Medical Laboratory Science: Hematology
Exam Materials
Course Introduction
This course provides an in-depth study of hematology with a focus on the principles and techniques used in medical laboratory science. Students will explore the structure, function, and disorders of blood cells, including red blood cells, white blood cells, and platelets. The course covers topics such as hematopoiesis, blood cell morphology, anemia, leukemias, coagulation disorders, and laboratory testing methods. Emphasis is placed on laboratory procedures for the identification and analysis of hematologic diseases, interpretation of laboratory results, quality assurance, and correlation with clinical conditions. Students will also develop skills in the use of automated analyzers and microscopy, preparing them for practice in clinical laboratory settings.
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 screening tests and reflexing testing are related.
Answer: In an attempt to reach a cost-effective and efficient diagnosis, a physicians investigation into a hematologic or hemostatic problem begins with screening tests. The results of these tests provide the clues to the diagnosis. Depending on the results of screening tests, more specific tests (reflex tests) can be ordered. The laboratory professional can aid the physician in choosing the appropriate reflex tests that will narrow the scope for the patient diagnosis.
Q2) Which of the following tests could be reflexed as the result of an abnormal prothrombin time?
A)Molecular analysis of clotting factors
B)Complete blood count
C)Measurement of albumin
D)Hemoglobin analysis
Answer: A
Q3) 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.
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Chapter 2: Cellular Homeostasis
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Sample Questions
Q1) In order to maintain ________,terminally differentiated blood cells must undergo
A)Cell cycle division;necrosis
B)Tumor suppression;apoptosis
C)Homeostasis;apoptosis
D)Cell regeneration;necrosis
Answer: C
Q2) The plasma membrane of blood cells is characterized by which of the following?
A)Carbohydrate components (glycolipids,glycoproteins)embedded in the lipid bilayer
B)The asymmetric distribution of the phospholipids
C)The hydrophilic ends of the phospholipids directed toward the inside of the lipid bilayer
D)The absence of peripheral proteins
Answer: B
Q3) 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) Splenomegaly as a result of bone marrow failure is indicative of:
A)Liver disease
B)Accelerated immune response
C)Extramedullary hematopoiesis
D)Nuclear asynchrony
Answer: C
Q2) Which of the following characterizes definitive erythropoiesis?
A)A self-renewing HSC in the AGM
B)The production of erythroid cells in the liver
C)The presence of hemoglobin F in erythroid cells
D)Megakaryocyte proliferation in the bone marrow
Answer: A
Q3) Primitive erythropoiesis in the yolk sac is important to what process?
A)Transportation of oxygen to developing tissue
B)Development of immunity
C)Liver development
D)Cellular differentiation
Answer: A
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Chapter 4: Hematopoiesis
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Q1) All of the following are functions of the BM stroma except:
A)Adhesion of hematopoietic precursors
B)Cell-to-cell interaction
C)Synthesis of cytokines
D)Incorporation of essential metals into mature cells
Q2) All of the following are characteristics of an optimal hematopoietic microenvironment except:
A)Fibronectin
B)Extracellular matrix
C)Stromal cells
D)Synthetic cytokines
Q3) Explain the role of stromal cells in the hematopoietic microenvironment.
Q4) Signal transduction pathways are propagated primarily through which of the following?
A)Kinases and protein phosphorylation
B)Phosphatases and protein dephosphorylation
C)Protein methylation
D)Histone deacetylation
Q5) Compare and contrast the HSC and the progenitor cells.How are they similar? How are they different?
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Chapter 5: The Erythrocyte
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Q1) The average RBC is what size?
A)20-25 mcM
B)2-3 ,mcM
C)12-15 mcM
D)7-8 mcM
Q2) What protein is the major membrane attachment point of the latticework that laminates the inner lining of the RBC membrane?
A)Tropomodulin
B)Troponyosin
C)Ankyrin
D)Band 3
Q3) What element or property contributes to the normal shape of the RBC?
A)Sodium
B)Spectrin tetramer
C)Calcium
D)Magnesium
Q4) Explain how the body catabolizes hemoglobin in both extravascular and intravascular hemolysis.
Q5) Explain how EPO regulates RBC production.
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Chapter 6: Hemoglobin
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Q1) An elevated hemoglobin A1C indicates that:
A)The patient has an elevated hemoglobin.
B)The patient is anemic.
C)The patient's RBCs have been exposed to an elevated blood glucose for a prolonged period of time.
D)The patient's RBCs need glucose.
Q2) Endothelium-derived relaxing factor has the ability to relax smooth muscle,dilate blood vessels,and:
A)Increase oxygen affinity.
B)Decrease oxygenation of tissues.
C)Inhibit of platelet aggregation.
D)Decrease formation of methemoglobin.
Q3) Which of the following sets of values represents a normal adult hemoglobin distribution?
A)90% A,5% A ,5% F
B)90% A,8% A ,2% F
C)97% A,1% F,2% A
D)96% A,2% A ,4% F
Q4) How would a tense configuration of hemoglobin impact the transport of oxygen?
Explain your answer.
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Chapter 7: Granulocytes and Monocytes
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Q1) Differentiate between absolute and relative concentrations of specific types of leukocytes and give an example of a condition that typically produces abnormal absolute or relative concentrations.
Q2) A(n)__________ has purple-black granules that obscure the cytoplasm,whereas a(n)__________ contains granules that orange to red in color.
A)eosinophil;neutrophil
B)monocyte;lymphocyte
C)lymphocyte;basophil
D)basophil;eosinophil
Q3) The basophil is the least plentiful cell found in the peripheral blood.What can it indicate when it is increased in the blood?
A)Infection
B)Malignancy
C)Inflammation
D)Allergic reaction
Q4) List 4 locations of neutrophils and the three sub-locations within the bone marrow.Explain the general purpose of these locations.
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Chapter 8: Lymphocytes
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Q1) Which of the following describes the distribution of lymphocytes within the body?
A)75% exist in peripheral blood,25% in lymph nodes and spleen
B)50% exist in the circulating pool,50% in the marginating pool
C)95% are found in the lymph nodes and spleen,5% in the peripheral blood
D)80% are short-lived,20% are long lived
Q2) Which of the following is considered the "pan-B" antigen?
A)CD4
B)CD8
C)CD19
D)CD10
Q3) Which of the following describes the components used to construct an immunoglobulin?
A)5 heavy chains
B)2 light chains
C)5 identical heavy chains with 2 identical light chains
D)2 identical heavy chains with 2 identical light chains
Q4) What is the difference between polyclonal antibodies and monoclonal antibodies?
List examples of disorders that generate each type of antibody in your answer.
Q5) Describe the immunologic features and functions of NK cells.
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Chapter 9: The Platelet
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Q1) Platelets are derived from which of the following?
A)Monoblasts
B)Pronormoblasts
C)Lymphoblasts
D)Megakaryocytes
Q2) Identify the major cytokines that regulate platelet production and describe their effects on megakaryocytic cells and circulating platelets.
Q3) On average,how long does a platelet live in the peripheral circulation?
A)6 hours
B)120 days
C)5 days
D)10 days
Q4) Increased DNA content in exact multiples that are contained within a single nuclear envelope defines cells that are:
A)Polyploid
B)Proliferating
C)Apoptotic
D)Differentiated
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Chapter 10: The Complete Blood Count and Peripheral
Blood Smear Evaluation
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Q1) A peripheral blood smear has an even distribution of both normocytic normochromic cells and microcytic hypochromic cells.What is this phenomenon called?
A)Extramedullary hematopoiesis
B)Nuclear-cytoplasmic asynchrony
C)Dimorphic cell population
D)Monoclonal cell population
Q2) What is one of the disease states associated with the presence of target cells?
A)Sickle cell anemia
B)Thalassemia
C)Uremia
D)Hemolytic anemia
Q3) List four pre-examination precautions that must be observed to produce quality results when performing a CBC.
Q4) A patient sample arrives in the laboratory with the name on the tube and no other information.What is missing?
Q5) Describe the purpose of and the way to calculate the "rule of three."
Q6) Why do we see Howell-Jolly bodies in patients who have had a splenectomy? Explain your answer.
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Chapter 11: Introduction to Anemia
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Q1) A patient experiencing intravascular hemolysis would likely show which of the following:
A)Leukocytosis
B)Decreased reticulocyte count
C)Hemosiderinuria
D)Negative DAT
Q2) CBC results on a pregnant patient indicate an MCV of 112 fl.What would be the most appropriate reflex test?
A)Iron studies
B)Bilirubin
C)LDH
D)Folate assay
Q3) All of the following are classic signs of anemia except:
A)Fatigue
B)Pallor
C)Shortness of breath
D)Nosebleeds
Q4) Patient results indicate an RPI of 1.8 and an MCV of 10 fl.Do these results make sense? Why or why not?
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Chapter 12: Anemias of Disordered Iron Metabolism and Heme Synthesis
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Q1) Explain the absorption and assimilation of nonheme iron into hemoglobin in the RBC.
Q2) The patient was found to have normal serum iron studies.What other reflex test(s)should be done?
A)Blood lead level
B)Porphyrin studies
C)Reticulocyte count
D)Osmotic fragility
Q3) Note the text states 200 mcg/L in premenopausal females and 300 µg/L in men and postmenopausal women (page 220).Iron overload exists when ferritin levels are higher than:
A)100 ng/mL
B)200 ng/mL
C)50 ng/mL
D)24 ng/mL
Q4) Differentiate between primary and secondary hemochromatosis.
Q5) Explain the difference between the chemical composition of hemosiderin and that of ferritin.
Q6) Explain how lead inhibits heme synthesis.
Page 14
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Chapter 13: Hemoglobinopathies: Qualitative Defects
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Q1) What reflex test is most appropriate for investigating these results?
A)Hemoglobin electrophoresis and iron studies
B)Bone marrow aspirate
C)Vitamin B and folate assays
D)Cytogenetic analysis
Q2) Based on these findings,what test would be the logical next step?
A)Bone marrow aspirate
B)Osmotic fragility
C)Sickle solubility test
D)Peripheral blood smear
Q3) Evolution dictates that patients with sickle cell disease have an inherent resistance to which of the following?
A)Babesia infections
B)Acute leukemia
C)Hemolytic transfusion reactions
D)Plasmodium infections
Q4) How is methemoglobin detected in the laboratory?
Q5) Explain how methemoglobin is formed and how its presence impacts oxygen delivery.Be sure to include oxygen affinity in your answer.
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Chapter 14: Thalassemia
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Q1) Correlate the mutation type to each of the following disorders:
a. -thalassemia major
b. -thalassemia major
c. - thalassemia silent carrier
Q2) Most defects in beta thalassemia are a result of what genetic defect?
A)Loss of gene expression because of promoter region methylation
B)Point mutations in regions of the DNA controlling gene expression
C)Deletion of the structural globin gene
D)Omission of the alpha globin chain
Q3) When a diagnosis of thalassemia is suspected,which test should always be done?
A)Hemoglobin electrophoresis
B)Bone marrow aspiration
C)Iron studies
D)Vitamin B assay
Q4) Thalassemias are defined as:
A)Qualitative defects in globin chain synthesis
B)Quantitative defects in globin chain synthesis
C)Kinetic defects of iron in heme synthesis
D)Structural defects in heme synthesis
Q5) Why are thalassemias considered a separate entity from hemoglobinopathies?
Page 16
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Chapter 15: Megaloblastic and Nonmegaloblastic
Macrocytic Anemias
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Q1) An analyzed blood specimen reveals the following: the MCV is increased,the hemoglobin level is decreased,and the reticulocyte count is normal or low.What test could give more information on the cause of the anemia without drawing another blood specimen?
A)Serum iron
B)Vitamin B assay
C)Blood smear morphological exam
D)Serum alcohol
Q2) Which of the following is found in megaloblastic anemia but not in nonmegaloblastic macrocytic anemia?
A)Macrocytic erythrocytes
B)Howell-Jolly bodies
C)Heinz bodies
D)Hypochromia
Q3) Predict the levels of MMA and homocysteine in patients with Vitamin B deficiency.
A)Both will be normal.
B)Both will be decreased.
C)Both will be increased.
D)MMA will be increased and homocysteine will be normal.
Page 17
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Chapter 16: Hypoproliferative Anemias
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Q1) Patients with renal disease are at risk for developing megaloblastic anemia because of:
A)Decreased EPO production and utilization
B)Increased NADPH production
C)Folate deficiency
D)Acute blood loss
Q2) Fanconi's syndrome is an example of:
A)Constitutional aplastic anemia
B)Acquired aplastic anemia
C)Constitutional anemia from external stimuli
D)Acquired aplastic anemia from external exposure
Q3) Acquired chronic pure red cell aplasia is a rare disorder encountered in association with several autoimmune disorders.What does the mechanism appear to be?
A)B cell-mediated immunosuppression of neutrophils
B)T cell-mediated immunosuppression of erythropoiesis
C)Cytokine-mediated immunosuppression of erythropoiesis
D)Increased serum erythropoietin
Q4) Define constitutional aplastic anemia,and give an example.
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Page 18
Chapter 17: Hemolytic Anemia: Membrane Defects
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Q1) A defect in ankyrin is described as:
A)A vertical interaction defect
B)A horizontal interaction defect
C)Both vertical and horizontal interaction defects
D)Cannot be determined
Q2) Which of the following causes horizontal interactions of skeletal protein abnormalities?
A)Ankyrin
B)Glycophorin C
C)Band 3
D)Protein 4.2
Q3) PNH is currently detected in the lab by which of the following?
A)Immunophenotyping
B)Ham and sucrose lysis tests
C)Donath-Landsteiner test
D)Osmotic fragility
Q4) Explain how a somatic mutation in the PIGA gene leads to PNH.
Q5) Explain why patients with HS typically have an MCHC >36%.
Q6) Differentiate between the three different subtypes of HE based on PB smear morphology.
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Chapter 18: Hemolytic Anemia: Enzyme Deficiencies
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Q1) Why are echinocytes seen in PK deficiency?
Q2) 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
Q3) The erythrocyte morphology associated with pyruvate kinase deficiency is:
A)Microcytic,hypochromic
B)Macrocytic,hypochromic
C)Normocytic,normochromic.
D)Normocytic,hypochromic
Q4) Female heterozygotes for G6PD deficiency have one population of cells that is normal and one that is G6PD deficient because:
A)There is random inactivation of one X chromosome
B)There is random inactivation of one Y chromosome.
C)There is random activation of one X chromosome.
D)There is random activation of one Y chromosome.
Q5) What is the purpose of the HMP shunt,and why is it important?
Q6) Why are Heinz bodies seen in G6PD deficiency?
Q7) How do Heinz bodies differ morphologically from other erythrocyte inclusions?
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Chapter 19: Hemolytic Anemia: Immune Anemias
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Q1) Which of the following pairs of mother and fetus shows the most likely potential for initiating HDFN in the fetus?
Mother Fetus
A)Group A,Rh positiveGroup O,Rh positive
B)Group B,Rh negativeGroup O,Rh positive
C)Group AB,Rh positiveGroup A,Rh negative
D)Group A,Rh negativeGroup AB,Rh negative
Q2) During transfusion,a patient developed pain in the area of the needle,shortness of breath,and chest tightness.What is the most likely cause?
A)Heart attack
B)Acute hemolytic transfusion reaction
C)TRALI
D)Anaphylactic transfusion reaction
Q3) Which of the following characterizes acute hemolytic transfusion reaction?
A)Extravascular hemolysis
B)Gastrointestinal hemorrhage
C)Intravascular hemolysis
D)Thrombosis
Q4) Compare the three mechanisms of drug-induced immune hemolysis.
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Chapter 20: Hemolytic Anemia: Nonimmune Defects
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Q1) In what type of hemolytic anemia does damage to the endothelial lining of the small vessels result in deposits of fibrin with the vessels?
A)Exercise-induced hemoglobinuria
B)The type associated with infectious agents
C)The type associated with animal venoms
D)Microangiopathic hemolytic anemia
Q2) A woman visits her obstetrician for a routine prenatal visit at 24 weeks.Her blood pressure is 180/100 and her urinalysis shows 3+ proteins.The peripheral blood smear demonstrated the presence of schistocytes.What other elevated test results might be found?
A)Liver enzymes
B)BUN and creatinine
C)PT and APTT
D)Haptoglobin
Q3) Explain why infections with Clostridium perfringens lead to hemolysis of the RBCs.
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) Which of the following anomalies is morphologically similar to toxic granulation and is often seen in patients who have poor mucopolysaccharide degradation?
A)May-Hegglin
B)Pelger-Huët
C)Chédiak-Higashi
D)Alder-Reilly
Q2) How does immediate neutrophilia differ from acute neutrophilia?
A)Immediate neutrophilia occurs within 4-5 hours of stimulus,whereas acute neutrophilia occurs within 30 minutes.
B)Immediate neutrophilia lasts 20-30 minutes,whereas acute neutrophilia lasts hours to days.
C)In immediate neutrophilia,circulating neutrophils show an increase in early neutrophil precursors,whereas acute neutrophilia has mature neutrophils.
D)In immediate neutrophilia,the leukocytes return to normal as the bone marrow production increases,whereas acute neutrophilia has mature neutrophils.
Q3) List three laboratory results that can distinguish a leukemoid reaction from CML.
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Chapter 22: Nonmalignant Lymphocyte Disorders
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Q1) Which of the following is an expected finding regarding the morphology of an activated lymphocyte that is different from a normal lymphocyte?
A)Oval nucleus
B)Prominent nucleoli
C)Abundant cytoplasm
D)Clumped chromatin
Q2) What are the most common laboratory findings in CMV infection in the newborn?
A)Thrombocytopenia and hemolytic anemia
B)Leukocytosis
C)Positive heterophile agglutinin test.
D)Viral DNA assay is negative.
Q3) What is the agent responsible for infectious mononucleosis?
A)Toxoplasmosis
B)CMV
C)EBV
D)Bordetella pertussis
Q4) Compare and contrast X-linked SCID and autosomal SCID.
Q5) 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) How are oncogenes and proto-oncogenes different?
A)Proto-oncogenes are activated tumor genes,whereas oncogenes are inactivated tumor suppressor genes.
B)Oncogenes can lead to tumor formation,whereas proto-oncogenes prevent tumor formation.
C)Oncogenes can lead to tumor formation,whereas proto-oncogenes are inactivated forms of oncogenes.
D)Oncogenes are tumor suppressors,whereas proto-oncogenes cause tumor formation.
Q2) Which two stains are used to differentiate the myeloid from the lymphoid blasts?
A)MPO and SBB
B)PAS and LAP
C)Acid phosphatase and LAP
D)Toluidine blue and reticulin stain
Q3) Bleeding,infections,and anemia are common complications of chemotherapy because:
A)Drugs are used kill normal cells as well as leukemic cells.
B)Normal cells are more susceptible to drug-induced apoptosis than leukemic cells.
C)Drugs bind preferentially to normal cells.
D)Drugs induce the formation of autoantibodies to normal cells.
Q4) Explain how proto-oncogenes contribute to tumor formation.
Page 25
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Chapter 24: Myeloproliferative Neoplasms
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Q1) Which of the following is described by the presence of circulating mast cells in the peripheral blood ( 10%),mast cells composing > 20% of the nucleated cells in bone marrow,and multiorgan failure:
A)MPN,U
B)Mast cell leukemia
C)PV
D)Clonal hypereosinophilia
Q2) A routine CBC is ordered on a patient.Results are as follows: WBC count: 22.0 × 10 /L
PLT: 957 × 10 /L
RBC: 5.00 × 10¹²/L
PB smear: moderate platelet clumping and giant platelets noted These results are characteristic of which disorder?
A)PMF
B)ET
C)PV
D)CML
Q3) Explain how a variant of CML is identified utilizing laboratory values.
Q4) Contrast MDS and MPN utilizing laboratory test result information.
Q5) Explain the significance of the Philadelphia chromosome in ALL.
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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) A 60-year-old patient visited his general practitioner because of fatigue and unexplained bruising.Physical examination revealed a frail,thin,pale man with widespread bruising.A CBC was ordered and revealed abnormal granularity of platelets and leukocytes.Red cells appeared dimorphic.Bone marrow analysis showed 20% ringed sideroblasts with dysplastic changes in RBC and WBC precursors.No cytogenetic abnormalities were detected.Based on this information,what is a probable diagnosis?
A)Acute leukemia
B)Chronic lymphocytic leukemia
C)Myelodysplastic syndrome
D)Myeloproliferative syndrome
Q3) Give at least five morphologic indicators of dyserythropoiesis.
Q4) Explain the International Prognostic Scoring System (IPSS)score system for prognosis and treatment of MDS.
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Chapter 26: Acute Myeloid Leukemias
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Q1) An acute leukemia patient presents with blast morphology that is of neutrophil lineage with Auer rods and pseudo-Pelger-Huët nuclei,myeloperoxidase,and Sudan Black B.Cytogenetic analysis reveals a t(8;21) ( q22;q22)translocation in the majority of the blasts.Which classification of AML best fits this morphology,immunophenotyping,and cytochemistry?
A)AML not otherwise categorized
B)AML with multilineage dysplasia
C)AML with recurrent genetic abnormalities
D)AML,therapy-related
Q2) What is the definition of acute leukemia,according to the World Health Organization?
Q3) Which of the following cell markers differentiate AML from ALL?
A)CD10,CD19,CD20,and CD22
B)CD2,CD3,CD5,and CD7
C)HLA-DR,CD34,and CD7
D)CD13,CD33,CD19,CD20,CD22,CD10,CD2,CD3,CD5,and CD7
Q4) Patients with acute myelomonocytic leukemia are at higher risk of infection compared with individuals with acute myelocytic leukemia with differentiation.Explain why there is a higher risk of infection in patients diagnosed with acute myelomonocytic leukemia.
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Chapter 27: Precursor Lymphoid Neoplasms
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Q1) Which of the following is a positive predictive factor in children with precursor B-ALL?
A)High leukocyte count;less than 1 year of age
B)Low leukocyte count;4-10 years of age
C)High leukocyte count;PBX1/E2A translocation
D)Hyperdiploid chromosomes,high leukocyte count,less than 1 year of age
Q2) A technologist is reviewing a patient's blood smear.She notices that 85% blasts are present but is having a difficult time identifying the lineage.Cytochemical staining is subsequently performed,and the results for MPO,SBB,NSE,and PAS are negative.Based on this information,what is the most likely lineage of the unknown blasts?
A)T lymphoid
B)B lymphoid
C)Erythroid
D)Myeloid
Q3) Name the classifications of ALL,and explain how they differ in molecular analysis and immunophenotype.
Q4) Summarize and explain why patients develop the clinical signs and symptoms oberserved in patients with ALL.
Q5) Contrast the clinical and laboratory findings of ALL to LBL.
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Chapter 28: Mature Lymphoid Neoplasms
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Q1) A physician is working up a patient.Based on physical examination,history,and initial screening tests,the physician suspects anaplastic large cell lymphoma (ALCL),but still needs to rule out classical Hodgkin lymophoma (HL).Which of the following test results would confirm ALCL?
A)CD15 positive,CD30 negative
B)CD15 positive,CD30 positive
C)CD15 negative,CD30 negative
D)CD15 negative,CD30 positive
Q2) Which of the following characteristics differentiates Hodgkin and non-Hodgkin lymphomas?
A)Molecular diagnostics and flow cytometry test results
B)Cytochemical and cytogenetic findings
C)Stage,distribution,mode of spread,extranodal disease,peripheral blood,cell type,and treatment regimen
D)Nodular growth pattern,BCL expression,and CD19+
Q3) Identify the lab features of the following disorders:
a.Plasmacytoma
b.Multiple myeloma
c.MGUS
d.Waldenström's macroglobulinemia
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Chapter 29: Hematopoietic Stem Cell Transplantation
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Q1) Which of the following occurs prior to infusion of stem cells into the recipient?
A)Blood count for ANC
B)Chimerism studies
C)GM-CSF infusion
D)CD34 enumeration
Q2) Which of the following laboratory tests is used to assess long-term engraftment?
A)Automated complete blood count
B)Chimerism
C)CD34 count by flow
D)Manual WBC count
Q3) Which of the following is used to quantitate the number of hematopoietic stem cells collected?
A)CD34 quantitation by immunophenotyping
B)Chimerism study by immunophenotyping
C)Ratio of neutrophils to lymphocytes
D)Cytochemical study
Q4) Explain the significance of HLA and ABO antigen compatibility in stem cell transplantation.
Q5) 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) Necrotic PMNs in a cytospin can be easily mistaken for which of the following?
A)Nucleated RBCs
B)Hairy cells
C)Leukemic blasts
D)Hypersegmented PMNs
Q2) One of the definitive signs of hemorrhage in the CNS is:
A)Increased RBC count
B)Significant increase in WBC
C)Erythrophagocytosis
D)Presence of histiocytes
Q3) How would the technologist differentiate between a traumatic specimen collection tap and a cerebral hemorrhage?
Provide at least three macroscopic and three microscopic findings.
Q4) Cells found in fluids can be reactive mesothelial cells or malignant cells.Which features are found in reactive cells but not in malignant cells?
A)Smooth nuclear membranes
B)Chromatin unevenly distributed
C)Nucleoli prominent and frequently multiply
D)Nuclear molding
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Chapter 31: Primary Hemostasis
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Q1) Which platelet ultrastructural zone has the functions of secretion,storage,and lipid metabolism?
A)Peripheral
B)Structural
C)Organelle
D)Membrane zone
Q2) Formation of a blood clot on the interior surface of an intact (unsevered)vessel is referred to as:
A)Blood coagulation
B)Hemostasis
C)Thrombosis
D)Fibrinolysis
Q3) Which of the following substances endogenous to the dense bodies is responsible for continuous platelet activation of surrounding platelets?
A)Platelet factor 4
B)Collagen
C)ADP
D)Epinephrine
Q4) 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) During activation of coagulation,all of the following bind to the phospholipid membrane surface forming a complex except:
A)Procoagulant zymogen (substrate)
B)Coagulation inhibitors
C)Procoagulant cofactors
D)Activated serine protease
Q2) What is the key component in secondary hemostasis that binds the platelets into a solid plug?
A)Fibrin
B)Tissue factor
C)Plasminogen
D)Thrombin
Q3) Hemostasis depends on which of the following?
A)The interaction between coagulation and fibrinolysis inhibitors
B)The interaction between platelets,coagulation proteins,and blood vessels
C)The rate of platelet destruction
D)the rate of endothelial cell turnover
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) A patient has a platelet count of 80 x 10 /L and a bleeding time of 15 minutes.From what is the patient most likely suffering?
A)A platelet function disorder
B)A quantitative platelet disorder
C)A combined platelet disorder
D)von Willebrand disease
Question: Is it good practice to perform a bleeding time on a thrombocytopenic patient?
No.Also Bleeding Times are being replaced in many labs by TEG (thromboelastography)and platelet function analyzers (i.e.PFA 100)
Q2) Aspirin affects platelet aggregation because it interferes with:
A)Cyclooxygenase activity
B)Platelet adhesion to collagen
C)Development of platelets
D)Binding of fibrinogen to platelets
Q3) Which of the following physical symptoms are associated with scurvy?
A)Hemangiomas
B)Ecchymoses
C)Bleeding into joints and muscles
D)Purpura fulminans
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Chapter 34: Disorders of Secondary Hemostasis
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Q1) Use this case to answer the following questions: ? A 5-year-old boy visits his primary care physician after an accident on his bike.It was his first accident,and he fell on his knees.His mother noticed severe swelling in his knees and elbows but thought that it was from the accident.She placed an ice pack on the affected areas and put him to rest.After a few days,the swelling had not improved,so she made an appointment to see his physician who asks him a few questions about the accident and then proceeds to perform a physical examination.The physician notes small hematomas on his elbows,knees,and his upper torso.The results from the blood draw follow.
PT: 12.2 sec (RR: 11.3-12.8 sec)
INR: 1.12
APTT: 72 sec (RR: 23-32 sec)
Platelet aggregation studies: normal aggregation with all agonists
The physician admits him to the area hospital.What should be the next course of action in investigating these results?
A)Repeat the aggregation studies
B)Start the patient on Coumadin
C)Order factor assays of the intrinsic pathway
D)Order factor assays of the intrinsic,extrinsic,and common pathways
Q2) What laboratory tests typically are utilized to detect lupus anticoagulants?
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Chapter 35: Thrombophilia
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Q1) It has been determined that a patient has activated protein C resistance.Name the most prevalent genetic mutation associated with this finding.
A)Guanine to adenine substitution on nucleotide 20210 of the prothrombin gene
B)Lysine to glutamic acid substitution on the sixth position on the beta globin chain
C)Arginine to glutamine substitution at the 506 position of factor V protein
D)Translocation of chromosome 22 onto the long arm of chromosome 9
Q2) How does a thrombus become a thromboembolus?
Q3) Which laboratory test is considered to have a reliable negative predictive value in the diagnosis of DVT?
A)Factor VLeiden
B)PT
C)tPA
D)D-dimer
Q4) Mutations in which of the following gene(s)lead to hyperhomocysteinemia?
A)HFE and MTHFR genes
B)CBS and MTHFR genes
C)Prothrombin gene
D)Factor V gene
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Chapter 36: Hemostasis: Laboratory Testing and Instrumentation
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Q1) Proper specimen collection for coagulation testing must be performed to eliminate contamination of substances that will interfere with the test results.Which of the following are considered contaminants for coagulation testing?
A)Sodium citrate and heparin anticoagulant
B)Tissue factor and anticoagulant carryover
C)Air and tissue factor
D)High hematocrit and anticoagulant carryover
Q2) A hemophilic A patient has a severe bleed and is being treated with Factor VIII concentrate.When testing his postinfusion,the factor VIII level does not increase.The problem could be:
A)Lupus anticoagulant
B)Improper drawing of the specimen
C)Factor VIII inhibitor
D)Factor IX inhibitor
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
Page 38
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Chapter 37: Hematology Procedures
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Q1) What is the screening test of choice in the workup of PNH?
A)Acid elution of hemoglobin F
B)Hemoglobin A estimation
C)Soluble transferrin receptor
D)Sugar-water test
Q2) A patient's osmotic fragility test results show beginning hemolysis at 0.40% NaCl and complete hemolysis at 0.20% NaCl.Increased numbers of which erythrocyte morphology are associated with these findings?
A)Schistocytes
B)Tear drop cells
C)Spherocytes
D)Target cells
Q3) A patient is about to begin a regimen of chemotherapy,and his attending has ordered a battery of lab tests including comprehensive chemistry metabolic panel,complete blood count,coagulation studies,amylase and lipase,hemoglobin
A1C,lipid panel,thyroid panel,PSA,rubella IgG,HIV,and syphilis.Five tiger-top tubes,2 light blue-top tubes,and 2 lavender-top tubes are needed.Correlate each test to the appropriate tube,and indicate the correct order of draw for the tubes.
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Chapter 38: Bone Marrow Examination
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Q1) All of the following are sites for bone marrow specimen collection except the:
A)Tibia
B)Femur
C)Sternum
D)Iliac crest
Q2) All of the following are required information on a bone marrow report except:
A)Site of sampling and type of sample(s)obtained
B)Side-by-side comparison of bone marrow differential and peripheral blood differential results
C)Results of ancillary studies
D)Final diagnosis by the pathologist
Q3) It has been determined that the M:E ratio of a 55-year-old patient is 12:1.What can be concluded about the cellularity of the bone marrow?
A)The bone marrow has myeloid hyperplasia.
B)The bone marrow has erythroid hyperplasia.
C)The bone marrow is normal.
D)The overall cellularity of the marrow is hypercellular.
Q4) Name five distinguishable characteristics that will help differentiate benign lymphoid aggregates and malignant lymphoma.
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Chapter 39: Automation in Hematology
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Q1) Which of the following represents the degree of light scatter that reflects cell complexity on the CELL-DYN Sapphire?
A)0 degrees
B)7 degrees
C)90 degrees
D)90 degrees depolarized
Q2) In the reticulocyte determination,using the Sysmex XE-2100,the fluorescent dye containing oxazine and polymethine penetrates the cell membranes and stains the blood cells.What does the oxazine bind to within the cells?
A)Residual DNA
B)Hemoglobin
C)Residual RNA
D)Mitochondria
Q3) Which of the following is a reported parameter for the ADVIA 120 but not for the LH 750 instrument?
A)RDW-CV
B)Retic%
C)CHCM
D)MCVr
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Chapter 40: Flow Cytometry
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Q1) Which of the following is(are)the clinical application(s)of flow cytometry?
A)Assessment of total body iron
B)Immunophenotyping
C)DNA amplification
D)Cytogenetic analysis
Q2) A single group of cells possessing identical aberrant phenotypes is defined as:
A)Monoclonal
B)Clonal
C)Tumorigenic
D)Contour gated
Q3) What is one advantage to using monoclonal antibodies rather than polyclonal antibodies in immunophenotyping?
A)They are commercially available.
B)The antigen can be recognized even if some parts of it are abnormal.
C)They have high purity and reproducibility.
D)They can be directly attached to fluorochromes.
Q4) Explain why flow cytometry is of limited use in identifying AML.
Q5) Explain the advantages of using flow cytometry to count reticulocytes.
Q6) For what reason is flow cytometry used in cell quantitation?
Q7) 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) Which specimen would be optimal for studying lymphoma?
A)Peripheral blood
B)Amniotic fluid
C)Involved lymph node
D)Solid tumor biopsy
Q2) What is the main difference between nondisjunction and anaphase lag?
A)Nondisjunction results in a trisomy and monosomy,whereas anaphase lag results in a monosomy only.
B)Nondisjunction results in polyploidy,whereas anaphase lag results in aneuploidy.
C)Anaphase lag results in a nonviable cell,whereas nondisjunction results in a viable cell.
D)There is no difference between anaphase lag and Nondisjunction.
Q3) Which of the following can result in trisomy?
A)Anaphase lag
B)Nondisjunction
C)Chromosome banding
D)Endomitosis
Q4) Describe the steps involved in cytogenetic harvesting and banding,and explain the purpose of each.
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Chapter 42: Molecular Analysis of Hematologic Diseases
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Q1) Name and compare two molecular methods used to detect mutations associated with sickle cell disease.
Q2) Inherited diseases are characterized by:
A)Sex-linked mutations expressed only in females
B)Acquired mutations detected only in affected organs
C)Lack of correlation between genotype and disease status among family members
D)Genetic defect generally present in all tissues of the patient's body
Q3) What is the definition of allele?
A)A fundamental substance of heredity that cells use to catalog,express,and propagate information
B)The two versions of a gene that are inherited from each parent
C)A messenger molecule that translates the DNA code to induce protein production
D)The functional unit composed of amino acids
Q4) Explain why molecular testing is essential not only in identifying disorders,such as cancer,but also during the course of a disease.
Q5) Explain the central dogma of molecular biology using proper nomenclature.Define each phase.
Q6) Give the advantages of PCR over Southern blot and advantages of Southern blot over PCR.
Page 44
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