Hematology

Question 1

Mutation typically seen in patients with essential thrombocythemia

Answer 1

CALR

Question 2

The primary defect in nearly 95% of Polycythemia vera patients

Answer 2

the primary defect in nearly 95% of patients is an acquired mutation in exon 14 of the tyrosine kinase JAK2 (V617F)

Question 3

Test to confirm Polycythemia vera

Answer 3

Peripheral blood for JAK2 mutation

Question 4

Renal disorders that can cause secondary polycythemia

Answer 4

renal cysts, cancer, renal artery stenosis, Bartter syndrome, and focal sclerosing glomerulonephritis.

Question 5

mutation seen in hereditary hemochromatosis

Answer 5

HFE gene

Question 6

mutations seen in patients with essential thrombocythemia

Answer 6

CALR and MPL

Question 7

RPMI

Answer 7

Roswell Park Institute

Question 8

Eosinophil secondary granules contain

Answer 8

toxic major basic protein (MBP), eosinophilic cationic protein (ECP), eosinophilic peroxidase & neurotoxin

Question 9

Basophil Specific granules contain

Answer 9

heparin, histamine and other factors of inflammation.
Similar to mast cells in function.

Question 10

large granular lymphocytes

Answer 10

Natural Killer cells (aka NK cells, large granular; innate)

Question 11

Monocytes are precursors to

Answer 11

tissue resident macrophages and dendritic cells
Tissue resident macrophages are phagocytic cells (Mononuclear phagocytic system)
Contain azurophilic granules
Antigen presenting cells

Question 12

The myeloid lineage

Answer 12

Erythrocytes
Platelets
Monocytic/phagocytic cells
Granulocytes

Question 13

The most likely explanation if a patient presents with elevated basophil counts is

Answer 13

Chronic Myelogenous Leukemia (CML)

Question 14

An adult human body contains how much blood?

Answer 14

5-8 liters of blood

Question 15

Wright’s stain

Answer 15

a polychromatic stain composed of methylene blue and eosin dyes.
stains cellular elements in peripheral blood and bone marrow smears.
James Homer Wright devised Wright’s stain procedure in 1902 by modifying the Romanowsky stain.

Question 16

Romanowsky stains include

Answer 16

Giemsa, Wright-Giemsa, Diss-Quik, and May-Grunwald-Giemsa.

Question 17

Differences between Wrights and Wrights Giemsa stain

Answer 17

The key difference between Wrights and Wrights Giemsa stain is that Wright-Giemsa stain produces more intense basophilic/nuclear staining, while Wright stain achieves a more eosinophilic appearance. The protocol for both stains is identical, with the second step being replaced by the preferred stain.
Wright-Giemsa stain is commonly used for general blood cell analysis, counting immature red and white blood cells, platelet counts, and neutrophil counts. It is also frequently used to evaluate bone marrow specimens, and if the Wright-Giemsa stain is not clear enough, you can use Giemsa stain to enhance stain intensity.

Question 18

RBC counts

Answer 18

4 to 6 x 10 to the 6/ml

Question 19

WBC counts

Answer 19

4.5-11.5 x 10 to the 3/ml
Neutrophils 60-70 % (60)
Lymphocytes 18-42 % (30)
Monocytes 2-11 % (6)
Eosinophil 1-3% (3)
Basophils 0-2% (1)

Question 20

“Central/Generative or Primary ” Lymphoid organs

Answer 20

Bone marrow and Thymus

Question 20

Platelets

Answer 20

150-450 x 103/ml

Question 21

bone marrow produces how much per day?

Answer 21

200,000,000,000 red cells per day,
10,000,000,000 white cells per day
400,000,000,000 platelets per day.

Question 22

bone marrow produces how much per day?

Answer 22

200 billion red cells per day; 2 to 3 million per second,
10 billion white cells per day
400 billion platelets per day.

Question 23

How many RBCs in 1 ml of blood

Answer 23

4 to 6 million

Question 24

Largest cell in the human body

Answer 24

The ovum 1000 microns
Nerve cells can be 1 meter long

Question 25

t cells can only recognize antigen when

Answer 25

t cells can only recognize antigen when processed and loaded onto MHC I or II molecules.

Question 26

Most cases of CLL can be identified using antibody specific panel

Answer 26

CD5, CD19, CD20, CD23, and immunoglobulin light chains

Question 27

The most common immunophenotype expression of CLL/SLL

Answer 27

coexpression of CD5, CD19, and CD23.

Question 28

Fluorescence in situ hybridization (FISH) is a highly sensitive test used to detect chromosomal abnormalities in patients with CLL/SLL.

Answer 28

Cytogenetics evaluation of the peripheral blood smear with FISH for 17p. deletion, 11q. deletion, 13q. deletion and trisomy 12 is routine pretreatment evaluation of patients with CLL. Though all patients with symptomatic and advanced-stage CLL/SLL are treated similarly, patients with 17p. deletion or 11q. deletion requires special consideration.17p. deletion causes CLL by TP53 mutation. TP53 is a tumor suppressor gene which is located on the short arm of chromosome 17. The normal “wild–type” TP53 gene activation occurs in response to damaged DNA and/or other stressors such as hypoxia, leading to cellular apoptosis. The deletion/point mutation of TP53 leads to CLL. 11q chromosome contains the ataxia-telangiectasia mutated (ATM) gene.

Question 29

ataxia-telangiectasia mutated (ATM) gene

Answer 29

ATM kinase is responsible for the delayed progression of the cell cycle in the presence of DNA damage, allowing the cell to repair the damage. ATM kinase phosphorylates tumor suppressor p53 protein in the presence of DNA damage. The phosphorylation of p53 protein ultimately leads to cell cycle arrest/apoptosis of cells with DNA damage. In the absence of ATM kinase in 11q. deletion, phosphorylation of p53 does not occur, which hence cannot prevent the cell cycle arrest in DNA damaged cells.

Question 30

Richter’s transformation

Answer 30

About 2 to 10% of CLL patients undergo Richter’s transformation, where CLL evolved into an aggressive lymphoma, most commonly diffuse large B-cell lymphoma, which presents with fever, rapid enlargement of previously stable nodal disease, and severely rising LDH levels. CLL can also transform into high-grade non-Hodgkin’s lymphoma by involving into B-cell prolymphocytic leukemia.