Assessment HEMA

Question 1

One chromosome breaks off and becomes attached to a different chromosome:

Addition
Deletion
Inversion
Translocation

Answer 1

Translocation

Question 2

CHROMOSOMAL CHANGES

Most common type of DNA change that can lead to leukemia.
A translocation means that a part of one chromosome breaks off and becomes attached to a different chromosome.
The point at which the break occurs can affect nearby genes—for example, it can turn on oncogenes or turn off genes that would normally help a cell to mature.

Answer 2

TRANSLOCATION

Question 3

Occur when part of a chromosome is lost.
This may result in the cell losing a gene that helped keep its growth in check, for example, a tumor suppressor gene.

Answer 3

DELETION

Question 4

Occur when part of a chromosome gets turned around, so it is now in reverse order.
This can result in the loss of a gene (or genes) because the cell can no longer read its instructions in protein translation.

Answer 4

INVERSION

Question 5

An extra chromosome or part of a chromosome is gained.
This can lead to too many copies of certain genes within the cell.
This can be a problem if one or more of these genes are oncogenes.

Answer 5

ADDITION

Question 6

The most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus:

Multipotential stem cell
Pluripotential stem cell
Totipotential stem cell

Answer 6

Totipotential stem cell

Question 7

TYPES OF HUMAN STEM CELLS

These cells are present in the first few hours after an ovum is fertilized.
Totipotential stem cells, the most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus.

Answer 7

Totipotential stem cells

Question 8

TYPES OF HUMAN STEM CELLS

These cells are present several days after fertilization.
Pluripotent stem cells can develop into any cell type, except they cannot develop into a fetus.

Answer 8

Pluripotential stem cells

Question 9

TYPES OF HUMAN STEM CELLS

These cells are derived from pluripotent stem cells.
They can be found in adults, but they are limited to specific types of cells to form tissues.
For example, bone marrow stem cells can produce all types of blood cells, bone cartilage, and adipose (fat) cells.

Answer 9

Multipotential stem cells

Question 10

The promyelocyte stage lasts about:

4 hours
12 hours
15 hours
24 hours
4.3 days

Answer 10

24 hours

Question 11

PROLIFERATIVE PHASE

First identifiable cell in the granulocytic series
Constitute approximately 1% of the total nucleated bone marrow cells
Stage lasts approximately 15 hours

Answer 11

Myeloblast

Question 12

Constitutes approximately 3% of the nucleated bone marrow cells
This stage lasts about 24 hours

Answer 12

Promyelocyte

Question 13

Approximately 12% of the proliferative cells existing in this stage
Myelocyte to metamyelocyte lasts an average of 4.3 days.
Once the metamyelocyte stage has been reached, cells have undergone four or five cell divisions and the proliferative phase comes to an end

Answer 13

Myelocyte

Question 14

MATURATION-STORAGE PHASE

Answer 14

Metamyelocytes 45%
Band 35%
Segmented granulocytes 20%

Segmented neutrophils in the maturation-storage compartment are frequently referred to as the marrow reserve.
This reserve constitutes a 4- to 8-day supply of neutrophils.

Question 15

The tourniquet should be applied __________ inches above the venipuncture site.

1 to 2 inches above the venipuncture site
3 to 4 inches above the venipuncture site
5 to 6 inches above the venipuncture site
8 to 9 inches above the venipuncture site

Answer 15

3 to 4 inches above the venipuncture site

The tourniquet should be applied 3 to 4 inches above the venipuncture site and left on for no longer than 1 minute before the venipuncture is performed.

Question 16

Anticoagulants that remove calcium needed for clotting by forming insoluble calcium salts: RODAK

EDTA
EDTA and heparin
EDTA and citrate
EDTA, citrate and oxalate
EDTA, citrate, oxalate and heparin

Answer 16

EDTA, citrate, and oxalate

Heparin prevents clotting by binding to anti- thrombin in the plasma and inhibiting
thrombin and activated coagulation factor X.

Question 17

Number of inversions of light blue top evacuated tube:

None
3 to 4
5 to 6
8

Answer 17

3 to 4

Light blue (citrate) 3 to 4x inversions
Green (heparin) 8x inversions
Purple (EDTA) 8x inversions

Question 18

Test orders: 1. Conduct continuous utilization reviews to ensure that physician laboratory orders are comprehensive and appropriate to patient condition; 2. Inform physician about laboratory test availability and ways to avoid unnecessary orders; 3. Reduce unnecessary repeat testing.

1 and 2
1 and 3
2 and 3
1, 2 and 3

Answer 18

1, 2 and 3

Question 19

Each new assay or assay modification must be validated for: 1. Accuracy, Precision; 2. Linearity; 3. Specificity; 4. Lower limit of detection ability

1 and 3
2 and 4
1, 2 and 3
1, 2, 3 and 4

Answer 19

1, 2, 3 and 4

Question 20

Adjuvant for infectious disease therapy:

Interleukin 2
Interleukin 3
Interleukin 6
Interleukin 12

Answer 20

Interleukin 12

Question 21

Major elements of the flow cytometer: 1. Optics; 2. Fluidics; 3. Computer; 4. Electronics

1 and 2
3 and 4
1, 2 and 3
1, 2, 3 and 4

Answer 21

1, 2, 3 and 4

Question 22

Total area of the Levy chamber with improved Neubauer ruling:

1 mm2
3 mm2
4 mm2
9 mm2

Answer 22

9 mm2

It is composed of two raised surfaces, each with a 3 mm x 3 mm square counting area or
grid (total area 9 mm2), separated by an H-shaped moat.

Question 23

For the manual WBC count: After the chamber is filled, allow the cells to settle for___ minutes before counting.

3 minutes
5 minutes
10 minutes
15 minutes

Answer 23

10 minutes

Question 24

Typical dilution for the manual platelet count:
1:10
1:20
1:100
1:200

Answer 24

1:100

Question 25

If fewer than 50 platelets are counted on each side, the procedure should be repeated by diluting the blood to: 1:10 1:20 1:100 1:200

Answer 25

1:20

Question 26

In the cyanmethemoglobin method, full conversion of hemoglobin to cyanmethemoglobin: 3 minutes 5 minutes 10 minutes 15 minutes

Answer 26

10 minutes

Question 27

WBC count that can interfere with the cyanmethemoglobin method: Greater than 4 x 10 9/L Greater than 7 x 10 9/L Greater than 11 x 10 9 /L Greater than 20 x 10 9/L

Answer 27

Greater than 20 x 10 9/L ## Footnote A high WBC count (greater than 20 x 10 9/L) or a high platelet count (greater than 700 x 10 9/L) can cause turbidity and a falsely high result. In this case, the reagent-sample solution can be centrifuged and the supernatant measured.

Question 28

Effect of dehydration to hematocrit reading: Decreased Increased Variable No effect

Answer 28

Increased ## Footnote The fluid loss associated with dehydration causes a decrease in plasma volume and falsely increases the hematocrit reading.

Question 29

An MCHC between 36 and 38 g/dL should be checked for: Codocytes Drepanocytes Elliptocytes Spherocytes

Answer 29

Spherocytes

Question 30

In the manual reticulocyte count, what is the ratio of blood and new methylene blue stain? 1:1 1:2 1:3 1:4

Answer 30

1:1 ## Footnote Mix equal amounts of blood and new methylene blue stain (2 to 3 drops, or approximately 50 mL each), and allow to incubate at room temperature for 3 to 10 minutes.

Question 31

To improve accuracy of the reticulocyte count, have another laboratorian count the other film; counts should agree within: Within 1% Within 5% Within 10% Within 20%

Answer 31

Within 20%

Question 32

The ESR of patients with severe anemia is: Critical Of diagnostic significance Of little diagnostic value

Answer 32

Of little diagnostic value ## Footnote because it will be falsely elevated.

Question 33

ESR and RBC mass: Directly proportional Inversely proportional Cannot be determined

Answer 33

Directly proportional ## Footnote The ESR is directly proportional to the red blood cell mass and inversely proportional to plasma viscosity.

Question 34

ESR of patient with leukemia: Decreased Increased Variable

Answer 34

Increased

Question 35

ESR of patient with leukocytosis: Decreased Increased Variable

Answer 35

Decreased

Question 36

An early indication of engraftment success after hematopoietic stem cell transplant. 1. RBC count; 2. Immature reticulocyte fraction; 3. Immature platelet fraction 2 only 1 and 2 2 and 3 1, 2 and 3

Answer 36

2 and 3 ## Footnote The immature reticulocyte fraction and the immature platelet fraction provide an early indication of engraftment success after hematopoietic stem cell transplant.

Question 37

Conditions associated with DIC: Examples of conditions associated with ENDOTOXINS THAT ACTIVATE CYTOKINES Acute promyelocytic or myelomonocytic leukemia Bacterial, protozoal, fungal and viral infections Coronary artery bypass surgery Hypovolemic and hemorrhagic shock

Answer 37

Bacterial, protozoal, fungal and viral infections

Question 38

Fibrinogen concentration in primary fibrinolysis: Decreased Increased Variable

Answer 38

Decreased

Question 39

Fibrinogen concentration in secondary fibrinolysis: Decreased Increased Variable

Answer 39

Decreased

Question 40

Bone marrow reticulocytes have an average maturation of: 1 day 1.5 days 2 days 2.5 days

Answer 40

2.5 days

Question 41

Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of: 1 day 1.5 days 2 days 2.5 days

Answer 41

1 day ## Footnote Bone marrow reticulocytes have an average maturation period of 2.5 days. Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of 1 day and represent approximately 0.5% to 1.5% of the circulating erythrocytes.

Question 42

Basophils have an average circulation time of about: 7 to 10 hours 8.5 hours 12 hours 2.5 days

Answer 42

8.5 hours ## Footnote Bone marrow reticulocytes have an average maturation period of 2.5 days. Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of 1 day and represent approximately 0.5% to 1.5% of the circulating erythrocytes.

Question 43

All identifiable patient information, whether written, computerized, visually, or audio recorded, or simply held in the memory of healthcare professionals, is subject to the duty of confidentiality, EXCEPT: Any clinical information about an individual’s diagnosis or treatment A picture, photograph, video, audiotape, or other images of the patient The patient's favorite restaurant and food Who the patient’s doctor is and what clinics patients attend and when

Answer 43

The patient's favorite restaurant and food

Question 44

It is used by medical laboratories in developing their quality management systems and assessing their own competence and for use by accreditation bodies in confirming or recognizing the competence of medical laboratories: ISO 11166 ISO 11469 ISO 15189 ISO 15819

Answer 44

ISO 15189 ## Footnote ISO 15189:2007 is for use by medical laboratories in developing their quality management systems and assessing their own competence and for use by accreditation bodies in confirming or recognizing the competence of medical laboratories.

Question 45

All of the following are examples of pre-analytical errors, EXCEPT: Specimen obtained from the wrong patient Specimen collected in the wrong tube or container Incorrect labeling of specimen Failure to report critical values immediately

Answer 45

Failure to report critical values immediately ## Footnote PREANALYTICAL (PREEXAMINATION) ■ Specimen obtained from the wrong patient ■ Specimen procured at the wrong time ■ Specimen collected in the wrong tube or container ■ Blood specimens collected in the wrong order ■ Incorrect labeling of specimen ■ Improper processing of specimen ANALYTICAL (EXAMINATION) ■ Oversight of instrument flags ■ Out-of-control QC results ■ Wrong assay performed POSTANALYTICAL (POSTEXAMINATION) ■ Verbal reporting of results ■ Instrument: Laboratory Information System (LIS) incompatibility error ■ Confusion about reference ranges ■ Failure to report critical values immediately

Question 46

EDTA is used in concentrations of _____ of whole blood 0.5 mg/1 mL of whole blood 1 mg/1mL of whole blood 1.5 mg/1 mL of whole blood 2 mg/1 mL of whole blood

Answer 46

1.5 mg/1 mL of whole blood

Question 47

Uncommon vascular complications that are not usually related to the technique include: Pseudoaneurysm Pseudoaneurysm and thrombosis Pseudoaneurysm, thrombosis and reflex arteriospasm Pseudoaneurysm, thrombosis, reflex arteriospasm and arteriovenous fistula formation

Answer 47

Pseudoaneurysm, thrombosis, reflex arteriospasm and arteriovenous fistula formation

Question 48

Complications include orthostatic hypotension, syncope and shock Vascular complications Cardiovascular complications Neurological complications Dermatological comlications

Answer 48

Cardiovascular complications

Question 49

Complications include diaphoresis, seizure and pain: Vascular complications Cardiovascular complications Neurological complications Dermatological comlications

Answer 49

Neurological complications

Question 50

Sister chromatids move to the equatorial plate. Prophase Metaphase Anaphase Telophase

Answer 50

Metaphase ## Footnote Characteristics of the Four Mitotic Periods PROPHASE The chromatin becomes tightly coiled. Nucleolus and nuclear envelope disintegrate. Centrioles move to opposite poles of the cell. METAPHASE Sister chromatids move to the equatorial plate. ANAPHASE Sister chromatids separate and move to opposite poles. TELOPHASE Chromosomes arrive at opposite poles. Nucleolus and nuclear membrane reappear. The chromatin pattern reappears.

Question 51

Megakaryocytes develop into platelets in approximately __ days. 3 days 5 days 9 days 12 days

Answer 51

5 days

Question 52

This cytokine promotes the growth of early hematopoietic cell lines: Interleukin 1 Interleukin 2 Interleukin 3 Interleukin 6

Answer 52

Interleukin 3 ## Footnote Promotes the growth of early hematopoietic cell lines (e.g., proliferation of CFU-GEMM, CFU-M, CFU-Meg, CFU-Eo, and CFU-Bs colonies from bone marrow). IL-3 acts with M-CSF to stimulate proliferation of monocytes and macrophages. It also stimulates granulocyte, monocyte, eosinophil, and mast cell production

Question 53

Hemoglobin appears for the first time: Rubriblast (pronormoblast) Prorubricyte (basophilic normoblast) Rubricyte (polychromatophilic normoblast) Metarubricyte (orthochromic normoblast)

Answer 53

Rubricyte (polychromatophilic normoblast)

Question 54

This pathway prevents denaturation of globin of the hemoglobin molecule by oxidation: Embden-Meyerhof pathway Hexose-monophosphate shunt Methemoglobin reductase pathway Luebering-Rapoport pathway

Answer 54

Hexose-monophosphate shunt ## Footnote Embden-Meyerhof Pathway Maintains cellular energy by generating ATP Oxidative pathway or hexose-monophosphate shunt Prevents denaturation of globin of the hemoglobin molecule by oxidation Methemoglobin reductase pathway Prevents oxidation of heme iron Luebering-Rapaport pathway Regulates oxygen affinity of hemoglobin

Question 55

RBCs inclusions, 0.2 to 2.0 mm in size, that can be seen with a stain such as crystal violet or brilliant cresyl blue; represent precipitated, denatured hemoglobin and are clinically associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such as phenacetin, and some hemoglobinopathies. Hemoglobin C crystals Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 55

Heinz bodies

Question 56

RBC inclusions that are aggregates of mitochondria, ribosomes, and iron particles. Clinically, they are associated with iron-loading anemias, hyposplenism, and hemolytic anemias. Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 56

Pappenheimer bodies

Question 57

RBC inclusions representing granules composed of ribosomes and RNA that are precipitated during the process of staining of a blood smear; associated clinically with disturbed erythropoiesis (defective or accelerated heme synthesis),lead poisoning, and severe anemias. Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 57

Basophilic stippling

Question 58

Nuclear remnants predominantly composed of DNA; believed to develop in periods of accelerated or abnormal erythropoiesis, because the spleen cannot keep upwith pitting these remnants from the cell. Its presence is associated with hemolytic anemias, pernicious anemia, and particularly post-splenectomy, physiologicalatrophy of the spleen. Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 58

Howell-Jolly bodies

Question 59

Anemias with low MCV and MCHC; microcytic, hypochromic RBCs, EXCEPT: Iron deficiency anemia Thalassemia Sideroblastic anemia Excessive alcohol ingestion

Answer 59

Excessive alcohol ingestion ## Footnote Low MCV, MCHC Microcytic, hypochromic Typical of maturation defects Iron deficiency anemia (some) Thalassemia Sideroblastic anemia --- Normal MCV, MCHC Normocytic, normochromic Typical of hypoproliferation Bone marrow disorder Iron deficiency anemia (some) Anemia of chronic disorders Autoimmune disease --- High MCV Macrocytic Typical of maturation defect Vitamin B12 deficiency Folate deficiency Excessive alcohol ingestion Hypothyroidism

Question 60

Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is MANY. 0 1+ 2+ 3+ 4+

Answer 60

3+ ## Footnote Grading of Erythrocyte Morphology 0 Normal appearance or slight variation in erythrocytes. 1+ Only a small population of erythrocytes displays a particular abnormality; the terms slightly increased or few would be comparable. 2+ More than occasional numbers of abnormal erythrocytes can be seen in a microscopic field; an equivalent descriptive term is moderately increased. 3+ Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is many. 4+ The most severe state of erythrocytic abnormality, with the abnormality prevalent throughout each microscopic field; comparable terms are marked or marked increase.

Question 61

Inherited hemolytic anemia due to structural membrane defect: Thalassemia Sickle cell anemia Pyruvate kinase deficiency Hereditary spherocytosis

Answer 61

Hereditary spherocytosis ## Footnote Examples of Inherited Hemolytic Anemias STRUCTURAL MEMBRANE DEFECTS Acanthocytosis Hereditary spherocytosis Hereditary elliptocytosis Hereditary stomatocytosis Hereditary xerocytosis Rh null disease ERYTHROCYTIC ENZYME DEFECTS G6PD deficiency Glutathione reductase Hexokinase Pyruvate kinase DEFECTS OF THE HEMOGLOBIN MOLECULE Hb C disorder Hb S-C disorder Hb S-S disorder (sickle cell anemia) Thalassemia

Question 62

Hemoglobinopathies associated with ABNORMAL MOLECULAR STRUCTURE: Alpha thalassemia Alpha and beta thalassemia Sickle cell anemia and beta thalassemia Sickle cell anemia, sickle cell trait and Hb C disease

Answer 62

Sickle cell anemia, sickle cell trait and Hb C disease ## Footnote Examples of Selected Hemoglobinopathies ABNORMAL MOLECULAR STRUCTURE Hb SS (sickle cell anemia) Hb SA (sickle cell trait) Hb C disease or trait RATE OF SYNTHESIS Beta-Thalassemia Alpha-Thalassemia COMBINATION OF TWO MOLECULAR ALTERATIONS OR A MOLECULAR ABNORMALITY AND SYNTHESIS DEFECT Hb S–Hb C Hb S–b-thalassemia

Question 63

Elongated and curved nucleus; very clumped chromatin: Myelocyte Metamyelocyte Band Segmenter neutrophil

Answer 63

Band

Question 64

Indented nucleus, clumped chromatin: Promyelocyte Myelocyte Metamyelocyte Band

Answer 64

Metamyelocyte

Question 65

Mast cells have an appearance similar to that of the blood: Monocyte Neutrophil Eosinophil Basophil

Answer 65

Basophil

Question 66

Once the metamyelocyte stage has been reached, cells have undergone ____ cell divisions and the proliferative phase comes to an end. 1 or 2 cell divisions 2 or 3 cell divisions 4 or 5 cell divisions 6 or 7 cell divisions

Answer 66

4 or 5 cell divisions

Question 67

Nuclear chromatin is coarse and clumped; dark blue (basophilic) cytoplasm around the periphery or in a radial pattern and few cytoplasmic vacuoles: Type I Downey cells Type II Downey cells Type III Downey cells

Answer 67

Type II Downey cells ## Footnote Descriptive Features of the Classic Downey Classification of Lymphocytes Seen in Infectious Mononucleosis Type I Nucleus May be irregularly shaped Cytoplasm Usually many cytoplasmic vacuoles, dark blue (basophilic) Type II Nucleus Chromatin is coarse and clumped Cytoplasm Increased amount, dark blue (basophilic) around the periphery or in a radial pattern, a few cytoplasmic vacuoles Type IIIa Nucleus Nucleoli usually visible, enlarged in size Cytoplasm Dark blue (basophilic)

Question 68

Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage: M0 myeloid M1 myeloid M2 myeloid M3 myeloid

Answer 68

M2 myeloid

Question 69

Abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations: M3 M4 M6 M7

Answer 69

M6 ## Footnote M6 erythroleukemia Also known as Di Guglielmo syndrome; abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations

Question 70

Small cells predominant; nuclear shape is regular with an occasional cleft; chromatin pattern is homogeneous and nucleoli are rarely visible; cytoplasm is moderately basophilic: L1 L2 L3

Answer 70

L1 ## Footnote L1 homogeneous One population of cells within the case; small cells predominant; nuclear shape is regular with an occasional cleft; chromatin pattern is homogeneous and nucleoli are rarely visible; cytoplasm is moderately basophilic L2 heterogeneous Large cells with an irregular nuclear shape; clefts in the nucleus are common; one or more large nucleoli are visible; cytoplasm varies in color L3 Burkitt lymphoma type Cells are large and homogeneous in size; nuclear shape is round or oval; one to three prominent nucleoli; cytoplasm is deeply basophilic with vacuoles often prominent

Question 71

Cells are large and homogeneous in size; nuclear shape is round or oval; one to three prominent nucleoli; cytoplasm is deeply basophilic with vacuoles often prominent: L1 L2 L3

Answer 71

L3

Question 72

Leukemic reticuloendotheliosis: Prolymphocytoc leukemia Plasma cell leukemia Hairy cell leukemia Sezary syndrome

Answer 72

Hairy cell leukemia

Question 73

Solid tumor counterpart of acute lymphoblastic leukemia: Lymphoma, undifferentiated Lymphoma, poorly differentiated leukemia Lymphoma, well-differentiated leukemia Chloroma granulocytic leukemia

Answer 73

Lymphoma, poorly differentiated leukemia

Question 74

Solid tumor counterpart of plasma cell leukemia: Reticulum cell sarcoma Chloroma granulocytic leukemia Myeloma Lymphoma, undifferentiated

Answer 74

Myeloma

Question 75

A distinctive feature of the megakaryocyte: Multinucleated Multilobular Multinucleated and multilobular None of these

Answer 75

Multilobular

Question 76

A target INR range of ____ is recommended for most indications (e.g., treatment or prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients who have had a myocardial infarction). INR range of 1.0 to 2.0 INR range of 2.0 to 3.0 INR range of 2.5 to 3.5 INR range of 4.0 to 5.0

Answer 76

INR range of 2.0 to 3.0 ## Footnote A target INR range of 2.0 to 3.0 is recommended for most indications (e.g., treatment or prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients who have had a myocardial infarction). An INR of 2.5 to 3.5 is recommended for patients with prosthetic heart valves. When the INR is used to guide anticoagulant therapy, there are fewer bleeding events.

Question 77

The target INR for pulmonary embolism (PE) treatment is ___ for the duration of anticoagulation. 1.0 1.5 2.5 3.0

Answer 77

3.0

Question 78

The new types of thromboplastins for measuring the PT are mixtures of phospholipids and recombinantly derived _____ tissue factor. Rabbit Pig Horse Human

Answer 78

Human ## Footnote NEW THROMBOPLASTINS The new types of thromboplastins for measuring the PT are mixtures of phospholipids and recombinantly derived human tissue factor. Because the new thromboplastins are more sensitive (typical ISI, 1.0) than the traditional North American ones (ISIs, 1.8 to 3.0), the PTs for patients with inherited or acquired deficiencies of coagulation factors will be much more prolonged with use of the new reagents, although normal values may change minimally.

Question 79

Anticoagulant therapy: Falsely decreased D-dimer values Falsely increased D-dimer values No effect Cannot be determined

Answer 79

Falsely decreased D-dimer values ## Footnote Conditions That Can Generate Falsely Decreased or Falsely Increased D-Dimer Values FALSELY DECREASED VALUES 1. Anticoagulant therapy 2. Smaller, older, nonprogressing thrombus FALSELY INCREASED VALUES 1. Various disease states 2. Post-therapeutic clinical procedures

Question 80

Smallest platelets seen: Wiskott-Aldrich syndrome May-Hegglin anomaly Alport syndrome Bernard-Soulier syndrome

Answer 80

Wiskott-Aldrich syndrome

Question 81

Glanzmann thrombasthenia and essential athrombia: Platelet adhesion defect Primary platelet aggregation defect Secondary platelet aggregation defect Isolated platelet factor III deficicency

Answer 81

Primary platelet aggregation defect ## Footnote Hereditary Platelet Function Defects ADHESION DEFECTS Bernard-Soulier syndrome Impaired adhesion to collagen AGGREGATION DEFECTS: PRIMARY Glanzmann thrombasthenia Essential athrombia AGGREGATION DEFECTS: SECONDARY Storage pool diseases Aspirin-like defects Release reaction defects ISOLATED PLATELET FACTOR III DEFICIENCY SEVERE COAGULATION FACTOR DEFICIENCIES Afibrinogenemia Factor VIII: C deficiency Factor IX: C deficiency

Question 82

Acquired platelet function defects: Bernard-Soulier syndrome Bernard-Soulier and Glanzmann thrombasthenia Uremia, multiple myeloma Uremia, multiple myeloma, vitamin B12 or folate deficiency

Answer 82

Uremia, multiple myeloma, vitamin B12 or folate deficiency ## Footnote ACQUIRED PLATELET FUNCTION DEFECTS 1. Myeloproliferative syndromes Essential thrombocythemia Chronic myelogenous leukemia Polycythemia vera Paroxysmal nocturnal hemoglobinuria Myelofibrosis RAEB syndrome Sideroblastic anemia 2. Paraprotein disorders Multiple myeloma Waldenström macroglobulinemia Essential monoclonal gammopathy 3. Autoimmune diseases Collagen vascular disease Antiplatelet antibodies Immune thrombocytopenias 4. Fibrinogen degradation products Disseminated intravascular coagulation Primary fibrinolytic syndromes Liver disease 5. Anemia Severe iron deficiency Severe B12 or folate deficiency 6. Uremia 7. Drug induced RAEB, refractory anemia with excess blasts

Question 83

Inherited platelet dysfunction: Bernard-Soulier syndrome Bernard-Soulier syndrome, Glanzmann's thrombasthenia Uremia, multiple myeloma Uremia, multiple myeloma, vitamin B12 or folate deficiency

Answer 83

Bernard-Soulier syndrome, Glanzmann's thrombasthenia ## Footnote INHERITED PLATELET DYSFUNCTION 1. Surface membrane defects Bernard-Soulier syndrome Glanzmann thrombasthenia Platelet-type von Willebrand disease 2. Defects of granule storage Alpha-granule deficiency Gray platelet syndrome 3. Dense granules Wiskott-Aldrich syndrome Hermansky-Pudlak syndrome Chédiak-Higashi syndrome TAR baby syndrome

Question 84

Patients with _____ , the most severe form of von Willebrand disease, are likely to have a major episode of bleeding early in life because significantly decreased amounts of vWF and VIII:C are produced. Type IA Type IIB Type IIC, IID Type III

Answer 84

Type III

Question 85

Conditions related to deficiencies of multiple coagulation factors: Hepatic disease Hepatic disease and anticoagulant overdose Anticoagulant overdose and vitamin K deficiency Hepatic disease, anticoagulant overdose, DIC and vitamin K deficiency

Answer 85

Hepatic disease, anticoagulant overdose, DIC and vitamin K deficiency

Question 86

Indented or twisted nucleus, lacy chromatin and gray-blue cytoplasm: Segmented neutrophil Band neutrophil Monocyte Lymphocyte

Answer 86

Monocyte

Question 87

Forward high-angle light scatter: 0 degree angle 2 to 3 degree angle 5 to 15 degree angle 90 degree angle

Answer 87

5 to 15 degree angle ## Footnote Angles of Light Scatter Various angles of light scatter can aid in cellular analysis. 1. Forward light scatter 0°. This is diffracted light, which relates to the volume of the cell. 2. Forward low-angle light scatter 2° to 3°. This characteristic can relate to size or volume. 3. Forward high angle 5° to 15°. This type of measurement allows for description of the refractive index of cellular components. 4. Orthogonal light scatter 90°. The result of this application of light scatter is the production of data based on reflection and refraction of internal components, which correlates with internal complexity

Question 88

RBC histogram to the LEFT: RBCs are larger than normal RBCs are smaller than normal Seen in megaloblastic anemia Treated anemia

Answer 88

RBCs are smaller than normal ## Footnote If the cells are smaller than normal, the curve will be more to the left, as in untreated iron deficiency anemia. If the cells are larger than normal, the histogram curve will be more to the right, as in the megaloblastic anemias. After appropriate treatment of the underlying cause of an anemia, the curve should move toward the normal range.

Question 89

Erythrocytes with an increased RDW; Homogenous in character, very little anisocytosis Homogenous, high degree of anisocytosis Heterogenous, very little anisocytosis Heterogenous, high degree of anisocytosis

Answer 89

Heterogenous, high degree of anisocytosis ## Footnote Erythrocytes with a normal RDW are homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear. Erythrocytes with an increased RDW are referred to as heterogeneous and exhibit a high degree of anisocytosis on a peripheral blood smear.

Question 90

MPV values should be based on specimens that are between ____ hours old. 1 and 4 hours old 4 and 8 hours old 6 and 12 hours old 12 and 16 hours old

Answer 90

1 and 4 hours old ## Footnote MPV is a measure of the average volume of platelets in a sample. In EDTA–anti-coagulated blood, platelets undergo a change in shape. This alteration (swelling) causes the MPV to increase approximately 20% during the first hour. After this time, the size is stable for at least 12 hours; however, MPV values should be based on specimens that are between 1 and 4 hours old. No single normal range exists. Patients with a lower platelet count normally have a higher MPV, and patients with a higher platelet count have a lower MPV. Analysis of a nomogram demonstrates that an MPV between 9.0 and 9.8 fL is in the normal range, if the platelet count is normal. MPVs from 7.8 to 8.9 fL or from 9.9 to 12.0 fL may be in the normal range, depending on the platelet count. DECREASED MPV: 1. Aplastic anemia 2. Megaloblastic anemia 3. Wiskott-Aldrich syndrome 4. After chemotherapy INCREASED MPV: 1. Idiopathic thrombocytopenic purpura 2. After splenectomy 3. Sickle cell anemia

Question 91

Measure of the uniformity of platelet size in a blood specimen: Platelet adhesion Platelet aggregation Mean platelet volume (MPV) Platelet distribution width (PDW)

Answer 91

Platelet distribution width (PDW)

Question 92

Placement of fire extinguishers every ___ feet. 75 feet 100 feet 125 feet 150 feet

Answer 92

75 feet ## Footnote Placement of fire extinguishers every 75 feet. A distinct system for marking the locations of fire extinguishers enables quick access when they are needed. Fire extinguishers should be checked monthly and maintained annually. Placement of manual fire alarm boxes near the exit doors. Travel distance should not exceed 200 feet.

Question 93

Surfaces in the specimen collection and processing area should be cleaned with: 70% isopropyl alcohol. 1:10 bleach solution. Soap and water. Any of the above

Answer 93

1:10 bleach solution.

Question 94

Which of the following is a proper way to clean up a small blood spill that has dried on a countertop? Moisten it with a disinfectant and carefully absorb it with a paper towel. Rub it with an alcohol pad, then wipe the area with a clean alcohol pad. Scrape it into a biohazard bag and wash the surface with soap and water. Use a disinfectant wipe and scrub it in ever-increasing concentric circles

Answer 94

Moisten it with a disinfectant and carefully absorb it with a paper towel.

Question 95

The following test orders for different patient shave been received at the same time. Which test would you collect first? Fasting glucose STAT glucose in the ER STAT hemoglobin in ICU ASAP CBC in ICU

Answer 95

STAT glucose in the ER

Question 96

A member of the clergy is with the patient when you arrive to collect a routine specimen. What should you do? Ask the patient’s nurse what you should do. Come back after the clergy person has gone. Fill out a form saying you were unable to collect the specimen. Say “Excuse me, I need to collect a specimen from this patient."

Answer 96

Come back after the clergy person has gone. ## Footnote If a physician or a member of the clergy is with the patient, don’t interrupt. The patient’s time with these individuals is private and limited. If the draw is not stat, timed or other urgent priority, go draw another patient and check back after that. If that is the only patient, wait outside the room for a few minutes or go back to the lab and draw the specimen on the next sweep. (In any case, always make certain your actions follow facility policy.) If the request is stat, timed, or other urgent priority , excuse yourself, explain why you are there, and ask permission to proceed.

Question 97

The most common complication encountered in obtaining a blood specimen; it is caused by leakage of a small amount of blood in the tissue around the puncture site: Petechiae Hematoma Ecchymosis Hemoconcentration

Answer 97

Ecchymosis ## Footnote Ecchymosis (Bruise): Bruising is the most common complication encountered in obtaining a blood specimen. It is caused by leakage of a small amount of blood in the tissue around the puncture site. Hematoma: A hematoma results when leakage of a large amount of blood around the puncture site causes the area to rapidly swell.

Question 98

A patient complains of extreme pain when you insert the needle during a venipuncture attempt. The pain does not subside, but the patient does not feel any numbness or burning sensation. You know the needle is in the vein because the blood is flowing into the tube. You have only two tubes to fill, and the first one is almost full. What should you do? Ask the patient if he or she wants you to continue the draw Discontinue the draw and attempt collection at another site Distract the patient with small talk and continue the draw Tell the patient to hang in there as you have only one tube left

Answer 98

Discontinue the draw and attempt collection at another site ## Footnote If marked or extreme pain occurs, or the patient asks you to remove the needle for any reason, the venipuncture should be terminated immediately, even if there are no other signs of nerve injury.

Question 99

Which type of patient is most likely to have an arteriovenous fistula or graft? Arthritic Dialysis Hospice Wheelchair-bound

Answer 99

Dialysis ## Footnote An arteriovenous (AV) shunt, fistula, or graft is the permanent surgical connection of an artery and vein by direct fusion (fistula), resulting in a bulging vein, or with a piece of vein or tubing (graft) that creates a loop under the skin. It is typically created to be used for dialysis, commonly joins the radial artery and cephalic vein above the wrist on the underside of the arm, and has a distinctive buzzing sensation called a “thrill” when palpated. A temporary shunt with tubing on the surface of the skin can also be created.

Question 100

Type of immersion oil with high viscosity and is used in brightfield and standard clinical microscopy. In hematology, this oil is routinely used. Type A Type B Type C

Answer 100

Type B ## Footnote Three types of immersion oil, differing in viscosity, are employed in the clinical laboratory: 1. Type A has very low viscosity and is used in fluorescence and darkfield studies. 2. Type B has high viscosity and is used in brightfield and standard clinical microscopy. In hematology, this oil is routinely used. 3. Type C has very high viscosity and is used with inclined microscopes with long-focus objective lenses and wide condenser gaps.

Question 101

The recommended cleaner for removing oil from objectives is: Benzene Xylene Water 70% alcohol or lens cleaner

Answer 101

70% alcohol or lens cleaner ## Footnote Use solvent sparingly. The use of xylene is discouraged, because it contains a carcinogenic component (benzene). Xylene is also a poor cleaning agent, leaving an oily film on the lens. Lens cleaner or 70% isopropyl alcohol employed sparingly on a cotton applicator stick can be used to clean the objective lenses.

Question 102

Often the objects appear to have “haloes” surrounding them. Brightfield microscope Darkfield microscope Phase-contrast microscope Polarized light microscope

Answer 102

Phase-contrast microscope

Question 103

True for PRECISION: Measure of agreement between an assay value and the theoretical “true value” of its analyte Magnitude of error separating the assay result from the true value Easy to define but difficult to establish and maintain Relatively easy to measure and maintain

Answer 103

Relatively easy to measure and maintain ## Footnote Accuracy is easy to define but difficult to establish and maintain; precision is relatively easy to measure and maintain. Precision is the expression of reproducibility or dispersion about the mean, often expressed as SD or CV%.

Question 104

Slope measures: Random error Constant systematic error Proportional systematic error Constant and proportional systematic error

Answer 104

Proportional systematic error ## Footnote Perfect correlation generates a slope of 1 and a y intercept of 0. Slope measures proportional systematic error; the higher the analyte value, the greater the deviation from the line of identity. Proportional errors are caused by malfunctioning instrument components or a failure of some part of the testing process. The magnitude of the error increases with the concentration or activity of the analyte. An assay with proportional error may be invalid. Intercept measures constant systematic error (or bias, in laboratory vernacular), a constant difference between the new and reference assay regardless of assay result magnitude. A laboratory director may choose to adopt a new assay with systematic error but must modify the published reference interval.

Question 105

The positive predictive value predicts the probability that an individual with a positive assay result ___ the disease or condition. Has Could have May have Will have

Answer 105

Has ## Footnote The positive predictive value predicts the probability that an individual with a positive assay result has the disease or condition. The negative predictive value predicts the probability that an individual with a negative assay result does not have the disease or condition.

Question 106

It describes the total number of events or conditions in a broadly defined population, for instance, the total number of patients with chronic heart disease in the Philippines. Incidence Prevalence False negative False positive

Answer 106

Prevalence ## Footnote Epidemiologists describe population events using the terms prevalence and incidence. 1. Prevalence describes the total number of events or conditions in a broadly defined population, for instance, the total number of patients with chronic heart disease in the United States. 2. Incidence describes the number of events occurring within a randomly selected number of subjects representing a population, over a defined time, for instance, the number of newcases of heart disease per 100,000 U.S. residents per year. Scientists use incidence, not prevalence, to select laboratory assays for specific applications such as screening or confirmation.

Question 107

Type of chromatin represented by the more darkly stained, condensed clumping pattern and is the transcriptionally inactive area of the nucleus Euchromatin Heterochromatin

Answer 107

Heterochromatin ## Footnote Morphologically, chromatin is divided into two types: (1) the heterochromatin, which is represented by the more darkly stained, condensed clumping pattern and is the transcriptionally inactive area of the nucleus (2) the euchromatin, which has diffuse, uncondensed, open chromatin and is the genetically active portion of the nucleus where DNA transcription into mRNA occurs. The euchromatin is loosely coiled and turns a pale blue when stained with Wright stain. More mature cells have more heterochromatin because they are less transcriptionally active.

Question 108

In ____, the tetraploid DNA is checked for proper replication and damage takes approximately 4 hours. G1 S G2 M G0

Answer 108

G2 ## Footnote The cell cycle is a biochemical and morphologic four-stage process through which a cell passes when it is stimulated to divide. These stages are G1 (gap 1), S (DNA synthesis), G2 (gap 2), and M (mitosis). G1 is a period of cell growth and synthesis of components necessary for replication. G1 lasts about 10 hours. In the S stage, DNA replication takes place, a process requiring about 8 hours. An exact copy of each chromosome is produced and they pair together as sister chromatids. The centrosome is also duplicated during the S stage. In G2, the tetraploid DNA is checked for proper replication and damage. G2 takes approximately 4 hours. The time spent in each stage can be variable, but mitosis takes approximately 1 hour. During G0 (quiescence) the cell is not actively in the cell cycle.

Question 109

All of the following statements refers to APOPTOSIS, except: Enlarged cell size due to swelling Reduced cell size due to shrinkage Condensation and fragmentation of the nucleus between nucleosomes Mostly physiologic to remove unwanted cells

Answer 109

Enlarged cell size due to swelling ## Footnote APOPTOSIS Reduced due to shrinkage Condensation and fragmentation between nucleosomes Mostly physiologic to remove unwanted cells; pathologic in response to cell injury ---- NECROSIS Enlarged due to swelling Random breaks and lysis (karyolysis) Pathologic; results from cell injury

Question 110

The process of replacing the active marrow by adipocytes (yellow marrow) during development is Hematopoiesis Progression Regression Retrogression

Answer 110

Retrogression ## Footnote The process of replacing the active marrow by adipocytes (yellow marrow) during development is called retrogression and eventually results in restriction of the active marrow in the adult to the sternum, vertebrae, scapulae, pelvis, ribs, skull, and proximal portion of the long bones.

Question 111

The major site of blood cell production during the second trimester of fetal development. Yolk sac Liver Spleen Bone marrow

Answer 111

Liver ## Footnote The liver serves as the major site of blood cell production during the second trimester of fetal development. In adults, the hepatocytes of the liver have many functions, including protein synthesis and degradation, coagulation factor synthesis, carbohydrate and lipid metabolism, drug and toxin clearance, iron recycling and storage, and hemoglobin degradation in which bilirubin is conjugated and transported to the small intestine for eventual excretion

Question 112

The largest lymphoid organ in the body: Bone marrow Thymus Liver Spleen

Answer 112

Spleen

Question 113

Cytokines that function for STEM CELL MOBILIZATION: IL-1 and IL-2 IL-2 and IFN-alpha IL-12 and IL-15 IL-3, G-CSF and GM-CSF

Answer 113

IL-3, G-CSF and GM-CSF

Question 114

In adults, hematopoietic tissue is located in the: Bone marrow Bone marrow and lymph nodes Bone marrow, lymph nodes, liver and spleen Bone marrow, lymph nodes, spleen, liver and thymus

Answer 114

Bone marrow, lymph nodes, spleen, liver and thymus

Question 115

In aplastic anemia, the bone marrow is: Empty Empty, hypoplastic Empty, hyperplastic Either hypoplastic or hyperplastic

Answer 115

Empty, hypoplastic

Question 116

Second step in phagocytosis: Recognition and attachement Ingestion Killing and digestion Formation of neutrophil extracellular trap

Answer 116

Ingestion ## Footnote PHAGOCYTOSIS (RODAK) 1. Recognition and attachment 2. Ingestion 3. Killing and digestion 4. Formation of neutrophil extracellular trap

Question 117

The promonocyte nucleus is deeply indented and should not be confused with a: Lymphocyte Erythrocyte Segmenter neutrophil Band neutrophil

Answer 117

Band neutrophil

Question 118

Which of the following cells does not exhibit myeloperoxidase (MPO) activity? Neutrophils Eosinophils Monocytes Lymphocytes

Answer 118

Lymphocytes ## Footnote Myeloperoxidase (MPO) is an enzyme found in the primary granules of granulocytic cells (neutrophils, eosinophils, and, to a certain extent, monocytes). Lymphocytes do not exhibit MPO activity. This stain is useful for differentiating the blasts of acute myeloid leukemia (AML) from those of acute lymphoblastic leukemia (ALL).

Question 119

NEWER TECHNIQUES USED IN THE DIAGNOSIS of acute leukemias: Morphology and cytochemistry Cytochemistry and cytogenetics Flow cytometry and cytogenetic analysis Flow cytometry, cytogenetic analysis and molecular testing

Answer 119

Flow cytometry, cytogenetic analysis and molecular testing

Question 120

Basophilic and granular cytoplasm MK-I MK-II MK-III

Answer 120

MK-II

Question 121

Differentiation stage(s) characterized by presence of demarcation system: MK-I MK-I and MK-II MK-II and MK-III MK-I, MK-II and MK-III

Answer 121

MK-I, MK-II and MK-III

Question 122

Cytokine(s) that function to stimulate megakaryocytopoiesis: Thrombopoietin (TPO) TPO and IL-3 TPO, IL-3 and IL-6 TPO, IL-3, IL-6 and IL-11

Answer 122

TPO, IL-3, IL-6 and IL-11

Question 123

Demonstrates the largest platelets seen and is also referred to as giant platelet syndrome: Epstein syndrome Mediterranean macrothrombocytopenia May-Hegglin anomaly Bernard-Soulier syndrome

Answer 123

Bernard-Soulier syndrome

Question 124

Ratio of blood to anticoagulant for coagulation testing: 1:4 1:9 4:1 9:1

Answer 124

9:1

Question 125

Hemostasis specimen STORAGE temperature: 1 to 6 C 18 to 24 C 36.5 to 37.5 C 30 to 37 C

Answer 125

18 to 24 C ## Footnote HEMOSTASIS SPECIMEN STORAGE TEMPERATURE Sodium citrate-anticoagulated whole blood specimens are placed in a rack and allowed to stand in a vertical position with the stopper intact and uppermost. The pH remains constant as long as the specimen is sealed. Specimens are maintained at 18° C to 24° C (ambient temperature), never at refrigerator temperatures. Storage at 1° C to 6° C activates factor VII, destroys platelet activity through uncontrolled activation, and causes the cryoprecipitation of large VWF multimers. Also, specimens should never be stored at temperatures greater than 24° C because heat causes deterioration of coagulation factors V and VIII.

Question 126

Most coagulation studies are carried out at which temperature? -20C -70C 24C 37C

Answer 126

37C

Question 127

Possible solution when specimen is icteric or lipemic for a clot-based test: PT falsely shortened; recollect specimen. PT falsely prolonged; recollect specimen. Measure PT using a mechanical coagulometer Adjust anticoagulant volume

Answer 127

Measure PT using a mechanical coagulometer

Question 128

Possible effect and solution when blood collection volume is less than the specified minimum for a clot-based test: PT falsely shortened; recollect specimen PT falsely prolonged; recollect specimen. Use reagent known to be insensitive to heparin Use chromogenic factor X assay instead of PT

Answer 128

PT falsely prolonged; recollect specimen.

Question 129

Test that assess deficiencies of all factors except VII and XIII: Prothrombin time (PT) Partial thromboplastin time (PTT) Thrombin time (TT) Reptilase time

Answer 129

Partial thromboplastin time (PTT)

Question 130

Part of the INITIAL VON WILLEBRAND DISEASE WORKUP: BT, PT and APTT CBC, PT and APTT CBC, BT, PT and APTT CBC, BT, PT, APTT and automated functional platelet assays Decreased vWF activity and personal/family history of mucocutaneous bleeding

Answer 130

CBC, PT and APTT

Question 131

DEFINITIVE DIAGNOSIS OF VON WILLEBRAND DISEASE: BT, PT and APTT CBC, PT and APTT CBC, BT, PT and APTT CBC, BT, PT, APTT and automated functional platelet assays Laboratory demonstration of decreased vWF activity Decreased vWF activity and personal/family history of mucocutaneous bleeding

Answer 131

Decreased vWF activity and personal/family history of mucocutaneous bleeding

Question 132

In Coulter instruments, which parameters are directly measured: RBC count and hemoglobin RBC and WBC counts RBC count and hematocrit RBC and WBC counts, hemoglobin

Answer 132

RBC and WBC counts, hemoglobin

Question 133

Lipemia, icterus: Increased Hb Increased Hb, decreased MCH Increased Hb and MCH Decreased Hb and MCH

Answer 133

Increased Hb and MCH

Question 134

Platelet clumps: Decreased platelets Decreased platelets and WBCs Decreased platelets, increased WBCs Increased platelets and WBCs

Answer 134

Decreased platelets, increased WBCs

Question 135

Parameters affected when the WBC count > 100,000/uL: Increased RBCs, decreased hemoglobin Decreased RBCs, increased hemoglobin Decreased RBCs and hemoglobin Increased RBcs and hemoglobin, incorrect hematocrit

Answer 135

Increased RBcs and hemoglobin, incorrect hematocrit

Question 136

Compare the volume of plasma to serum obtained from a given volume of whole blood: Plasma greater volume than serum Plasma lesser volume than serum Same volume Variable

Answer 136

Plasma greater volume than serum

Question 137

EDTA is used in concentrations of ___ mg/1 mL of whole blood. 0.5 mg/1 mL of whole blood 1.5 mg/1 mL of whole blood 2.0 mg/1 mL of whole blood 2.5 mg/1 mL of whole blood

Answer 137

1.5 mg/1 mL of whole blood

Question 138

A 7.0 mL EDTA tube is received in the laboratory containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the following tests will most likely be erroneous? A. RBC count B. Hemoglobin C. Hematocrit D. WBC count

Answer 138

C. Hematocrit

Question 139

EDTA-induced pseudothrombocytopenia can be identified on blood smear by: A. Finding platelets pushed to the feathered end B. Finding platelets adhering to WBCs C. Finding no platelets at all on the smear D. Bluish discoloration to the macroscopic appearance of the slide

Answer 139

B. Finding platelets adhering to WBCs ## Footnote Platelet satellitosis (platelet encircling the peripheral borders of neutrophils) is seen in a rare patient whose blood is anticoagulated with EDTA. This phenomenon is thought to be due to a serum factor which reacts in the presence of EDTA.

Question 140

The automated platelet count on an EDTA specimen is 58 x 10 9th/L. The platelet estimate on the blood smear appears normal, but it was noted that the platelets were surrounding the neutrophils. The next step should be to: A. Report the automated platelet count since it is more accurate than a platelet estimate B. Warm the EDTA tube and repeat the automated platelet count C. Rerun the original specimen since the platelet count and blood smear estimate do not match D. Recollect a specimen for a platelet count using a different anticoagulant

Answer 140

D. Recollect a specimen for a platelet count using a different anticoagulant

Question 141

Sodium citrate in the concentration of ___ solution has been adopted as the appropriate concentration for coagulation studies. A. 1.5% B. 2.8% C. 3.2% D. 3.8%

Answer 141

C. 3.2% ## Footnote Sodium citrate in the concentration of a 3.2% solution has been adopted as the appropriate concentration by the ICSH and the International Society for Thrombosis and Hemostasis for coagulation studies.

Question 142

Which ratio of anticoagulant to blood is correct for coagulation procedures? A. 1:4 B. 1:5 C. 1:9 D. 1:10

Answer 142

C. 1:9

Question 143

Which results would be expected for the PT and APTT in a patient with polycythemia? A. Both prolonged B. Both shortened C. Normal PT, prolonged APTT D. Both normal

Answer 143

A. Both prolonged

Question 144

What is the proper angle of needle insertion for phlebotomy? A. 5 degrees B. 15 degrees C. 35 degrees D. 45 degrees

Answer 144

B. 15 degrees

Question 145

Select the needle most commonly used in standard venipuncture in an adult: A. One inch, 18 gauge B. One inch, 21 gauge C. One-half inch, 21 gauge D. One-half inch, 25 gauge

Answer 145

B. One inch, 21 gauge

Question 146

The bevel of the needle should be held _____ in the performance of a venipuncture. A. Sideways B. Upward C. Downward D. In any direction

Answer 146

B. Upward

Question 147

Most common complication encountered in obtaining a blood specimen: A. Ecchymosis (bruise) B. Hematoma C. Hemoconcentration D. Anemia

Answer 147

A. Ecchymosis (bruise)

Question 148

It is caused by leakage of a SMALL AMOUNT OF BLOOD in the tissue around the puncture site: A. Ecchymosis (bruise) B. Hematoma C. Hemoconcentration D. Anemia

Answer 148

A. Ecchymosis (bruise)

Question 149

Leakage of a LARGE AMOUNT OF BLOOD around the puncture site causes the area to rapidly swell: A. Ecchymosis (bruise) B. Hematoma C. Hemoconcentration D. Anemia

Answer 149

B. Hematoma

Question 150

VASCULAR COMPLICATIONS of phlebotomy: A. Bleeding from the site of the venipuncture and hematoma B. Pseudoaneurysm, thrombosis C. Reflex arteriospasm, arteriovenous fistula formation D. All of these

Answer 150

D. All of these ## Footnote Bleeding from the site of the venipuncture and hematoma formation are the most common vascular complications. Uncommon vascular complications that are not usually related to the technique include pseudoaneurysm, thrombosis, reflex arteriospasm, and arteriovenous fistula formation.

Question 151

CARDIOVASCULAR COMPLICATIONS of phlebotomy: A. Orthostatic hypotension B. Syncope C. Shock and cardiac arrest D. All of these

Answer 151

D. All of these

Question 152

A blood sample is needed from a patient with IV fluids running in both arms. Which of the following is an acceptable procedure? A. Any obtainable vein is satisfactory. B. Obtain sample from above the IV site. C. Obtain sample from below the IV site with special restrictions. D. Disconnect the IV line. E. Do not draw a blood specimen

Answer 152

C. Obtain sample from below the IV site with special restrictions.

Question 153

When encountering a patient with a FISTULA, the phlebotomist should: Apply the tourniquet below the fistula Use the other arm Collect the blood from the fistula Attach a syringe to the T-tube connector

Answer 153

Use the other arm ## Footnote FISTULA: Permanent surgical connection between an artery and a vein (used for dialysis) CANNULA: Tube that can be inserted into a cavity

Question 154

If a patient adamantly refuses to have blood drawn, you should: Convince the patient to be cooperative Notify the patient’s nurse or physician Restrain the patient and draw the blood Write a note to the patient’s physician

Answer 154

Notify the patient’s nurse or physician

Question 155

Blood collection tubes are labeled: As soon as the test order is received Before the specimen is even collected Immediately after specimen collection After returning to the laboratory

Answer 155

Immediately after specimen collection

Question 156

Which of the following is a proper way to clean up a small blood spill that has dried on a countertop? Moisten it with a disinfectant and carefully absorb it with a paper towel Rub it with an alcohol pad, then wipe the area with a clean alcohol pad Scrape it into a biohazard bag and wash the surface with soap and water Use a disinfectant wipe and scrub it in ever increasing concentric circles

Answer 156

Moisten it with a disinfectant and carefully absorb it with a paper towel

Question 157

The appropriate dilution of bleach to be used in laboratory disinfection is: 1:2 1:5 1:10 1:100

Answer 157

1:10

Question 158

Which order of events should be followed at the conclusion of a laboratory worker's shift in order to prevent the spread of bloodborne pathogens? Remove gloves, disinfect area, wash hands, remove lab coat Disinfect area, remove gloves, remove lab coat, wash hands Disinfect area, remove gloves, wash hands, remove lab coat Remove gloves, wash hands, remove lab coat, disinfect area

Answer 158

Disinfect area, remove gloves, remove lab coat, wash hands ## Footnote According to the OSHA Bloodborne Pathogens Rule of 1992, gloves and lab coats are to be removed after disinfection of the work area.

Question 159

Isolation techniques: Prevent spread of infection from patient to hospital personnel Prevent spread of infection from patient to other patients Protect infection prone patient from pathogens All of these

Answer 159

All of these

Question 160

In ENTERIC ISOLATION, the technologist is required to wear Gown and gloves Gown, mask and gloves Gown, mask, gloves and shoe coverings Mask

Answer 160

Gown and gloves ## Footnote STRICT ISOLATION: Gown, mask and gloves ENTERIC ISOLATION: Gown and gloves RESPIRATORY ISOLATION: Mask, gloves WOUND AND SKIN ISOLATION: Gown and gloves PROTECTIVE ISOLATION: Gown, mask, gloves, shoe coverings

Question 161

Reverse isolation may be used for: A patient with the measles An adult patient with the flu A patient with tuberculosis A patient with severe burns

Answer 161

A patient with severe burns ## Footnote Patients requiring PROTECTIVE ISOLATION are those with compromised immune systems, such as neutropenic patients (those with abnormally low white blood cell counts); severely burned patients; and patients with compromised immune systems, such as patients with AIDS.

Question 162

The first hemostatic response to injury of a blood vessel is: Platelet adhesion Platelet aggregation Vasoconstriction Extrinsic coagulation

Answer 162

Vasoconstriction

Question 163

The enzyme inhibited by aspirin is: Thromboxane synthetase Cyclooxygenase Lactate dehydrogenase Phospholipase

Answer 163

Cyclooxygenase

Question 164

The life span of a platelet is about: 2 to 3 hours 1 to 3 days 8 to 11 days 60 to 80 days

Answer 164

8 to 11 days

Question 165

Approximately ___ of the total number of platelets circulate in the systemic circulation? One-fourth One-third One-half Two-thirds

Answer 165

Two-thirds

Question 166

The normal range of platelets in the systemic circulation is: 50 - 150 x 10 9th/L 100 - 200 x 10 9th/L 150 - 400 x 10 9th/L Greater than 500 x 10 9th/L

Answer 166

150 - 400 x 10 9th/L

Question 167

Effect of platelet clumps to automated cell counting: Decreased platelets and WBCs Increased platelets and WBCs Decreased platelets, increased WBCs Increased platelets, decreased WBCs

Answer 167

Decreased platelets, increased WBCs ## Footnote RATIONALE: Large clumps counted as WBCs and not platelets CORRECTIVE ACTION: Redraw specimen in sodium citrate, multiply result by 1.1

Question 168

In disseminated intravascular coagulation (DIC) and immune thrombocytopenic purpura (ITP): There is decreased production of platelets There is increased destruction of platelets There is a defect of platelet membrane There is defect of platelet release reaction

Answer 168

There is increased destruction of platelets

Question 169

Immune thrombocytopenic purpura (ITP): Formerly known as disseminated intravascular coagulation (DIC) Absence of megakaryocytes in the bone marrow Widespread formation of platelet thrombi Due to platelet antibodies

Answer 169

Due to platelet antibodies

Question 170

In thrombocythemia, the platelets are: Increased Decreased Normal Normal in number, abnormal morphology

Answer 170

Increased

Question 171

Which of the following is characteristic of Bernard-Soulier syndrome? Giant platelets Normal bleeding time Abnormal aggregation with ADP Increased platelet count

Answer 171

Giant platelets

Question 172

Platelet aggregation studies revealed normal aggregation curves with collagen, epinephrine, and ADP, but an abnormal aggregation curve with ristocetin. Based on these findings, what is the differential diagnosis? -Von Willebrand disease and Bernard-Soulier syndrome -Glanzmann's thrombasthenia and von Willebrand disease -Storage pool disease and Glanzmann's thrombasthenia -Bernard-Soulier syndrome and storage pool disease

Answer 172

Von Willebrand disease and Bernard-Soulier syndrome

Question 173

Which set of platelet responses would be most likely be associated with Glanzmann's thrombasthenia? -Normal platelet aggregation response to ADP and ristocetin; decreased response to collagen -Normal platelet aggregation response to collagen; decreased response to ADP and collagen -Normal platelet aggregation response to ristocetin; decreased response to collagen, ADP and epinephrine -Normal platelet aggregation response to ADP; decreased response to collagen and ristocetin

Answer 173

Normal platelet aggregation response to ristocetin; decreased response to collagen, ADP and epinephrine

Question 174

Primary PLATELET AGGREGATION disorders: Bernard-Soulier syndrome Glanzmann's thrombasthenia Essential athrombia Glanzmann's thrombasthenia and essential athrombia

Answer 174

Glanzmann's thrombasthenia and essential athrombia ## Footnote Glanzmann thrombasthenia and essential athrombia are similar, rare, primary aggregation disorders.

Question 175

To evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets, should be observed per oil immersion field?* 1 to 4 8 to 20 4 to 10 20 to 50

Answer 175

8 to 20

Question 176

If an average of 10 platelets are seen per oil immersion field, what is the estimated platelet count? 50 x 10 9th/L 100 x 10 9th/L 200 x 10 9th/L 300 x 10 9th/L

Answer 176

200 x 10 9th/L ## Footnote For platelet estimate on a wedge smear: Factor is 20,000

Question 177

In the Ivy method of bleeding time, the blood pressure cuff is inflated to: 20 mm. Hg 30 mm. Hg 40 mm. Hg 45 mm. Hg

Answer 177

40 mm. Hg

Question 178

Normal platelet adhesion depends upon: Fibrinogen Glycoprotein Ib Glycoprotein IIb, IIIa complex Calcium

Answer 178

Glycoprotein Ib ## Footnote Glycoprotein Ib is a platelet receptor for VWF. Glycoprotein Ib and VWF are both necessary for a normal platelet adhesion. Other proteins that play a role in platelet adhesion are glycoproteins V and IX

Question 179

Storage pool deficiencies are defects of: Platelet adhesion Platelet aggregation Platelet granules Platelet production

Answer 179

Platelet granules ## Footnote Storage pool deficiencies are defects of platelet granules. Most commonly, a decrease in platelet-dense granules is present with decreased release of ADP, ATP, calcium, and serotonin from platelet-dense granules.

Question 180

Which defect characterizes Gray's syndrome? Platelet adhesion defect Dense granule defect Alpha granule defect Coagulation defect

Answer 180

Alpha granule defect ## Footnote Gray’s syndrome is a platelet granule defect associated with a decrease in alpha granules resulting in decreased production of alpha granule proteins such as platelet factor 4 and beta thromboglobulin. Alpha granule deficiency results in the appearance of agranular platelets when viewed on a Wright’s stained blood smear.

Question 181

Hereditary hemorrhagic telangiectasia is a disorder of: Platelets Clotting proteins Fibrinolysis Connective tissue

Answer 181

Connective tissue ## Footnote Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) is a connective tissue disorder associated with telangiectases (dilated capillaries) of the mucous membranes and skin. Lesions may develop on the tongue, lips, palate, face, hands, nasal mucosa, and throughout the gastrointestinal tract. This disorder is an autosomal dominant condition that usually manifests in adolescence or early adulthood.

Question 182

In which of the following lists the steps of hemostatic response in the correct order? Fibrinolysis → injury → secondary hemostasis → primary hemostasis Injury → primary hemostasis → secondary hemostasis → fibrinolysis Injury → secondary hemostasis → primary hemostasis → fibrinolysis Injury → fibrinolysis → primary hemostasis → secondary hemostasis

Answer 182

Injury → primary hemostasis → secondary hemostasis → fibrinolysis

Question 183

Primary substrate of thrombin: Fibrinogen Prothrombin Factor V Factor X

Answer 183

Fibrinogen

Question 184

Which results are associated with hemophilia A? Prolonged APTT, normal PT Prolonged PT and APTT Prolonged PT, normal APTT Normal PT and APTT

Answer 184

Prolonged APTT, normal PT ## Footnote Hemophilia A is associated with factor VIII deficiency. Factor VIII is a factor in the intrinsic coagulation pathway that is evaluated by the APTT and not the PT test. The PT test evaluates the extrinsic and common pathways.

Question 185

Normal PT and APTT results in a patient with a poor wound healing may be associated with: Factor VII deficiency Factor VIII deficiency Factor XII deficiency Factor XIII deficiency

Answer 185

Factor XIII deficiency ## Footnote Factor XIII deficiency can lead to impaired wound healing and may cause severe bleeding problems. Factor XIII is a fibrin stabilizing factor that changes the fibrinogen bonds in fibrin polymers to stable covalent bonds. Factor XIII is not involved in the process of fibrin formation and, therefore, the PT and APTT are both normal.

Question 186

Which coagulation factor is present in the highest concentration in plasma? Factor II Factor XII Factor I Factor VII

Answer 186

Factor I

Question 187

Which of the following participates ONLY in the extrinsic pathway? Factor VII Factor IX Factor X Factor II

Answer 187

Factor VII

Question 188

Plasma thromboplastin or prothrombinase includes: -Calcium ion only -Complex of calcium ions and activated factor XI -Complex of activated factor VII and calcium ions -Complex of activated factors X and V, platelet factor 3 and calcium ions

Answer 188

Complex of activated factors X and V, platelet factor 3 and calcium ions

Question 189

The activated partial thromboplastin time is NOT affected by deficiency of: Factor VIII Factor IX Factor XI Factor VII

Answer 189

Factor VII

Question 190

Prothrombin time is NOT affected by a deficiency of: Factor VIII Factor V Factor I Factor X

Answer 190

Factor VIII

Question 191

Classic hemophilia is a condition in which there may be a: Prolonged bleeding time Decrease in platelets Prolonged prothrombin time Prolonged activated partial thromboplastin time

Answer 191

Prolonged activated partial thromboplastin time

Question 192

Which of the following is vitamin K dependent? Factor XII Fibrinogen Antithrombin III Factor VII

Answer 192

Factor VII

Question 193

Last factor to be depressed n vitamin K deficiency: Factor II Factor VII Factor X Factor IX

Answer 193

Factor II

Question 194

Which of the following factors is not present in BaSO4 adsorbed plasma? Factor VIII Factor II Factor XII Factor V

Answer 194

Factor II

Question 195

Which one of the following factors typically shows an increase in liver disease? Factor VII Factor VIII Factor IX Factor X

Answer 195

Factor VIII

Question 196

Which of the following factor deficiencies is associated with either no bleeding or only a minor bleeding tendency, even after trauma or surgery? Factor X Factor XII Factor XIII Factor V

Answer 196

Factor XII

Question 197

In which of the following diseases would you most likely find an abnormal prothrombin time: Hemophilia A Hemophilia B vWD DIC

Answer 197

DIC

Question 198

Increased APTT with a normal PT would indicate a deficiency of: Factor II Factor VII Factor IX Factor X

Answer 198

Factor IX

Question 199

Normal APTT with an increased PT would indicate a deficiency of: Factor II Factor VII Factor I Factor IX

Answer 199

Factor VII

Question 200

Increased APTT and PT would indicate a deficiency of: Factor V Factor XI Factor XII Factor VIII

Answer 200

Factor V

Question 201

PTT measures all factors except for: I and V VIII and IX V and VIII VII and XIII

Answer 201

VII and XIII

Question 202

A patient on therapeutic warfarin will most likely have a(an): -Normal PT/INR, increased APTT, prolonged bleeding time, low platelet count -Increased PT/INR, increased APTT, normal bleeding time, normal platelet count -Normal PT/INR, normal APTT, normal bleeding time, normal platelet count -Increased PT/INR, normal APTT, prolonged bleeding time, low platelet count

Answer 202

Increased PT/INR, increased APTT, normal bleeding time, normal platelet count

Question 203

Reversal of heparin overdose can be achieved by administration of: Vitamin K Anti-thrombin Protamine sulfate Warfarin

Answer 203

Protamine sulfate

Question 204

The preferred blood product for a bleeding patient with von Willebrand's disease is transfusion with: Factor II, VII, IX, X concentrates Platelet Concentrates Fresh Frozen Plasma and Platelets Cryoprecipitated AHF

Answer 204

Cryoprecipitated AHF

Question 205

Which of the following laboratory findings is associated with Factor XIII deficiency? Prolonged activated partial thromboplastin time Clot solubility in a 5 molar urea solution Prolonged thrombin time Prolonged prothrombin time

Answer 205

Clot solubility in a 5 molar urea solution

Question 206

The following results were obtained on a patient: prolonged bleeding time, normal platelet count, normal PT, and prolonged APTT. Which of the following disorders is most consistent with these results? Hemophilia A Hemophilia B vWD Glanzmann's thrombasthenia

Answer 206

vWD

Question 207

A patient has a history of mild hemorrhagic episodes. Laboratory results include a prolonged prothrombin time and activated partial thromboplastin time. The abnormal prothrombin time was corrected by normal and adsorbed plasma, but not aged serum. Which of the following coagulation factors is deficient? Prothrombin Factor V Factor X Factor VII

Answer 207

Factor V

Question 208

A 56-year-old woman was admitted to the hospital with a history of a moderate to severe BLEEDING tendency of a several years' duration. Epistaxis and menorrhagia were reported. Prolonged APTT was corrected with fresh normal plasma, adsorbed plasma, and aged serum. Deficiency of which of the following is most likely? Factor XII Factor VIII Factor XI Factor IX

Answer 208

Factor XI ## Footnote Prolonged APTT corrected with normal plasma, adsorbed plasma and aged serum: Deficiency of factor XI or XII Factor XI deficiency - patient exhibits bleeding (hemophilia C) Factor XII deficiency - negative bleeding

Question 209

The abnormal APTT seen in pathological circulating anticoagulant is: Corrected with aged serum Corrected with adsorbed plasma Corrected with normal plasma Not corrected with any of the above

Answer 209

Not corrected with any of the above

Question 210

The activity of the lupus anticoagulant and anticardiolipin antibodies appears to be directed against: Factor V Factor VIII Factor IX Phospholipid

Answer 210

Phospholipid

Question 211

A prolonged Stypven (Russell viper venom) time is associated with deficiency of the following factors EXCEPT: Factor I Factor II Factor X Factor VII

Answer 211

Factor VII

Question 212

The laboratory test for monitoring heparin therapy is: PT PTT Bleeding time Thrombin time

Answer 212

PTT

Question 213

All of the following tests are affected by heparin therapy except: Thrombin time Whole blood clotting time APTT Reptilase time

Answer 213

Reptilase time

Question 214

An abnormal thrombin time is associated with: Factor X deficiency Excess plasminogen Fibrinogen deficiency Protein C deficiency

Answer 214

Fibrinogen deficiency

Question 215

The observation of a normal reptilase time and a prolonged thrombin time is indicative of: Presence of fibrin degradation products Hypoplasminogenemia Dysfibrinogenemia Presence of heparin

Answer 215

Presence of heparin

Question 216

Which of the following coagulation test results is normal in patient with classic vWD? Bleeding time APTT Platelet count Factor VIII:C and vWF

Answer 216

Platelet count

Question 217

Primary inhibitor of the fibrinolytic system? Protein C Protein S Alpha2 antiplasmin Alpha2 macroglobulin

Answer 217

Alpha2 antiplasmin

Question 218

The D-dimer test is a specific test for: Plasminogen activation Plasmin degradation of fibrinogen Plasmin degradation of fibrin Factor XIII

Answer 218

Plasmin degradation of fibrin

Question 219

Acute disseminated intravascular coagulation is characterized by: Hypofibrinogenemia Thrombocytosis Negative D-dimer Shortened thrombin time

Answer 219

Hypofibrinogenemia

Question 220

A positive protamine sulfate is suggestive of: vWD Primary fibrinolysis DIC Glanzmann's thrombasthenia

Answer 220

DIC

Question 221

Which factor deficiency is associated with a prolonged PT and APTT? X VIII IX XI

Answer 221

X ## Footnote Factor X, a common pathway factor deficiency, is most likely suspected, because both PT and APTT are prolonged. Other causes may include liver disease, vitamin K deficiency, and anticoagulant drugs such as Coumadin and heparin.

Question 222

The following results were obtained on a patient: normal platelet count and function, normal PT, and prolonged APTT. Which of the following disorders is most consistent with these results? Hemophilia A Bernard-Soulier syndrome von Willebrand's disease Glanzmann's thrombasthenia

Answer 222

Hemophilia A ## Footnote Hemophilia A is associated with the deficiency of factor VIII resulting in bleeding and an abnormal APTT. The platelet number and function are normal in this disorder. Von Willebrand's disease is a disorder of platelet adhesion associated with decreased VWF and factor VIII, causing an abnormal platelet function test and an abnormal APTT test. Both Glanzmann's thrombasthenia and Bernard-Soulier syndrome cause deficient platelet aggregation, but do not cause an abnormal APTT.

Question 223

Fibrin monomers are increased in which of the following conditions? Primary fibrinolysis DIC Factor VIII deficiency Fibrinogen deficiency

Answer 223

DIC ## Footnote Increased fibrin monomers result from coagulation activation. DIC is an acquired condition associated with spontaneous activation of coagulation and fibrinolysis. In primary fibrinolysis, the fibrinolytic system is activated and fibrin monomers are normal.

Question 224

Which of the following is associated with multiple factor deficiencies? An inherited disorder of coagulation Severe liver disease Dysfibrinogenemia Lupus anticoagulant

Answer 224

Severe liver disease ## Footnote Most of the clotting factors are made in the liver. Therefore, severe liver disease results in multiple factor deficiencies.

Question 225

Which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant? Thrombin time test Diluted Russell's viper venom test (DRVVT) D-dimer test FDP test

Answer 225

Diluted Russell's viper venom test (DRVVT) ## Footnote Russell's viper venom (RVV) reagent contains factors X and V, activating enzymes that are strongly phospholipid dependent. The reagent also contains RVV, calcium ions, and phospholipid. In the presence of phospholipid autoantibodies such as lupus anticoagulant, the reagent phospholipid is partially neutralized causing prolongation of the clotting time

Question 226

What clotting factors (cofactors) are inhibited by protein S? V and X Va and VIIIa VIII and IX VIII and X

Answer 226

Va and VIIIa ## Footnote Factors Va and VIIIa are deactivated by protein S and activated protein C.

Question 227

The Bethesda assay is used for which determination? Lupus anticoagulant titer Factor VIII inhibitor titer Factor V Leiden titer Protein S deficiency

Answer 227

Factor VIII inhibitor titer ## Footnote The Bethesda assay is a quantitative assay for factor VIII inhibitor. In this assay, normal plasma is incubated with different dilutions of the patient's plasma or a normal control. The inhibitor inactivates factor VIII present in normal plasma following incubation for 2 hours at 37°C. The residual activities in the sample are determined, and the inhibitor titer is calculated.

Question 228

Fibrinogen, which has been implicated as a primary risk factor for thrombotic disorders, increases approximately _____ mg/dL per DECADE in the elderly (65 to 79 years), 174 from 280 mg/dL to over 300 mg/dL. 1 mg/dL per decade 5 mg/dL per decade 10 mg/dL per decade 15 mg/dL per decade

Answer 228

10 mg/dL per decade

Question 229

The only abnormal test result in CHRONIC DIC: PT APTT Thrombin time D-dimer

Answer 229

D-dimer ## Footnote DIC, although characteristically identified through its hemorrhagic symptoms, is classified as a THROMBOTIC DISORDER 1. ACUTE DIC UNCOMPENSATED PT, PTT, and thrombin time are prolonged; the fibrinogen level is reduced to less than 100 mg/dL; and fibrin degradation products, including D-dimers, are significantly increased 2. CHRONIC DIC COMPENSATED Only elevated test result may be the D-dimer assay value, a hallmark of unregulated coagulation and fibrinolysis

Question 230

DIC is also known as: Defibrination syndrome Consumption coagulopathy Both of these None of these

Answer 230

Both of these ## Footnote DIC involves all hemostatic systems: vascular intima, platelets, leukocytes, coagulation, coagulation control pathways, and fibrinolysis.

Question 231

Assess deficiencies of factors II, V, VII, or X: Platelet count Prothrombin time (PT) Partial thromboplastin time (PTT) Thrombin time

Answer 231

Prothrombin time (PT) ## Footnote SCREENING TESTS FOR GENERALIZED HEMOSTATIC DISORDER 1. HEMOGLOBIN, HEMATOCRIT; RETICULOCYTE COUNT: Anemia associated with chronic bleeding; bone marrow response 2. PLATELET COUNT: Thrombocytopenia 3. PT: Deficiencies of factors II (prothrombin), V, VII, or X 4. PTT: Deficiencies of all factors except VII and XIII 5: THROMBIN TIME OR FIBRINOGEN ASSAY: Hypofibrinogenemia and dysfibrinogenemia

Question 232

Assess deficiencies of all factors except VII and XIII: Platelet count Prothrombin time (PT) Partial thromboplastin time (PTT) Thrombin time

Answer 232

Partial thromboplastin time (PTT) ## Footnote SCREENING TESTS FOR GENERALIZED HEMOSTATIC DISORDER 1. HEMOGLOBIN, HEMATOCRIT; RETICULOCYTE COUNT: Anemia associated with chronic bleeding; bone marrow response 2. PLATELET COUNT: Thrombocytopenia 3. PT: Deficiencies of factors II (prothrombin), V, VII, or X 4. PTT: Deficiencies of all factors except VII and XIII 5: THROMBIN TIME OR FIBRINOGEN ASSAY: Hypofibrinogenemia and dysfibrinogenemia

Question 233

The target INR for PULMONARY EMBOLISM (PE) treatment: 1 2 3 4

Answer 233

3 ## Footnote INR 2-3: Recommended for most indications (e.g., treatment or prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients who have had a myocardial infarction) INR 2.5 - 3.5: Recommended for patients with prosthetic heart valves INR 3: Pulmonary embolism (PE) treatment

Question 234

Which of the following is considered to be an advantage of the MECHANICAL end-point detection methodology? It is not affected by lipemia in the test sample It has the ability to provide a graph of clot formation It can incorporate multiple wavelengths into a single testing sequence It can measure proteins that do not have fibrin formation as the end-point

Answer 234

It is not affected by lipemia in the test sample ## Footnote A hemostasis laboratory manager may choose to maintain a separate mechanical end-point coagulometer to substitute for the optical instrument if the specimen is too cloudy for optical determinations.

Question 235

In end-stage liver disease, the fibrinogen level may fall to less than ___mg/dL, which is a mark of liver failure. Less than 100 mg/dL Less than 200 mg/dL Less than 300 mg/dL Less than 400 mg/dL

Answer 235

Less than 100 mg/dL ## Footnote In end-stage liver disease, the fibrinogen level may fall to less than 100 mg/dL, which is a mark of liver failure.

Question 236

PT and APTT are prolonged when the fibrinogen level is ____ mg/dL or less. 100 mg/dL or less 130 mg/dL or less 150 mg/dL or less 200 mg/dL or less

Answer 236

100 mg/dL or less

Question 237

Which of the following locations is not a site of extramedullary hematopoiesis? Bone marrow Liver Spleen Thymus

Answer 237

Bone marrow ## Footnote BONE MARROW - MEDULLARY SITE

Question 238

Which of the following is decreased in cases of intravascular hemolytic anemia? Bilirubin Urine hemosiderin Haptoglobin Serum hemoglobin

Answer 238

Haptoglobin

Question 239

Patients with renal failure often exhibit compromised hematopoietic activity because of which of the following? Concurrent depression of the thyroid Decreased production of erythropoietin Decreased production of GM-CSF BM suppression caused by medications

Answer 239

Decreased production of erythropoietin

Question 240

Which laboratory test is best used for DEFINITIVE diagnosis of sickle cell anemia? Solubility testing Hemoglobin electrophoresis Peripheral smear review for sickle cells Bone marrow analysis

Answer 240

Hemoglobin electrophoresis

Question 241

Which of the following best describes the function of the Rapoport-Leubering pathway? It produces ATP to help maintain RBC membrane deformability It results in reduction of glutathione It produces 2,3 diphosphoglycerate (2,3 DPG) It produces cytochrome reductase

Answer 241

It produces 2,3 diphosphoglycerate (2,3 DPG)

Question 242

The degree of effective erythropoiesis is best assessed by: Serum iron levels Serial hemoglobin determinations Reticulocyte count Ferrokinetic studies

Answer 242

Reticulocyte count

Question 243

Which of the following hemoglobins is composed of four beta globin chains? Hemoglobin F Hemoglobin C Bart's hemoglobin Hemoglobin H

Answer 243

Hemoglobin H

Question 244

Which of the following cells exhibit IgE receptors on their surface membranes? Basophils Eosinophils Band neutrophils Monocytes

Answer 244

Basophils

Question 245

Which cells are involved in immediate hypersensitivity reactions? Eosinophils Basophils Plasma cells Reactive lymphocytes

Answer 245

Basophils

Question 246

Which conditions which shift the oxyhemoglobin dissociation curve to the right? Acidosis Alkalosis Multiple blood transfusions Increased quantities of hemoglobin S or C

Answer 246

Acidosis

Question 247

In which stage of erythrocytic maturation does hemoglobin formation begin? Reticulocyte Pronormoblast Basophilic normoblast Polychromatophilic normoblast

Answer 247

Polychromatophilic normoblast

Question 248

What is the last nucleated stage in development of erythrocyte? Prorubricyte Rubricyte Metarubricyte Reticulocyte

Answer 248

Metarubricyte

Question 249

Which is the major hemoglobin found in the RBCs of patients with SICKLE CELL TRAIT? Hemoglobin S Hemoglobin F Hemoglobin A2 Hemoglobin A1

Answer 249

Hemoglobin A1

Question 250

All of the following are associated with hemolytic anemia except: Methemoglobinemia Hemoglobinuria Hemoglobinemia Increased haptoglobin

Answer 250

Increased haptoglobin ## Footnote Decreased haptoglobin

Question 251

Which of these hemoglobin derivatives cannot be reduced back to normal hemoglobin? Methemoglobin Hemiglobin Carboxyhemoglobin Sulfhemoglobin

Answer 251

Sulfhemoglobin

Question 252

Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow? Progressive decrease in overall cell size Increasing basophilia of cytoplasm Nuclear division without cytoplasmic division Fusion of the nuclear lobes

Answer 252

Nuclear division without cytoplasmic division

Question 253

he type of nuclear reproduction seen in megakaryocytes is: Polypoid mitosis Endomitosis Meiosis Binary fission

Answer 253

Endomitosis

Question 254

The outermost zone of platelet is called: Peripheral zone Sol-gel zone Alpha zone Organelle zone

Answer 254

Peripheral zone

Question 255

Which of the following cells is the largest cell in the BONE MARROW? Monocyte Megakaryocyte Osteoblast Mast cell

Answer 255

Megakaryocyte

Question 256

The number of platelets an average megakaryocyte generates is approximately: 25 to 50 50 to 200 200 to 500 2,000 to 4,000

Answer 256

2,000 to 4,000

Question 257

Portion of DNA that is ACTIVE in gene expression and stains lightly with Wright stain: Euchromatin Heterochromatin

Answer 257

Euchromatin

Question 258

Portion of DNA that is INACTIVE during transcription to messenger RNA and stains deeply with Wright stain: Euchromatin Heterochromatin

Answer 258

Heterochromatin

Question 259

Apoptosis is morphologically identified by: Cellular swelling Nuclear condensation Rupture of the cytoplasm Rupture of the nucleus

Answer 259

Nuclear condensation ## Footnote APOPTOSIS CELL SIZE: reduced due to shrinkage NUCLEUS: condensation and fragmentation between nucleosomes NECROSIS CELL SIZE: enlarged due to swelling NUCLEUS: random breaks and lysis (karylolysis)

Question 260

The morphologic manifestation of APOPTOSIS is _______ of the cell. Shrinkage of the cell Swelling of the cell

Answer 260

Shrinkage of the cell

Question 261

The first morphologic manifestation of NECROSIS is _______ of the cell. Shrinkage of the cell Swelling of the cell

Answer 261

Swelling of the cell

Question 262

Dendritic cells are derived from: Common lymphoid progenitor Common myeloid progenitor

Answer 262

Common lymphoid progenitor

Question 263

Which of the following red blood cell precursors is the LAST STAGE TO UNDERGO MITOSIS? Pronormoblast Basophilic normoblast Polychromatophilic normoblast Orthochromic normoblast

Answer 263

Polychromatophilic normoblast

Question 264

Tertiary granules of the neutrophils are formed during the: * Promyelocyte stage Myelocyte and metamyelocyte stage Metamyelocyte and band stage Band and segmented neutrophil stage

Answer 264

Metamyelocyte and band stage ## Footnote Primary (Azurophilic) Granules Formed during the promyelocyte stage Last to be released (exocytosis) Secondary (Specific) Granules Formed during myelocyte and metamyelocyte stages Third to be released Tertiary Granules Formed during metamyelocyte and band stages Second to be released Secretory Granules (Secretory Vesicles) Formed during band and segmented neutrophil stages First to be released (fuse to plasma membrane)

Question 265

Chondroitin sulfates such as heparan: Neutrophil secondary granules Eosinophil secondary granules Basophil secondary granules

Answer 265

Basophil secondary granules

Question 266

Which erythrocyte metabolic pathway generates adenosine triphosphate (ATP) via glycolysis? Embden-Meyerhof Hexose monophosphate Rapoport-Luebering Methemoglobin reductase

Answer 266

Embden-Meyerhof

Question 267

ron is TRANSPORTED IN PLASMA via: Hemosiderin Ferritin Transferrin Hemoglobin

Answer 267

Transferrin

Question 268

Multilobed nucleus: MK-I MK-II MK-III

Answer 268

MK-III

Question 269

Moderately condensed chromatin: MK-I MK-II MK-III

Answer 269

MK-II

Question 270

Deeply and variably condensed chromatin: MK-I MK-II MK-III

Answer 270

MK-III

Question 271

Reagent for the solubility test: Ferric cyanide and detergent 2% sodium metabisulfite Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin) 1% sodium hydroxide

Answer 271

Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)

Question 272

Hemoglobin SOLUBILITY TEST is a screening test for: Hemoglobin A2 Hemoglobin F Hemoglobin S Unstable hemoglobins

Answer 272

Hemoglobin S

Question 273

Color of blood in sulfhemoglobinemia: Chocolate brown Cherry red Mauve lavender Bright red

Answer 273

Mauve lavender

Question 274

The red blood cell protein that is responsible for deformability and flexibility of the red blood cell is: Spectrin Glycophorin Glycine Erythropoietin

Answer 274

Spectrin

Question 275

In hemoglobin C, glutamic acid on the 6th position of beta chain is replaced by which amino acid? Lysine Valine Arginine Glutamine

Answer 275

Lysine

Question 276

The most mature cell that can undergo mitosis is the: Promyelocyte Myelocyte Metamyelocyte Band

Answer 276

Myelocyte

Question 277

Granulocytic precursor with an indented or kidney-shaped nucleus: Promyelocyte Myelocyte Metamyelocyte Band

Answer 277

Metamyelocyte

Question 278

Granulocytic cell with a sausage-shaped nucleus: Promyelocyte Myelocyte Metamyelocyte Band

Answer 278

Band

Question 279

Most reliable way to differentiate a mature from an immature granulocyte: Size of the cell Color of the cytoplasm Size of the nucleus Chromatin pattern

Answer 279

Chromatin pattern

Question 280

Reliable way to differentiate PLATELET PRECURSORS: Size of the cell Cytoplasmic appearance Nucleus Chromatin pattern

Answer 280

Cytoplasmic appearance

Question 281

Alpha and dense granules of platelets: In peripheral zone In sol-gel zone In organelle zone In membranous system

Answer 281

In organelle zone

Question 282

The term for cell movement across the cellular membranes from the blood vessels to the tissues is called: Diapedesis Endocytosis Margination Chemotaxis

Answer 282

Diapedesis

Question 283

G1 or cell growth: 1 hour 4 hours 8 hours 10 hours

Answer 283

10 hours ## Footnote CELL CYCLE. G0, nondividing cell; G1, cell growth (10 hours) ; S, DNA replication (8 hours); G2, protein synthesis (4 hours); M, mitosis (1 hour) followed by cytokinesis or cell division.

Question 284

S or DNA replication 1 hour 4 hours 8 hours 10 hours

Answer 284

8 hours ## Footnote CELL CYCLE. G0, nondividing cell; G1, cell growth (10 hours) ; S, DNA replication (8 hours); G2, protein synthesis (4 hours); M, mitosis (1 hour) followed by cytokinesis or cell division.

Question 285

G2 or protein synthesis: 1 hour 4 hours 8 hours 10 hours

Answer 285

4 hours ## Footnote CELL CYCLE. G0, nondividing cell; G1, cell growth (10 hours) ; S, DNA replication (8 hours); G2, protein synthesis (4 hours); M, mitosis (1 hour) followed by cytokinesis or cell division.

Question 286

M or mitosis: * 1 hour 4 hours 8 hours 10 hours

Answer 286

1 hour

Question 287

What is the ratio of IRON TO PYRROLE in 1 heme portion of the hemoglobin molecule? 1 iron to 2 pyrrole rings 2 iron to 1 pyrrole ring 1 iron to 4 pyrrole rings 4 iron to 1 pyrrole ring

Answer 287

1 iron to 4 pyrrole rings ## Footnote The heme portion of the hemoglobin molecule consists of one iron (Fe2+) atom and four pyrrole rings that are joined to each other. A complete hemoglobin molecule consists of four heme molecules, each of which is attached to one molecule of the protein globin.

Question 288

Densely packed chromatin: Myelocyte Metamyelocyte Band Segmented neutrophil

Answer 288

Segmented neutrophil

Question 289

Very clumped chromatin: Myelocyte Metamyelocyte Band Segmented neutrophil

Answer 289

Band

Question 290

Basophils have an average circulation time of about ____ hours. 7 hours 8.5 hours 9 hours 12 hours

Answer 290

8.5 hours ## Footnote Basophils have an average circulation time of about 8.5 hour

Question 291

Basophils remain in the maturation-storage phase for: 7 hours 8.5 hours 9.5 hours 12 hours

Answer 291

12 hours ## Footnote Basophils remain in this phase for the shortest period, approximately 12 hours.

Question 292

A patient has macrocytic anemia, the physician suspects pernicious anemia. Which tests would best rule in a definitive diagnosis of pernicious anemia? Homocysteine Intrinsic factor antibodies Ova and parasite examination for D. latum Bone marrow examination

Answer 292

Intrinsic factor antibodies

Question 293

G6PD deficiency episodes are related to which of the following? Exposure to oxidant drugs Defective globin chains Antibodies to RBCs Abnormal protein structures

Answer 293

Exposure to oxidant drugs

Question 294

Lack of vitamin B12 or folic acid hinders the erythroblast in manufacturing: Heme Globin DNA RNA

Answer 294

DNA

Question 295

The nitroblue tetrazolium reduction test is used to assist in the diagnosis of: Leukocyte adhesion disorders (LADs) Chronic granulomatous disease (CGD) May-Hegglin anomaly Pelger-Huet anomaly

Answer 295

Chronic granulomatous disease (CGD)

Question 296

Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright's-stained blood smear? Basophilic stippling Heinz bodies Howell-Jolly bodies Siderotic granules

Answer 296

Heinz bodies

Question 297

Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)? Anti-I Anti-i Anti-M Anti-P

Answer 297

Anti-P

Question 298

Bite cells are usually seen in patients with: Rh null disease Chronic granulomatous disease G6PD deficiency Pyruvate kinase deficiency

Answer 298

G6PD deficiency

Question 299

Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia? Sulfonamides Penicillin Tetracycline Chloramphenicol

Answer 299

Chloramphenicol

Question 300

Which anemia has red cell morphology similar to that seen in iron deficiency anemia? Sickle cell anemia Thalassemia Pernicious anemia Hereditary spherocytosis

Answer 300

Thalassemia

Question 301

Auer rods may be seen in all of the following except: Acute myeloid leukemia Acute promyelocytic leukemia Acute lymphoblastic leukemia Acute myelomonocytic leukemia

Answer 301

Acute lymphoblastic leukemia

Question 302

In myeloid cells, the stain that selectively identifies PHOSPHOLIPIDS in the membranes of both primary and secondary granules is: PAS Myeloperoxidase Sudan black B Tdt

Answer 302

Sudan black B

Question 303

Sodium fluoride maybe added to naphthyl ASD (NASDA) esterase reaction. The fluoride is added to inhibit a positive reaction with: Megakaryocytes Monocytes Erythrocytes Granulocytes

Answer 303

Monocytes

Question 304

What is the characteristic finding seen in the peripheral smear of a patient with multiple myeloma? Microcytic hypochromic cells Intracellular inclusion bodies Rouleaux Hypersegmented neutrophils

Answer 304

Rouleaux

Question 305

Of the following, the disease most closely associated with granulocyte hyposegmentation is: May-Hegglin anomaly Pelger-Huet anomaly Chediak-Higashi syndrome Gaucher's disease

Answer 305

Pelger-Huet anomaly

Question 306

Which of the following is associated with Alder-Reilly inclusions? Membrane defect of lysosomes Dohle bodies and giant platelets Two-lobed neutrophils Mucopolysaccharidosis

Answer 306

Mucopolysaccharidosis

Question 307

Asynchronous development of hematopoietic cells within the bone marrow is the result of: Inadequate levels of RNA Decreased erythropoietin Defective stem cells Impaired DNA synthesis

Answer 307

Impaired DNA synthesis

Question 308

Megaloblastic anemia is characterized by all of the following, EXCEPT: Decreased WBCs and retics Hypersegmented neutrophils Oval macrocytes Increased platelets

Answer 308

Increased platelets

Question 309

Many microspherocytes and schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with: Hereditary spherocytosis Disseminated intravascular coagulation Autoimmune hemolytic anemia Extensive burns

Answer 309

Extensive burns

Question 310

In myelofibrosis, the characteristic abnormal red cell morphology is: Target cells Schistocytes Teardrop cells Ovalocytes

Answer 310

Teardrop cells

Question 311

In the French-American-Bristish (FAB) classification, myelomonocytic leukemia would be: M1 and M2 M3 M4 M5

Answer 311

M4

Question 312

A cytogenic abnormality is found in almost 50% of the patients with which of the following classifications of acute nonlymphocytic leukemia? M1 M3 M5 M6

Answer 312

M3

Question 313

DIC is most often associated with which of the following FAB designation of acute leukemia? M1 M3 M4 M5

Answer 313

M3

Question 314

Which of the following stains is helpful in the diagnosis of suspected erythroleukemia? Peroxidase Periodic acid-Schiff Nonspecific esterase Acid phosphatase

Answer 314

Periodic acid-Schiff

Question 315

Which type of anemia is usually present in a patient with acute leukemia? Microcytic, hyperchromic Microcytic, hypochromic Normocytic, normochromic Macrocytic, normochromic

Answer 315

Normocytic, normochromic

Question 316

In the French-American-British (FAB) classification, acute lymphocytic leukemia is divided into groups according to: Prognosis Immunology Cytochemistry Morphology

Answer 316

Morphology

Question 317

The FAB classification of ALL seen most commonly in children is: L1 L2 L3 Burkitt's type

Answer 317

L1

Question 318

In addition to the number of blasts, what other criterion is essential for the diagnosis of RARS? More than 15% ringed sideroblasts Dyshematopoiesis in all three lineages More than 5% ringed sideroblasts Pancytopenia

Answer 318

More than 15% ringed sideroblasts

Question 319

Using an electronic cell counter analyzer, an increased RDW should correlate with: Spherocytosis Anisocytosis Leukocytosis Presence of NRBCs

Answer 319

Anisocytosis ## Footnote The RDW parameter correlates with the degree of anisocytosis seen on the morphological examination. The reference range is 11.5%-14.5%

Question 320

Which of the following organs is responsible for the "pitting process" for RBCs? Liver Spleen Kidney Lymph nodes

Answer 320

Spleen ## Footnote The spleen is the supreme filter of the body, pitting imperfections from the erythrocyte without destroying the integrity of the membrane.

Question 321

Which of the following conditions may produce spherocytes in a peripheral smear? Pelger-Huët anomaly Pernicious anemia Autoimmune hemolytic anemia Sideroblastic anemia

Answer 321

Autoimmune hemolytic anemia ## Footnote Spherocytes are produced in autoimmune hemolytic anemia.

Question 322

Iron deficiency anemia may be distinguished from anemia of chronic infection by: Serum iron level Red cell morphology Red cell indices Total iron-binding capacity

Answer 322

Total iron-binding capacity ## Footnote In iron deficiency anemia, the serum iron and ferritin levels are decreased and the total iron-binding capacity and RBC protoporphyrin are increased. In chronic disease, serum iron and TIBC are both decreased because the iron is trapped in reticuloendothelial (RE) cells, and is unavailable to the red cells for hemoglobin production.

Question 323

Storage iron is usually best determined by: Serum transferrin levels Hgb values Myoglobin values Serum ferritin levels

Answer 323

Serum ferritin levels ## Footnote Ferritin enters the serum from all ferritin-producing tissues, and therefore is considered to be a good indicator of body storage iron. Because iron stores must be depleted before anemia develops, low serum ferritin levels precede the fall in serum iron associated with iron deficiency anemia.

Question 324

Which morphological classification is characteristic of megaloblastic anemia? Normocytic, normochromic Microcytic, normochromic Macrocytic, hypochromic Macrocytic, normochromic

Answer 324

Macrocytic, normochromic

Question 325

Which anemia is characterized by a lack of intrinsic factor that prevents B12 absorption? Tropical sprue Transcobalamin deficiency Blind loop syndrome Pernicious anemia

Answer 325

Pernicious anemia ## Footnote Pernicious anemia is caused by a lack of intrinsic factor, which prevents vitamin B12 absorption.

Question 326

The macrocytes typically seen in megaloblastic processes are: Crescent-shaped Teardrop-shaped Ovalocytic Pencil-shaped

Answer 326

Ovalocytic ## Footnote Macrocytes in true megaloblastic conditions are oval macrocytes as opposed to the round macrocytes that are usually seen in alcoholism and obstructive liver disease.

Question 327

The morphological characteristic(s) associated with the Chédiak-Higashi syndrome is (are): Pale blue cytoplasmic inclusions Giant lysosomal granules Small, dark-staining granules and condensed nuclei Nuclear hyposegmentation

Answer 327

Giant lysosomal granules ## Footnote Chédiak-Higashi syndrome is a disorder of neutrophil phagocytic dysfunction caused by depressed chemotaxis and delayed degranulation. The degranulation disturbance is attributed to interference from the giant lysosomal granules characteristic of this disorder.

Question 328

The WHO classification requires what percentage for the blast count in the blood or bone marrow for the diagnosis of AML? At least 30% At least 20% At least 10% Any percentage

Answer 328

At least 20%

Question 329

Howell-Jolly bodies are composed of: DNA Iron Reticulum RNA

Answer 329

DNA

Question 330

When acanthocytes are found on the blood smear, it is usually the result of Abnormal membrane permeability Altered membrane lipids Mechanical trauma Polymerization of hemoglobin molecules

Answer 330

Altered membrane lipids

Question 331

The morphologic abnormality characteristically found in hemoglobinopathies: Elliptocytes Dacryocytes Codocytes Discocytes

Answer 331

Codocytes

Question 332

Hereditary stomatocytosis is manifested physiologically by changes in: Hemoglobin oxygen affinity Membrane cation permeability Efficiency of hemoglobin reduction Glycolytic ATP production

Answer 332

Membrane cation permeability ## Footnote The major defect in hereditary stomatocytosis is altered permeability of the red cell membrane to Na+ and K+ ions.

Question 333

Abetalipoproteinemia is characterized by mild anemia and numerous on the peripheral blood smear. Acanthocytes Elliptocytes Echinocytes Stomatocytes

Answer 333

Acanthocytes

Question 334

The fish tapeworm Diphyllobothrium latum is associated with the development of: Microcytic anemia Macrocytic anemia Hemolytic anemia Hypoproliferative anemia

Answer 334

Macrocytic anemia ## Footnote The fish tapeworm competes for vitamin B12, and a macrocytic (megaloblastic) anemia may develop. Hookworm infestation causes chronic blood loss and a microcytic anemia due to iron deficiency.

Question 335

Which of the following represents the principal defect in chronic granulomatous disease (CGD)? Chemotactic migration Phagocytosis Lysosomal formation and function Oxidative respiratory burst

Answer 335

Oxidative respiratory burst ## Footnote Chronic granulomatous disease (CGD) is a hereditary disorder in which neutrophils are incapable of killing most ingested microbes. The disease is usually fatal because of defective generation of oxidative metabolism products, such as superoxide anions and hydrogen peroxide, which are essential for killing.

Question 336

A Gaucher cell is best described as a macrophage with: "Wrinkled" cytoplasm due to an accumulation of glucocerebroside "Foamy" cytoplasm filled with unmetabolized sphingomyelin Pronounced vacuolization and deposits of cholesterol Abundant cytoplasm containing storage iron and cellular remnants

Answer 336

"Wrinkled" cytoplasm due to an accumulation of glucocerebroside ## Footnote Gaucher disease is a lipid storage disorder in which there is an accumulation of glucocerebroside in the macrophages because of a genetic lack of glucocerebrosidase, an enzyme required for normal lipid metabolism. Gaucher cells are found in the liver, spleen, and bone marrow.

Question 337

The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia, and large platelets is called: May-Hegglin anomaly Chediak-Higashi syndrome Pelger-Huet anomaly Alder-Reilly anomaly

Answer 337

May-Hegglin anomaly ## Footnote May-Hegglin anomaly is an autosomal dominant disorder in which large blue cytoplasmic structures that resemble Dohle bodies are found in the granulocytes and possibly the monocytes.

Question 338

Perl's Prussian blue is a stain used to detect: DNA RNA Iron Glycogen

Answer 338

Iron ## Footnote When stained with a mixture of potassium ferricyanide and hydrochloric acid, nonheme iron stains bright blue. This is the most common stain used for storage iron. It can be used on bone marrow to identify sideroblasts, peripheral blood to identify the presence of siderocytes, or urine to perform hemosiderin testing.

Question 339

Solid tumor counterpart of acute lymphoblastic leukemia: * Lymphoma, undifferentiated Lymphoma, poorly-differentiated Lymphoma, well-differentiated Myeloma

Answer 339

Lymphoma, poorly-differentiated ## Footnote LEUKEMIA TYPE SOLID TUMOR COUNTERPART STEM CELL LEUKEMIA: Lymphoma, undifferentiated ACUTE LYMPHOBLASTIC: Lymphoma, poorly leukemia differentiated; lymphocytic CHRONIC LYMPHOCYTIC: Lymphoma, well leukemia differentiated; lymphocytic MONOCYTIC LEUKEMIA: Reticulum cell sarcoma ACUTE MYELOGENOUS: Chloroma granulocytic leukemia PLASMA CELL LEUKEMIA: Myeloma

Question 340

Solid tumor counterpart of plasma cell leukemia: * Lymphoma, undifferentiated Reticulum cell sarcoma Chloroma Myeloma

Answer 340

Myeloma ## Footnote LEUKEMIA TYPE SOLID TUMOR COUNTERPART STEM CELL LEUKEMIA: Lymphoma, undifferentiated ACUTE LYMPHOBLASTIC: Lymphoma, poorly leukemia differentiated; lymphocytic CHRONIC LYMPHOCYTIC: Lymphoma, well leukemia differentiated; lymphocytic MONOCYTIC LEUKEMIA: Reticulum cell sarcoma ACUTE MYELOGENOUS: Chloroma granulocytic leukemia PLASMA CELL LEUKEMIA: Myeloma

Question 341

FAB type M6 is characterized by increased: Promyelocytes and lysozyme activity Marrow megakaryocytes and thrombocytosis Marrow erythroblasts and multinucleated red cells Marrow monoblasts and immature monocytes

Answer 341

Marrow erythroblasts and multinucleated red cells

Question 342

It can be used to clean the objective lenses: Normal saline Formalin Xylene Lens cleaner or 70% isopropyl alcohol

Answer 342

Lens cleaner or 70% isopropyl alcohol ## Footnote The use of xylene is discouraged, because it contains a carcinogenic component (benzene). Xylene is also a poor cleaning agent, leaving an oily film on the lens.

Question 343

All of the following are components of the modified Drabkin's reagent EXCEPT: Potassium cyanide, potassium ferricyanide Dihydrogen potassium phosphate Nonionic detergent Sodium chloride

Answer 343

Sodium chloride

Question 344

Microhematocrit tube: Length 75 mm, inner bore of 1.2 mm Length 115 mm, bore of 3 mm Length of 300 mm, bore of 2.5 mm Length of 11.5 cm, bore of 3 mm

Answer 344

Length 75 mm, inner bore of 1.2 mm

Question 345

Duplicate hematocrit results should agree within __ unit (%). * 1% 2% 5% 15%

Answer 345

1%

Question 346

When comparing spun microhematocrit results with hematocrit results obtained on an electronic cell counter, the spun hematocrit results may vary from ___ because of this trapped plasma (unless the cell counter has been calibrated against spun microhematocrits uncorrected for trapped plasma). 1 to 3% lower 1 to 3% higher 3 to 5% lower 3 to 5% higher

Answer 346

1 to 3% higher

Question 347

The difference between the total cells counted on each side should be less than ___%. A greater variation could indicate an uneven distribution, which requires that the procedure be repeated. Less than 10% Less than 15% Less than 20% Less than 30%

Answer 347

Less than 10%

Question 348

If the WBC count is above 30 x 10 9th/L, it is advisable to use this dilution: 1:10 1:20 1:100 1:200

Answer 348

1:100 ## Footnote TYPICAL WBC DILUTION - 1:20 Above 30 x 10 9th/L - 1:100 100 to 300 x 10 9th/L - 1:200 Below 3 x 10 9th/L - 1:10

Question 349

For manual WBC count, the filled counting chamber should be allowed to stand for __ prior to performing the count to give the WBCs time to settle. 3 minutes 5 minutes 10 minutes 15 minutes

Answer 349

10 minutes

Question 350

For manual platelet count, the filled counting chamber should be allowed to stand for __ prior to performing the count to give the platelets time to settle. 3 minutes 5 minutes 10 minutes 15 minutes

Answer 350

15 minutes

Question 351

Insufficient centrifugation will result in: A false increase in hematocrit (Hct) value A false decrease in Hct value No effect on Hct value All of these options, depending on the patient

Answer 351

A false increase in hematocrit (Hct) value ## Footnote Insufficient centrifugation does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.

Question 352

What effect would using a buffer at pH 6.0 have on a Wright's-stained smear? Red cells would be stained too pink White cell cytoplasm would be stained too blue Red cells would be stained too blue Red cells would lyse on the slide

Answer 352

Red cells would be stained too pink ## Footnote The pH of the buffer is critical in Romanowsky stains. When the pH is too low (<6.4), the red cells take up more acid dye (eosin), becoming too pink. Leukocytes also show poor nuclear detail when the pH is decreased.

Question 353

A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because: The WBC count would be falsely lower The RBC count is too low Nucleated RBCs are counted as leukocytes Nucleated RBCs are confused with giant platelets

Answer 353

Nucleated RBCs are counted as leukocytes ## Footnote The automated hematology analyzers enumerate all nucleated cells. NRBCs are counted along with WBCs, falsely elevating the WBC count. To correct the WBC count, determine the number of NRBCs per 100 WBCs. Corrected WBC count = (uncorrected WBC count ÷ [NRBC's + 100]) × 100.

Question 354

In essential thrombocythemia, the platelets are: Increased in number and functionally abnormal Normal in number and functionally abnormal Decreased in number and functional Decreased in number and functionally abnormal

Answer 354

Increased in number and functionally abnormal ## Footnote In essential thrombocythemia, the platelet count is extremely elevated. These platelets are abnormal in function, leading to both bleeding and thrombotic diathesis.

Question 355

Which of the following cells is considered pathognomonic for Hodgkin's disease? Niemann-Pick cells Reactive lymphocytes Flame cells Reed-Sternberg cells

Answer 355

Reed-Sternberg cells ## Footnote The morphological common denominator in Hodgkin's lymphoma is the Reed-Sternberg (RS) cell. It is a large, binucleated cell with a dense nucleolus surrounded by clear space. These characteristics give the RS cell an "owl's eye" appearance.

Question 356

In myelofibrosis, the characteristic abnormal red blood cell morphology is that of: Target cells Schistocytes Teardrop cells Ovalocytes

Answer 356

Teardrop cells ## Footnote The marked amount of fibrosis, both medullary and extramedullary, accounts for the irreversible red cell morphological change to a teardrop shape. The red cells are "teared" as they attempt to pass through the fibrotic tissue.

Question 357

The erythrocytosis seen in relative polycythemia occurs because of: Decreased arterial oxygen saturation Decreased plasma volume of circulating blood Increased erythropoietin levels Increased erythropoiesis in the bone marrow

Answer 357

Decreased plasma volume of circulating blood ## Footnote Relative polycythemia is caused by a reduction of plasma rather than an increase in red blood cell volume or mass. Red cell mass is increased in both PV and secondary polycythemia, but erythropoietin levels are high only in secondary polycythemia.

Question 358

Cells that exhibit a positive stain with acid phosphatase and are not inhibited with tartaric acid are characteristically seen in: Infectious mononucleosis Infectious lymphocytosis Hairy cell leukemia T-cell acute lymphoblastic leukemia

Answer 358

Hairy cell leukemia

Question 359

In addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera? -Decreased platelets, decreased granulocytes, decreased erythropoietin level -Decreased platelets, decreased granulocytes, increased erythropoietin level -Increased platelets, increased granulocytes, increased erythropoietin level -Increased platelets, increased granulocytes, decreased erythropoietin level

Answer 359

Increased platelets, increased granulocytes, decreased erythropoietin level ## Footnote PV is not due to the activity of erythropoietin. The production of erythropoietin is almost completely suppressed in this malignant condition.

Question 360

Which of the following is not a cause of ABSOLUTE secondary erythrocytosis? Defective cardiac or pulmonary function High-altitude adjustment Dehydration secondary to diuretic use Hemoglobins with increased oxygen affinity

Answer 360

Dehydration secondary to diuretic use ## Footnote Dehydration is a cause of relative (pseudo) erythrocytosis due to plasma loss.

Question 361

Which of the following is NOT classified as a myeloproliferative disorder? Polycythemia vera Essential thrombocythemia Multiple myeloma Chronic myelogenous leukemia

Answer 361

Multiple myeloma ## Footnote Multiple myeloma is a malignant lymphoproliferative disorder characterized by a clonal proliferation of plasma cells and multiple bone tumors.

Question 362

Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive chronic myelogenous leukemia? MYC/IGH BCR/ABL PML/RARA JAK2

Answer 362

BCR/ABL ## Footnote The Philadelphia chromosome, t(9;22), is detected in almost all cases of CML (depends on detection method) and results in a mutated BCR/ABL fusion gene.

Question 363

In which of the following would an absolute monocytosis not be seen? Tuberculosis Recovery stage of acute bacterial infection Collagen disorders Infectious mononucleosis

Answer 363

Infectious mononucleosis ## Footnote IM - LYMPHOCYTOSIS

Question 364

Naphthol AS-D chloroacetate esterase (specific) is usually positive in _____ cells, and alpha naphthyl acetate esterase (nonspecific)is useful for identifying blast cells of ______lineage. Granulocytic; monocytic Monocytic; granulocytic Granulocytic; lymphocytic Monocytic; lymphocytic

Answer 364

Granulocytic; monocytic ## Footnote Naphthol AS-D chloroacetate esterase (specific) reacts strongly in granulocytic cells, and alpha-naphthyl acetate esterase (nonspecific) stains positively in monocytic cells.

Question 365

What is the key diagnostic test for Hodgkin lymphoma? Bone marrow biopsy Lymph node biopsy Spinal tap Skin biopsy

Answer 365

Lymph node biopsy ## Footnote The test that would be the most beneficial for the diagnosis of Hodgkin lymphoma is a lymph node biopsy.

Question 366

Which of the following is NOT a characteristic finding in polycythemia vera? Blood pancytosis Increased red cell mass Increased erythropoietin level Increased blood viscosity

Answer 366

Increased erythropoietin level ## Footnote Primary polycythemia (vera) is a malignant myeloproliferative disorder characterized by autonomous marrow production of erythrocytes in the presence of low erythropoietin levels.

Question 367

What combination of reagents is used to measure hemoglobin? Hydrochloric acid and p-dimethylaminobenzaldehyde Potassium ferricyanide and potassium cyanide Sodium bisulfite and sodium metabisulfite Sodium citrate and hydrogen peroxide

Answer 367

Potassium ferricyanide and potassium cyanide ## Footnote The standard assay for hemoglobin utilizes potassium ferricyanide. This solution, formerly called Drabkin's reagent, is now called cyanmethemoglobin (HiCN) reagent. The ferricyanide oxidizes hemoglobin iron from ferrous (Fe2+) to ferric (Fe3+), and the potassium cyanide stabilizes the pigment as cyanmethemoglobin for spectrophotometric measurement.

Question 368

The components of Wright's stain include: Crystal violet and safranin Brilliant green and neutral red New methylene blue and carbolfuchsin Methylene blue and eosin

Answer 368

Methylene blue and eosin ## Footnote One type of Romanowsky stain is the Wright's stain. It is a polychrome stain consisting of methylene blue and eosin.

Question 369

Which of the following red cell inclusions stain with both Perl's Prussian blue and Wright's stain? Howell-Jolly bodies Basophilic stippling Pappenheimer bodies Heinz bodies

Answer 369

Pappenheimer bodies ## Footnote Pappenheimer bodies are iron deposits associated with mitochondria, and they stain with both Perl's Prussian blue and Wright's stain.

Question 370

Which of the following is NOT a source of error when measuring hemoglobin by the cyanmethemoglobin method? Excessive anticoagulant White blood cell count that exceeds linearity limits Lipemic plasma Scratched or dirty hemoglobin measuring cell

Answer 370

Excessive anticoagulant ## Footnote Excessive anticoagulant does not affect hemoglobin readings. Anything that causes an increase in absorbance will cause a hemoglobin that is read spectrophotometrically to be falsely high.

Question 371

Blood drop size in the manual wedge technique: 1 to 2 mm in diameter 2 to 3 mm in diameter 4 to 5 mm in diameter 5 to 6 mm in diameter

Answer 371

2 to 3 mm in diameter ## Footnote TOO LARGE A DROP: Long or thick film TOO SMALL A DROP: Short or thin film

Question 372

In manual wedge technique, the PUSHER SLIDE is held securely in the dominant hand at about: 15 to 20 degree angle 30 to 45 degree angle 45 to 50 degree angle 80 to 90 degree angle

Answer 372

30 to 45 degree angle

Question 373

In the preparing wedge smear from blood samples of polycythemic patients, the angle between the two slides should be: 25 30 35 45

Answer 373

25 ## Footnote When the hematocrit is higher than normal (i.e., 60%), as is found in patients with polycythemia or in newborns, the angle should be lowered (i.e., 25 degrees) so the film is not too short and thick.

Question 374

When a blood film is viewed through the microscope, the RBCs appear redder than normal, the neutrophils are barely visible, and the eosinophils are bright orange. What is the most likely cause? Slide was overstained Stain was too alkaline Buffer was too acidic Slide was not rinsed adequately

Answer 374

Buffer was too acidic ## Footnote EXCESSIVELY PINK STAIN Insufficient staining Prolonged washing time Mounting the coverslips before they are dry Too high acidity of the stain or buffer EXCESSIVELY BLUE STAIN Thick films Prolonged staining time Inadequate washing Too high an alkalinity of stain or

Question 375

Detects lymphocytic cells and certain abnormal erythrocytic cells by staining of cytoplasmic glycogen: Periodic acid Schiff (PAS) Peroxidase Sudan black B (SBB) Toluidine blue

Answer 375

Periodic acid Schiff (PAS)

Question 376

Counting area for manual RBC count: 0.2 mm2 1 mm2 4 mm2

Answer 376

0.2 mm2

Question 377

Counting area for manual WBC count: 0.2 mm2 1 mm2 4 mm2

Answer 377

4 mm2

Question 378

Counting area for manual platelet count: 0.2 mm2 1 mm2 4 mm2

Answer 378

1 mm2

Question 379

To increase accuracy of the WBC differential, it is advisable to count at least ___ cells when the WBC count is higher than 40 x 10 9th/L. Count 50 cells Count 100 cells Count 200 cells Count 300 or 400 cells

Answer 379

Count 200 cells

Question 380

In WBC differential, if the WBC count is 100 x 10 9th/L or greater, it would be more precise and accurate to count ____ cells. Count 50 cells Count 100 cells Count 200 cells Count 300 or 400 cells

Answer 380

Count 300 or 400 cells

Question 381

Effect of excess anticoagulant to hematocrit: Increase Decrease No effect Cannot be determined

Answer 381

Decrease

Question 382

Which of the following will stain the GRANULOCYTES only? Naphthol AS-D chloroacetate Alpha-naphthyl acetate esterase Alpha-naphthyl butyrate esterase All of these

Answer 382

Naphthol AS-D chloroacetate

Question 383

Dehydration: Decreased hematocrit Increased hematocrit Variable hematocrit Hematocrit cannot be determined

Answer 383

Increased hematocrit ## Footnote The fluid loss associated with dehydration causes a decrease in plasma volume and falsely INCREASES the hematocrit reading.

Question 384

Myeloperoxidase (MPO) and Sudan Black B (SBB) staining results: Opposite Parallel Undetermined Variable

Answer 384

Parallel

Question 385

Which mutation is shared by a large percentage of patients with polycythemia vera, essential thrombocythemia, and primary myelofibrosis? BCR/ABL JAK2 V617F PDGFR RUNX1

Answer 385

JAK2 V617F ## Footnote The JAK2 V617F mutation is present in numerous cases of myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia, and primary myelofibrosis. BCR/ABL mutations are seen in CML, and PDGFR mutations are seen in neoplasms with eosinophilia. RUNX mutations may be seen in some cases of acute leukemias.

Question 386

A patient has a CBC and peripheral smear with an elevated WBC count and left shift, suggestive of a diagnosis of CML. Which of the following tests would be the most helpful in CONFIRMING the suspected diagnosis? Cytochemical staining for myeloperoxidase and LAP Karyotyping for the Philadelphia chromosome Flow cytometry for myeloid cell markers Lymph node biopsies for metastasis

Answer 386

Karyotyping for the Philadelphia chromosome ## Footnote Although leukocyte alkaline phosphatase (LAP) scores tend to be decreased in chronic myelogenous leukemia (CML) and myeloid cells are present, karyotyping for the presence of the Philadelphia chromosome (9;22 translocation) is required for the confirmation of a diagnosis of CML.

Question 387

A 75-year-old male patient visits his physician for an annual checkup. His CBC showed an elevated WBC count with numerous small lymphocytes and smudge cells, and a subsequent bone marrow biopsy and aspirate showed hypercellularity with increased lymphoid cells. What is a presumptive diagnosis based on this information? * Acute lymphoblastic leukemia Chronic lymphocytic leukemia Hairy cell leukemia Therapy-related acute myelogenous leukemia

Answer 387

Chronic lymphocytic leukemia ## Footnote This smear and bone marrow picture is typical of chronic lymphocytic leukemia (CLL) with numerous mature small lymphocytes.

Question 388

Which of the following appearances describes the types of cells seen in Sezary syndrome? Plasma cells containing immunoglobulin deposits Large circulating micromegakaryocytes Lymphocytes with convoluted, cerebriform nuclei Prolymphocytes with prominent azurophilic granules

Answer 388

Lymphocytes with convoluted, cerebriform nuclei ## Footnote Sezary cells are lymphoma cells characterized by cerebriform nuclei and irregular nuclear outlines.

Question 389

A patient's differential count shows an elevated eosinophil count. This is consistent with which of the following? Aplastic anemia Bacterial infection Parasitic infection Viral infection

Answer 389

Parasitic infection ## Footnote Elevated eosinophil counts are often seen in parasitic infections, particularly those caused by helminths.

Question 390

A patient has a splenomegaly, and his CBC shows a left shift; bizarre RBCs, including dacryocytes; and notable platelet abnormalities. Which of the following would be the most helpful in determining the patient's diagnosis? Bone marrow biopsy LAP staining Karyotyping for the Philadelphia chromosome Spleen biopsy

Answer 390

Bone marrow biopsy ## Footnote A bone marrow biopsy would help in confirming a diagnosis of primary myelofibrosis, which is a possible diagnosis suggested by the dacryocytes, left shift, and abnormal platelets. If the patient had primary myelofibrosis, the bone marrow would likely show areas of fibrosis, in addition to increases in megakaryocytes and abnormal platelets.

Question 391

Lipemia can cause turbidity in the cyanmethemoglobin method and a falsely high hemoglobin result. It can be corrected by: -Reagent-sample solution can be centrifuged and the supernatant measured -Adding 0.01 mL of the patient's plasma to 5 mL of the cyanmethemoglobin reagent and using this solution as the reagent blank -Making a 1:2 dilution with distilled water (1 part diluted sample plus 1 part water) and multiplying the results from the standard curve by 2. -Cannot be corrected

Answer 391

Adding 0.01 mL of the patient's plasma to 5 mL of the cyanmethemoglobin reagent and using this solution as the reagent blank

Question 392

If FEWER THAN 50 PLATELETS are counted on each side, the procedure should be repeated by diluting the blood to: 1:10 1:20 1:100 1:200

Answer 392

1:20

Question 393

If MORE THAN 500 PLATELETS are counted on each side a ____ dilution should be made. 1:10 1:20 1:100 1:200

Answer 393

1:200

Question 394

WBC COUNT that can cause turbidity in the cyanmethemoglobin method resulting to falsely high hemoglobin value: Greater than 5 x 10 9th/L Greater than 10 x 10 9th/L Greater than 15 x 10 9th/L Greater than 20 x 10 9th/L

Answer 394

Greater than 20 x 10 9th/L ## Footnote A high WBC count (greater than 20 x 10 9th/L) or a high platelet count (greater than 700 x 10 9th/L) can cause turbidity and a falsely high result. IN THIS CASE, THE REAGENT-SAMPLE SOLUTION CAN BE CENTRIFUGED AND THE SUPERNATANT MEASURED.

Question 395

PLATELET COUNT that can cause turbidity in the cyanmethemoglobin method resulting to falsely high hemoglobin value: Greater than 150 x 10 9th/L Greater than 200 x 10 9th/L Greater than 500 x 10 9th/L Greater than 700 x 10 9th/L

Answer 395

Greater than 700 x 10 9th/L A high WBC count (greater than 20 x 10 9th/L) or a high platelet count (greater than 700 x 10 9th/L) can cause turbidity and a falsely high result. IN THIS CASE, THE REAGENT-SAMPLE SOLUTION CAN BE CENTRIFUGED AND THE SUPERNATANT MEASURED.

Question 396

When the correct area of a specimen from a patient with a normal RBC count is viewed, there are generally about ____ RBCs per 100x oil immersion field. 10 to 15 RBCs per OIF 20 to 25 RBCs per OIF 100 to 150 RBCs per OIF 200 to 250 RBCs per OIF

Answer 396

200 to 250 RBCs per OIF

Question 397

The IMPEDANCE PRINCIPLE OF CELL COUNTING is based on the detection and measurement of CHANGES IN ELECTRICAL RESISTANCE produced by cells as they traverse a small aperture. Electrical resistance between the ___ electrodes, or impedance in the current, occurs as the cells pass through the sensing aperture, causing voltage pulses that are measurable. Two (2) electrodes Three (3) electrodes Four (4) electrodes Ten (10) electrodes

Answer 397

Two (2) electrodes

Question 398

Forward, low angle light scatter: 0 degree angle 2 to 3 degree angle 5 to 15 degree angle 90 degree angle

Answer 398

2 to 3 degree angle ## Footnote Forward-angle: 0 degree - cell volume Forward low-angle: 2 to 3 degrees - cell volume Forward high-angle: 5 to 15 degrees - internal complexity Orthogonal, side: 90 degrees - internal complexity

Question 399

Forward, high angle light scatter: 0 degree angle 2 to 3 degree angle 5 to 15 degree angle 90 degree angle

Answer 399

5 to 15 degree angle ## Footnote Forward-angle: 0 degree - cell volume Forward low-angle: 2 to 3 degrees - cell volume Forward high-angle: 5 to 15 degrees - internal complexity Orthogonal, side: 90 degrees - internal complexity

Question 400

Erythrocytes with NORMAL RDW: -Homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear -Heterogeneous and exhibit a high degree of anisocytosis

Answer 400

Homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear

Question 401

Erythrocytes with INCREASED RDW: -Homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear -Heterogeneous and exhibit a high degree of anisocytosis

Answer 401

Heterogeneous and exhibit a high degree of anisocytosis

Question 402

THE ESR IS ____ PROPORTIONAL TO THE RED BLOOD CELL MASS and _____proportional to plasma viscosity. Direct, direct Direct, inverse Inverse, direct Inverse, inverse

Answer 402

Direct, inverse

Question 403

In automated cell counters, these parameters are directly measured: WBC and RBC WBC, RBC, and hemoglobin WBC and hemoglobin RBC only

Answer 403

WBC, RBC, and hemoglobin

Question 404

All of the following are causes of spurious increase in WBCs, except: Cryoglobulin Cryofibrinogen Monoclonal proteins Smudge cells

Answer 404

Smudge cells ## Footnote SPURIOUS INCREASE IN WBC Cryoglobulin, cryofibrinogen Heparin, monoclonal proteins Nucleated RBCs, unlysed RBCs Platelet clumping SPURIOUS DECREASE IN WBC Clotting, smudge cells Uremia plus immunosuppressants

Question 405

All of the following are causes of spurious increase in RBCs, except: Autoagglutination Cryoglobulin, cryofibrinogen Giant platelets High WBCs

Answer 405

Autoagglutination ## Footnote SPURIOUS INCREASE IN RBC Cryoglobulin, cryofibrinogen Giant platelets High WBC (>50,000/mL) SPURIOUS DECREASE IN RBC Autoagglutination, clotting Hemolysis (in vitro) Microcytic red cells

Question 406

Based on the detection and measurement of changes in electrical resistance produced by cells as they transverse a small aperture in a conducting solution: Impedance principle of cell counting Optical principle of cell counting

Answer 406

Impedance principle of cell counting

Question 407

Based on the degree of scatter and the amount of light reaching the sensor depend on the volume of the cell: Impedance principle of cell counting Optical principle of cell counting

Answer 407

Optical principle of cell counting

Question 408

Cold agglutinins: Decreased RBCs, increased MCV and MCHC, grainy appearance Increased RBCs, decreased MCV and MCHC, grainy appearance

Answer 408

Decreased RBCs, increased MCV and MCHC, grainy appearance ## Footnote RATIONALE: Agglutination of RBCs CORRECTIVE ACTION: Warm specimen to 37° C and rerun

Question 409

Lipemia and icterus: Decreased hemoglobin and MCH Increased hemoglobin and MCH

Answer 409

Increased hemoglobin and MCH ## Footnote RATIONALE: Turbidity affects spectrophotometric reading for hemoglobin CORRECTIVE ACTION: Plasma replacement

Question 410

Nucleated RBCs, megakaryocyte fragments, or micromegakaryoblasts: Decreased WBCs in newer instruments Increased WBCs in older instruments

Answer 410

Increased WBCs in older instruments ## Footnote RATIONALE: Nucleated RBCs or micromegakaryoblasts counted as WBCs CORRECTIVE ACTION: Newer instruments eliminate this error and count nucleated RBCs and correct the WBC count; count micromegakaryoblasts per 100 WBCs and correct

Question 411

Platelet clumps: Decreased platelets, increased WBCs Increased platelets, decreased WBCs

Answer 411

Decreased platelets, increased WBCs ## Footnote RATIONALE: Large clumps counted as WBCs and not platelets CORRECTIVE ACTION: Redraw specimen in sodium citrate, multiply result by 1.1

Question 412

Leukemia, especially with chemotherapy: Decreased WBCs, increased platelets Increased WBCs, decreased platelets

Answer 412

Decreased WBCs, increased platelets ## Footnote RATIONALE Fragile WBCs, fragments counted as platelets CORRECTIVE ACTION Review film, perform phase platelet count or CD61 count

Question 413

WBC > 100,000/µL: Decreased hemoglobin, decreased RBCs, incorrect hematocrit Increased hemoglobin, increased RBCs, incorrect hematocrit

Answer 413

Increased hemoglobin, increased RBCs, incorrect hematocrit ## Footnote RATIONALE: Turbidity affects spectrophotometric reading for hemoglobin, WBCs counted with RBC count CORRECTIVE ACTION: Manual HCT; perform manual HGB (spin/read supernatant), correct RBC count, recalculate indices; if above linearity, dilute for correct WBC count

Question 414

All of the following are causes of spurious decrease in MCHC, except: * Autoagglutination High WBCs Spuriously low hemoglobin Spuriously high hematocrit

Answer 414

Autoagglutination ## Footnote SPURIOUS INCREASE IN MCHC Autoagglutination, clotting Hemolysis (in vitro, in vivo) Spuriously HIGH Hb Spuriously LOW Hct SPURIOUS DECREASE IN MCHC High WBC (>50,000/μL) Spuriously LOW Hb, Spuriously HIGH Hct

Question 415

Shift to the left in RBC histogram means: Population of smaller cells (microcytosis) Population of larger cells (macrocytosis)

Answer 415

Population of smaller cells (microcytosis)

Question 416

A stained blood film is held up to the light and observed to be bluer than normal. What microscopic abnormality might be expected on this film? Rouleaux Spherocytosis Reactive lymphocytosis Toxic granulation

Answer 416

Rouleaux ## Footnote MACROSCOPIC EXAMINATION OF BLOOD FILM 1. BLUER Increased blood proteins, as in plasma cell myeloma, and that ROULEAUX may be seen on the film 2. GRAINY RBC agglutination, as in cold hemagglutinin diseases 3. HOLES Increased lipid levels 4. BLUE SPECKS OUT AT THE FEATHER EDGE Markedly increased WBC counts and platelet counts

Question 417

Holes all over the blood film indicates: RBC agglutination Markedly increased WBC and platelet counts Increased lipid levels Increased blood proteins as in multiple myeloma

Answer 417

Increased lipid levels ## Footnote MACROSCOPIC EXAMINATION OF BLOOD FILM 1. BLUER Increased blood proteins, as in plasma cell myeloma, and that ROULEAUX may be seen on the film 2. GRAINY RBC agglutination, as in cold hemagglutinin diseases 3. HOLES Increased lipid levels 4. BLUE SPECKS OUT AT THE FEATHER EDGE Markedly increased WBC counts and platelet counts

Question 418

Which of the following tests is the most effective means of assessing red blood cell generation in response to anemia? RDW Reticulocyte count Platelet count CB

Answer 418

Reticulocyte count

Question 419

Which of the following conditions is not usually associated with marked reticulocytosis? Four days after a major hemorrhage Drug-induced autoimmune hemolytic anemia Sickle cell anemia Pernicious anemia

Answer 419

Pernicious anemia ## Footnote The reticulocyte count is not usually elevated in pernicious anemia even though increased marrow erythropoiesis occurs. The defective cellular maturation that occurs in megaloblastic anemias results in the death of many red cells in the bone marrow (ineffective erythropoiesis).

Question 420

If 60 reticulocytes are counted in 1000 red blood cells, what is the reticulocyte count? 0.06% 0.6% 6.0% 60.0%

Answer 420

6.0%

Question 421

To improve accuracy of the RETICULOCYTE COUNT, have another laboratorian count the other film; counts should agree within: 20% 30% 40% 50%

Answer 421

20%

Question 422

Which of the following is NOT associated with causing a falsely low ESR? Column used is slanted EDTA tube is clotted EDTA tube is one-third full EDTA specimen is 24 hours old

Answer 422

Column used is slanted

Question 423

The reagent used in the traditional sickle cell screening test is: Sodium chloride Sodium citrate Sodium metabisulfite Sodium-potassium oxalate

Answer 423

Sodium metabisulfite

Question 424

Hemoglobin SOLUBILITY TEST is a screening test for: Hemoglobin A2 Hemoglobin F Hemoglobin S Unstable hemoglobins

Answer 424

Hemoglobin S

Question 425

Reagent for the solubility test: Hydrochloric acid Ferric cyanide and detergent 2% sodium metabisulfite Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)

Answer 425

Sodium hydrosulfite (dithionite) and a detergent-based lysing agent (saponin)

Question 426

Positive result in the solubility test (sodium dithionite test for hemoglobin S): Normal looking RBCs or slightly crenated RBCs Sickle cells or 'holly leaf' form of RBCs Clear solution, black lines of the reader scale are visible through the solution Turbid solution, reader scale is not visible through the test solution

Answer 426

Turbid solution, reader scale is not visible through the test solution ## Footnote If the solubility test is positive, hemoglobin electrophoresis should be performed on the specimen.

Question 427

Paroxysmal nocturnal hemoglobinuria is characterized by flow cytometry results that are: Negative for CD55 and CD59 Positive for CD55 and CD59 Negative for CD4 and CD8 Positive for all normal CD markers

Answer 427

Negative for CD55 and CD59

Question 428

If the sugar water test is positive, _____ procedure should be performed before a diagnosis of PNH is made. Autohemolysis test Hemoglobin electrophoresis Osmotic fragility test Sucrose hemolysis test

Answer 428

Sucrose hemolysis test

Question 429

Anticoagulant for the sugar water and sucrose hemolysis test: EDTA Citrate Heparin Oxalate

Answer 429

Citrate

Question 430

What are the INITIAL laboratory tests that are performed for the diagnosis of anemia? CBC, iron studies, and reticulocyte count CBC, reticulocyte count, and peripheral blood film examination Reticulocyte count and serum iron, vitamin B12 and folate assays Bone marrow study, iron studies, and peripheral blood film examination

Answer 430

CBC, reticulocyte count, and peripheral blood film examination

Question 431

Dilution for RBC count in AUTOMATED cell counters: 1:100 1:200 1: 50,000 1: 500

Answer 431

1: 50,000

Question 432

Dilution for WBC count in AUTOMATED cell counters: 1:100 1:200 1: 50,000 1: 500

Answer 432

1: 500

Question 433

A decreased osmotic fragility test would be associated which of the following conditions? Sickle cell anemia Hereditary spherocytosis HDN Acquired hemolytic anemia

Answer 433

Sickle cell anemia

Question 434

A Miller disk is an ocular device used to facilitate counting of: Platelets Reticulocytes Sickle cells Nucleated RBCs

Answer 434

Reticulocytes

Question 435

The Coulter principle for counting of cells is based upon the fact that: Isotonic solutions conduct electricity better than cells do Conductivity varies proportionally to the number of cells Cells conduct electricity better than saline does Isotonic solutions cannot conduct electricity

Answer 435

Isotonic solutions conduct electricity better than cells do

Question 436

Side angle scatter in a laser-based cell counting system is used to measure: Cell size Cytoplasmic granularity Cell number Immunologic (antigenic) identification

Answer 436

Cytoplasmic granularity

Question 437

Falsely elevated automated platelet counts may result from: Platelet satellitism Platelet agglutinins Exceptionally large platelets Erythrocyte inclusion bodies

Answer 437

Erythrocyte inclusion bodies

Question 438

The mean platelet volume (MPV): Analogous to the MCHC Direct measure of the platelet count Measurement of the average volume of platelets Comparison of the patient's value to the normal value

Answer 438

Measurement of the average volume of platelets

Question 439

The RDW and MCV are both quantitative descriptors of erythrocyte size. If both are increased, the most probable erythrocytic abnormality would be: Iron deficiency anemia Acquired aplastic anemia Megaloblastic anemia Hemoglobinopathy

Answer 439

Megaloblastic anemia

Question 440

In an erythrocyte histogram, the erythrocytes that are larger than normal will be to the _____ of the normal distribution curve. Right Left In the middle

Answer 440

Right

Question 441

If the RBC distribution on a histogram demonstrates a homogeneous pattern and a small SD, the peripheral blood smear would probably exhibit: Extreme anisocytosis Very little anisocytosis A single population of spherocytes A single population of macrocytes

Answer 441

Very little anisocytosis

Question 442

Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria? Autosomal dominant inheritance Red cell membrane defects Positive direct antiglobulin test Measured platelet count

Answer 442

Red cell membrane defects

Question 443

An enzyme deficiency associated with a moderate to severe hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions formed by denatured hemoglobin is: Lactate dehydrogenase deficiency G-6-PD deficiency Pyruvate kinase deficiency Hexokinase deficiency

Answer 443

G-6-PD deficiency

Question 444

The presence of excessive rouleaux formation on a blood smear is often accompanied by an increased: Reticulocyte count Sedimentation rate Hematocrit Erythrocyte count

Answer 444

Sedimentation rate

Question 445

MPV values should be based on specimens that are between ____ and ___ hours old. 1 and 4 hours old 4 and 6 hours old 6 and 8 hours old 16 and 18 hours old

Answer 445

1 and 4 hours old ## Footnote MPV values should be based on specimens that are between 1 and 4 hours old.

Question 446

Complications include orthostatic hypotension, syncope and shock * Vascular complications Cardiovascular complications Neurological complications Dermatological comlications

Answer 446

Cardiovascular complications ## Footnote Cardiovascular complications include orthostatic hypotension, syncope, shock, and cardiac arrest.

Question 447

Complications include diaphoresis, seizure and pain: * Vascular complications Cardiovascular complications Neurological complications Dermatological comlications

Answer 447

Neurological complications ## Footnote Neurological Complications Post-phlebotomy patients can exhibit some neurological complications. These include diaphoresis, seizure, pain, and nerve damage. A physician should be consulted immediately.

Question 448

Sister chromatids move to the equatorial plate. * Prophase Metaphase Anaphase Telophase

Answer 448

Metaphase ## Footnote Characteristics of the Four Mitotic Periods PROPHASE The chromatin becomes tightly coiled. Nucleolus and nuclear envelope disintegrate. Centrioles move to opposite poles of the cell. METAPHASE Sister chromatids move to the equatorial plate. ANAPHASE Sister chromatids separate and move to opposite poles. TELOPHASE Chromosomes arrive at opposite poles. Nucleolus and nuclear membrane reappear. The chromatin pattern reappears.

Question 449

Megakaryocytes develop into platelets in approximately __ days. * 3 days 5 days 9 days 12 days

Answer 449

5 days ## Footnote Megakaryocytes develop into platelets in approximately 5 days.

Question 450

This cytokine promotes the growth of early hematopoietic cell lines: * Interleukin 1 Interleukin 2 Interleukin 3 Interleukin 6

Answer 450

Interleukin 3 ## Footnote Promotes the growth of early hematopoietic cell lines (e.g., proliferation of CFU-GEMM, CFU-M, CFU-Meg, CFU-Eo, and CFU-Bs colonies from bone marrow). IL-3 acts with M-CSF to stimulate proliferation of monocytes and macrophages. It also stimulates granulocyte, monocyte, eosinophil, and mast cell production

Question 451

Hemoglobin appears for the first time: * Rubriblast (pronormoblast) Prorubricyte (basophilic normoblast) Rubricyte (polychromatophilic normoblast) Metarubricyte (orthochromic normoblast)

Answer 451

Rubricyte (polychromatophilic normoblast) ## Footnote Hemoglobin appears for the first time in the third maturational stage, the rubricyte or polychromatic normoblast.

Question 452

This pathway prevents denaturation of globin of the hemoglobin molecule by oxidation: * Embden-Meyerhof pathway Hexose-monophosphate shunt Methemoglobin reductase pathway Luebering-Rapoport pathway

Answer 452

Hexose-monophosphate shunt ## Footnote Embden-Meyerhof Pathway Maintains cellular energy by generating ATP Oxidative pathway or hexose-monophosphate shunt Prevents denaturation of globin of the hemoglobin molecule by oxidation Methemoglobin reductase pathway Prevents oxidation of heme iron Luebering-Rapaport pathway Regulates oxygen affinity of hemoglobin

Question 453

RBCs inclusions, 0.2 to 2.0 mm in size, that can be seen with a stain such as crystal violet or brilliant cresyl blue; represent precipitated, denatured hemoglobin and are clinically associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such as phenacetin, and some hemoglobinopathies. * Hemoglobin C crystals Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 453

Heinz bodies ## Footnote Heinz bodies are inclusions, 0.2 to 2.0 mm in size, that can be seen with a stain such as crystal violet or brilliant cresyl blue. They represent precipitated, denatured hemoglobin and are clinically associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such as phenacetin, and some hemoglobinopathies.

Question 454

RBC inclusions that are aggregates of mitochondria, ribosomes, and iron particles. Clinically, they are associated with iron-loading anemias, hyposplenism, and hemolytic anemias. * Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 454

Pappenheimer bodies

Question 455

RBC inclusions representing granules composed of ribosomes and RNA that are precipitated during the process of staining of a blood smear; associated clinically with disturbed erythropoiesis (defective or accelerated heme synthesis),lead poisoning, and severe anemias. * Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 455

Basophilic stippling

Question 456

Nuclear remnants predominantly composed of DNA; believed to develop in periods of accelerated or abnormal erythropoiesis, because the spleen cannot keep upwith pitting these remnants from the cell. Its presence is associated with hemolytic anemias, pernicious anemia, and particularly post-splenectomy, physiologicalatrophy of the spleen. * Basophilic stippling Heinz bodies Howell-Jolly bodies Pappenheimer bodies

Answer 456

Howell-Jolly bodies ## Footnote Howell-Jolly bodies are believed to develop in periods of accelerated or abnormal erythropoiesis, because the spleen cannot keep up with pitting these remnants from the cell. The presence of Howell-Jolly bodies is associated with hemolytic anemias, pernicious anemia, and particularly post-splenectomy, physiological atrophy of the spleen.

Question 457

Anemias with low MCV and MCHC; microcytic, hypochromic RBCs, EXCEPT: * Iron deficiency anemia Thalassemia Sideroblastic anemia Excessive alcohol ingestion

Answer 457

Excessive alcohol ingestion ## Footnote Low MCV, MCHC Microcytic, hypochromic Typical of maturation defects Iron deficiency anemia (some) Thalassemia Sideroblastic anemia --- Normal MCV, MCHC Normocytic, normochromic Typical of hypoproliferation Bone marrow disorder Iron deficiency anemia (some) Anemia of chronic disorders Autoimmune disease --- High MCV Macrocytic Typical of maturation defect Vitamin B12 deficiency Folate deficiency Excessive alcohol ingestion Hypothyroidism

Question 458

Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is MANY. * 0 1+ 2+ 3+ 4+

Answer 458

3+ ## Footnote Grading of Erythrocyte Morphology 0 Normal appearance or slight variation in erythrocytes. 1+ Only a small population of erythrocytes displays a particular abnormality; the terms slightly increased or few would be comparable. 2+ More than occasional numbers of abnormal erythrocytes can be seen in a microscopic field; an equivalent descriptive term is moderately increased. 3+ Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is many. 4+ The most severe state of erythrocytic abnormality, with the abnormality prevalent throughout each microscopic field; comparable terms are marked or marked increase.

Question 459

Inherited hemolytic anemia due to structural membrane defect: * Thalassemia Sickle cell anemia Pyruvate kinase deficiency Hereditary spherocytosis

Answer 459

Hereditary spherocytosis ## Footnote Examples of Inherited Hemolytic Anemias STRUCTURAL MEMBRANE DEFECTS Acanthocytosis Hereditary spherocytosis Hereditary elliptocytosis Hereditary stomatocytosis Hereditary xerocytosis Rh null disease ERYTHROCYTIC ENZYME DEFECTS G6PD deficiency Glutathione reductase Hexokinase Pyruvate kinase DEFECTS OF THE HEMOGLOBIN MOLECULE Hb C disorder Hb S-C disorder Hb S-S disorder (sickle cell anemia) Thalassemia

Question 460

Hemoglobinopathies associated with ABNORMAL MOLECULAR STRUCTURE: * Alpha thalassemia Alpha and beta thalassemia Sickle cell anemia and beta thalassemia Sickle cell anemia, sickle cell trait and Hb C disease

Answer 460

Sickle cell anemia, sickle cell trait and Hb C disease ## Footnote Examples of Selected Hemoglobinopathies ABNORMAL MOLECULAR STRUCTURE Hb SS (sickle cell anemia) Hb SA (sickle cell trait) Hb C disease or trait RATE OF SYNTHESIS Beta-Thalassemia Alpha-Thalassemia COMBINATION OF TWO MOLECULAR ALTERATIONS OR A MOLECULAR ABNORMALITY AND SYNTHESIS DEFECT Hb S-Hb C Hb S-b-thalassemia

Question 461

Elongated and curved nucleus; very clumped chromatin: * Myelocyte Metamyelocyte Band Segmenter neutrophil

Answer 461

Band

Question 462

Indented nucleus, clumped chromatin: * Promyelocyte Myelocyte Metamyelocyte Band

Answer 462

Metamyelocyte

Question 463

Mast cells have an appearance similar to that of the blood: * Monocyte Neutrophil Eosinophil Basophil

Answer 463

Basophil ## Footnote Mast cells (tissue basophils) are not observed in the blood of healthy persons. These cells have an appearance similar to that of the blood basophil. Mast cells have a round or oval nucleus. The granules of the mast cell do not overlie the nucleus as they do in basophils.

Question 464

Once the metamyelocyte stage has been reached, cells have undergone ____ cell divisions and the proliferative phase comes to an end. * 1 or 2 cell divisions 2 or 3 cell divisions 4 or 5 cell divisions 6 or 7 cell divisions

Answer 464

4 or 5 cell divisions ## Footnote Once the metamyelocyte stage has been reached, cells have undergone four or five cell divisions and the proliferative phase comes to an end.

Question 465

Nuclear chromatin is coarse and clumped; dark blue (basophilic) cytoplasm around the periphery or in a radial pattern and few cytoplasmic vacuoles: * Type I Downey cells Type II Downey cells Type III Downey cells

Answer 465

Type II Downey cells ## Footnote Descriptive Features of the Classic Downey Classification of Lymphocytes Seen in Infectious Mononucleosis Type I Nucleus May be irregularly shaped Cytoplasm Usually many cytoplasmic vacuoles, dark blue (basophilic) Type II Nucleus Chromatin is coarse and clumped Cytoplasm Increased amount, dark blue (basophilic) around the periphery or in a radial pattern, a few cytoplasmic vacuoles Type IIIa Nucleus Nucleoli usually visible, enlarged in size Cytoplasm Dark blue (basophilic)

Question 466

Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage: * M0 myeloid M1 myeloid M2 myeloid M3 myeloid

Answer 466

M2 myeloid ## Footnote M2 myeloidMyeloid cells demonstrate maturation beyond the blast and promyelocyte stage

Question 467

Abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations: * M3 M4 M6 M7

Answer 467

M6 ## Footnote M6 erythroleukemiaAlso known as Di Guglielmo syndrome; abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations

Question 468

Small cells predominant; nuclear shape is regular with an occasional cleft; chromatin pattern is homogeneous and nucleoli are rarely visible; cytoplasm is moderately basophilic: * L1 L2 L3

Answer 468

L1 ## Footnote L1 homogeneous One population of cells within the case; small cells predominant; nuclear shape is regular with an occasional cleft; chromatin pattern is homogeneous and nucleoli are rarely visible; cytoplasm is moderately basophilic L2 heterogeneous Large cells with an irregular nuclear shape; clefts in the nucleus are common; one or more large nucleoli are visible; cytoplasm varies in color L3 Burkitt lymphoma type Cells are large and homogeneous in size; nuclear shape is round or oval; one to three prominent nucleoli; cytoplasm is deeply basophilic with vacuoles often prominent

Question 469

Cells are large and homogeneous in size; nuclear shape is round or oval; one to three prominent nucleoli; cytoplasm is deeply basophilic with vacuoles often prominent: * L1 L2 L3

Answer 469

L3 ## Footnote L1 homogeneous One population of cells within the case; small cells predominant; nuclear shape is regular with an occasional cleft; chromatin pattern is homogeneous and nucleoli are rarely visible; cytoplasm is moderately basophilic L2 heterogeneous Large cells with an irregular nuclear shape; clefts in the nucleus are common; one or more large nucleoli are visible; cytoplasm varies in color L3 Burkitt lymphoma type Cells are large and homogeneous in size; nuclear shape is round or oval; one to three prominent nucleoli; cytoplasm is deeply basophilic with vacuoles often prominent

Question 470

Leukemic reticuloendotheliosis: * Prolymphocytoc leukemia Plasma cell leukemia Hairy cell leukemia Sezary syndrome

Answer 470

Hairy cell leukemia

Question 471

Solid tumor counterpart of acute lymphoblastic leukemia: * Lymphoma, undifferentiated Lymphoma, poorly differentiated leukemia Lymphoma, well-differentiated leukemia Chloroma granulocytic leukemia

Answer 471

Lymphoma, poorly differentiated leukemia

Question 472

Solid tumor counterpart of plasma cell leukemia: * Reticulum cell sarcoma Chloroma granulocytic leukemia Myeloma Lymphoma, undifferentiated

Answer 472

Myeloma

Question 473

A distinctive feature of the megakaryocyte: * Multinucleated Multilobular Multinucleated and multilobular None of these

Answer 473

Multilobular ## Footnote A distinctive feature of the megakaryocyte is that it is multilobular, not multinucleated. The fully mature lobes of the megakaryocyte shed platelets from the cytoplasm on completion of maturation.

Question 474

A target INR range of ____ is recommended for most indications (e.g., treatment or prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients who have had a myocardial infarction). * INR range of 1.0 to 2.0 INR range of 2.0 to 3.0 INR range of 2.5 to 3.5 INR range of 4.0 to 5.0

Answer 474

INR range of 2.0 to 3.0 ## Footnote A target INR range of 2.0 to 3.0 is recommended for most indications (e.g., treatment or prophylaxis of deep venous thrombosis [DVT], or prevention of further clotting in patients who have had a myocardial infarction). An INR of 2.5 to 3.5 is recommended for patients with prosthetic heart valves. When the INR is used to guide anticoagulant therapy, there are fewer bleeding events.

Question 475

The target INR for pulmonary embolism (PE) treatment is ___ for the duration of anticoagulation. * 1.0 1.5 2.5 3.0

Answer 475

3.0 ## Footnote The target INR for pulmonary embolism (PE) treatment is 3.0 for the duration of anticoagulation.

Question 476

The new types of thromboplastins for measuring the PT are mixtures of phospholipids and recombinantly derived _____ tissue factor. * Rabbit Pig Horse Human

Answer 476

Human ## Footnote NEW THROMBOPLASTINS The new types of thromboplastins for measuring the PT are mixtures of phospholipids and recombinantly derived human tissue factor. Because the new thromboplastins are more sensitive (typical ISI, 1.0) than the traditional North American ones (ISIs, 1.8 to 3.0), the PTs for patients with inherited or acquired deficiencies of coagulation factors will be much more prolonged with use of the new reagents, although normal values may change minimally.

Question 477

Anticoagulant therapy: * Falsely decreased D-dimer values Falsely increased D-dimer values No effect Cannot be determined

Answer 477

Falsely decreased D-dimer values ## Footnote Conditions That Can Generate Falsely Decreased or Falsely Increased D-Dimer Values FALSELY DECREASED VALUES 1. Anticoagulant therapy 2. Smaller, older, nonprogressing thrombus FALSELY INCREASED VALUES 1. Various disease states 2. Post-therapeutic clinical procedures

Question 478

Smallest platelets seen: * Wiskott-Aldrich syndrome May-Hegglin anomaly Alport syndrome Bernard-Soulier syndrome

Answer 478

Wiskott-Aldrich syndrome

Question 479

Glanzmann thrombasthenia and essential athrombia: * Platelet adhesion defect Primary platelet aggregation defect Secondary platelet aggregation defect Isolated platelet factor III deficicency

Answer 479

Primary platelet aggregation defect ## Footnote Hereditary Platelet Function Defects ADHESION DEFECTS Bernard-Soulier syndrome Impaired adhesion to collagen AGGREGATION DEFECTS: PRIMARY Glanzmann thrombasthenia Essential athrombia AGGREGATION DEFECTS: SECONDARY Storage pool diseases Aspirin-like defects Release reaction defects ISOLATED PLATELET FACTOR III DEFICIENCY SEVERE COAGULATION FACTOR DEFICIENCIES Afibrinogenemia Factor VIII: C deficiency Factor IX: C deficiency

Question 480

Acquired platelet function defects: * Bernard-Soulier syndrome Bernard-Soulier and Glanzmann thrombasthenia Uremia, multiple myeloma Uremia, multiple myeloma, vitamin B12 or folate deficiency

Answer 480

Uremia, multiple myeloma, vitamin B12 or folate deficiency ## Footnote ACQUIRED PLATELET FUNCTION DEFECTS 1. Myeloproliferative syndromes Essential thrombocythemia Chronic myelogenous leukemia Polycythemia vera Paroxysmal nocturnal hemoglobinuria Myelofibrosis RAEB syndrome Sideroblastic anemia 2. Paraprotein disorders Multiple myeloma Waldenström macroglobulinemia Essential monoclonal gammopathy 3. Autoimmune diseases Collagen vascular disease Antiplatelet antibodies Immune thrombocytopenias 4. Fibrinogen degradation products Disseminated intravascular coagulation Primary fibrinolytic syndromes Liver disease 5. Anemia Severe iron deficiency Severe B12 or folate deficiency 6. Uremia 7. Drug induced RAEB, refractory anemia with excess blasts

Question 481

Inherited platelet dysfunction: * Bernard-Soulier syndrome Bernard-Soulier syndrome, Glanzmann's thrombasthenia Uremia, multiple myeloma Uremia, multiple myeloma, vitamin B12 or folate deficiency

Answer 481

Bernard-Soulier syndrome, Glanzmann's thrombasthenia ## Footnote INHERITED PLATELET DYSFUNCTION 1. Surface membrane defects Bernard-Soulier syndrome Glanzmann thrombasthenia Platelet-type von Willebrand disease 2. Defects of granule storage Alpha-granule deficiency Gray platelet syndrome 3. Dense granules Wiskott-Aldrich syndrome Hermansky-Pudlak syndrome Chédiak-Higashi syndrome TAR baby syndrome

Question 482

Patients with _____ , the most severe form of von Willebrand disease, are likely to have a major episode of bleeding early in life because significantly decreased amounts of vWF and VIII:C are produced. * Type IA Type IIB Type IIC, IID Type III

Answer 482

Type III Patients with type III, the most severe form of von Willebrand disease, are likely to have a major episode of bleeding early in life because significantly decreased amounts of vWF and VIII:C are produced.

Question 483

Conditions related to deficiencies of multiple coagulation factors: * Hepatic disease Hepatic disease and anticoagulant overdose Anticoagulant overdose and vitamin K deficiency Hepatic disease, anticoagulant overdose, DIC and vitamin K deficiency Hepatic disease, anticoagulant overdose, DIC and vitamin

Answer 483

K deficiency ## Footnote CONDITIONS RELATED TO DEFICIENCIES OF MULTIPLE COAGULATION FACTORS Hepatic disease, anticoagulant overdose (e.g., heparin or warfarin), DIC, vitamin K deficiency

Question 484

Indented or twisted nucleus, lacy chromatin and gray-blue cytoplasm: * Segmented neutrophil Band neutrophil Monocyte Lymphocyte

Answer 484

Monocyte

Question 485

orward high-angle light scatter: * 0 degree angle 2 to 3 degree angle 5 to 15 degree angle 90 degree anglez

Answer 485

5 to 15 degree angle ## Footnote Angles of Light Scatter Various angles of light scatter can aid in cellular analysis. 1. Forward light scatter 0°. This is diffracted light, which relates to the volume of the cell. 2. Forward low-angle light scatter 2° to 3°. This characteristic can relate to size or volume. 3. Forward high angle 5° to 15°. This type of measurement allows for description of the refractive index of cellular components. 4. Orthogonal light scatter 90°. The result of this application of light scatter is the production of data based on reflection and refraction of internal components, which correlates with internal complexity

Question 486

RBC histogram to the LEFT: * RBCs are larger than normal RBCs are smaller than normal Seen in megaloblastic anemia Treated anemia

Answer 486

RBCs are smaller than normal ## Footnote If the cells are smaller than normal, the curve will be more to the left, as in untreated iron deficiency anemia. If the cells are larger than normal, the histogram curve will be more to the right, as in the megaloblastic anemias. After appropriate treatment of the underlying cause of an anemia, the curve should move toward the normal range.

Question 487

Erythrocytes with an increased RDW; * Homogenous in character, very little anisocytosis Homogenous, high degree of anisocytosis Heterogenous, very little anisocytosis Heterogenous, high degree of anisocytosis

Answer 487

Heterogenous, high degree of anisocytosis ## Footnote Erythrocytes with a normal RDW are homogeneous in character and exhibit very little anisocytosis on a peripheral blood smear. Erythrocytes with an increased RDW are referred to as heterogeneous and exhibit a high degree of anisocytosis on a peripheral blood smear.

Question 488

MPV values should be based on specimens that are between ____ hours old. * 1 and 4 hours old 4 and 8 hours old 6 and 12 hours old 12 and 16 hours old

Answer 488

1 and 4 hours old ## Footnote MPV is a measure of the average volume of platelets in a sample. In EDTA-anti-coagulated blood, platelets undergo a change in shape. This alteration (swelling) causes the MPV to increase approximately 20% during the first hour. After this time, the size is stable for at least 12 hours; however, MPV values should be based on specimens that are between 1 and 4 hours old. No single normal range exists. Patients with a lower platelet count normally have a higher MPV, and patients with a higher platelet count have a lower MPV. Analysis of a nomogram demonstrates that an MPV between 9.0 and 9.8 fL is in the normal range, if the platelet count is normal. MPVs from 7.8 to 8.9 fL or from 9.9 to 12.0 fL may be in the normal range, depending on the platelet count. DECREASED MPV: 1. Aplastic anemia 2. Megaloblastic anemia 3. Wiskott-Aldrich syndrome 4. After chemotherapy INCREASED MPV: 1. Idiopathic thrombocytopenic purpura 2. After splenectomy 3. Sickle cell anemia

Question 489

Measure of the uniformity of platelet size in a blood specimen: * Platelet adhesion Platelet aggregation Mean platelet volume (MPV) Platelet distribution width (PDW)

Answer 489

Platelet distribution width (PDW) The PDW is a measure of the uniformity of platelet size in a blood specimen. This parameter serves as a validity check and monitors false results. A normal PDW is less than 20%.

Question 490

Placement of fire extinguishers every ___ feet. * 75 feet 100 feet 125 feet 150 feet

Answer 490

75 feet ## Footnote Placement of fire extinguishers every 75 feet. A distinct system for marking the locations of fire extinguishers enables quick access when they are needed. Fire extinguishers should be checked monthly and maintained annually. Placement of manual fire alarm boxes near the exit doors. Travel distance should not exceed 200 feet.

Question 491

Surfaces in the specimen collection and processing area should be cleaned with: * 70% isopropyl alcohol. 1:10 bleach solution. Soap and water. Any of the above

Answer 491

1:10 bleach solution.

Question 492

Which of the following is a proper way to clean up a small blood spill that has dried on a countertop? * Moisten it with a disinfectant and carefully absorb it with a paper towel. Rub it with an alcohol pad, then wipe the area with a clean alcohol pad. Scrape it into a biohazard bag and wash the surface with soap and water. Use a disinfectant wipe and scrub it in ever-increasing concentric circles

Answer 492

Moisten it with a disinfectant and carefully absorb it with a paper towel.

Question 493

The following test orders for different patient shave been received at the same time. Which test would you collect first? * Fasting glucose STAT glucose in the ER STAT hemoglobin in ICU ASAP CBC in ICU

Answer 493

STAT glucose in the ER ## Footnote ER stats typically have priority over other stats.

Question 494

A member of the clergy is with the patient when you arrive to collect a routine specimen. What should you do? * Ask the patient's nurse what you should do. Come back after the clergy person has gone. Fill out a form saying you were unable to collect the specimen. Say "Excuse me, I need to collect a specimen from this patient."

Answer 494

Come back after the clergy person has gone. ## Footnote If a physician or a member of the clergy is with the patient, don't interrupt. The patient's time with these individuals is private and limited. If the draw is not stat, timed or other urgent priority, go draw another patient and check back after that. If that is the only patient, wait outside the room for a few minutes or go back to the lab and draw the specimen on the next sweep. (In any case, always make certain your actions follow facility policy.) If the request is stat, timed, or other urgent priority , excuse yourself, explain why you are there, and ask permission to proceed.

Question 495

The most common complication encountered in obtaining a blood specimen; it is caused by leakage of a small amount of blood in the tissue around the puncture site: * Petechiae Hematoma Ecchymosis Hemoconcentration

Answer 495

Ecchymosis ## Footnote Ecchymosis (Bruise): Bruising is the most common complication encountered in obtaining a blood specimen. It is caused by leakage of a small amount of blood in the tissue around the puncture site. Hematoma: A hematoma results when leakage of a large amount of blood around the puncture site causes the area to rapidly swell.

Question 496

A patient complains of extreme pain when you insert the needle during a venipuncture attempt. The pain does not subside, but the patient does not feel any numbness or burning sensation. You know the needle is in the vein because the blood is flowing into the tube. You have only two tubes to fill, and the first one is almost full. What should you do? * -Ask the patient if he or she wants you to continue the draw -Discontinue the draw and attempt collection at another site -Distract the patient with small talk and continue the draw -Tell the patient to hang in there as you have only one tube left

Answer 496

Discontinue the draw and attempt collection at another site ## Footnote If marked or extreme pain occurs, or the patient asks you to remove the needle for any reason, the venipuncture should be terminated immediately, even if there are no other signs of nerve injury.

Question 497

Which type of patient is most likely to have an arteriovenous fistula or graft? * Arthritic Dialysis Hospice Wheelchair-bound

Answer 497

Dialysis ## Footnote An arteriovenous (AV) shunt, fistula, or graft is the permanent surgical connection of an artery and vein by direct fusion (fistula), resulting in a bulging vein, or with a piece of vein or tubing (graft) that creates a loop under the skin. It is typically created to be used for dialysis, commonly joins the radial artery and cephalic vein above the wrist on the underside of the arm, and has a distinctive buzzing sensation called a "thrill" when palpated. A temporary shunt with tubing on the surface of the skin can also be created.

Question 498

Type of immersion oil with high viscosity and is used in brightfield and standard clinical microscopy. In hematology, this oil is routinely used. * Type A Type B Type C

Answer 498

Type B ## Footnote Three types of immersion oil, differing in viscosity, are employed in the clinical laboratory: 1. Type A has very low viscosity and is used in fluorescence and darkfield studies. 2. Type B has high viscosity and is used in brightfield and standard clinical microscopy. In hematology, this oil is routinely used. 3. Type C has very high viscosity and is used with inclined microscopes with long-focus objective lenses and wide condenser gaps.

Question 499

The recommended cleaner for removing oil from objectives is: * Benzene Xylene Water 70% alcohol or lens cleaner

Answer 499

70% alcohol or lens cleaner ## Footnote Use solvent sparingly. The use of xylene is discouraged, because it contains a carcinogenic component (benzene). Xylene is also a poor cleaning agent, leaving an oily film on the lens. Lens cleaner or 70% isopropyl alcohol employed sparingly on a cotton applicator stick can be used to clean the objective lenses.

Question 500

Often the objects appear to have "haloes" surrounding them. Brightfield microscope Darkfield microscope Phase-contrast microscope Polarized light microscope

Answer 500

Phase-contrast microscope ## Footnote This phase difference produces variation in light intensity from bright to dark, creating contrast in the image. Often the objects appear to have "haloes" surrounding them.

Question 501

True for PRECISION: -Measure of agreement between an assay value and the theoretical "true value" of its analyte -Magnitude of error separating the assay result from the true value -Easy to define but difficult to establish and maintain -Relatively easy to measure and maintain

Answer 501

Relatively easy to measure and maintain ## Footnote Accuracy is easy to define but difficult to establish and maintain; precision is relatively easy to measure and maintain. Precision is the expression of reproducibility or dispersion about the mean, often expressed as SD or CV%.

Question 502

Slope measures: * Random error Constant systematic error Proportional systematic error Constant and proportional systematic error

Answer 502

Proportional systematic error ## Footnote Perfect correlation generates a slope of 1 and a y intercept of 0. Slope measures proportional systematic error; the higher the analyte value, the greater the deviation from the line of identity. Proportional errors are caused by malfunctioning instrument components or a failure of some part of the testing process. The magnitude of the error increases with the concentration or activity of the analyte. An assay with proportional error may be invalid. Intercept measures constant systematic error (or bias, in laboratory vernacular), a constant difference between the new and reference assay regardless of assay result magnitude. A laboratory director may choose to adopt a new assay with systematic error but must modify the published reference interval.

Question 503

The positive predictive value predicts the probability that an individual with a positive assay result ___ the disease or condition. * Has Could have May have Will have

Answer 503

Has ## Footnote The positive predictive value predicts the probability that an individual with a positive assay result has the disease or condition. The negative predictive value predicts the probability that an individual with a negative assay result does not have the disease or condition.

Question 504

It describes the total number of events or conditions in a broadly defined population, for instance, the total number of patients with chronic heart disease in the Philippines. Incidence Prevalence False negative False positive

Answer 504

Prevalence ## Footnote Epidemiologists describe population events using the terms prevalence and incidence. 1. Prevalence describes the total number of events or conditions in a broadly defined population, for instance, the total number of patients with chronic heart disease in the United States. 2. Incidence describes the number of events occurring within a randomly selected number of subjects representing a population, over a defined time, for instance, the number of new cases of heart disease per 100,000 U.S. residents per year. Scientists use incidence, not prevalence, to select laboratory assays for specific applications such as screening or confirmation.