with no radiotherapy?
Burkitt lymphoma
Neoplastic lymphocytes with non-cleaved clumped nuclei and very basophilic cytoplasm with prominent vacuoles describes:
Burkitt lymphoma cells
Starry Sky cell
Burkitts Lymphoma
Acute myelomonocytic leukemia is positive for which of the following?
CD13 and CD14
Which of the following are mature pan-B cell markers?
CD19 and CD20
Which of the following are mature pan-T cell markers?
CD3 and CD5
Which automatic hematology analyzer performs the white count by both optical scatter and electrical impedance, and them compares the two as an internal quality control check?
CELL-DYN 4000
What is the clinical significance of an enlarged lymph nodes?
Can be benign or malignant depending on the microscopic evaluation
Why is Burkitt lymphoma such an aggressive malignancy?
Cells have a high proliferative rate
A middle-aged man has a white blood cell (WHC) count of 80 with 90% lymphocytes and many smudge cells. Which of the following is most likely?
Chronic lymphocytic leukemia (CLL)
Which of the following is most commonly seen in the elderly >70-year-old population?
Chronic lymphocytic leukemia (CLL)
A patient sample comes off an automated cell counter with a failure of the red call "rule of three". The red count is lower than expected given the hemoglobin. The mean cell volume, mean cell hemoglobin and mean cell hemoglobin concentration are elevated. Which of the following is the most likely reason for this failure?
Cold agglutinin
What principle does the Sysmex SE-9000/9500 use to analyze and separate white cell populations?
Low frequency DC and high-frequency current (DC/RF)
Which of the following indicates a favorable prognosis in acute lymphoid leukemia (ALL)?
Low white count at diagnosis
A normal 3 month old boy has a hemoglobin of 11.2 g/dL. Which of the following is true about his hemoglobin? It is:
Lower than that of an adult of the same age
Which of the following is always calculated on cell counters?
MCHC
All of the following are normal peripheral blood RBC findings at birth in a full-term infant except:
MCV <90 fL
All of the following will be invalid when lipemia is present in a blood sample except:
Mean cell volume
MGUS
Monoclonal Gammopathy of Undetermined Significance
Which of the following is true regarding the symptoms of acute leukemia?
Most symptoms are related to abnormal cell counts
MALT
Mucosa Associated Lymphoid Tissye mucosa-associated lymphoid tissue
Serum protein electrophoresis on an elderly patient reveals a monoclonal protein spike. Increased plasma cells are present in the bone marrow. They are CD19 and CD20 negative, but demonstrate high density CD38 and monoclonal cytoplasmic immunoglobulin (Ig). What is the most likely diagnosis?
Multiple Myeloma
Malignant proliferation of plasma cells with osteolytic bone lesions and the presence of monoclonal immunoglobulin in the serum describe:
Multiple myeloma
Normal lymph nodes contain all of the following cell types except:
Myelocytes
What does the pneumatic system of cell counters do?
Operates the valves and moves the sample
What is the most likely reason that the red blood cell count remains elevated in a newborn for the first 2 weeks of life?
Partial anoxia exists in utero and erythropoietin increases
Worst prognosis of ALL
Philadelphia chromosome
A patients white blood count comes off an automated cell counter as 380. Which of the following could be reported without any additional testing?
Platelet count
Which of the following age groups normally has the lowest mean red cell values (RBC count, Hgb, Hct)
Preterm premature
FAB Classification
RA: Refractory Anemia RARS: Refractory Anemia with Ringed Sideroblasts RAEB: Refractory Anemia with Excess Blasts RAEB-t: Refractory Anemia with Excess Blasts in Transformation CMML: Chronic MyeloMonocytic Leukemia
WHO Classification
RA: Refractory Anemia RCMD: Refractory Cytopenia with Multilineage Dysplasia RARS: Refractory Anemia with Ringed Sideroblasts RAEB: Refractory Anemia with Excess Blasts MDS-U: MYelodysplastic syndrome, unclassified MDS-5q: Myelodysplastic syndrome associated, with del(5q)
Which of the following is true regarding automated reticulocyte counts?
RNA is stained with various dyes that allow for detection of reticulocytes by optical scatter or fluorescence
If platelets stick together...
Redraw with NaCitrate
What is the diagnostic cell, fonund in involved lymph nodes, for Hodgkin lymphoma?
Reed-Sternberg cell
All of the following may be found in the myelodysplastic syndromes (MDSs) except:
Reticulocytosis
Mature T cells with cerebriform, clefted nuclei found in the skin and peripheral blood describe:
Sezary cells
Mycosis fungoides
Sezary cells NOT A FUNGUS
Forward light scatter, when used in an instrument employing the optical scatter principle, correlates with cell:
Size
An automated hematology analyzer is used to evaluate a blood specimen. Which of the following, coming off the instrument, would require performance of a manual white cell differential as opposed to smear review?
Suppression of automated differential data
A 15-year-old boy presents complaining of severe headaches; he has a white count of 76.0 x 10^9/L, platelet count of 55 x 10^9 and a hematocrit of 33%. When a white cell differential is performed, most of the nucleated cells are blasts. They are CD2, CD4, CD8 positive. What is the most likely diagnosis?
T cell acute lymphoid leukemia
Why is there a relative lymphocytosis in a 2 year old?
The absolute number of lymphocytes is increased as the immune system develops.
Why is the white count in a normal full-term newborn elevated shortly after birth?
There is an absolute increase in lymphocytes
What is the preferred specimen to evaluate cellular morphology in the lymphoproliferative disorders?
Touch imprints of nodes
What is the recommended method for establishing accuracy of automated hematology analyzers?
Use commercially prepared whole blood calibrators
Platelet volume normally:
Varies inversely with the platelet count
Which of the following is more likely to result from poor absorption rather than inadequate nutritional intake in the elderly?
Vitamin B12 deficiency
What is the most appropriate action for dealing with a cold agglutinin?
Warm sample to 37 and rerun
Platelet Satellitism
When drawn with EDTA Surrounds PMN
Platelet clumps would most likely interfere with which other automated parameter?
White blood cell count
Which of the following occurs if testing is not performed with 24 hours from specimen collection?
White blood cells deteriorate and red blood cells swell
Which of the following is true regarding the clinical course of chronic lymphocytic leukemia (CLL)?
incurable but with a median survival of approximately 10 years
What is the greatest limitation of automated cell counters?
inherent specimen problems leading to occasional spurious results
What is the normal bone marrow cellularity in teh geriatric >65-year-old population
30%
An 85-year-old woman has a hemoglobin of 10.5 g/dL. This is:
A sign of an underlying disease and requires further evaluation
