HEMA 1 EXAM Flashcards
The bevel of the needle should be held ______ in the performance of a venipuncture.
A. sideways
B. upward
C. downward
D. in any direction
upward
*bevel of the needle should be upward to penetrate the skin and avoid difficulty in obtaining the specimen
A blood sample is need 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.
Obtain sample from below the IV site with special restrictions.
*A limb with an IV running should not be used for
venipuncture because of contamination to the specimen. The patient’s other arm or an alternate site should be selected. If no alternate site can be found, the IV should be turned off by the physician
and blood can be drawn from below the infusion site after a few minutes.
Which of the following skin puncture areas is acceptable for the collection of capillary blood from an infant?
A. Previous puncture site
B. Posterior curve of the heel
C. Arch
D. Medial or lateral plantar surface
Medial or lateral plantar surface
Capillary Blood Collection: Appropriate Site
INFANT:
medial or lateral plantar surface of the heel, with a puncture no deeper than 2.0mm beneath the plantar heel-skin surface and no more than half this distance at the posterior curve of the heel
ADULT:
Fingertip (3rd or 4th finger); Earlobe
Which parameters are calculated rather than directly measured?
A. Hematocrit and erythrocyte distribution width
B. Erythrocyte count and leukocyte count
C. Leukocyte count and hematocrit
D. Platelet count and platelet volume
Hematocrit and erythrocyte distribution width
*Directly
Measured: RBC and WBC count, Hemoglobin
Calculated: Hct, RDW
The delta check is used to detect
A. the use of the correct anticoagulant
B. The time of storage of a tested specimen
C. the difference between current and past patient results
D. the proper collection time of a patient specimen
The difference between current and past patient
results
*Delta checks are particularly important to rule out mislabeling, clerical error, or possibly an analytical error. It is another quality control method for comparing a patient’s own leukocyte, hemoglobin, MCV, and platelet values with previous results.
A peripheral blood smear can be prepared from
A. EDTA-anticoagulated blood within 1 hour of collection
B. Free-flowing capillary blood
C. Citrated whole blood
D. Both A and B
Both A and B
*The preparation of a blood smear may be conducted at the patient’s bedside or in the laboratory, if EDTA anticoagulated blood is used. Although, free-flowing capillary blood may be used as well.
Your co-intern keeps on making a blood smear that is too long, this can be resolved by:
A. Decreasing the angle of the pusher slide
B. Increasing the angle of the pusher slide
C. Using a larger drop of blood
D. Pushing the slide slower in smearing out the blood
Increasing the angle of the pusher slide
TOO LONG/TOO THIN
-Using a smaller drop of blood; Increasing the angle of the pusher slide
TOO SHORT/TOO THICK
-Using a larger drop of blood; Decreasing the angle of the pusher slide
FEATURES OF A GOOD BLOOD SMEAR PREP
1. The film is two thirds to three fourths the length of the slide.
- The film is finger shaped, very slightly rounded at the feather edge, not bullet shaped; this provides the widest area for examination.
- The lateral edges of the film are visible.
- The film is smooth without irregularities, holes, or streaks.
- When the slide is held up to the light, the thin portion (feather edge) of the film has a “rainbow” appearance.
- The whole drop of blood is picked up and spread.
If a blood smear stains too red on microscopic examination of a Wright-stained preparation,
possible causes include that
A. the staining time was too long
B. the stain was too basic
C. the buffer was too acidic and the exposure time was too short
D. the buffer was too basic and the exposure time was too long
the buffer was too acidic and the exposure time was too short
*Wright stain is composed of a basic dye (Methylene blue) and acidic dye (Eosin). The overall color and intensity of staining in a Wright-stained blood smear
vary with cell maturity and type, so proper staining is crucial for proper identification.
In the S phase of mitotic division, how long does DNA replication occurs?
A. 1 hour
B. 2 hours
C. 4 hours
D. 8 hours
8 hours
Which of the following is NOT a function of a quantitative QC program?
A. Detects shifts in control values
B. Compares the accuracy of controls to reference values
C. Monitors the correct functioning of equipment,
reagents, and individual technique
D. Confirms the correct identity of patient specimens
Confirms the correct identity of patient specimens
- QC activities include monitoring the performance of laboratory instruments, reagents, other testing products, and equipment.
- A written record of QC activities for each procedure or function should include details of deviation from the usual results, problems, or failures in functioning or in the analytical
(examination) procedure and any corrective action taken in response to these problems.
Acceptable limits of a control value must fall
A. within +1 standard deviation of the mean
B. between 1 and 2 standard deviations of the mean
C. within ‡2 standard deviations of the mean
D. within ‡3 standard deviations of the mean
within ‡2 standard deviations of the mean
*Confidence or control limits are calculated from the mean and the SD. The confidence limits represent a set of mathematically established limits into which the majority of values (results) will fall. Within the confidence limits, the results are assumed to be accurate. It is common practice to use ±2 SD as the limit of confidence.
Which characteristic is inaccurate with respect to the anticoagulant K3 EDTA?
A. Removes ionized calcium (Ca2+) from fresh whole blood by the process of chelation
B. Is used for most routine coagulation studies
C. Is the most commonly used anticoagulant in hematology
D. Is conventionally placed in lavender-stoppered evacuated tubes
Is used for most routine coagulation studies
EDTA: Most common anticoagulant used in Hematology Laboratory
Lavender – Hematology tests
Pink - Bloodbanking
Royal Blue – Toxic Elements
Tan – Lead Determination
White – Molecular studies
Citrate: Used in routine coagulation studies
The normal sequence of blood cell development is
A. Liver and spleen—yolk sac—red bone marrow
B. Yolk sac—red bone marrow—liver and spleen
C. Yolk sac—thymus—liver and spleen—red bone marrow
D. Yolk sac–liver and spleen—red bone marrow
Yolk sac–liver and spleen—red bone marrow
MESOBLASTIC: First cell to be produced: erythroblasts
- Occurs early in embryonic
development, cells from the
mesoderm migrate to the
yolk sac
HEPATIC: Liver becomes the major site of hematopoiesis; but other organs such as spleen, kidney, thymus, and lymph
node also contribute to the process
MEDULLARY: At the end of 24 weeks gestation, Bone marrow becomes the primary
site of hematopoiesis.
By age 18, red marrow can be found in the
A. Skull bones
B. Vertebrae and ribs and Skull bones
C. Skull bones, Sternum and pelvis, Vertebrae and ribs
D. None of the above
Skull bones, Sternum and pelvis, Vertebrae and ribs
*By age 18, red marrow is found only in the vertebrae, ribs, sternum, skull bones, pelvis, and, to some extent, the proximal epiphyses of the femur and humerus.
* During infancy and early childhood, all the bones in the body contain primarily red (active) marrow.
* When retrogression occurs, hematopoietically
inactive yellow marrow is scattered throughout the red marrow so that, in adults, there is approximately equal amounts of red and yellow marrow. (Rodak 6th ed., 2020)
What is the first type of cell produced by the developing embryo?
A. Erythrocyte
B. Granulocyte
C. Lymphocyte
D. Thrombocyte
Erythrocyte
Yolk Sac or Mesoblastic phase
-From the developing embryo,
erythroblasts are produced
Medullary or Myeloid Phase
- An increase in the production of granulocytes cause an increase of M:E ratio
As a blood cell matures, the overall cell diameter in
most cases
A. increases
B. decreases
C. remains the same
decreases
What is the immature erythrocyte found in the
bone marrow with the following characteristics: 12 to 17 mm in diameter, N:C of 4:1, nucleoli not usually apparent, and basophilic cytoplasm?
A. Rubriblast (pronormoblast)
B. Reticulocyte
C. Metarubricyte (orthochromatic normoblast)
D. Prorubricyte (basophilic normoblast)
Prorubricyte (basophilic normoblast)
With a normal diet, an erythrocyte remains in the
reticulocyte stage in the circulating blood for
A. 1 day
B. 2.5 days
C. 3 days
D. 120 days
1 day
*Life span of RBCs: 120 days
Remains in the
Reticulocyte stage: 1 day
Increased amounts of 2,3-DPG______ the oxygen affinity of the hemoglobin molecule.
A. Increases
B. Decreases
C. Do not alter
Decreases
Which condition will shift the oxyhemoglobin dissociation curve to the right?
A. Acidosis
B. Alkalosis
C. Multiple blood transfusions
D. Increased quantities of Hb S or C
Acidosis
- Acidosis is associated with a shift to the right of the oxyhemoglobin dissociation curve and, therefore, increased oxygen release (decreased
affinity of Hgb for oxygen). - Multiple blood transfusions shift the curve to the left because the transfused blood is low in 2,3-DPG.
- Hgb S and Hgb C do not change the affinity of oxygen for hemoglobin; however, many
hemoglobinopathies do.
The most common erythrocytic enzyme deficiency involving the Embden-Meyerhof Glycolytic Pathway (EMP) is a deficiency of
A. ATPase
B. PK
C. G6PD
D. LD
PK
EMP
- Pyruvate Kinase (PK)
-Maintains cellular energy by
generating ATP
HMP
-Glucose-6-phosphate
dehydrogenase (G6PD) Prevents denaturation of globin by oxidation
Rapoport- Luebering Pathway
-Permits the accumulation of
2,3-DPG; regulates oxygen
affinity of hemoglobin
Methemoglobin Reductase Pathways
-Prevent oxidation of heme iron;
maintains iron into functional
state (ferrous)
If you are grading changes in erythrocytic size or shape using a scale of 0 to 4+ and many erythrocytes deviate from normal per microscopic field, the typical score would be
A. 1+
B. 2+
C. 3+
D. 4+
3+
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.
Heinz bodies can be observed in cases of
A. Pernicious anemia
B. G6PD deficiency
C. Iron loading anemia
D. Lead poisoning
G6PD deficiency
Which of the following is the term for erythrocytes resembling a stack of coins on thin sections of a peripheral blood smear?
A. Anisocytosis
B. Poikilocytosis
C. Agglutination
D. Rouleaux formation
Rouleaux formation
Anisocytosis
- Variation in size
Poikilocytosis
-Variation in shape
Agglutination
-Clumping of erythrocytes, caused by the presence of antibodies reacting with antigens on the erythrocyte
Rouleaux formation
-Arrangement of erythrocytes in
groups that resemble stacks of coin; associated with the presence of cryoglobulins
Rouleaux of red blood cells when seen in the monolayer of blood smear is a characteristic of:
A. Hypersplenism
B. Hypogammaglobulinemia
C. Cold Hemagglutinin Disease
D. Multiple Myeloma
Multiple Myeloma
*Multiple Myeloma – a clonal plasma cell neoplasm
associated with abnormal protein production, particularly immunoglobulins. IgG antibodies are found in majority of the patients.
The abnormal protein frequently found in the urine of persons with multiple myeloma is
A. albumin
B. globulin
C. IgG
D. Bence Jones
Bence Jones
*Urine tests for Bence Jones protein has been clinically
significant in the identification of Multiple Myeloma.
Howell-Jolly bodies are composed of
A. DNA
B. Iron
C. RNA
D. Hemoglobin
DNA
Howell-Jolly bodies
-DNA; Feulgen Stain (+)
Pappenheimer bodies
-Iron
Basophilic Stippling
-RNA; Aggregated ribosomes
Heinz Bodies
-Denatured Hemoglobin
Which of the following inclusions is only visible with
supravital staining?
A. Basophilic Stippling
B. Cabot rings
C. Heinz Bodies
D. Pappenheimer bodies
Heinz Bodies
RHH: only visible with supravital stains
R - Reticulocytes
H - Heinz bodies
H - Hb H
If a male patient has a reticulocyte count of 5% and a packed cell volume of 0.45 L/L, what is his corrected reticulocyte count?
A. 2.5%
B. 4.5%
C. 5.0%
D. 10%
5.0%
CRC: %retics x Hct/45
On a Wright-stained peripheral blood smear, stress or shift reticulocytes are
A. Smaller than normal reticulocytes
B. About the same size as normal reticulocytes
C. Larger than normal reticulocytes
D. Noticeable because of a decreased blue tint
Larger than normal reticulocytes
*Stress of shift reticulocytes are released by the BM to compensate during anemia, which is why they are larger than normal retics.
If a febrile, newborn infant had 4 nucleated red blood cells when a 100 cell WBC differential was performed, how would this be interpreted?
A. Lymphocytes were mistaken for nucleated red blood cells.
B. The baby was suffering from hemolytic disease of the fetus and newborn (HDFN).
C. Nucleated red blood cells can be expected in febrile patients.
D. During the first few days of life, the presence of a few nucleated red blood cells is normal.
During the first few days of life, the presence of a few nucleated red blood cells is normal.
*Orthochromic normoblasts often are identified in the
full-term infant on the first day of life but disappear within postnatal days 3 to 5. These nucleated RBCs (NRBCs) may persist longer than a week in immature infants.
The average number of NRBCs ranges from 3 to 10 per 100 white blood cells (WBCs) in a healthy full-term infant to 25 NRBCs per 100 WBCs in a premature infant.
The erythrocyte morphology associated with anemia in an otherwise healthy individual caused by acute blood loss is usually
A. Microcytic
B. Megaloblastic
C. Normochromic
D. Hypochromic
Normochromic
Insufficient centrifugation will result in:
A. A false increase in hematocrit (Hct) value
B. A false decrease in Hct value
C. No effect on Hct value
D. All of these options, depending on the patient
A false increase in hematocrit (Hct) value
*Insufficient centrifugaBon does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.
A 7.0 ml ethylenediaminetetraacetic acid (EDTA) tube is received in the laboratory containing only 2.0mL of blood. If the laboratory is using manual
techniques, which of the following tests will most likely be erroneous?
A. RBC count
B. Hemoglobin (Hgb)
C. Hct
D. WBC count
Hct
Excessive anticoagulant causes shrinkage of cells; thus, the Hct will be affected. RBC and WBC counts remain the same, as does the Hgb content.
A decreased osmotic fragility test would be associated with which of the following conditions?
A. Sickle cell anemia
B. Hereditary spherocytosis
C. Hemolytic disease of the newborn
D. Acquired hemolytic anemia
Sickle cell anemia
*Osmotic fragility is decreased when numerous sickle cells and target cells are present and is increased in the presence of spherocytes.
A falsely elevated Hct is obtained. Which of the following calculated values will NOT be affected?
A. MCV
B. MCH
C. MCHC
D. Red cell distribution width (RDW)
MCH
*The red cell distribution width (RDW) is calculated by electronic cell counters and reflects the variance in the size of the red cell population. Electronic cell counters calculate Hct from the MCV and RBC count. Therefore, the RDW would be affected by an erroneous MCV.
All of the following factors may influence the erythrocyte sedimentation rate (ESR) EXCEPT
A. Blood drawn into a sodium citrate tube
B. Anisocytosis, poikilocytosis
C. Plasma proteins
D. Caliber of the tube
Blood drawn into a sodium citrate tube
- EDTA and Sodium citrate can be used without any effect on the ESR.
- Anisocytosis and poikilocytosis may impede rouleaux formation, thus causing a low ESR.
- Plasma proteins, especially fibrinogen and immunoglobulins, enhance rouleaux, increasing the ESR. Reference ranges must be established for different caliber tubes.
Modified Westergren: currently the most commonly used method for ESR
Westergren:
- Anticoagulant: Citrate
- Ratio of Anticoagulant to Blood: 1:4
- Color of Stopper: Black
A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral blood smear because:
A. The WBC count would be falsely lower
B. The RBC count is too low
C. nRBCs are counted a leukocytes
D. nRBCs are confused with giant plts
nRBCs are counted a leukocytes
*The automated hematology analyzers enumerate all
nucleated cells. nRBCs are counted along with WBCs,
falsely elevating the WBC count.
Formula:
corrected= Uncorrected WBC ct. x 100 / nRBC + 100
The Coulter principle for counting of cells is based upon the fact that:
A. Isotonic solutions conduct electricity better than cells do
B. Conductivity varies proportionally to the number of cells
C. Cells conduct electricity better than saline does
D. Isotonic solutions cannot conduct electricity
Isotonic solutions conduct electricity better than cells do
- Electronic cell (Coulter) counters use the principle of electrical impedance.
- Two electrodes suspended in isotonic solutions are separated by a glass tube having a small aperture.
- A vacuum is applied, and as a cell passes through the aperture it impedes the flow of current and generates a voltage pulse.
Which is the first stage of erythrocytic maturation in
which the cytoplasm is pink due to the formation of
hemoglobin?
A. Reticulocyte
B. Pronormoblast
C. Basophilic normoblast
D. Polychromatic normoblast
Polychromatic normoblast
*In normal erythrocytic maturation, Hgb formation in the late polychromatic normoblast stage gives the
cytoplasm a prominent pink coloration. The red cell
continues to produce Hgb throughout the reticulocyte
stage of development
If an alkaline (pH8.6) electrophoresis is performed,
hemoglobin E has the same mobility as hemoglobin
A. S
B. F
C. A
D. C
C
Which is the major Hgb found in the RBCs of patients with sickle cell trait?
A. Hgb S
B. Hgb F
C. Hgb A2
D. Hgb A
Hgb A
Sickle Cell Trait
(Resistant to P. falciparum)
* 40% or less Hb S
* 60% or more Hb A
* Normal or slightly increased Hb A2
Sickle Cell Disease
* 80% to 95% Hb S
* 0% to 20% Hb F
* normal amount of Hb A2
Paroxysmal nocturnal hemoglobinuria exhibits
sensitivity of one population of red blood cells to
A. warm antibodies
B. cold antibodies
C. complement
D. either A or B
complement
Which of the following is most true of paroxysmal nocturnal hemoglobinuria (PNH)?
A. It is a rare acquired stem cell disorder that results in hemolysis
B. It is inherited as a sex-linked trait
C. It is inherited as an autosomal dominant trait
D. It is inherited as an autosomal recessive trait
It is a rare acquired stem cell disorder that results in hemolysis
- PNH is a rare, acquired stem cell disorder that results in abnormalities of the red cell membrane.
o This causes the red cells to be highly sensitive to complement-mediated hemolysis. - Because this is a stem cell disorder, abnormalities
are seen in leukocytes and platelets, as well as in red cells. PNH is characterized by recurrent, episodic intravascular hemolysis, hemoglobinuria,
and venous thrombosis. (Harr, 4th ed.)
The morphological classification of anemias is based on which of the following?
A. M:E (myeloid: erythroid) ratio
B. Prussian blue stain
C. RBC indices
D. Reticulocyte count
RBC indices
*RBC indices classify the anemia morphologically. Anemias can be classified morphologically by the use of laboratory data; physiologically, based upon the
mechanism; and clinically, based upon an assessment of symptoms
“Bite cells” are usually seen in patients with:
A. Rh null trait
B. Chronic granulomatous disease
C. G6PD deficiency
D. PK deficiency
G6PD deficiency
Heinz bodies are demonstrated using a supravital stain. These are then pitted from the RBCs by the spleen, resulting in RBC fragments sometimes called
bite or helmet cells.
Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia?
A. Sulfonamides
B. Penicillin
C. Tetracycline
D. Chloramphenicol
Chloramphenicol
APLASTIC ANEMIA
* Characterized by pancytopenia
* BM: empty and hypoplasCc
* Congenital: Fanconi’s Anemia
Characterized by:
-Mental Retardation
-Hyperpigmentation of skin
-Absence of thymus and radius
- Acquired: caused by exposure to drugs, radiation, or with the use of chloramphenicol.
All of the following are characteristic findings in a
patient with iron deficiency anemia except:
A. Microcytic, hypochromic red cell morphology
B. Decreased serum iron and ferritin levels
C. Decreased total iron-binding capacity (TIBC)
D. Increased RBC protoporphyrin
Decreased total iron-binding capacity (TIBC)
Storage iron is usually best determined by:
A. Serum transferrin levels
B. TIBC
C. Hgb values
D. Serum ferritin levels
Serum ferritin levels
Transferrin saturation
-Indirect Indicator of Transport iron and transferrin level
TIBC
-Indirect indicator of transferrin level
Serum Ferritin
-Indicator of Iron stores
Serum Iron level
-Indicator of available transport iron
Which anemia is characterized by a lack of intrinsic factor that prevents B12 absorption?
A. Tropical sprue
B. Transcobalamin deficiency
C. Blind loop syndrome
D. Pernicious anemia
Pernicious anemia
- PERNICIOUS develops slowly and insidiously in patients when autoimmune antibodies to intrinsic factor or to parietal cells destroy their parietal cells so that they are left without intrinsic factor.
- Tropical sprue and Blind loop syndrome – have been associated with Vit. 12 deficiency among elderly adults
Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias?
A. MCV 99 fl, MCH 28 pg, MCHC 31%
B. MCV 62 fL, MCH 27 pg, MCHC 30%
C. MCV 125 fL, MCH 36 pg, MCHC 34%
D. MCV 78 fL, MCH 23 pg, MCHC 30%
MCV 125 fL, MCH 36 pg, MCHC 34%
Reference Values:
MCV 80 to 100 fL
MCH 26 to 34 pg
MCHC 32 to 36 g/dL
In a 1:200 dilution of a patient’s sample, 336 cells were counted in an area of 0.2 mm2. What is the RBC count?
A. 1.68 x 1012/L
B. 3.36 x 1012/L
C. 4.47 x 1012/L
D. 6.668 x 1012/L
3.36 x 1012/L
A manual WBC count was performed. A total of 25 cells were counted in all 9-mm2 squares of a Neubauer-ruled hemacytometer. A 1:10 dilution was used. What is the WBC count?
A. 0.28 x 109/L
B. 278 x 109/L
C. 27.8 x 109/L
D. 0.4 x 109/L
0.28 x 109/L
The ability of an assay to distinguish the targeted analyte from interfering substances within the specimen matrix is called:
A. Analytical specificity
B. Analytical sensitivity
C. Clinical specificity
D. Clinical sensitivity
Analytical sensitivity
Euchromantin functions as the:
A. Site of microtubule production
B. Transcriptionally active DNA
C. Support structure for nucleoli
D. Attachment site for centrioles
Transcriptionally active DNA
EUCHROMATIN
* Diffuse, uncondensed, open chromatin pattern
* Transcriptionally active DNA
HETEROCHROMATIN:
* Darkly stained, condensed clumping pattern
* Transcriptionally inactive area of nucleus
Apoptosis is morphologically identified by:
a. Cellular swelling
b. Nuclear condensation
c. Rupture of the cytoplasm
d. Rupture of the nucleus
Nuclear condensation
The BEST source of active bone marrow from a 20 year old would be:
A. Iliac Crest
B. Femur
C. Distal Radius
D. Tibia
Iliac Crest
BONE MARROW ASPIRATION
ADULT
-Posterior Iliac Crest (preferred site); Anterior Iliac Crest, Sternum
INFANTS younger than 18 months of age
-Tibia
What growth factor is produced in the kidneys and is used to treat anemia associated with kidney disease?
A. EPO
B. TPO
C. G-CSF
D. KIT ligand
EPO
EPO
* Anemia of chronic renal disease
* Treatment of anemia in cancer
patients on chemo
* Autologous pre-donation blood collection
* Anemia in HIV infection to permit use of zidovudine
* Post autologous HSC transplant
G-CSF
* Chemotherapy-induced neutropenia
* Stem cell mobilization
* Peripheral blood/BM transplantation
When a patient has severe anemia and the bone marrow is unable to effectively produce red blood cells to meet the increased demand, one of the body’s responses is:
A. Extramedullary hematopoiesis in the liver and
spleen
B. Decreased production of erythropoietin by the kidney
C. Increased apoptosis of erythrocyte progenitor cells
D. Increased proportion of yellow marrow in the long bones
Extramedullary hematopoiesis in the liver and spleen
*EXTRAMEDULLARY HEMATOPOIESIS
Production of blood cells outside the BM, such as in the spleen, liver, or lymph nodes. This usually occurs in response to severe anemia or bone marrow fibrosis causing loss of hematopoiesis.
Which of the following is an erythroid progenitor?
A. Pronormoblast
B. Reticulocyte
C. CFU-E
D. Orthochromic normoblast
CFU-E
PROGENITOR
-Undifferentiated (immature)
hematopoietic cell that is committed to a cell line but cannot be identified morphologically
PRECURSOR
-Differentiating, immature
hematopoietic cell stage that is
morphologically identifiable as
belonging to a given cell line
Hypoxia stimulates RBC production by:
A. Inducing more pluripotent stem cells into the erythroid lineage
B. Stimulating EPO production by the kidney
C. Increasing the number of RBC mitoses
D. Stimulating the production of fibronectin by macrophages of the bone marrow
Stimulating EPO production by the kidney
*HYPOXIA
-detected by the peritubular fibroblasts, which then produce erythropoietin (EPO), the major
stimulatory cytokine for RBCs.
-When there is hemorrhage, increased RBC destruction, or other factors that diminish the oxygen-carrying capacity of the blood, the production of EPO is increased.
Erythropoietin can increase the production of RBCs by:
A. Promoting apoptosis of erythroid progenitors
B. Decreasing intravascular hemolysis
C. Increasing EPO receptor sites
D. Promoting early release of reticulocytes from bone marrow
Increasing EPO receptor sites
EPO increase production of RBCs by:
* Early release of reticulocytes
* Inhibition of apoptosis
* Reduced marrow transit time
What single feature of normal RBCs is most responsible for limiting their life span?
A. Loss of the nucleus
B. Increased flexibility of the cell membrane
C. Reduction of hemoglobin iron
D. Loss of mitochondria
Loss of the nucleus
*Aged RBCs or senescent cells are not capable of regenerating catabolized enzymes due to their lack of nucleus. If they reach their lifespan of 120 days, the cell membrane becomes more permeable to water causing the cell to become swollen and rigid. Thus, they are trapped in the spleen, readily phagocytized by macrophages.
What pathway anaerobically generates energy in the form of ATP?
A. 2,3-BPG pathway
B. Embden-Meyerhof pathway
C. Hexose monophosphate pathway
D. Rapoport-Luebering pathway
Embden-Meyerhof pathway
EMP (Anaerobic glycolysis)
-Pyruvate Kinase (PK)
-Maintains cellular energy by
generating ATP
HMP (Aerobic RBC metabolism)
-Glucose-6-phosphate
dehydrogenase (G6PD);
-Prevents denaturation of
globin by oxidation
Rapoport-Luebering Pathway
-Permits the accumulation of
2,3-DPG; regulates oxygen affinity of hemoglobin
Methemoglobin Reductase Pathways
-Prevent oxidation of heme iron;
maintains iron into functional
state (ferrous)
Which of the following is an example of a transmembrane or integral membrane protein?
A. Actin
B. Ankyrin
C. Glycophorin A
D. Spectrin
Glycophorin A
A hemoglobin molecule is composed of:
A. One heme molecule and four globin chains
B. Ferrous iron, protoporphyrin IX, and a globin chain
C. Protoporphyrin IX and four globin chains
D. Four heme molecules and four globin chains
Four heme molecules and four globin chains
1 Hemoglobin
- 4 heme molecules and 4 globin chains
Heme
- 1 iron and 4 Pyrrole rings
What is the normal distribution of hemoglobins in healthy adults?
A. 80% to 90% HbA, 5% to 10% HbA2, 1% to 5% HbF
B. 80% to 90% HbA2, 5% to 10% HbA, 1% to 5% HbF
C. >95% HbA, <3.5% HbA2, 1% to 2% HbF
D. 90% HbA, 5% Hb F, 5% Hb A2
> 95% HbA, <3.5% HbA2, 1% to 2% HbF
What membrane-associated protein in enterocytes
transports iron from the intestinal lumen into the
enterocyte?
A. DMT1
B. Ferroportin
C. Transferrin
D. Hephaestin
DMT1
DMT1
- Transports ferrous iron into the ENTEROCYTE
Ferroportin
-Transports iron from ENTEROCYTE to plasma
Transferrin
-Transports iron INTO the cell
HEPCIDIN
- REGULATES transfer of
iron from the enterocyte into the plasma
The transfer of iron from the enterocyte into the plasma is regulated by:
A. Transferrin
B. Ferroportin
C. Hephaestin
D. Hepcidin
Hepcidin
Which of the following would NOT interfere with the result when hemoglobin determination is performed by the cyanmethemoglobin method?
A. Increased lipids
B. Elevated WBC count
C. Lyse-resistant RBCs
D. Fetal hemoglobin
Fetal hemoglobin
*CYANMETHEMOGLOBIN
* Reference method for hemoglobin assay
* Not used to separate the different types of hemoglobin (for HPLC and hemoglobin
electrophoresis)
* used to measure Hgb concentration based on the
absorbance of cyanmethemoglobin at 540 nm
A patient has a hemoglobin level of 8.0 g/dL. According to the rule of three, what is the expected range for the hematocrit?
A. 21% to 24%
B. 23.7% to 24.3%
C. 24% to 27%
D. 21% to 27%
21% to 27%
3 x Hgb = Hct(%)
Which of the following would be associated with an elevated ESR value?
A. Microcytosis
B. Polycythemia
C. Decreased globulins
D. Inflammation
Inflammation
STAGES OF ESR
1. Rouleaux formation
2. Sedimentation/ Settling
3. Packing
INCREASED Inflammation
DECREASED Microcytosis, Polycythemia,
Decreased Globulins
Modification sometimes used in conjunction with DC electronic impedance:
A. Electronic Impedance
B. Radiofrequency
C. Optical Scatter
D. None of these
Radiofrequency
Electronic impedance
(MOST common methodology used)
-Also known as low-voltage direct current (DC), was developed by coulter in the 1950s
Radiofrequency
- Alternating current (AC) resistance, a modification sometimes used in conjunction with DC electronic impedance
Optical Scatter
- Uses both laser and nonlaser light, is frequently employed in today’s hematology instrumentation
Orthogonal light scatter is used to measure:
A. Cell nuclear volume
B. Internal complexity of the cell
C. Cellular granularity
D. Nuclear density
Internal complexity of the cell
A stained blood film is held up to the light and observed to be bluer than normal. What microscopic abnormality might be expected on this film?
A. Rouleaux
B. Spherocytosis
C. Reactive lymphocytosis
D. Toxic granulation
Rouleaux
Bluer
-Increased blood proteins, as in plasma cell myeloma, and that rouleaux may be seen on the film
Grainy
- RBC agglutination, as in cold hemagglutinin disease
Holes
- Increased lipid levels
Blue Specks out at the Feather Edge
- Markedly increased WBC counts and platelet counts
A blood film for a patient with a normal RBC count has an average of 10 platelets per oil immersion field. Which of the following values best correlates with the estimate per microliter?
A. 20,000
B. 100,000
C. 200,000
D. 400,000
200,000
WBC ESTIMATE:
HPO X2000
OIO X3000
PLATELET ESTIMATE:
X20000
What is the absolute count (x109/L) for the lymphocytes if the total WBC count is 9.5 x 109/L and there are 37% lymphocytes?
A. 3.5
B. 6.5
C. 13
D. 37
3.5
Which of the following blood film findings indicates EDTA-induced pseudothrombocytopenia?
A. The platelets are pushed to the feathered end.
B. The platelets are adhering to WBCs.
C. No platelets at all are seen on the film.
D. The slide has a bluish discoloration when examined macroscopically.
The platelets are adhering to WBCs.
EDTA-induced
pseudothrombocytopenia
due to platelet satellitism/ platelet clumping
- If collected in EDTA
anticoagulant, redraw blood specimen in citrate anticoagulant and multiply the
platelet count by a factor of 1.1 to correct for dilutional effect of liquid citrate anticoagulant
What is the largest hematopoietic cell found in a normal bone marrow aspirate?
A. Osteoblast
B. Monocyte
C. Pronormoblast
D. Megakaryocyte
Megakaryocyte
MEGAKARYOCYTE
Largest hematopoietic cell in the bone marrow
MONOCYTE Largest cell found in the circulation
What are the initial laboratory tests that are performed for the diagnosis of anemia?
A. CBC, iron studies, and reticulocyte count
B. CBC, reticulocyte count, and peripheral blood
film examination
C. Reticulocyte count and serum iron, vitamin B12,
and folate assays
D. Bone marrow study, iron studies, and peripheral
blood film examination
CBC, reticulocyte count, and peripheral blood film examination
Initial Diagnosis
-CBC with RBC indices, RDW,
Reticulocyte Count, Peripheral
Blood Film Examination
Investigation
- Reticulocyte count and MCV
Classification
- MCV, reticulocyte count, and RDW
An increase in which one of the following suggests a shortened life span of RBCs and hemolytic anemia?
a. Hemoglobin concentration
b. Hematocrit
c. Reticulocyte count
d. Red cell distribution width
Reticulocyte count
RETICULOCYTE COUNT
When the RBC mass falls, it is the result of decreased RBC production or a shortened life span. Normal erythropoiesis corrects for a shorter life span by increasing the production rate, which the reticulocyte count measures.
Which of the following findings is consistent with a diagnosis of megaloblastic anemia?
A. Hyposegmentation of neutrophils
B. Decreased serum lactate dehydrogenase level
C. Absolute increase in reticulocytes
D. Increased MCV
Increased MCV
*Absolute reticulocyte
count
- useful in initially classifying anemias into the categories of decreased or ineffective RBC production (decreased reticulocyte count) and excessive RBC loss (increased reticulocyte count)
*MCV (Mean Cell Volume)
- when the reticulocyte count is decreased, the MCV can further
classify the anemia into three
subgroups: normocytic anemias,
microcytic anemias, and macrocytic anemias.
The primary pathophysiologic mechanism of anemia
associated with chronic kidney disease is:
A. Inadequate production of erythropoietin
B. Excessive hemolysis
C. Hematopoietic stem cell mutation
D. Toxic destruction of stem cells
Inadequate production of erythropoietin
*Anemia is a common complication of chronic kidney
disease (CKD), with a positive correlation between anemia and renal disease severity.
The primary cause of anemia in CKD is inadequate renal production of erythropoietin. Without erythropoietin, the bone marrow lacks adequate
stimulation to produce RBCs.
Which one of the following findings is NOT consistent
with myelophthisic anemia?
A. Reticulocytosis
B. Teardrop RBCs
C. Extramedullary hematopoiesis
D. Leukoerythroblastic blood picture
Reticulocytosis
MYELOPHTHISIC ANEMIA
* due to the infiltration of abnormal cells into the bone marrow and subsequent destruction and
replacement of normal hematopoietic cells
characterized by:
- teardrop RBCs, normocytic RBCs
- Reticulocytopenia
- Leukoerythroblastic blood picture
- Extramedullary hematopoiesis
A sign of hemolysis that is typically associated with both fracmentation and macrophage-mediated hemolysis is:
A. Hemoglobinuria
B. Hemosiderinuria
C. Hemoglobinemia
D. Elevated urinary urobilinogen level
Elevated urinary urobilinogen level
Which one of the following sets of results is consistent with HS?
A. Decreased osmotic fragility, negative DAT result
B. Decreased osmotic fragility, positive DAT result
C. Increased osmotic fragility, negative DAT result
D. Increased osmotic fragility, positive DAT result
Increased osmotic fragility, negative DAT result
In autoimmune hemolytic anemia, a positive DAT is
evidence that an:
A. IgM antibody is in the patient’s serum
B. IgG antibody is in the patient’s serum
C. IgM antibody is sensitizing the patient’s red blood cells
D. IgG antibody is sensitizing the patient’s red blood cells
IgG antibody is sensitizing the patient’s red blood cells
Which of the following is the most definitive test for Hb S?
A. Hemoglobin solubility test
B. Hemoglobin electrophoresis at alkaline pH
C. Osmotic fragility test
D. Hemoglobin electrophoresis at acid pH
Hemoglobin electrophoresis at acid pH
SCREENING TEST: Hemoglobin Solubility test
CONFIRMATORY: Hemoglobin Electrophoresis at Acid pH, HPLC, Capillary Electrophoresis
The screening test for Hb S that uses a reducing agent, such as sodium dithionite, is based on the fact that hemoglobins that sickle:
A. Are insoluble in reduced, deoxygenated form
B. Form methemoglobin more readily and cause a color change
C. Are unstable and precipitate as Heinz bodies
D. Oxidize quickly and cause turbidity
Are insoluble in reduced, deoxygenated form
*The most common screening test for Hb S, called the hemoglobin solubility test, capitalizes on the decreased solubility of deoxygenated Hb S in solution, producing turbidity.
Thalassemia is caused by:
A. Structurally abnormal hemoglobins
B. Absent or reduced synthesis of a polypeptide chain of hemoglobin
C. Excessive absorption of iron
D. Reduced or absent protoporphyrin synthesis
Absent or reduced synthesis of a polypeptide chain of hemoglobin
Hb Bart is composed of:
A. Two alpha and two beta chains
B. Two epsilon and two gamma chains
C. Four beta chains
D. Four gamma chains
Four beta chains
The greatest portion of operational body iron is normally contained in what compound?
A. Heme
B. Ferritin
C. Cytochrome
D. Mitochondria
Heme
*Most of the iron in the body is in the form of hemoglobin in red cells, which contain about 1 mg of iron per mL of RBCs or about 2 to 3 g of iron total.
Which of the following is more typical of nonmegaloblastic than megaloblastic anemia?
A. Oval macrocytes
B. Round macrocytes
C. Howell-jolly bodies
D. Hypersegmented neutrophil
Oval macrocytes
After a man was found unconscious in his garage with
the car motor running, he was transported to the emergency department. When blood was drawn for a complete blood count, the plasma was noted to be bright red. What kind of variant hemoglobin should be suspected?
A. Hemoglobin F
B. Sulfhemoglobin
C. Methemoglobin
D. Carboxyhemoglobin
Carboxyhemoglobin
What factors contribute to the sickling of erythrocytes in sickle cell disease crisis?
A. Increase in blood pH and increase in oxygen
B. Extremely hoy weather
C. Extremely reduced oxygen and increased acidity in the blood
D. Sickling is spontaneous
Extremely reduced oxygen and increased acidity in the blood
The RDW and MCV are both quantitative descriptors of erythrocyte size. If both are increased, erythrocytic abnormality would be:
A. IDA
B. Acquired Aplastic Anemia
C. Megaloblastic Anemia
D. Hemoglobinopathy
Megaloblastic Anemia
- An elevated MCV level (>100 fL) is associated with macrocytic anemias, such as megaloblastic anemia caused by Vit. 12 or folic acid deficiency. RDW is also
increased due to the presence of macrocytes in the blood.
Major systems in a flow cytometer include all of the
following EXCEPT
A. fluidics
B. optics
C. computerized electronics
D. gating
gating
4 major systems in a flow cytometer:
- Fluidics
- Optics
- Computer
- Electronics
Gating
- Restriction of data analysis to one cell population
In the photo-optical method, the change in light transmission versus the ___ is used to determine the activity of coagulation factors or stages.
A. amount of patient’s plasma
B. amount of test reagent
C. time
D. temperature
time
*PHOTO-OPTICAL METHODS
- The principle of photo-optical measurement is that a change in light transmission measured as optical density (absorbance) versus time can be used to quantitatively determine the activity of various coagulation stages or factors
