Hema Redemption Exam Flashcards
An important marker associated with T-lymphocytes:
CD 2
CD 19
CD 56
CD 34
CD 2
These are fused primary granules seen in myeloblasts:
ACP
Auer rods
Lysozymes
Barr bodies
Auer Rods
Part of the platelet that maintains its shape:
Sol gel zone
Peripheral zone
Organelle zone
Membranous system
Sol gel zone
Which of the following is not considered as a storage pool defect due to a deficiency of platelet granules?
Bernard-Soulier syndrome
Hermansky-Pudlak syndrome
Gray platelet syndrome
Wiskott-Aldrich syndrome
None of the above
Bernard-Soulier syndrome
One of the following is not a qualitative platelet disorder:
Bernard-Soulier syndrome
Thrombotic thrombocytopenic purpura
Gray platelet syndrome
Wiskott-Aldrich syndrome
None of the above
Thrombotic thrombocytopenic purpura
The most preferable site of puncture in the Duke’s method of bleeding time determination is the:
Ring finger
Toe
Thumb
Middle finger
Earlobe
Earlobe
What combination of reagents is used to measure haemoglobin?
Hydrochloric acid and p-dimethyl aminobenzaldehyde
Sodium citrate and hydrogen peroxide
Sodium bisulfite and sodium metabisulfite
Potassium ferricyanide and potassium cyanide
NOTC
Potassium ferricyanide and potassium cyanide
Which of the following is not associated with causing a falsely low ESR?
Column use is slanted
EDTA tube is clotted
EDTA tube is 1/3 full
EDTA specimen is 24 hours old
NOTC
Column use is slanted
To best preserve cellular morphology, differential smears from an EDTA specimen should be made no more than how many hours after collection?
24
12
5
1
5
The blood smear made on a patient with polycythemia vera is too short. What should be done to correct this problem?
Use a smaller drop of blood
Adjust the angle of the spreader slide to 45 degrees
Increase the angle of the spreader slide
Decrease the angle of the spreader slide
Do nothing
Decrease the angle of the spreader slide
The components of Wright’s stain include:
Methylene blue and eosin
Crystal violet and safranin
New methylene blue and carbolfuchsin
Hematoxylin and eosin
Methylene blue and eosin
What is the reason for red blood cells to be bright red and the WBC nuclei to be poorly stained when using Wright’s stain?
The staining time is too long
The stain or buffer is too acidic
The stain or buffer is too alkaline
The smear was not washed long enough
The stain or buffer is too acidic
If 60 reticulocytes are counted in 1000 RBC, an RBC count of 3.00x10^12/L (3.0x10^6/µL). The calculated absolute reticulocyte count reported in SI units is:
1.8 x 10^9/L
18 x 10^9/L
180 x 10^9/L
180 x 10^3/µL
180 x 10^9/L
Evaluate the LAP activity and which condition best fits the result?
PV
CML
Leukemoid Reaction
NOTC
PV
What is the principle of automated impedance cell counters?
Angle of laser beam scatter by cells
Amplification of an electrical current by cells
Change in optical density of the solution containing cells
Interruption of an electrical current by cells
NOTC
Amplification of an electrical current by cells
Which of the following statement about microhematocrit is false?
Hemolysis causes falsely low results
Trapped plasma causes falsely high results
A tube less than half full causes falsely low results
Excessive centrifugation causes falsely low results
Excessive centrifugation causes falsely low results
To evaluate normal platelet numbers in appropriate area of blood smear, approximately how many platelets should be observed per oil immersion field?
20 – 50
1 – 4
4 – 10
10 – 20
8 – 20
8-20
A CSF has 285 red blood cells counted in the 5 red blood cell squares after being diluted in an Unopette (1:100). What is the calculated RBC count/µL?
142,500
2,850,000
285, 000
750,000
1, 425, 000
1,425,000
The white blood cell count is 10.5. There are 5 nucleated red blood cells seen on the 100 cell differential. What is the corrected WBC count?
5.0
9.5
10
10.5
5.5
10
All of the following may cause a falsely decreased platelet count except:
Schistocytes
Giant platelets
Platelet clumps
Platelet satellitosis
Clotted sample
Schistocytes
A leukocyte count greater than the linearity of the automated analyser will falsely elevate which other CBC parameter?
WBC
Hgb
RDW
Hct
RBC
Hgb
If a WBC count is performed on a 1:100 dilution and the number of cells counted in total of 8 squares is 50. Then what is the WBC count?
5,000
6,250
50,000
62,500
3,000
6,250
How many WBCs should be counted when lymphocytes counted is greater than neutrophils?
50
100
200
400
500
200
Platelet estimate of 150,000/ µL
Low normal
Slightly increased
Normal
Moderately increased
Markedly increased
Low Normal
1% ammonium oxalate in distilled water is a type of diluent for what type of cell count?
Eosinophil
Reticulocyte
Platelet
WBC
RBC
Platelet
Effect of grounded electricity in CBC count:
falsely high
falsely low
no effect
Falsely high
Detergent in automated systems are used for:
Cleaning agent in probes
Lysing agent
Reduce reaction times
Clearing agent in cuvettes
None of the above
Lysing Agent
This coagulation factor is called Christmas factor
Factor IX
Factor XI
Factor XII
Factor XIII
Factor IX
Calcium, a phospholipid substitute for platelet and an activator are added to the patient’s fresh plasma. The generation of fibrin is the endpoint:
Bleeding time
Protime
APTT
Thrombin time
Reptilase time
APTT
A modification of which procedure can be used to measure fibrinogen?
PT
APTT
Thrombin time
Fibrin degradation products
All of the above
Thrombin Time
Which of the following clotting factors are measured by the APTT test?
II, VII, IX, X
VII, X, V, II, I
XII, XI, IX, VIII, X, V, II, I
XII, VII, X, V, II, I
XIII
XII, XI, IX, VIII, X, V, II, I
Which coagulation tests would be abnormal in a vitamin K deficient patient?
Fibrinogen level
PT only
PT and APTT
Thrombin time
Reptilase time
PT & APTT
Which of the following is the most likely coagulation disorder?
Platelet count – decreased
bleeding time – prolonged
clotting time – normal
APTT – normal PT – normal
Thrombocytopenia
Factor VIII deficiency
Glanzmann’s thrombasthenia
Liver disease
Thrombocytopenia
A patient with a severe decrease in Factor X activity would demonstrate normal:
aPTT
PT
Thrombin time
Bleeding time
Bleeding Time
Patient profile:
PT – normal
APTT – prolonged
Mixing studies :
APTT + fresh plasma –CORRECTED
APTT + aged serum – NOT CORRECTED
APTT + adsorbed plasma –CORRECTED
Factor VIII
Factor VIII
Factor IX
Factor VII
Factor X
Factor XIII
Factor VIII
When performing a microhematocrit, where should one read the percentage of packed red blood cell column from a microhematocrit reading device?
Below the buffy coat
Above the buffy coat
Below the plasma
Above the clay
Below the buffy coat
Fragile white blood cells seen in leukemia patients may cause pseudoleukopenia which in turn may cause automated WBC and WBC estimate not to match. What action should be taken if this occurs?
Incubate the specimen at 37°C for 15 minutes
Perform a plasma replacement procedure
Perform a manual WBC hemacytometer count
Prepare a buffy coat for the WBC estimate
Add 22% bovine albumin to stabilize the WBC
Perform a manual WBC hemacytometer count
Smudge cells can cause the automated WBC and the WBC estimate not to match. What action can be taken to prevent this occurrence?
Incubate the specimen at 37°C for 15 minutes
Perform a plasma replacement procedure
Perform a manual WBC hemacytometer count
Prepare a buffy coat for the WBC estimate
Add 22% bovine albumin to stabilize the WBC
Add 22% bovine albumin to stabilize the WBC
Which one of the following can produce a normal MCV but hypochromic red blood cells to appear on the peripheral blood smear?
Platelet satellitism
Cold agglutinin
Hyperglycemia
Cryoglobulin
Hyperglycemia
Alpha-naphtol-AS-D-acetate esterase (NASDA): 3+
NASDA with sodium fluoride: 1+
ALL
AML
AMoL
AMML
AEL
AMoL
What is the most frequently acquired inhibitor in hereditary deficiencies?
Anti-von Willebrand factor
Lupus like anticoagulant
Anti-VIII
Anti – I
Anti-plasmin
Anti-VIII
The following results are available on a 25-year old male patient:
PT: 13.4 second INR: 1.2 PTT: 56.8 seconds
A mixing study was performed and the corrected results are as follows: PTT (unincubated): 55.8 seconds
PTT (incubated): 57.0 seconds
The results indicate the presence of a(n):
Circulating anticoagulant
Vitamin K deficiency
Factor deficiency
Liver disease
DIC
Circulating anticoagulant
If a coagulation test is prolonged due to a deficiency of a plasma coagulation factor, then the test should be corrected by the addition of which of the following?
Protamine sulfate
Normal plasma
Vitamin
Heparin
Barium sulfate
Normal plasma
A 27 year old female complains of mucous membrane bleeding:
PT: 40.2 seconds INR: 4.0 PTT: 158.5 seconds
Fibrinogen: 73 mg/dL D-dimer: 5.46
These lab results are consistent with which diagnosis:
Disseminated intravascular coagulopathy
Von Willebrand’s disease
Vitamin K deficiency
Classic Hemophilia
Factor Deficiency
Disseminated intravascular coagulopathy
Which of the following is a hereditary platelet disorder characterized by decreased platelet production accompanied by the presence of Döhle bodies in polymorphonuclear cells?
Bernard – Soulier syndrome
Wiskott-Aldrich anomaly
Ehlers-Danlos syndrome
May-Hegglin anomaly
Chediak-Higashi anomaly
May-Hegglin anomaly
A falsely decrease ESR may be caused by:
Vibrations from opening and closing the refrigerator and freezer doors
Heat released from the refrigerator
Lower temperatures from air rushing out on opening the freezer
AOTC
NOTC
Lower temperatures from air rushing out on opening the freezer
Which of the following blood film findings indicate EDTA induced pseudothrombocytopenia?
The platelets are pushed to the feathered end
The platelets are adhering to WBCs
No platelets at all are seen on the film
The slide has a bluish discoloration when examined macroscopically
The platelet aggregate with each other
The platelets are adhering to WBCs
Which of the following inherited leukocyte disorders might be seen in Hurler syndrome?
Pelger-Huet anomaly
Chediak-Higashi syndrome
Alder-Reilly anomaly
May-Hegglin anomaly
Alder-Reilly anomaly
Modified True or False
A. May-Hegglin inclusions and Dohle-Amato bodies are both composed of RNA
B. May-Hegglin inclusions and Dohle-Amato bodies may be both observed in neutrophils.
A is true, B is false
B is true, A is false
both are true
neither are true
both are true
A. Pernicious anemia and PelgerHuet anomaly are disorders that affect neutrophil nucleus.
B. The nuclei in both disorders have a characteristic “pince-nez” appearance.
A is true, B is false
B is true, A is false
both are true
neither are true
A is true, B is false
All of the following may produce neutrophilia except:
Nutritional deficiency
Appendicitis
Rheumatoid arthritis
Corticosteroids
RBC hemolysis
Nutritional deficiency
Which of the following would be least helpful in distinguishing CML from neutrophilic leukemoid reaction?
An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes
Leukocyte alkaline phosphatase score
Presence of marked splenomegaly
Neutrophils with Dohle bodies and toxic granulation
An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes
A monocyte that has phagocytized a nucleus is called:
LE cell
Flame cell
Tart cells
Smudge cells
Faggot cells
Tart cells
After use what should be done to the hemacytometer and the cover glass?
Wiped with gauze moistened with alcohol
Washed with distilled water and detergent, after which they are dried with cloth and placed in absolute alcohol
Wiped with a piece of cloth, soaked in Normal Saline solution and dried
All of the above can be done
Washed with distilled water and detergent, after which they are dried with cloth and placed in absolute alcohol
What is the large cell with characteristics mirror – image nuclei and prominent nucleoli, likened to an owl‘s eyes?
Reed – Sternberg cell
Osteroclast
Ferrata cell
Gaucher‘s cell
Pelger-Huet cell
Reed – Sternberg cell
In multichannel counter employing the electrical impedance method, particles larger than 35 fl are considered
Platelets
Leukocytes
Lymphocytes
RBCs
Monocytes
Lymphocytes
The cells are counted in consecutive fields as the blood film is moved from side to side.
Crenellation Technique
Longitudinal method
Battlement method
None of the above
Crenellation Technique
Which of the following diseases is associated with a positive Tdt and PAS stain?
ALL
AML
CML
CGD
ALL
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
Mean cell volume (MCV) is calculated using the following formula:
(Hgb ÷ RBC) × 10
(Hct ÷ RBC) × 10
(Hct ÷ Hgb) × 100
(Hgb ÷ RBC) × 100
(Hct ÷ RBC) × 10
A Miller disk is an ocular device used to facilitate counting of:
Platelets
Reticulocytes
Sickle cells
Nucleated red blood cells (NRBCs)
Reticulocytes
All of the following factors may influence the erythrocyte sedimentation rate (ESR) except:
Anisocytosis, poikilocytosis
Plasma proteins
Blood drawn into a sodium citrate tube
Caliber of the tube
Blood drawn into a sodium citrate tube
What is the major type of leukocyte seen in the peripheral smear of a patient with aplastic anemia?
Segmented neutrophil
Lymphocyte
Monocyte
Eosinophil
Lymphocyte
In which age group would 60% lymphocytes be a normal finding?
6 months–2 years
4–6 years
11–15 years
40–60 years
6 months–2 years
Which of the following results on an automated differential suggests that a peripheral smear should be reviewed manually?
Segs = 70%
Band = 6%
Mono = 15%
Eos = 2%
Mono = 15%
Auer rods may be seen in all of the following except:
L1
M4
M1
M3
M6
L1
Which type of anemia is usually present in a patient with acute leukemia?
Microcytic, hyperchromic
Microcytic, hypochromic
Normocytic, normochromic
Macrocytic, normochromic
Normocytic, normochromic
In leukemia, which term describes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by nucleated red cells?
Leukoerythroblastosis
Myelophthisis
Dysplasia
Megaloblastosis
Leukoerythroblastosis
Which of the following is a characteristic of Auer rods?
They are composed of azurophilic granules
They stain periodic acid–Schiff (PAS) positive
They are predominantly seen in chronic myelogenous leukemia (CML)
They are nonspecific esterase positive
They are composed of azurophilic granules
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?
Acute myelocytic leukemia (AML)
CML
Acute undifferentiated leukemia (AUL)
Acute lymphocytic leukemia (ALL)
Acute myelocytic leukemia (AML)
In myeloid cells, the stain that selectively identifies phospholipid in the membranes of both primary and secondary granules is:
PAS
Myeloperoxidase
Sudan Black B stain
Terminal deoxynucleotidyl transferase
Sudan Black B stain
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
Features of secondary polycythemia include all of the following except:
Splenomegaly
Decreased oxygen saturation
Increased red cell mass
Increased erythropoietin
Splenomegaly
What influence does the Philadelphia (Ph1) chromosome have on the prognosis of patients with chronic myelocytic leukemia?
It is not predictive
The prognosis is better if Ph1 is present
The prognosis is worse if Ph1 is present
The disease usually transforms into AML when Ph1 is present
The prognosis is better if Ph1 is present
The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except:
Replacement of normal marrow precursors by leukemic cells causing anemia
Decrease in functional leukocytes causing infection
Hemorrhage secondary to thrombocytopenia
Decreased erythropoietin production
Decreased erythropoietin production
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
The pathology of multiple myeloma includes which of the following?
Expanding plasma cell mass
Overproduction of monoclonal immunoglobulins
Production of osteoclast activating factor (OAF) and other cytokines
All of these options
All of these options
Waldenström’s macroglobulinemia is a malignancy of the:
Lymphoplasmacytoid cells
Adrenal cortex
Myeloblastic cell lines
Erythroid cell precursors
Lymphoplasmacytoid cells
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
In certain instances, platelet counts done in a peripheral blood smear are low although the patient is healthy. This is probably because:
Platelets tend to clump on one area of the smear
Platelets tend to enlarge so they are mistaken for red cells
Platelets tend to enlarge so they are mistaken for white cells
Platelets dissolved easily when exposed to atmospheric oxygen
Platelets tend to clump on one area of the smear
Measurement of the bleeding time is principally a test of
The interaction between platelets and blood vessels
The interaction between platelets only
The integrity of the blood vessels alone
None of these
The interaction between platelets and blood vessels
Blood specimen collected using EDTA is unacceptable in Kaplow’sMethod of LAP because
EDTA is inhibitory against the activity of neutrophil alkaline phosphatase
Acidic pH prematurely activates the alkaline phosphatase enzyme
EDTA destroys neutrophilic granules
EDTA dilutes blood specimen
EDTA is inhibitory against the activity of neutrophil alkaline phosphatase
Excessive lysing of RBC’s because of delay either in making the larger dilution after addition of the lysing agent will cause:
Negative error
Positive error
Either
Both at the same time
Negative error
Factors that affect the rate of sedimentation of erythrocytes include:
Tilting the tubeUsing refrigerated blood
Use of specimen collected 24 hours previously
Using heparin as anticoagulant
AOTC
AOTC
In an electronic particle counter, the height of the peak on the oscilloscope screen is proportional to the:
Weight of the particle
Size of the particle
Density of the particle
Speed of passage
Dilution of the sample
Size of the particle
The laboratory test that is essential in the diagnosis of autoimmune hemolytic anemia?
Total RBC count
Reticulocyte count
Platelet count
Direct Antiglobulin test
Acidified serum test
Direct Antiglobulin test
Reticulocyte count is increased in all of the following except:
Hemolytic anemia
Sickle cell anemia
Beta thalassemia
Untreated aplastic anemia
Erythroblastosis fetalis
Untreated aplastic anemia
The erythrocytes on a smear stain blue-green and the nuclear chromatin of leukocytes stains blue purple when
There is prolonged buffering of the smear
There is insufficient staining time
The Wright’s staining reaction is too acidic
The Wright’s staining reaction is too alkaline
The methyl alcohol has oxidized to formic acid
The Wright’s staining reaction is too alkaline
Optimum pH of the buffer during staining of blood film is between:
6.2 - 6.8
6.2 - 7.0
6.4 - 6.8
7.0 - 8.0
6.4 - 6.8
Westergren tube:
Approximately 300 cm in length
Approximately 2.55 mm internal bore
Approximately 5.5 mm external bore
Has graduation of up to 100 mm
Approximately 2.55 mm internal bore
Kaolin, celite, glass, ellagic acid and micronized silica is used in the aPTT to:
activate FXI
activate FXII
provide calcium ions
stimulate platelet factor 3 release
stimulate factor IX - VIII - X combination
activate FXII
Fuchs Rosenthal hemocytometer is ___ deep
0.1 mm
0.2 mm
0.3 mm
0.5 mm
NOTC
0.2 mm
A patient with a hematocrit of 35% has a corrected reticulocyte count of 5%. Give the RPI
4.6%
3.3%
0.3%
None of the above
3.3%
4 - 6 WBCs / hpf is approximate equivalent to a WBC count of
13,000 - 18,000 cu mm
10,000 - 13,000 cu mm
7,000 - 10,000 cu mm
4,000 - 7,000 cu mm
7,000 - 10,000 cu mm
After centrifugation of a blood specimen contained in a capillary tube, the platelets amd the leukocytes may be found in the:
Top layer
Second layer
Third layer
Fourth layer
Third layer
If the anticipated WBC count of the patient is around 110 x 109/L, then the recommended dilution and the type of Thoma pipet to use is
1:20, WBC Thoma pipet
1:10, WBC Thoma pipet
1:200, RBC Thoma pipet
1:100, RBC Thoma pipet
1:200, RBC Thoma pipet
When the absolute numbers of each of the individual leukocyte types are totaled, the sum should be equal to:
WBC count
100
The WBC count minus the absolute neutrophil count
50% of the WBC count
WBC count
What is the critical value for the hemoglobin level?
<50 g/L and 100 g/L
50 g/L and 110 g/L
70 g/L and 300 g/L
70 g/L and 200 g/L
70 g/L and 200 g/L
If the medtech multiplies the RBC count of a normal individual by three, the resulting value will most probably reflect the:
Hgb of the patient
Hct of the patient
MCV of the patient
Weight of the patient
Hgb of the patient
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
