Heamatology

You answered the question correctly.
Which of the following is a genetic platelet disorder characterized by giant platelets,

abnormal screening tests for platelet function and moderate to severe
thrombocytopenia?
The correct answer is highlighted below
Glanzman disorder
Hemophilia A
Disseminated intravascular coagulation (DIC)
Bernard-Soulier syndrome
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Bernard-Soulier syndrome is characterized by giant platelets, abnormal screening tests

for platelet function and moderate to severe thrombocytopenia.
Question Difficulty: Level 5

You answered the question incorrectly.
A 1:20 dilution is made for a manual WBC count. The four corner squares on both
sides of a hemocytometer are counted. A TOTAL of 100 cells are counted in that
area. What is the white blood cell count in terms of a liter
(? x 109/L)?
2.5
25
250
2500
25000
Feedback
First, determine the number of WBC's from the hemocytometer as follows:
WBC count = (dilution ratio x # of cells counted x 10) / (# mm2 area counted)
Then: WBC count = (20 x 100 x 10) / (8) = 2500 WBC/mm3 (or 2500 WBC/uL or 2.5
x 103 WBC/uL)
Next, to find the WBC count per liter, multiply the WBC count/uL by the number of
uL/L (there are 106 uL/L)
So: (2.5 x 103 WBC/uL) x (106 uL/L) = 2.5 x 109 WBC/L
Classification of acute leukemia in the United States relies on two main systems, the
FAB (French American British) and the WHO (World Health Organization)
classifications. In order to diagnose acute leukemia, the FAB system requires
______% of non-erythroid blasts to be present in the bone marrow/peripheral blood,
while the WHO system requires the presence of ________% non-erythroid blasts.
40%, 20%
30%, 20%
20%, 30%
20%, 40%
Feedback
In order to diagnose acute leukemia, the FAB system requires 30% of non-erythroid
blasts to be present in the bone marrow/peripheral blood, while the WHO system
requires the presence of 20% non-erythroid blasts.
Which of these methods could be used to differentiate between Howell-Jolly bodies

and Pappenheimer bodies and what results would be noted?
Wright-Giemsa stain: Pappenheimer bodies stain blue but Howell-Jolly bodies

do not stain blue
Wright-Giemsa stain: Howell-Jolly bodies stain blue but Pappenheimer bodies
do not stain blue
Prussian blue stain: Howell-Jolly bodies stain blue but Pappenheimer bodies do
not stain blue
Prussian blue stain: Pappenheimer bodies stain blue but Howell-Jolly bodies do
not stain blue
Feedback
Prussian blue stain would help to differentiate between Pappenheimer bodies and
Howell-Jolly bodies. Prussian blue stains iron. Pappenheimer bodies, which contain
iron, will stain blue. Howell-Jolly bodies will not stain with Prussian blue because
they do not contain iron.
Both Howell-Jolly bodies and Pappenheimer bodies will stain with Wright-Giemsa
stain.
The role of the laboratory technologist in processing bone marrow aspirates can vary
depending on laboratory and clinician protocols. Which of the following roles may be
performed by a laboratory technologist?(Select all that apply)
The correct answers are highlighted below
Make smears from samples delivered by clinicians.

Makes smears at bedside.
Perform bone marrow aspirate and biopsy.
Interpret bone marrows.
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The laboratory technologist's role may include: making smears, either at the patient
bedside or in the laboratory, and staining the smears. The clinician or pathologist
obtains the bone marrow samples and interprets the results. In some laboratories, the
technologist may also be responsible for performing the bone marrow differential
count.
Which of these blood levels will increase during hemolysis?
Serum (plasma)LDH
Serum (plasma)bilirubin
Reticulocytes
All of the above
None of the above
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Hemolysis is characterized by increased levels of Serum (plasma) LDH and bilirubin,

and an increased number of reticulocytes.
Which of the following is not true in terms of platelet characteristics?
Produced in the bone marrow by megakaryocytes.

Possess an inherent sticky property that aids in adhesion and aggregation.
Have a lifespan of roughly 9-12 days.
Are normally found circulating in their inactive, spiny form.
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Platelets do not circulate in inactivated, spiny forms. The spiny, sticky form of the
platelet is initiated once the platelets become activated in response to blood vessel
damage.
The two main compartments of the bone marrow are the venous sinuses/blood vessels
and hematopoietic cords.
True
False
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This statement is true. The two main compartments of the bone marrow are the
venous sinuses/blood vessels and hematopoietic cords.

When performing a manual white blood cell count, 256 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?
12,500
9,600
12,575
12,425
12,000
Feedback
WBC calculation =
((# of Cells Counted X Dilution Factor X Depth Factor) / (# of Square Millimeters

Counted)) = WBC per mm3
Average of 256 + 224 = 240

dilution factor = 20
area counted = 4 mm2
So... 240 cells x 20 x 10 / 4 = 12,000
Corrected WBC count calculation = uncorrected WBC count x 100 / # of NRBCs

+100
So... 12,000 x 100 / 25 + 100 = 9,600

If one finds excessive Rouleaux formation on a blood smear examination, then one
might also find an increased:
leukocyte count
erythrocyte sedimentation rate
hematocrit
osmotic fragility
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Rouleaux is strongly associated with abnormally increased erythrocyte sedimentation

rates. Rouleaux does not affect leukocyte counts, hematocrit determinations, or
osmotic fragility test results.
The expected life span of a normal red blood cell is:
3-4 months
1-2 months
3-6 weeks
1-3 weeks
Feedback
The life span of normal red blood cells in the circulation is approximately 120 days.

How does hydroxyurea aid in the treatment of sickle cell disease?
Acts as an analgesic in pain management.

Inhibits the HbF to HbA switch.
Induces increased production of HbF.
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Hydroxyurea induces increased production of HbF. Most sickle cell patients who have
increased levels of HbF experience milder forms of the disease than do patients with
normal or low levels of HbF. Therefore, the focus of molecular treatments for sickle
cell disease is to increase the level of fetal hemoglobin (HbF).

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?
CD3
CD4
CD8
CD36
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HbSS blood may contain reticulocytes with an abnormal presence of CD36 on their
membranes, allowing platelets to form a bridge between these young sickle cells and
endothelial cells in post-capillary venules. This initial slow down of blood flow
creates an environment in which cells containing HbSS can easily form sickled cells.
CD3, CD4, and CD8 are all associated with T-lymphocytes.

Newborns who will develop Hemoglobin H disease may demonstrate up to 30% of

which type of hemoglobin?
Bart's
Fetal
Lepore
Sickle
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Neonates who have alpha thalassemia intermedia form insufficient amounts of alpha
chains. The gamma chain is present in high amounts, forming tetramers known as
Bart's hemoglobin.
As gamma chain production decreases, beta chain production increases and they begin
forming beta chain tetramers (Hemoglobin H) instead.
Alpha thalassemia is defined as:
The production of an abnormal form of hemoglobin due to the substitution of an

amino acid in the alpha chain.
The decrease in the rate of production of Hb A due to a substitution of an amino
acid in the alpha chain.
The decrease in the rate of production of alpha chains due to a partial or total
deletion of the genetic code.
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Thalassemia in general is the decrease in the rate of production of a globin chain due
to a partial or total deletion of the genetic code. In alpha thalassemia this deletion
affects at least one of four gene loci.
Myelodysplastic syndromes can BEST be described as follows:
A myeloproliferative disorder
An acute leukemia that is in remission
A leukemia that typically progresses to thrombocytopenia and lymphocytic
leukemia
A qualitative disorder of erythroid, myeloid and/or megakaryoctic cell series
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In myelodysplastic syndromes, the bone marrow stem cells are unable to effectively
make erythroid, myeloid or megakaryocytic cells due to a qualitative or quantitative
defect. These syndromes can lead to AML, or acute myelogenous leukemia.

Which tests will be abnormal in a patient with Fibrin Stabilizing factor deficiency?
PT
APTT
Factor XIII
Both a & b
Feedback
Factor XIII is also known as fibrin stabilizing factor, therefore, an abnormal level of
factor XIII would be expected in a patient with fibrin stabilizing factor deficiency.
What clinical characteristics might a person with beta thalassemia intermedia exhibit?
Severe facial distortions

Shortened life-span
Some splenomegaly
None of these
Feedback
Growth and development in children with beta thalassemia intermedia is usually

normal and most patients have a normal life span. However, they can demonstrate
splenomegaly and some facial bone deformity.

An India Ink preparation is used to identify:
Crystals in synovial fluid

Cryptococcus neoformans in CSF
Bacteria in CSF
WBCs in synovial fluid
Feedback
India ink preparation performed on spinal fluid is used to demonstrate the

polysaccharide capsule of Cryptococcus neoformans by negative staining. Direct
detection of capsular antigen by agglutination or immunoassay techniques is much
more sensitive, and has largely replaced the India Ink stain for clinical specimens.
A patient has the following hematology test results. Classify the anemia present by
choosing one of the options below.
Hgb = 8.1 g/dL
Hct = 31%
RBC = 4.0 x 1012/L
Macrocytic, hypochromic
Normocytic, normochromic
Microcytic, normochromic
Microcytic, hypochromic
Feedback
To classify the type of anemia present, it is necessary to solve for the RBC indices.
The MCV in this case would be 78 fl, the MCH is 20 pg, and the MCHC is 26%.
Therefore, this anemia is classified as a microcytic, hypochromic anemia.
Which ethnic group has the highest incidence of hereditary hemochromatosis in the
United States?
Caucasians of Celtic descent

African Americans
Persons of Mediterranean descent
Hispanics
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In the US, Caucasians of Celtic descent have the highest incidence of hereditary
hemochromatosis.
If the dilution is 1:100, and the average platelet count from both sides of the
hemacytometer counting chamber in 2 mm2 is 68, what is the calculated platelet
count?
680,000/mm3
6,800/mm3
68,000/mm3
680/mm3
34,000/mm3
Feedback
A simple way to calculate platelet counts on the hemacytometer is to multiply the

average platelet count between the two sides of the chamber by 1,000. In this case 68
x 1,000 = 68,000 platelets. The longer derivation is as follows:
The standard dilution of blood for platelet counts is 1:100; therefore the dilution
factor is 100. The volume of diluted blood used is based on the area and depth of the
counting area. The area counted is 1 mm2 per side (since we are using the average
platelet count, we only use the area of one side) and the depth factor is 10.
((Total number of cells counted x dilution factor x depth factor(mm)) / area in mm2) =
platelets per mm3
The cytospin technique perfectly preserves the morphology of blood cells in a fluid
sample.
True
False
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Cytopspining uses centrifugation to remove the liquid portion of the fluid as the cells
are deposited on the slide. This introduces cytospin artifact, which can stretch the
cytoplams and distort nuclear shapes as compared to the same cells in the peripheral
blood.

The morphologic characteristic(s) associated with the Chediak-Higashi syndrome is

(are):
Pale blue cytoplasmic inclusions

Giant lysosomal granules
Neutrophils with many small granules and vacuoles
Nuclear hypo-segmentation
Feedback
Giant lysosomal granules are associated with Chediak Higashi syndrome. Pale blue
cytoplasmic inclusions are dohle bodies or dohle-like bodies as found in May Hegglin
anomaly. Neutrophils with many small granules and vacuoles, also called toxic
granulation or toxic vacuolation, are associated with infections. Finally, nuclear
hypo-segmentation is associated with Pelger Huet anomaly.
A hemocytometer is generally not used for which of the following:
Cell counts in CSF

Synovial fluid crystal counts
RBC/WBC counts
Platelet counts
Feedback
Synovial fluid crystals are best examined fresh using only a slide and coverslip, and a
polarizing microscope.
A simple check which can be employed to verify that hemoglobin and hematocrit
values match would be:
Hematocrit X 3 = hemoglobin
Hemoglobin X 3 = hematocrit
Hemoglobin / hematocrit = 3
Hemoglobin + hematocrit = 3
Feedback
The hematocrit is equal to approximately 3 times the hemoglobin level.
Which of the following is the immediate precursor of the mature neutrophil?
myelocyte
metamyelocyte
promyelocyte
band
myeloblast
Feedback
The progression of the maturation of the neutrophil is:
Blast- Promyelocyte- Myelocyte- Metamyelocyte- Band neutrophil- Segmented

Neutrophil
So the immediate precursor of a mature segmented neutrophil is the band form.
Classic automated blood cell counters are based on:

Laser scatter
Radio frequency
Light absorption
Impedance principle
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The Coulter or impedance principle became the industry standard in the early 1970s.
What is the MOST likely explanation for a patient with sickle cell anemia whose
hemoglobin has dropped to 4 g/dL and has a reticulocyte count of 0.1%
Increased hemolysis due to hypersplenism

Aplastic crisis
Thrombotic crisis
Occult blood loss
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An aplastic crisis is a transient cessation of bone marrow activity seen in sickle cell
anemia, which may be triggered by parvovirus B19 infection and/or folic acid
deficiency, and characterized by decreased production of reticulocytes. This causes
the anemia to become much worse as the blood cell counts and
hemoglobin/hematocrit fall dangerously low.
What would be a PROBABLE diagnosis for a habitual alcoholic with slight elevations
in the PT and APTT tests?
Lupus inhibitor
DIC
Platelet antibody
Liver disease
Feedback
Liver disease caused by alcoholism will lead to the ineffective production of vitamin
K dependent coagulation factors, which can cause slightly elevated PT or aPTT tests.
All of the following are characteristic findings in patients with iron deficiency anemia
EXCEPT:
microcytic, hypochromic red cell morphology

decreased serum iron level
decreased total iron-binding capacity (TIBC)
decreased ferritin
decreased hemoglobin
Feedback
Iron deficiency anemia, or IDA, is associated with an increased TIBC as there is less
iron to bind to transferrin. Microcytic, hypochromic red cell morphology, a decreased
serum iron level, a decreased serum ferritin level, and a decreased hemoglobin level
are all characteristics associated with IDA.
Which of the following factors does not affect the result of the aPTT assay?
Factor X
Factor IX
Factor VIII
Factor VII
Feedback
The aPTT is prolonged secondary to deficiency of factors of the intrinsic pathway,

specifically: prekallekrein, high-molecular-weight kininogen, Factors XII, XI, IX,
VIII, X, V, II, and I.
What is the platelet precursor cell found in the bone marrow?
megakaryocyte
megaloblast
myeloblast
pronormoblast
Feedback
Megakaryocytes are the precursors of platelets. A megaloblast is an abnormally large

erythroblast. A myeloblast is a precursor cell in the neutrophilic cell lineage. A
pronormoblast is another term for rubriblast and is a precursor cell in the red blood
cell lineage.
Aspirin (salicylic acid) affects platelet function by:
inhibiting cyclooxygenase
inhibiting lipids
inhibiting carbohydrates
activating nucleic acid
activating Factor VIII
Feedback
Aspirin, or acetylsalicylic acid, acts as an antithrombotic agent due to inhibition of
platelet function by acetylation of the platelet cyclooxygenase, also known as COX.
This prevents arachidonic acid from catalzying the reaction that allows for normal
coagulation, which results in an irreversible inhibition of platelet-dependent
thromboxane formation.
Which one of the following conditions is NOT associated with hereditary

spherocytosis?
Increased osmotic fragility

An MCHC greater than 37%
Intravascular hemolysis
Extravascular hemolysis
Feedback
Intravascular hemolysis does not occur when a patient is suffering from hereditary
spherocytosis. Instead, the spleen and liver often remove the spherocytes from
circulation; a process called extravascular hemolysis. In spherocytes, the MCHC is
increased due the the decreased surface to volume ratio of the red cell. In addition,
spherocytes have an increased osmotic fragility.
Which of the following would be the most characteristic finding in synovial fluid in a
case of pseudogout:
Monosodium urate crystals

Calcium pyrophosphate crystals
Macrophage infiltration
Mixed RBC/WBC infiltration
Feedback
Calcium pyrophosphate crystals are characteristic of pseudogout.

What procedure(s) would be acceptable to run on an EDTA specimen containing a

small clot?
platelet count only

ESR only
no procedures will be accurate
hemoglobin by cyanmet method
hematocrit if performed by manual method
Feedback
Any type of clot, whether microscopic, small, or large will cause erroneous results in
the hematology and coagulation laboratories.
A 1:100 dilution of a patient peripheral blood was made and 136 Platelets were
counted in 5 small RBC counting blocks of a Neubauer-ruled hemocytometer. What is
the Platelet count?
27 x 103/µL
68 x 103/µL
136 x 103/µL
680 x 103/µL
13.6 x 103/µL
Feedback
The general formula for calculating cellular elements on a Neubauer hemocytometer

is as follows:
Count = [(Dilution Factor) x (Cell Count)] ÷ (Area Counted mm3)
*note: area counted for RBC squares = (0.2mm x 0.2mm x 0.1mm) x 5 squares =
0.020mm3
Count = (100 x 136) ÷ (0.020) = 680,000/mm3 (or 680 x 103/ µL)
(Note: mm3 is the same volume as µL)
Which of the following tests is used to quantify a coagulation inhibitor?
Prothrombin time
Thrombin time
Mixing study
Bethesda assay
Feedback
The Bethesda assay is used to measure the titer and activity of the antibody present in
a patient's sample. Prothrombin time is an initial screening procedure for bleeding
disorders and a test used for monitoring anticoagulant therapy. A thrombin time is
used to detect heparin interference in an aPTT mixing study. A mixing study is
performed to detect the presence of a factor deficiency or coagulation inhibitor, but
does not quantify the result.
The INR (international normalized ratio) is calculated using the following formula:
INR=(PT patient / PT normal) raised to the _____.
ISI
15
Feedback
The correct answer is the ISI, or the International Sensitivity Index. Manufacturers
assign an ISI to each batch of thromboplastin reagent after comparing it to a "working
reference" reagent preparation. This working reference has been calibrated against an
internationally accepted standard reference preparations.
Which of the following tests may be used to confirm screening test results for a lupus
anticoagulant (or antiphospholipid antibody)?
activated partial thromboplastin time

prothrombin time
factor assays
Russell Viper Venom test
Feedback
Hexagonal Phase phospholipid tests, Platelet Neutralization tests, Thrombin Time

tests, Kaolin clotting time, tissue thromboplastin inhibition tests, dRVVT (Russell
viper venom test), and the detection of cardiolipin antibodies are all tests that can be
utilized to confirm the presence of lupus anticoagulant.
Which of the following methods is not used to detect and differentiate white blood
cells in most hematology analyzers:
Disruption of electrical current

Conductivity measurement using high frequency electromagnetic probe
Forward angle light scatter
Lysis of white cells with subsequent conversion to hemiglobincyanide followed
by colorimetric determination
Feedback
The hemiglobincyanide method is used to measure hemoglobin, not white cells.
Which hemoglobin can be decreased in alpha thalassemia?
Hb A
Hb A2
Hb F
Hb H
Feedback
Because alpha chains are needed to form all normal hemoglobins, and alpha
thalassemia is the decrease in production of alpha chains, all normal hemoglobins can
be decreased in alpha thalassemia: A, A2, and F.
How is the Mean Cell Volume calculated?

(Hemoglobin / Red blood cells) X 10
(Hemoglobin / Red blood cells) X 100
(Hematocrit %/ Red blood cells) X 10
(Hematocrit % X Hemoglobin) X 100
Feedback
The Mean Cell Volume, or the MCV, can be calculated by dividing the hematocrit by
the red blood cells and multiplying by 10. The MCV describes the volume, or size, of
the red blood cell population.
Reviewing a stained blood smear with the 10x objective is beneficial for what?
getting the overall picture of the blood cells

evaluating the quality of the blood smear
assessing the quality of the Wright’s stain
all of the above
Feedback
Using the 10x objective is helpful for all of the choices listed as this low objective
view will show to overall picture of the cells, the slide quality, and the quality of the
smear itself.

Abnormal granulation can be seen in the cytoplasm of leukocytes in which of the
following conditions?
Pelger-Huet anomaly
Alder anomaly
May-Hegglin anomaly
Chediak-Higashi anomaly
Feedback
Alder anomaly and Chediak-Higashi anomaly both present with abnormal granulation
in white blood cells.
Which of the following is NOT an expected or common laboratory finding in patients

with hereditary hemochromatosis (HH)?
Elevated hemoglobin and hematocrit

Elevated transferrin saturation
Presence of HFE mutation
Elevated serum ferritin
Feedback
Typical laboratory findings in HH include elevated transferrin saturation, elevated

serum ferritin, and presence of an HFE mutation. Elevated hemoglobin and
hematocrit are not typically associated with HH.

Hemoglobin H bodies are tetramers of which globin chain?
alpha
beta
delta
gamma
Feedback
Hemoglogin H is comprised of beta chain tetramers that form when insufficient alpha
chains are produced. These tetramers (Hemoglobin H bodies) are seen in alpha
thalassemia intermedia or Hemoglobin H disease.
In which of the following conditions might Cabot rings be observed in erythrocytes

on a Wright-stained peripheral blood smear?
Megaloblastic anemia
Moderate iron deficiency anemia
Lead poisoning
Multiple myeloma
Feedback
Cabot rings have been observed in megaloblastic anemia and lead poisoning. They
have also been observed in cases of severe anemia, leukemia, myelodysplastic
syndromes, and other cases of dyserythropoiesis.
They are not associated with moderate iron deficiency anemia or multiple myeloma.
Barr bodies are usually classified as:
Pathological
Reactive
Non-pathological
Feedback
Barr bodies are the drumstick-shaped inactive X-chromosome that is found attached
to a nuclear lobe of some granulocytes in peripheral blood smears from females. This
morphologic change is considered non-pathological.
In which organ or tissue do T-lymphocytes mature?
bone marrow
thymus
lymph nodes
spleen
Feedback
T-lymphocytes are created in the bone marrow, but develop in the thymus (hence their
name- "T" lymphocytes). B-lymphocytes are created and matured in the bone
marrow.
Which statement best describes the relationship between dietary iron and iron
absorption in a healthy individual?
Only a small percentage of dietary iron is absorbed and used.

All dietary iron is needed for hemoglobin and therefore absorbed.
Most people need to take dietary iron supplements to meet their needs for iron.
All dietary iron is absorbed and excess is stored.
Feedback
Due to iron recycling, only a small percentage of dietary iron is absorbed and used.
Which of the following stains is not routinely used when examining peripheral blood
smears ?
Wright
Romanowksy
Wright-Giemsa
May-Grunwaldt
Feedback
May-Grunwaldt stain is not routinely used for peripheral blood smears.
What causes the hemolysis associated with infection by malaria organisms?
Release of merozoites from erythrocytes

Invasion of erythrocytes by merozoites
Host’s immunologic response to infected erythrocytes
Toxins produced by the malarial organism
Feedback
After a malaria parasite infects a human host, the sporozoites infect hepatocytes,
where they multiply. Once in the liver, these organisms differentiate to the stage of
merozoites, infect red blood cells. Within the red blood cells, the parasites multiply
further while bursting out of the red blood cells to infect new red blood cells.

What is the approximate percentage of individuals in the US who are heterozygous
for HFE mutations?
0.05% to 0.10%
1% to 2%
10% to 12%
20% to 25%
Feedback
Approximately 10% to 12% of individuals in the US are heterozygous for HFE

mutations.
Match the characteristics with the cell type.
Your answers are on the left. The correct answers are on the right and highlighted.
Large Lymphocyte Cytoplasm indented by surrounding red cells

Large Lymphocyte May contain a few azurophilic granules
Band Neutrophil Light pink cytoplasm with many fine specific granules
Match the characteristics with the cell type.
Large Lymphocyte Cytoplasm indented by surrounding red cells
Large Lymphocyte May contain a few azurophilic granules
Band Neutrophil Light pink cytoplasm with many fine specific granules
What is the corrected white blood cell count if the WBC is 14,460, and there were 47
nucleated red blood cells per 100 white blood cells noted on the differential count?
6,796 wbc
9,837 wbc
10,165 wbc
21,256 wbc
28,920 wbc
Feedback
Corrected WBC count = uncorrected WBC count x (100 / NRBCs +100)
Corrected WBC count = 14,460 x (100/147) = 9,837
How does hemophilia A differ from hemophilia B?
Hemophilia A is an inherited disorder and hemophilia B is an acquired disorder.

The symptoms are drastically different.
Factor VIII is deficient in hemophilia A and factor IX is deficient in hemophilia
B.
Feedback
Hemophila A and B differ in that factor VIII is deficient in hemophilia A and factor
IX is deficient in hemophilia B. These two disorders are frequently described together
since they have similar clinical pictures and are both inherited coagulation disorders.
Their treatment is different in that the two types require synthetic factor VIII or IX
respectively amongst other treatment medications based on symptoms and bleeding
severity.
Which of the following tests is used to monitor therapy with unfractionated heparin?
Prothrombin time (PT)

Activated partial thromboplastin time (aPTT)
Fibrinogen assay
Platelet function assay
Feedback
The aPTT test is used to monitor therapy with unfractionated heparin.
Hemoglobin H bodies can directly alter the:

function of the spleen

bone marrow micro environment
rate of hemoglobin production
integrity of the RBC membrane
Feedback
When unstable hemoglobin is formed, such as Hemoglobin H in alpha thalassemia

intermedia, it precipitates close to the RBC membrane. The integrity of the membrane
is compromised when macrophages remove the precipitated tetramers out of the cell,
cells appearing "bitten" (schiztocytes).
Flow cytometry is not a useful tool in the study of this disorder:
HIV
Leukemia
Viral hepatitis
Lymphoma
Feedback
Viral hepatitis is diagnosed primarily by ELISA techniques.

The cells marked by blue arrows in the image below are associated with all of the
following conditions except:
Myelofibrosis
Hepatic cirrhosis
Thalassemia
Myelophthisis
Feedback
The intended response is hepatic cirrhosis.
Tear drop cells are formed in each of the disorders listed except in hepatic cirrhosis.
Tear drop red cells form when they squeeze through the narrow configurations of
fibrin strands in a clotting meshwork of the spleen and in marrow fibrosis. The
squeezing process and mechanical tampering destroys and molds the erythrocyte
membranes, resulting in tear drop formations.
In the accompanying photograph, the presence of the Howell-Jolly body (red arrow)
suggests splenic interventions; the spherocytes point to hemolysis.

An 8 year old boy presents with a 2 week history of high fevers and lethargy.
He has shown petechiae and bleeding gums for approximately 3 weeks. Upon
physical examination, the following was noted: Enlarged cervical lymph nodes, Pale
and febrile, Enlarged spleen. His laboratory results were the following:
Hgb = 6.3g/dl
Hct = 18.9%
RBC count = 2.89 x 109/L
WBC Count = 96 x 109/L
Platelet count = 23 x 109/L
Differential: 90% blasts, 5% bands, 5% neutrophils
BM aspirate > 90% blasts
What is this patient most likely suffering from?
Polycythemia vera
Chronic Leukemia
Acute Leukemia
Infectious Mononucleosis
Feedback
The correct answer is acute leukemia. Acute leukemia is associated with bone pain,
hepatosplenomegaly, and swollen lymph nodes. In addition, infections (causing
fevers) and bleeding are common. A high white blood cell count with many blasts in
the peripheral blood and bone marrow, along with a low platelet and rbc count are
also highly associated with this condition.
What is the pathophysiology (direct cause) of the iron overload in hereditary

hemochromatosis?
absorption of excessive amounts of iron in the small intestine

ingestion of excessive amounts of iron from diet or supplements.
inability of the body to excrete normal amounts of dietary iron
failure of the hematopoietic tissue to incorporate iron into hemoglobin
Feedback
The direct cause of iron overload in HH is absorption of excessive amounts of iron in

the small intestine.
Which of the following statements are FALSE regarding the bone marrow BIOPSY
specimen?
Bone marrow cellularity can be accurately determined

Cellular morphologic detail can be determined.
Bone marrow architecture can be examined
Bone marrow biopsy can be performed with a syringe
Feedback
Both B and D are the correct choices for this question as they are both false. Cellular
morphologic detail CANNOT be determined via bone marrow biopsies and bone
marrow biopsies ARE NOT performed with a syringe, as both bone and marrow are
sampled during the biopsy procedure using a longer, thicker needle (without syringe).
Match each anemia listed below with the mechanism for the anemia.
Aplastic anemia Defective stem cell production

Thalassemia Interruption of hemoglobin production
Megaloblastic anemia Interruption of DNA Synthesis
Anemia associated with chronic renal Interruption of development of precursor
disease cells
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Defective stem cell production results in the development of aplastic anemia.

Interruption of hemoglobin production results in thalassemia.
Interruption of DNA synthesis results in the development of a megaloblastic anemia.
Interruption in the development of precursor cells is an anemia that is caused by
chronic renal disease.
What is the normal cellularity of an iliac crest bone marrow biopsy in a 50 year old
male:
20%
35%
50%
65%
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The normal cellularity decreases by about 10% for each decade of life over the age of
50.
Which abnormal hemoglobins may be formed in alpha thalassemia?

Hb Bart's
Hb Lepore
Hb E
Hb H
Hb O
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In alpha thalassemia intermedia or Hemoglobin H disease, insufficient alpha chains

are produced. The remaining globin chains often form tetramers.
In neonates the gamma chain is present in high amounts, forming tetramers known as
Bart's hemoglobin. As gamma chain production decreases, beta chain production
increases. Adults form beta chain tetramers (Hemoglobin H).
Blood samples for complete blood counts are collected on morning rounds and stored
in a rack in the phlebotomist's basket. When the phlebotomist delivers the samples to
your work station, the cells and plasma in the samples have separated. One of the
samples has lipemic plasma. Which of the following parameters may be affected by
the lipemia?
RDW
MCV
MCHC
None of the parameters would be affected
Feedback
The MCHC may be affected by lipemia as well as hemolysis, and red cell
agglutination. The photometric measurement of the hemoglobin may be affected by
the lipemia, which would then impact the MCHC calculation.
MCV is a measurement of red cell volume and not impacted by lipemia.
RDW is a measurement of red cell size and not impacted by lipemia.
What is a prominent morphologic feature of lead poisoning:
Basophilic stippling
Hypersegmentation
Macrocytosis
Target cell
Feedback
Basophilic stippling is strongly associated with lead poisoning the lead toxicity can
affect the bone marrow; causing this phenomenon.
Match the erroneous automated platelet count result caused by the corresponding
conditions below.
Spurious increase Cryoglobulin, cyrofibrinogen

Spurious increase White cell fragments, Hemolysis
Spurious decrease Clotting, Platelet satellitosis
Spurious decrease Platelet clumping
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Spurious increase: Cryoglobulin, cyrofibrinogen, White cell fragments, Hemolysis
Spurious decrease: Clotting, Platelet satellitosis, Platelet clumping
The beta hemoglobin chain loci are found on which chromosome?
Chromosome 11
Chromosome 16
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The beta hemoglobin chain loci are found on chromosome 11. Alpha and zeta
hemoglobin loci are found on chromosome 16.
T lymphocytes are characterized by all of the following functions EXCEPT which?
Secrete cytokines
Synthesize antibody
Comprise majority of cells in blood lymphocyte pool
Help regulate immune response
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T lymphocytes perform all of the listed functions EXCEPT synthesizing antibodies. B

lymphocytes actually synthesize antibodies. T lymphocytes secrete cytokines,
comprise the majority of cells in the lymphocyte pool and help regulate immune
response.
A small clot in a tube drawn for a CBC would have the MOST effect on which one of
the following tests?
RBC
WBC
Hematocrit
Platelet count
Hemoglobin
Feedback
Small clots are actually platelet clumps and fibrin strands. Therefore, the platelet
count will be falsely decreased as hematology analyzers would not be able to count
the individual platelets in the clump.

Which of the following constitutes the alpha hemoglobin chain coding?
Two gene loci; one each on chromosome 11.

Four gene loci; two each on chromosome 11.
Two gene loci; one each on chromosome 16.
Four gene loci; two each on chromosome 16.
Feedback
Humans need four gene loci that code for the alpha hemoglobin chain, in order to
make their full component of normal hemoglobins. Two alpha chain gene loci are
found on each chromosome 16.
The same staining protocol can be used for bone marrow smears as is used for
peripheral blood smears.
True
False
Feedback
Bone marrow smears are much more cellular and require additional contact time in
both stain and buffer. They should not be processed in exactly the same way as
peripheral bloods.

Match the descriptions below with their corresponding cell types:
Lymphocyte Pale blue cytoplasm. Nucleus may be oval or indented.

Monocyte Blue-gray opaque cytoplasm. Nucleus may have
convolutions.
Segmented Light pink cytoplasm with fine granules. Nucleus with 2-5
Neutrophil lobes.
Eosinophil Colorless cytoplasm with large red refractile granules.
Feedback
Lymphocyte: Pale blue cytoplasm with azurophilic granules. Nucleus may be oval or
indented.
Monocyte: Blue-gray opaque cytoplasm. Nucleus may have convolutions.
Segmented Neutrophil: Light pink cytoplasm with fine granules. Nucleus with 2-5
lobes.
Eosinophil: Colorless cytoplasm with large red-orange refractile granules.
A patient with a history of frequent mild bleeding episodes has the following results:
Normal PT
Prolonged aPTT corrected by normal plasma during mixing studies
Which of the following could be a possible cause of the initial aPTT prolongation?
factor VII deficiency

factor IX deficiency
factor V deficiency
a circulating inhibitor is present
Feedback
The deficiency of factor IX would cause an abnormal initial aPTT result and would
also correct upon mixing with normal pooled plasma. If the mixing of normal pooled
plasma results in the "normalizing" of the aPTT result, then a factor deficiency is
present and there is no circulating inhibitor present. Factor VII is involved in PT
testing, which would not be the cause of prolongation in this case. Factor V is
involved in both PT and aPTT testing; therefore in this case, could not be the cause as
the PT is normal.

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You answered the question correctly.

Which of the following is a genetic platelet disorder characterized by giant platelets,

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Bernard-Soulier syndrome is characterized by giant platelets, abnormal screening tests

Question Difficulty: Level 5

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First, determine the number of WBC's from the hemocytometer as follows:

So: (2.5 x 103 WBC/uL) x (106 uL/L) = 2.5 x 109 WBC/L

Question Difficulty: Level 8

You answered the question incorrectly.

The correct answer is highlighted below

Question Difficulty: Level 6

You answered the question incorrectly.

Which of these methods could be used to differentiate between Howell-Jolly bodies

Wright-Giemsa stain: Pappenheimer bodies stain blue but Howell-Jolly bodies

Question Difficulty: Level 9

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The correct answers are highlighted below

Make smears from samples delivered by clinicians.

Question Difficulty: Level 6

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Which of these blood levels will increase during hemolysis?

The correct answer is highlighted below

Hemolysis is characterized by increased levels of Serum (plasma) LDH and bilirubin,

Question Difficulty: Level 6

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Which of the following is not true in terms of platelet characteristics?

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Produced in the bone marrow by megakaryocytes.

Question Difficulty: Level 5

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The correct answer is highlighted below

Question Difficulty: Level 5

Question Difficulty: Level 3

Question Difficulty: Level 4

You answered the question correctly.

The correct answer is highlighted below

((# of Cells Counted X Dilution Factor X Depth Factor) / (# of Square Millimeters

Average of 256 + 224 = 240

So... 240 cells x 20 x 10 / 4 = 12,000

Corrected WBC count calculation = uncorrected WBC count x 100 / # of NRBCs

So... 12,000 x 100 / 25 + 100 = 9,600

Question Difficulty: Level 6

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Rouleaux is strongly associated with abnormally increased erythrocyte sedimentation

Question Difficulty: Level 4

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The expected life span of a normal red blood cell is:

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Question Difficulty: Level 4

How does hydroxyurea aid in the treatment of sickle cell disease?

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Acts as an analgesic in pain management.

Question Difficulty: Level 7

You answered the question correctly.

In HbSS blood, an increased amount of which of the following surface antigens on

The correct answer is highlighted below

CD3, CD4, and CD8 are all associated with T-lymphocytes.

Question Difficulty: Level 6

Newborns who will develop Hemoglobin H disease may demonstrate up to 30% of

The correct answer is highlighted below

Question Difficulty: Level 5