HEMA Harr Flashcards
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. A false increase in hematocrit (Hct) value
Explanation: Insufficient centrifugation does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.
Variation in red cell size observed on the
peripheral smear is described as:
A. Anisocytosis
B. Hypochromia
C. Poikilocytosis
D. Pleocytosis
A. Anisocytosis
Which of the following is the preferable site for
bone marrow aspiration and biopsy in an adult?
A. Iliac crest
B. Sternum
C. Tibia
D. Spinous processes of a vertebra
A. Iliac crest
Explanation: The iliac crest is the most frequently used site for bone marrow aspiration and biopsy. This site is the
safest and most easily accessible, with the bone just beneath the skin, and neither blood vessels nor nerves are in the vicinity.
Mean cell volume (MCV) is calculated using the
following formula:
A. (Hgb ÷ RBC) × 10
B. (Hct ÷ RBC) × 10
C. (Hct ÷ Hgb) × 100
D. (Hgb ÷ RBC) × 100
B. (Hct ÷ RBC) × 10
What term describes the change in shape of erythrocytes seen on a Wright’s-stained peripheral
blood smear?
A. Poikilocytosis
B. Anisocytosis
C. Hypochromia
D. Polychromasia
A. Poikilocytosis
Explanation: Variation in shape of the erythrocytes on a peripheral blood smear is poikilocytosis. Anisocytosis refers to a change in size. Hypochromia is an increase in central pallor in erythrocytes. Polychromasia describes the bluish tinge of the immature erythrocytes (reticulocytes) circulating in the peripheral blood
Calculate the mean cell hemoglobin concentration (MCHC) using the following values:
Hgb: 15 g/dL (150 g/L)
Hct: 47 mL/dL (0.47)
RBC: 4.50 × 106/μL (4.50 × 1012/L)
A. 9.5% (.095)
B. 10.4% (.104)
C. 31.9% (.319)
D. 33.3% (.333)
C. 31.9% (.319)
Explanation: MCHC is the average concentration of Hgb in red cells expressed as a percentage. It expresses the ratio of the weight of Hgb to the volume of erythrocytes and is calculated by dividing Hgb by the Hct, and then multiplying by 100.
A decreased MCHC indicates that cells are hypochromic. In this example, (15 ÷ 47) × 100 = 31.9%. The reference range for MCHC is 32%–36%.
A manual white blood cell (WBC) count was performed. A total of 36 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. 0.4 × 109/L
B. 2.5 × 109/L
C. 4.0 × 109/L
D. 8.0 × 109/L
A. 0.4 × 109/L
Explanation: The formula used for calculating manual cell counts
using a hemacytometer is: Number of cells counted × dilution factor × depth factor (10) divided by the area. In this example, 36 × 10 × 10 = 3600 ÷ 9 =
400/mm3 or 0.4 × 109/L.
When an erythrocyte containing iron granules is stained with Prussian blue, the cell is called a:
A. Spherocyte
B. Leptocyte
C. Schistocyte
D. Siderocyte
D. Siderocyte
explanation: Siderocytes are red cells containing iron granules and are visible when stained with Prussian blue.
A 7.0-mL ethylenediaminetetraacetic acid (EDTA) tube is received in the laboratory containing only 2.0 mL of blood. If the laboratory is using manual
techniques, which of the following tests will most likely be erroneous?
A. RBC count
B. Hemoglobin (Hgb)
C. Hct
D. WBC count
C. Hct
explanation: 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 1:200 dilution of a patient’s sample was made and 336 red cells were counted in an area of 0.2 mm2. What is the RBC count?
A. 1.68 × 1012/L
B. 3.36 × 1012/L
C. 4.47 × 1012/L
D. 6.66 × 1012/L
B. 3.36 × 1012/L
Explanation:
RBC count = number of cells counted × dilution factor × depth factor (10), divided by the area.
In this example, 336 × 200 × 10 = 672,000 ÷ 0.2 = 3.36 × 106/mm3 = 3.36 × 1012/L.
What phagocytic cells produce lysozymes that are bacteriocidal?
A. Eosinophils
B. Lymphocytes
C. Platelets
D. Neutrophils
D. Neutrophils
If a patient has a reticulocyte count of 7% and an Hct of 20%, what is the corrected reticulocyte count?
A. 1.4%
B. 3.1%
C. 3.5%
D. 14%
B. 3.1%
Explanation: In anemic states, the reticulocyte percentage is not
a true measure of reticulocyte production. The following formula must be applied to calculate the corrected (for anemia) reticulocyte count.
Corrected reticulocyte count = reticulocytes (%) × Hct ÷ 45, the average normal Hct. In this case, 7 × (20 ÷ 45) = 3.1.
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
A. Sickle cell anemia
What effect would using a buffer at pH 6.0 have on a Wright’s-stained smear?
A. Red cells would be stained too pink
B. White cell cytoplasm would be stained too blue
C. Red cells would be stained too blue
D. Red cells would lyse on the slide
A. Red cells would be stained too pink
Explanation: 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.
Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be
detected on a Wright’s-stained blood smear?
A. Basophilic stippling
B. Heinz bodies
C. Howell–Jolly bodies
D. Siderotic granules
B. Heinz bodies
Explanation: Heinz bodies are irregular, refractile, purple inclusions that are not visible with Wright’s stain but show up
with supravital staining. The other three inclusions can be detected with Wright’s stain.
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)
B. MCH
A Miller disk is an ocular device used to facilitate counting of:
A. Platelets
B. Reticulocytes
C. Sickle cells
D. Nucleated red blood cells (NRBCs)
B. Reticulocytes
SITUATION: RBC indices obtained on an anemic patient are as follows: MCV 88 μm3 (fL); MCH 30 pg; MCHC 34% (.340). The RBCs on the peripheral smear would appear:
A. Microcytic, hypochromic
B. Microcytic, normochromic
C. Normocytic, normochromic
D. Normocytic, hypochromic
C. Normocytic, normochromic
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
A. Blood drawn into a sodium citrate tube
What staining method is used most frequently to stain and manually count reticulocytes?
A. Immunofluorescence
B. Supravital staining
C. Romanowsky staining
D. Cytochemical staining
B. Supravital staining
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
A. Isotonic solutions conduct electricity better than cells do
A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because:
A. The WBC count would be falsely lower
B. The RBC count is too low
C. Nucleated RBCs are counted as leukocytes
D. Nucleated RBCs are confused with giant platelets
C. Nucleated RBCs are counted as leukocytes
Using an electronic cell counter analyzer, an increased RDW should correlate with:
A. Spherocytosis
B. Anisocytosis
C. Leukocytosis
D. Presence of NRBCs
B. Anisocytosis
Given the following values, which set of red blood cell indices suggests spherocytosis?
A. MCV 76 μm3 MCH 19.9 pg MCHC 28.5%
B. MCV 90 μm3 MCH 30.5 pg MCHC 32.5%
C. MCV 80 μm3 MCH 36.5 pg MCHC 39.0%
D. MCV 81 μm3 MCH 29.0 pg MCHC 34.8%
C. MCV 80 μm3 MCH 36.5 pg MCHC 39.0%
Which of the following statistical terms reflects the best index of precision when comparing two CBC parameters?
A. Mean
B. Median
C. Coefficient of variation
D. Standard deviation
C. Coefficient of variation
Which of the following is considered a normal hemoglobin?
A. Carboxyhemoglobin
B. Methemoglobin
C. Sulfhemoglobin
D. Deoxyhemoglobin
D. Deoxyhemoglobin
Which condition will shift the oxyhemoglobin dissociation curve to the right?
A. Acidosis
B. Alkalosis
C. Multiple blood transfusions
D. Increased quantities of hemoglobin S or C
A. Acidosis
What is the major type of leukocyte seen in the peripheral smear of a patient with aplastic anemia?
A. Segmented neutrophil
B. Lymphocyte
C. Monocyte
D. Eosinophil
B. Lymphocyte
What is the normal WBC differential lymphocyte percentage (range) in the adult population?
A. 5%–10%
B. 10%–20%
C. 20%–44%
D. 50%–70%
C. 20%–44%
In which age group would 60% lymphocytes be a normal finding?
A. 6 months–2 years
B. 4–6 years
C. 11–15 years
D. 40–60 years
A. 6 months–2 years
Which of the following results on an automated differential suggests that a peripheral smear should be reviewed manually?
A. Segs = 70%
B. Band = 6%
C. Mono = 15%
D. Eos = 2%
C. Mono = 15%
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
D. Polychromatic normoblast
Which of the following can shift the hemoglobin oxygen dissociation curve to the right?
A. Increases in 2,3 DPG
B. Acidosis
C. Hypoxia
D. All of these options
D. All of these options
Which of the following Hgb configurations is characteristic of Hgb H?
A. γ4
B. α2-γ2
C. β4
D. α2-β2
A. γ4
Autoagglutination of red cells at room temperature can cause which of the following abnormal test results?
A. Low RBC count
B. High MCV
C. Low hematocrit
D. All of these options
D. All of these options
Hypersplenism is characterized by:
A. Polycythemia
B. Pancytosis
C. Leukopenia
D. Myelodysplasia
C. Leukopenia
Which of the following organs is responsible for the “pitting process” for RBCs?
A. Liver
B. Spleen
C. Kidney
D. Lymph nodes
B. Spleen
Spherocytes differ from normal red cells in all of the following except:
A. Decreased surface to volume
B. No central pallor
C. Decreased resistance to hypotonic saline
D. Increased deformability
D. Increased deformability
Which of the following is not associated with hereditary spherocytosis?
A. Increased osmotic fragility
B. An MCHC greater than 36%
C. Intravascular hemolysis
D. Extravascular hemolysis
C. Intravascular hemolysis
Which of the following disorders has an increase in osmotic fragility?
A. Iron deficiency anemia
B. Hereditary elliptocytosis
C. Hereditary stomatocytosis
D. Hereditary spherocytosis
D. Hereditary spherocytosis
The anemia seen in sickle cell disease is usually:
A. Microcytic, normochromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Normocytic, hypochromic
C. Normocytic, normochromic
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
D. Hgb A
Select the amino acid substitution that is
responsible for sickle cell anemia.
A. Lysine is substituted for glutamic acid at the sixth position of the α-chain
B. Valine is substituted for glutamic acid at the sixth position of the β-chain
C. Valine is substituted for glutamic acid at the sixth position of the α-chain
D. Glutamine is substituted for glutamic acid at the sixth position of the β-chain
B. Valine is substituted for glutamic acid at the sixth position of the β-chain
All of the following are usually found in Hgb C
disease except:
A. Hgb C crystals
B. Target cells
C. Lysine substituted for glutamic acid at the sixth position of the β–chain
D. Fast mobility of Hgb C at pH 8.6
D. Fast mobility of Hgb C at pH 8.6
Which of the following hemoglobins migrates to the same position as Hgb A2 at pH 8.6?
A. Hgb H
B. Hgb F
C. Hgb C
D. Hgb S
C. Hgb C
Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?
A. Hgb A: 40% Hgb S: 35% Hgb F: 5%
B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%
C. Hgb A: 0% Hgb A2: 5% Hgb F: 95%
D. Hgb A: 80% Hgb S: 10% Hgb A2: 10%
B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%
Explanation: Electrophoresis at alkaline pH usually shows 50%–70% Hgb A, 20%–40% Hgb S, and normal levels of Hgb A2 in a patient with the sickle cell trait.
In which of the following conditions will
autosplenectomy most likely occur?
A. Thalassemia major
B. Hgb C disease
C. Hgb SC disease
D. Sickle cell disease
D. Sickle cell disease
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
A. It is a rare acquired stem cell disorder that results in hemolysis
Hemolytic uremic syndrome (HUS) is
characterized by all of the following except:
A. Hemorrhage
B. Thrombocytopenia
C. Hemoglobinuria
D. Reticulocytopenia
D. Reticulocytopenia
An autohemolysis test is positive in all the following conditions except:
A. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
B. Hereditary spherocytosis (HS)
C. Pyruvate kinase (PK) deficiency
D. Paroxysmal nocturnal hemoglobinuria (PNH)
D. Paroxysmal nocturnal hemoglobinuria (PNH)
Explanation: The autohemolysis test is positive in G6PD and PK deficiencies and in HS, but is normal in PNH because lysis in PNH requires sucrose to enhance complement binding.
Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
A. Anti-I
B. Anti-i
C. Anti-M
D. Anti-P
D. Anti-P
Explanation: PCH is caused by the anti-P antibody, a cold autoantibody that binds to the patient’s RBCs at low temperatures and fixes complement.
All of the following are associated with
intravascular hemolysis except:
A. Methemoglobinemia
B. Hemoglobinuria
C. Hemoglobinemia
D. Decreased haptoglobin
A. Methemoglobinemia
Autoimmune hemolytic anemia is best
characterized by which of the following?
A. Increased levels of plasma C3
B. Spherocytic red cells
C. Decreased osmotic fragility
D. Decreased unconjugated bilirubin
B. Spherocytic red cells
Explanation:
Spherocytes are characteristic of autoimmune hemolytic anemia and result in an increased osmotic fragility. In autoimmune hemolytic anemias (AIHAs),
production of autoantibodies against one’s own red cells causes hemolysis or phagocytic destruction of RBCs.
“Bite cells” are usually seen in patients with:
A. Rh null trait
B. Chronic granulomatous disease
C. G6PD deficiency
D. PK deficiency
C. G6PD deficiency
Explanation:
In patients with G6PD deficiency, the red cells are unable to reduce nicotinamide adenine dinucleotide phosphate (NADP) to NADPH; consequently, Hgb is denatured and Heinz bodies are formed. “Bite cells”
appear in the peripheral circulation as a result ofsplenic pitting of Heinz bodies.
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
C. RBC indices
Which of the following is a common finding in aplastic anemia?
A. A monoclonal disorder
B. Tumor infiltration
C. Peripheral blood pancytopenia
D. Defective DNA synthesis
C. Peripheral blood pancytopenia
Explanation:
Aplastic anemia has many causes, such as chemical, drug, or radiation poisoning; congenital aplasia; and Fanconi’s syndrome. All result in depletion of hematopoietic precursors of all cell lines, leading to peripheral blood pancytopenia.
Congenital dyserythropoietic anemias (CDAs) are characterized by:
A. Bizarre multinucleated erythroblasts
B. Cytogenetic disorders
C. Megaloblastic erythropoiesis
D. An elevated M:E ratio
A. Bizarre multinucleated erythroblasts
Microangiopathic hemolytic anemia is
characterized by:
A. Target cells and Cabot rings
B. Toxic granulation and Döhle bodies
C. Pappenheimer bodies and basophilic stippling
D. Schistocytes and nucleated RBCs
D. Schistocytes and nucleated RBCs
Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia?
A. Sulfonamides
B. Penicillin
C. Tetracycline
D. Chloramphenicol
D. Chloramphenicol
Sickle cell disorders are:
A. Hereditary, intracorpuscular RBC defects
B. Hereditary, extracorpuscular RBC defects
C. Acquired, intracorpuscular RBC defects
D. Acquired, extracorpuscular RBC defects
A. Hereditary, intracorpuscular RBC defects
Which of the following conditions may produce spherocytes in a peripheral smear?
A. Pelger–Huët anomaly
B. Pernicious anemia
C. Autoimmune hemolytic anemia
D. Sideroblastic anemia
C. Autoimmune hemolytic anemia
A patient’s peripheral smear reveals numerous
NRBCs, marked variation of red cell morphology, and pronounced polychromasia. In addition to a
decreased Hgb and decreased Hct values, what other CBC parameters may be anticipated?
A. Reduced platelets
B. Increased MCHC
C. Increased MCV
D. Decreased red-cell distribution width (RDW)
C. Increased MCV
What red cell inclusion may be seen in the peripheral blood smear of a patient
postsplenectomy?
A. Toxic granulation
B. Howell–Jolly bodies
C. Malarial parasites
D. Siderotic granules
B. Howell–Jolly bodies
Reticulocytosis usually indicates:
A. Response to inflammation
B. Neoplastic process
C. Aplastic anemia
D. Red cell regeneration
D. Red cell regeneration
Hereditary pyropoikilocytosis (HP) is a red cell membrane defect characterized by:
A. Increased pencil-shaped cells
B. Increased oval macrocytes
C. Misshapen budding fragmented cells
D. Bite cells
C. Misshapen budding fragmented cells
The osmotic fragility test result in a patient with thalassemia major would most likely be:
A. Increased
B. Decreased
C. Normal
D. Decreased after incubation at 37°C
B. Decreased
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
C. Decreased total iron-binding capacity (TIBC)
Iron deficiency anemia may be distinguished from anemia of chronic infection by:
A. Serum iron level
B. Red cell morphology
C. Red cell indices
D. Total iron-binding capacity
D. Total iron-binding capacity
Which anemia has red cell morphology similar to that seen in iron deficiency anemia?
A. Sickle cell anemia
B. Thalassemia syndrome
C. Pernicious anemia
D. Hereditary spherocytosis
B. Thalassemia syndrome
Iron deficiency anemia is characterized by:
A. Decreased plasma iron, decreased % saturation, increased total iron-binding capacity (TIBC)
B. Decreased plasma iron, decreased plasma ferritin, normal RBC porphyrin
C. Decreased plasma iron, decreased % saturation, decreased TIBC
D. Decreased plasma iron, increased % saturation, decreased TIBC
A. Decreased plasma iron, decreased % saturation, increased total iron-binding capacity (TIBC)
Storage iron is usually best determined by:
A. Serum transferrin levels
B. Hgb values
C. Myoglobin values
D. Serum ferritin levels
D. Serum ferritin levels
All of the following are associated with
sideroblastic anemia except:
A. Increased serum iron
B. Ringed sideroblasts
C. Dimorphic blood picture
D. Increased RBC protoporphyrin
C. Dimorphic blood picture
What is the basic hematological defect seen in patients with thalassemia major?
A. DNA synthetic defect
B. Hgb structure
C. β-Chain synthesis
D. Hgb phosphorylation
C. β-Chain synthesis
Which of the following is the primary Hgb in patients with thalassemia major?
A. Hgb D
B. Hgb A
C. Hgb C
D. Hgb F
D. Hgb F
A patient has an Hct of 30%, a hemoglobin of 8 g/dL, and an RBC count of 4.0 × 1012/L. What is the morphological classification of this anemia?
A. Normocytic normochromic
B. Macrocytic hypochromic
C. Microcytic hypochromic
D. Normocytic hyperchromic
C. Microcytic hypochromic
In which of the following conditions is Hgb A2 elevated?
A. Hgb H
B. Hgb SC disease
C. β-Thalassemia minor
D. Hgb S trait
C. β-Thalassemia minor
Which of the following parameters may be similar for the anemia of inflammation and iron deficiency
anemia?
A. Normocytic indices
B. Decreased serum iron concentration
C. Ringed sideroblasts
D. Pappenheimer bodies
B. Decreased serum iron concentration
Which morphological classification is
characteristic of megaloblastic anemia?
A. Normocytic, normochromic
B. Microcytic, normochromic
C. Macrocytic, hypochromic
D. Macrocytic, normochromic
D. Macrocytic, normochromic
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
D. Pernicious anemia
All of the following are characteristics of
megaloblastic anemia except:
A. Pancytopenia
B. Elevated reticulocyte count
C. Hypersegmented neutrophils
D. Macrocytic erythrocyte indices
B. Elevated reticulocyte count
A patient with a vitamin B12 anemia is given a high dosage of folate. Which of the following is expected as a result of this treatment?
A. An improvement in neurological problems
B. An improvement in hematological abnormalities
C. No expected improvement
D. Toxicity of the liver and kidneys
B. An improvement in hematological abnormalities
Which of the following disorders is associated with ineffective erythropoiesis?
A. G6PD deficiency
B. Liver disease
C. Hgb C disease
D. Megaloblastic anemia
D. Megaloblastic anemia
A 50-year-old patient is suffering from pernicious anemia. Which of the following laboratory data are most likely for this patient?
A. RBC = 2.5 × 1012/L;
WBC =12,500/μL (12.5 × 109/L);
PLT = 250,000/μL (250 × 109/L)
B. RBC = 4.5 × 1012/L;
WBC = 6,500/μL (6.5 ×109/L);
PLT = 150,000/μL (150 × 109/L)
C. RBC = 3.0 × 1012/L;
WBC = 5,000/μL (5.0 × 109/L);
PLT = 750,000/μL (750 × 109/L)
D. RBC = 2.5 × 1012/L;
WBC = 2,500/μL (2.5 × 109/L);
PLT = 50,000/μL (50 × 109/L)
D. RBC = 2.5 × 1012/L;
WBC = 2,500/μL (2.5 × 109/L);
PLT = 50,000/μL (50 × 109/L)
Which of the following may be seen in the
peripheral blood smear of a patient with
obstructive liver disease?
A. Schistocytes
B. Macrocytes
C. Howell–Jolly bodies
D. Microcytes
B. Macrocytes
The macrocytes typically seen in megaloblastic processes are:
A. Crescent-shaped
B. Teardrop-shaped
C. Ovalocytic
D. Pencil-shaped
C. Ovalocytic
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%
C. MCV 125 fL, MCH 36 pg, MCHC 34%
A patient has 80 nucleated red blood cells per 100 leukocytes. In addition to increased polychromasia on the peripheral smear, what other finding may be present on the CBC?
A. Increased platelets
B. Increased MCV
C. Increased Hct
D. Increased red blood cell count
D. Increased red blood cell count
Which of the following is an unusual complication that may occur in infectious mononucleosis?
A. Splenic infarctions
B. Dactylitis
C. Hemolytic anemia
D. Giant platelets
A. Splenic infarctions
In a patient with human immunodeficiency virus (HIV) infection, one should expect to see:
A. Shift to the left in WBCs
B. Target cells
C. Reactive lymphocytes
D. Pelgeroid cells
C. Reactive lymphocytes
Which inclusions may be seen in leukocytes?
A. Döhle bodies
B. Basophilic stippling
C. Malarial parasites
D. Howell–Jolly bodies
A. Döhle bodies
Which of the following is contained in the primary granules of the neutrophil?
A. Lactoferrin
B. Myeloperoxidase
C. Histamine
D. Alkaline phosphatase
B. Myeloperoxidase
What is the typical range of relative lymphocyte percentage in the peripheral blood smear of a 1-year-old child?
A. 1%–6%
B. 27%–33%
C. 35%–58%
D. 50%–70%
D. 50%–70%
Qualitative and quantitative neutrophil changes noted in response to infection include all of the following except:
A. Neutrophilia
B. Pelgeroid hyposegmentation
C. Toxic granulation
D. Vacuolization
B. Pelgeroid hyposegmentation
Neutropenia is present in patients with which absolute neutrophil counts?
A. <1.5 × 109/L
B. <5.0 × 109/L
C. <10.0 × 109/L
D. <15.0 × 109/L
A. <1.5 × 109/L
The morphological characteristic(s) associated with the Chédiak–Higashi syndrome is (are):
A. Pale blue cytoplasmic inclusions
B. Giant lysosomal granules
C. Small, dark-staining granules and condensed nuclei
D. Nuclear hyposegmentation
B. Giant lysosomal granules
The familial condition of Pelger–Huët anomaly is important to recognize because this disorder must be differentiated from:
A. Infectious mononucleosis
B. May–Hegglin anomaly
C. A shift-to-the-left increase in immature granulocytes
D. G6PD deficienc
C. A shift-to-the-left increase in immature granulocytes
SITUATION: A differential shows reactive
lymphocytes, and the physician suspects a viral infection is the cause. What is the expected laboratory finding in a patient with a cytomegalovirus (CMV) infection?
A. Heterophile antibody: positive
B. Epstein–Barr virus (EBV)–immunoglobulin
(IgM): positive
C. Direct antiglobulin test (DAT): positive
D. CMV–IgM: positive
D. CMV–IgM: positive
Neutrophil phagocytosis and particle ingestion are associated with an increase in oxygen utilization called respiratory burst. What are the two most important products of this biochemical reaction?
A. Hydrogen peroxide and superoxide anion
B. Lactoferrin and NADPH oxidase
C. Cytochrome b and collagenase
D. Alkaline phosphatase and ascorbic acid
A. Hydrogen peroxide and superoxide anion
Which of the morphological findings are
characteristic of reactive lymphocytes?
A. High nuclear:cytoplasmic ratio
B. Prominent nucleoli
C. Basophilic cytoplasm
D. All of these options
D. All of these options
Auer rods may be seen in all of the following except:
A. Acute myelomonocytic leukemia (M4)
B. Acute lymphoblastic leukemia
C. Acute myeloid leukemia without maturation (M1)
D. Acute promyelocytic leukemia (M3)
C. Acute myeloid leukemia without maturation (M1)
Which type of anemia is usually present in a patient with acute leukemia?
A. Microcytic, hyperchromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Macrocytic, normochromic
C. Normocytic, normochromic
In leukemia, which term describes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by nucleated red cells?
A. Myelophthisis
B. Dysplasia
C. Leukoerythroblastosis
D. Megaloblastosis
C. Leukoerythroblastosis
The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except:
A. Replacement of normal marrow precursors by leukemic cells causing anemia
B. Decrease in functional leukocytes causing infection
C. Hemorrhage secondary to thrombocytopenia
D. Decreased erythropoietin production
C. Hemorrhage secondary to thrombocytopenia
Which type of acute myeloid leukemia is called the true monocytic leukemia and follows an acute or subacute course characterized by monoblasts, promonocytes, and monocytes?
A. Acute myeloid leukemia, minimally differentiated
B. Acute myeloid leukemia without maturation
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia
D. Acute monocytic leukemia
In which age group does acute lymphoblastic leukemia occur with the highest frequency?
A. 1–15 years
B. 20–35 years
C. 45–60 years
D. 60–75 years
A. 1–15 years
Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia?
A. Acute myeloid leukemia without maturation
B. Acute promyelocytic leukemia
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia
B. Acute promyelocytic leukemia
An M:E ratio of 10:1 is most often seen in:
A. Thalassemia
B. Leukemia
C. Polycythemia vera
D. Myelofibrosis
B. Leukemia
Which of the following is a characteristic of Auer rods?
A. They are composed of azurophilic granules
B. They stain periodic acid–Schiff (PAS) positive
C. They are predominantly seen in chronic
myelogenous leukemia (CML)
D. They are nonspecific esterase positive
A. They are composed of azurophilic granules
SITUATION: The following laboratory values are seen:
WBCs = 6.0 × 109/L
Hgb = 6.0 g/dL
RBCs = 1.90 × 1012/L
Hct = 18.5%
Platelets = 130 × 109/L
Serum vitamin B12 and folic acid: normal
WBC Differential:
6% PMNs
40% lymphocytes
4% monocytes
50% blasts
Bone Marrow:
40% myeloblasts
60% promegaloblasts
40 megaloblastoid
NRBCs/100 WBCs
These results are most characteristic of:
A. Pernicious anemia
B. Acute myeloid leukemia without maturation
C. Acute erythroid leukemia
D. Acute myelomonocytic leukemia
C. Acute erythroid leukemia
Explanation: In acute erythroid leukemia, more than 50% of nucleated bone marrow cells are erythroid and more than 30% nonerythroid cells are blasts. Pernicious anemia results in pancytopenia and low vitamin B12
concentrations.
SITUATION: A peripheral smear shows 75% blasts. These stain positive for both Sudan Black B (SBB) and peroxidase. Given these values, which of the following disorders is most likely?
A. Acute myelocytic leukemia (AML)
B. CML
C. Acute undifferentiated leukemia (AUL)
D. Acute lymphocytic leukemia (ALL)
A. Acute myelocytic leukemia (AML)
In myeloid cells, the stain that selectively identifies phospholipid in the membranes of both primary and secondary granules is:
A. PAS
B. Myeloperoxidase
C. Sudan Black B stain
D. Terminal deoxynucleotidyl transferase (TdT)
C. Sudan Black B stain
Leukemic lymphoblasts reacting with anti-CALLA are characteristically seen in:
A. B-cell ALL
B. T-cell ALL
C. Null-cell ALL
D. Common ALL
D. Common ALL
Explanation: The majority of non-T, non-B ALL blast cells display the common ALL antigen (CALLA) marker.
Which of the following reactions are often positive in ALL but are negative in AML?
A. Terminal deoxynucleotidyl transferase and PAS
B. Chloroacetate esterase and nonspecific esterase
C. Sudan Black B and peroxidase
D. New methylene blue and acid phosphatase
A. Terminal deoxynucleotidyl transferase and PAS
Explanation: Terminal deoxynucleotidyl
transferase is positive in all types of ALL except L3. Both terminal deoxynucleotidyl transferase and PAS
are negative in AML.
A patient’s peripheral blood smear and bone marrow both show 70% blasts. These cells are negative for Sudan Black B stain. Given these data, which of the following is the most likely diagnosis?
A. Acute myeloid leukemia
B. Chronic lymphocytic leukemia
C. Acute promyelocytic leukemia
D. Acute lymphocytic leukemia
D. Acute lymphocytic leukemia
Which of the following leukemias are included in the 2008 World Health Organization classification of myeloproliferative neoplasms?
A. Chronic myelogenous leukemia (CML)
B. Chronic neutrophilic leukemia (CNL)
C. Chronic eosinophilic leukemia (CEL)
D. All of these options are classified as
myeloproliferative neoplasms (MPN)
D. All of these options are classified as
myeloproliferative neoplasms (MPN)
In addition to morphology, cytochemistry, and immunophenotyping, the WHO classification of myelo- and lymphoproliferative disorders is based
upon which characteristic?
A. Proteomics
B. Cytogenetic abnormalities
C. Carbohydrate-associated tumor antigen production
D. Cell signaling and adhesion markers
B. Cytogenetic abnormalities
The WHO classification requires what percentage for the blast count in the blood or bone marrow for the diagnosis of AML?
A. At least 30%
B. At least 20%
C. At least 10%
D. Any percentage
B. At least 20%
What would be the most likely designation by the WHO for the FAB AML M2 by the French–American–British classification?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)
C. AML with t(8;21)
What would be the most likely designation by the WHO for the FAB AML M3 by the French–American–British classification?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)
A. AML with t(15;17)
Which AML cytogenetic abnormality is associated with acute myelomonocytic leukemia with marrow eosinophilia under the WHO classification of AML with recurrent genetic abnormalities?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)
D. AML with inv(16)
What would be the most likely classification by the WHO for the FAB AML M7 by the French–American–British classification?
A. Acute myeloid leukemias with recurrent genetic abnormalities
B. Acute myeloid leukemia with multilineage dysplasia
C. Acute myeloid leukemia not otherwise categorized
D. Acute leukemias of ambiguous lineage
C. Acute myeloid leukemia not otherwise categorized
The leukocyte alkaline phosphatase (LAP) stain on a patient gives the following results
10(0) 48(1+) 38(2+) 3(3+) 1(4+)
Calculate the LAP score.
A. 100
B. 117
C. 137
D. 252
C. 137
CML is distinguished from leukemoid reaction by which of the following?
A. CML: low LAP; leukemoid: high LAP
B. CML: high LAP; leukemoid: low LAP
C. CML: high WBC; leukemoid: normal WBC
D. CML: high WBC; leukemoid: higher WBC
A. CML: low LAP; leukemoid: high LAP
A 19-year-old man came to the emergency department with severe joint pain, fatigue, cough, and fever. Review the following laboratory results:
WBCs 21.0 × 109/L
RBCs 3.23 × 1012/L
Hgb 9.6 g/dL
PLT 252 × 109/L
What is the corrected WBC count?
A. 8.1 × 109/L
B. 16.7 × 109/L
C. 21.0 × 109/L
D. 80.8 × 109/L
B. 16.7 × 109/L
Explanation:
The formula for correcting the WBC count for the presence of NRBCs is:
Total WBC × 100 or (21.0 × 100) ÷ 126 =
16.7 × 109/L
A manual WBC count is performed. Eighty WBCs are counted in the four large corner squares of a Neubauer hemacytometer. The dilution is 1:100.
What is the total WBC count?
A. 4.0 × 109/L
B. 8.0 × 109/L
C. 20.0 × 109/L
D. 200.0 × 109/L
C. 20.0 × 109/L
A manual RBC count is performed on a pleural fluid. The RBC count in the large center square of the Neubauer hemacytometer is 125, and the dilution is 1:200.
What is the total RBC count?
A. 27.8 × 109/L
B. 62.5 × 109/L
C. 125.0 × 109/L
D. 250.0 × 109/L
D. 250.0 × 109/L
Review the following automated CBC values.
WBCs = 17.5 × 109/L (flagged)
MCV = 86.8 fL
RBCs = 2.89 × 1012/L
MCH = 28.0 pg
Hgb = 8.1 g/dL
MCHC = 32.3%
Hct = 25.2%
PLT = 217 × 109/L
Many sickle cells were observed upon review of the peripheral blood smear. Based on this finding and the results provided, what automated parameter of
this patient is most likely inaccurate and what follow-up test should be done to accurately assess this parameter?
A. MCV/perform reticulocyte count
B. Hct/perform manual Hct
C. WBC/perform manual WBC count
D. Hgb/perform serum:saline replacement
C. WBC/perform manual WBC count
Review the following CBC results on a 2-day-old infant:
WBCs = 15.2 × 109/L MCV = 105 fL
RBCs = 5.30 × 1012/L MCH = 34.0 pg
Hgb = 18.5 g/dL MCHC = 33.5%
Hct = 57.9% PLT = 213 × 109/L
These results indicate:
A. Macrocytic anemia
B. Microcytic anemia
C. Liver disease
D. Normal values for a 2-day-old infant
D. Normal values for a 2-day-old infant
Which of the following initiates in vivo
coagulation by activation of factor VII?
A. Protein C
B. Tissue factor
C. Plasmin activator
D. Thrombomodulin
B. Tissue factor
Which of the following clotting factors plays a role in clot formation in vitro, but not in vivo? in vitro clot formation and not in vivo coagulation?
A. VIIa
B. IIa
C. XIIa
D. Xa
C. XIIa
The anticoagulant of choice for most routine coagulation studies is:
A. Sodium oxalate
B. Sodium citrate
C. Heparin
D. Ethylenediaminetetraacetic acid (EDTA)
B. Sodium citrate
Which ratio of anticoagulant-to-blood is correct for coagulation procedures?
A. 1:4
B. 1:5
C. 1:9
D. 1:10
C. 1:9
Which results would be expected for the
prothrombin time (PT) and activated partial thromboplastin time (APTT) in a patient with polycythemia?
A. Both prolonged
B. Both shortened
C. Normal PT, prolonged APTT
D. Both normal
A. Both prolonged
What reagents are used in the PT test?
A. Thromboplastin and sodium chloride
B. Thromboplastin and potassium chloride
C. Thromboplastin and calcium
D. Actin and calcium chloride
C. Thromboplastin and calcium
Which test would be abnormal in a patient with factor X deficiency?
A. PT only
B. APTT only
C. PT and APTT
D. Thrombin time
C. PT and APTT
Which clotting factor is not measured by PT and APTT tests?
A. Factor VIII
B. Factor IX
C. Factor V
D. Factor XIII
D. Factor XIII
A modification of which procedure can be used to measure fibrinogen?
A. PT
B. APTT
C. Thrombin time
D. Fibrin degradation products
C. Thrombin time
Which of the following characterizes vitamin K?
A. It is required for biological activity of fibrinolysis
B. Its activity is enhanced by heparin therapy
C. It is required for carboxylation of glutamate residues of some coagulation factors
D. It is made by the endothelial cells
C. It is required for carboxylation of glutamate residues of some coagulation factors
Which statement about the fibrinogen/fibrin degradation product test is correct?
A. It detects early degradation products (X and Y)
B. It is decreased in disseminated intravascular
coagulation (DIC)
C. It evaluates the coagulation system
D. It detects late degradation products (D and E)
D. It detects late degradation products (D and E)
Which of the following clotting factors are measured by the APTT test?
A. II, VII, IX, X
B. VII, X, V, II, I
C. XII, XI, IX, VIII, X, V, II, I
D. XII, VII, X, V, II, I
C. XII, XI, IX, VIII, X, V, II, I
Which coagulation test(s) would be abnormal in a vitamin K–deficient patient?
A. PT only
B. PT and APTT
C. Fibrinogen level
D. Thrombin time
B. PT and APTT
Which of the following is correct regarding the international normalized ratio (INR)?
A. It uses the International Sensitivity Ratio (ISR)
B. It standardizes PT results
C. It standardizes APTT results
D. It is used to monitor heparin therapy
B. It standardizes PT results
Which of the following is referred to as an endogenous activator of plasminogen?
A. Streptokinase
B. Transamidase
C. Tissue plasminogen activator
D. Tissue plasminogen activator inhibitor
C. Tissue plasminogen activator
Which protein is the primary inhibitor of the fibrinolytic system?
A. Protein C
B. Protein S
C. α2-Antiplasmin
D. α2-Macroglobulin
C. α2-Antiplasmin
Which of the following statements is correct regarding the D-dimer test?
A. Levels are decreased in DIC
B. Test detects polypeptides A and B
C. Test detects fragments D and E
D. Test has a negative predictive value
D. Test has a negative predictive value
A protein that plays a role in both coagulation and platelet aggregation is:
A. Factor I
B. Factor VIII
C. Factor IX
D. Factor XI
A. Factor I
A standard 4.5-mL blue-top tube filled with 3.0 mL of blood was submitted to the laboratory for PT and APTT tests. The sample is from a patient undergoing surgery the following morning for a
tonsillectomy. Which of the following is the necessary course of action by the technologist?
A. Run both tests in duplicate and report the
average result
B. Reject the sample and request a new sample
C. Report the PT result
D. Report the APTT result
B. Reject the sample and request a new sample
Which statement is correct regarding sample storage for the prothrombin time test?
A. Stable for 24 hours if the sample is capped
B. Stable for 24 hours if the sample is refrigerated
at 4°C
C. Stable for 4 hours if the sample is stored at 4°C
D. Should be run within 8 hours
A. Stable for 24 hours if the sample is capped
In primary fibrinolysis, the fibrinolytic activity results in response to:
A. Increased fibrin formation
B. Spontaneous activation of fibrinolysis
C. Increased fibrin monomers
D. DIC
B. Spontaneous activation of fibrinolysis
Plasminogen deficiency is associated with:
A. Bleeding
B. Thrombosis
C. Increased fibrinolysis
D. Increased coagulation
B. Thrombosis
Which of the following clotting factors are activated by thrombin that is generated by tissue pathway (TF-VIIa)?
A. XII, XI
B. XII, I
C. I, II
D. V, VIII
D. V, VIII
What substrate is used in a chromogenic factor assay?
A. p-nitroanaline
B. Chloropheonol red
C. Prussian blue
D. Ferricyanide
A. p-nitroanaline
Which of the following antibodies is used in the D-dimer assay?
A. Polyclonal directed against X and Y fragments
B. Polyclonal directed against D-dimer
C. Monoclonal against D and E fragments
D. Monoclonal against D-dimer
D. Monoclonal against D-dimer
Refer to the following results:
PT = prolonged
APTT = prolonged
Platelet count = decreased
Which disorder may be indicated?
A. Factor VIII deficiency
B. von Willebrand’s disease
C. DIC
D. Factor IX deficiency
C. DIC
Which of the following is a predisposing condition for the development of DIC?
A. Adenocarcinoma
B. Idiopathic thrombocytopenic purpura (ITP)
C. Post-transfusion purpura (PTP)
D. Heparin-induced thrombocytopenia (HIT)
C. Post-transfusion purpura (PTP)
Which laboratory test is used to screen for activated protein C resistance?
A. Mixing studies with normal plasma
B. Mixing studies with factor-deficient plasma
C. Modified APTT with and without activated protein C
D. Modified PT with and without activated protein C
C. Modified APTT with and without activated protein C
Patient History
A 3-year-old male was admitted to a hospital with scattered petechiae and epistaxis. The patient had normal growth and had no other medical problems
except for chickenpox 3 weeks earlier. His family history was unremarkable.
Laboratory Results:
PT: 11 sec (10–13 sec)
APTT: 32 sec (28–37 sec)
Platelet count: 18 × 103/μL (150–450 × 103/μL)
These clinical manifestations and laboratory results are consistent with which condition?
A. TTP
B. DIC
C. ITP
D. HUS
C. ITP
Patient History
A 12-year-old white male has the following symptoms: visible bruising on arms and legs, bruising after sports activities, and excessive postoperative hemorrhage following tonsillectomy
3 months ago. His family history revealed that his mother suffers from heavy menstrual bleeding, and his maternal grandfather had recurrent
nosebleeds and bruising. Abnormal
aggregation with ristocetin.
These clinical manifestations and laboratory results are consistent with which diagnosis?
A. Factor VIII deficiency
B. von Willebrand’s disease
C. Glanzmann’s thrombasthenia
D. Bernard–Soulier syndrome
B. von Willebrand’s disease
The following results are obtained from a patient who developed severe bleeding:
Prolonged PT and APTT
Platelet count = 100 × 109 /L
Fibrinogen = 40 mg/dL
Which of the following blood products should be recommended for transfusion?
A. Factor VIII concentrate
B. Platelets
C. Fresh frozen plasma
D. Cryoprecipitate
C. Fresh frozen plasma
A 30-year-old woman develops signs and symptoms of thrombosis in her left lower leg following 5 days of heparin therapy. The patient had open-heart surgery 3 days previously and has been on heparin ever since. Which of the following would be the most helpful in making the diagnosis?
A. Fibrinogen assay
B. Prothrombin time
C. Platelet counts
D. Increased heparin dose
C. Platelet counts
The following laboratory results were obtained on a 25-year-old woman with menorrhagia after delivery of her second son. The patient has no previous bleeding history.
Normal platelet count; normal bleeding time;
normal PT; prolonged APTT
Mixing of the patient’s plasma with normal plasma corrected the prolonged APTT on immediate testing. However, mixing followed by 2-hour incubation at 37°C caused a prolonged APTT.
What is the most probable cause of these laboratory results?
A. Lupus anticoagulant
B. Factor VIII deficiency
C. Factor IX deficiency
D. Factor VIII inhibitor
D. Factor VIII inhibitor
