Unit 4 Review Flashcards
True or False? Anemia, low platelet count, and low leukocytes count, usually with absolute neutropenia, are commonly present in myelodysplastic syndrome
True
The level of erytrhopoietin in the urine is _______ in patients with polycythemia Vera as compared to to other types of polycythemia
Decreased
The hallmark of laboratory studies in chronic myeloproliferative disorders is:
Cytogenetic abnormalities
Chronic myeloproliferative disorders include which of the following:
- A, B, and C
- essential thrombocythemia
- chronic myelogenous leukemia
- polycythemia vera
Periodic-acid Schaffer (PAS) reaction is:
Negative in myelocytes
The hematology report for CLL looks most like which of the following:
Decreased WBC with 90% immature lymph’s
Chronic lymphocytic leukemia is defined as an:
Malignancy of the thymus
Periodic Acid Schiff reaction stains:
Glycogen
Which of the following statements is true of Multiple myeloma?
1– The presence of the Reed-Sternberg cell
2– presence of Bence-Jones protein
3– Presence of “M” spike on electrophoresis
4– A plasma cell leukemia
2,3, and 4 are correct
Sudan Black stain differentiates:
Acute myelogenous leukemia from ALL
The FAB classification of leukemia is a means of:
*both A and B
- classifying acute leukemias
Assessing prognosis
Leukemia secondary to Burkitt’s lymphoma is:
FAB L3
50-90% of myeloblasts in a peripheral blood is typical of which of the following:
Acute granulocytic leukemia (MI)
Very low levels of leukeocyte alkaline phosphatase can be found in:
*all of the above
- viral hepatitis
- IM
- PCH
Patients with initial phase CML are prone to:
Low-grade fevers, night sweats, and splenic infarction
A common characteristic of acute lymphoblastic leukemia is:
Bone and joint pain
The most consistent chromosomal abnormality in CLL is _______?
Trisomy of chromosome 12
The type of acute leukemia most commonly seen in children is:
Acute lymphocytic
The nature of MDS (myelodysplastic syndromes) occurring in those older than 50 and include:
*all of the above
- CMML and CLL
- CML and CLL
- RA, CMML, and RARS
What FAB classification would match the following description: large and small megakaryoblasts with high N:C ratio; pale agranular cytoplasm?
M7
Oncogenes are:
- both B and C
- genetic targets of carcinogens
- altered versions of normal genes
Which of the following terms as not used to refer to myelodysplastic syndromes?
Myeloproliferative syndrome
AML is the ______ leukemia subtype
Most common
From the list below, which are the prominent hematological findings in MDS
- A and B only
- Sideroblastic, Howell-Jolly bodies
- giant platelets, hypogranulation
What FAB classification would match the following description: small cells predominate, nuclear shape is regular with occasional cleft?
L1
SHORT ANSWER: What is the cytochemical stain that best separates acute myelocytic from acute monocytic leukemia?
The Naphthol Esterase stain is used for differentiating the myelocytic from monocytic leukemias
What FAB classification would match the followoing description: both myelogenous and monocytic cells are present, at least 20% of total WBC?
M4
Peripheral blood characteristics of which of the following disease has the following presentation?
RBC x 10^12/L increasing significantly
WBC x 10^9/L increasing
Platelets x 10^9/L moderately increasing
Polycythemia
The Philadelphia chromosome is typically associated with:
Chronic myelogenous leukemia
What FAB classification would match the following description: large cells with irregular nuclear shape: clefts is nucleus are common?
L2
The alpha-naphthyl acetate esterase cytochemical staining reaction is:
Strongly positive in monocytes
Chemical exposure is more strongly linked to an increased risk of _______ leukemia than acute lymphoblastic leukemia
Acute myelogenous
SHORT ANSWER: Comparing lymphoma vs. leukemia, give 2 ways they differ from each other
A lymphoma is a solid mass that presents as a tumor within the tissues that may spill over into the blood, appearing like leukemia. Leukemia is not a mass, but a neoplastic proliferative disease characterized by overproduction of immature/mature cells of various types in the blood/bone marrow
Lymphomas are generally characterized by into 2 types (Hodgkin’s & non-Hodgkins) based on the presence/absence of Reed-Sternberg cells. Leukemias are classified either according to the FAB (AMLs: Mo-M7; ALLs: L1-L3) or WHO classification systems
What FAB classification would match the following description: blasts and promyelocytes predominate without further maturation?
M1
What FAB classifcation would match the following descriptionl: promyelocytes predominate in the bone marrow?
M3
What FAB classification would match the following description: known as DiGulielmo syndrome, abnormal proliferation of all cells?
M6
SHORT ANSWER: list 2 myelodysplastic syndromes:
1- refractory anemia (RA)
2- Refractory anemia with RInger Sideroblasts (RARS)
What FAB classification would match the following description: most cells are monocytic?
M5
SHORT ANSWER: list 3 factors related to the occurrence of leukemia:
1- genetic & immunological factors (oncogenes, translocation most common)
2- occupational/environmental exposure (ionizing radiation, insert/herb/fungicides)
3- viral agents (EBV, HIV, HTLV-1)
The most common disorder in patients with essential thrombocythemia is:
Thrombotic or bleeding problems
What FAB classification would match the following description: cells are large and homogeneous in size: nuclear shape is round with 1-3 prominent nucleoli
L3
The most frequent leukocytes found in peripheral blood are:
Neutrophils
The function of the entire leukocytuc system is to:
Defend the body against disease
The granulocyte cells that are believed to descend from a common multipotential stem cell in the bone marrow are:
Neutrophils and eosinophils
The types of granulocytic leukocytes found in the proliferative compartment of the bone marrow are:
Myeloblasts
Promyelocytes
Myelocyte
Metamyelocyte
The types of granulocytic leukocytes found in the maturation-storage compartment of the bone marrow are:
Metamyelocytes
Band form neutrophils
Segmented neutrophils
Mature eosinophil
Mature basophil
Release of neutrophils from the bone marrow is believed to be influenced by
Interleukins
The stages of neutrophilic granulocyte development are:
Myeloblast
Promyelocyte
Myelocyte
Metamyelocyte
Band and segemented neutrophil
Marginating granulocytes in the peripheral blood can be found:
Adhering to the vascular endothelium
The half-life of circulating granulocytes in normal blood is estimated to be:
7-10 hours
Identify the cell with these characteristics: prominent primary granules that are rich in myeloperoxidase and chloroacetate esterase and have a diameter of 14 to 20 um
Promyelocyte
The earliest granulocytic maturational stage in which secondary or specific granules appear is:
Myelocyte
The mature granulocytes seen in the peripheral blood of healthy persons include
*both A and B
- band form and segmented neutrophils
- eosinophil and basophil
The granules of segmented neutrophils contain
- all of the above
- lysosomal hydrolases
- lysozymes
- myeloperoxide
Which of the following are contents of basophilic granules?
*both A and B
- Heparin
- Histamine
The tissue basophil can be referred to as:
A mast cell
A leukocyte with the morphological characteristics of being the largest normal mature leukocyte in the peripheral blood and having a convoluted or twisted nucleus is the:
Monocyte
A cluster designation (CD) got specific lineages of cells
Indicates a known cluster of monoclonal antibodies binding to a known antigen
Cells of the mononuclear phagocyte system include:
- A and B
- monocytes
- macrophages
The immediate precursor of the macrophage is the:
Monocyte
Monocytes are capable of -
- phagocytosis
- synthesis of biologically important compounds
- assuming a killer role
Classical monocytes participate in immune body defense by:
Phagocytizing bacteria
The mononuclear phagocyte system consists of histiocytes. These cells can be found in the:
Loose connective tissue
The reference range for segmented neutrophil count in adults is:
40-74%
The total leukocyte count can be increased in certain states. Select the conditions when this is not true
Use of immunosuppressive agents
One the basis of the following data, calculate the absolute value of the segmented neutrophils. Total leukocyte count = 12 x 10^9/L; percentage of segmented neutrophils value is:
9.6 x 10^9/L
An adult female has a total WBC count of 5.5 x 10^9/L. Her leukocyte differential was segmented neutrophils 20%, eosinophils 4%, basophils 1%, monocytes 3%, and lymphocytes 68%. She is demonstrating:
Absolute neutropenia
An increase in metamyeocytes, myelocytes and promyelocytes can be referred to as:
A shift to the left
What is the normal reference range of the segmented neutrophil absolute value?
1.4 x 6 x 10^9/L
The absolute value of segmented neutrophils can be an unreliable indicator of overwhelming infection because:
It drops in many patients because the circulating granulocytes are mobilized into the tissue site of infection
The functions of monocytes and macrophages include all of the following functions except:
Synthesize growth inhibitory factors
MI macrophages mainly:
Secrete proinflammatory cytokines
The major function of neutrophilic granulocytes is:
Phagocytosis
The major function of eosinophils is:
Suppression of inflammatory reactions
The principle leukocyte type involved in phagocytosis is the:
Neutrophil
The correct sequences of events in successful phagocytosis is are:
Chemotaxis
Opsonization
Phagosome formation
The action of antibacterial substances
Neutrophils function as phagocytic cells in the circulating blood
When the bacteria enter the circulation
Why are mature neutrophils more easily able to enter the circulating blood from the bone marrow than immature neutrophils?
They have plasticity that allows them to squeeze through the endothelial cells that line bone marrow sinusoids
The value of the LAP stain is to
Differentiate malignant disorders from leukemoid reactions
Lymph nodes are:
Secondary lymphoid tissue
Liver is
Not a lymphoid tissue
Spleen is:
Secondary lymphoid tissue
Red Bone Marrow is:
Primary lymphoid tissue
The thymus is
Primary lymphoid tissue
Peyers patch is:
Secondary lymphoid tissue
The T cells are found in the
- all of above
- perifollicular areas of the lymph nodes
- paracortex regions of the lymph nodes
- periarteriolar regions of the spleen
A major site of B-lymphocyte localization and proliferation is:
Lymphoid follicles
The process of lymphocyte recirculation is important in:
Commitment of lymphocytes to T and B cells
T lymphocytes constitutes ______ % of the blood lymphocytes pool in adults.
60-85%
Lymphocytes represent approximately _______% of the total circulating leukocytes in adults
35
The percentage of lymphocytes as compared with the other types of leukocytes in the peripheral blood ______ as humans age
Decreases
If an adult patient has a total leukocyte count of 20 x 10^9/L and a 50% lymphocyte count on the differential count, the absolute lymphocyte value is ________ x 10^9/L
10
If an adult has a percentage of lymphocyte exceeding the normal reference range this is called:
Relative lymphocytosis
If an adult female has a total WBC count of 4.6 x 10^9/L and a leukocyte differential on segmented neutrophils 24%, eosinophils 4%, monocytes 8%, and lymphocytes 64%, she is demonstrating
Relative lymphocytosis
As a lymphocyte matures, the nuclear-cytoplasmic ratio
Increases
As a lymphocyte matures, the overall size generally ________ in older cells.
Decreases
As a lymphocyte matures, the number of nucleoli
Decreases
As a lymphocyte matures, the chromatin clumping
Increases
As a lymphocyte matures, the quantity of cytoplasm
Decreases
The most characteristic morphological features of variant lymphocytes include:
Increased overall size, possibly one to three nucleoli, and abundant cytoplasm
Rieder’s cells are associated with:
CLL
Vacuolated lymphocytes are associated with
Niemann-Pick disease and Burkitt’s lymphoma
Crystalline inclusions are associated with:
B-cell lymphoproliferative disorder
Smudge cells are associated with:
CLL
Antibody production is associated with
Lymphocytes
T cells are responsible for:
- all of the above
- humoral immunity
- cell-mediated immunity
- growth and differentiation
Functions of sensitized T lymphocytes include:
*both A and B
- protection against intracellular pathogens
- chronic rejection in organ transplantation
A major function of CD4+ (Th2 subset) lymphocytes is
Extracellular bacteria defense
A patient with AIDS most likely has a decrease in
CD4+ cells
The CD markers including CD4 and CD8 are associated with:
T lymphocytes
The subset of B lymphocytes thta can produce light levels of IL-10 is
Regulator B cells
Antibody-independent role for B cells in immune reposes include:
Production of cytokines to shape type and strength of immune response
The effect of IL-21 on B lymphocytes is
Promoting differentiation of B cells to become plasma cells
One of the CD markers that distinguishes early-B cells from other maturational stages of B-cell development is:
CD10
Lymphocyte development in the thymus and bursal equivalent are:
Antigen independent
A characteristic feature of a early or immature B cell is
- both A and B
- cytoplasmic (cIg) immunoglobulin chains
- surface immunoglobulin (sIg) as IgM
The surface marker associated with B lymphocytes is
IgM
Mature B cells produces surface immunoglobulin (sIg)
- both A and B
- IgM
- IgD
A phenotypic marker of a distinct subset of NK cells is
CD56^bright
B lymphocytes
- both A and B
- are activated by antigens
- can secrete antibodies
Plasma cell are:
Terminally (end stage) of differentiated B cells
Long-lived plasma cells are generated in:
T-dependent germinal centers
An abnormal plasma cell with red-staining cytoplasm is a
Flame cells
Leukocytosis can be caused by
Increased movement of immature cells out of the bone marrow’s proliferative compartment
Neutrophilia can be related to a variety of conditions or disorders. Select the appropriate conditions:
Burns
A laboratory assay that can be used to differentiate a leukemoid reaction from chronic myelogenous leukemia is:
Leukocyte alkaline phosphatase (LAP) stain
Charcot-Leyden crystals can be found in ______ of patients with active eosinophilic inflammation
- all of the above
- sputum
- tissues
- stool
Monocytosis can be observed in
*all of the above
- TB
- fever of unknown origin
- RA
Neutropenia can be observed in
- All of the above
- bone marrow injury
- nutritional deficiency
- increased destruction and utilization
Cyclic neutropenia is characterized by:
- early manifestation in infants
Pseudo-Pegler-Huet anomaly may be associated with the clinical condition of:
Acute infection
Which of the following is characteristic of Pelger-Huet anomaly?
Failure of the nucleus to Segment
Pelger-Huet anomaly may be
Related to a maturational arrest in some acute infections
Pelegrín-Huet anomaly can be differentiated from conditions with an increased percentage of
Hyposegmentation of neutrophils
Which of the following is characteristics of hypersegmentation?
Five or more nuclear segments
Hypersegmentation may be:
Associated with a deficiency of vitamin B12 of folic acid
Which of the following is characteristic of Dohle Body inclusions?
Single or mulitple pale-blue staining inclusions
Dohle bodies may be:
Associated with viral infections and burns
Which of the following is characteristic of of toxic granulation?
Dark blue-black precipitates RNA
In the United Sates, human diseases caused by Ehrlichia species can be caused by:
*All of the above
- E. Chaffeensis
- E. Ewing II
- E. Phagocytophilia
Ehrlichiosis is transmitted by ________
Ticks
Which of the following is characteristic of May-Hegglin anomaly?
Dohle body-like inclusions and giant platelets
May-Hegelian can be differentiated from similar conditions by:
Presence of abnormally large platelets
Which of the following is characteristic of Chekiak-Higashi syndrome?
Gigantic peroxidase-positive deposits
Cheddar Higashi syndrome may be
Associated with frequent infections in children or young adults
Chediak-Higashi syndrome is associated with the:
Neutrophilic series
Chediak-Higashi syndrome can be differentiate from other intracellular inclusions by:
Abnormal inclusions in neutrophils and lymphocytes
Which of the following is characteristic of Alder-Reilly inclusions?
Precipitated mucopolysaccharides
Cytoplasmic inclusion in Alder-Reilly anomaly can resemble
Very coarse toxic granulation
The granulocyte disorder most closely associated with cytoplasmic granule fusion is:
Alder-Reilly anomaly
Chronic granulomatous disease is associated with the Cells of the
Neutrophilic series
Lazy leukocyte syndrome is associated with the:
Neutrophilic serious
Gaucher’s disease is associated with
Monocytic-macrophage series
Niemann-Pick disease associated with
Monocytic-macrophage series
Gaucher’s cells have:
A deficiency of Beta-glucocerebrosidase
Lymphocytopenia means a
Total decrease in lymphocytes
Radiation exposure results in
Lymphocytopenia
Cytotoxic drugs results in
Lymphocytopenia
Examples of viral diseases with lymphocyte involvement include:
*all of the above
- IM
- CMV
- AIDS
The IM results in:
Lymphocytosis
Whooping cough results in:
Lymphocytosis
Toxoplasmosis results in
Lymphocytosis
The helper subset of T lymphocytes is _______ in AIDS
Decreased
Immune deficiency disorders result in:
Lymphocytopenia
Which of the following characterizes IM?
Etiology: EBV
The laboratory findings in IM are generally characterized by:
An increase in variant lymphocytes
EBV infects lymphocytes by attaching to what receptor?
CD4
On a peripheral blood smear examination, the variant (atypical) lymphocytes have the characteristics of ________origin
T-cell
The EBV virus infects
B cells
Which of the following are characterizes reactive lymphocytosis?
Lymphocyte counts of 20-50 x 10^9/L
Which of the following are characteristics of CMV infection?
Etiology: a herpes family virus
AIDS is caused by:
HIV-1
Which of the following generally characterize(s) toxoplasmosis?
- all of the above
- symptoms may resemble IM
- occurrence in pregnant women who own cats
- etiology: parasitic
Which antibody test has replaced the LE cell preparation in the diagnosis of SLE?
ANA test
Whatis the appropriate reagent for the reticulocyte count?
New methylene blue
What is the appropriate procedure and characteristics for the Westergren methods?
The procedure measures the rate of of erythrocyte settling
What source of error will have the greatest effect on test results?
Excessive anticoagulants will produce shrinkage of cells
In a platelet count, what error will have the greatest effect on the test result?
Specimens stored at room temperature for more than 5 hours will produce inaccurate results
In a reticulocyte count, what error will have the greatest effect on the test result?
Refractile bodies can produce a false-positive observations
The correct reference value for erythrocyte count for adult male is:
4.5-5.9 x 10^9/L
The correct reference value for Hb assay for adult females?
12.0-16.0 g/dL
The correct reference value for absolute lymphocyte (adult) is
1.2-3.4 x 10^9/L
The reference value for the leukocyte count is:
4.5 x 11.0. X 10^9/L
The reference value for PCV in adult females is:
36-45%
The reference value for direct platelet count is
150 x 400 x 10^9/L
The reference value for the reticulocyte count (newborn infants)
2.5-6.5%
The reference value for the Westerngren ESR method (adult male over 50) is
Up to 15 mm/h
What clinical or specimen condition will produce an increased total leukocyte count?
Inflammation
Which clinical or specimen condition will produce an increased PCV?
Polycythemia
Which clinical or specimen condition will produce an increased reticulocyte count test results?
Hemolytic anemia crisis
Which clinical specimen or condition will produce an increased Westergren ESR method test results?
Rouleaux formation
Which clinical conditions will produce an increased value of neutrophils?
Bacterial infections
What clinical condition will produce an increased value of lymphocytes?
Viral infection
What clinical condition will produce an increased value of monocytes?
TB
What clinical condition will produce an increased value of eosinophils?
Invasive parasites
What clinical condition will produce a decreased reticulocyte count?
Megaloblastic anemia
What clinical conditions will produce a decreased Westergren ESR values?
Polycythemia Vera
A normal blood smear should have no more than approximately________ (max) number for platelets per oil immersion field in an area where the erythrocytes are just touching each other
20
The PCV procedure can be affected by the:
*all of the above
- speed of the centrifuge
- length of time centrifuged
- ratio of anticoagulant to whole blood
Which of the following erythrovytic inclusions contain RNA and can be observed by staining with new methylene blue?
Reticulocytes
The sedimentation rate of erythrocytes can be affected by the:
- all of them
- ratio of anticoagulant to whole blood
- position of tube
- temperature of the specimen or laboratory
Cellulose acetate at pH 8.6 separates the Hb fractions
*both A and C
S
A
If an alkaline (pH 8.6) electrophoresis is performed, Hb E has the same mobility as Hb?
A
Heinz bodies are:
Denatured by crystal violet stain
Prussian Blue stain produces:
Precipitation of free iron into blue or blue-green granules
Periodic acid-Schaffer produces
Intense cytoplasmic granular staining particles in erythroleukemia
Peroxidase stain produces
Non-staining in lymphocytes
The result for an Leukocyte alkaline phosphatase (LAP) stain is:
Normal, if the result is 32-182 with fast blue RR dye
Leukocytes that demonstrate a positive reaction in tartaric acid-resistant phosphatase cytochemical staining are the lymphocytes seen in
Hairy cell Leukemia
LAP blood smears should be stained with ______ of specimen collection
8 hours
What is the white cell with at LEAST two lobes?
Polysegmented neutrophil
A WBC with red/orange granules
Eosinophils
What carries blood histamine?
Basophil
Describe a Promyelocyte
Size = 14-20 um
N:C ratio = 3.1
Nucleus = oval
Nucleoli = 1-5
Chromatin = smooth
Cytoplasm = non-specific granules, moderate blue
What are the steps of phagocytosis?
- engulfment
- formation of phagosome
- formation of phagolysosome
- digestion
Chemical stains to differentiate leukemoid reaction from CML
LAP (leukocyte alkaline phosphatase)?
How is an absolute count obtained?
Multiplying the total WBC by the % of the type of cell question
Describe ESR
- nonspecific indicator of infection
- that must be set up within 2 hours of collection
- that sits undisturbed for an hour
- that cannot be moved or jarred during its hour resting
- normal values for men: 0-10; women: 0-20
What are three conditions that would increase eosinophils?
- allergy
- drug reaction
- parasitic infections
- collagen disease
- Hodgkins disease
- myeloproliferative diseases
When are LE cells seen?
When blood cells are ruptured and nuclear material is released, which interacts with specific antibody by phagocytosis
Where do T-cells mature and differetiate?
Thymus
What is the cell that is fully differentiated B cells and its function?
- plasma cells
- making antibodies
What is the % of T and B cells in circulation?
- 80-85% —> T-cells
- 10-15% —> B cells
What organs are primary lymphoid tissue?
Thymus and bone marrow
What are the organs of secondary lymphoid tissue?
- Spleen
- Lymph nodes
- Peyers patch
- GALT
What is the increase of white cells?
Leukocytosis
What is the decrease of white cells?
Leukocytopenia
What are the 4 reasons for neutrophilia?
- inflammation conditions
- infection
- surgery
- Burns
- Stress
- Drug/Hormones
- Malignant - Leukemia
Describe Pelegrín-Huet anomaly
Genetic, benign anomaly where 90% of the neutrophils are bi-lobed.
Describe Psuedo-Pelegrín Huet
May be drug induced or may occur in a maturational arrest associated with some acute infection
Describe May-Hegglin Anomaly
Genetic condition characterized by the presence of Dohle-like bodies in neutrophils, eosinophils and monocytes
What condition are toxic granulation and Dohle bodies seen in?
- neutrophils in infectious state
—> burns
—> malignant disorders
—> drug therapy - monocytes in viral infections
—> burns
—> certian drugs
—> May-Hegglin (Dohle body)
What are 5 causes of lymphocytosis?
- IM
- Infectious hepatitis
- CMV
- mumps
- varicella
- rubeola
- rubella
- atypical pneumonia
- TB
- toxoplasmosis
Describe infectious lymphocytosis
An acute poorly defined mild benign condition caused by a virus (probably Coxsackie) seen in mainly in children
Describe Toxoplasmosis
A widespread disease that occurs in humans and animals whose definitive host is cats. Pregnant women who get this parasite can pass it along to their unborn child
What are the disease conditions are caused by EBV
- IM
- Burkett’s lymphoma
- Nasopharyngeal carcinoma
- Neoplasm’s of the thymus, parotid gland and Supra-glottic larynx
What are 2 conditions that cause leukocpenia?
- DiGeorge syndrome
- AIDS
- SLE
Decribe Bordetalla pertussis
- also called whooping cough
- causes leukocytosis as high as 100,000.
- caused by a gram-negative bacillus
- More than one million deaths a year and people are the only natural host