Clinical Hematology
Midterm Exam
Course Introduction
Clinical Hematology explores the fundamental principles and practices involved in the study of blood, blood-forming organs, and blood diseases. This course covers the normal and abnormal aspects of hematopoiesis, complete blood count interpretation, and the pathophysiology, diagnosis, and management of common hematological disorders such as anemias, leukemias, lymphomas, bleeding and clotting disorders. Students will gain practical laboratory skills in hematological techniques and instrumentation, as well as develop clinical reasoning abilities to correlate laboratory findings with patient presentation. Emphasis is placed on integration of theoretical knowledge with case studies and evidence-based approaches to patient care in hematology.
Recommended Textbook
Clinical Laboratory Hematology 3rd Edition by Shirlyn B. McKenzie
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Chapter 1: Introduction
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Q1) Explain how the hemostatic pathway is activated in times of need.
Answer: Traumatic events to body tissue stimulate the activation of repair mechanisms.As a result of both external and internal stimuli,the hemostatic pathway becomes activated in stages called primary and secondary hemostasis and fibrinolysis.
Q2) All of the following must be considered when establishing a reference interval for a group of individuals except:
A)The geographic area
B)Age of the population
C)Occupations of the population
D)Sex of the population
Answer: C
Q3) The liquid portion of blood is called:
A)Bilirubin
B)Plasma
C)Whole blood
D)Albumin
Answer: B
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Chapter 2: Cellular Homeostasis
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Q1) Explain in detail how p53 and Rb can contribute to the onset of malignancy.
Answer: Rb is the protein product of the retinoblastoma susceptibility gene, which predisposes individuals to retinoblastomas and other tumors when only one functional copy is present. Rb is present throughout the cell cycle. Phosphorylations vary with each cell-cycle phase. In its hypophosphorylated (active) state, Rb has antiproliferative effects, inhibiting cell cycling. It does this by inhibiting transcription factors required for the transcription of genes needed for cell proliferation, rendering them nonfunctional. Hyperphosphorylation, on the other hand, neutralizes (inactivates) the Rb protein, thus promoting cell cycle division.
P53 acts as a molecular policeman; it monitors the integrity of the genome. It can activate and inhibit gene expression depending on the target gene. It is activated in response to DNA breakage, and slows cell-cycle division to initiate DNA repair or apoptosis. It functions as a tumor suppressor gene, and it is the most common mutated gene in tumors.
Q2) Describe the apoptotic pathway.
Answer: Death receptor binding of death receptor to cell receptor caspase recruitment activation of initiator caspases activation of effector caspases cleavage of crucial cellular proteins cell death.
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Chapter 3: Structure and Function of Hematopoietic Organs
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Q1) Hypersplenism associated with compensatory hypertrophy of the spleen is associated with:
A)Neoplasms when malignant cells occupy much of the splenic space
B)Congestive heart failure
C)Liver cirrhosis with portal hypertension
D)Infection and inflammatory diseases
Answer: D
Q2) Explain how the bone marrow receives nutrients to survive.
Answer: The bone marrow receives nutrients primarily through the nutrient artery and the periosteal capillary. The capillaries join with the venous sinuses as they re-enter the marrow. The sinuses gather into wider collecting sinuses that then open into the central longitudinal vein (central sinus).
Q3) The primary hematopoietic function of the spleen is:
A)Extramedullary hematopoiesis
B)Lymphatic drainage
C)Culling and pitting
D)T cell maturation
Answer: C
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Chapter 4: Hematopoiesis
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Q1) Which component of the BM stroma is responsible for the formation of the ECM?
A)Cytokines
B)Fibroblasts
C)Osteoclasts
D)Osteoblasts
Q2) Which component allows the hematopoietic precursors to attach to the bone marrow microenvironment?
A)SCF
B)FL
C)CAM
D)IFN
Q3) Which components are included in the stromal cell compartment?
A)Matrix proteins and regulatory cytokines
B)Adipocytes,endothelial cells,fibroblasts,T lymphocytes,and macrophages
C)Stem cells
D)Progenitor cells
Q4) Explain how hematopoiesis uses autocrine,paracrine,and juxtacrine signaling.Choose one and provide an example of signaling through that pathway.
Q5) Explain the role of stromal cells in the hematopoietic microenvironment.
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Chapter 5: The Erythrocyte
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Q1) Energy metabolism of the erythrocyte is achieved primarily through which of the following?
A)Aerobic glycolysis
B)Anaerobic glycolysis
C)Asexual replication
D)Mitosis
Q2) What contributes to the RBC cell's membrane integrity?
A)Skeletal proteins
B)Glycolytic pathway
C)2,3-BPG
D)Methemoglobin reductase
Q3) Predict the results of erythropoietin in a patient with hypoxia.
A)It will be increased.
B)It will be normal.
C)It will be decreased.
D)This cannot be determined.
Q4) Explain how the body catabolizes hemoglobin in both extravascular and intravascular hemolysis.
Q5) Describe the nuclear and cytoplasmic morphologic changes in erythrocytes during maturation.
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Chapter 6: Hemoglobin
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Q1) Which non-alpha-globin chain composes the predominating normal hemoglobin in adults?
A)Gamma
B)Delta
C)Beta
D)Zeta
Q2) Correlate embryonic/fetal hemoglobin production to stages of fetal hematopoiesis.
Q3) Which of the following causes a left shift in the oxygen dissociation curve (normal blood pH: 7.35-7.45)?
A)A blood pH of 7.54
B)A body temperature of 103°F
C)An increased 2,3-BPG concentration
D)An increased pCO
Q4) Which of the following is an expression of the oxygen affinity of hemoglobin?
A)Oxyhemoglobin
B)Deoxyhemoglobin
C)PCO
D)P50
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Chapter 7: Granulocytes and Monocytes
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Q1) Which of the following is associated with an increased leukocyte concentration?
A)Birth,pregnancy,infection
B)Older adults,birth
C)Older adults,pregnancy
D)Tissue necrosis,whole body irradiation
Q2) IL-5 is the cytokine that is required for which cell type to proliferate and terminally differentiate?
A)Neutrophil
B)Eosinophil
C)Basophil
D)Monocyte
Q3) The process by which neutrophils migrate through the VEC into the tissues is known as:
A)Chemotaxis.
B)Opsonization.
C)Diapedesis.
D)Phagocytosis.
Q4) List and explain the steps that neutrophils take to leave the peripheral blood circulation and lead to the neutrophil kill function.
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Chapter 8: Lymphocytes
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Q1) Reactive lymphocytes differ from normal lymphocytes in that the reactive form:
A)Is larger with an increase in basophilic cytoplasm,vacuoles,and scalloped cell shape
B)Has a condensed nuclear pattern with light pink cytoplasm
C)Has many granules,deep basophilic cytoplasm,and blast-like nucleus
D)Has a condensed nuclear chromatin,eccentric nucleus,and deep blue cytoplasm
Q2) Describe the immunologic features and functions of NK cells.
Q3) A blood sample from a 5-month-old infant indicates a WBC count of 12.5 × 10 /L with 65% lymphocytes.What can you conclude from this?
A)The infant is normal.
B)The infant has an infection as indicated by the elevated WBC count.
C)The infant has a malignancy in the lymphocyte lineage.
D)There is not enough information to draw accurate conclusions.
Q4) Which of the following is a characteristic of NK cells?
A)They function in the innate immune response.
B)They are capable of antibody synthesis
C)They are made up the majority of lymphocytes in peripheral blood.
D)They phagocytize bacteria.
Q5) What is the difference between polyclonal antibodies and monoclonal antibodies?
List examples of disorders that generate each type of antibody in your answer.
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Chapter 9: The Platelet
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Q1) The normal reference interval for the mean platelet volume (MPV)is:
A)9-11
B)11-14 g/dL
C)150-450 * 10 /L
D)8-12 fL
Q2) On average,how long does a platelet live in the peripheral circulation?
A)6 hours
B)120 days
C)5 days
D)10 days
Q3) Laboratory results for a patient indicate that the platelet count is 89 × 10 /L.What is likely to be observed in the peripheral blood for this patient if the platelet count is the result of increased physiological platelet destruction?
A)Megakaryocytes
B)Megakaryoblasts
C)Reticulated platelets
D)Megathrombocytes
Q4) Describe megakaryocyte development and the role of endomitosis and thrombopoietin in this process.
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Chapter 10: The Complete Blood Count and Peripheral
Blood Smear Evaluation
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Q1) List four pre-examination precautions that must be observed to produce quality results when performing a CBC.
Q2) Why do we see Howell-Jolly bodies in patients who have had a splenectomy?
Explain your answer.
Q3) An instrument printout reveals an RDW of 33.Which of the following would best correlate with those results?
A)The presence of a dimorphic cell population on the PB smear
B)The presence of marked polychromasia on the PB smear
C)The presence of spherocytes on the PB smear
D)The presence of macro-ovalocytes on the PB smear
Q4) Which RBC inclusion is characterized by diffusely staining RNA precipitate that can be seen when blood is stained with Wright's stain?
A)Heinz bodies
B)Pappenheimer bodies
C)Howell-Jolly bodies
D)Basophilic stippling
Q5) Describe the purpose of and the way to calculate the "rule of three."
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Q6) A patient sample arrives in the laboratory with the name on the tube and no other information.What is missing?
Chapter 11: Introduction to Anemia
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Q1) Which of the following laboratory tests could be used to help identify the cause of an anemia?
A)Platelet count
B)Haptoglobin concentration
C)RBC count
D)Absolute lymphocyte count
Q2) A patient experiencing compensated hemolytic disease would show which of the following lab results?
A)RBC count: 2.8 × 10 /L
B)MCV: 73 fL
C)MCHC: 28 g/dL
D)Hb 15.4 g/dL
Q3) The finding of a positive direct antiglobulin test (DAT)for a patient is likely to result in which of the following pathologies:
A)Increased bone marrow production of erythrocytes
B)Increased erythrocyte destruction
C)Decreased bone marrow production of erythrocytes
D)Liver disease
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Chapter 12: Anemias of Disordered Iron Metabolism and Heme Synthesis
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Q1) The most common form of hereditary hemochromatosis is the result of which gene mutation?
A)HFE
B)Hepcidin gene
C)Ferroportin gene
D)HJV
Q2) An unknown sample reveals low serum iron,high TIBC,low ferritin,low hemoglobin,and a microcytic hypochromic picture in the peripheral blood.Which stage of IDA is this?
A)Stage 1 IDA
B)Stage 2 IDA
C)Stage 3 IDA
D)Cannot be determined based on the information given
Q3) The hereditary form of sideroblastic anemia is most commonly the result of:
A)Decreased hepcidin synthesis
B)Mutation of the HFE gene
C)Abnormal ALAS
D)Increased absorption of iron
Q4) Explain how lead inhibits heme synthesis.
Q5) Differentiate between primary and secondary hemochromatosis.
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Chapter 13: Hemoglobinopathies: Qualitative Defects
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Q1) Which abnormal hemoglobin is slow moving and migrates closely with hemoglobin
A on cellulose acetate at an alkaline pH?
A)Hemoglobin S
B)Hemoglobin D
C)Hemoglobin M
D)Hemoglobin C
Q2) Thalassemias are produced as a result of:
A)Quantitative defects in globin chain synthesis
B)Qualitative defects in globin chain synthesis
C)Structural defects in heme synthesis
D)Molecular defects in hemoglobin synthesis
Q3) Sickle cell trait is not as severe as sickle cell anemia,so why is the sickle cell trait important to diagnose?
A)One in four children born to trait parents have the disease.
B)Sickle cell trait can mask other diseases.
C)Doing so eliminates the need for pharmacologic agent treatment.
D)Cells still sickle under the same conditions as with the disease.
Q4) Other than hemoglobin S,name two abnormal hemoglobins that produce a positive sickle solubility test.Explain how they could be differentiated from HbS.
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Chapter 14: Thalassemia
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Q1) Choose the thalassemia with the best prognosis from the following choices.
A)Hgb H disease
B)Silent carrier alpha thalassemia
C)Beta thalassemia minor
D)Beta thalassemia intermedia
Q2) a-thalassemia major results from deletion in _____ alleles of the alpha chain gene.
A)1
B)2
C)3
D)4
Q3) Why are thalassemias considered a separate entity from hemoglobinopathies?
Q4) The geographic prevalence of -thalassemia is highest in which ancestry group?
A)Mediterranean,American Indian
B)Asian,Mediterranean,African
C)Canadian,African,Indian
D)South American,African,Asian
Q5) Nucleated red blood cells in the peripheral blood are a common finding in beta thalassemia patients.Explain why.
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Chapter 15: Megaloblastic and Nonmegaloblastic
Macrocytic Anemias
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Q1) Pernicious anemia is a malabsorption of vitamin B from what component deficiency?
A)Gastric juice
B)Intrinsic factor
C)Histamine
D)Folate
Q2) The defect in DNA synthesis associated with megaloblastic anemia affects which cells?
A)Only erythrocytes
B)Only gastric cells and WBCs
C)Only neurological cells
D)All dividing cells
Q3) What can falsely elevate the serum folate level?
A)Hemolysis of the serum sample
B)Recent low dietary intake
C)Vitamin B deficiency
D)Recent alcohol consumption
Q4) Explain how high alcohol intake can cause macrocytosis.
Q5) Explain how vitamin B deficiency can cause folate deficiency.
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Q6) Explain why peripheral neuropathy is a common finding in vitamin B deficiency.
Chapter 16: Hypoproliferative Anemias
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Q1) Which of the following puts a patient taking chloramphenicol at risk for developing aplastic anemia?
A)The drug promotes an immune response against stem cells.
B)The drug is toxic to the bone marrow.
C)The drug results in stem cell resistance to essential cytokines.
D)The drug causes decreased cytokine production.
Q2) Recent evidence suggests that the pathophysiology of most cases of acquired aplastic anemia is most likely:
A)Drug exposure
B)Viral infections
C)Defective stem cells
D)Immunologic suppression of hematopoiesis
Q3) Define constitutional aplastic anemia,and give an example.
Q4) The presence of what poikilocyte would lead to a suspicion of myelophthisic anemia rather than pure red cell aplasia?
A)Dacryocyte
B)Drepanocyte
C)Schistocyte
D)Stomatocyte
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Chapter 17: Hemolytic Anemia: Membrane Defects
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Q1) Which of the following causes horizontal interactions of skeletal protein abnormalities?
A)Ankyrin
B)Glycophorin C
C)Band 3
D)Protein 4.2
Q2) Laboratory findings on a stained blood smear exhibit striking erythrocyte morphologic abnormalities.The MCV is decreased,osmotic fragility is abnormal,and the thermal sensitivity test demonstrates an increase in erythrocyte fragmentation.Autohemolysis in increased and is not corrected with glucose.What disorder is associated with these findings?
A)Hereditary pyropoikilocytosis
B)Hereditary stomatocytosis
C)PNH
D)Hereditary spherocytosis
Q3) The SAO variant of HE is associated with:
A)Defective pectrin tetramer formation
B)Defective protein 4.1
C)Defective band 3 protein and abnormally tight binding to ankyrin
D)All of the above
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Chapter 18: Hemolytic Anemia: Enzyme Deficiencies
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Q1) Which molecule is responsible for the neutralization of harmful peroxides?
A)G6P
B)Glutathione
C)HK
D)PK
Q2) What is the purpose of the HMP shunt,and why is it important?
Q3) All of the following support the diagnosis of G6PD deficiency except:
A)Presence of Heinz bodies with new methylene blue stain
B)"Bite cells"
C)Hemolytic morphology during oxidative event
D)Reticulocytopenia
Q4) Intrinsic erythrocyte enzyme deficiencies lead to:
A)Increased erythrocyte oxidative susceptibility
B)Exacerbated immune response against erythrocytes
C)Increased opsonization of erythrocytes
D)Increased extravascular hemolysis
Q5) Why are Heinz bodies seen in G6PD deficiency?
Q6) How do Heinz bodies differ morphologically from other erythrocyte inclusions?
Q7) Why are echinocytes seen in PK deficiency?
Page 20
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Chapter 19: Hemolytic Anemia: Immune Anemias
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Q1) Which of the following characterizes acute hemolytic transfusion reaction?
A)Extravascular hemolysis
B)Gastrointestinal hemorrhage
C)Intravascular hemolysis
D)Thrombosis
Q2) Autoantibodies associated with CAD are directed against which antigen system?
A)ABO
B)I
C)Rh
D)P
Q3) A patient with SLE shows evidence of decreased hemoglobin and ongoing hemolysis.The DAT is negative.Which of the following is the most likely explanation for these results?
A)The subclass of IgG is not recognized by the polyspecific AHG.
B)The thermal amplitude of the antibody is <37°C.
C)High-dose IVIG used in treatment is interfering with the binding of AHG.
D)There is insufficient IgG for detection.
Q4) Compare the three mechanisms of drug-induced immune hemolysis.
Q5) Explain why the DAT profile in CAD is reactive only with polyspecific AHG and anti-C3 but not with anti-IgG.
Page 21
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Chapter 20: Hemolytic Anemia: Nonimmune Defects
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Q1) Which of following is identified as an initiator of exercise-induced hemoglobinuria associated with running?
A)Prosthetic heart valves
B)Extensive thermal burns
C)Erythrocyte membrane disorder
D)Exercise-induced oxidative stress and erythrocyte age
Q2) What features are identified on the peripheral blood smear in TTP?
A)Increase in presence of reticulocytes,nucleated erythrocytes,abundance of schistocytes
B)Leukocytosis with left shift,and schistocytes present reticulocytopenia
C)Abundance of schistocytes,thrombocytosis,and leukopenia
D)Nucleated erythrocytes,Howell-Jolly bodies,and absence of schistocytes
Q3) Which of the following is found to be a factor in TTP?
A)Escherichia coli O157:H7
B)Shigella species
C)S.pneumoniae
D)Shigella dysenteriae serotype I
Q4) Explain how the action of E.coli O157:H7 toxin is related to the development of HUS.
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Chapter 21: Nonmalignant Disorders of Leukocytes:
Granulocytes and Monocytes
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Q1) A patient has a fever and a WBC of 25 × 10 /L with bands and metamyelocytes present.Which of the following conditions describes these results?
A)Reactive leukopenia
B)Pseudoneutrophilia
C)Left shift
D)May-Hegglin anomaly
Q2) What causes sea-blue histiocytosis,and how is the sea-blue histiocyte identified?
Q3) What disease state correlates highly with the presence of cytoplasmic vacuoles in freshly drawn blood?
A)Ehrlichia sp.infection
B)Septicemia
C)HIV infection
D)Malaria
Q4) Which of the following can result in basophilia?
A)Chronic myeloproliferative neoplasm
B)Parasitic infections
C)Connective tissue disorders
D)All of the above
Page 23
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Chapter 22: Nonmalignant Lymphocyte Disorders
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Q1) Which of the following statements best describes the pathogenesis of HIV infection?
A)HIV virus selectively infects T helper cells,incorporates its own DNA into the T helper's DNA,and lyses the cell.
B)HIV virus infects all lymphocytes,incorporates its own DNA into the T helper's DNA,and changes the T helper's identity.
C)HIV virus infects all cells involved in cell-mediated immunity,incorporates its own DNA into the DNA of the infected cells,and lyses the cells.
D)HIV infects T-suppressor cells and initiates apoptosis.
Q2) A 42-year-old HIV-positive patient recently was diagnosed with disseminated histoplasmosis.Which of the following should be ordered to monitor this patient's progression?
A)HIV antibody screen
B)HBsAg
C)CBC
D)CD4:CD8 ratio
Q3) Correlate antibody titers with the stage of infection.What antibody titer excludes current infection?
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Chapter 23: Introduction to Hematopoietic Neoplasms
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Q1) Which of the following does the World Health Organization use to classify hematopoietic neoplasms?
A)Lineage morphology
B)Clinical presentation
C)HIV status
D)DNA profiling
Q2) Which of the following disorders is characterized by signs of dyshematopoiesis?
A)Acute leukemias
B)Chronic leukemias
C)Myelodysplastic syndromes
D)Myeloproliferative disorders
Q3) Explain how proto-oncogenes contribute to tumor formation.
Q4) Which of the following have the potential to progress into acute leukemia:
A)Myeloproliferative neoplasms
B)Acute neutrophilia
C)Megaloblastic anemias
D)Reactive leukocytosis
Q5) Name the two main classification systems that identify MDS and acute leukemia.Indicate how they are different.
Q6) What is the difference between the HSC and the cancer stem cell?
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Chapter 24: Myeloproliferative Neoplasms
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Q1) The myeloproliferative disorder best described by increased leukocytes,immature granulocytes,and decreased LAP with the Philadelphia chromosome present is which of the following?
A)CIMF
B)CML
C)PV
D)ET
Q2) CML is characterized by which of the following:
A)A shift to the left in WBCs
B)A massive increase in mature WBCs
C)A peripheral blood or bone marrow blast count >20%
D)A shift to the left in RBCs,platelets,and WBCs
Q3) Which age range is nearest to the peak incidence of CML?
A)0-5 years
B)20-25 years
C)35-45 years
D)55-65 years
Q4) Contrast MDS and MPN utilizing laboratory test result information.
Q5) Explain how a variant of CML is identified utilizing laboratory values.
Q6) Explain the significance of the Philadelphia chromosome in ALL.
Page 26
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Chapter 25: Myelodysplastic Syndromes
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Q1) What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?
A)A minimum of 30% ringed sideroblasts
B)A minimum of 5% ringed sideroblasts
C)A minimum of 5% monoblasts
D)A minimum of 15% ringed sideroblasts
Q2) Which of the following is a defining characteristic of myelodysplastic syndromes (MDS)?
A)One or more peripheral blood cytopenias
B)The presence of BCR/ABL1
C)Overproliferation of all myeloid elements
D)Dyslymphopoiesis
Q3) Which World Health Organization (WHO)classification for MDS is best supported when the peripheral blood shows a general cytopenia,5-19% blasts with Auer rods,and <1 × 10 /L monocytes?
A)Refractory anemia
B)Refractory anemia with excess blasts 2
C)MDS associated with isolated del(5q)
D)Refractory cytopenia with multilineage dysplasia
Q4) Explain the pathophysiology of MDS.
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Chapter 26: Acute Myeloid Leukemias
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Q1) How is erythrocyte morphology likely to be described in patients with AML?
A)Normocytic normochromic
B)Microcytic hypochromic
C)Microcytic normochromic
D)Variable with anisocytosis
Q2) Which acute leukemia is characterized by a blast population with both myeloid and monocytic markers on the same cell?
A)AML with multilineage dysplasia
B)Acute myelomonocytic leukemia
C)Acute monoblastic and monocytic leukemia
D)AML with an MDS-related cytogenic abnormality
Q3) A laboratory professional notes single azurophilic needlelike inclusions in the cytoplasm of many of the circulating blasts while reviewing a blood smear of an AML patient.What is the most probable identification of the inclusion?
A)Toxic granulation
B)Uric acid crystals
C)Döhle bodies
D)Auer rods
Q4) Explain how bone marrow analysis helps establish an AML diagnosis.
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Chapter 27: Precursor Lymphoid Neoplasms
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Q1) Name the classifications of ALL,and explain how they differ in molecular analysis and immunophenotype.
Q2) Which of the following is an expected finding in the peripheral blood smear of an ALL patient?
A)A normal platelet count
B)The presence of nucleated RBCs
C)A decreased platelet count
D)An absolute increase in mature lymphocytes
Q3) Cytogenetic analysis confirms the presence of t(1;14).This verifies which of the following types of ALL?
A)Precursor B-cell ALL
B)Precursor T-cell ALL
C)PV
D)AML
Q4) Which of the following is a classic morphologic finding in the peripheral blood in ALL?
A)Increased WBC and platelets with increased lymphoblasts
B)Lymphoblasts,decreased platelets,and decreased neutrophils
C)Lymphoblasts,increased platelets,and increased neutrophils
D)Increased WBC,platelets,and neutrophils
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Chapter 28: Mature Lymphoid Neoplasms
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Q1) Which of the following best represents the hematologic picture of a patient with lymphoma?
A)Prominent lymphocytosis
B)Normal until later stages of the disease
C)Prominent leukocytosis
D)Low hemoglobin,hematocrit,and platelet count
Q2) A 25-year-old male presents with an enlarged lymph node in his axillary region.Further testing confirms malignancy in the enlarged lymph node but nowhere else.In which stage of lymphoma,according to the Ann Arbor classification system,is the patient?
A)Stage I
B)Stage II
C)Stage III
D)Stage IV
Q3) Which protein is identified as a free light chain in the urine?
A)MGUS
B)Heavy chains
C)M spike
D)Bence-Jones
Q4) Explain how ALL and Burkitt-type ALL are different morphologically.
30
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Chapter 29: Hematopoietic Stem Cell Transplantation
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Q1) Which of the following diseases can be treated with an allogeneic transplant?
A)Hodgkin lymphoma
B)Solid organ tumors
C)Non-Hodgkin lymphoma
D)Acute leukemia
Q2) When calculating the dose of stem cells needed for the recipient,what factor per kilogram of recipient weight must be considered?
A)When using umbilical cord blood,a minimum of 3.0 × 105 of total nucleated cells
B)Cell doses of a minimum of 2.5-5.0 × 106 CD34+ cells
C)Cell doses of a minimum of 0.5-1.5 × 103 CD56+ cells
D)When using umbilical cord blood,a minimum of 1.0 × 103 of total nucleated cells.
Q3) Which of the following best represents the proper order for drug regimen for a SCT patient?
A)Chemotherapy > antihistamine and antiemetic > GM-CSF
B)Antihistamine and antiemetic > GM-CSF > chemotherapy
C)Chemotherapy > GM-CSF > antihistamine and antiemetic
D)GM-CSF > antihistamine and antiemetic > chemotherapy
Q4) Explain the graft-versus-leukemia process in stem cell transplantation.
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Chapter 30: Morphologic Analysis of Body Fluids in the
Hematology
Laboratory
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Q1) What morphological characteristics of the following cell types will help the technologist differentiate them?
a.Mesothelial cells
b.Adenocarcinoma
c.Leukemic blasts
d.Small-cell carcinoma
Q2) Which type of fluid is milky in appearance and is formed from long-standing effusions resulting from chronic conditions?
A)Transudate
B)Pseudochylous
C)Exudates
D)Chylous
Q3) The technique that should be performed to differentiate starch particles from pathogenic crystals in fluids is:
A)Examination with polarized light
B)Examination with fluorescent light
C)Examination with Wright stain
D)Calculation of RBC to WBC ratio
Q4) What is the significance of micro-organisms present in the cytospin?
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Chapter 31: Primary Hemostasis
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Q1) Which of the following defines the strength of a selected agonist?
A)Location in which they are derived
B)Ability to induce the full range of platelet functions
C)Ability to interact with thromboxane A
D)Speed by which the platelets become activated
Q2) Describe megakaryocyte development and the role of endomitosis and thrombopoietin in this process.
Q3) Which of the following acts as a transport portal for granules to move from the organelle zone to the membrane zone?
A)Open canalicular system
B)Dense tubular system
C)Membrane glycoproteins
D)Endoplasmic reticulum
Q4) Which of the following best describes the role of platelet factor 4?
A)Stimulates platelet aggregation
B)Contributes to fibrin formation
C)Neutralizes heparin
D)Acts as a mitogenic factor
Q5) Explain the biochemistry involved in platelet function.
Q6) Correlate blood vessel histology to vessel type and function in hemostasis.
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Chapter 32: Secondary Hemostasis and Fibrinolysis
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Q1) Which of the following is responsible for urokinase-catalyzed plasminogen (PLG)activation?
A)ADAMTS-13
B)LRP
C)UPAR
D)EPCR
Q2) Why is vitamin K necessary for some coagulation proteins to become functional?
A)Vitamin K activates coagulation zymogens.
B)Vitamin K binds coagulation factors to a phospholipid surface.
C)Vitamin K combines with VWF in the circulation.
D)Vitamin K is required for gamma-carboxylation of glutamic acid residues.
Q3) Which of the following is a role of thrombin?
A)Activates anticoagulant (protein C)
B)Increases fibrinolysis
C)Inhibits endothelial cell release of tissue plasminogen activator
D)Inhibits the formation of fibrin monomers
Q4) What are the roles of thrombin in coagulation?
Q5) Compare and contrast systemic and physiologic fibrinolysis.
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Chapter 33: Disorders of Primary Hemostasis
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Q1) What would be the expected laboratory results in a patient with thrombocytopenia?
A)Platelet counts <50 × 10 /L
B)Normal bleeding time
C)Abnormally prolonged PT and APTT
D)Decreased fibrinogen
Q2) A patient is exhibiting multiple pinpoint hemorrhages on his upper torso.This would be described as:
A)Hematomas
B)Ecchymoses
C)Purpura
D)Petechiae
Q3) Which hemostatic disorder usually is represented by a decreased platelet count,normal PT,normal APTT,and abnormal bleeding time?
A)Thrombocytosis
B)Thrombocytopenia
C)Vascular disorder
D)Platelet dysfunction
Q4) How do hematologic disorders contribute to the pathogenesis of thrombocytopenia?
Q5) Give at least five markers of differentiation between acute and chronic ITP.
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Chapter 34: Disorders of Secondary Hemostasis
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Q1) A patient might be suffering from a coagulopathy.Which of the following physical manifestations would suggest a primary hemostatic pathway problem?
A)Hematomas
B)Petechiae
C)Joint and muscle bleeding
D)Ecchymoses
Q2) What plasma factor levels of the deficient factor can be expected in a female carrier of FVIII or FIX deficiency?
A)25% of the normal plasma levels
B)12.5% of the normal plasma levels
C)50% of the normal plasma levels
D)5% of the normal plasma levels
Q3) A patient has a prolonged PT.Which deficiency can you infer from this result?
A)Coagulation factors of the extrinsic pathway
B)Coagulation factors of the intrinsic pathway
C)Platelets
D)Coagulation factors of the common pathway
Q4) What laboratory tests typically are utilized to detect lupus anticoagulants?
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Chapter 35: Thrombophilia
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Q1) Why does a patient who had a thrombotic incident receive both heparin and Coumadin for 4-5 days before heparin is discontinued?
A)Heparin is not effective as an anticoagulant without Coumadin.
B)Coumadin requires heparin for its full anticoagulant effect.
C)Coumadin and heparin have a synergistic effect
D)Coumadin 's full effect is not achieved for 4- days after initiation because of the half-life of the vitamin K coagulation factors.
Q2) A 30-year-old patient is diagnosed with a third episode of DVT.He is currently hospitalized and receiving heparin therapy.The physician orders a thrombotic risk battery of tests.What is the most appropriate action that the laboratory professional should take?
A)Call the physician and explain that testing will not be accurate during anticoagulant therapy and during the thrombotic episode
B)Perform the battery of tests in the thrombosis risk profile but note that results are not reliable
C)Perform a PT and an APTT,and,if prolonged,refuse to do the testing
D)Call the physician and explain that this patient is not a candidate for thrombosis risk testing
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Chapter 36: Hemostasis: Laboratory Testing and Instrumentation
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Q1) A patient is screened positive for APCR.What does this mean?
A)The patient is at risk for hemorrhage.
B)The patient has a factor VL d n mutation.
C)The patient is at risk for thrombosis.
D)The patient is on heparin.
Q2) Prothrombin time measures the clotting factors in the:
A)Intrinsic pathway
B)Formation of fibrin
C)Extrinsic pathway
D)Fibrinolytic pathway
Q3) A patient with a fibrinolytic deficiency would:
A)Be prone to increased lysis
B)Have increased levels of plasminogen
C)Have abnormal screening tests (PT and APTT)
D)Be prone to increased clotting
Q4) If blood is collected through an indwelling catheter,care must be taken to:
A)Prevent the citrate contamination of the line
B)Flush the line with saline and discard the first 5 ml of blood
C)Draw the sample quickly to prevent clotting
D)Flush the line with sterile water
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Chapter 37: Hematology Procedures
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Q1) All of the following are needed on a phlebotomist's supply tray to perform a venipuncture except:
A)Needles
B)Tourniquets
C)Gauze
D)Lancets
Q2) Which of the following is not mandated by OSHA?
A)The use of two patient identifiers when collecting blood samples
B)The use of plastic tubes when performing venipuncture
C)Education regarding regulation of the transmission of blood-borne pathogens
D)Education regarding regulation of needle sticks
Q3) The microscopic examination of a Wright-stained blood smear revealed bright red erythrocytes and pale leukocyte nuclei.What is the best explanation for this appearance?
A)The buffer is too acidic.
B)The staining process was prolonged.
C)The blood smear was too thick.
D)The Wright stain was too alkaline.
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Chapter 38: Bone Marrow Examination
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Q1) The Prussian blue stain is used to stain what element?
A)Organelle-associated enzymes
B)Carbohydrates
C)Iron
D)Proteins
Q2) Which of the following is an expected finding in the bone marrow in a patient with the following results: serum iron = 124 mcg/dL (reference range: 35-170 ug/dL);TIBC = 284 mcg/dL (reference range: 225-425 mcg/dL)?
A)Decreased or absent Prussian blue specks
B)Adequate iron stores with Prussian blue stain
C)Sea blue histiocytes
D)Increased iron stores
Q3) What are the main reasons for using a core biopsy specimen versus an aspirate specimen?
Q4) What is the overall cellularity range of a bone marrow in a 35-year-old female patient?
A)35-45%
B)55-75%
C)50-60%
D)70-80%
Page 40
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Chapter 39: Automation in Hematology
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Q1) The immature platelet fraction (IPF)is a parameter derived from the Sysmex XE-2100's
RET scattergram.An increased IPF is associated with:
A)Aplastic anemia
B)Pernicious anemia
C)Acute lymphocytic leukemia
D)Immune thrombocytopenic purpura
Q2) Which of the following binds to residual RNA in reticulocytes on the Sysmex XE-2100 analyzer?
A)New methylene blue
B)Propidium iodide
C)Polymethine
D)Oxazine
Q3) What is the principle of impedance?
Name at least two instruments that employ this method for blood cell counting.
Q4) What cellular characteristic is evaluated by radio frequency?
A)Size
B)Density
C)Shape
D)Complexity
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Chapter 40: Flow Cytometry
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Q1) CD34 enumeration is useful in bone marrow and peripheral blood stem cell transplantation.For this enumeration,the EWGCCA recommendations include proper technique and interpretation of the flow cytometry analysis.Which of the following standards was recommended for proper acquisition of events?
A)Include platelets and unlysed red blood cells and debris
B)Include only CD34 dim staining populations
C)Use bright fluorochrome conjugates of class II or III monoclonal antibodies that detect all glycoforms of CD34
D)Acquire only 10 CD34 positive cells
Q2) Which of the following is considered a drawback of immunophenotyping a suspected acute leukemia?
A)AML NOC
B)Lineage heterogeneity
C)Lack of sensitivity
D)Lack of specificity
Q3) Name at least two pitfalls in immunophenotyping mature lymphoid malignancies,and explain how you would correct this.
Q4) Explain the advantages of using flow cytometry to count reticulocytes.
Q5) What is the purpose of CD34 count?
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Chapter 41: Chromosome Analysis of Hematopoietic and Lymphoid Disorders
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Q1) A karyotype is a representation of:
A)The molecular structure of DNA
B)The double-helix structure of DNA
C)The cell's immunophenotype
D)Chromosome grouping
Q2) During the harvesting phase of sample preparation,the cells are arrested in metaphase by:
A)Incubation with colchicine
B)Fixing with Carnoy's fixative
C)Incubation with KCl
D)Addition of phytohemagglutinin
Q3) A laboratory professional should process a bone marrow aspirate for cytogenetic analysis in a patient with a lymphoma by using which of the following?
A)Tissue culture
B)Direct harvest
C)Suspension tissue culture
D)Mitogen stimulation with PHA
Q4) A cytogenetic analysis is performed,and the result is inv (7) ( q21q32).Name the structural aberration,and explain how it was formed.
Page 43
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Chapter 42: Molecular Analysis of Hematologic Diseases
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Q1) Which of the following molecular techniques is useful in detecting the point mutations in a suspected hemoglobinopathy:
A)DNA amplification and sequencing
B)qPCR
C)High-resolution melt curve analysis
D)RT-PCR
Q2) Explain why molecular testing is essential not only in identifying disorders,such as cancer,but also during the course of a disease.
Q3) Which of the following methods would be most useful for identifying point mutations anywhere in the DNA segment?
A)Southern blot analysis
B)PCR
C)DNA sequencing
D)FISH
Q4) Explain the central dogma of molecular biology using proper nomenclature.Define each phase.
Q5) Give the advantages of PCR over Southern blot and advantages of Southern blot over PCR.
Q6) Explain the impact of a positive test for HTLV-1 in a lymphoma patient.
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