HEMA Flashcards
1
Q
CLSI recommends the following order of draw for both ETS collection and in filling tubes from a syringe.
Order of Draw
1. Sterile tube (blood culture)
2. Blue-top coagulation tube
3. Serum tube with or without clot activator, with or without gel
4. Heparin tube with or without gel plasma separator
5. EDTA tube
6. Glycolytic inhibitor tube
A
Noted
Stop - sterile
Light - Light blue
Red
Stay - SST
Put - PST
Green
Light - Lavender
Go - gray
2
Q
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
A
Plasma greater volume than serum
3
Q
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
A
1.5 mg/1 mL of whole blood
4
Q
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?
RBC count
Hemoglobin
Hematocrit
WBC count
A
Hematocrit
5
Q
EDTA-induced pseudothrombocytopenia can be identified on blood smear by:
Finding platelets pushed to the feathered end
Finding platelets adhering to WBCs
Finding no platelets at all on the smear
Bluish discoloration to the macroscopic appearance of the slide
A
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.
6
Q
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:
Report the automated platelet count since it is more accurate than a platelet estimate
Warm the EDTA tube and repeat the automated platelet count
Rerun the original specimen since the platelet count and blood smear estimate do not match
Recollect a specimen for a platelet count using a different anticoagulant
A
Recollect a specimen for a platelet count using a different anticoagulant
7
Q
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:
Report the automated platelet count since it is more accurate than a platelet estimate
Warm the EDTA tube and repeat the automated platelet count
Rerun the original specimen since the platelet count and blood smear estimate do not match
Recollect a specimen for a platelet count using a different anticoagulant
A
Recollect a specimen for a platelet count using a different anticoagulant
8
Q
Sodium citrate in the concentration of ___ solution has been adopted as the appropriate concentration for coagulation studies.
1.5%
2.8%
3.2%
3.8%
A
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.
9
Q
Which ratio of anticoagulant to blood is correct for coagulation procedures?
1:4
1:5
1:9
1:10
A
1:9
10
Q
Which results would be expected for the PT and APTT in a patient with polycythemia?
Both prolonged
Both shortened
Normal PT, prolonged APTT
Both normal
A
Both prolonged
11
Q
What is the proper angle of needle insertion for phlebotomy?
5 degrees
15 degrees
35 degrees
45 degrees
A
15 degrees
12
Q
Select the needle most commonly used in standard venipuncture in an adult:
One inch, 18 gauge
One inch, 21 gauge
One-half inch, 21 gauge
One-half inch, 25 gauge
A
One inch, 21 gauge
The advantage of using a 1-inch needle is that it provides better control during venipuncture.
13
Q
The bevel of the needle should be held _____ in the performance of a venipuncture.
Sideways
Upward
Downward
In any direction
A
Upward
14
Q
Most common complication encountered in obtaining a blood specimen:
Ecchymosis (bruise)
Hematoma
Hemoconcentration
Anemia
A
Ecchymosis (bruise)
15
Q
It is caused by leakage of a SMALL AMOUNT OF BLOOD in the tissue around the puncture site:
Ecchymosis (bruise)
Hematoma
Hemoconcentration
Anemia
A
Ecchymosis (bruise)
16
Q
Leakage of a LARGE AMOUNT OF BLOOD around the puncture site causes the area to rapidly swell:
Ecchymosis (bruise)
Hematoma
Hemoconcentration
Anemia
A
Hematoma
17
Q
VASCULAR COMPLICATIONS of phlebotomy:
Bleeding from the site of the venipuncture and hematoma
Pseudoaneurysm, thrombosis
Reflex arteriospasm, arteriovenous fistula formation
All of these
A
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.
18
Q
CARDIOVASCULAR COMPLICATIONS of phlebotomy:
Orthostatic hypotension
Syncope
Shock and cardiac arrest
All of these
A
All of these
19
Q
A blood sample is needed from a patient with IV fluids running in both arms. Which of the following is an acceptable procedure?
Any obtainable vein is satisfactory.
Obtain sample from above the IV site.
Obtain sample from below the IV site with special restrictions.
Disconnect the IV line.
Do not draw a blood specimen.
A
Obtain sample from below the IV site with special restrictions.
20
Q
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
A
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
21
Q
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
A
Notify the patient’s nurse or physician
22
Q
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
A
Immediately after specimen collection
23
Q
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
A
Moisten it with a disinfectant and carefully absorb it with a paper towel
24
Q
The appropriate dilution of bleach to be used in laboratory disinfection is:
1:2
1:5
1:10
1:100
A
1:10
25
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.
26
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
27
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
28
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.
29
The first hemostatic response to injury of a blood vessel is:
Platelet adhesion
Platelet aggregation
Vasoconstriction
Extrinsic coagulation
Vasoconstriction
30
The enzyme inhibited by aspirin is:
Thromboxane synthetase
Cyclooxygenase
Lactate dehydrogenase
Phospholipase
Cyclooxygenase
31
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
32
Approximately ___ of the total number of platelets circulate in the systemic circulation?
One-fourth
One-third
One-half
Two-thirds
Two-thirds
33
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
34
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
35
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
36
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
37
In thrombocythemia, the platelets are:
Increased
Decreased
Normal
Normal in number, abnormal morphology
Increased
38
Which of the following is characteristic of Bernard-Soulier syndrome?
Giant platelets
Normal bleeding time
Abnormal aggregation with ADP
Increased platelet count
Giant platelets
39
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
40
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
41
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.
42
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
43
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
44
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
45
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.
46
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.
47
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.
48
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.
49
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
50
Primary substrate of thrombin:
Fibrinogen
Prothrombin
Factor V
Factor X
Fibrinogen
51
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.
52
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.
53
Which coagulation factor is present in the highest concentration in plasma?
Factor II
Factor XII
Factor I
Factor VII
Factor I
54
Which of the following participates ONLY in the extrinsic pathway?
Factor VII
Factor IX
Factor X
Factor II
Factor VII
55
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
56
The activated partial thromboplastin time is NOT affected by deficiency of:
Factor VIII
Factor IX
Factor XI
Factor VII
Factor VII
57
Prothrombin time is NOT affected by a deficiency of:
Factor VIII
Factor V
Factor I
Factor X
Factor VIII
58
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
59
Which of the following is vitamin K dependent?
Factor XII
Fibrinogen
Antithrombin III
Factor VII
Factor VII
60
Last factor to be depressed n vitamin K deficiency:
Factor II
Factor VII
Factor X
Factor IX
Factor II
61
Which of the following factors is not present in BaSO4 adsorbed plasma?
Factor VIII
Factor II
Factor XII
Factor V
Factor II
62
Which one of the following factors typically shows an increase in liver disease?
Factor VII
Factor VIII
Factor IX
Factor X
Factor VIII
63
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
64
In which of the following diseases would you most likely find an abnormal prothrombin time:
Hemophilia A
Hemophilia B
vWD
DIC
DIC
65
Increased APTT with a normal PT would indicate a deficiency of:
Factor II
Factor VII
Factor IX
Factor X
Factor IX
66
Normal APTT with an increased PT would indicate a deficiency of:
Factor II
Factor VII
Factor I
Factor IX
Factor VII
67
Increased APTT and PT would indicate a deficiency of:
Factor V
Factor XI
Factor XII
Factor VIII
Factor V
68
PTT measures all factors except for:
I and V
VIII and IX
V and VIII
VII and XIII
VII and XIII
69
A patient on therapeutic warfarin will most likely have a(an):
Normal PT/INR, increased APTT, prolonged bleeding time, low platelet count
Increased PT/INR, increased APTT, normal bleeding time, normal platelet count
Normal PT/INR, normal APTT, normal bleeding time, normal platelet count
Increased PT/INR, normal APTT, prolonged bleeding time, low platelet count
Increased PT/INR, increased APTT, normal bleeding time, normal platelet count
70
Reversal of heparin overdose can be achieved by administration of:
Vitamin K
Anti-thrombin
Protamine sulfate
Warfarin
Protamine sulfate
71
The preferred blood product for a bleeding patient with von Willebrand’s disease is transfusion with:
Factor II, VII, IX, X concentrates
Platelet Concentrates
Fresh Frozen Plasma and Platelets
Cryoprecipitated AHF
Cryoprecipitated AHF
72
Which of the following laboratory findings is associated with Factor XIII deficiency?
Prolonged activated partial thromboplastin time
Clot solubility in a 5 molar urea solution
Prolonged thrombin time
Prolonged prothrombin time
Clot solubility in a 5 molar urea solution
73
The following results were obtained on a patient: prolonged bleeding time, normal platelet count, normal PT, and prolonged APTT. Which of the following disorders is most consistent with these results?
Hemophilia A
Hemophilia B
vWD
Glanzmann's thrombasthenia
vWD
74
A patient has a history of mild hemorrhagic episodes. Laboratory results include a prolonged prothrombin time and activated partial thromboplastin time. The abnormal prothrombin time was corrected by normal and adsorbed plasma, but not aged serum. Which of the following coagulation factors is deficient?
Prothrombin
Factor V
Factor X
Factor VII
Factor V
75
A 56-year-old woman was admitted to the hospital with a history of a moderate to severe BLEEDING tendency of a several years’ duration. Epistaxis and menorrhagia were reported. Prolonged APTT was corrected with fresh normal plasma, adsorbed plasma, and aged serum. Deficiency of which of the following is most likely?
Factor XII
Factor VIII
Factor XI
Factor IX
Factor XI
Prolonged APTT corrected with normal plasma, adsorbed plasma and aged serum:
Deficiency of factor XI or XII
Factor XI deficiency - patient exhibits bleeding (hemophilia C)
Factor XII deficiency - negative bleeding
76
The abnormal APTT seen in pathological circulating anticoagulant is:
Corrected with aged serum
Corrected with adsorbed plasma
Corrected with normal plasma
Not corrected with any of the above
Not corrected with any of the above
77
The activity of the lupus anticoagulant and anticardiolipin antibodies appears to be directed against:
Factor V
Factor VIII
Factor IX
Phospholipid
Phospholipid
78
A prolonged Stypven (Russell viper venom) time is associated with deficiency of the following factors EXCEPT:
Factor I
Factor II
Factor X
Factor VII
Factor VII
79
The laboratory test for monitoring heparin therapy is:
PT
PTT
Bleeding time
Thrombin time
PTT
80
All of the following tests are affected by heparin therapy except:
Thrombin time
Whole blood clotting time
APTT
Reptilase time
Reptilase time
81
An abnormal thrombin time is associated with:
Factor X deficiency
Excess plasminogen
Fibrinogen deficiency
Protein C deficiency
Fibrinogen deficiency
82
The observation of a normal reptilase time and a prolonged thrombin time is indicative of:
Presence of fibrin degradation products
Hypoplasminogenemia
Dysfibrinogenemia
Presence of heparin
Presence of heparin
83
Which of the following coagulation test results is normal in patient with classic vWD?
Bleeding time
APTT
Platelet count
Factor VIII:C and vWF
Platelet count
84
Primary inhibitor of the fibrinolytic system?
Protein C
Protein S
Alpha2 antiplasmin
Alpha2 macroglobulin
Alpha2 antiplasmin
85
The D-dimer test is a specific test for:
Plasminogen activation
Plasmin degradation of fibrinogen
Plasmin degradation of fibrin
Factor XIII
Plasmin degradation of fibrin
86
Acute disseminated intravascular coagulation is characterized by:
Hypofibrinogenemia
Thrombocytosis
Negative D-dimer
Shortened thrombin time
Hypofibrinogenemia
87
A positive protamine sulfate is suggestive of:
vWD
Primary fibrinolysis
DIC
Glanzmann's thrombasthenia
DIC
88
Which factor deficiency is associated with a prolonged PT and APTT?
X
VIII
IX
XI
X
Factor X, a common pathway factor deficiency, is most likely suspected, because both PT and APTT are prolonged. Other causes may include liver disease, vitamin K deficiency, and anticoagulant drugs such as Coumadin and heparin.
89
The following results were obtained on a patient: normal platelet count and function, normal PT, and prolonged APTT. Which of the following disorders is most consistent with these results?
Hemophilia A
Bernard–Soulier syndrome
von Willebrand’s disease
Glanzmann’s thrombasthenia
Hemophilia A
Hemophilia A is associated with the deficiency of factor VIII resulting in bleeding and an abnormal APTT. The platelet number and function are normal in this disorder.
Von Willebrand’s disease is a disorder of platelet adhesion associated with decreased VWF and factor VIII, causing an abnormal platelet function test and an abnormal APTT test.
Both Glanzmann’s thrombasthenia and Bernard–Soulier syndrome cause deficient platelet aggregation, but do not cause an abnormal APTT.
90
Fibrin monomers are increased in which of the following conditions?
Primary fibrinolysis
DIC
Factor VIII deficiency
Fibrinogen deficiency
DIC
Increased fibrin monomers result from coagulation activation. DIC is an acquired condition associated with spontaneous activation of coagulation and fibrinolysis.
In primary fibrinolysis, the fibrinolytic system is activated and fibrin monomers are normal.
91
Which of the following is associated with multiple factor deficiencies?
An inherited disorder of coagulation
Severe liver disease
Dysfibrinogenemia
Lupus anticoagulant
Severe liver disease
Most of the clotting factors are made in the liver. Therefore, severe liver disease results in multiple factor deficiencies.
92
Which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant?
Thrombin time test
Diluted Russell’s viper venom test (DRVVT)
D-dimer test
FDP test
Diluted Russell’s viper venom test (DRVVT)
Russell’s viper venom (RVV) reagent contains factors X and V, activating enzymes that are strongly phospholipid dependent. The reagent also contains RVV, calcium ions, and phospholipid. In the presence of phospholipid autoantibodies such as lupus anticoagulant, the reagent phospholipid is partially neutralized causing prolongation of the clotting time.
93
What clotting factors (cofactors) are inhibited by protein S?
V and X
Va and VIIIa
VIII and IX
VIII and X
Va and VIIIa
Factors Va and VIIIa are deactivated by protein S and activated protein C.
94
The Bethesda assay is used for which determination?
Lupus anticoagulant titer
Factor VIII inhibitor titer
Factor V Leiden titer
Protein S deficiency
Factor VIII inhibitor titer
The Bethesda assay is a quantitative assay for factor VIII inhibitor. In this assay, normal plasma is incubated with different dilutions of the patient’s plasma or a normal control. The inhibitor inactivates factor VIII present in normal plasma following incubation for 2 hours at 37°C. The residual activities in the sample are determined, and the inhibitor titer is calculated.
95
Fibrinogen, which has been implicated as a primary risk factor for thrombotic disorders, increases approximately _____ mg/dL per DECADE in the elderly (65 to 79 years), 174 from 280 mg/dL to over 300 mg/dL.
1 mg/dL per decade
5 mg/dL per decade
10 mg/dL per decade
15 mg/dL per decade
10 mg/dL per decade
96
The only abnormal test result in CHRONIC DIC:
PT
APTT
Thrombin time
D-dimer
D-dimer
DIC, although characteristically identified through its hemorrhagic symptoms, is classified as a THROMBOTIC DISORDER
1. ACUTE DIC UNCOMPENSATED
PT, PTT, and thrombin time are prolonged; the fibrinogen level is reduced to less than 100 mg/dL; and fibrin degradation products, including D-dimers, are significantly increased
2. CHRONIC DIC COMPENSATED
Only elevated test result may be the D-dimer assay value, a hallmark of unregulated coagulation and fibrinolysis
97
DIC is also known as:
Defibrination syndrome
Consumption coagulopathy
Both of these
None of these
Both of these
DIC involves all hemostatic systems: vascular intima, platelets, leukocytes, coagulation, coagulation control pathways, and fibrinolysis.
98
Assess deficiencies of factors II, V, VII, or X:
Platelet count
Prothrombin time (PT)
Partial thromboplastin time (PTT)
Thrombin time
Prothrombin time (PT)
SCREENING TESTS FOR GENERALIZED HEMOSTATIC DISORDER
1. HEMOGLOBIN, HEMATOCRIT; RETICULOCYTE COUNT:
Anemia associated with chronic bleeding; bone marrow response
2. PLATELET COUNT: Thrombocytopenia
3. PT: Deficiencies of factors II (prothrombin), V, VII, or X
4. PTT: Deficiencies of all factors except VII and XIII
5: THROMBIN TIME OR FIBRINOGEN ASSAY:
Hypofibrinogenemia and dysfibrinogenemia
99
Assess deficiencies of all factors except VII and XIII:
Platelet count
Prothrombin time (PT)
Partial thromboplastin time (PTT)
Thrombin time
Partial thromboplastin time (PTT)
SCREENING TESTS FOR GENERALIZED HEMOSTATIC DISORDER
1. HEMOGLOBIN, HEMATOCRIT; RETICULOCYTE COUNT:
Anemia associated with chronic bleeding; bone marrow response
2. PLATELET COUNT: Thrombocytopenia
3. PT: Deficiencies of factors II (prothrombin), V, VII, or X
4. PTT: Deficiencies of all factors except VII and XIII
5: THROMBIN TIME OR FIBRINOGEN ASSAY:
Hypofibrinogenemia and dysfibrinogenemia
100
The target INR for PULMONARY EMBOLISM (PE) treatment:
1
2
3
4
3
INR 2-3:
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 2.5 - 3.5:
Recommended for patients with prosthetic heart valves
INR 3:
Pulmonary embolism (PE) treatment
101
Which of the following is considered to be an advantage of the MECHANICAL end-point detection methodology?
It is not affected by lipemia in the test sample
It has the ability to provide a graph of clot formation
It can incorporate multiple wavelengths into a single testing sequence
It can measure proteins that do not have fibrin formation as the end-point
It is not affected by lipemia in the test sample
A hemostasis laboratory manager may choose to maintain a separate mechanical end-point coagulometer to substitute for the optical instrument if the specimen is too cloudy for optical determinations.
102
In end-stage liver disease, the fibrinogen level may fall to less than ___mg/dL, which is a mark of liver failure.
Less than 100 mg/dL
Less than 200 mg/dL
Less than 300 mg/dL
Less than 400 mg/dL
Less than 100 mg/dL
In end-stage liver disease, the fibrinogen level may fall to less than 100 mg/dL, which is a mark of liver failure.
103
PT and APTT are prolonged when the fibrinogen level is ____ mg/dL or less.
100 mg/dL or less
130 mg/dL or less
150 mg/dL or less
200 mg/dL or less
100 mg/dL or less
104
ADDITIONAL: INFECTIOUS CRISES are the primary cause of death in sickle cell anemia .
ADDITIONAL: HEPCIDIN - REGULATE BODY IRON LEVELS. HEPCIDIN is a hormone produced by hepatocytes to REGULATE BODY IRON LEVELS, particularly absorption of iron in the intestine and release of iron from macrophages
105
Which of the following locations is not a site of extramedullary hematopoiesis?
Bone marrow
Liver
Spleen
Thymus
Bone marrow
BONE MARROW - MEDULLARY SITE
106
Which of the following is decreased in cases of intravascular hemolytic anemia?
Bilirubin
Urine hemosiderin
Haptoglobin
Serum hemoglobin
Haptoglobin
107
Patients with renal failure often exhibit compromised hematopoietic activity because of which of the following?
Concurrent depression of the thyroid
Decreased production of erythropoietin
Decreased production of GM-CSF
BM suppression caused by medications
Decreased production of erythropoietin
108
Which laboratory test is best used for DEFINITIVE diagnosis of sickle cell anemia?
Solubility testing
Hemoglobin electrophoresis
Peripheral smear review for sickle cells
Bone marrow analysis
Hemoglobin electrophoresis
109
Which of the following best describes the function of the Rapoport-Leubering pathway?
It produces ATP to help maintain RBC membrane deformability
It results in reduction of glutathione
It produces 2,3 diphosphoglycerate (2,3 DPG)
It produces cytochrome reductase
It produces 2,3 diphosphoglycerate (2,3 DPG)
110
The degree of effective erythropoiesis is best assessed by:
Serum iron levels
Serial hemoglobin determinations
Reticulocyte count
Ferrokinetic studies
Reticulocyte count
111
Which of the following hemoglobins is composed of four beta globin chains?
Hemoglobin F
Hemoglobin C
Bart's hemoglobin
Hemoglobin H
Hemoglobin H
112
Which of the following cells exhibit IgE receptors on their surface membranes?
Basophils
Eosinophils
Band neutrophils
Monocytes
Basophils
113
Which cells are involved in immediate hypersensitivity reactions?
Eosinophils
Basophils
Plasma cells
Reactive lymphocytes
Basophils
114
Which conditions which shift the oxyhemoglobin dissociation curve to the right?
Acidosis
Alkalosis
Multiple blood transfusions
Increased quantities of hemoglobin S or C
Acidosis
115
In which stage of erythrocytic maturation does hemoglobin formation begin?
Reticulocyte
Pronormoblast
Basophilic normoblast
Polychromatophilic normoblast
Polychromatophilic normoblast
116
What is the last nucleated stage in development of erythrocyte?
Prorubricyte
Rubricyte
Metarubricyte
Reticulocyte
Metarubricyte
117
Which is the major hemoglobin found in the RBCs of patients with SICKLE CELL TRAIT?
Hemoglobin S
Hemoglobin F
Hemoglobin A2
Hemoglobin A1
Hemoglobin A1
118
All of the following are associated with hemolytic anemia except:
Methemoglobinemia
Hemoglobinuria
Hemoglobinemia
Increased haptoglobin
Increased haptoglobin
Feedback
Decreased haptoglobin
119
Which of these hemoglobin derivatives cannot be reduced back to normal hemoglobin?
Methemoglobin
Hemiglobin
Carboxyhemoglobin
Sulfhemoglobin
Sulfhemoglobin
120
Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow?
Progressive decrease in overall cell size
Increasing basophilia of cytoplasm
Nuclear division without cytoplasmic division
Fusion of the nuclear lobes
Nuclear division without cytoplasmic division
121
The type of nuclear reproduction seen in megakaryocytes is:
Polypoid mitosis
Endomitosis
Meiosis
Binary fission
Endomitosis
122
The outermost zone of platelet is called:
Peripheral zone
Sol-gel zone
Alpha zone
Organelle zone
Peripheral zone
123
Which of the following cells is the largest cell in the BONE MARROW?
Monocyte
Megakaryocyte
Osteoblast
Mast cell
Megakaryocyte
124
The number of platelets an average megakaryocyte generates is approximately:
25 to 50
50 to 200
200 to 500
2,000 to 4,000
2,000 to 4,000
125
Portion of DNA that is ACTIVE in gene expression and stains lightly with Wright stain:
Euchromatin
Heterochromatin
Euchromatin
126
Portion of DNA that is INACTIVE during transcription to messenger RNA and stains deeply with Wright stain:
Euchromatin
Heterochromatin
Heterochromatin
127
Apoptosis is morphologically identified by:
Cellular swelling
Nuclear condensation
Rupture of the cytoplasm
Rupture of the nucleus
Nuclear condensation
APOPTOSIS
CELL SIZE: reduced due to shrinkage
NUCLEUS: condensation and fragmentation between nucleosomes
NECROSIS
CELL SIZE: enlarged due to swelling
NUCLEUS: random breaks and lysis (karylolysis)
128
The morphologic manifestation of APOPTOSIS is _______ of the cell.
Shrinkage of the cell
Swelling of the cell
Shrinkage of the cell
129
The first morphologic manifestation of NECROSIS is _______ of the cell.
Shrinkage of the cell
Swelling of the cell
Swelling of the cell
130
Dendritic cells are derived from:
Common lymphoid progenitor
Common myeloid progenitor
Common lymphoid progenitor
131
Which of the following red blood cell precursors is the LAST STAGE TO UNDERGO MITOSIS?
Pronormoblast
Basophilic normoblast
Polychromatophilic normoblast
Orthochromic normoblast
Polychromatophilic normoblast
132
Tertiary granules of the neutrophils are formed during the:
Promyelocyte stage
Myelocyte and metamyelocyte stage
Metamyelocyte and band stage
Band and segmented neutrophil stage
Metamyelocyte and band stage
Primary (Azurophilic) Granules
Formed during the promyelocyte stage
Last to be released (exocytosis)
Secondary (Specific) Granules
Formed during myelocyte and metamyelocyte stages
Third to be released
Tertiary Granules
Formed during metamyelocyte and band stages
Second to be released
Secretory Granules (Secretory Vesicles)
Formed during band and segmented neutrophil stages
First to be released (fuse to plasma membrane)
133
Chondroitin sulfates such as heparan:
Neutrophil secondary granules
Eosinophil secondary granules
Basophil secondary granules
Basophil secondary granules
134
Which erythrocyte metabolic pathway generates adenosine triphosphate (ATP) via glycolysis?
Embden-Meyerhof
Hexose monophosphate
Rapoport-Luebering
Methemoglobin reductase
Embden-Meyerhof
135
Iron is TRANSPORTED IN PLASMA via:
Hemosiderin
Ferritin
Transferrin
Hemoglobin
Transferrin
136
Multilobed nucleus:
MK-I
MK-II
MK-III
MK-III
137
Moderately condensed chromatin:
MK-I
MK-II
MK-III
MK-II
138
Deeply and variably condensed chromatin:
MK-I
MK-II
MK-III
MK-III
139
Reagent for the solubility test:
Ferric cyanide and detergent
2% sodium metabisulfite
Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)
1% sodium hydroxide
Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)
140
Hemoglobin SOLUBILITY TEST is a screening test for:
Hemoglobin A2
Hemoglobin F
Hemoglobin S
Unstable hemoglobins
Hemoglobin S
141
Color of blood in sulfhemoglobinemia:
Chocolate brown
Cherry red
Mauve lavender
Bright red
Mauve lavender
142
The red blood cell protein that is responsible for deformability and flexibility of the red blood cell is:
Spectrin
Glycophorin
Glycine
Erythropoietin
Spectrin
143
In hemoglobin C, glutamic acid on the 6th position of beta chain is replaced by which amino acid?
Lysine
Valine
Arginine
Glutamine
Lysine
144
The most mature cell that can undergo mitosis is the:
Promyelocyte
Myelocyte
Metamyelocyte
Band
Myelocyte
145
Granulocytic precursor with an indented or kidney-shaped nucleus:
Promyelocyte
Myelocyte
Metamyelocyte
Band
Metamyelocyte
146
Granulocytic cell with a sausage-shaped nucleus:
Promyelocyte
Myelocyte
Metamyelocyte
Band
Band
147
Most reliable way to differentiate a mature from an immature granulocyte:
Size of the cell
Color of the cytoplasm
Size of the nucleus
Chromatin pattern
Chromatin pattern
148
Reliable way to differentiate PLATELET PRECURSORS:
Size of the cell
Cytoplasmic appearance
Nucleus
Chromatin pattern
Cytoplasmic appearance
149
Alpha and dense granules of platelets:
In peripheral zone
In sol-gel zone
In organelle zone
In membranous system
In organelle zone
150
The term for cell movement across the cellular membranes from the blood vessels to the tissues is called:
Diapedesis
Endocytosis
Margination
Chemotaxis
Diapedesis
151
G1 or cell growth:
1 hour
4 hours
8 hours
10 hours
10 hours
CELL CYCLE.
G0, nondividing cell;
G1, cell growth (10 hours) ;
S, DNA replication (8 hours);
G2, protein synthesis (4 hours);
M, mitosis (1 hour) followed by cytokinesis or cell division.
152
S or DNA replication
1 hour
4 hours
8 hours
10 hours
8 hours
CELL CYCLE.
G0, nondividing cell;
G1, cell growth (10 hours) ;
S, DNA replication (8 hours);
G2, protein synthesis (4 hours);
M, mitosis (1 hour) followed by cytokinesis or cell division.
153
G2 or protein synthesis:
1 hour
4 hours
8 hours
10 hours
4 hours
CELL CYCLE.
G0, nondividing cell;
G1, cell growth (10 hours) ;
S, DNA replication (8 hours);
G2, protein synthesis (4 hours);
M, mitosis (1 hour) followed by cytokinesis or cell division.
154
M or mitosis:
1 hour
4 hours
8 hours
10 hours
1 hour
CELL CYCLE.
G0, nondividing cell;
G1, cell growth (10 hours) ;
S, DNA replication (8 hours);
G2, protein synthesis (4 hours);
M, mitosis (1 hour) followed by cytokinesis or cell division.
155
What is the ratio of IRON TO PYRROLE in 1 heme portion of the hemoglobin molecule?
1 iron to 2 pyrrole rings
2 iron to 1 pyrrole ring
1 iron to 4 pyrrole rings
4 iron to 1 pyrrole ring
1 iron to 4 pyrrole rings
The heme portion of the hemoglobin molecule consists of one iron (Fe2+) atom and four pyrrole rings that are joined to each other.
A complete hemoglobin molecule consists of four heme molecules, each of which is attached to one molecule of the protein globin.
156
Densely packed chromatin:
Myelocyte
Metamyelocyte
Band
Segmented neutrophil
Segmented neutrophil
157
Very clumped chromatin:
Myelocyte
Metamyelocyte
Band
Segmented neutrophil
Band
158
Basophils have an average circulation time of about ____ hours.
7 hours
8.5 hours
9 hours
12 hours
8.5 hours
Basophils have an average circulation time of about 8.5 hours.
159
Basophils remain in the maturation-storage phase for:
7 hours
8.5 hours
9.5 hours
12 hours
12 hours
Basophils remain in this phase for the shortest period, approximately 12 hours.
160
A patient has macrocytic anemia, the physician suspects pernicious anemia. Which tests would best rule in a definitive diagnosis of pernicious anemia?
Homocysteine
Intrinsic factor antibodies
Ova and parasite examination for D. latum
Bone marrow examination
Intrinsic factor antibodies
161
G6PD deficiency episodes are related to which of the following?
Exposure to oxidant drugs
Defective globin chains
Antibodies to RBCs
Abnormal protein structures
Exposure to oxidant drugs
162
Lack of vitamin B12 or folic acid hinders the erythroblast in manufacturing:
Heme
Globin
DNA
RNA
DNA
163
The nitroblue tetrazolium reduction test is used to assist in the diagnosis of:
Leukocyte adhesion disorders (LADs)
Chronic granulomatous disease (CGD)
May-Hegglin anomaly
Pelger-Huet anomaly
Chronic granulomatous disease (CGD)
164
Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright’s-stained blood smear?
Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Siderotic granules
Heinz bodies
165
Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
Anti-I
Anti-i
Anti-M
Anti-P
Anti-P
166
Bite cells are usually seen in patients with:
Rh null disease
Chronic granulomatous disease
G6PD deficiency
Pyruvate kinase deficiency
G6PD deficiency
167
Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia?
Sulfonamides
Penicillin
Tetracycline
Chloramphenicol
Chloramphenicol
168
Which anemia has red cell morphology similar to that seen in iron deficiency anemia?
Sickle cell anemia
Thalassemia
Pernicious anemia
Hereditary spherocytosis
Thalassemia
169
Auer rods may be seen in all of the following except:
Acute myeloid leukemia
Acute promyelocytic leukemia
Acute lymphoblastic leukemia
Acute myelomonocytic leukemia
Acute lymphoblastic leukemia
170
In myeloid cells, the stain that selectively identifies PHOSPHOLIPIDS in the membranes of both primary and secondary granules is:
PAS
Myeloperoxidase
Sudan black B
Tdt
Sudan black B
171
Sodium fluoride maybe added to naphthyl ASD (NASDA) esterase reaction. The fluoride is added to inhibit a positive reaction with:
Megakaryocytes
Monocytes
Erythrocytes
Granulocytes
Monocytes
172
What is the characteristic finding seen in the peripheral smear of a patient with multiple myeloma?
Microcytic hypochromic cells
Intracellular inclusion bodies
Rouleaux
Hypersegmented neutrophils
Rouleaux
173
Of the following, the disease most closely associated with granulocyte hyposegmentation is:
May-Hegglin anomaly
Pelger-Huet anomaly
Chediak-Higashi syndrome
Gaucher's disease
Pelger-Huet anomaly
174
Which of the following is associated with Alder-Reilly inclusions?
Membrane defect of lysosomes
Dohle bodies and giant platelets
Two-lobed neutrophils
Mucopolysaccharidosis
Mucopolysaccharidosis
175
Asynchronous development of hematopoietic cells within the bone marrow is the result of:
Inadequate levels of RNA
Decreased erythropoietin
Defective stem cells
Impaired DNA synthesis
Impaired DNA synthesis
176
Megaloblastic anemia is characterized by all of the following, EXCEPT:
Decreased WBCs and retics
Hypersegmented neutrophils
Oval macrocytes
Increased platelets
Increased platelets
177
Many microspherocytes and schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with:
Hereditary spherocytosis
Disseminated intravascular coagulation
Autoimmune hemolytic anemia
Extensive burns
Extensive burns
178
In myelofibrosis, the characteristic abnormal red cell morphology is:
Target cells
Schistocytes
Teardrop cells
Ovalocytes
Teardrop cells
179
In the French-American-Bristish (FAB) classification, myelomonocytic leukemia would be:
M1 and M2
M3
M4
M5
M4
180
A cytogenic abnormality is found in almost 50% of the patients with which of the following classifications of acute nonlymphocytic leukemia?
M1
M3
M5
M6
M3
181
DIC is most often associated with which of the following FAB designation of acute leukemia?
M1
M3
M4
M5
M3
182
FAB type M6 is characterized by increased:
Promyelocytes and lysozyme activity
Marrow megakaryocytes and thrombocytosis
Marrow erythroblasts and multinucleated red cells
Marrow monoblasts and immature monocytes
Marrow erythroblasts and multinucleated red cells
183
Which of the following stains is helpful in the diagnosis of suspected erythroleukemia?
Peroxidase
Periodic acid-Schiff
Nonspecific esterase
Acid phosphatase
Periodic acid-Schiff
184
Which type of anemia is usually present in a patient with acute leukemia?
Microcytic, hyperchromic
Microcytic, hypochromic
Normocytic, normochromic
Macrocytic, normochromic
Normocytic, normochromic
185
In the French-American-British (FAB) classification, acute lymphocytic leukemia is divided into groups according to:
Prognosis
Immunology
Cytochemistry
Morphology
Morphology
186
The FAB classification of ALL seen most commonly in children is:
L1
L2
L3
Burkitt's type
L1
187
In addition to the number of blasts, what other criterion is essential for the diagnosis of RARS?
More than 15% ringed sideroblasts
Dyshematopoiesis in all three lineages
More than 5% ringed sideroblasts
Pancytopenia
More than 15% ringed sideroblasts
188
Using an electronic cell counter analyzer, an increased RDW should correlate with:
Spherocytosis
Anisocytosis
Leukocytosis
Presence of NRBCs
Anisocytosis
The RDW parameter correlates with the degree of anisocytosis seen on the morphological examination. The reference range is 11.5%–14.5%.
189
Which of the following organs is responsible for the “pitting process” for RBCs?
Liver
Spleen
Kidney
Lymph nodes
Spleen
The spleen is the supreme filter of the body, pitting imperfections from the erythrocyte without destroying the integrity of the membrane.
190
Which of the following conditions may produce spherocytes in a peripheral smear?
Pelger–Huët anomaly
Pernicious anemia
Autoimmune hemolytic anemia
Sideroblastic anemia
Autoimmune hemolytic anemia
Spherocytes are produced in autoimmune hemolytic anemia.
191
Iron deficiency anemia may be distinguished from anemia of chronic infection by:
Serum iron level
Red cell morphology
Red cell indices
Total iron-binding capacity
Total iron-binding capacity
In iron deficiency anemia, the serum iron and ferritin levels are decreased and the total iron-binding capacity and RBC protoporphyrin are increased.
In chronic disease, serum iron and TIBC are both decreased because the iron is trapped in reticuloendothelial (RE) cells, and is unavailable to the
red cells for hemoglobin production.
192
Storage iron is usually best determined by:
Serum transferrin levels
Hgb values
Myoglobin values
Serum ferritin levels
Serum ferritin levels
Ferritin enters the serum from all ferritin-producing tissues, and therefore is considered to be a good indicator of body storage iron.
Because iron stores must be depleted before anemia develops, low serum ferritin levels precede the fall in serum iron associated with iron deficiency anemia.
193
Which morphological classification is characteristic of megaloblastic anemia?
Normocytic, normochromic
Microcytic, normochromic
Macrocytic, hypochromic
Macrocytic, normochromic
Macrocytic, normochromic
194
Which anemia is characterized by a lack of intrinsic factor that prevents B12 absorption?
Tropical sprue
Transcobalamin deficiency
Blind loop syndrome
Pernicious anemia
Pernicious anemia
Pernicious anemia is caused by a lack of intrinsic factor, which prevents vitamin B12 absorption.
195
The macrocytes typically seen in megaloblastic processes are:
Crescent-shaped
Teardrop-shaped
Ovalocytic
Pencil-shaped
Ovalocytic
Macrocytes in true megaloblastic conditions are oval macrocytes as opposed to the round macrocytes that are usually seen in alcoholism and obstructive liver disease.
196
The morphological characteristic(s) associated with the Chédiak–Higashi syndrome is (are):
Pale blue cytoplasmic inclusions
Giant lysosomal granules
Small, dark-staining granules and condensed nuclei
Nuclear hyposegmentation
Giant lysosomal granules
Chédiak–Higashi syndrome is a disorder of neutrophil phagocytic dysfunction caused by depressed chemotaxis and delayed degranulation. The degranulation disturbance is attributed to interference from the giant lysosomal granules characteristic of this disorder.
197
The WHO classification requires what percentage for the blast count in the blood or bone marrow for the diagnosis of AML?
At least 30%
At least 20%
At least 10%
Any percentage
At least 20%
198
Howell-Jolly bodies are composed of:
DNA
Iron
Reticulum
RNA
DNA
199
When acanthocytes are found on the blood smear, it is usually the result of
Abnormal membrane permeability
Altered membrane lipids
Mechanical trauma
Polymerization of hemoglobin molecules
Altered membrane lipids
200
The morphologic abnormality characteristically found in hemoglobinopathies:
Elliptocytes
Dacryocytes
Codocytes
Discocytes
Codocytes
201
Hereditary stomatocytosis is manifested physiologically by changes in:
Hemoglobin oxygen affinity
Membrane cation permeability
Efficiency of hemoglobin reduction
Glycolytic ATP production
Membrane cation permeability
The major defect in hereditary stomatocytosis is altered permeability of the red cell membrane to Na+ and K+ ions.
202
Abetalipoproteinemia is characterized by mild anemia and numerous on the peripheral blood smear.
Acanthocytes
Elliptocytes
Echinocytes
Stomatocytes
Acanthocytes
203
The fish tapeworm Diphyllobothrium latum is associated with the development of:
Microcytic anemia
Macrocytic anemia
Hemolytic anemia
Hypoproliferative anemia
Macrocytic anemia
The fish tapeworm competes for vitamin B12, and a macrocytic (megaloblastic) anemia may develop.
Hookworm infestation causes chronic blood loss and a microcytic anemia due to iron deficiency.
204
Which of the following represents the principal defect in chronic granulomatous disease (CGD)?
Chemotactic migration
Phagocytosis
Lysosomal formation and function
Oxidative respiratory burst
Oxidative respiratory burst
Chronic granulomatous disease (CGD) is a hereditary disorder in which neutrophils are incapable of killing most ingested microbes. The disease is usually fatal because of defective generation of oxidative metabolism products, such as superoxide anions and hydrogen peroxide, which are essential for killing.
205
A Gaucher cell is best described as a macrophage with:
"Wrinkled" cytoplasm due to an accumulation of glucocerebroside
"Foamy" cytoplasm filled with unmetabolized sphingomyelin
Pronounced vacuolization and deposits of cholesterol
Abundant cytoplasm containing storage iron and cellular remnants
"Wrinkled" cytoplasm due to an accumulation of glucocerebroside
Gaucher disease is a lipid storage disorder in which there is an accumulation of glucocerebroside in the macrophages because of a genetic lack of glucocerebrosidase, an enzyme required for normal lipid metabolism. Gaucher cells are found in the liver, spleen, and bone marrow.
206
The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia, and large platelets is called:
May-Hegglin anomaly
Chediak-Higashi syndrome
Pelger-Huet anomaly
Alder-Reilly anomaly
May-Hegglin anomaly
May-Hegglin anomaly is an autosomal dominant disorder in which large blue cytoplasmic structures that resemble Dohle bodies are found in the granulocytes and possibly the monocytes.
207
Perl's Prussian blue is a stain used to detect:
DNA
RNA
Iron
Glycogen
Iron
When stained with a mixture of potassium ferricyanide and hydrochloric acid, nonheme iron stains bright blue. This is the most common stain used for storage iron. It can be used on bone marrow to identify sideroblasts, peripheral blood to identify the presence of siderocytes, or urine to perform hemosiderin testing.
208
Solid tumor counterpart of acute lymphoblastic leukemia:
Lymphoma, undifferentiated
Lymphoma, poorly-differentiated
Lymphoma, well-differentiated
Myeloma
Lymphoma, poorly-differentiated
LEUKEMIA TYPE SOLID TUMOR COUNTERPART
STEM CELL LEUKEMIA: Lymphoma, undifferentiated
ACUTE LYMPHOBLASTIC: Lymphoma, poorly leukemia differentiated; lymphocytic
CHRONIC LYMPHOCYTIC: Lymphoma, well leukemia differentiated; lymphocytic
MONOCYTIC LEUKEMIA: Reticulum cell sarcoma
ACUTE MYELOGENOUS: Chloroma granulocytic leukemia
PLASMA CELL LEUKEMIA: Myeloma
209
Solid tumor counterpart of plasma cell leukemia:
Lymphoma, undifferentiated
Reticulum cell sarcoma
Chloroma
Myeloma
Myeloma
LEUKEMIA TYPE SOLID TUMOR COUNTERPART
STEM CELL LEUKEMIA: Lymphoma, undifferentiated
ACUTE LYMPHOBLASTIC: Lymphoma, poorly leukemia differentiated; lymphocytic
CHRONIC LYMPHOCYTIC: Lymphoma, well leukemia differentiated; lymphocytic
MONOCYTIC LEUKEMIA: Reticulum cell sarcoma
ACUTE MYELOGENOUS: Chloroma granulocytic leukemia
PLASMA CELL LEUKEMIA: Myeloma
210
It can be used to clean the objective lenses:
Normal saline
Formalin
Xylene
Lens cleaner or 70% isopropyl alcohol
Lens cleaner or 70% isopropyl alcohol
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.
211
All of the following are components of the modified Drabkin’s reagent EXCEPT:
Potassium cyanide, potassium ferricyanide
Dihydrogen potassium phosphate
Nonionic detergent
Sodium chloride
Sodium chloride
212
Microhematocrit tube:
Length 75 mm, inner bore of 1.2 mm
Length 115 mm, bore of 3 mm
Length of 300 mm, bore of 2.5 mm
Length of 11.5 cm, bore of 3 mm
Length 75 mm, inner bore of 1.2 mm
213
Duplicate hematocrit results should agree within __ unit (%).
1%
2%
5%
15%
1%
214
When comparing spun microhematocrit results with hematocrit results obtained on an electronic cell counter, the spun hematocrit results may vary from ___ because of this trapped plasma (unless the cell counter has been calibrated against spun microhematocrits uncorrected for trapped plasma).
1 to 3% lower
1 to 3% higher
3 to 5% lower
3 to 5% higher
1 to 3% higher
215
The difference between the total cells counted on each side should be less than ___%. A greater variation could indicate an uneven distribution, which requires that the procedure be repeated.
Less than 10%
Less than 15%
Less than 20%
Less than 30%
Less than 10%
216
If the WBC count is above 30 x 10 9th/L, it is advisable to use this dilution:
1:10
1:20
1:100
1:200
1:100
TYPICAL WBC DILUTION - 1:20
Above 30 x 10 9th/L - 1:100
100 to 300 x 10 9th/L - 1:200
Below 3 x 10 9th/L - 1:10
217
For manual WBC count, the filled counting chamber should be allowed to stand for __ prior to performing the count to give the WBCs time to settle.
3 minutes
5 minutes
10 minutes
15 minutes
10 minutes
218
For manual platelet count, the filled counting chamber should be allowed to stand for __ prior to performing the count to give the platelets time to settle.
3 minutes
5 minutes
10 minutes
15 minutes
15 minutes
219
Insufficient centrifugation will result in:
A false increase in hematocrit (Hct) value
A false decrease in Hct value
No effect on Hct value
All of these options, depending on the patient
A false increase in hematocrit (Hct) value
Insufficient centrifugation does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.
220
What effect would using a buffer at pH 6.0 have on a Wright’s-stained smear?
Red cells would be stained too pink
White cell cytoplasm would be stained too blue
Red cells would be stained too blue
Red cells would lyse on the slide
Red cells would be stained too pink
The pH of the buffer is critical in Romanowsky stains. When the pH is too low (<6.4), the red cells take up more acid dye (eosin), becoming too pink. Leukocytes also show poor nuclear detail when the pH is decreased.
221
A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because:
The WBC count would be falsely lower
The RBC count is too low
Nucleated RBCs are counted as leukocytes
Nucleated RBCs are confused with giant platelets
Nucleated RBCs are counted as leukocytes
The automated hematology analyzers enumerate all nucleated cells. NRBCs are counted along with WBCs, falsely elevating the WBC count. To correct the WBC count, determine the number of NRBCs per 100 WBCs. Corrected WBC count = (uncorrected WBC count ÷ [NRBC’s + 100]) × 100.
222
In essential thrombocythemia, the platelets are:
Increased in number and functionally abnormal
Normal in number and functionally abnormal
Decreased in number and functional
Decreased in number and functionally abnormal
Increased in number and functionally abnormal
In essential thrombocythemia, the platelet count is extremely elevated. These platelets are abnormal in function, leading to both bleeding and thrombotic diathesis.
223
Which of the following cells is considered pathognomonic for Hodgkin’s disease?
Niemann–Pick cells
Reactive lymphocytes
Flame cells
Reed–Sternberg cells
Reed–Sternberg cells
The morphological common denominator in Hodgkin’s lymphoma is the Reed–Sternberg (RS) cell. It is a large, binucleated cell with a dense nucleolus surrounded by clear space. These characteristics give the RS cell an “owl’s eye” appearance.
224
In myelofibrosis, the characteristic abnormal red blood cell morphology is that of:
Target cells
Schistocytes
Teardrop cells
Ovalocytes
Teardrop cells
The marked amount of fibrosis, both medullary and extramedullary, accounts for the irreversible red cell morphological change to a teardrop shape. The red cells are “teared” as they attempt to pass through the fibrotic tissue.
225
The erythrocytosis seen in relative polycythemia occurs because of:
Decreased arterial oxygen saturation
Decreased plasma volume of circulating blood
Increased erythropoietin levels
Increased erythropoiesis in the bone marrow
Decreased plasma volume of circulating blood
Relative polycythemia is caused by a reduction of plasma rather than an increase in red blood cell volume or mass. Red cell mass is increased in both PV and secondary polycythemia, but erythropoietin levels are high only in secondary polycythemia.
226
Cells that exhibit a positive stain with acid phosphatase and are not inhibited with tartaric acid are characteristically seen in:
Infectious mononucleosis
Infectious lymphocytosis
Hairy cell leukemia
T-cell acute lymphoblastic leukemia
Hairy cell leukemia
227
In addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera?
Decreased platelets, decreased granulocytes, decreased erythropoietin level
Decreased platelets, decreased granulocytes, increased erythropoietin level
Increased platelets, increased granulocytes, increased erythropoietin level
Increased platelets, increased granulocytes, decreased erythropoietin level
Increased platelets, increased granulocytes, decreased erythropoietin level
PV is not due to the activity of erythropoietin. The production of erythropoietin is almost completely suppressed in this malignant condition.
228
Which of the following is not a cause of ABSOLUTE secondary erythrocytosis?
Defective cardiac or pulmonary function
High-altitude adjustment
Dehydration secondary to diuretic use
Hemoglobins with increased oxygen affinity
Dehydration secondary to diuretic use
Dehydration is a cause of relative (pseudo) erythrocytosis due to plasma loss.
229
Which of the following is NOT classified as a myeloproliferative disorder?
Polycythemia vera
Essential thrombocythemia
Multiple myeloma
Chronic myelogenous leukemia
Multiple myeloma
Multiple myeloma is a malignant lymphoproliferative disorder characterized by a clonal proliferation of plasma cells and multiple bone tumors.
230
Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive chronic myelogenous leukemia?
MYC/IGH
BCR/ABL
PML/RARA
JAK2
BCR/ABL
The Philadelphia chromosome, t(9;22), is detected in almost all cases of CML (depends on detection method) and results in a mutated BCR/ABL fusion gene.
231
In which of the following would an absolute monocytosis not be seen?
Tuberculosis
Recovery stage of acute bacterial infection
Collagen disorders
Infectious mononucleosis
Infectious mononucleosis
IM - LYMPHOCYTOSIS
232
Naphthol AS-D chloroacetate esterase (specific) is usually positive in _____ cells, and alpha naphthyl acetate esterase (nonspecific)is useful for identifying blast cells of ______lineage.
Granulocytic; monocytic
Monocytic; granulocytic
Granulocytic; lymphocytic
Monocytic; lymphocytic
Granulocytic; monocytic
Naphthol AS-D chloroacetate esterase (specific) reacts strongly in granulocytic cells, and alpha-naphthyl acetate esterase (nonspecific) stains positively in monocytic cells.
233
What is the key diagnostic test for Hodgkin lymphoma?
Bone marrow biopsy
Lymph node biopsy
Spinal tap
Skin biopsy
Lymph node biopsy
The test that would be the most beneficial for the diagnosis of Hodgkin lymphoma is a lymph node biopsy.
234
Which of the following is NOT a characteristic finding in polycythemia vera?
Blood pancytosis
Increased red cell mass
Increased erythropoietin level
Increased blood viscosity
Increased erythropoietin level
Primary polycythemia (vera) is a malignant myeloproliferative disorder characterized by autonomous marrow production of erythrocytes in the presence of low erythropoietin levels.
235
What combination of reagents is used to measure hemoglobin?
Hydrochloric acid and p-dimethylaminobenzaldehyde
Potassium ferricyanide and potassium cyanide
Sodium bisulfite and sodium metabisulfite
Sodium citrate and hydrogen peroxide
Potassium ferricyanide and potassium cyanide
The standard assay for hemoglobin utilizes potassium ferricyanide. This solution, formerly called Drabkin's reagent, is now called cyanmethemoglobin (HiCN) reagent. The ferricyanide oxidizes hemoglobin iron from ferrous (Fe2+) to ferric (Fe3+), and the potassium cyanide stabilizes the pigment as cyanmethemoglobin for spectrophotometric measurement.
236
The components of Wright's stain include:
Crystal violet and safranin
Brilliant green and neutral red
New methylene blue and carbolfuchsin
Methylene blue and eosin
Methylene blue and eosin
One type of Romanowsky stain is the Wright's stain. It is a polychrome stain consisting of methylene blue and eosin.
237
Which of the following red cell inclusions stain with both Perl's Prussian blue and Wright's stain?
Howell-Jolly bodies
Basophilic stippling
Pappenheimer bodies
Heinz bodies
Pappenheimer bodies
Pappenheimer bodies are iron deposits associated with mitochondria, and they stain with both Perl's Prussian blue and Wright's stain.
238
Which of the following is NOT a source of error when measuring hemoglobin by the cyanmethemoglobin method?
Excessive anticoagulant
White blood cell count that exceeds linearity limits
Lipemic plasma
Scratched or dirty hemoglobin measuring cell
Excessive anticoagulant
Excessive anticoagulant does not affect hemoglobin readings.
Anything that causes an increase in absorbance will cause a hemoglobin that is read spectrophotometrically to be falsely high.
239
Blood drop size in the manual wedge technique:
1 to 2 mm in diameter
2 to 3 mm in diameter
4 to 5 mm in diameter
5 to 6 mm in diameter
2 to 3 mm in diameter
TOO LARGE A DROP: Long or thick film
TOO SMALL A DROP: Short or thin film
240
In manual wedge technique, the PUSHER SLIDE is held securely in the dominant hand at about:
15 to 20 degree angle
30 to 45 degree angle
45 to 50 degree angle
80 to 90 degree angle
30 to 45 degree angle
241
In the preparing wedge smear from blood samples of polycythemic patients, the angle between the two slides should be:
25
30
35
45
25
When the hematocrit is higher than normal (i.e., 60%), as is found in patients with polycythemia or in newborns, the angle should be lowered (i.e., 25 degrees) so the film is not too short and thick.
242
When a blood film is viewed through the microscope, the RBCs appear redder than normal, the neutrophils are barely visible, and the eosinophils are bright orange. What is the most likely cause?
Slide was overstained
Stain was too alkaline
Buffer was too acidic
Slide was not rinsed adequately
Buffer was too acidic
EXCESSIVELY PINK STAIN
Insufficient staining
Prolonged washing time
Mounting the coverslips before they are dry
Too high acidity of the stain or buffer
EXCESSIVELY BLUE STAIN
Thick films
Prolonged staining time
Inadequate washing
Too high an alkalinity of stain or diluent
243
Detects lymphocytic cells and certain abnormal erythrocytic cells by staining of cytoplasmic glycogen:
Periodic acid Schiff (PAS)
Peroxidase
Sudan black B (SBB)
Toluidine blue
Periodic acid Schiff (PAS)
244
Counting area for manual RBC count:
0.2 mm2
1 mm2
4 mm2
0.2 mm2
245
Counting area for manual WBC count:
0.2 mm2
1 mm2
4 mm2
4 mm2
246
Counting area for manual platelet count:
0.2 mm2
1 mm2
4 mm2
1 mm2
247
To increase accuracy of the WBC differential, it is advisable to count at least ___ cells when the WBC count is higher than 40 x 10 9th/L.
Count 50 cells
Count 100 cells
Count 200 cells
Count 300 or 400 cells
Count 200 cells
248
In WBC differential, if the WBC count is 100 x 10 9th/L or greater, it would be more precise and accurate to count ____ cells.
Count 50 cells
Count 100 cells
Count 200 cells
Count 300 or 400 cells
Count 300 or 400 cells
249
Effect of excess anticoagulant to hematocrit:
Increase
Decrease
No effect
Cannot be determined
Decrease
250
Which of the following will stain the GRANULOCYTES only?
Naphthol AS-D chloroacetate
Alpha-naphthyl acetate esterase
Alpha-naphthyl butyrate esterase
All of these
Naphthol AS-D chloroacetate
251
Dehydration:
Decreased hematocrit
Increased hematocrit
Variable hematocrit
Hematocrit cannot be determined
Increased hematocrit
The fluid loss associated with dehydration causes a decrease in plasma volume and falsely INCREASES the hematocrit reading.
252
Myeloperoxidase (MPO) and Sudan Black B (SBB) staining results:
Opposite
Parallel
Undetermined
Variable
Parallel
253
Which mutation is shared by a large percentage of patients with polycythemia vera, essential thrombocythemia, and primary myelofibrosis?
BCR/ABL
JAK2 V617F
PDGFR
RUNX1
JAK2 V617F
The JAK2 V617F mutation is present in numerous cases of myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia, and primary myelofibrosis.
BCR/ABL mutations are seen in CML, and PDGFR mutations are seen in neoplasms with eosinophilia. RUNX mutations may be seen in some cases of acute leukemias.
254
A patient has a CBC and peripheral smear with an elevated WBC count and left shift, suggestive of a diagnosis of CML. Which of the following tests would be the most helpful in CONFIRMING the suspected diagnosis?
Cytochemical staining for myeloperoxidase and LAP
Karyotyping for the Philadelphia chromosome
Flow cytometry for myeloid cell markers
Lymph node biopsies for metastasis
Karyotyping for the Philadelphia chromosome
Although leukocyte alkaline phosphatase (LAP) scores tend to be decreased in chronic myelogenous leukemia (CML) and myeloid cells are present, karyotyping for the presence of the Philadelphia chromosome (9;22 translocation) is required for the confirmation of a diagnosis of CML.
255
A 75-year-old male patient visits his physician for an annual checkup. His CBC showed an elevated WBC count with numerous small lymphocytes and smudge cells, and a subsequent bone marrow biopsy and aspirate showed hypercellularity with increased lymphoid cells. What is a presumptive diagnosis based on this information?
Acute lymphoblastic leukemia
Chronic lymphocytic leukemia
Hairy cell leukemia
Therapy-related acute myelogenous leukemia
Chronic lymphocytic leukemia
This smear and bone marrow picture is typical of chronic lymphocytic leukemia (CLL) with numerous mature small lymphocytes.
256
Which of the following appearances describes the types of cells seen in Sezary syndrome?
Plasma cells containing immunoglobulin deposits
Large circulating micromegakaryocytes
Lymphocytes with convoluted, cerebriform nuclei
Prolymphocytes with prominent azurophilic granules
Lymphocytes with convoluted, cerebriform nuclei
Sezary cells are lymphoma cells characterized by cerebriform nuclei and irregular nuclear outlines.
257
A patient’s differential count shows an elevated eosinophil count. This is consistent with which of the following?
Aplastic anemia
Bacterial infection
Parasitic infection
Viral infection
Parasitic infection
Elevated eosinophil counts are often seen in parasitic infections, particularly those caused by helminths.
258
A patient has a splenomegaly, and his CBC shows a left shift; bizarre RBCs, including dacryocytes; and notable platelet abnormalities. Which of the following would be the most helpful in determining the patient’s diagnosis?
Bone marrow biopsy
LAP staining
Karyotyping for the Philadelphia chromosome
Spleen biopsy
Bone marrow biopsy
A bone marrow biopsy would help in confirming a diagnosis of primary myelofibrosis, which is a possible diagnosis suggested by the dacryocytes, left shift, and abnormal platelets. If the patient had primary myelofibrosis, the bone marrow would likely show areas of fibrosis, in addition to increases in megakaryocytes and abnormal platelets.
259
Lipemia can cause turbidity in the cyanmethemoglobin method and a falsely high hemoglobin result. It can be corrected by:
Reagent-sample solution can be centrifuged and the supernatant measured
Adding 0.01 mL of the patient’s plasma to 5 mL of the cyanmethemoglobin reagent and using this solution as the reagent blank
Making a 1:2 dilution with distilled water (1 part diluted sample plus 1 part water) and multiplying the results from the standard curve by 2.
Cannot be corrected
Adding 0.01 mL of the patient’s plasma to 5 mL of the cyanmethemoglobin reagent and using this solution as the reagent blank
260
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
261
If MORE THAN 500 PLATELETS are counted on each side a ____ dilution should be made.
1:10
1:20
1:100
1:200
1:200
262
WBC COUNT that can cause turbidity in the cyanmethemoglobin method resulting to falsely high hemoglobin value:
Greater than 5 x 10 9th/L
Greater than 10 x 10 9th/L
Greater than 15 x 10 9th/L
Greater than 20 x 10 9th/L
Greater than 20 x 10 9th/L
A high WBC count (greater than 20 x 10 9th/L) or a high platelet count (greater than 700 x 10 9th/L) can cause turbidity and a falsely high result. IN THIS CASE, THE REAGENT-SAMPLE SOLUTION CAN BE CENTRIFUGED AND THE SUPERNATANT MEASURED.
263
PLATELET COUNT that can cause turbidity in the cyanmethemoglobin method resulting to falsely high hemoglobin value:
Greater than 150 x 10 9th/L
Greater than 200 x 10 9th/L
Greater than 500 x 10 9th/L
Greater than 700 x 10 9th/L
Greater than 700 x 10 9th/L
A high WBC count (greater than 20 x 10 9th/L) or a high platelet count (greater than 700 x 10 9th/L) can cause turbidity and a falsely high result. IN THIS CASE, THE REAGENT-SAMPLE SOLUTION CAN BE CENTRIFUGED AND THE SUPERNATANT MEASURED.
264
When the correct area of a specimen from a patient with a normal RBC count is viewed, there are generally about ____ RBCs per 100x oil immersion field.
10 to 15 RBCs per OIF
20 to 25 RBCs per OIF
100 to 150 RBCs per OIF
200 to 250 RBCs per OIF
200 to 250 RBCs per OIF
265
The IMPEDANCE PRINCIPLE OF CELL COUNTING is based on the detection and measurement of CHANGES IN ELECTRICAL RESISTANCE produced by cells as they traverse a small aperture. Electrical resistance between the ___ electrodes, or impedance in the current, occurs as the cells pass through the sensing aperture, causing voltage pulses that are measurable.
Two (2) electrodes
Three (3) electrodes
Four (4) electrodes
Ten (10) electrodes
Two (2) electrodes
266
Forward, low angle light scatter:
0 degree angle
2 to 3 degree angle
5 to 15 degree angle
90 degree angle
2 to 3 degree angle
Forward-angle: 0 degree - cell volume
Forward low-angle: 2 to 3 degrees - cell volume
Forward high-angle: 5 to 15 degrees - internal complexity
Orthogonal, side: 90 degrees - internal complexity
267
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
Forward-angle: 0 degree - cell volume
Forward low-angle: 2 to 3 degrees - cell volume
Forward high-angle: 5 to 15 degrees - internal complexity
Orthogonal, side: 90 degrees - internal complexity
268
Erythrocytes with NORMAL RDW:
Homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear
Heterogeneous and exhibit a high degree of anisocytosis
Homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear
269
Erythrocytes with INCREASED RDW:
Homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear
Heterogeneous and exhibit a high degree of anisocytosis
Heterogeneous and exhibit a high degree of anisocytosis
270
THE ESR IS ____ PROPORTIONAL TO THE RED BLOOD CELL MASS and _____proportional to plasma viscosity.
Direct, direct
Direct, inverse
Inverse, direct
Inverse, inverse
Direct, inverse
271
In automated cell counters, these parameters are directly measured:
WBC and RBC
WBC, RBC, and hemoglobin
WBC and hemoglobin
RBC only
WBC, RBC, and hemoglobin
272
All of the following are causes of spurious increase in WBCs, except:
Cryoglobulin
Cryofibrinogen
Monoclonal proteins
Smudge cells
Smudge cells
SPURIOUS INCREASE IN WBC
Cryoglobulin, cryofibrinogen
Heparin, monoclonal proteins
Nucleated RBCs, unlysed RBCs
Platelet clumping
SPURIOUS DECREASE IN WBC
Clotting, smudge cells
Uremia plus immunosuppressants
273
All of the following are causes of spurious increase in RBCs, except:
Autoagglutination
Cryoglobulin, cryofibrinogen
Giant platelets
High WBCs
Autoagglutination
SPURIOUS INCREASE IN RBC
Cryoglobulin, cryofibrinogen
Giant platelets
High WBC (>50,000/mL)
SPURIOUS DECREASE IN RBC
Autoagglutination, clotting
Hemolysis (in vitro)
Microcytic red cells
274
Based on the detection and measurement of changes in electrical resistance produced by cells as they transverse a small aperture in a conducting solution:
Impedance principle of cell counting
Optical principle of cell counting
Impedance principle of cell counting
275
Based on the degree of scatter and the amount of light reaching the sensor depend on the volume of the cell:
Impedance principle of cell counting
Optical principle of cell counting
Optical principle of cell counting
276
Cold agglutinins:
Decreased RBCs, increased MCV and MCHC, grainy appearance
Increased RBCs, decreased MCV and MCHC, grainy appearance
Decreased RBCs, increased MCV and MCHC, grainy appearance
RATIONALE: Agglutination of RBCs
CORRECTIVE ACTION: Warm specimen to 37° C and rerun
277
Lipemia and icterus:
Decreased hemoglobin and MCH
Increased hemoglobin and MCH
Increased hemoglobin and MCH
RATIONALE: Turbidity affects spectrophotometric reading for hemoglobin
CORRECTIVE ACTION: Plasma replacement
278
Nucleated RBCs, megakaryocyte fragments, or micromegakaryoblasts:
Decreased WBCs in newer instruments
Increased WBCs in older instruments
Increased WBCs in older instruments
RATIONALE: Nucleated RBCs or micromegakaryoblasts counted as WBCs
CORRECTIVE ACTION: Newer instruments eliminate this error and count nucleated RBCs and correct the WBC count; count micromegakaryoblasts per 100 WBCs and correct
279
Platelet clumps:
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
280
Leukemia, especially with chemotherapy:
Decreased WBCs, increased platelets
Increased WBCs, decreased platelets
Decreased WBCs, increased platelets
RATIONALE Fragile WBCs, fragments counted as platelets
CORRECTIVE ACTION Review film, perform phase platelet count or CD61 count
281
WBC > 100,000/µL:
Decreased hemoglobin, decreased RBCs, incorrect hematocrit
Increased hemoglobin, increased RBCs, incorrect hematocrit
Increased hemoglobin, increased RBCs, incorrect hematocrit
RATIONALE: Turbidity affects spectrophotometric reading for hemoglobin, WBCs counted with RBC count
CORRECTIVE ACTION: Manual HCT; perform manual HGB (spin/read supernatant), correct RBC count, recalculate indices; if above linearity, dilute for correct WBC count
282
All of the following are causes of spurious decrease in MCHC, except:
Autoagglutination
High WBCs
Spuriously low hemoglobin
Spuriously high hematocrit
Autoagglutination
SPURIOUS INCREASE IN MCHC
Autoagglutination, clotting
Hemolysis (in vitro, in vivo)
Spuriously HIGH Hb
Spuriously LOW Hct
SPURIOUS DECREASE IN MCHC
High WBC (>50,000/μL)
Spuriously LOW Hb,
Spuriously HIGH Hct
283
Shift to the left in RBC histogram means:
Population of smaller cells (microcytosis)
Population of larger cells (macrocytosis)
Population of smaller cells (microcytosis)
284
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?
Rouleaux
Spherocytosis
Reactive lymphocytosis
Toxic granulation
Rouleaux
MACROSCOPIC EXAMINATION OF BLOOD FILM
1. BLUER
Increased blood proteins, as in plasma cell myeloma, and that ROULEAUX may be seen on the film
2. GRAINY
RBC agglutination, as in cold hemagglutinin diseases
3. HOLES Increased lipid levels
4. BLUE SPECKS OUT AT THE FEATHER EDGE
Markedly increased WBC counts and platelet counts
285
Holes all over the blood film indicates:
RBC agglutination
Markedly increased WBC and platelet counts
Increased lipid levels
Increased blood proteins as in multiple myeloma
Increased lipid levels
MACROSCOPIC EXAMINATION OF BLOOD FILM
1. BLUER
Increased blood proteins, as in plasma cell myeloma, and that ROULEAUX may be seen on the film
2. GRAINY
RBC agglutination, as in cold hemagglutinin diseases
3. HOLES Increased lipid levels
4. BLUE SPECKS OUT AT THE FEATHER EDGE
Markedly increased WBC counts and platelet counts
286
Which of the following tests is the most effective means of assessing red blood cell generation in response to anemia?
RDW
Reticulocyte count
Platelet count
CBC
Reticulocyte count
287
Which of the following conditions is not usually associated with marked reticulocytosis?
Four days after a major hemorrhage
Drug-induced autoimmune hemolytic anemia
Sickle cell anemia
Pernicious anemia
Pernicious anemia
The reticulocyte count is not usually elevated in pernicious anemia even though increased marrow erythropoiesis occurs. The defective cellular maturation that occurs in megaloblastic anemias results in the death of many red cells in the bone marrow (ineffective erythropoiesis).
288
If 60 reticulocytes are counted in 1000 red blood cells, what is the reticulocyte count?
0.06%
0.6%
6.0%
60.0%
6.0%
289
To improve accuracy of the RETICULOCYTE COUNT, have another laboratorian count the other film; counts should agree within:
20%
30%
40%
50%
20%
290
Which of the following is NOT associated with causing a falsely low ESR?
Column used is slanted
EDTA tube is clotted
EDTA tube is one-third full
EDTA specimen is 24 hours old
Column used is slanted
291
The reagent used in the traditional sickle cell screening test is:
Sodium chloride
Sodium citrate
Sodium metabisulfite
Sodium-potassium oxalate
Sodium metabisulfite
292
Hemoglobin SOLUBILITY TEST is a screening test for:
Hemoglobin A2
Hemoglobin F
Hemoglobin S
Unstable hemoglobins
Hemoglobin S
293
Reagent for the solubility test:
Hydrochloric acid
Ferric cyanide and detergent
2% sodium metabisulfite
Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)
Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)
294
Positive result in the solubility test (sodium dithionite test for hemoglobin S):
Normal looking RBCs or slightly crenated RBCs
Sickle cells or ‘holly leaf’ form of RBCs
Clear solution, black lines of the reader scale are visible through the solution
Turbid solution, reader scale is not visible through the test solution
Turbid solution, reader scale is not visible through the test solution
If the solubility test is positive, hemoglobin electrophoresis should be performed on the specimen.
295
Paroxysmal nocturnal hemoglobinuria is characterized by flow cytometry results that are:
Negative for CD55 and CD59
Positive for CD55 and CD59
Negative for CD4 and CD8
Positive for all normal CD markers
Negative for CD55 and CD59
296
If the sugar water test is positive, _____ procedure should be performed before a diagnosis of PNH is made.
Autohemolysis test
Hemoglobin electrophoresis
Osmotic fragility test
Sucrose hemolysis test
Sucrose hemolysis test
297
Anticoagulant for the sugar water and sucrose hemolysis test:
EDTA
Citrate
Heparin
Oxalate
Citrate
298
What are the INITIAL laboratory tests that are performed for the diagnosis of anemia?
CBC, iron studies, and reticulocyte count
CBC, reticulocyte count, and peripheral blood film examination
Reticulocyte count and serum iron, vitamin B12 and folate assays
Bone marrow study, iron studies, and peripheral blood film examination
CBC, reticulocyte count, and peripheral blood film examination
299
Dilution for RBC count in AUTOMATED cell counters:
1:100
1:200
1: 50,000
1: 500
1: 50,000
300
Dilution for WBC count in AUTOMATED cell counters:
1:100
1:200
1: 50,000
1: 500
1: 500
301
A decreased osmotic fragility test would be associated which of the following conditions?
Sickle cell anemia
Hereditary spherocytosis
HDN
Acquired hemolytic anemia
Sickle cell anemia
302
A Miller disk is an ocular device used to facilitate counting of:
Platelets
Reticulocytes
Sickle cells
Nucleated RBCs
Reticulocytes
303
The Coulter principle for counting of cells is based upon the fact that:
Isotonic solutions conduct electricity better than cells do
Conductivity varies proportionally to the number of cells
Cells conduct electricity better than saline does
Isotonic solutions cannot conduct electricity
Isotonic solutions conduct electricity better than cells do
304
Side angle scatter in a laser-based cell counting system is used to measure:
Cell size
Cytoplasmic granularity
Cell number
Immunologic (antigenic) identification
Cytoplasmic granularity
305
Falsely elevated automated platelet counts may result from:
Platelet satellitism
Platelet agglutinins
Exceptionally large platelets
Erythrocyte inclusion bodies
Erythrocyte inclusion bodies
306
The mean platelet volume (MPV):
Analogous to the MCHC
Direct measure of the platelet count
Measurement of the average volume of platelets
Comparison of the patient’s value to the normal value
Measurement of the average volume of platelets
307
The RDW and MCV are both quantitative descriptors of erythrocyte size. If both are increased, the most probable erythrocytic abnormality would be:
Iron deficiency anemia
Acquired aplastic anemia
Megaloblastic anemia
Hemoglobinopathy
Megaloblastic anemia
308
In an erythrocyte histogram, the erythrocytes that are larger than normal will be to the _____ of the normal distribution curve.
Right
Left
In the middle
Right
309
If the RBC distribution on a histogram demonstrates a homogeneous pattern and a small SD, the peripheral blood smear would probably exhibit:
Extreme anisocytosis
Very little anisocytosis
A single population of spherocytes
A single population of macrocytes
Very little anisocytosis
310
Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?
Autosomal dominant inheritance
Red cell membrane defects
Positive direct antiglobulin test
Measured platelet count
Red cell membrane defects
311
An enzyme deficiency associated with a moderate to severe hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions formed by denatured hemoglobin is:
Lactate dehydrogenase deficiency
G-6-PD deficiency
Pyruvate kinase deficiency
Hexokinase deficiency
G-6-PD deficiency
312
The presence of excessive rouleaux formation on a blood smear is often accompanied by an increased:
Reticulocyte count
Sedimentation rate
Hematocrit
Erythrocyte count
Sedimentation rate
313
MPV values should be based on specimens that are between ____ and ___ hours old.
1 and 4 hours old
4 and 6 hours old
6 and 8 hours old
16 and 18 hours old
1 and 4 hours old
MPV values should be based on specimens that are between 1 and 4 hours old.
