Hematology Part 2 Flashcards
A 78-year-old man was previously diagnosed with chronic lymphocytic leukemia (CLL). Periodic CBCs were ordered, and several months of CBCs maintained an appearance consistent with cases of CLL.
WBC 58.5 10x12/L
Hct 36.0% MCHC 33%
RBC 3.90 10x12/L MCV 92 fL
Platelet 132x109/L
Hgb 12.0 g/dL
MCH 3 pg
Differential: 70% lymphocytes, 8% segmented neutrophils, 2% monocytes, 20% unidentified cells with lymphoid appearance and a prominent nucleolus
Which of the following is most likely?
a. The patient has developed Se ́zary syndrome
b. The patient has developed prolymphocytic leukemia
c. The patient has developed multiple myeloma
d. The patient now has a concurrent case of CLL and ALL
B
Multiple myeloma exhibits laboratory features except which of the following?
a. Occasional plasma cells in the peripheral blood
b. Rouleaux
c. Hypercalcemia
d. Decreased immunoglobulin
D
The diagnostic cell type seen in Hodgkin lymphoma is:
a. Binucleate plasma cell
b. Reed Sternberg cell
c. Bence Jones lymphocyte
d. Burkitt lymphocyte
B
Which of the following appearances describes the types of cells seen in Se ́zary syndrome?
a. Plasma cells containing immunoglobulin deposits
b. Large circulating micromegakaryocytes
c. Lymphocytes with convoluted, cerebriform nuclei
d. Prolymphocytes with prominent azurophilic granules
C
Which of the following best describes the function of the hexose-monophosphate pathway?
a. It produces ATP to help maintain RBC membrane deformability
b. It results in the reduction of glutathione
c. It produces 2,3 diphosphoglycerate (2,3 DPG)
d. It produces cytochrome b reductase
B
A patient has a reticulocyte count of 3.5%. This shows which of the following?
a. Bone marrow response in producing more RBCs because of increased need
b. A normal reticulocyte count
c. Patient transfusion of whole blood
d. Lack of response to vitamin therapy after a diagnosis of iron-deficiency anemia
A.
Retic Count Normal Value- 0.5 to 1.5% or 0.5 to 2.0%
Which of the following cases does not warrant a bone marrow examination?
a. Presence of blasts on the peripheral smear
b. Postchemotherapy assessment for minimal residual disease
c. Diagnosis of iron-deficiency anemia
d. Diagnosis of suspected systemic fungal infection
D
A bone marrow sample for a patient with newly diagnosed chronic myelogenous leukemia would often be expected to have an M/E ratio of:
a. 1:1
b. 2:1
c. 1:2
d. 10:1
D
Chronic myelogenous leukemia would have an M:E ratio of >10:1
Which of the following is not implicated as a cause of nonmegaloblastic macrocytic anemia?
a. Alcoholism
b. Hemochromatosis
c. Hypothyroidism
d. Liver disease
B
Nonmegaloblastic macrocytic anemia other causes:
Liver disease, Alcoholism, Hypothyroidism, Reticulocytosis
Which of the following results is consistent with a diagnosis of aplastic anemia?
a. Hypocellular bone marrow, absolute neutrophil count of 0.5x10^9/L, platelet count of 40x10^9/L, Hgb 8 g/dL
b. Hypocellular bone marrow, absolute neutrophil count of 2.5x10^9/L, platelet count of 75x10^9/L,
Hgb 10 g/dL
c. Hypercellular bone marrow, absolute neutrophil count of 1.5 x10^9/L, platelet count of
100x10^9/L, Hgb 14 g/dL
d. Hypocellular bone marrow, absolute neutrophil count of 0.5x10^9/L, platelet count of 90x10^9/L,
Hgb 11 g/dL
A
According to RODAKS, diagnostic criteria for aplastic anemia requires:
1. hypocellular bone marrow
2. Absolute neutrophil count = less than 1.5x10^9/L
3. Platelet count = less than 50x10^9/L
4. Hemoglobin = less than 10 g/dL
5. Decreased reticulocyte response
The following statement is true of mutations in a- thalassemia compared to those seen in b- thalassemia:
a. Mutations in a-thalassemia occur as a result of reduced or absent expression of the globin gene
b. Mutations in a-thalassemia occur as a result of the deletion of one or more globin genes
c. Thea-globingeneisexpressedonchromosome11
d. Theb-globingeneisexpressedonchromosome16
B
A patient’s genotype is a/a.This patient will have a CBC that shows which of the following?
a. Decreased RBC count with numerous target cells
b. Decreased RBC count with microcytic RBC
c. Increased RBC count with normal RBCs
d. Increased RBC count with microcytic/ hypochromic RBCs
D
Patients with sickle cell anemia and b-thalassemia major may not show clinical symptoms until the patient is at least 6 months of age because of which of the following?
a. The mutations are acquired after the child is born
b. The mutations are activated by dietary and maternal factors
c. The mutations may not manifest clinically at birth because the presence of hemoglobin F decreases
d. The mutations lead to elevations in a genes that compensate for the decreased gene expression
C
The thymus is a site used as a maturation compart- ment for:
a. B cells
b. T cells
c. Megakaryocytes
d. Monocytes
B
A manual hemocytometer count was required to check a patient’s total WBC count. A 1:20 dilution was made and used when the four large “W” squares were counted on both sides of the hemacy- tometer. A total of 105 cells were counted between the two sides. What was the patient’s total WBC count?
a. 0.33109/L
b. 2.1109/L
c. 2.6109/L
d. 5.3109/L
C
Hereditary elliptocytosis results from defects in which of the following?
a. Ankyrin
b. Band 3 protein
c. Spectrin
d. Pyruvate
C
Primary neutrophil granules contain:
a. Acetyltransferase, collagenase, gelatinase, lysozyme, b2-microglobulin
b. Alkaline phosphatase, cytochrome b558, complement receptor 1, complement 1q receptor,vesicle-associated membrane-2
c. b2-Microglobulin, collagenase, gelatinase lactoferrin, neutrophil gelatinase-associated lipocalin
d. Acid b-glycerophosphatase, cathespins, defensins, elastase, myeloperoxidase, proteinase-3
D
Primary neutrophil granules contain:
a. Acetyltransferase, collagenase, gelatinase, lysozyme, b2-microglobulin
b. Alkaline phosphatase, cytochrome b558, complement receptor 1, complement 1q receptor,vesicle-associated membrane-2
c. b2-Microglobulin, collagenase, gelatinase lactoferrin, neutrophil gelatinase-associated lipocalin
d. Acid b-glycerophosphatase, cathespins, defensins, elastase, myeloperoxidase, proteinase-3
D
Primary neutrophil granules- OPTION D
Secondary (Specific granules)- OPTION C
Tertiary (Gelatinase)- OPTION A
Secretory granules- OPTION B
Patients with suspected paroxysmal cold hemoglobinuria can be confirmed by performing which of the following?
a. Direct antiglobulin test (DAT)
b. Donath-Landsteiner test
c. Osmotic fragility test
d. G6PD activity assay
B
