Body Fluid Analysis in the Hematology Laboratory

Question 1

Refer to the following scenario to answer questions 1 and 2: A spinal fluid specimen is diluted 1:2 with Türk solution to perform
the nucleated cell count. A total of 6 nucleated cells are counted
on both sides of the hemacytometer, with all nine squares
counted on both sides. Undiluted fluid is used to perform the
RBC count. A total of 105 RBCs is counted on both sides of the
hemacytometer, with four large squares on both sides counted.

1. The nucleated cell count is ___/mL.
   a. 3
   b. 7
   c. 13
   d. 66

Answer 1

b. 7

Question 2

Refer to the following scenario to answer questions 1 and 2: A spinal fluid specimen is diluted 1:2 with Türk solution to perform
the nucleated cell count. A total of 6 nucleated cells are counted
on both sides of the hemacytometer, with all nine squares
counted on both sides. Undiluted fluid is used to perform the
RBC count. A total of 105 RBCs is counted on both sides of the
hemacytometer, with four large squares on both sides counted.

2. The RBC count is ___/mL.
   a. 131
   b. 263
   c. 1050
   d. 5830

Answer 2

a. 131

Question 3

3. Based on the cell counts, the appearance of the fluid is:
   a. Turbid
   b. Hemolyzed
   c. Clear
   d. Cloudy

Answer 3

c. Clear

Question 4

4. All of the following cells are normally seen in CSF, serous
   fluids, and synovial fluids except:
   a. Lining cells
   b. Neutrophils
   c. Lymphocytes
   d. Monocytes/histiocytes (macrophages)

Answer 4

b. Neutrophils

Question 5

5. Spinal fluid was obtained from a 56-year-old woman. On
   receipt in the laboratory, the fluid was noted to be slightly
   bloody. When a portion of the fluid was centrifuged, the
   supernatant was clear. The cell counts were 5200 RBCs/mL3
   and 24 WBCs/mL. On the cytocentrifuge preparation,
   several nucleated RBCs were seen. The differential was
   52% lymphocytes, 20% neutrophils, 22% monocytes,
   4% myelocytes, and 2% blasts. What is the most likely explanation for these results?

a. Bone marrow contamination
b. Bacterial meningitis
c. Peripheral blood contamination
d. Leukemic infiltration in the central nervous system

Answer 5

a. Bone marrow contamination

Question 6

6. A 34-year-old woman with a history of breast cancer developed a pleural effusion. The fluid obtained was bloody and
   had a nucleated cell count of 284/mL. On the cytocentrifuge preparation, there were several neutrophils and a few
   monocytes/histiocytes. There were also several clusters of
   large, dark-staining cells. These cell clumps appeared
   “three-dimensional” and contained some mitotic figures.
   What is the most likely identification of the cells in
   clusters?
   a. Mesothelial cells
   b. Metastatic tumor cells
   c. Cartilage cells
   d. Pneumocytes

Answer 6

b. Metastatic tumor cells

Question 7

7. A serous fluid with a clear appearance, specific gravity of
   1.010, protein concentration of 1.5 g/dL, and fewer than
   500 mononuclear cells/mL would be considered:
   a. Infectious
   b. An exudate
   c. A transudate
   d. Sterile

Answer 7

c. A transudate

Question 8

8. On the cytocentrifuge slide prepared from a peritoneal fluid
   sample, many large cells are seen, singly and in clumps. The
   cells have a “fried egg” appearance and basophilic cytoplasm, and some are multinucleated. These cells should be
   reported as:
   a. Suspicious for malignancy
   b. Macrophages
   c. Large lymphocytes
   d. Mesothelial cells

Answer 8

d. Mesothelial cells

Question 9

Refer to the following scenario to answer questions 9 and 10: A 56-yearold man came to the physician’s office with complaints of pain and
swelling in his left big toe. Fluid aspirated from the toe was strawcolored and cloudy. The WBC count was 2543/mL. The differential
consisted mainly of neutrophils and monocytes/histiocytes. Intracellular and extracellular crystals were seen on the cytocentrifuge
slide. The crystals were needle-shaped and, when polarized with the
use of the red compensator, appeared yellow on the y-axis.
9. The crystals are:
a. Cholesterol
b. Hyaluronidase
c. Monosodium urate
d. Calcium pyrophosphate

Answer 9

c. Monosodium urate

Question 10

Refer to the following scenario to answer questions 9 and 10: A 56-yearold man came to the physician’s office with complaints of pain and
swelling in his left big toe. Fluid aspirated from the toe was strawcolored and cloudy. The WBC count was 2543/mL. The differential
consisted mainly of neutrophils and monocytes/histiocytes. Intracellular and extracellular crystals were seen on the cytocentrifuge
slide. The crystals were needle-shaped and, when polarized with the
use of the red compensator, appeared yellow on the y-axis

10. This patient’s painful toe was caused by:
    a. Gout
    b. Infection
    c. Inflammation
    d. Pseudogout

Answer 10

a. Gout