heme externship 1.7-1.8 Flashcards by Sydney Thomas

repeated phelbotomy in pateints with PV may lead to the development of:
A. folic acid deficiency
B. sideroblastic anemia
C. IDA
D. hemolytic anemia

C. IDA

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in ET, the PLTs are:
A. increased in number and functionally abnormal
B. normal in number and functionally abnormal
C. decreased in number ad functional
D. decreased in number and functionally abnormal

A. increased and abnormal

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which of the following cells is considered pathognomic for hodgkin disease
A. nieman npick cells
B. reactive lymphocytes
C. flame cells
D. Reedsternberg cells

D. reed sternberg

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in myelofibrosis the characteristic abnormal RBC morphology is:
A. target cells
B. schistocytes
C. teardrop
D. ovalocytes

C. teardrop
- due to passage in fibrotic tissue

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PV is characterized by
A. increased plasma volume
B. pancytopenia
C. decreased O2 sat
D. absolute increase in total RBC mass

D. absolute increase in total RBC mass

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features of secondary polycythemia include all of the following except:
A. splenomegaly
B. decreased O2 sat
C. increased RBC mass
D. increased EPO

A. splenomegally
- characteristic for PV but not secondary

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erythrocytosis in relative polycythemia occurs because of:
A. decreased arterial O2 saturation
B. decreased plasma volume of circulating blood
C. increased erythropoietin levels
D. increased erythropoiesis in BM

B. decreased plasma vol

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in PV, what is characteristically seen in PS
A. panmyelosis
B. pancytosis
C. pantytopenia
D. panhyperplasia

B. pancytosis
- increase in all cell lines

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LAP staining performed on a patient gives the following results:
10(0)
48(1+)
38(3+)
1(4+)
calculate the LAP score

137
LAP = (number of cells of grade x score)
LAP = (48x1)+(38x2)+(3x3)+(1x4)
LAP = 137

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CML is distinguished from leukamoid reaction by which of the following
A. CML; low LAP, Leuakmoid; high LAP
B. CML; high LAP, leuk; low LAO
C. CML high WBC, leuk;normal WBC
D. CML; high WBC, leuk; higher WBC

A. CML; low LAP, leukamoid high LAP

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which of the following occurs in idiopathic myelofibrosis
A> myeloid metaplasia
B. leukoerythroblastosis
C. fibrosis of BM
D. all of these

D. all of these

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what influence does the philidelphia chromosome have on the prognosis of patients with CML
A. it is not predictive
B. the prognosis is better if present
C. the prognosis is worse if present
D. the disease usually transforms into AML when present

B. better prognosis if present
- hybrid gene 9;22

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which of the following is (are) commonly found in CML
A. tear drop cells
B. intense LAP stain
C. decrease in granulocytes
D> an increase in basophils

D. increase in basophils

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in which of the following conditions does LAP show the least activity
A. leukamoid reactions
B. IMF
C. PV
D. CML

D. CML

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a striking feature of PS of a CML pt is
A. bizarre blast cells
B. normal nimner of typical granulocytes
C. presence of granulocytes at different stages
D, pancytopenia

C.
differentiation between CML and AML is the presence of many stages of development of granulocytes in CML whereas AML is only blasts

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which of the following is often associated with CML but not AML
A. infections
B. WBC greater than 20*10^9/L
C. hemorrhage
D. splenomegaly

D. splenmegaly

MM and Waldenstrom macroglobulinemia have all of the following in common except
A. monoclonal gammopaathy
B. hyperviscosity of blood
C. Bence jones proteins
D. osteolytic lesions

D. osteolytic lesions

what is the characteristic finding seen in the PS from a pt with MM
A. microcytic hypochromic cells
B. intracellular inclusion bodies
C. rouleaux
D. hypersegmented neutrophils

C. rouleux
- due to increased proteins in plasma coating zeta potential of cells

all of the following are associated with the diagnosis of Multiple myeloma except
A. marrow plasmacytosis
B. lytic bone leasions
C. serum and/or urine M component (monoclonal protein)
D. Ph1 chromosome

D. Ph1 chromosome
- marker for CML not MM

multiple myeloma is most difficult to distinguish from
A. CLL
B. acute myelogenous leukemia
C. benign monoclonal gammopathy
D. benign adenoma

C. benign monoclonal gammopathy
- PS in both has few plasma cells, marrow of MM will have plasmacytosis

the pathology of multiple myeloma includes which of the following
A. expanding plasma cell mass
B. overproduction of monoclonal immunoglobulins
C. production of osteoclast activating factor (OAF) and other cytokines
D. all of these

D. all of these
- MM plasma cells secrete IL-6 and OAF to activate osteoclats leading to lytic lesions

Waldenstrom macroglobulinemia is a malignancy of the:
A. lymphoplasmacytoid cells
B. adrenal cortex
C. myeloblastic cell lines
D. erythroid cell precursor

A. lymphoplasmacytoid cells
- plasma cells that don’t look like plasma cells secreting IgM

cells the exhibit positive staining with acid phosphatase and are not inhibited by tartaric acid are characteristically seen in
A. infectious mono
B. infectious lymphocytosis
C. hairy cell leukemia
D. T cell acute lymphoblastic leukemia

C. hairy cell leukemia
- tartaric acid = TRAP stain = hairy cells

the jak2 mutation may be positive in all of the following chronic myeloproliferative disorders except
A. ET
B. IMF
C. PV
D. CML

D. CML

all of the following are major criteria for the 2008 WHO diagnostic criteria for ET **except** A. plt count of >450*10^9 B. megakaryocyte proliferation with large and mature morphology and no or little granulocyte or erythroid proliferation C. demonstration of jak2 or other clonal markers D. evidence of clonality

a 19 yr old man came to the emergency department with severe joint pain, fatigue, cough, and fever. Lab results are as follows: - WBC: 21*10^9 - RBC: 3.23*10^12 - hgb: 9.6 g/dL - PLT: 252*10^9 - 17 bands, 75 segs, 5 lymphs, 2 monos, 1 eosinophil, 26 nRBCs what is the corrected WBC count A. 8.1 B. 16.7 C. 21 D. 80.8

B. 16.7 - corrected for presence of nRBC -( total WBC x 100 ) / ( nRBC + WBCs in diff)

a manual WBC count is performed. Eighty of the 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 B. 8.0 C. 20.0 D. 200.0

C. 20,000 / uL = 20.0*10^9/L - equation: (cells * 10 * dilution factor) / (number of WBC squares counted)

a manual RBC ount is performed on a pleural fluid. The RBC count in the large center square of thee Neubauer hemacytometer is 125, and the dilution is 1:200. what is the total RBC count A. 27.8*10^9/L B. 62.5 C. 125 D. 250

D 250,000/L = 250*10^9/L

automatced CBC results are as follows: - WBC: 17.5 - RBC: 2.89 - hgb 8.1 - hct: 25.2 - MCV: 86.8 fL - MCH 28.0 pg - MCHC: 32.3% - PLT: 217 many sickle cells were observed on review of PS. On the basis of this finding and the results provided, what automated parameter of this PT is most likely inaccurate, and what follow up test should be done to accurately asses this parameter. A. MCV/reticulocyte count B. hct/perform manual hct C. WBC/ perform manual WBC count D. hgb/ perform serum-saline replacement

C. WBC - the WBC counting process involves lysing of RBCs, sickle cells present will not lyse it will alter the WBC

the following results were obtained for a 2 day old - WBC: 15.2 - RBC: 5.3 - hgb: 18.5 - hct: 57.9% - MCV: 105fL - MCH: 34 pg - MCHC: 33.5% - PLT: 213 these results indicate: A. macrocytic anemia B. microcytic anemia C. liver disease D. normal results for a 2 day old

D. normal for a 2 day old - everything is higher in a baby and drops as they age

a 61 yr old woman has automated results has the following flags: - WBC: ++++ - thrombocytosis - abnormal WBC, RBC and PLT pop - WBC diff showed: 14 band, 50 segs, 7 lymphs, 4 monos, 10 metas, 8 myelos, 1 promyelo, 3 eosinophils, 3 basophils, 2 nRBCs (all results showed R) what is the presumptive diagnosis A. leukamoid reacitno B. CML C. AMl D. megalobalstic anemia

B. CML - due to the high WBC, myelo maturation stages and basophils

a patient with a presumptive CML diagnosis with the following results: - WBC: ++++ - thrombocytosis - abnormal WBC, RBC and PLT pop - WBC diff showed: 14 band, 50 segs, 7 lymphs, 4 monos, 10 metas, 8 myelos, 1 promyelo, 3 eosinophils, 3 basophils, 2 nRBCs (all results showed R) which parameters can be released without further follow up verification procedures A. WBC and relative WBC percentages B. RBCs and PLTs C. hgb and hct D. none of the counts can be released without followup verification

D. all results showing an R for review as well as an above linearity WBC will need to be reviewed

a 45 year old man had automated results as follows (ish): - scatterplot with nRBC region - bumpy PLT histogram - PLT count of 46 and thrombocytopenia what procedure is indicated before results are released A. redraw sample in sodium citrate and multiply PLTs by 1.11 B. dilute WBCs 1:10; multiply by 10 C. perform plasma blank hgb to correct for lipemia D. warm specimen at 37 for15 minutes

A. - results most likley due to platelet clumps from EDTA tube