Assessment HEMA Flashcards
One chromosome breaks off and becomes attached to a different chromosome:
Addition
Deletion
Inversion
Translocation
Translocation
CHROMOSOMAL CHANGES
Most common type of DNA change that can lead to leukemia.
A translocation means that a part of one chromosome breaks off and becomes attached to a different chromosome.
The point at which the break occurs can affect nearby genes—for example, it can turn on oncogenes or turn off genes that would normally help a cell to mature.
TRANSLOCATION
Occur when part of a chromosome is lost.
This may result in the cell losing a gene that helped keep its growth in check, for example, a tumor suppressor gene.
DELETION
Occur when part of a chromosome gets turned around, so it is now in reverse order.
This can result in the loss of a gene (or genes) because the cell can no longer read its instructions in protein translation.
INVERSION
An extra chromosome or part of a chromosome is gained.
This can lead to too many copies of certain genes within the cell.
This can be a problem if one or more of these genes are oncogenes.
ADDITION
The most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus:
Multipotential stem cell
Pluripotential stem cell
Totipotential stem cell
Totipotential stem cell
TYPES OF HUMAN STEM CELLS
These cells are present in the first few hours after an ovum is fertilized.
Totipotential stem cells, the most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus.
Totipotential stem cells
TYPES OF HUMAN STEM CELLS
These cells are present several days after fertilization.
Pluripotent stem cells can develop into any cell type, except they cannot develop into a fetus.
Pluripotential stem cells
TYPES OF HUMAN STEM CELLS
These cells are derived from pluripotent stem cells.
They can be found in adults, but they are limited to specific types of cells to form tissues.
For example, bone marrow stem cells can produce all types of blood cells, bone cartilage, and adipose (fat) cells.
Multipotential stem cells
The promyelocyte stage lasts about:
4 hours
12 hours
15 hours
24 hours
4.3 days
24 hours
PROLIFERATIVE PHASE
First identifiable cell in the granulocytic series
Constitute approximately 1% of the total nucleated bone marrow cells
Stage lasts approximately 15 hours
Myeloblast
Constitutes approximately 3% of the nucleated bone marrow cells
This stage lasts about 24 hours
Promyelocyte
Approximately 12% of the proliferative cells existing in this stage
Myelocyte to metamyelocyte lasts an average of 4.3 days.
Once the metamyelocyte stage has been reached, cells have undergone four or five cell divisions and the proliferative phase comes to an end
Myelocyte
MATURATION-STORAGE PHASE
Metamyelocytes 45%
Band 35%
Segmented granulocytes 20%
Segmented neutrophils in the maturation-storage compartment are frequently referred to as the marrow reserve.
This reserve constitutes a 4- to 8-day supply of neutrophils.
The tourniquet should be applied __________ inches above the venipuncture site.
1 to 2 inches above the venipuncture site
3 to 4 inches above the venipuncture site
5 to 6 inches above the venipuncture site
8 to 9 inches above the venipuncture site
3 to 4 inches above the venipuncture site
The tourniquet should be applied 3 to 4 inches above the venipuncture site and left on for no longer than 1 minute before the venipuncture is performed.
Anticoagulants that remove calcium needed for clotting by forming insoluble calcium salts: RODAK
EDTA
EDTA and heparin
EDTA and citrate
EDTA, citrate and oxalate
EDTA, citrate, oxalate and heparin
EDTA, citrate, and oxalate
Heparin prevents clotting by binding to anti- thrombin in the plasma and inhibiting
thrombin and activated coagulation factor X.
Number of inversions of light blue top evacuated tube:
None
3 to 4
5 to 6
8
3 to 4
Light blue (citrate) 3 to 4x inversions
Green (heparin) 8x inversions
Purple (EDTA) 8x inversions
Test orders: 1. Conduct continuous utilization reviews to ensure that physician laboratory orders are comprehensive and appropriate to patient condition; 2. Inform physician about laboratory test availability and ways to avoid unnecessary orders; 3. Reduce unnecessary repeat testing.
1 and 2
1 and 3
2 and 3
1, 2 and 3
1, 2 and 3
Each new assay or assay modification must be validated for: 1. Accuracy, Precision; 2. Linearity; 3. Specificity; 4. Lower limit of detection ability
1 and 3
2 and 4
1, 2 and 3
1, 2, 3 and 4
1, 2, 3 and 4
Adjuvant for infectious disease therapy:
Interleukin 2
Interleukin 3
Interleukin 6
Interleukin 12
Interleukin 12
Major elements of the flow cytometer: 1. Optics; 2. Fluidics; 3. Computer; 4. Electronics
1 and 2
3 and 4
1, 2 and 3
1, 2, 3 and 4
1, 2, 3 and 4
Total area of the Levy chamber with improved Neubauer ruling:
1 mm2
3 mm2
4 mm2
9 mm2
9 mm2
It is composed of two raised surfaces, each with a 3 mm x 3 mm square counting area or
grid (total area 9 mm2), separated by an H-shaped moat.
For the manual WBC count: After the chamber is filled, allow the cells to settle for___ minutes before counting.
3 minutes
5 minutes
10 minutes
15 minutes
10 minutes
Typical dilution for the manual platelet count:
1:10
1:20
1:100
1:200
1:100
If fewer than 50 platelets are counted on each side, the procedure should be repeated by diluting the blood to:
1:10
1:20
1:100
1:200
1:20
In the cyanmethemoglobin method, full conversion of hemoglobin to cyanmethemoglobin:
3 minutes
5 minutes
10 minutes
15 minutes
10 minutes
WBC count that can interfere with the cyanmethemoglobin method:
Greater than 4 x 10 9/L
Greater than 7 x 10 9/L
Greater than 11 x 10 9 /L
Greater than 20 x 10 9/L
Greater than 20 x 10 9/L
A high WBC count (greater than 20 x 10 9/L) or a high platelet count (greater than 700 x 10
9/L) can cause turbidity and a falsely high result.
In this case, the reagent-sample solution can be centrifuged and the supernatant
measured.
Effect of dehydration to hematocrit reading:
Decreased
Increased
Variable
No effect
Increased
## Footnote
The fluid loss associated with dehydration causes a decrease in plasma volume and
falsely increases the hematocrit reading.
An MCHC between 36 and 38 g/dL should be checked for:
Codocytes
Drepanocytes
Elliptocytes
Spherocytes
Spherocytes
In the manual reticulocyte count, what is the ratio of blood and new methylene blue stain?
1:1
1:2
1:3
1:4
1:1
Mix equal amounts of blood and new methylene blue stain (2 to 3 drops, or approximately
50 mL each), and allow to incubate at room temperature for 3 to 10 minutes.
To improve accuracy of the reticulocyte count, have another laboratorian count the other film; counts should agree within:
Within 1%
Within 5%
Within 10%
Within 20%
Within 20%
The ESR of patients with severe anemia is:
Critical
Of diagnostic significance
Of little diagnostic value
Of little diagnostic value
because it will be falsely elevated.
ESR and RBC mass:
Directly proportional
Inversely proportional
Cannot be determined
Directly proportional
The ESR is directly proportional to the red blood cell mass and inversely proportional to
plasma viscosity.
ESR of patient with leukemia:
Decreased
Increased
Variable
Increased
ESR of patient with leukocytosis:
Decreased
Increased
Variable
Decreased
An early indication of engraftment success after hematopoietic stem cell transplant. 1. RBC count; 2. Immature reticulocyte fraction; 3. Immature platelet fraction
2 only
1 and 2
2 and 3
1, 2 and 3
2 and 3
The immature reticulocyte fraction and the immature platelet fraction provide an early
indication of engraftment success after hematopoietic stem cell transplant.
Conditions associated with DIC: Examples of conditions associated with ENDOTOXINS THAT ACTIVATE CYTOKINES
Acute promyelocytic or myelomonocytic leukemia
Bacterial, protozoal, fungal and viral infections
Coronary artery bypass surgery
Hypovolemic and hemorrhagic shock
Bacterial, protozoal, fungal and viral infections
Fibrinogen concentration in primary fibrinolysis:
Decreased
Increased
Variable
Decreased
Fibrinogen concentration in secondary fibrinolysis:
Decreased
Increased
Variable
Decreased
Bone marrow reticulocytes have an average maturation of:
1 day
1.5 days
2 days
2.5 days
2.5 days
Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of:
1 day
1.5 days
2 days
2.5 days
1 day
Bone marrow reticulocytes have an average maturation period of 2.5 days.
Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage
for an average of 1 day and represent approximately 0.5% to 1.5% of the circulating
erythrocytes.
Basophils have an average circulation time of about:
7 to 10 hours
8.5 hours
12 hours
2.5 days
8.5 hours
Bone marrow reticulocytes have an average maturation period of 2.5 days.
Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage
for an average of 1 day and represent approximately 0.5% to 1.5% of the circulating
erythrocytes.
All identifiable patient information, whether written, computerized, visually, or audio recorded, or simply held in the memory of healthcare professionals, is subject to the duty of confidentiality, EXCEPT:
Any clinical information about an individual’s diagnosis or treatment
A picture, photograph, video, audiotape, or other images of the patient
The patient’s favorite restaurant and food
Who the patient’s doctor is and what clinics patients attend and when
The patient’s favorite restaurant and food
It is used by medical laboratories in developing their quality management systems and assessing their own competence and for use by accreditation bodies in confirming or recognizing the competence of medical laboratories:
ISO 11166
ISO 11469
ISO 15189
ISO 15819
ISO 15189
ISO 15189:2007 is for use by medical laboratories in developing their quality management
systems and assessing their own competence and for use by accreditation bodies in
confirming or recognizing the competence of medical laboratories.
All of the following are examples of pre-analytical errors, EXCEPT:
Specimen obtained from the wrong patient
Specimen collected in the wrong tube or container
Incorrect labeling of specimen
Failure to report critical values immediately
Failure to report critical values immediately
PREANALYTICAL (PREEXAMINATION)
■ Specimen obtained from the wrong patient
■ Specimen procured at the wrong time
■ Specimen collected in the wrong tube or container
■ Blood specimens collected in the wrong order
■ Incorrect labeling of specimen
■ Improper processing of specimen
ANALYTICAL (EXAMINATION)
■ Oversight of instrument flags
■ Out-of-control QC results
■ Wrong assay performed
POSTANALYTICAL (POSTEXAMINATION)
■ Verbal reporting of results
■ Instrument: Laboratory Information System (LIS) incompatibility error
■ Confusion about reference ranges
■ Failure to report critical values immediately
EDTA is used in concentrations of _____ of whole blood
0.5 mg/1 mL of whole blood
1 mg/1mL of whole blood
1.5 mg/1 mL of whole blood
2 mg/1 mL of whole blood
1.5 mg/1 mL of whole blood
Uncommon vascular complications that are not usually related to the technique include:
Pseudoaneurysm
Pseudoaneurysm and thrombosis
Pseudoaneurysm, thrombosis and reflex arteriospasm
Pseudoaneurysm, thrombosis, reflex arteriospasm and arteriovenous fistula formation
Pseudoaneurysm, thrombosis, reflex arteriospasm and arteriovenous fistula formation
Complications include orthostatic hypotension, syncope and shock
Vascular complications
Cardiovascular complications
Neurological complications
Dermatological comlications
Cardiovascular complications
Complications include diaphoresis, seizure and pain:
Vascular complications
Cardiovascular complications
Neurological complications
Dermatological comlications
Neurological complications
Sister chromatids move to the equatorial plate.
Prophase
Metaphase
Anaphase
Telophase
Metaphase
Characteristics of the Four Mitotic Periods
PROPHASE
The chromatin becomes tightly coiled.
Nucleolus and nuclear envelope disintegrate.
Centrioles move to opposite poles of the cell.
METAPHASE
Sister chromatids move to the equatorial plate.
ANAPHASE
Sister chromatids separate and move to opposite poles.
TELOPHASE
Chromosomes arrive at opposite poles.
Nucleolus and nuclear membrane reappear.
The chromatin pattern reappears.
Megakaryocytes develop into platelets in approximately __ days.
3 days
5 days
9 days
12 days
5 days
This cytokine promotes the growth of early hematopoietic cell lines:
Interleukin 1
Interleukin 2
Interleukin 3
Interleukin 6
Interleukin 3
Promotes the growth of early hematopoietic cell lines (e.g., proliferation of CFU-GEMM,
CFU-M, CFU-Meg, CFU-Eo, and CFU-Bs colonies from bone marrow).
IL-3 acts with M-CSF to stimulate proliferation of monocytes and macrophages. It also
stimulates granulocyte, monocyte, eosinophil, and mast cell production
Hemoglobin appears for the first time:
Rubriblast (pronormoblast)
Prorubricyte (basophilic normoblast)
Rubricyte (polychromatophilic normoblast)
Metarubricyte (orthochromic normoblast)
Rubricyte (polychromatophilic normoblast)
This pathway prevents denaturation of globin of the hemoglobin molecule by oxidation:
Embden-Meyerhof pathway
Hexose-monophosphate shunt
Methemoglobin reductase pathway
Luebering-Rapoport pathway
Hexose-monophosphate shunt
Embden-Meyerhof Pathway
Maintains cellular energy by generating ATP
Oxidative pathway or hexose-monophosphate shunt
Prevents denaturation of globin of the hemoglobin molecule by oxidation
Methemoglobin reductase pathway
Prevents oxidation of heme iron
Luebering-Rapaport pathway
Regulates oxygen affinity of hemoglobin
RBCs inclusions, 0.2 to 2.0 mm in size, that can be seen with a stain such as crystal violet or brilliant cresyl blue; represent precipitated, denatured hemoglobin and are clinically associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such as phenacetin, and some hemoglobinopathies.
Hemoglobin C crystals
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Heinz bodies
RBC inclusions that are aggregates of mitochondria, ribosomes, and iron particles. Clinically, they are associated with iron-loading anemias, hyposplenism, and hemolytic anemias.
Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Pappenheimer bodies
RBC inclusions representing granules composed of ribosomes and RNA that are precipitated during the process of staining of a blood smear; associated clinically with disturbed erythropoiesis (defective or accelerated heme synthesis),lead poisoning, and severe anemias.
Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Basophilic stippling
Nuclear remnants predominantly composed of DNA; believed to develop in periods of accelerated or abnormal erythropoiesis, because the spleen cannot keep upwith pitting these remnants from the cell. Its presence is associated with hemolytic anemias, pernicious anemia, and particularly post-splenectomy, physiologicalatrophy of the spleen.
Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Howell-Jolly bodies
Anemias with low MCV and MCHC; microcytic, hypochromic RBCs, EXCEPT:
Iron deficiency anemia
Thalassemia
Sideroblastic anemia
Excessive alcohol ingestion
Excessive alcohol ingestion
Low MCV, MCHC
Microcytic, hypochromic
Typical of maturation defects
Iron deficiency anemia (some)
Thalassemia
Sideroblastic anemia
—
Normal MCV, MCHC
Normocytic, normochromic
Typical of hypoproliferation
Bone marrow disorder
Iron deficiency anemia (some)
Anemia of chronic disorders
Autoimmune disease
—
High MCV
Macrocytic
Typical of maturation defect
Vitamin B12 deficiency
Folate deficiency
Excessive alcohol ingestion
Hypothyroidism
Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is MANY.
0
1+
2+
3+
4+
3+
Grading of Erythrocyte Morphology
0 Normal appearance or slight variation in erythrocytes.
1+ Only a small population of erythrocytes displays a particular abnormality; the terms
slightly increased or few would be comparable.
2+ More than occasional numbers of abnormal erythrocytes can be seen in a microscopic
field; an equivalent descriptive term is moderately increased.
3+ Severe increase in abnormal erythrocytes in each microscopic field; an equivalent
descriptive term is many.
4+ The most severe state of erythrocytic abnormality, with the abnormality prevalent
throughout each microscopic field; comparable terms are marked or marked increase.
Inherited hemolytic anemia due to structural membrane defect:
Thalassemia
Sickle cell anemia
Pyruvate kinase deficiency
Hereditary spherocytosis
Hereditary spherocytosis
Examples of Inherited Hemolytic Anemias
STRUCTURAL MEMBRANE DEFECTS
Acanthocytosis
Hereditary spherocytosis
Hereditary elliptocytosis
Hereditary stomatocytosis
Hereditary xerocytosis
Rh null disease
ERYTHROCYTIC ENZYME DEFECTS
G6PD deficiency
Glutathione reductase
Hexokinase
Pyruvate kinase
DEFECTS OF THE HEMOGLOBIN MOLECULE
Hb C disorder
Hb S-C disorder
Hb S-S disorder (sickle cell anemia)
Thalassemia
Hemoglobinopathies associated with ABNORMAL MOLECULAR STRUCTURE:
Alpha thalassemia
Alpha and beta thalassemia
Sickle cell anemia and beta thalassemia
Sickle cell anemia, sickle cell trait and Hb C disease
Sickle cell anemia, sickle cell trait and Hb C disease
Examples of Selected Hemoglobinopathies
ABNORMAL MOLECULAR STRUCTURE
Hb SS (sickle cell anemia)
Hb SA (sickle cell trait)
Hb C disease or trait
RATE OF SYNTHESIS
Beta-Thalassemia
Alpha-Thalassemia
COMBINATION OF TWO MOLECULAR ALTERATIONS OR A MOLECULAR ABNORMALITY
AND SYNTHESIS DEFECT
Hb S–Hb C
Hb S–b-thalassemia
Elongated and curved nucleus; very clumped chromatin:
Myelocyte
Metamyelocyte
Band
Segmenter neutrophil
Band
Indented nucleus, clumped chromatin:
Promyelocyte
Myelocyte
Metamyelocyte
Band
Metamyelocyte
Mast cells have an appearance similar to that of the blood:
Monocyte
Neutrophil
Eosinophil
Basophil
Basophil
Once the metamyelocyte stage has been reached, cells have undergone ____ cell divisions and the proliferative phase comes to an end.
1 or 2 cell divisions
2 or 3 cell divisions
4 or 5 cell divisions
6 or 7 cell divisions
4 or 5 cell divisions
Nuclear chromatin is coarse and clumped; dark blue (basophilic) cytoplasm around the periphery or in a radial pattern and few cytoplasmic vacuoles:
Type I Downey cells
Type II Downey cells
Type III Downey cells
Type II Downey cells
Descriptive Features of the Classic Downey Classification of Lymphocytes Seen in
Infectious Mononucleosis
Type I
Nucleus May be irregularly shaped
Cytoplasm Usually many cytoplasmic vacuoles, dark blue (basophilic)
Type II
Nucleus Chromatin is coarse and clumped
Cytoplasm Increased amount, dark blue (basophilic) around the periphery or in a radial
pattern, a few cytoplasmic vacuoles
Type IIIa
Nucleus Nucleoli usually visible, enlarged in size
Cytoplasm Dark blue (basophilic)
Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage:
M0 myeloid
M1 myeloid
M2 myeloid
M3 myeloid
M2 myeloid
Abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations:
M3
M4
M6
M7
M6
M6 erythroleukemia
Also known as Di Guglielmo syndrome; abnormal proliferation of both erythroid and
granulocytic precursors; may include abnormal megakaryocytic and monocytic
proliferations
Small cells predominant; nuclear shape is regular with an occasional cleft; chromatin pattern is homogeneous and nucleoli are rarely visible; cytoplasm is moderately basophilic:
L1
L2
L3
L1
L1 homogeneous
One population of cells within the case; small cells predominant; nuclear shape is regular
with an occasional cleft; chromatin pattern is homogeneous and nucleoli are rarely visible;
cytoplasm is moderately basophilic
L2 heterogeneous
Large cells with an irregular nuclear shape; clefts in the nucleus are common; one or more
large nucleoli are visible; cytoplasm varies in color
L3 Burkitt lymphoma type
Cells are large and homogeneous in size; nuclear shape is round or oval; one to three
prominent nucleoli; cytoplasm is deeply basophilic with vacuoles often prominent
Cells are large and homogeneous in size; nuclear shape is round or oval; one to three prominent nucleoli; cytoplasm is deeply basophilic with vacuoles often prominent:
L1
L2
L3
L3
Leukemic reticuloendotheliosis:
Prolymphocytoc leukemia
Plasma cell leukemia
Hairy cell leukemia
Sezary syndrome
Hairy cell leukemia
Solid tumor counterpart of acute lymphoblastic leukemia:
Lymphoma, undifferentiated
Lymphoma, poorly differentiated leukemia
Lymphoma, well-differentiated leukemia
Chloroma granulocytic leukemia
Lymphoma, poorly differentiated leukemia
Solid tumor counterpart of plasma cell leukemia:
Reticulum cell sarcoma
Chloroma granulocytic leukemia
Myeloma
Lymphoma, undifferentiated
Myeloma
A distinctive feature of the megakaryocyte:
Multinucleated
Multilobular
Multinucleated and multilobular
None of these
Multilobular
A target INR range of ____ is recommended for most indications (e.g., treatment or prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients who have had a myocardial infarction).
INR range of 1.0 to 2.0
INR range of 2.0 to 3.0
INR range of 2.5 to 3.5
INR range of 4.0 to 5.0
INR range of 2.0 to 3.0
A target INR range of 2.0 to 3.0 is recommended for most indications (e.g., treatment or
prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients
who have had a myocardial infarction).
An INR of 2.5 to 3.5 is recommended for patients with prosthetic heart valves.
When the INR is used to guide anticoagulant therapy, there are fewer bleeding events.
The target INR for pulmonary embolism (PE) treatment is ___ for the duration of anticoagulation.
1.0
1.5
2.5
3.0
3.0
The new types of thromboplastins for measuring the PT are mixtures of phospholipids and recombinantly derived _____ tissue factor.
Rabbit
Pig
Horse
Human
Human
NEW THROMBOPLASTINS
The new types of thromboplastins for measuring the PT are mixtures of phospholipids and
recombinantly derived human tissue factor.
Because the new thromboplastins are more sensitive (typical ISI, 1.0) than the traditional
North American ones (ISIs, 1.8 to 3.0), the PTs for patients with inherited or acquired
deficiencies of coagulation factors will be much more prolonged with use of the new
reagents, although normal values may change minimally.
Anticoagulant therapy:
Falsely decreased D-dimer values
Falsely increased D-dimer values
No effect
Cannot be determined
Falsely decreased D-dimer values
Conditions That Can Generate Falsely Decreased or Falsely Increased D-Dimer Values
FALSELY DECREASED VALUES
1. Anticoagulant therapy
2. Smaller, older, nonprogressing thrombus
FALSELY INCREASED VALUES
1. Various disease states
2. Post-therapeutic clinical procedures
Smallest platelets seen:
Wiskott-Aldrich syndrome
May-Hegglin anomaly
Alport syndrome
Bernard-Soulier syndrome
Wiskott-Aldrich syndrome
Glanzmann thrombasthenia and essential athrombia:
Platelet adhesion defect
Primary platelet aggregation defect
Secondary platelet aggregation defect
Isolated platelet factor III deficicency
Primary platelet aggregation defect
Hereditary Platelet Function Defects
ADHESION DEFECTS
Bernard-Soulier syndrome
Impaired adhesion to collagen
AGGREGATION DEFECTS: PRIMARY
Glanzmann thrombasthenia
Essential athrombia
AGGREGATION DEFECTS: SECONDARY
Storage pool diseases
Aspirin-like defects
Release reaction defects
ISOLATED PLATELET FACTOR III DEFICIENCY
SEVERE COAGULATION FACTOR DEFICIENCIES
Afibrinogenemia
Factor VIII: C deficiency
Factor IX: C deficiency
Acquired platelet function defects:
Bernard-Soulier syndrome
Bernard-Soulier and Glanzmann thrombasthenia
Uremia, multiple myeloma
Uremia, multiple myeloma, vitamin B12 or folate deficiency
Uremia, multiple myeloma, vitamin B12 or folate deficiency
ACQUIRED PLATELET FUNCTION DEFECTS
1. Myeloproliferative syndromes
Essential thrombocythemia
Chronic myelogenous leukemia
Polycythemia vera
Paroxysmal nocturnal hemoglobinuria
Myelofibrosis
RAEB syndrome
Sideroblastic anemia
2. Paraprotein disorders
Multiple myeloma
Waldenström macroglobulinemia
Essential monoclonal gammopathy
3. Autoimmune diseases
Collagen vascular disease
Antiplatelet antibodies
Immune thrombocytopenias
4. Fibrinogen degradation products
Disseminated intravascular coagulation
Primary fibrinolytic syndromes
Liver disease
5. Anemia
Severe iron deficiency
Severe B12 or folate deficiency
6. Uremia
7. Drug induced
RAEB, refractory anemia with excess blasts
Inherited platelet dysfunction:
Bernard-Soulier syndrome
Bernard-Soulier syndrome, Glanzmann’s thrombasthenia
Uremia, multiple myeloma
Uremia, multiple myeloma, vitamin B12 or folate deficiency
Bernard-Soulier syndrome, Glanzmann’s thrombasthenia
INHERITED PLATELET DYSFUNCTION
1. Surface membrane defects
Bernard-Soulier syndrome
Glanzmann thrombasthenia
Platelet-type von Willebrand disease
2. Defects of granule storage
Alpha-granule deficiency
Gray platelet syndrome
3. Dense granules
Wiskott-Aldrich syndrome
Hermansky-Pudlak syndrome
Chédiak-Higashi syndrome
TAR baby syndrome
Patients with _____ , the most severe form of von Willebrand disease, are likely to have a major episode of bleeding early in life because significantly decreased amounts of vWF and VIII:C are produced.
Type IA
Type IIB
Type IIC, IID
Type III
Type III
Conditions related to deficiencies of multiple coagulation factors:
Hepatic disease
Hepatic disease and anticoagulant overdose
Anticoagulant overdose and vitamin K deficiency
Hepatic disease, anticoagulant overdose, DIC and vitamin K deficiency
Hepatic disease, anticoagulant overdose, DIC and vitamin K deficiency
Indented or twisted nucleus, lacy chromatin and gray-blue cytoplasm:
Segmented neutrophil
Band neutrophil
Monocyte
Lymphocyte
Monocyte
Forward high-angle light scatter:
0 degree angle
2 to 3 degree angle
5 to 15 degree angle
90 degree angle
5 to 15 degree angle
Angles of Light Scatter
Various angles of light scatter can aid in cellular analysis.
1. Forward light scatter 0°. This is diffracted light, which relates to the volume of the cell.
2. Forward low-angle light scatter 2° to 3°. This characteristic can relate to size or volume.
3. Forward high angle 5° to 15°. This type of measurement allows for description of the
refractive index of cellular components.
4. Orthogonal light scatter 90°. The result of this application of light scatter is the
production of data based on reflection and refraction of internal components, which
correlates with internal complexity
RBC histogram to the LEFT:
RBCs are larger than normal
RBCs are smaller than normal
Seen in megaloblastic anemia
Treated anemia
RBCs are smaller than normal
If the cells are smaller than normal, the curve will be more to the left, as in untreated iron
deficiency anemia.
If the cells are larger than normal, the histogram curve will be more to the right, as in the
megaloblastic anemias.
After appropriate treatment of the underlying cause of an anemia, the curve should move
toward the normal range.
Erythrocytes with an increased RDW;
Homogenous in character, very little anisocytosis
Homogenous, high degree of anisocytosis
Heterogenous, very little anisocytosis
Heterogenous, high degree of anisocytosis
Heterogenous, high degree of anisocytosis
Erythrocytes with a normal RDW are homogeneous in character and exhibit very little
anisocytosis on a peripheral blood smear.
Erythrocytes with an increased RDW are referred to as heterogeneous and exhibit a high
degree of anisocytosis on a peripheral blood smear.
MPV values should be based on specimens that are between ____ hours old.
1 and 4 hours old
4 and 8 hours old
6 and 12 hours old
12 and 16 hours old
1 and 4 hours old
MPV is a measure of the average volume of platelets in a sample.
In EDTA–anti-coagulated blood, platelets undergo a change in shape. This alteration
(swelling) causes the MPV to increase approximately 20% during the first hour. After this
time, the size is stable for at least 12 hours; however, MPV values should be based on
specimens that are between 1 and 4 hours old.
No single normal range exists. Patients with a lower platelet count normally have a higher
MPV, and patients with a higher platelet count have a lower MPV.
Analysis of a nomogram demonstrates that an MPV between 9.0 and 9.8 fL is in the
normal range, if the platelet count is normal. MPVs from 7.8 to 8.9 fL or from 9.9 to 12.0 fL
may be in the normal range, depending on the platelet count.
DECREASED MPV:
1. Aplastic anemia
2. Megaloblastic anemia
3. Wiskott-Aldrich syndrome
4. After chemotherapy
INCREASED MPV:
1. Idiopathic thrombocytopenic purpura
2. After splenectomy
3. Sickle cell anemia
Measure of the uniformity of platelet size in a blood specimen:
Platelet adhesion
Platelet aggregation
Mean platelet volume (MPV)
Platelet distribution width (PDW)
Platelet distribution width (PDW)
Placement of fire extinguishers every ___ feet.
75 feet
100 feet
125 feet
150 feet
75 feet
Placement of fire extinguishers every 75 feet. A distinct system for marking the locations
of fire extinguishers enables quick access when they are needed. Fire extinguishers
should be checked monthly and maintained annually.
Placement of manual fire alarm boxes near the exit doors. Travel distance should not
exceed 200 feet.
Surfaces in the specimen collection and processing area should be cleaned with:
70% isopropyl alcohol.
1:10 bleach solution.
Soap and water.
Any of the above
1:10 bleach solution.
Which of the following is a proper way to clean up a small blood spill that has dried on a countertop?
Moisten it with a disinfectant and carefully absorb it with a paper towel.
Rub it with an alcohol pad, then wipe the area with a clean alcohol pad.
Scrape it into a biohazard bag and wash the surface with soap and water.
Use a disinfectant wipe and scrub it in ever-increasing concentric circles
Moisten it with a disinfectant and carefully absorb it with a paper towel.
The following test orders for different patient shave been received at the same time. Which test would you collect first?
Fasting glucose
STAT glucose in the ER
STAT hemoglobin in ICU
ASAP CBC in ICU
STAT glucose in the ER
A member of the clergy is with the patient when you arrive to collect a routine specimen. What should you do?
Ask the patient’s nurse what you should do.
Come back after the clergy person has gone.
Fill out a form saying you were unable to collect the specimen.
Say “Excuse me, I need to collect a specimen from this patient.”
Come back after the clergy person has gone.
If a physician or a member of the clergy is with the patient, don’t interrupt. The patient’s
time with these individuals is private and limited. If the draw is not stat, timed or other
urgent priority, go draw another patient and check back after that. If that is the only
patient, wait outside the room for a few minutes or go back to the lab and draw the
specimen on the next sweep. (In any case, always make certain your actions follow facility
policy.) If the request is stat, timed, or other urgent priority , excuse yourself, explain why
you are there, and ask permission to proceed.
The most common complication encountered in obtaining a blood specimen; it is caused by leakage of a small amount of blood in the tissue around the puncture site:
Petechiae
Hematoma
Ecchymosis
Hemoconcentration
Ecchymosis
Ecchymosis (Bruise): Bruising is the most common complication encountered in obtaining
a blood specimen. It is caused by leakage of a small amount of blood in the tissue around
the puncture site.
Hematoma: A hematoma results when leakage of a large amount of blood around the
puncture site causes the area to rapidly swell.
A patient complains of extreme pain when you insert the needle during a venipuncture attempt. The pain does not subside, but the patient does not feel any numbness or burning sensation. You know the needle is in the vein because the blood is flowing into the tube. You have only two tubes to fill, and the first one is almost full. What should you do?
Ask the patient if he or she wants you to continue the draw
Discontinue the draw and attempt collection at another site
Distract the patient with small talk and continue the draw
Tell the patient to hang in there as you have only one tube left
Discontinue the draw and attempt collection at another site
If marked or extreme pain occurs, or the patient asks you to remove the needle for any
reason, the venipuncture should be terminated immediately, even if there are no other
signs of nerve injury.
Which type of patient is most likely to have an arteriovenous fistula or graft?
Arthritic
Dialysis
Hospice
Wheelchair-bound
Dialysis
An arteriovenous (AV) shunt, fistula, or graft is the permanent surgical connection of an
artery and vein by direct fusion (fistula), resulting in a bulging vein, or with a piece of vein
or tubing (graft) that creates a loop under the skin. It is typically created to be used for
dialysis, commonly joins the radial artery and cephalic vein above the wrist on the
underside of the arm, and has a distinctive buzzing sensation called a “thrill” when
palpated. A temporary shunt with tubing on the surface of the skin can also be created.
Type of immersion oil with high viscosity and is used in brightfield and standard clinical microscopy. In hematology, this oil is routinely used.
Type A
Type B
Type C
Type B
Three types of immersion oil, differing in viscosity, are employed in the clinical laboratory:
1. Type A has very low viscosity and is used in fluorescence and darkfield studies.
2. Type B has high viscosity and is used in brightfield and standard clinical microscopy. In
hematology, this oil is routinely used.
3. Type C has very high viscosity and is used with inclined microscopes with long-focus
objective lenses and wide condenser gaps.
The recommended cleaner for removing oil from objectives is:
Benzene
Xylene
Water
70% alcohol or lens cleaner
70% alcohol or lens cleaner
Use solvent sparingly. The use of xylene is discouraged, because it contains a
carcinogenic component (benzene). Xylene is also a poor cleaning agent, leaving an oily
film on the lens. Lens cleaner or 70% isopropyl alcohol employed sparingly on a cotton
applicator stick can be used to clean the objective lenses.
Often the objects appear to have “haloes” surrounding them.
Brightfield microscope
Darkfield microscope
Phase-contrast microscope
Polarized light microscope
Phase-contrast microscope
True for PRECISION:
Measure of agreement between an assay value and the theoretical “true value” of its analyte
Magnitude of error separating the assay result from the true value
Easy to define but difficult to establish and maintain
Relatively easy to measure and maintain
Relatively easy to measure and maintain
Accuracy is easy to define but difficult to establish and maintain; precision is relatively
easy to measure and maintain.
Precision is the expression of reproducibility or dispersion about the mean, often
expressed as SD or CV%.
Slope measures:
Random error
Constant systematic error
Proportional systematic error
Constant and proportional systematic error
Proportional systematic error
Perfect correlation generates a slope of 1 and a y intercept of 0.
Slope measures proportional systematic error; the higher the analyte value, the greater the
deviation from the line of identity. Proportional errors are caused by malfunctioning
instrument components or a failure of some part of the testing process. The magnitude of
the error increases with the concentration or activity of the analyte. An assay with
proportional error may be invalid.
Intercept measures constant systematic error (or bias, in laboratory vernacular), a
constant difference between the new and reference assay regardless of assay result
magnitude. A laboratory director may choose to adopt a new assay with systematic error
but must modify the published reference interval.
The positive predictive value predicts the probability that an individual with a positive assay result ___ the disease or condition.
Has
Could have
May have
Will have
Has
The positive predictive value predicts the probability that an individual with a positive
assay result has the disease or condition.
The negative predictive value predicts the probability that an individual with a negative
assay result does not have the disease or condition.
It describes the total number of events or conditions in a broadly defined population, for instance, the total number of patients with chronic heart disease in the Philippines.
Incidence
Prevalence
False negative
False positive
Prevalence
Epidemiologists describe population events using the terms prevalence and incidence.
1. Prevalence describes the total number of events or conditions in a broadly defined
population, for instance, the total number of patients with chronic heart disease in the United States.
2. Incidence describes the number of events occurring within a randomly selected number
of subjects representing a population, over a defined time, for instance, the number of newcases of heart disease per 100,000 U.S. residents per year.
Scientists use incidence, not prevalence, to select laboratory assays for specific
applications such as screening or confirmation.
Type of chromatin represented by the more darkly stained, condensed clumping pattern and is the transcriptionally inactive area of the nucleus
Euchromatin
Heterochromatin
Heterochromatin
Morphologically, chromatin is divided into two types:
(1) the heterochromatin, which is represented by the more darkly stained, condensed
clumping pattern and is the transcriptionally
inactive area of the nucleus
(2) the euchromatin, which has diffuse, uncondensed, open chromatin and is the genetically active portion of the nucleus where DNA transcription into mRNA
occurs. The euchromatin is loosely coiled and turns a pale blue when stained with Wright
stain.
More mature cells have more heterochromatin because they are less transcriptionally
active.
In ____, the tetraploid DNA is checked for proper replication and damage takes approximately 4 hours.
G1
S
G2
M
G0
G2
The cell cycle is a biochemical and morphologic four-stage process through which a cell
passes when it is stimulated to divide.
These stages are G1 (gap 1), S (DNA synthesis), G2 (gap 2), and M (mitosis).
G1 is a period of cell growth and synthesis of components necessary for replication. G1 lasts about 10 hours.
In the S stage, DNA replication takes place, a process requiring about 8 hours. An exact
copy of each chromosome is produced and they pair together as sister chromatids. The
centrosome is also duplicated during the S stage.
In G2, the tetraploid DNA is checked for proper replication and damage. G2 takes
approximately 4 hours.
The time spent in each stage can be variable, but mitosis takes approximately 1 hour.
During G0 (quiescence) the cell is not actively in the cell cycle.
All of the following statements refers to APOPTOSIS, except:
Enlarged cell size due to swelling
Reduced cell size due to shrinkage
Condensation and fragmentation of the nucleus between nucleosomes
Mostly physiologic to remove unwanted cells
Enlarged cell size due to swelling
APOPTOSIS
Reduced due to shrinkage
Condensation and fragmentation between nucleosomes
Mostly physiologic to remove unwanted cells; pathologic in response to cell injury
—-
NECROSIS
Enlarged due to swelling
Random breaks and lysis (karyolysis)
Pathologic; results from cell injury
The process of replacing the active marrow by adipocytes (yellow marrow) during development is
Hematopoiesis
Progression
Regression
Retrogression
Retrogression
The process of replacing the active marrow by adipocytes (yellow marrow) during
development is called retrogression and eventually results in restriction of the active
marrow in the adult to the sternum, vertebrae, scapulae, pelvis, ribs, skull, and proximal
portion of the long bones.
The major site of blood cell production during the second trimester of fetal development.
Yolk sac
Liver
Spleen
Bone marrow
Liver
The liver serves as the major site of blood cell production during the second trimester of
fetal development.
In adults, the hepatocytes of the liver have many functions, including protein synthesis and
degradation, coagulation factor synthesis, carbohydrate and lipid metabolism, drug and
toxin clearance, iron recycling and storage, and hemoglobin degradation in which bilirubin
is conjugated and transported to the small intestine for eventual excretion
The largest lymphoid organ in the body:
Bone marrow
Thymus
Liver
Spleen
Spleen
Cytokines that function for STEM CELL MOBILIZATION:
IL-1 and IL-2
IL-2 and IFN-alpha
IL-12 and IL-15
IL-3, G-CSF and GM-CSF
IL-3, G-CSF and GM-CSF
In adults, hematopoietic tissue is located in the:
Bone marrow
Bone marrow and lymph nodes
Bone marrow, lymph nodes, liver and spleen
Bone marrow, lymph nodes, spleen, liver and thymus
Bone marrow, lymph nodes, spleen, liver and thymus
In aplastic anemia, the bone marrow is:
Empty
Empty, hypoplastic
Empty, hyperplastic
Either hypoplastic or hyperplastic
Empty, hypoplastic
Second step in phagocytosis:
Recognition and attachement
Ingestion
Killing and digestion
Formation of neutrophil extracellular trap
Ingestion
PHAGOCYTOSIS (RODAK)
1. Recognition and attachment
2. Ingestion
3. Killing and digestion
4. Formation of neutrophil extracellular trap
The promonocyte nucleus is deeply indented and should not be confused with a:
Lymphocyte
Erythrocyte
Segmenter neutrophil
Band neutrophil
Band neutrophil
Which of the following cells does not exhibit myeloperoxidase (MPO) activity?
Neutrophils
Eosinophils
Monocytes
Lymphocytes
Lymphocytes
Myeloperoxidase (MPO) is an enzyme found in the primary granules of granulocytic cells
(neutrophils, eosinophils, and, to a certain extent, monocytes). Lymphocytes do not exhibit
MPO activity. This stain is useful for differentiating the blasts of acute myeloid leukemia
(AML) from those of acute lymphoblastic leukemia (ALL).
NEWER TECHNIQUES USED IN THE DIAGNOSIS of acute leukemias:
Morphology and cytochemistry
Cytochemistry and cytogenetics
Flow cytometry and cytogenetic analysis
Flow cytometry, cytogenetic analysis and molecular testing
Flow cytometry, cytogenetic analysis and molecular testing
Basophilic and granular cytoplasm
MK-I
MK-II
MK-III
MK-II
Differentiation stage(s) characterized by presence of demarcation system:
MK-I
MK-I and MK-II
MK-II and MK-III
MK-I, MK-II and MK-III
MK-I, MK-II and MK-III
Cytokine(s) that function to stimulate megakaryocytopoiesis:
Thrombopoietin (TPO)
TPO and IL-3
TPO, IL-3 and IL-6
TPO, IL-3, IL-6 and IL-11
TPO, IL-3, IL-6 and IL-11
Demonstrates the largest platelets seen and is also referred to as giant platelet syndrome:
Epstein syndrome
Mediterranean macrothrombocytopenia
May-Hegglin anomaly
Bernard-Soulier syndrome
Bernard-Soulier syndrome
Ratio of blood to anticoagulant for coagulation testing:
1:4
1:9
4:1
9:1
9:1
Hemostasis specimen STORAGE temperature:
1 to 6 C
18 to 24 C
36.5 to 37.5 C
30 to 37 C
18 to 24 C
HEMOSTASIS SPECIMEN STORAGE TEMPERATURE
Sodium citrate-anticoagulated whole blood specimens are placed in a rack and allowed to
stand in a vertical position with the stopper intact and uppermost. The pH remains
constant as long as the specimen is sealed. Specimens are maintained at 18° C to 24° C
(ambient temperature), never at refrigerator temperatures.
Storage at 1° C to 6° C activates factor VII, destroys platelet activity through uncontrolled
activation, and causes the cryoprecipitation of large VWF multimers. Also, specimens
should never be stored at temperatures greater than 24° C because heat causes
deterioration of coagulation factors V and VIII.
Most coagulation studies are carried out at which temperature?
-20C
-70C
24C
37C
37C
Possible solution when specimen is icteric or lipemic for a clot-based test:
PT falsely shortened; recollect specimen.
PT falsely prolonged; recollect specimen.
Measure PT using a mechanical coagulometer
Adjust anticoagulant volume
Measure PT using a mechanical coagulometer
Possible effect and solution when blood collection volume is less than the specified minimum for a clot-based test:
PT falsely shortened; recollect specimen
PT falsely prolonged; recollect specimen.
Use reagent known to be insensitive to heparin
Use chromogenic factor X assay instead of PT
PT falsely prolonged; recollect specimen.
Test that assess deficiencies of all factors except VII and XIII:
Prothrombin time (PT)
Partial thromboplastin time (PTT)
Thrombin time (TT)
Reptilase time
Partial thromboplastin time (PTT)
Part of the INITIAL VON WILLEBRAND DISEASE WORKUP:
BT, PT and APTT
CBC, PT and APTT
CBC, BT, PT and APTT
CBC, BT, PT, APTT and automated functional platelet assays
Decreased vWF activity and personal/family history of mucocutaneous bleeding
CBC, PT and APTT
DEFINITIVE DIAGNOSIS OF VON WILLEBRAND DISEASE:
BT, PT and APTT
CBC, PT and APTT
CBC, BT, PT and APTT
CBC, BT, PT, APTT and automated functional platelet assays
Laboratory demonstration of decreased vWF activity
Decreased vWF activity and personal/family history of mucocutaneous bleeding
Decreased vWF activity and personal/family history of mucocutaneous bleeding
In Coulter instruments, which parameters are directly measured:
RBC count and hemoglobin
RBC and WBC counts
RBC count and hematocrit
RBC and WBC counts, hemoglobin
RBC and WBC counts, hemoglobin
Lipemia, icterus:
Increased Hb
Increased Hb, decreased MCH
Increased Hb and MCH
Decreased Hb and MCH
Increased Hb and MCH
Platelet clumps:
Decreased platelets
Decreased platelets and WBCs
Decreased platelets, increased WBCs
Increased platelets and WBCs
Decreased platelets, increased WBCs
Parameters affected when the WBC count > 100,000/uL:
Increased RBCs, decreased hemoglobin
Decreased RBCs, increased hemoglobin
Decreased RBCs and hemoglobin
Increased RBcs and hemoglobin, incorrect hematocrit
Increased RBcs and hemoglobin, incorrect hematocrit
Compare the volume of plasma to serum obtained from a given volume of whole blood:
Plasma greater volume than serum
Plasma lesser volume than serum
Same volume
Variable
Plasma greater volume than serum
EDTA is used in concentrations of ___ mg/1 mL of whole blood.
0.5 mg/1 mL of whole blood
1.5 mg/1 mL of whole blood
2.0 mg/1 mL of whole blood
2.5 mg/1 mL of whole blood
1.5 mg/1 mL of whole blood
A 7.0 mL EDTA tube is received in the laboratory containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the following tests will most likely be erroneous?
A. RBC count
B. Hemoglobin
C. Hematocrit
D. WBC count
C. Hematocrit
EDTA-induced pseudothrombocytopenia can be identified on blood smear by:
A. Finding platelets pushed to the feathered end
B. Finding platelets adhering to WBCs
C. Finding no platelets at all on the smear
D. Bluish discoloration to the macroscopic appearance of the slide
B. Finding platelets adhering to WBCs
Platelet satellitosis (platelet encircling the peripheral borders of neutrophils) is seen in a
rare patient whose blood is anticoagulated with EDTA. This phenomenon is thought to be
due to a serum factor which reacts in the presence of EDTA.
The automated platelet count on an EDTA specimen is 58 x 10 9th/L. The platelet estimate on the blood smear appears normal, but it was noted that the platelets were surrounding the neutrophils. The next step should be to:
A. Report the automated platelet count since it is more accurate than a platelet estimate
B. Warm the EDTA tube and repeat the automated platelet count
C. Rerun the original specimen since the platelet count and blood smear estimate do not match
D. Recollect a specimen for a platelet count using a different anticoagulant
D. Recollect a specimen for a platelet count using a different anticoagulant
Sodium citrate in the concentration of ___ solution has been adopted as the appropriate concentration for coagulation studies.
A. 1.5%
B. 2.8%
C. 3.2%
D. 3.8%
C. 3.2%
Sodium citrate in the concentration of a 3.2% solution has been adopted as the
appropriate concentration by the ICSH and the International Society for Thrombosis and
Hemostasis for coagulation studies.
Which ratio of anticoagulant to blood is correct for coagulation procedures?
A. 1:4
B. 1:5
C. 1:9
D. 1:10
C. 1:9
Which results would be expected for the PT and APTT in a patient with polycythemia?
A. Both prolonged
B. Both shortened
C. Normal PT, prolonged APTT
D. Both normal
A. Both prolonged
What is the proper angle of needle insertion for phlebotomy?
A. 5 degrees
B. 15 degrees
C. 35 degrees
D. 45 degrees
B. 15 degrees
Select the needle most commonly used in standard venipuncture in an adult:
A. One inch, 18 gauge
B. One inch, 21 gauge
C. One-half inch, 21 gauge
D. One-half inch, 25 gauge
B. One inch, 21 gauge
The bevel of the needle should be held _____ in the performance of a venipuncture.
A. Sideways
B. Upward
C. Downward
D. In any direction
B. Upward
Most common complication encountered in obtaining a blood specimen:
A. Ecchymosis (bruise)
B. Hematoma
C. Hemoconcentration
D. Anemia
A. Ecchymosis (bruise)
It is caused by leakage of a SMALL AMOUNT OF BLOOD in the tissue around the puncture site:
A. Ecchymosis (bruise)
B. Hematoma
C. Hemoconcentration
D. Anemia
A. Ecchymosis (bruise)
Leakage of a LARGE AMOUNT OF BLOOD around the puncture site causes the area to rapidly swell:
A. Ecchymosis (bruise)
B. Hematoma
C. Hemoconcentration
D. Anemia
B. Hematoma
VASCULAR COMPLICATIONS of phlebotomy:
A. Bleeding from the site of the venipuncture and hematoma
B. Pseudoaneurysm, thrombosis
C. Reflex arteriospasm, arteriovenous fistula formation
D. All of these
D. All of these
Bleeding from the site of the venipuncture and hematoma formation are the most
common vascular complications.
Uncommon vascular complications that are not usually related to the technique include
pseudoaneurysm, thrombosis, reflex arteriospasm, and arteriovenous fistula formation.
CARDIOVASCULAR COMPLICATIONS of phlebotomy:
A. Orthostatic hypotension
B. Syncope
C. Shock and cardiac arrest
D. All of these
D. All of these
A blood sample is needed from a patient with IV fluids running in both arms. Which of the following is an acceptable procedure?
A. Any obtainable vein is satisfactory.
B. Obtain sample from above the IV site.
C. Obtain sample from below the IV site with special restrictions.
D. Disconnect the IV line.
E. Do not draw a blood specimen
C. Obtain sample from below the IV site with special restrictions.
When encountering a patient with a FISTULA, the phlebotomist should:
Apply the tourniquet below the fistula
Use the other arm
Collect the blood from the fistula
Attach a syringe to the T-tube connector
Use the other arm
FISTULA: Permanent surgical connection between an artery and a vein (used for dialysis)
CANNULA: Tube that can be inserted into a cavity
If a patient adamantly refuses to have blood drawn, you should:
Convince the patient to be cooperative
Notify the patient’s nurse or physician
Restrain the patient and draw the blood
Write a note to the patient’s physician
Notify the patient’s nurse or physician
Blood collection tubes are labeled:
As soon as the test order is received
Before the specimen is even collected
Immediately after specimen collection
After returning to the laboratory
Immediately after specimen collection
Which of the following is a proper way to clean up a small blood spill that has dried on a countertop?
Moisten it with a disinfectant and carefully absorb it with a paper towel
Rub it with an alcohol pad, then wipe the area with a clean alcohol pad
Scrape it into a biohazard bag and wash the surface with soap and water
Use a disinfectant wipe and scrub it in ever increasing concentric circles
Moisten it with a disinfectant and carefully absorb it with a paper towel
The appropriate dilution of bleach to be used in laboratory disinfection is:
1:2
1:5
1:10
1:100
1:10
Which order of events should be followed at the conclusion of a laboratory worker’s shift in order to prevent the spread of bloodborne pathogens?
Remove gloves, disinfect area, wash hands, remove lab coat
Disinfect area, remove gloves, remove lab coat, wash hands
Disinfect area, remove gloves, wash hands, remove lab coat
Remove gloves, wash hands, remove lab coat, disinfect area
Disinfect area, remove gloves, remove lab coat, wash hands
According to the OSHA Bloodborne Pathogens Rule of 1992, gloves and lab coats are to
be removed after disinfection of the work area.
Isolation techniques:
Prevent spread of infection from patient to hospital personnel
Prevent spread of infection from patient to other patients
Protect infection prone patient from pathogens
All of these
All of these
In ENTERIC ISOLATION, the technologist is required to wear
Gown and gloves
Gown, mask and gloves
Gown, mask, gloves and shoe coverings
Mask
Gown and gloves
STRICT ISOLATION: Gown, mask and gloves
ENTERIC ISOLATION: Gown and gloves
RESPIRATORY ISOLATION: Mask, gloves
WOUND AND SKIN ISOLATION: Gown and gloves
PROTECTIVE ISOLATION: Gown, mask, gloves, shoe coverings
Reverse isolation may be used for:
A patient with the measles
An adult patient with the flu
A patient with tuberculosis
A patient with severe burns
A patient with severe burns
Patients requiring PROTECTIVE ISOLATION are those with compromised immune systems,
such as neutropenic patients (those with abnormally low white blood cell counts); severely
burned patients; and patients with compromised immune systems, such as patients with
AIDS.
The first hemostatic response to injury of a blood vessel is:
Platelet adhesion
Platelet aggregation
Vasoconstriction
Extrinsic coagulation
Vasoconstriction
The enzyme inhibited by aspirin is:
Thromboxane synthetase
Cyclooxygenase
Lactate dehydrogenase
Phospholipase
Cyclooxygenase
The life span of a platelet is about:
2 to 3 hours
1 to 3 days
8 to 11 days
60 to 80 days
8 to 11 days
Approximately ___ of the total number of platelets circulate in the systemic circulation?
One-fourth
One-third
One-half
Two-thirds
Two-thirds
The normal range of platelets in the systemic circulation is:
50 - 150 x 10 9th/L
100 - 200 x 10 9th/L
150 - 400 x 10 9th/L
Greater than 500 x 10 9th/L
150 - 400 x 10 9th/L
Effect of platelet clumps to automated cell counting:
Decreased platelets and WBCs
Increased platelets and WBCs
Decreased platelets, increased WBCs
Increased platelets, decreased WBCs
Decreased platelets, increased WBCs
RATIONALE: Large clumps counted as WBCs and not platelets
CORRECTIVE ACTION: Redraw specimen in sodium citrate, multiply result by 1.1
In disseminated intravascular coagulation (DIC) and immune thrombocytopenic purpura (ITP):
There is decreased production of platelets
There is increased destruction of platelets
There is a defect of platelet membrane
There is defect of platelet release reaction
There is increased destruction of platelets
Immune thrombocytopenic purpura (ITP):
Formerly known as disseminated intravascular coagulation (DIC)
Absence of megakaryocytes in the bone marrow
Widespread formation of platelet thrombi
Due to platelet antibodies
Due to platelet antibodies
In thrombocythemia, the platelets are:
Increased
Decreased
Normal
Normal in number, abnormal morphology
Increased
Which of the following is characteristic of Bernard-Soulier syndrome?
Giant platelets
Normal bleeding time
Abnormal aggregation with ADP
Increased platelet count
Giant platelets
Platelet aggregation studies revealed normal aggregation curves with collagen, epinephrine, and ADP, but an abnormal aggregation curve with ristocetin. Based on these findings, what is the differential diagnosis?
-Von Willebrand disease and Bernard-Soulier syndrome
-Glanzmann’s thrombasthenia and von Willebrand disease
-Storage pool disease and Glanzmann’s thrombasthenia
-Bernard-Soulier syndrome and storage pool disease
Von Willebrand disease and Bernard-Soulier syndrome
Which set of platelet responses would be most likely be associated with Glanzmann’s thrombasthenia?
-Normal platelet aggregation response to ADP and ristocetin; decreased response to collagen
-Normal platelet aggregation response to collagen; decreased response to ADP and collagen
-Normal platelet aggregation response to ristocetin; decreased response to collagen, ADP and epinephrine
-Normal platelet aggregation response to ADP; decreased response to collagen and ristocetin
Normal platelet aggregation response to ristocetin; decreased response to collagen, ADP and epinephrine
Primary PLATELET AGGREGATION disorders:
Bernard-Soulier syndrome
Glanzmann’s thrombasthenia
Essential athrombia
Glanzmann’s thrombasthenia and essential athrombia
Glanzmann’s thrombasthenia and essential athrombia
Glanzmann thrombasthenia and essential athrombia are similar, rare, primary aggregation
disorders.
To evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets, should be observed per oil immersion field?*
1 to 4
8 to 20
4 to 10
20 to 50
8 to 20
If an average of 10 platelets are seen per oil immersion field, what is the estimated platelet count?
50 x 10 9th/L
100 x 10 9th/L
200 x 10 9th/L
300 x 10 9th/L
200 x 10 9th/L
For platelet estimate on a wedge smear:
Factor is 20,000
In the Ivy method of bleeding time, the blood pressure cuff is inflated to:
20 mm. Hg
30 mm. Hg
40 mm. Hg
45 mm. Hg
40 mm. Hg
Normal platelet adhesion depends upon:
Fibrinogen
Glycoprotein Ib
Glycoprotein IIb, IIIa complex
Calcium
Glycoprotein Ib
Glycoprotein Ib is a platelet receptor for VWF. Glycoprotein Ib and VWF are both necessary
for a normal platelet adhesion. Other proteins that play a role in platelet adhesion are
glycoproteins V and IX
Storage pool deficiencies are defects of:
Platelet adhesion
Platelet aggregation
Platelet granules
Platelet production
Platelet granules
Storage pool deficiencies are defects of platelet granules. Most commonly, a decrease in
platelet-dense granules is present with decreased release of ADP, ATP, calcium, and
serotonin from platelet-dense granules.
Which defect characterizes Gray’s syndrome?
Platelet adhesion defect
Dense granule defect
Alpha granule defect
Coagulation defect
Alpha granule defect
Gray’s syndrome is a platelet granule defect associated with a decrease in alpha granules
resulting in decreased production of alpha granule proteins such as platelet factor 4 and
beta thromboglobulin. Alpha granule deficiency results in the appearance of agranular
platelets when viewed on a Wright’s stained blood smear.
Hereditary hemorrhagic telangiectasia is a disorder of:
Platelets
Clotting proteins
Fibrinolysis
Connective tissue
Connective tissue
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) is a connective
tissue disorder associated with telangiectases (dilated capillaries) of the mucous
membranes and skin. Lesions may develop on the tongue, lips, palate, face, hands, nasal
mucosa, and throughout the gastrointestinal tract. This disorder is an autosomal dominant
condition that usually manifests in adolescence or early adulthood.
In which of the following lists the steps of hemostatic response in the correct order?
Fibrinolysis → injury → secondary hemostasis → primary hemostasis
Injury → primary hemostasis → secondary hemostasis → fibrinolysis
Injury → secondary hemostasis → primary hemostasis → fibrinolysis
Injury → fibrinolysis → primary hemostasis → secondary hemostasis
Injury → primary hemostasis → secondary hemostasis → fibrinolysis
Primary substrate of thrombin:
Fibrinogen
Prothrombin
Factor V
Factor X
Fibrinogen
Which results are associated with hemophilia A?
Prolonged APTT, normal PT
Prolonged PT and APTT
Prolonged PT, normal APTT
Normal PT and APTT
Prolonged APTT, normal PT
Hemophilia A is associated with factor VIII deficiency. Factor VIII is a factor in the intrinsic coagulation pathway that is evaluated by the APTT and not the PT test. The PT test evaluates the extrinsic and common pathways.
Normal PT and APTT results in a patient with a poor wound healing may be associated with:
Factor VII deficiency
Factor VIII deficiency
Factor XII deficiency
Factor XIII deficiency
Factor XIII deficiency
Factor XIII deficiency can lead to impaired wound healing and may cause severe bleeding problems. Factor XIII is a fibrin stabilizing factor that changes the fibrinogen bonds in fibrin polymers to stable covalent bonds. Factor XIII is not involved in the process of fibrin formation and, therefore, the PT and APTT are both normal.
Which coagulation factor is present in the highest concentration in plasma?
Factor II
Factor XII
Factor I
Factor VII
Factor I
Which of the following participates ONLY in the extrinsic pathway?
Factor VII
Factor IX
Factor X
Factor II
Factor VII
Plasma thromboplastin or prothrombinase includes:
-Calcium ion only
-Complex of calcium ions and activated factor XI
-Complex of activated factor VII and calcium ions
-Complex of activated factors X and V, platelet factor 3 and calcium ions
Complex of activated factors X and V, platelet factor 3 and calcium ions
The activated partial thromboplastin time is NOT affected by deficiency of:
Factor VIII
Factor IX
Factor XI
Factor VII
Factor VII
Prothrombin time is NOT affected by a deficiency of:
Factor VIII
Factor V
Factor I
Factor X
Factor VIII
Classic hemophilia is a condition in which there may be a:
Prolonged bleeding time
Decrease in platelets
Prolonged prothrombin time
Prolonged activated partial thromboplastin time
Prolonged activated partial thromboplastin time
Which of the following is vitamin K dependent?
Factor XII
Fibrinogen
Antithrombin III
Factor VII
Factor VII
Last factor to be depressed n vitamin K deficiency:
Factor II
Factor VII
Factor X
Factor IX
Factor II
Which of the following factors is not present in BaSO4 adsorbed plasma?
Factor VIII
Factor II
Factor XII
Factor V
Factor II
Which one of the following factors typically shows an increase in liver disease?
Factor VII
Factor VIII
Factor IX
Factor X
Factor VIII
Which of the following factor deficiencies is associated with either no bleeding or only a minor bleeding tendency, even after trauma or surgery?
Factor X
Factor XII
Factor XIII
Factor V
Factor XII
In which of the following diseases would you most likely find an abnormal prothrombin time:
Hemophilia A
Hemophilia B
vWD
DIC
DIC
Increased APTT with a normal PT would indicate a deficiency of:
Factor II
Factor VII
Factor IX
Factor X
Factor IX
Normal APTT with an increased PT would indicate a deficiency of:
Factor II
Factor VII
Factor I
Factor IX
Factor VII
Increased APTT and PT would indicate a deficiency of:
Factor V
Factor XI
Factor XII
Factor VIII
Factor V
PTT measures all factors except for:
I and V
VIII and IX
V and VIII
VII and XIII
VII and XIII
