Hematology 2

You answered the question incorrectly.
Which of the following actions would be appropriate for the investigation of an

initially prolonged PT test? (Choose all that apply)
The correct answers are highlighted below
Check for clots in the sample

Check patient history
Check for anticoagulant therapy
Immediately cancel the test and request a new sample
Feedback
The first steps in determining the cause of prolongation should always be to check the
sample integrity, check the patient history for liver disease or other coagulation
disorders, and ensure the patient is not receiving anticoagulant therapy. Sample
integrity includes pre-analytical factors such as clotting of the sample, hemolysis, not
enough specimen, etc. Specifically, clots in the sample would conclude that
coagulation factors have been consumed during the clotting process, allowing for
decreased levels present to participate in the actual test reaction. This causes a false
prolongation of the result. Canceling the PT test without investigation of the cause of
prolongation is not advised as the patient may have an underlying problem that
garners further investigation from the laboratory.
Question Difficulty: Level 5
You answered the question correctly.
CD5 antigen is normally found on which of the following lymphocyte populations?
The correct answer is highlighted below
Mature T cells
Normal B cells
Both mature T cells and normal B cells
Feedback
CD5 is present on mature T cells, but is not present on normal B cells. The presence
of CD5 on B cells may indlcate a B cell malignant process.
All helper cells are T cells. Consequently, in a normal lymphocyte population, it is

reasonable to expect all CD4-positive cells to be CD3-positive as well. True or False?
True
False
Feedback
If CD3 marks all normal mature T cells and if CD4 marks T-helper cells (which are
mature T cells), then one would expect all CD4 positive cells in the gated lymphocyte
population to also be CD3 positive.
All of the following will cause a falsely decreased erythrocyte sedimentation rate
EXCEPT:
ESR tube is slanted

EDTA tube is clotted
EDTA tube is one-third full
EDTA specimen is 24 hours old
Feedback
Tilting of the westergren tube accelerates the fall of the erythrocytes which can cause
a falsely elevated ESR. Fibrin clots, diluted samples, and old samples can give a
falsely decreased ESR result.
Which of the following represents the percent population of T-helper cells in this
sample data?
absolute lymphocyte count= 2.4 x 109/L
%CD3 = 60
%CD4 = 40
%CD8 = 20
60%
40%
20%
Feedback
T-helper cells are CD4 positive. The flow results reflected 40% CD4.
CD3 is a pan T cell marker (and should reflect CD4 plus CD8).
CD8 is the cytotoxic/suppressor T cell marker.

Found frequently in a newborn's blood the cells indicated by arrow in this illustration
are:
Band
Small lymphocytes
Metamyelocytes
Nucleated red cells
Feedback
Not normally seen in the peripheral blood of adults, but are often seen in the blood of
newborns.

Identify the nucleated blood cell:
Lymphocyte
Neutrophil
Band form
Monocyte
Eosinophil
Basophil
What morphological change is present in the image indicated by the arrow?
Barr bodies
Slight toxic granulation
Hypersegmented nucleus
Hyposegmented
Feedback
The neutrophil in this image is demonstrating hypersegmentation. Hypersegmentation

is defined as a nucleus containing more than 5 lobes.
Which FAB designation is called the “true” monocytic leukemia and is characterized
by monoblasts, promonocytes, and monocytes?
FAB Ml
FAB M3
FAB M4
FAB M5
Feedback
FAB M5 is acute monoblastic leukemia
FAB M1 is acute myeloblastic leukemia without maturation
FAB M3 is acute promyelocytic leukemia
FAB M4 is acute myelomonocytic leukemia
Disseminated intravascular coagulation (DIC) is associated with all of the following

clinical conditions except:

Septicemia
Obstetric emergencies
Intravascular hemolysis
Thrombocytosis
Feedback
Disseminated intravascular coagulation (DIC) is a thrombohemorrhagic disorder

involving the generation of intravascular clots with the consumption of coagulation
factors/proteins and platelets. This condition is characterized by intravascular
coagulation and hemorrhage with a DECREASED platelet count. DIC is most
commonly observed in severe sepsis and septic shock. It is also associated with
obstetric complications such as amniotic fluid embolism, abruptio placentae,
hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome/eclampsia, as
well as other conditions and disease states.
Which group of conditions INCREASES the risk of HbS polymerization?
Acid pH, dehydration, decreased level of 2,3-DPG

Alkaline pH, dehydration, increased level of 2,3-DPG
Acid pH,dehydration, increased level of 2,3-DPG
Alkaline pH,dehydration, decreased level of 2,3-DPG
Feedback
The risk of HbS polymerization is enhanced by a low (acid) pH, a state of

dehydration, and increased levels of 2,3-DPG. Increased temperature (above 37°C)
also adds to the risk.

Which one of the following determinations is MOST reliable for evaluating bone
marrow activity?
Hemoglobin
Reticulocyte count
Platelet count
Hemolytic index
Feedback
Reticulocyte counts evaluate the activity of the bone marrow; as the bone marrow is
attempting to recover from an abnormal hematological state, there are more
reticulocytes produced. Retic counts are often used to evaluate the effectiveness of
therapy for stimulating the bone marrow.
A 2-year-old girl showed multiple bruises and had the following laboratory findings:
Hgb 13.5 mg/dl

RBC= 3.9 million/ cu mm
WBC= 8,000/cu mm
Platelets= 5,000/cu mm
Bone marrow= M: E ratio = 3:1
Megakaryocytes= increased
These results are MOST suggestive of which condition?
Glanzman thrombasthenia
Aldrich syndrome
Idiopathic thrombocytopenia purpura
Thrombotic thrombocytopenia purpura
Feedback
Peak prevelance of ITP occurs in children 2-4 years, while TTP occurs more often in
adults. The platelet count is low, but unaffected in Glanzman thrombasthenia. We can
reasonably rule out Aldrich syndrome since this is a little girl, and the overwhelming
majority of patients with this disease are male.
Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are

called:
Heinz bodies
Howell-Jolly bodies
Basophilic stippling
Pappenheimer bodies
Feedback
Howell-Jolly bodies are composed of DNA, usually left from the nucleus, that appears
as a round, dark-staining inclusion in the cytoplasm of red blood cells. Howell-Jolly
bodies can be found in various conditions including splenectomy and anemia.

Which of the following conditions would be associated with an increased osmotic

fragility test result?
hereditary spherocytosis
iron deficiency anemia
sickle cell anemia after splenectomy
chronic liver disease
thalassemia
Feedback
Hereditary spherocytosis is associated with increased osmotic fragility, while the

other four choices are actually associated with decreased osmotic fragility.
Identify the cell in this illustration indicated by the arrow:

Metamyelocyte
Segmented neutrophil
Lymphocyte
Monocyte
Feedback
Lymphocytes are generally the smallest normal WBC seen in the peripheral blood.
Hypochromia can best be described as:
Immature red blood cells

Abnormal erythropoiesis
Increase in nucleated RBCs
Decrease in Hgb concentration in RBCs
Feedback
Hypochromia is characterized on the peripheral blood film by an increase in central

pallor of red cells. In normal red cells, the area of central pallor is limited to the
middle third of the red cell; it is enlarged in hypochromia.
In which age group is hereditary hemochromatosis (HH) most likely to be initially

detected based on clinical symptoms?
Middle aged adults

Young adults
School age children
Infants
Feedback
Most patients with HH become symptomatic during middle age.
What is the Wright-Giemsa stain used for MOST often in laboratory science?
peripheral & Cytospin smears

bone marrows
urinalysis
gram stains
Feedback
Wright-Giemsa stains are commonly used in the hematology laboratory for peripheral
and cytospin blood smears to identify and quantitate blood cells.
Which of the following cells are capable of producing antibodies and lymphokines:
Thrombocytes
Macrophages
Lymphocytes
Granulocytes
Feedback
Lymphokines are biologically active molecules produced by lymphocytes in response

to specific stimulants.
The alkaline hemoglobin electrophoresis pattern that is shown on the right includes
controls for A, S, and C; and A and F above and below the patient results. (NOTE:
ASC and AF are simply labels for the controls and do not indicate order of
migration.) The patient was tested in duplicate and the results are in lanes 3 and 4.
The patient lanes (3 and 4) displayed in these hemoglobin electrophoresis patterns are
consistent with what diagnosis?
HbSA
HbSC
HbSD
HbS/HPFH
Feedback
This alkaline hemoglobin electrophoresis shows nearly equal bands in the "S" and "F"
positions.
Lymphocyte
Neutrophil
Band form
Monocyte
Eosinophil
Basophil

Nitric oxide is associated with the prevention of vaso-occlusion by decreasing cellular

aderence to endothelium. Which amino acid is DECREASED in patients with sickle
cell disease and is needed as a substrate to produce nitric oxide?
L-arginine
L-glutamine
L-lysine
L-tyrosine
Feedback
The amino acid, L-arginine is a substrate needed to produce nitric oxide.
Where is the main site of action for monocytes after diapedesis?
Peripheral blood
Body tissues
Bone marrow
Digestive tract
Feedback
The main site of action for monocytes is body tissues after diapedesis. Monocytes
function in the immune system by responding to inflammation signals and moving to
sites of infection in the tissues. There monocytes divide and differentiate into
macrophages and dendritic cells to elicit an immune response.

Where is the main site of action for monocytes after diapedesis?
Peripheral blood
Body tissues
Bone marrow
Digestive tract
Feedback
The main site of action for monocytes is body tissues after diapedesis. Monocytes
function in the immune system by responding to inflammation signals and moving to
sites of infection in the tissues. There monocytes divide and differentiate into
macrophages and dendritic cells to elicit an immune response.
Granulocytes include neutrophils, basophils and platelets.
True
False
Feedback
Platelets are not considered granulocytes as they are not white blood cells.

Lymphocyte
Neutrophil
Band form
Monocyte
Eosinophil
Basophil
A laboratory professional is going to perform a mixing study to differentiate between

a factor deficiency and a coagulation inhibitor as the cause of a prolonged
prothrombin time (PT) or activated partial thromboplastin time (aPTT) test result. The
mixing study should be performed within what time frame following collection of the
specimen?
4 hours
8 hours
24 hours
48 hours
Feedback
A mixing study should be performed within 4 hours of specimen collection.
Performing a mixing study will help to differentiate between a factor deficiency and a
coagulation inhibitor as the cause of a prolonged prothrombin time (PT) or activated
partial thromboplastin time (aPTT) test result.
A mixing study is performed by mixing the patient plasma that has a prolonged PT or
aPTT with normal pooled plasma. A PT and/or aPTT is then retested on the mixed
sample.
If the cause of the prolonged PT and/or aPTT is a factor deficiency, or multiple factor
deficiencies, the normal pooled plasma will increase the factor levels to the point of
correcting the prolonged test result. However, the addition of normal pooled plasma
will not correct the prolonged test result if the cause is a coagulation inhibitor.
A laboratory professional is going to perform a mixing study to differentiate between

a factor deficiency and a coagulation inhibitor as the cause of a prolonged
prothrombin time (PT) or activated partial thromboplastin time (aPTT) test result. The
mixing study should be performed within what time frame following collection of the
specimen?
4 hours
8 hours
24 hours
48 hours
Feedback
A mixing study should be performed within 4 hours of specimen collection.
Performing a mixing study will help to differentiate between a factor deficiency and a
coagulation inhibitor as the cause of a prolonged prothrombin time (PT) or activated
partial thromboplastin time (aPTT) test result.
A mixing study is performed by mixing the patient plasma that has a prolonged PT or
aPTT with normal pooled plasma. A PT and/or aPTT is then retested on the mixed
sample.
If the cause of the prolonged PT and/or aPTT is a factor deficiency, or multiple factor
deficiencies, the normal pooled plasma will increase the factor levels to the point of
correcting the prolonged test result. However, the addition of normal pooled plasma
will not correct the prolonged test result if the cause is a coagulation inhibitor.
This drawing depicts which beta chain genotype ?
Beta thalassemia minor

Beta thalassemia intermedia
Beta thalassemia major
Delta-beta thalassemia minor
Feedback
This drawing depicts beta thalassemia minor B+/B. In Beta thalassemia minor B+/B,
one beta gene locus is partially deleted or inactive.
The dissolution of a clot with 5 M urea indicates which one of the following factor
deficiencies?
Factor II
Factor XIII
von Willebrand disease
Lupus anticoagulant
Factor IX
Feedback
Factor XIII is used to stabilize the final fibrin clot. If the factor XIII is dysfunctional
or found in decreased levels, fibrin clots will dissolve in the laboratory when 5M urea
is added. In normal patients with normal factor XIII, the clot will not dissolve.
Which of the following conditions can produce a normal APTT and a prolonged PT?
Factor IX deficiency
Factor VII deficiency
Factor VIII deficiency
Factor X deficiency
Feedback
Only the factor VII would cause and increase only in the PT result as factors IX and
VIII are tested only in the aPTT test and factor X is tested for in both tests.
Which of the following conditions can produce a normal APTT and a prolonged PT?
Factor VIII deficiency
Factor X deficiency
Feedback
Only the factor VII would cause and increase only in the PT result as factors IX and
VIII are tested only in the aPTT test and factor X is tested for in both tests.
Which of these white blood cell populations would have the MOST side scatter when
analyzed using flow cytometry?
Monocytes
Lymphocytes
Granulocytes
Feedback
Granulocytes are the most granular population; they have the most side scatter of the
cell populations that are listed.
Match the descriptions with the cells.
Your answers are on the left. The correct answers are on the right and highlighted.
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.
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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.

The red cells indicated by the arrows in this image exhibit which of the following
abnormal erythrocyte shapes?
Acanthocytes
Schistocytes
Spherocytes
Stomatocytes
Feedback
Stomatocytes have a slit like appearance in the area of central pallor - many chemical
agents may cause this abnormality.
The predominant cells seen on the CSF smear in this illustration are indicative of:

Normal cytocentrifuged smear
Viral meningitis
Bacterial meningitis
Fungal infection
Feedback
Intracellular bacteria within neutrophils are indicative of bacterial infection.
Which of the following is a general term describing variation in red cell size?
Anisocytosis
Macrocytosis
Microcytosis
Poikilocytosis
Feedback
The term used to describe variation in red blood cell size is anisocytosis.
Macrocytosis describes an increase in red cell size. Microcytosis describes a decrease
in red cell size. Poikilocytosis describes variation in red blood cell shape.
Case Study
The image on the right is representative of the peripheral blood smear from a five-
month-old immigrant from Asia. Her mother was concerned that the child was not
eating well. Her spleen was palpable.
These blood count results were reported:
Parameter Patient Result Reference Interval

RBC 5.5 x 1012/L 3.1 - 4.5 x 1012/L
Hgb 9.6 g/dL 9.5 - 13.5 g/dL
HCT 30.4% 29- 41%
MCV 55.4 fl 74 - 108 fl
MCH 17.5 pg 25 - 35 pg
MCHC 31.6 g/dL 30 - 36 g/dL
RDW 34.9% 11 - 15%
Reticulocyte 10.9% 0.5 - 4.0%
Knowing that the family is from a region of Thailand where HbE carriers are
prevalent, the physician ordered a hemoglobin electrophoresis. The hemoglobin
electrophoresis detected HbE.
Based on the blood count results and this representative microscopic field, which of
the following peripheral blood findings should be reported?

Microcytes (microspherocytes)
Macrocytes
Sickle cells
Target cells
Nucleated red blood cells
Parasitic inclusions
Feedback
Peripheral blood smear findings of microcytes or microspherocytes, target cells, and

nucleated red blood cells should be reported. Macrocytes are not present. The MCV
result correlates with a finding of microcytes. A few red blood cell fragments may be
seen, but sickle cells are not present. The inclusion that is noted in this field is a cell
nucleus in a nucleated red blood cell and not a blood parasite.
Homozygous hemoglobin E is common in Southeast Asia and presents with very mild
anemia and seldom requires transfusion. Over 30 million people in the world are HbE
carriers, making this abnormal hemoglobin almost as common as HbS. Hemoglobin E
is uncommon in North America and in Europe, but with changing immigration
patterns, Hb E cannot be ignored.
Clinically, a very important and severe syndrome is hemoglobin E/beta thalassemia in which
there is hemolysis requiring repeated transfusions. The patient has a severe anemia, low
MCV, and high RBC. This is characteristic of Hgb E/beta thalassemia.

Case Study
The image on the right is representative of the peripheral blood smear from a five-
month-old immigrant from Asia. Her mother was concerned that the child was not
eating well. Her spleen was palpable.
These blood count results were reported:
Parameter Patient Result Reference Interval

RBC 5.5 x 1012/L 3.1 - 4.5 x 1012/L
Hgb 9.6 g/dL 9.5 - 13.5 g/dL
HCT 30.4% 29- 41%
MCV 55.4 fl 74 - 108 fl
MCH 17.5 pg 25 - 35 pg
MCHC 31.6 g/dL 30 - 36 g/dL
RDW 34.9% 11 - 15%
Reticulocyte 10.9% 0.5 - 4.0%
Knowing that the family is from a region of Thailand where HbE carriers are
prevalent, the physician ordered a hemoglobin electrophoresis. The hemoglobin
electrophoresis detected HbE.
Based on the blood count results and this representative microscopic field, which of
the following peripheral blood findings should be reported?
Microcytes (microspherocytes)
Macrocytes
Sickle cells
Target cells
Nucleated red blood cells
Parasitic inclusions
Feedback
Peripheral blood smear findings of microcytes or microspherocytes, target cells, and

nucleated red blood cells should be reported. Macrocytes are not present. The MCV
result correlates with a finding of microcytes. A few red blood cell fragments may be
seen, but sickle cells are not present. The inclusion that is noted in this field is a cell
nucleus in a nucleated red blood cell and not a blood parasite.
Homozygous hemoglobin E is common in Southeast Asia and presents with very mild
anemia and seldom requires transfusion. Over 30 million people in the world are HbE
carriers, making this abnormal hemoglobin almost as common as HbS. Hemoglobin E
is uncommon in North America and in Europe, but with changing immigration
patterns, Hb E cannot be ignored.
Clinically, a very important and severe syndrome is hemoglobin E/beta thalassemia in which
there is hemolysis requiring repeated transfusions. The patient has a severe anemia, low
MCV, and high RBC. This is characteristic of Hgb E/beta thalassemia.
A manual white blood cell count was performed by the hematology technologist. The
cell counts for both sides were 38 and 42 respectively. All nine large squares were
counted on each side. The dilution for this kit was pre-measured at 1:10. What should
the technologist report as the white cell count?
4.8 x 10^9/L
4.4 x 10^9/L
.48 x 10^9/L
0.44 x 10^9/L
Feedback
Calculation:
Cells Counted (in this case the average of both sides) X dilution factor (in this case
10) / # of sqaures counted (in this case 9) X 0.1mm (depth of solution) X area of each
square (1mm2)
So, in this problem:
(40 x 10) / (9 x 1mm2 x 0.1mm) = 444.4/mm3 (can be converted to 0.44 x 109/L)
Please identify the illustrated leukocyte.
Monocyte
Lymphocyte
Basophil
Eosinophil
Platelet
Feedback
The cell in the image on the right is a segmented neutrophil. It is characterized by its 2
- 5 nuclear lobes that are connected by thread-like filaments. The cytoplasm is pale
and contains secondary (specific) granules as opposed to the azurophilic (primary)
granules seen in earlier cells of the myeloid cell line.
What is the correct procedure when using a winged collection device (butterfly) to
draw a light-blue top tube intended for a coagulation test if this is the first tube that
will be collected in the draw?
Draw and discard a red-top tube that only contains an additive for clot activation
before collecting the light-blue top tube that will be used for coagulation studies.
Draw and discard a waste light-blue top tube before the tube that will be used for
coagulation studies.
Draw only the light-blue top tube that will be used for coagulation studies and
then perform a second venipuncture for additional tubes.
There is no correct procedure because a winged collection device cannot be used
for collecting specimens for coagulation studies.
Feedback
A winged blood collection device (butterfly) can be used for collecting a specimen for
coagulation studies, but a waste tube must be drawn first. The waste tube is drawn
first to remove the air in the tubing of the winged collection device. The waste tube
must also be a light-blue top tube or a tube that contains no additives or
anticoagulants. A red-top tube that contains a clot-activator cannot be used.
Once blood flows through the tubing, the waste tube can be removed and discarded.
The waste tube does not need to be completely filled. If the air is not displaced from
the tubing into a waste tube, it will be drawn into the tube used for testing and cause a
short-fill of the tube. An inadequately filled tube will alter the required blood-to-
anticoagulant ratio needed for coagulation studies, thus adversely affecting results.
A tube that contains an additive or anticoagulant other than sodium citrate (the
anticoagulant present in light-blue top tubes) must not be used as the waste tube.
Additional tubes can be collected, using the proper order of draw, after the
coagulation tube has been drawn. A separate venipuncture is not required.
The M:E ratio in chronic myelocytic leukemia is usually:
Normal
High
Low
Variable
Feedback
The normal M:E ratio in the bone marrow is 2:1 - 4:1. However, in CML, the M:E
ratio is usually >5:1 and can reach 20:1 or greater.

This image is from a patient with alpha thalassemia. Though not diagnostic for this
condition, what morphology is present which would lead you to consider the presence
of globin chain tetramers?
basophilic stippling
codocytes (targets)
ovalocytes
schistocytes (fragments)
Feedback
Though not diagnostic for alpha thalassemia, schistocytes (fragmented RBCs) indicate
that there is one of several forms of red blood cell destruction occurring. The RBCs
may be fragmented due to the damage caused by the presence of hemoglobin
tetramers.

If a patient's WBC is 50,000/mm3, what test should be ordered to determine if this is

a leukemoid reaction or a chronic myelocytic leukemia?
Peroxidase stain
Sternheimer stain
Leukocyte alkaline phosphatase stain
Sudan Black B stain
Feedback
Leukocyte alkaline phosphatase (LAP) stain is used to differentiate chronic

myelocytic (myelogenous) leukemia (CML) from leukemoid reactions. The LAP
score is calculated and is high in reactive states, such as leukemoid reactions, but is
low in CML.
What principle(s) of flow cytometry are employed when performing

immunophenotyping:
Defraction gradients
Impedance
Defraction gradients and impedance
Fluorescent antibody tagging and light scatter
Feedback
Flow cytometry employs a combination of fluorescent antibody tagging of cells and
analysis with laser light scatter.
Hemophilia A is associated with a deficiency in which coagulation factor:
Factor IX
Factor VIII
Factor X
Factor V
Feedback
Hemophilia A is a sex-linked recessive disorder characterized by deficiency of Factor

VIII. It is the most frequent congenital coagulation disorder.

A women in labor is bleeding, has a very high fever, and is in danger of losing the
fetus. Laboratory results include a platelet count of 15 x 109/L (normal platelet count
= 150 - 450 x 109/L), prolonged PT and aPTT, decreased fibrinogen, and increased D-
dimer. Her automated blood count flagged for blood smear review, and the cells
indicated by the arrows were seen on her peripheral smear along with a decrease in
the number of platelets present. What condition is suggested by these results?
Thrombotic thrombocytopenic purpura (TTP)

Hemolytic uremic syndrome (HUS)
Disseminated intravascular coagulation (DIC)
Feedback
As we can see from this patient's laboratory test results, her D-dimer is elevated, her
PT and aPTT are prolonged, her fibrinogen and platelet count are dramatically
decreased. This is a classic profile for DIC. Thrombocytopenia and the presence of
schistocytes on the peripheral blood smear are also associated with TTP and HUS, but
the abnormal D-dimer and coagulation tests point to DIC.
Which of the following may interfere with the accurate measurement of hemoglobin:
Leukocytosis
EDTA
Heparin
Leukocytosis and lipemia
Feedback
Anything that can cause significant turbidity in a blood sample, such as high
leukocyte count or lipemia can potentially interfere with the accuracy of a
spectrophotometric hemoglobin assay.
A known sickle cell trait patient has a hemoglobin electrophoresis test performed.
Which of the following hemoglobin percentage sets would most closely match this
patient's diagnostic state?
Hgb A = 90%, Hgb S = 8%, Hgb A2 = 2%, Hgb F = 0%

Feedback
The correct set of patient data would be: Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%,
Hgb F = 0%
Patients with sickle cell trait commonly have Hgb A values between 40 and 60%, Hgb
S values between 20 and 40% and Hgb A2 values between 2 and 3%.

Hemophilia A, hemophilia B, and Von Willebrand's disease together constitute

approximately what percentage of all hereditary coagulation disorders:
90%
80%
60%
40%
Feedback
Hemophilia A represents about 80% of hereditary coagulation disorders and is 10

times more prevalent than hemophilia B.
A teenage boy is visiting his doctor under the suspicion of a viral illness. He has
always been relatively healthy without many illness-related complaints. The doctor
decides to order a laboratory workup including a complete blood count. A peripheral
blood smear is reviewed. The image on the right is a representative field, with a
predominance of the arrowed cells throughout the smear. Which of the following
conditions would be most consistent with this patient's history and peripheral blood
picture?
Hereditary Spherocytosis
Hereditary Stomatocytosis
Hereditary Elliptocytosis
Feedback
The correct response is hereditary elliptocytosis. This particular condition is

associated with very few patient symptoms. In fact, many individuals do not know
that they have the condition until a routine blood smear review reveals the
overwhelming presence of elliptocytes.
This peripheral smear is not consistent with hereditary spherocytosis or
stomatocytosis, as these conditions would show their own distinct red blood cell
morphology. In hereditary spherocytosis, there is a predominance of spherocytes,
which are not present in this peripheral smear. The same concept applies to hereditary
stomatocytosis, with the predominance of stomatocytes.

This image represents a field of red blood cells (RBCs) that were stained using a
supravital stain. How would these cells appear if they were viewed on a Wright
stained smear?
Polychromatophilic RBCs
RBCs containing basophilic stippling
RBCs containing Cabot's rings
RBCs containing Pappenheimer bodies
Feedback
The cells containing blue particulates in this image are classified as reticulocytes
when using supravital stain. When using Wright stain, the cells would appear larger
and a bit bluer, a key indication of reticulocytes; these cells would be described as
polychromatophilic RBCs on Wright stained smears.
Match the form of red blood cell inclusions in each of the images with a
corresponding clinical condition.
Hereditary sideroblastic anemia Frame A

Autoimmune hemolytic anemia Frame B
Recurrent fever Frame C
Postsplenectomy syndrome Frame D
Feedback
In Frame A are Pappenheimer bodies, appearing as tiny blue-staining bodies in

Wright-stained smears (confirmed with an iron stain), often in pairs and more
commonly at the periphery of the cell characteristically found in sideroblastic anemia.
The erythrocyte marked by a blue arrow in Frame B displays very finely granular
basophilic stippling, as found in autoimmune hemolytic anemias. The red blood cell
inclusion in Frame C is a plasmodium ring form of Falciparium malaria and
associated with recurrent fever. In Frame D are erythrocytes containing Howell-Jolly
bodies remaining in the circulation after splenectomy.
Monoclonal antibodies are designed to bind to all antigens on cell surfaces.
True
False
Feedback
The statement is false.
Monoclonal antibodies are designed to bind only to specific matching antigens. This
principle is what allows for sorting of individual cell lines and populations within a
sample containing a mix of different types of cells.
Leukemias and lymphomas can be diagnosed and staged using monoclonal antibodies
that are specific to their correlating antigens.

Which one of the following anticoagulants is used most commonly for most
coagulation studies?
Potassium oxalate
Sodium citrate
Heparin
EDTA
Feedback
Sodium citrate is the anticoagulant of choice for most coagulation studies. EDTA
anticoagulated samples are used most often in hematology and/or blood
bank. Heparinized tubes are common in chemistry testing. Potassium oxalate is most
commonly used for glucose or lactate determinations.
The reticulocyte count is used to assess which of the following:
Increased blood loss

Microcytic anemia
Macrocytic anemia
RBC production by the bone marrow
Feedback
An increased number of reticulocytes in the peripheral blood is indicative of increased
production of RBCs by the bone marrow.
What is the MOST likely cause of a patient who developed a severe hemolytic
episode after taking anti-malarial drugs, and red cell inclusions caused by denatured
hemoglobin were seen on the differential smear?
G-6-PD deficiency
Thalassemia major
Pyruvate kinase deficiency
Paroxysmal nocturnal hemoglobinuria
Feedback
Individuals with G6PD deficiency develop a nonimmune hemolytic anemia in

response to antimalarial drugs, most commonly primaquine.
Calculate the mean corpuscular hemoglobin content (MCHC) when Hgb = 15 g/dl
(150 g/L), RBC count = 4.50 x 106/µL (4.50 x 1012/L), and Hct = 47% (0.47).
9.5 g/dL
10.4 g/dL
31.9 g/dL
33.9 g/dL
34.7 g/dL
Feedback
MCHC = (Hemglobin (g/dL) / Hematocrit (%)) x 100
Which of the following conditions can be associated with the red blood cell
morphologies shown in this image?
Autoimmune hemolytic anemia

Iron deficiency
Beta thalassemia
Feedback
The small, spherical, dense, orange-staining red blood cells shown are spherocytes.
These cells are highly associated with hemolytic anemias. The spherocytes shown in
this image are not indicative of hereditary spherocytosis, as the spherocytes do not
predominate the peripheral blood field.
The small red cells of iron deficiency anemia and thalassemia are pale staining and
are hollow centrally. Microcytes of thalassemia may contain a small central density
giving the appearance of a "target."
Which of the following best represents the quantity of resultant bleed in order of
smallest bleed to largest (assuming identical trauma)?
Artery -> Arteriole -> Capillary

Venuole -> Artery -> Vein
Venuole -> Vein -> Artery
Artery -> Vein -> Arteriole
Feedback
The quantity of a bleed in order of smallest bleed to largest would be: Venuole ->
Vein -> Artery.
Match each of the three boxes on the left with the appropriate magnification on the
right:
Color, Rouleau, Overall Slide Quality, Cell Distribution 10X

Platelet estimates RBC-platelet-WBC morphology WBC differential RBC 100X
inclusions (Oil)
Select area to examine, WBC estimate 40X
(Dry)
Feedback
10X- Color, Rouleau, Overall Slide Quality, Cell Distribution
100X (Oil)- Platelet estimates RBC-platelet-WBC morphology WBC differential

RBC inclusions
40X (Dry)- Select area to examine, WBC estimate
How would the RBCs appear on the peripheral blood smear if the red cell indices
obtained on a patient are as follows:
MCV 88.5 f1
MCH 30.2 pg
MCHC 33.1 %
Hypochromic, microcytic
Normochromic, microcytic
Normochromic, normocytic
Hypochromic, normocytic
Feedback
MCV normal range = 80-100 fL. This patient has normal RBC size or is
normocytic. MCH normal range = 27-31 pg, MCHC normal range = 32-36%;
therfore the cells are also normochromic as the MCH and MCHC are within normal
limits.

These cells tend to occur in tight clusters. They may have prominent nucleoli,
immature chromatin, and scant cytoplasm.
macrophages
lipocytes
tumor cells
megakaryocytes
Feedback
Tumor cells generally tend to occur in tight clusters and show prominent nucleoli,
immature chromatin, and scant cytoplasm.
The Philadelphia chromosome is associated with which of the following blood

disorders?
chronic myelogenous leukemia

chronic lymphocytic leukemia
acute granulocytic leukemia
acute lymphocytic leukemia
polycythemia vera
Feedback
The Philadelphia chromosome is characterized by a translocation between

chromosome 9 and 22 and is strongly associated with chronic myelogenous leukemia,
or CML.
What is the CORRECT blood-to-anticoagulant ratio for coagulations tests?
4:1
5:1
9:1
10:1
Feedback
By properly filling the specimen collection tube to the line indicated for coagulation
studies, a 9:1 ratio should be created with the blood-to-anticoagulant in the tube. This
correct ratio is necessary for accurate coagulation test results.
All of the following are true concerning the Erythrocyte Sedimentation Rate
EXCEPT:
Can be used to follow the course of a disease

ESR is decreased during inflammatory conditions
Highest ESR values usually seen in Multiple Myeloma
Increased in rheumatoid conditions
Feedback
ESR is actually increased during inflammatory conditions. Therefore choice B is the

correct answer as it is a false statement.
Phagocytosis is a function of which of the following types of cells:
Lymphocytes
Erythrocytes
Thrombocytes
Monocytes
Feedback
Neutrophils,monocytes, and macrophages all have phagocytic properties.
Which beta thalassemia shows no anemia and may not be detected using hemoglobin
electrophoresis?
Beta thalassemia minima

Beta thalassemia minor
Beta thalassemia intermedia
Beta thalassemia major
Feedback
Beta thalassemia minima (silent carrier) shows no anemia and may not be detected
using hemoglobin electrophoresis. The silent carrier state of beta thalassemia, Bsc/B,
involves one minor beta chain deletion or mutation. This state produces such a small
drop in the level of beta chain synthesis that the alpha to beta chain ratio remains at a
near normal state.
Hemoglobin A levels remain normal (95% or higher).
Which changes Fibrinogen into Fibrin Monomer:
Heparin
Calcium 2+ ions
Tissue Factor
Thrombin
Feedback
Thrombin converts fibrinogen to fibrin monomers. These polymerize to form a fibrin

clot, which is then covalently crosslinked by activated factor XIII (fibrin-stabilizing
factor).

If a patient has a white blood count of 40,000/µL, the MOST useful test to distinguish
between bacterial infection and chronic granulocytic leukemia would be?
Wright’s stain
Peroxidase
Periodic acid-Schiff (PAS)
Leukocyte alkaline phosphatase (LAP)
Brilliant Cresyl blue
Feedback
The LAP stain is used to determine if an increase of cells is due to chronic

myelogenous leukemia or a leukamoid reaction due to infection or similar
conditions. Cells from a noncancerous reaction stain positive with many intense blue
granules; cells from chronic myelogenous leukemia have few blue granules. Wright
stain does not provide any differential information other than possible cell
classification. The myeloperoxidase stain is used to distinuish between the immature
cells in acute myeloblastic leukemia (cells stain positive) and those in acute
lymphoblastic leukemia (cells stain negative). The Periodic Acid-Schiff (PAS) stain
is primarily used to identify erythroleukemia, a leukemia of immature red blood
cells. Brilliant Cresyl Blue is most often used as a supravital stain in reticulocyte
evaluations. It may also be used as an aid in the detection of alpha-thalassemia.
Which of the following blood smear observations would support the diagnosis of
Multiple Myeloma if a patient demonstrated plasma cells in his bone marrow and had
an elevated serum IgG?
some anisocytosis
some target cells
microcytic RBC's
Rouleaux formation
Feedback
Plasma cells in the bone marrow with an increase in IgG is suggestive of multiple
myeloma; which is strongly associated with rouleaux formation due to the increased
immunoglobulins present.
If a sodium citrate sample drawn for coagulation is noted to be filled an inch below
the fill line (black line), then the specimen is considered:
unacceptable for coagulation studies

acceptable for coagulation studies
acceptable if the tube can be filled with additional blood
acceptable if only the PT test is to be performed
Feedback
In coagulation tesing, the sodium citrate tubes MUST be filled to the black line,
meaning properly filled, to ensure the proper ratio of blood to anticoagulant inside of
the tube; which should be 9:1. If the tube is not filled adequately, the specimen must
be not be used for testing and a redraw should be requested.
=====================
Which of the following cells is characterized by a thin rim of cytoplasm around the
nucleus?
Small lymphocyte
Large lymphocyte
Monocyte
Feedback
Small lymphocytes are characterized by a thin rim of cytoplasm around the nucleus.
At times, the cytoplasm may even be difficult to observe if it is scant.
Which of the following statements best describes a normal erythrocyte?
A round, disc-shaped, brick red cell with an area of central pallor

A round, disc-shaped, brick red cell with a nucleus
A round, disc-shaped, brick red cell containing myoglobin
A round, disc-shaped, brick red cell which transports lipids
Which of the following viruses is MOST often reported as the cause of infection
leading to aplastic crisis in a patient with sickle cell disease?
Adenovirus
Ebstein-Barr virus
Parvovirus B19
Zoster-simplex virus
Feedback
Parvovirus B19 is the most common causitive agent of aplastic crisis in sickle cell
disease.
Which of the following viruses is MOST often reported as the cause of infection
leading to aplastic crisis in a patient with sickle cell disease?
Adenovirus
Ebstein-Barr virus
Parvovirus B19
Zoster-simplex virus
Feedback
Parvovirus B19 is the most common causitive agent of aplastic crisis in sickle cell
disease.
The site most frequently used to collect bone marrow samples from adults is:
sternum
anterior iliac crest
posterior iliac crest
tibia
Feedback
The iliac crest is usually considered to be a safer place to harvest bone marrow.
The life span of RBCs containing Hemoglobin H is typically:
decreased
increased
unchanged
Feedback
The life span of an RBC containing Hemoglobin H bodies is decreased because the
RBC membrane is compromised when macrophages attempt to remove this unstable
hemoglobin, which is precipitated just inside the membrane.

Lymphocytes contain many specific cytoplasmic granules.
True
False
Feedback
Lymphocytes do not contain specific granules. They can contain cytoplasmic

azurophilic granules, also known as non-specific or primary granules.
Laboratory results obtained on a 47-year old patient were as follows:
WBC 51.2 x 103/µL

RBC 4.27 x 106/µL
HGB 12.6 g/dl
HCT 36.9%
PLT 403 x 103/µL
Differential:
50% segmented neutrophils
20% bands
12% lymphocytes
7% monocytes
1% eosinophils
9% metamyelocytes
1% myelocytes
RBC morphology: normocytic, normochromic
WBC morphology: moderate toxic granulation, slight Dohle body
Which test would be MOST helpful in establishing a diagnosis in this case?
LAP stain
Nonspecific esterase stain
Acid phosphatase
Oil Red O
Sudan Black B
Feedback
The LAP stain is used to determine if an increase of cells is due to chronic

myelogenous leukemia or a noncancerous reaction such as an infection. Cells from a
noncancerous reaction stain positive with many intense blue granules, while cells
from chronic myelogenous leukemia have few blue granules.
Match the conditions listed below with the elements that may be seen on a stained
CSF smear when this condition is present.
Hemosiderin deposits Previous subarachnoid hemorrhage (SAH)

Neutrophilic pleocytosis Bacterial meningitis
Nucleated red blood cells (NRBCs) Bone marrow contamination of the CSF
Lymphocytic pleocytosis Viral meningitis
Feedback
Hemosiderin deposits would indicate a previous SAH. As red blood cells degenerate
further, the breakdown products are seen in macrophages as dark, granular, iron-laden
hemosiderin deposits.
Neutrophilic pleocytosis may be seen with bacterial meningitis.
The presence of NRBCs in the CSF would point to bone marrow contamination of the
CSF sample. Bone marrow contamination of the CSF can occur if a vertebral process,
which is part of the spinal column vertebra, is nicked or pierced when performing the
lumbar puncture.
Lymphocytic pleocytosis may indicate viral meningitis.

Which one of the following is the mechanism for the production of platelet
satellitism?
An IgG antibody is directed against clotting factor VIII.

An IgG antibody is directed against von Willebrand factor (vWF).
An IgG antibody is directed against GP IIb/IIIA on the platelet membrane.
An IgG antibody is directed against fibrinogen.
Feedback
Platelet satellitism is a rare situation in which an IgG antibody is directed against the
glycoprotein IIb/IIIa complex on the platelet membrane. The antibody-coated platelets
rosette around neutrophils, causing a falsely low platelet count to be recorded with
automated instrumentation. Monocytes may also show some rosetting. No antibodies
are formed against Factor VIII, vWF, or fibrinogen that result in platelet satellitism.
What is another name used to designate a fully committed B-lymphocyte:
T-lymphocyte
Reactive lymphocyte
Large lymphocyte
Plasma cell
Feedback
Plasma cells are the end stage of B lymphocyte maturation; they are not normally seen
in peripheral blood.
The gene loci for the alpha globin chains are adjacent to the locus for which other
globin chain ?
Beta
Delta
Epsilon
Zeta
Feedback
The order of globin gene loci on chromosome 16 is Zeta, Alpha 2, and Alpha 1.
The following factors are measured by either the PT or aPTT EXCEPT:
Factor VIII
Factor IX
Factor V
Factor XIII
a&b
Feedback
Factor XIII is not measured in the PT or aPTT tests, as this is the clot stabilizing
factor. Factor VIII and Factor IX are measured in aPTT assays. Factor V is measured
in both PT and aPTT tests.
The nucleus of a small lymphocyte is about the same size as a:
Normal erythrocyte
Small monocyte
Large platelet
Band neutrophil
Feedback
The nucleus of a small lymphocyte is about the same size as a normal erythrocyte.
Therefore, it is acceptable to infer red blood cell size when a small lymphocyte is
present in the field to compare to.
Contin
Howell-Jolly bodies are composed of:

Hemoglobin
DNA
Iron
Phospholipids
Feedback
Howell-Jolly bodies are residual fragments of DNA within erythrocytes. They may be
seen in pernicious anemia and thalassemias.
Match the following cells with their corresponding characteristics:
Antibody production B-Cell

Associated with the thymus, cellular immunity T-Cell
Classified as a phagocyte Neither T-Cell nor B-Cell
Which of the following would not be considered a part of the body's cellular immune
system:
Macrophages
Mast cells
Neutrophils
Thrombocytes
Feedback
Thrombocytes, or platelets, are of course involved with hemostasis, not immunity.
Which of the following would not be represented in the usual classification of anemia:
Microcytic, hypochromic
Normocytic, normochromic
Normocytic, hyperchromic
Macrocytic
Feedback
The word hyperchromic would imply an increase in the concentration of hemoglobin,

inconsistent with the concept of anemia.
Which of the following conditions will show an increased prothrombin time (PT) with
a normal activated thromboplastin time (aPTT)?
Factor VIII definiency
Factor X deficiency
Feedback
In factor VII deficiency, the PT test is abnormal while the aPTT test is normal since
factor VII is tested for in the PT test, but not in the aPTT test. Factor IX and VIII
deficiencies would show an abnormal aPTT test witha normal PT test. Finally factor
X deficiency would show an increased PT and aPTT since factor X is utilized in both
tests.

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You answered the question incorrectly.

Which of the following actions would be appropriate for the investigation of an

The correct answers are highlighted below

Check for clots in the sample

Question Difficulty: Level 5

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CD5 antigen is normally found on which of the following lymphocyte populations?

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All helper cells are T cells. Consequently, in a normal lymphocyte population, it is

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Question Difficulty: Level 6

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ESR tube is slanted

Question Difficulty: Level 7

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absolute lymphocyte count= 2.4 x 109/L

The correct answer is highlighted below

Question Difficulty: Level 4

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The correct answer is highlighted below

Question Difficulty: Level 3

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The correct answer is highlighted below

Question Difficulty: Level 4

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What morphological change is present in the image indicated by the arrow?

The correct answer is highlighted below

The neutrophil in this image is demonstrating hypersegmentation. Hypersegmentation

Question Difficulty: Level 3

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The correct answer is highlighted below

FAB M5 is acute monoblastic leukemia

FAB M1 is acute myeloblastic leukemia without maturation

FAB M3 is acute promyelocytic leukemia

FAB M4 is acute myelomonocytic leukemia

Question Difficulty: Level 8

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Disseminated intravascular coagulation (DIC) is associated with all of the following

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Disseminated intravascular coagulation (DIC) is a thrombohemorrhagic disorder

Question Difficulty: Level 7

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Which group of conditions INCREASES the risk of HbS polymerization?

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Acid pH, dehydration, decreased level of 2,3-DPG

The risk of HbS polymerization is enhanced by a low (acid) pH, a state of

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Hgb 13.5 mg/dl

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Question Difficulty: Level 6

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Remnants of erythrocyte nuclei, nuclear fragments, or aggregates of chromosomes are

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Question Difficulty: Level 7

Which of the following conditions would be associated with an increased osmotic

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Hereditary spherocytosis is associated with increased osmotic fragility, while the

Question Difficulty: Level 5