TEST BANK Rodak's Hematology Clinical Principles and Applications Elaine M. Keohane, Catherine N. Otto, Jeanine M. Walenga
TABLE OF CONTENTS Part I: Introduction to Hematology 1. An Overview of Clinical Laboratory Hematology 2. Quality Assurance in Hematology and Hemostasis Testing Part II: Blood Cell Production, Structure, and Function 3. Cellular Structure and Function 4. Hematopoiesis 5. Erythrocyte Production and Destruction 6. Erythrocyte Metabolism and Membrane Structure and Function 7. Hemoglobin Metabolism 8. Iron Kinetics and Laboratory Assessment 9. Leukocyte Development, Kinetics, and Functions 10. Platelet Production, Structure, and Function Part III: Laboratory Evaluation of Blood Cells 11. Manual, Semiautomated, and Point-of-Care Testing and Hematology 12. Automated Blood Cell Analysis
13. Examination of the Peripheral Blood Film and Correlation with the Complete Blood Count 14. Bone Marrow Examination 15. Body Fluid Analysis in the Hematology Laboratory Part IV: Erythrocyte Disorders 16. Anemias: Red Blood Cell Morphology and Approach to Diagnosis 17. Disorders of Iron Kinetics and Heme Metabolism 18. Anemias Caused by Defects of DNA Metabolism 19. Bone Marrow Failure 20. Introduction to Increased Destruction of Erythrocytes 21. Intrinsic Defects Leading to Increased Erythrocyte Destruction 22. Extrinsic Defects Leading to Increased Erythrocyte Destruction-- Nonimmune Causes 23. Extrinsic Defects Leading to Increased Erythrocyte Destruction-- Immune Causes 24. Hemoglobinopathies (Structural Defects in Hemoglobin) 25. Thalassemias Part V: Leukocyte Disorders 26. Non-Malignant Leukocyte Disorders 27. Intro to Hematologic Malignancies 28. Flow Cytometric Analysis in Hematologic Disorders 29. Molecular Diagnostics in the Clinical Laboratory
30. Cytogenetics 31. Acute Leukemias 32. Myeloproliferative Neoplasms 33. Myelodysplastic Syndromes 34. Mature Lymphoid Neoplasms Part VI: Hemostasis and Thrombosis 35. Normal Hemostasis and Coagulation 36. Hemorrhagic Disorders and Laboratory Assessment 37. Qualitative Disorders of Platelets and Vasculature 38. Thrombocytopenia and Thrombocytosis 39. Thrombotic Disorders and Laboratory Assessment 40. Antithrombotic Therapies and Their Laboratory Assessment 41. Laboratory Evaluation of Hemostasis 42. Hemostasis and Coagulation Instrumentation Part VII: Hematology and Hemostasis in Selected Populations 43. Hematology and Hemostasis in the Pediatric, Geriatric, and Pregnant Populations
Rodaks Hematology 6th Edition Walenga Test Bank 1. Chapter 01-01 Hematology is the study of: *a. blood cells. b. serum electrolytes. c. plasma hormone levels. d. bacteria in the blood. General Feedback: Hematology is the study of blood cells—red blood cells, white blood cells, and platelets. Plasma and serum electrolytes and hormone levels are evaluated in various subdivisions of clinical chemistry, and bacteria are evaluated in clinical microbiology.
2. Chapter 01-02 The morphology of blood cells is important to evaluate: a. every time a complete blood count (CBC) is requested on a patient. b. when an instrument-generated flag is obtained. *c. when a profiling instrument result is abnormal. d. when the white count is elevated. General Feedback: Every laboratory must determine—based on its instrumentation, needs of the clinician and other parameter flags that alert the medical laboratory scientist to the necessity for further evaluation—when it is necessary to evaluate cell morphology. Many instrument-generated flags, although useful, may not require review. If an automated CBC does not suggest the need, no reason exists to evaluate the blood film, even if the white count is elevated.
3. Chapter 01-03 Who is ultimately responsible for determining the specimen integrity before analysis? *a. Medical laboratory professional b. Nursing staff c. Phlebotomist d. Specimen-processing personnel General Feedback: The medical laboratory scientist is responsible for ensuring the integrity of a specimen before analysis. Only he or she can judge whether the specimen is acceptable so that valid results can be obtained. Acceptable criteria include such things as type of specimen for the test ordered (e.g., blood, serum, urine); appropriate additive present (if needed) and amount of specimen relative to the additive; time interval since obtained; and presence or absence of hemolysis, lipemia, and other similar conditions. None of the other personnel named have the education and understanding to fully make that judgment.
4. Chapter 01-04 Hematocrit is also called: a. white cell count. b. bone marrow examination. c. red blood cell (RBC) count. *d. packed red cell volume. General Feedback: Historically the hematocrit was determined by centrifuging an aliquot of anticoagulated whole blood under specified conditions (e.g., centrifugal force, capillary tube length, and bore diameter) and then determining the ratio of the space occupied by the packed red cells compared with that of the entire blood volume in the capillary tube, often expressed as a percentage. Hence, it is also called the packed red cell volume.
5. Chapter 01-05 The primary function of platelets is to: a. defend the body against bacterial invasion. b. carry oxygen to tissues. *c. facilitate blood clotting. d. regulate acid-base balance. General Feedback: Whenever disruption occurs to a blood vessel so that bleeding results, platelets respond initially to stop the bleeding in small vessels; they also play an integral role in facilitating the formation of a blood clot. White cells defend against bacterial invasion; red cells (i.e., hemoglobin) carry oxygen to tissues; and a complex interaction of plasma electrolytes, proteins, and carbon dioxide participates in acid-base balance.
6. Chapter 01-06 Which of the following can be evaluated only through the microscopic examination of a stained blood film? a. White blood cell (WBC) count b. Reticulocyte count c. Hemoglobin concentration *d. Presence or absence of cytoplasmic inclusions General Feedback: Making and staining a blood film and then placing it under a microscope allow the medical laboratory scientist to evaluate the morphology of blood cells and examine them for the presence or absence of blood cell inclusions. These inclusions are important for cell identification and, when abnormal inclusions are present, sometimes provide “clues” as to the cause of disease. All the other parameters mentioned are or can be performed using an automated hematology instrument, including reticulocyte counting.
7. Chapter 01-07 Upon centrifugation of a blood specimen, the layer between the red blood cells and plasma is called the: a. hematocrit. *b. buffy coat. c. serum. d. platelet pellet. General Feedback: When blood is centrifuged, the layer between the red cells and plasma is called the buffy coat. This layer consists of both white blood cells and platelets. The hematocrit is the packed cell volume that reflects the number of red blood cells. The serum is the liquid portion of the blood formed from a clotted blood sample. The platelet pellet is a special layer of platelets that is required for platelet function studies. This layer of platelets is prepared from a whole blood specimen using specific centrifugation time and speed.
8. Chapter 01-08 Select the term that describes a low white blood cell count. *a. Leukopenia b. Leukocytosis c. Neutropenia d. Leukemia General Feedback: The term leukopenia refers to a low total white blood cell count. Leukocytosis is a term that describes an increase in white blood cell count. Neutropenia is a low cell count that is specific to the neutrophils. Leukemia is cancer of the blood cells, most often white blood cells.
2. Chapter 02-02 A patient’s white blood cells (WBCs) are counted on an automated cell counter 10 times. The mean white count is 8000/mL, and the standard deviation (SD) is 300. What is the coefficient of variation (CV)? a. 0.04% b. 2.6% *c. 3.8% d. 26% General Feedback: % CV = (SD/mean) × 100 = (300/8000) × 100 = 3.8%.
3. Chapter 02-03 What does the CV calculated in Question 2 describe about the white cell counts? a. Accuracy b. Reliability c. Proper calibration *d. Precision General Feedback: The CV is a measure of precision, or how well a result can be reproduced. It allows comparisons of assays with different means and is a unitless number, although usually expressed as a percentage. Accuracy is how close a result is to the true value; proper calibration is required to obtain accuracy. Reliability is how well a method holds both accuracy and precision over time.
4. Chapter 02-04 A patient specimen is analyzed on an instrument known to be in control from previous assays performed on a calibrated instrument and gives a hemoglobin result of 13.2 g/dL. Two hours later it is evaluated on another instrument that is being evaluated for purchase by the laboratory. The result is 11.8 g/dL. This result, when compared with the first, is: a. acceptable agreement. b. reportable. c. precise agreement. *d. inaccurate. General Feedback: This result is inaccurate compared with the first because it is significantly different. Precision is not known, because multiple results are needed to determine precision; in addition, precision must be determined using the same instrument, not between instruments. Because it is not accurate, it cannot be reported.
5. Chapter 02-05 Which is true regarding reference ranges?
a. Should be derived from reference books b. Need to be determined only for adults c. Can be established by running the test procedure on 10 healthy people *d. Are ranges of values for an analyte in normal healthy people General Feedback: Reference ranges should be determined by evaluating a group of perhaps as many as 120 normal healthy people for the same analyte. If the analyte differs in different groups, based on data such as age and sex, it must be determined for each group if at all possible.
6. Chapter 02-06 A test that is positive in all patients who have the disease but also in some who do not have the disease is: *a. sensitive. b. specific. c. precise. d. reliable. General Feedback: Sensitivity (diagnostic) is defined by the number of people with the disease who test positive. In this case, all patients with the disease have a positive result, so the test is very sensitive. The test, however, is not specific because it is also positive in some people who do not have the disease. Reliability refers to the performance stability of a test over time. Precision evaluates reproducibility of the result if repeated multiple times on a specimen.
7. Chapter 02-07 The antinuclear antibody (ANA) test is positive in almost all people who have systemic lupus erythematosus (SLE). It is also positive in some patients who do not have SLE. The antideoxyribonucleic acid (antiDNA) test is positive only in people with SLE but not in all who do. Which of the following is true? *a. The ANA test is a good screening test, and anti-DNA test is a good confirmatory test. b. The anti-DNA test is a good screening test, and the ANA test is a good confirmatory test. c. Both are good screening tests for SLE. d. Neither of these tests is valid. General Feedback: Because almost all patients with SLE have a positive ANA test, it is a good screening test (if the result is negative, it practically rules out this diagnosis for a patient). However, because the ANA test is also positive in other patients, the anti-DNA test is a good confirmatory test, because only patients with SLE have a positive result. In practice, the ANA test is done first; if it is positive, then the anti-DNA test is done as follow-up. If a patient is positive with both tests, then his or her diagnosis is SLE.
8. Chapter 02-08 A purchased hemoglobin standard is used to adjust a hemoglobinometer. This standard is being used as a: a. control. b. precision check. c. delta check. *d. calibrator. General Feedback: Standards are used to calibrate instruments. Controls are used to routinely evaluate the accuracy of a method once it is calibrated. Precision is a measure of reproducibility, whereas delta checks compare a patient result with a previous result (same test on the same patient). This can only be done for a test result that essentially does not vary significantly from testing time to testing time.
9. Chapter 02-09 The tubing that brings the lyse reagent to the hemoglobin cuvette on an automated cell counter is pinched and not delivering any reagent. All hemoglobin values are greater than 20 g/dL. This represents what type of error? a. Random b. Imprecision *c. Constant systematic d. Proportional systematic General Feedback: A constant systematic error is one in which the magnitude of the error remains the same throughout the range of the test measurement. The error is proportional if the magnitude varies relative to the result. This is not a random error, which happens only infrequently and is not predictable. Precision requires multiple measurements of the same specimen and evaluates the ability to consistently reproduce the result.
10. Chapter 02-10 One of two controls that have been evaluated over the last 28 days gives a result on day 29 between 2 and 3 SDs of the mean; the other control is within 2 SDs of its mean. What is the correct procedure to follow? a. Ignore the result unless it happens again the next day. *b. Rerun the control and, if acceptable, continue with patients. c. Recalibrate the instrument. d. Open new vials of controls and repeat both controls. General Feedback: One control is acceptable, whereas the other is a warning that the method may be going out of control. The test option in this case is to repeat the analysis of the control, and if it is acceptable, continue with patient analysis, reporting the results. The instrument
does not appear to need recalibration because one control is acceptable and the other is within 3 SDs (1 result of 20 can acceptably be within ±3 SDs). If the repeat on the “out of control” vial is still out between 2 and 3 SDs, then a new vial of that control should be opened and analyzed. The control that was acceptable does need to be repeated.
11. Chapter 02-11 The control values for both controls for the prothrombin test were ranging between the mean and ±1 SD for the first 19 days of use. Starting on day 20, the values for both were consistently between +1 and +2 SDs. This is an example of a: *a. shift. b. trend. c. random error. d. predictable error. General Feedback: If all results are consistently different from the previous in the same direction, it indicates a shift in the methodology has occurred. A trend would show a gradual change over time. This is neither a predictable error nor a random error because it is consistent.
12. Chapter 02-12 Which would most likely be associated with the situation described in Question 11? a. Operator error b. Fading light source c. Miscalibrated instrument *d. Starting a new lot number of thromboplastin reagent General Feedback: Shifts can occur when a new reagent is introduced. A fading light source would lead to trend error. If the instrument were calibrated incorrectly, both controls should be out; likewise, operator error would result in both controls being unacceptable.
13. Chapter 02-13 Which group of patients should not be included in establishing moving averages using red cell indices? *a. Chemotherapy patients b. Female patients c. Obstetric patients d. Surgical patients General Feedback: The moving average method works well in institutions that assay specimens from generalized populations that contain minimal numbers of sickle cell or oncology patients. This method is not restricted in female, obstetric, or surgical patients.
14. Chapter 02-14 A laboratory comparing its results to those of other laboratories on the same specimen is an example of: a. precision monitoring. b. internal quality assessment. *c. external quality assessment. d. delta checks. General Feedback: When results are compared with those of another laboratory, this is part of external quality assessment. Internal quality assessment is done totally within one laboratory. Delta checks compare a patient result with a previous result on the same patient. Precision is determined by multiple analysis of the same specimen.
15. Chapter 02-15 The best way to prevent errors in the laboratory is to: a. purchase high-quality instruments from reputable vendors. *b. hire professionals with integrity. c. have quality management. d. perform external quality control procedures. General Feedback: Competent professional staff that act with integrity can ensure that the best-quality results are routinely obtained for patients. A high-quality instrument is effective only when it is correctly calibrated and maintained. Management, although ultimately responsible, relies on the laboratory personnel to be aware of potential problems in assays. External quality control programs do not guarantee the daily validity of patient results.
16. Chapter 02-16 A laboratory gets numerous complaints regarding the length of time it takes hematology results to get to the emergency department. What would be an appropriate response? *a. Make this a quality assurance project. b. Ignore the complaints. c. Explain why it takes so long. d. Tell the employees to work faster. General Feedback: Quality assurance evaluates the process from the time a test is ordered until it is reported to the correct patient chart. One of the responsibilities of a clinical laboratory is to get results to physicians and other caretakers in a timely manner; the acceptable turnaround time for a particular procedure will vary depending on the reason it is ordered. Obviously, an emergency department has a need for rapid turnaround time. Complaints from caregivers should never be ignored; it probably is not reasonable to tell employees to work
faster, and explaining why it takes so long will not help provide good patient care.
17. Chapter 02-17 The precision limits of a method are defined by: a. the mean. *b. the SD. c. sensitivity. d. specificity. General Feedback: Evaluating the same specimen multiple times and applying statistics to the results determine precision or reproducibility. The SD describes the precision. The mean is the average result (assuming a gaussian distribution). Sensitivity describes how well a test identifies positive patients, whereas specificity is how well it identifies only positive patients.
18. Chapter 02-18 A clinical laboratory scientist performs 30 replicate hemoglobin determinations on a single blood sample. When statistics are used to determine the precision of the method, the mean is 13.8 g/dL and 1 SD is 0.1 g/dL. This means that 95.5% of the results on this specimen lie: a. between 13.4 and 14.2 g/dL. *b. between 13.6 and 14.0 g/dL. c. between 13.5 and 14.1 g/dL. d. between 13.7 and 13.9 g/dL. General Feedback: Because 1 SD is 0.1 g/dL, 2 SD = 0.2 g/dL. Thus 95.5% of the results lie between 13.6 (±2 SDs) and 14.0 (+2 SDs).
19. Chapter 02-19 The following hemoglobin results, reported in g/dL, are obtained on a hospitalized patient on 3 consecutive days: Day 1 Day 2 Day 3 14.3 11.5 14.4 The SD for this hemoglobin method was calculated in Question 18. A delta check was obtained on day 2. Controls were run as appropriate each day and were all within limits for this procedure. What is the most probable reason for the day 2 result when compared with those for days 1 and 3? a. It is within the 95.5% confidence levels for this test. *b. It may represent an error in patient identification. c. The patient had a major blood loss between days 1 and 2. d. It is within the 99% confidence levels for this test.
General Feedback: The results for days 1 and 3 are statistically the same result (i.e., they are within the 95.5% confidence levels for this procedure and are therefore precise). The result for day 2 is clearly very significantly different, thus giving a delta check (the only possible explanation of those given here is that a patient identification error occurred and the specimen on day 2 is from a different patient). Delta checks are designed to help pick up this kind of critical error. If it had been within the 99% confidence limits, it would have been within 3 SDs, or no less than 14.0 g/dL. Because the results from day 1 and day 3 are the same, blood loss with a drop in hemoglobin cannot explain the day 2 results.
1. Chapter 03-01 What component of the erythrocyte is most responsible for its cytoskeleton and cellular integrity? a. Glycocalyx *b. Cytoskeletal protein c. Nucleus d. Golgi apparatus General Feedback: Cytoskeletal proteins are found on the inner cytoplasmic side of the membrane and form the lattice of the cytoskeleton.
2. Chapter 03-02 What cellular component of the erythrocyte is its control center? a. Heterochromatin b. Golgi apparatus *c. Nucleus d. Cytoplasm General Feedback: The nucleus is the control center of the cell, is responsible for all its chemical reactions, and is the site of deoxyribonucleic acid (DNA) replication and transcription.
3. Chapter 03-03 How does the genetically active portion of the nuclear chromatin look when stained with Wright stain? a. Condensed, darkly stained b. Clumped, dark purple c. Ropelike, pink or red *d. Diffuse, uncondensed and pale blue General Feedback: The genetically active portion of the nuclear chromatin, composed of DNA plus supporting proteins, appears diffuse and uncondensed and stains pale blue with Wright stain. It is also called euchromatin. Chromatin, which is condensed and stains darkly, is also called heterochromatin; it is the genetically inactive portion of the nucleus.
4. Chapter 03-04 What cellular component “directs traffic” for smooth functioning? a. Mitochondria b. Ribosomes *c. Golgi apparatus d. Nucleoli General Feedback:
The Golgi apparatus directs traffic in the cell, where it is responsible for modifying, sorting, and packaging macromolecules for secretion or delivery to other organelles within the cell.
5. Chapter 03-05 If the cytoplasm of a cell is very basophilic or dark blue when stained with Wright stain, it contains: a. low concentration of lysosomes. *b. large number of ribosomes. c. small number of ribosomes. d. high concentration of lysosomes. General Feedback: Ribosomes, which are made up of ribonucleic acid (RNA), stain dark blue or basophilic with Wright stain. If a cell’s cytoplasm contains many ribosomes, it will stain very blue.
6. Chapter 03-06 Protein synthesis occurs in what part of a cell? *a. Ribosomes b. Nucleus c. Mitochondria d. Lysosomes General Feedback: Protein synthesis occurs on ribosomes, found in rough endoplasmic reticulum.
7. Chapter 03-07 What cellular component is responsible for energy production and metabolic processes? a. Ribosomes b. Nucleus *c. Mitochondria d. Lysosomes General Feedback: Mitochondria are responsible for energy production and metabolic processes of a cell.
8. Chapter 03-08 Lysosomes are found in the cytoplasm of many cells and contain: a. cholesterol. *b. hydrolytic enzymes. c. glycoproteins. d. RNA.
General Feedback: Lysosomes contain hydrolytic enzymes.
9. Chapter 03-09 What cellular structures appear as granules with Wright stain? a. Ribosomes b. Golgi bodies c. Mitochondria *d. Lysosomes General Feedback: With Wright stain, lysosomes are visualized as azurophilic granules.
10. Chapter 03-10 The nucleolus of a cell is composed of: a. hydrolytic enzymes. b. glycoproteins. *c. RNA. d. lipids. General Feedback: The nucleolus is composed of ribosomal RNA, DNA, and proteins in loose fibrillar form and is found within the nucleus of a cell.
11. Chapter 03-11 Where are surface markers that help in cell identification found? *a. Cell membrane b. Golgi complex c. Rough endoplasmic reticulum d. Nucleus General Feedback: Surface markers are found on the cell membrane and are primarily composed of glycoproteins. Cluster differentiation (CD) numbers are used to identify them.
12. Chapter 03-12 A cell that is actively synthesizing protein has: *a. more nucleoli. b. more heterochromatin. c. fewer ribosomes. d. fewer mitochondria. General Feedback:
A cell that is active in protein synthesis has more nucleoli, less heterochromatin (and more euchromatin), and more mitochondria and ribosomes.
13. Chapter 03-13 If the lysosomal membrane ruptures, what is the consequence to the cell? a. Activates cell nucleus to replicate DNA. b. Enhances protein synthesis by ribosomes. *c. Damages internal cell structures. d. Facilitates rearrangement of intracellular organelles. General Feedback: When the lysosomal membrane is ruptured, its contents denature and digest DNA, RNA, and intracellular proteins; and ultimately the cell lyses.
14. Chapter 03-14 After birth, where does hematopoiesis predominantly occur? *a. Bone marrow b. Spleen c. Liver d. Lymph nodes General Feedback: After birth, hematopoiesis predominantly occurs in the bone marrow.
15. Chapter 03-15 Erythropoietin is a growth factor affecting erythroid progenitors and is produced by what organ? a. Bone marrow b. Spleen *c. Kidney d. Liver General Feedback: Erythropoietin is a growth factor affecting erythroid progenitors and is produced by the kidney when it senses hypoxia.
16. Chapter 03-16 In what stage of the cell cycle does DNA replication occur? a. G1 *b. S c. G2 d. M
General Feedback: S is the stage where DNA replication occurs. G1 is a period of cell growth and synthesis of components. M is mitosis. Stage G2 has tetraploid DNA and a large cell volume.
17. Chapter 03-17 Which morphologic characteristic is representative of apoptosis? a. Inflammation b. Cell swelling *c. Cell shrinkage d. Cell lysis General Feedback: Only cell shrinkage is characteristic of apoptosis. The other three are characteristic of cell death by necrosis.
1. Chapter 04-01 What are the major hematopoietic sites in the fetus and in the adult? Fetus Adult a. Lymph node spleen *b. Liver bone marrow c. Liver spleen d. Bone marrow liver General Feedback: The major site of hematopoiesis in the fetus is in the liver, which retains some minor production until about 2 weeks after birth. In the adult, it is the bone marrow, where production begins in the fifth month of fetal life.
2. Chapter 04-02 How do cells get from the bone marrow into peripheral circulation? a. Stem cells escape the bone marrow and mature in peripheral circulation. b. Mature cells attach to a carrier protein for transport. c. Capillaries flow into the marrow and pluck out precursor cells. *d. Mature cells squeeze through spaces in the vessel endothelial lining. General Feedback: As mature blood cells come into contact with endothelial cells in the bone marrow, they bind to the surface via a receptor-mediated process. The binding creates a space between the luminal adventitial and endothelial cells. The adventitial cells are capable of contracting, which allows mature blood cells to pass through the basement membrane and interact with the endothelial layer. This allows the bone marrow cells to escape into circulation.
3. Chapter 04-03 When hematopoiesis occurs in the liver in an adult, it is called: a. intramedullary. b. intermedullary. c. normal. *d. extramedullary. General Feedback: Whenever hematopoiesis occurs outside the bone marrow in an adult, other than lymphopoiesis in lymphatic tissue, it is called extramedullary. This is abnormal.
4. Chapter 04-04 Where are developing red cells located in the bone marrow? *a. Adjacent to the outer surfaces of the vascular sinuses b. Outside the vascular walls of the sinusoids
c. Deep in the cords d. Randomly spaced throughout the cords General Feedback: Maturing red cells are found in two places in the bone marrow: (1) adjacent to the outer surfaces of the vascular sinuses and (2) surrounding iron-laden macrophages.
5. Chapter 04-05 Which splenic process removes inclusions from circulating red blood cells? a. Hemorrhage b. Macrophage c. Culling *d. Pitting General Feedback: Macrophages in the spleen normally remove abnormal inclusions from red cells, which is called pitting. Culling occurs when the cells are phagocytized with subsequent degradation of cell organelles.
6. Chapter 04-06 Where are the venous sinuses of the spleen located? a. White pulp *b. Red pulp c. Gray matter d. White matter General Feedback: The venous sinuses are located in the red pulp of the spleen.
7. Chapter 04-07 What condition is most associated with autosplenectomy? a. Abdominal trauma b. Thrombocytopenia *c. Sickle cell anemia d. Iron deficiency General Feedback: In sickle cell anemia, repeated sickling events in the spleen, where the red cells are stressed, result in multiple splenic infarcts. Eventually, the spleen is no longer functional. This results in functional loss of the spleen and is called an autosplenectomy.
8. Chapter 04-08 Which is a characteristic of lymph? a. Solid substance
*b. Low protein c. Low red blood cells d. Superficial General Feedback: Lymph is the fluid portion of blood that escapes into the connective tissue and is characterized by a low protein concentration and the absence of RBCs.
9. Chapter 04-09 What bone marrow cells can differentiate into all of the blood cells? a. Burst-forming unit—erythroid (BFU-E) b. Colony-forming unit—granulocyte-monocyte (CFU-GM) c. Colony-forming unit—granulocyte, erythrocyte, monocyte, and megakaryocyte (CFU-GEMM) *d. Hematopoietic stem cells (HSCs) General Feedback: The stem cell from which all blood cells are derived is the HSC. The other stem cells mentioned are all committed to one or more blood cell lineage: BFU-E to erythroid; CFU-GM to granulocytes and monocytes; and CFU-GEMM to granulocytes, erythroid, monocytes, and megakaryocytes (from which platelets are derived).
10. Chapter 04-10 Which condition can nondevelopment of the thymus during gestation cause? *a. Failure to thrive b. Sickle cell disease c. Anemia d. Renal disease General Feedback: Nondevelopment of the thymus during gestation can result in failure to thrive, uncontrollable infections, and death in infancy.
11. Chapter 04-11 Having swollen lymph nodes is called: a. niche. b. porphyrias. *c. adentitis. d. hypersplenism. General Feedback: Adentitis is infection or inflammation of the lymph node.
12. Chapter 04-12 Blood enters the spleen through:
a. lymph nodes. b. vena cava. c. right renal artery. *d. central splenic artery. General Feedback: Blood enters the spleen through the central splenic artery located at the hilum and branches outward through the trabeculae.
13. Chapter 04-13 Which function is performed by cytokines except: a. proliferation. *b. regeneration. c. differentiation. d. maturation. General Feedback: Cytokines are responsible for stimulation or inhibition of production, differentiation, and trafficking of mature blood cells and their precursors.
14. Chapter 04-14 Which is a hematopoietic growth factor? *a. Interleukin b. BFU-E c. Fibroblast d. HSC General Feedback: Only interleukin, of those listed, is a hematopoietic growth factor. The rest are cells found in the bone marrow. Actually several interleukins exist, each of which has a number (IL-1, IL-3, IL-6), that can affect various hematopoietic cells. In addition, other cytokines (e.g., erythropoietin, thrombopoietin) affect blood cell production.
15. Chapter 04-15 What is the primary mechanism for the anemia associated with kidney disease? a. Hemolysis b. Hemorrhage *c. Inadequate synthesis of erythropoietin d. Inadequate synthesis of interleukins General Feedback: Erythropoietin is the cytokine that has its primary effect on red cell production. It is synthesized in the kidney; thus when the kidney is diseased, erythropoietin synthesis is decreased. This decreases red cell production, leading to anemia.
16. Chapter 04-16 Which is not a function of macrophages in the bone marrow? *a. Activating adipose cells b. Secreting cytokines c. Storing iron d. Phagocytizing senescent cells General Feedback: Macrophages do not activate adipose cells. They perform all the other listed functions.
17. Chapter 04-17 Kupffer cells, found in the liver, are: a. adipose cells. *b. macrophages. c. immature red cells. d. immature granulocytes (neutrophils). General Feedback: Kupffer cells are specialized macrophages found in the liver.
18. Chapter 04-18 Germinal centers in lymph nodes contain primarily: *a. B cells. b. macrophages. c. neutrophils. d. T cells. General Feedback: Germinal centers contain primarily B cells and their progeny.
19. Chapter 04-19 The thymus is responsible for the initial development of: a. macrophages. *b. T cells. c. B cells. d. neutrophils. General Feedback: The thymus contains lymphoid cells that undergo conditioning in the thymus and become T cells.
20. Chapter 04-20 Apoptosis is: a. enhanced red cell production.
*b. programmed cell death. c. directed exit of cells from the bone marrow. d. accidental cell death from trauma. General Feedback: Apoptosis is programmed cell death, which is a normal physiologic process eliminating unwanted, abnormal, or harmful cells. It is different from accidental death because of trauma—this is called necrosis.
21. Chapter 04-21 Colony-stimulating factors: a. have poor affinity for their target cells. b. require high concentrations to be effective. *c. are produced by many cells. d. are all lineage specific. General Feedback: Colony-stimulating factors need only be present in a very low concentration to be effective. They have a high affinity for their target cells, binding to specific receptors on the cell surface. Many different cells produce them, and many of them affect several different cell lines.
1. Chapter 05-01 Where is erythropoietin synthesized? a. Bone marrow *b. Kidney c. Lymph nodes d. Spleen General Feedback: Erythropoietin is synthesized primarily in the kidney. A very small amount is produced in the liver.
2. Chapter 05-02 What stimulates production of erythropoietin? a. Decreased red cell number in the bone marrow b. Increased peripheral red cell number c. Decreased iron stores *d. Decreased oxygen level in tissue General Feedback: Peritubular cells in the kidney detect an undersupply of oxygen in tissue (also called hypoxia). They then synthesize erythropoietin. This increases red cell production in the bone marrow, unless the marrow is unable to respond the erythropoietin stimulus.
3. Chapter 05-03 Erythropoietin increases the number of red cells by all of the following mechanisms except: *a. prolonging cell life span. b. shortening cell division times. c. allowing earlier cell egress from the bone marrow. d. increasing the rate of hemoglobin synthesis. General Feedback: Erythropoietin has no effect on red cell life span. It does perform all the other functions listed.
4. Chapter 05-04 Why do men typically have higher erythrocyte counts than women? a. They weigh more and have more blood vessels. b. They do not lose as much blood each month. *c. Testosterone stimulates erythropoiesis. d. They have more oxygen in their blood. General Feedback: Testosterone stimulates red cell production.
5. Chapter 05-05 Programmed cell death is called: a. necrosis. *b. apoptosis. c. hemolysis. d. phagocytosis. General Feedback: Apoptosis is programmed cell death, a normal physiologic process to remove damaged, abnormal, or unneeded cells. Necrosis is abnormal death because of trauma or damage. Hemolysis is cell death by rupture (which is abnormal). Phagocytosis is the primary mechanism for removal of senescent cells, but it also can remove damaged cells.
6. Chapter 05-06 What is the main site for iron storage in the bone marrow? a. Stem cells b. Transferrin molecules c. Endothelial cells *d. Macrophages General Feedback: Macrophages are the primary site for storage of iron in the bone marrow. Stem cells of various kinds are precursors to blood cells. Transferrin is the protein that binds and transports iron to either storage or developing red blood cells (RBCs). Endothelial cells are the lining cells of the bone marrow and blood vessels.
7. Chapter 05-07 Which is true of red cell precursors as they mature? a. The nuclear-to-cytoplasmic ratio increases. b. The cells become larger. *c. The cytoplasm becomes less basophilic. d. The nucleoli become more prominent. General Feedback: In general, basophilia decreases as the red cell matures (one exception to this: the basophilic normoblast is characteristically more basophilic than its precursor, the pronormoblast). The nuclear-tocytoplasmic ratio actually decreases, the cells become smaller, and nucleoli become less prominent and eventually disappear.
8. Chapter 05-08 Which has a pyknotic nucleus? a. Pronormoblast b. Basophilic normoblast c. Polychromatophilic normoblast *d. Orthochromic normoblast