1.8 Hematology Problem-Solving Flashcards
A 19-year-old man came to the emergency department with severe joint pain, fatigue, cough, and fever. Review the following laboratory results:
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WBCs: 21.0 x 10^9/L
RBCs: 3.23 x 10^12/L
Hgb: 9.6 g/dL
PLT: 252 x 10^9/L
Differential:
17 band neutrophils;
75 segmented neutrophils
5 lymphocytes;
2 monocytes;
1 eosinophil;
26 NRBCs
What is the correct WBC count?
A. 8.1 x 10^9/L
B. 16.7 x 10^9/L
C. 21.0 x 10^9/L
D. 80.8 x 10^9/L
B. 16.7 x 10^9/L
A manual WBC count is performed. Eighty WBCs are counted in the four large corner squares of a Neubauer hemacytometer. The dilution is 1:100. What is the total WBC count?
A. 4.0 x 10^9/L
B. 8.0 x 10^9/L
C. 20.0 x 10^9/L
D. 200.0 x 10^9/L
C. 20.0 x 10^9/L
A manual RBC count is performed on pleural fluid. The RBC count in the large center square of the Neubauer hemacytometer is 125, and the dilution is 1:200. What is the total RBC count?
A. 27.8 x 10^9/L
B. 62.5 x 10^9/L
C. 125.0 x 10^9/L
D. 250.0 x 10^9/L
D. 250.0 x 10^9/L
Review the scatterplot of WBCs shown. Which section of the scatterplot denotes the number of monocytes?
A. A
B. B
C. C
D. D
A. A
Review the following automated CBC values.
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WBC = 17.5 x 10^9/L (flagged)
RBC = 2.89 x 10^12/L
Hgb = 8.1 g/dL
Hct = 25.2%
MCV = 86.8 fL
MCH = 28.0 pg
MCHC = 32.3%
PLT = 217 x 10^9/L
Many sickle cells were observed on review of the peripheral blood smear. On the basis of this finding and the results provided, what automated parameter of this patient is most likely inaccurate, and what follow-up test should be done to accurately assess this parameter?
A. MCV/perform reticulocyte count
B. Hct/perform manual Hct
C. WBC/ perform manual WBC count
D. Hgb/perform serum-saline replacement
C. WBC/ perform manual WBC count
Review the following CBC results for a 2-day-old infant:
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WBC = 15.2 x 10^9/L
RBC = 5.30 x 10^9/L
Hgb = 18.5 g/dL
Hct = 57.9%
MCV = 105 fL
MCH = 34.0 pg
MCHC = 33.5%
PLT = 213 x 10^9/L
These results indicate:
A. Macrocytic anemia
B. Microcytic anemia
C. Liver disease
D. Normal values for a 2-day-old infant
D. Normal values for a 2-day-old infant
Review the following scatterplot, histograms, and automated values for a 21-year-old college student.
WBC differential:
5 band neutrophils
27 segmented neutrophils
60 atypical lymphocytes
6 monocytes
1 eosinophil
1 basophil
What is the presumptive diagnosis?
A. Infectious mononucleosis
B. Monocytosis
C. CLL
D. Beta-Thalassemia
A. Infectious mononucleosis
Review the following scatterplot, histograms, and automated values for a 61-year-old woman.
WBC differential:
14 band neutrophils
50 segmented neutrophils
7 lymphocytes
4 monocytes
10 metamyelocytes
8 myelocytes
1 promyelocyte
3 eosinophils
3 basophils
2 NRBCs/ 100 WBCS
What is the presumptive diagnosis?
A. Leukemoid reaction
B. CML
C. AML
D. Megaloblastic leukemia
B. CML
Review the automated results from the previous question. Which parameters can be released without further follow-up verification procedures?
A. WBC and relative percentages of WBC populations
B. RBCs and PLTs
C. Hgb and Hct
D. None of the automated counts can be released without follow-up verification
D. None of the automated counts can be released without follow-up verification
Refer to the following scatterplot, histograms, and automated values for a 45-year-old man. What follow-up verification procedure is indicated before these results can be released?
A. Redraw blood sample using a sodium citrate tube; multiple PLTs x 1.11
B. Dilute WBCs 1:10 multiply x 10
C. Perform plasma blank Hgb to correct for lipemia
D. Warm specimen at 37 C for 15 minutes; rerun specimen
A. Redraw blood sample using a sodium citrate tube; multiple PLTs x 1.11
Refer to the following scatterplot, histograms, and automated values for a 52-year-old woman. What follow-up verification procedure is indicated before these results can be released?
A. Redraw specimen using a sodium citrate tube; multiply PLTs x 1.11
B. Dilute WBCs 1:10; multiply x 10
C. Perform plasma blank Hgb to correct for lipemia
D. Warm the specimen at 37 C for 15 minutes; rerun the specimen
D. Warm the specimen at 37 C for 15 minutes; rerun the specimen
Refer to the following scatterplot, histograms, and automated values for a 33-year-old woman. What follow-up verification procedure is indicated before these results can be released?
A. Perform a manual Hct and redraw the sample using a sodium citrate tube; multiply PLTs x 1.11
B. Dilute WBCs 1;10; multiply x 10
C. Perform plasma blank Hgb to correct for lipemia
D. Warm the specimen at 37C for 15 minutes; rerun the specimen
C. Perform plasma blank Hgb to correct for lipemia
Refer to the following scatterplot, histograms, and automated values for a 48-year-old man. What follow-up verification procedure is indicated before the five-part WBC differential results can be released?
A. Dilute WBCs 1:10; multiply x 10
B. Redraw with sample using a sodium citrate tube; multiple WBCs x 1.1
C. Prepare buffy coat peripheral blood smear, and perform a manual differential
D. Warm specimen at 37 C for 15 minutes; rerun specimen
C. Prepare buffy coat peripheral blood smear, and perform a manual differential
Review the following CBC results for a 70-year-old man:
WBC = 58.2 x 10^9/L
RBC = 2.68 x 10^12/L
Hgb = 8.5 g/dL
Hct = 26.5 mL/ dL%
MCV = 98 fL
MCH = 31.7 pg
MCHC = 32.6%
PLT = 132 x 10^9/L
Differential:
96 lymphocytes
2 band neutrophils
2 segmented neutrophils
25 smudge cells/1 WBCs
What is the most likely diagnosis on the basis of these values?
A. ALL
B. CLL
C. Infectious mononucleosis
D. Myelodysplastic syndrome
B. CLL
Refer to the following scatterplot, histograms, and automated values for a 28-year-old woman who had undergone preoperative laboratory testing. A manual WBC differential was requested by her physician. The WBC differential was not significantly different from the automated five-part differential; however, the medical laboratory scientist noted 3+ elliptocytes/ovalocytes while reviewing the RBC morphology. What is the most likely diagnosis for this patient?
A. DIC
B. HE (ovalocytosis)
C. Cirrhosis
D. Hgb C disease
B. HE (ovalocytosis)
Refer to the following scatterplot, histograms, and automated values for a 53-year-old man who had undergone preoperative laboratory testing. What is the most likely diagnosis for this patient?
A. IDA
B. PV
C. Sideroblastic anemia
D. Beta-thalassemia minor
D. Beta-thalassemia minor
