Insufficient centrifugation will result in:
A. A false increase in HCT value.
Erythrocytes that vary in size form the normal 6-8 um are described as exhibiting:
B. Anisocytosis.
Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult?
C. Iliac Crest
Mean cell volume is calculated using the following formula:
A. (Hct / Rbc) x 10
What term describes the change in shape of erythrocytes seen on a Wright's stained peripheral blood smear?
A. Poikilocytosis
Calculate the mean cell hemoglobin concentration (MCHC) using the following values:
Hgb: 15 g/dl
RBC: 4.5 x 10^6 /ul
Hct: 47 mL/dL- 31.9% (.319)
- (hgb / hct) x 100= (MCHC)
A manual white blood cell count (WBC) was performed. A total of 36 cells were counted in all 9mm squares of a neubauer-ruled hemocytometer. The dilution used was 1:10. What is the WBC count?
0.4 x 10^9 / L
When an erythrocyte containing iron granuals is stained with Prussian Blue, the cell is called a:
A. Siderocyte.
A 7.0 mL (EDTA) tube is received in the lab containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the following tests will most likely be erroneous?
- C. HCT
- Exessive anticoagulant causes shrinkage of the cells.
A 1:200 dilution of a patient's sample was made and 336 red cells were counted in an area of .2 mm^2.
What is the RBC count?3.36 x 10^12 / L
What phagocytic cells produce lysozymes that are bacteriocidal?
B. Neutrophils
If a patient has a reticulocyte count of 7% and an HCT of 20% what is the corrected reticulocyte count?
(retic% x HCT) / 45 (normal HCT)3.1%
A decreased osmotic fragility test would be associated with which of the following conditions?
A. Sickle cell anemia
What effect would using a buffer at pH of 6.0 have on a Wright's stained smear?
- D. Red cells stain too pink.
- < 6.4 red cells take up too much of the acid dye eosin.
Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright's stained blood smear?
D. Heinz bodies.
A falsely elevated HTC is obtained. Which of the following calculated values will not be affected?
D. MCH.
A Miller disk is an ocular device used to facilitate the counting of:
A. Reticulocytes.
RBC indices obtained from a patient are as follows:
MCV: 88fL.
MCH: 30pg.
MCHC:34%
The RBCs on the peripheral blood smear would appear:
C. Normocytic, normochromic.
All of the following factors may influence the erythrocyte sedimentation rate (ESR) EXCEPT:
B. Blood drawn into a sodium citrate tube.
What staining method is used most frequently to stain and count reticulocytes?
B. Supravital staining
The Coulter principle for counting cells is based on the fact that:
C. Isotonic solutions conduct electricity better than cells do.
A correction is needed for WBC counts when nucleated RBCs are seen on the peripheral blood smear because:
B. Nucleated RBCs are counted as leukocytes.
Using a Coulter counter analyzer, an increased RDW should correlate with:
C. Anisocytosis.
Given the following values, which set of red blood cell indices suggests Spherocytosis?
A. Mcv 80ug^3, MCH 36.5 pg, MCHC 39.0%
Which of the following statistical terms reflects the best index of precision?
C. Coefficient Of Variation.
Which of the following is considered a normal hemoglobin?
C. Deoxyhemoglobin (unoxygenated hemoglobin)
Which condition will shift the oxyhemoglobin dissociation curve to the right?
D. Acidosis.
What is the major type of leukocyte seen in the peripheral smear of a patient with aplastic anemia?
C. Lymphocyte.
What is the normal WBC differential lymphocyte percentage range in the adult population?
C. 20-50%
In which age group would 60% lymphocytes be a normal finding?
D. 6 months to 2 years.
Which of the following results on an automated differential suggests that a peripheral smear should be reviewed manually?
C. Mono 15%
In which stage of erythrocyte maturation does HGB begin to form?
D. Polychromatic normoblast.
Which of the following can shift the hemoglobin oxygen dissociation curve to the right?
D. All of the above.
Which of the following HGB configurations is characteristic of HGB H?
A. Beta4
Autoagglutination of red cells at room temperature can result in which of the following?
D. All of the above.
Hypersplenism is characterized by:
B. Leukopenia.
Which of the following organs is resposinble for the "pitting process" for RBCs?
B. Spleen
Spherocytes differ from normal red cells in all of the following except:
B. Increased deformability.
Which of the following is not associated with hereditary Spherocytosis?
B. Intravascular hemolysis.
Which of the following disorders has an increase in osmotic fragility?
B. Hereditary spehrocytosis due to a decreased tolerance to swelling.
The anemia seen in sickle cell disease is usually:
D. Normocytic, normochromic.
Which is the major HGB found in the RBCs of patients with sickle trait?
A. Hgb A (50-70%)
Select the amino acid substitution that is responsible for sickle cell anemia.
B. Valine is substituted for glutamic acid at the sixth position of the Beta chain.
All of the following are usually found in Hgb C disease except:
D. Fast mobility of Hgb C at pH 8.6.
Which of the following hemoglobins migrates to the same position as Hgb A2 at pH 8.6?
B. Hgb C.
Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?
B. Hgb A 60%, Hgb S 40%, Hgb A2 2%.
In which of the following conditions will autosplenectomy occur?
A. Sickle cell disease.
Which of the following is most true of paroxysmal nocturnal hemaglobinuria (PNH)?
B. It is an aquired hemolytic anemia.
Hemolytic uremic syndrome ( HUS) is characterized by all of the following except:
C. Reticulocytopenia.
An autohemolysis test is positive in all of the following areas except:
A. Paroxysmal Nocturnal Hemoglobinuria. (PNH).
Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
C. Anti- P
All of the following are associated with hemolytic anemia except:
B. Increased Haptoglobin.
Autoimmune hemolytic anemia is best characterized by which of the following?
D. Spherocytic red cells.
"Bite Cells" are usually seen in patients with:
D. G6PD deficiency.
The morphological classification of anemias is based on which of the following?
B. RBC Indices.
Which of the following is a common finding in aplastic anemia?
B. Peripheral blood pancytopenia.
Congenital dyserythropoietic anemias (CDAs) are characterized by:
C. Bizzare multinucleated erythroblasts.
Microangiopathic hemolytic anemia is characterized by:
A. Schistocytes and nucleated RBCs.
Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia?
C. Chloramphenicol.
Sickle cell disorders are:
D. Hereditary intracorpuscular RBC defects.
Which of the following conditions may produce spherocytes in the peripheral smear?
A. Autoimmune hemolytic anemia.
A patient's peripheral smear reveals numerous NRBCs, marked variation of red cell morphology, and pronounced polychromasia. In addition to a decreased Hgb and decreased Hct values, what other CBC parameters may be anticipated?
D. This patient's abnormal peripheral smear indicated marked red cell regeneration, causing many reticulocytes to be released from the marrow. Since reticulocytes are larger than mature RBCs, the MCV will be slightly elevated.
What red cell inclusion may be seen in the peripheral blood smear of a patient post splenectomy?
C. As a result of a splenectomy, Howell-Jolly bodies may be seen in great numbers. One of the main functions of the spleen is the pitting function, which allows inclusions to be removed from the red cell without destroying the cell membrane.
Reticulocytosis usually indicates:
A. Reticulocytes are polychromatic macrocytes, and the presence of reticulocytes indicates red cell regeneration. The bone marrow's appropriate to anemia is to deliver red cells prematurely to the peripheral circulation. In this way, reticulocytes and possibly nucleated red cells may be seen in the peripheral smear.
Hereditary pyropoikilocytosis (HP) is a red cell membrane defect characterized by:
D. HP is a membrane defect charactetized by a spectrin abnormality and thermal instability. The MCV Is decreased and the red cells appear to be budding and fragmented.
The osmotic fragility test result in a patient with Thalassemia major would most likely be:
A. Numerous target cells are present in thalassemia patients. Because target cells have increased surface volume, the osmotic fragility is decreased.
All of the following are characteristic findings in a patient with iron deficiency anemia except:
C. There is an increase in TIBC and in RBC protoporphyrin because of a decreased level of iron in iron deficiency anemia. Morphological characteristics of iron defiency anemia include a microcytic, hypochromic blood picture. Platelets are usually small and increased in number.
Iron deficiency anemia may be distinguished from anemia of chronic infection by:
D. In iron deficiency anemia, the serum iron level is decreased and the total iron binding capacity is increased. In chronic disease the iron is trapped in reticuloendothelial (RE) cells and is therefor unavailable to the red cells. Serum iron and TIBC are both decreased.
Which anemia has a red cell morphology similar to that seen in iron deficiency anemia?
C. Iron deficiency anemia and thalassemia are both classified as microcytic, hypochromic anemias. Iron deficiency anemia is caused by defective heme synthesis, whereas thalassemia is caused by decreased globin chain synthesis.
Iron deficiency anemia is characterized by:
A. Iron deficiency anemia is characterized by decreased plasma iron, increased TIBC, decreased % saturation, and microcytic, hypochromic, anemia. Iron deficiency occurs in three phases: iron depletion, iron-deficient erythropoiesis, and iron deficiency anemia.
Storage iron is usually best determined by:
C. Ferratin enters the serum from all ferritin-producing tissues and therefore is considered to he a good indicator of body storage iron. Because iron stores must be depleted before anemia developes, low serum ferritin levels precede the fall in serum iron associated with iron deficiency anemia.
All of the following are associated with sideroblastic anemia except:
D. Sideroblastic anemia has a decreased red blood cell protoporphyrin. The defect in sideroblastic anemia involves ineffective erythropoiesis. The failure to produce RBC protoporphyrin occurs because the nonheme iron is trapped in the mitochondria and is unable to be recycled.
What is the basic hematological defect seen in patients with thalassemia major?
D. In thalassemia major there is little or no producion of the beta-chain, resulting in severly depressed or no synthesis of Hgb A. Severe anemia is seen, along with skeletal abnormalities and marked splenomegaly. The patient is usually supported by transfusion therapy.
Which of the following is the primary Hgb in patients with thalassemia major?
C. Patients with thalassemia major are unable to synthesize the beta-chain; hence little or no Hgb A is prduced. However gamma chains continue to be synthesized and lead to variable elevations of Hgb F in these patients.
A patient has a HCT of 30%, a hemoglobin of 8g/dL, and a RBC count of 4.0 x 10^12/L. What is the morphological classification of this anemia?
C. The indices will provide a morphological classification of this anemia. The MCV is 75 fL (reference range 80-96), the MCH is 20.0 pg (reference range 27-33 pg), and the MCHC is 26.6% (reference range 33-36%). Therefoer, this anemia is microcytic hypochromc.
In which of the following conditions is Hgb A2 elevated?
A. Hgb A2 is part of the normal complement of adult Hgb. This Hgb is elevated with beta thalassemia minor because the individual condition has only one normal beta gene; consequently, there is a slight elevation of Hgb A2 and Hgb F.
Which of the following parameters may be similar for the anemia of inflammation and iron deficiency anemia?
D. Thirty to fifty percent of the individuals with the anemia of chronic inflammation demonstrate a microcytic hypochromic blood picture with decreased serum iron. Serum iron is decreased because it is unable to escape from the RE cells to be delivered to the pronormoblast in the bone marrow.
Which morphological classification is characteristic of megeloblastic anemia?
B. Megeloblastic macrocytic anemia is normochromic because there is no defect in the Hgb synthesis. These anemias are a group of asynchronized anemias characterized by defective nuclear maturation due to defective deoxyribonucleic acid (DNA) synthesis. This abnormality accounts for the megaloblastic features in the bone marrow and the macrocytosis in the peripheral blood.
A schilling test gives the following results: part I: 2% excretion of radioactive vitamin B12 ( normal=5-35%) part II: 8% excretion of radioactive vitamin B12 after intrinsic factor was given with vitamin B12 (normal= 7-10%). These results indicate:
C. Pernicious anemia is caused by a lack of intrinsic factor, which prevents vitamin B12 absorption. An abnormal ecretion in Part 1 indicates that vitamin B12 was not absorbed through the intestine. Normal excretion of labeled B12 after administration of intrinsic factor in Part 2 of the Schilling test indicates a pernicious anemia.
All of the following are characteristics of megaloblastic anemia except:
B. Megaloblastic anemias are associated with an ineffective erythropoiesis and therefor a decrease in the reticulocyte count.
A patient with vitamin B12 anemia is given a high dosage of folate. Which of the following is expected as a result of this treatment?
A. Administration of folic acid to a patient with vitamin B12 deficiency will improve the hematological abnormalities; however, the neurological problems will continue. This helps to confirm the correct diagnosis of vitamin B12 deficiency.
Which of the disorders below causes ineffective erythropoiesis?
C. Ineffective erythropoiesis is caused by destruction of erythroid precurser cells prior to their release from the bone marrow. Pernicious anemia results from defective DNA synthesis; it is suggested that the asynchronous development of red cells renders them more liable to intramedullary destruction.
A 50 year old patient is suffering from pernicious anemia. Which of the following laboratory data are most likely for this patient?
C. Patients with pernicious anemia demonstrate a pancytopenia with low WBC, PLT, and RBC counts. Because this is a megaloblastic process and a DNA maturation defect, all cell lines are affected. In the bone marrow, this results in abnormally large precursor cells, maturation asynchrony, hyperplasia of all cell lines, and low M:E ratio.
Which of the following may be seen in the peripheral blood smear of a patient with obstructive liver disease?
A. Patients with obstructive liver disease may have red blood cells that have an increased tendacy toward the deposition of lipid on the surface of the red cell. Consequently, the red cells are larger or more macrocytic than normal red cells.
The macrocytes typically seen in megaloblastic precesses are:
B. Macrocytes in true megaloblastic conditions are oval macrocytes as opposed to round macrocytes that are usually seen in alcoholism and obstructive liver disease.
Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias?
C. The red cell indices in a patient with megaloblastic anemia are macrocytic and normochromic. The macrocytosis is prominant, with an MCV ranging from 100-130 fL.
A patient has 80 nucleated red cells per 100 leukocytes. In addition to increased polychromasia on the peripheral smear, what other finding may be present on tue CBC?
D. The patient will have an increased MCV. One of the causes of a macrocytic anemia that is not megaloblastic in an increased reticulocyte count, here noted as an increased polychromasia. Reticulocytes are polychromatic macrocytes; therefore, the MCV is slightly increased.
Which of the following is an unusual complication that may occur in infectious mononucleosis?
D. Occasionally patients with infectious mononucleosis develope a potent cold aggutinin with Anti I specificity. This cold autoantibody can cause strong hemolysis and a hemolytic anemia.
In patients with human immunodeficiency virus (HIV) infection, one should expect to see:
B. HIV infection brings about several hematological abnormalities seen on the peripheral blood smear examination; most patients demonstrate reactive lymphocytes and have granualocytopenia.
What inclusions may be seen in leukocytes?
D. Döhle Bodies are RNA rich areas within polymorphonuclearmneutrophils (PMNs) that are oval and light blue in color. Although often associated with infectious states, they are seen in a wide range of conditions and toxic reactions, including hemolytic and pernicious anemias, chronic granulocytic leukemia, and therapy with antineoplastic drugs. The other inclusions are associated with erythrocytes.
Which of the following is contained in the primary granuals of the neutrophil?
B. Myeloperoxidase, lysozyme, and acid phosphatase are enzymes that are contained in the primary granuals of neutrophils. The contents of secondary and tertiary granuals include lactoferrin, collagenase, NADPH oxidase, and alkaline phosphatase.
What is the typical range of relative lymphocyte percentage in the peripheral blood smear of a one year old?
B. The mean relative lymphocyte percentage for a 1 year old is 61% compared to the mean lymphocyte percentage of 35% for an adult.
Qualitative and quantitative neutrophil changes noted in response to infection include all of the following except:
A. Neutrophil changes associated with infection may include neutrophilia, shift to the left, toxic granulation, Döhle Bodies, and vacuolization. Pelgeroid hyposegmentation is noted in neutrophils from individuals with the Pelger-Huët anomaly and as an acquired anomaly induced by drug ingestion or secondary to conditions such as leukemia.
Neutropenia is present in patients with which absolute counts?
B. Neutropenia is defined as an absolute decrease in the number of circulating neutrophils. This condition is present in patients having neutrophil counts of less than 1.5 x 10^9 / L.
The morphological characteristics associated with the Chédiac-Higashi syndrome are:
B. Chédiak-Higashi syndrome is a disorder of neutrophilic phagocytic dysfunction caused by depressed chemotaxis and delayed degranulation. The degranualtion disturbance is attributed to interference from the giant lysosomal granuals.
The familial condition of Pelger-Huët anomaly is important to recognize because this disorder must be differentiated from:
B. Pelger-Huët anomaly is a benign familial condition reported in 1 out of 6000 individuals. Care must be taken to differentiat Pelger-Huët cells from the numerous band neutrophils and metamyelocytes that may be ovserved during severe infection or a shift to the left immaturity in granulocye stages.
What is the expected laboratory findings in a patient with cytomegalovirus (MCV) infection?
B. If both The heterophile antibody test and the EBV-IgM test are negative in a patient with reactive lymphocytosis and a suspect viral infection, the serum should be analyzed for IgM antibodies to CMV. CMV belongs to the herpes virus family and is endemic worldwide. CMV infection is the most common cause of heterophile-negative infectious mononucleosis.
Neutrophil phagocytosis and particle ingestion are associated with an increase in oxygen utilization reffered to as a respiratory burst. What are the two most important products of this biochemical reaction?
A. The biochemical products of the respiratory burst that are involved during phagocytosis are hydrogen peroxide and superoxide anion. The activated neutrophil discharged the enzyme NADPH oxidase into the phagolysosome, where it converts O2 to superoxide anion (O2-), which is the reduced to hydrogen peroxide (H2O2).
Which of the morphological findings are characteristic of reactive lymphocyes?
D. Both reactive lymphocytes and blasts may have basophilic cytoplasm, a high N:C ratio, and the presence of prominant nucleoli. Blasts, however, have an extremely fine nuclear chromatin staining pattern as viewed on a Wright-Giemsa-Stained smear.
Auer rods may be seen in all of the following except:
A. Auer rods are not seen characteristically in lymphoblasts. They may be seen in myeloblasts, promyelocytes, and monoblasts.
Which type of anemia is typically present in a patient with acute leukemia?
C. Acute leukemia is normally associated with normocytic normochromic anemia. Anemia in acute leukemia is usually present form the onset and may be severe; however, there is no inherent nutritional deficiency leading to either a microcytic, hypochromic, or megaloblastic process.
In leukemia, which term describes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by occasional nucleated red blood cells?
D. The presence of immature leukocytes and nucleated red cells is denoted Leukoerythroblastosis. Myelophthisis refers to replacement of bone marrow by a disease process such as neoplasm. The development of abnormal tissue is called displasia.
The basic pathophysiological mechanisms responsible for producing signs and symptoms of leukemia include all of the following except:
A. Replacement of normal marrow
What staining method is used most frequently to stain and manually count reticulocytes?
A supravital stain, such as new methylene blue N or brilliant cresyl blue, is used to stain reticulocytes (indicated by the arrows in Image B) for an actual count.
Stains used most often are new methylene blue (1% NMB plus 1.6% potassium oxalate anticoagulant) and brilliant cresol blue (BCB; 1% in saline). Blood and stain are mixed in equal amounts and incubated for 10 minutes for NMB and 15 to 30 minutes for BCB.