HEMA Flashcards
(124 cards)
1
Q
Normal adult hemoglobin (hemoglobin A) consists of FOUR HEME GROUPS AND FOUR POLYPEPTIDE CHAINS with a total of 574 AMINO ACIDS.
A
Noted, composition of adult hemoglobin: 4 heme and 4 polypeptide chains, total of 574 amino acids
2
Q
One chromosome breaks off and becomes attached to a different chromosome:
Addition
Deletion
Inversion
Translocation
A
Translocation
CHROMOSOMAL CHANGES
TRANSLOCATIONS
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.
DELETIONS
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.
INVERSIONS
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.
ADDITION
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.
3
Q
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
A
Totipotential stem cell
TYPES OF HUMAN STEM CELLS
Functionally, three types of human stem cells exist:
1. Totipotential 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.
- Pluripotential 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. - Multipotential 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.
4
Q
The promyelocyte stage lasts about:
4 hours
12 hours
15 hours
24 hours
4.3 days
A
24 hours
PROLIFERATIVE PHASE
Myeloblast: 15 hours
First identifiable cell in the granulocytic series
Constitute approximately 1% of the total nucleated bone marrow cells
Stage lasts approximately 15 hours
Promyelocyte: 24 hours
Constitutes approximately 3% of the nucleated bone marrow cells
This stage lasts about 24 hours
Myelocyte
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
MATURATION-STORAGE PHASE
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.
5
Q
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
A
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.
6
Q
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
A
EDTA, citrate and oxalate
Ethylenediaminetetraacetic acid (EDTA), citrate, and oxalate remove calcium needed for clotting by forming insoluble calcium salts.
Heparin prevents clotting by binding to anti- thrombin in the plasma and inhibiting thrombin and activated coagulation factor X.
7
Q
Number of inversions of light blue top evacuated tube:
None
3 to 4
5 to 6
8
A
3 to 4
Light blue (citrate) 3 to 4x inversions
Green (heparin) 8x inversions
Purple (EDTA) 8x inversions
8
Q
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
A
1, 2 and 3
9
Q
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
A
1, 2, 3 and 4
Each new assay or assay modification must be validated for:
1. Accuracy
2. Precision
3. Linearity
4. Specificity
5. Lower limit of detection ability
10
Q
Adjuvant for infectious disease therapy:
Interleukin 2
Interleukin 3
Interleukin 6
Interleukin 12
A
Interleukin 12
11
Q
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
A
1, 2, 3 and 4
The basic design of a flow cytometer involves four major elements: optics, fluidics, electronics, and a computer equipped with specialized software.
1. Optics
2. Fluidics
3. Electronics
4. Computer
12
Q
Total area of the Levy chamber with improved Neubauer ruling:
1 mm2
3 mm2
4 mm2
9 mm2
A
9 mm2
Levy chamber with improved Neubauer ruling:
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.
13
Q
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
A
10 minutes
14
Q
Typical dilution for the manual platelet count:
1:10
1:20
1:100
1:200
A
1:100
15
Q
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
A
1:20
16
Q
In the cyanmethemoglobin method, full conversion of hemoglobin to cyanmethemoglobin:
3 minutes
5 minutes
10 minutes
15 minutes
A
10 minutes
17
Q
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
A
Greater than 20 x 10 9/L
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.
18
Q
Effect of dehydration to hematocrit reading:
Decreased
Increased
Variable
No effect
A
Increased
The fluid loss associated with dehydration causes a decrease in plasma volume and falsely increases the hematocrit reading.
19
Q
An MCHC between 36 and 38 g/dL should be checked for:
Codocytes
Drepanocytes
Elliptocytes
Spherocytes
A
Spherocytes
An MCHC between 36 and 38 g/dL should be checked for spherocytes.
20
Q
In the manual reticulocyte count, what is the ratio of blood and new methylene blue stain?
1:1
1:2
1:3
1:4
A
1:1
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.
21
Q
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%
A
Within 20%
22
Q
The ESR of patients with severe anemia is:
Critical
Of diagnostic significance
Of little diagnostic value
A
Of little diagnostic value
The ESR of patients with severe anemia is of little diagnostic value, because it will be falsely elevated.
23
Q
ESR and RBC mass:
Directly proportional
Inversely proportional
Cannot be determined
A
Directly proportional
The ESR is directly proportional to the red blood cell mass and inversely proportional to plasma viscosity.
24
Q
ESR of patient with leukemia:
Decreased
Increased
Variable
A
Increased
25
ESR of patient with leukocytosis:
Decreased
Increased
Variable
Decreased
26
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
2 and 3
The immature reticulocyte fraction and the immature platelet fraction provide an early indication of engraftment success after hematopoietic stem cell transplant.
27
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
Bacterial, protozoal, fungal and viral infections
28
Fibrinogen concentration in primary fibrinolysis:
Decreased
Increased
Variable
Decreased
29
Bone marrow reticulocytes have an average maturation of:
1 day
1.5 days
2 days
2.5 days
2.5 days
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.
30
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
1 day
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.
31
Basophils have an average circulation time of about:
7 to 10 hours
8.5 hours
12 hours
2.5 days
8.5 hours
Basophils remain in the maturation-storage phase for approximately 12 hours.
Basophils have an average circulation time of about 8.5 hours.
32
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
The patient's favorite restaurant and food
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. It covers the following:
1. Any clinical information about an individual’s diagnosis or treatment
2. A picture, photograph, video, audiotape, or other images of the patient 3. Who the patient’s doctor is and what clinics patients attend and when
4. Anything else that may be used to identify patients either directly or indirectly so that any of the information above, combined with the patient’s name or address or full postcode or the patient’s date of birth, can identify them.
33
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
ISO 15189
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.
34
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
Failure to report critical values immediately
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
35
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
1.5 mg/1 mL of whole blood
36
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
Pseudoaneurysm, thrombosis, reflex arteriospasm and arteriovenous fistula formation
Uncommon vascular complications that are not usually related to the technique include pseudoaneurysm, thrombosis, reflex arteriospasm, and arteriovenous fistula formation.
37
Complications include orthostatic hypotension, syncope and shock
Vascular complications
Cardiovascular complications
Neurological complications
Dermatological comlications
Cardiovascular complications
Cardiovascular complications include orthostatic hypotension, syncope, shock, and cardiac arrest.
38
Complications include diaphoresis, seizure and pain:
Vascular complications
Cardiovascular complications
Neurological complications
Dermatological comlications
Neurological Complications
Post-phlebotomy patients can exhibit some neurological complications. These include diaphoresis, seizure, pain, and nerve damage. A physician should be consulted immediately.
39
Sister chromatids move to the equatorial plate.
Prophase
Metaphase
Anaphase
Telophase
Metaphase
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.
40
Megakaryocytes develop into platelets in approximately __ days.
3 days
5 days
9 days
12 days
5 days
Megakaryocytes develop into platelets in approximately 5 days.
41
This cytokine promotes the growth of early hematopoietic cell lines:
Interleukin 1
Interleukin 2
Interleukin 3
Interleukin 6
Interleukin 3
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
42
Hemoglobin appears for the first time:
Rubriblast (pronormoblast)
Prorubricyte (basophilic normoblast)
Rubricyte (polychromatophilic normoblast)
Metarubricyte (orthochromic normoblast)
Rubricyte (polychromatophilic normoblast)
Hemoglobin appears for the first time in the third maturational stage, the rubricyte or polychromatic normoblast.
43
This pathway prevents denaturation of globin of the hemoglobin molecule by oxidation:
Embden-Meyerhof pathway
Hexose-monophosphate shunt
Methemoglobin reductase pathway
Luebering-Rapoport pathway
Hexose-monophosphate shunt
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
44
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
Heinz bodies
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.
45
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
Pappenheimer bodies
46
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
Basophilic stippling
47
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
Howell-Jolly bodies
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.
48
Anemias with low MCV and MCHC; microcytic, hypochromic RBCs, EXCEPT:
Iron deficiency anemia
Thalassemia
Sideroblastic anemia
Excessive alcohol ingestion
Excessive alcohol ingestion
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
49
Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is MANY.
0
1+
2+
3+
4+
3+
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.
50
Inherited hemolytic anemia due to structural membrane defect:
Thalassemia
Sickle cell anemia
Pyruvate kinase deficiency
Hereditary spherocytosis
Hereditary spherocytosis
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
51
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
Sickle cell anemia, sickle cell trait and Hb C disease
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
52
Elongated and curved nucleus; very clumped chromatin:
Myelocyte
Metamyelocyte
Band
Segmenter neutrophil
Band
53
Indented nucleus, clumped chromatin:
Promyelocyte
Myelocyte
Metamyelocyte
Band
Metamyelocyte
54
Mast cells have an appearance similar to that of the blood:
Monocyte
Neutrophil
Eosinophil
Basophil
Basophil
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.
55
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
4 or 5 cell divisions
Once the metamyelocyte stage has been reached, cells have undergone four or five cell divisions and the proliferative phase comes to an end.
56
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
Type II Downey cells
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)
57
Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage:
M0 myeloid
M1 myeloid
M2 myeloid
M3 myeloid
M2 myeloid
Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage
58
Abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations:
M3
M4
M6
M7
M6
M6 erythroleukemia
Also known as Di Guglielmo syndrome; abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations
59
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
L1
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
60
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
L3
61
Leukemic reticuloendotheliosis:
Prolymphocytoc leukemia
Plasma cell leukemia
Hairy cell leukemia
Sezary syndrome
Hairy cell leukemia
62
Solid tumor counterpart of acute lymphoblastic leukemia:
Lymphoma, undifferentiated
Lymphoma, poorly differentiated leukemia
Lymphoma, well-differentiated leukemia
Chloroma granulocytic leukemia
Lymphoma, poorly differentiated leukemia
63
Solid tumor counterpart of plasma cell leukemia:
Reticulum cell sarcoma
Chloroma granulocytic leukemia
Myeloma
Lymphoma, undifferentiated
Myeloma
64
A distinctive feature of the megakaryocyte:
Multinucleated
Multilobular
Multinucleated and multilobular
None of these
Multilobular
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.
65
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
INR range of 2.5 to 3.5
66
The target INR for pulmonary embolism (PE) treatment is ___ for the duration of anticoagulation.
1.0
1.5
2.5
3.0
3.0
67
The new types of thromboplastins for measuring the PT are mixtures of phospholipids and recombinantly derived _____ tissue factor.
Rabbit
Pig
Horse
Human
Human
68
Anticoagulant therapy:
Falsely decreased D-dimer values
Falsely increased D-dimer values
No effect
Cannot be determined
Falsely decreased D-dimer values
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
69
Smallest platelets seen:
Wiskott-Aldrich syndrome
May-Hegglin anomaly
Alport syndrome
Bernard-Soulier syndrome
Wiskott-Aldrich syndrome
70
Glanzmann thrombasthenia and essential athrombia:
Platelet adhesion defect
Primary platelet aggregation defect
Secondary platelet aggregation defect
Isolated platelet factor III deficicency
Primary platelet aggregation defect
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
71
Acquired platelet function defects:
Bernard-Soulier syndrome
Bernard-Soulier and Glanzmann thrombasthenia
Uremia, multiple myeloma
Uremia, multiple myeloma, vitamin B12 or folate deficiency
Uremia, multiple myeloma, vitamin B12 or folate deficiency
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
72
Inherited platelet dysfunction:
Bernard-Soulier syndrome
Bernard-Soulier syndrome, Glanzmann's thrombasthenia
Uremia, multiple myeloma
Uremia, multiple myeloma, vitamin B12 or folate deficiency
Bernard-Soulier syndrome, Glanzmann's thrombasthenia
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
73
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
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.
74
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 K deficiency
CONDITIONS RELATED TO DEFICIENCIES OF MULTIPLE COAGULATION FACTORS
Hepatic disease, anticoagulant overdose (e.g., heparin or warfarin), DIC, vitamin K deficiency
75
Indented or twisted nucleus, lacy chromatin and gray-blue cytoplasm:
Segmented neutrophil
Band neutrophil
Monocyte
Lymphocyte
Monocyte
76
Forward high-angle light scatter:
0 degree angle
2 to 3 degree angle
5 to 15 degree angle
90 degree angle
5 to 15 degree angle
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
77
RBC histogram to the LEFT:
RBCs are larger than normal
RBCs are smaller than normal
Seen in megaloblastic anemia
Treated anemia
RBCs are smaller than normal
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.
78
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
Heterogenous, high degree of anisocytosis
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.
79
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
1 and 4 hours old
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
80
Measure of the uniformity of platelet size in a blood specimen:
Platelet adhesion
Platelet aggregation
Mean platelet volume (MPV)
Platelet distribution width (PDW)
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%.
81
Placement of fire extinguishers every ___ feet.
75 feet
100 feet
125 feet
150 feet
75 feet
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.
82
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
1:10 bleach solution.
83
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
Moisten it with a disinfectant and carefully absorb it with a paper towel.
84
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
STAT glucose in the ER
ER stats typically have priority over other stats
85
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."
Come back after the clergy person has gone.
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.
86
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
Ecchymosis
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.
87
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
Discontinue the draw and attempt collection at another site
88
Which type of patient is most likely to have an arteriovenous fistula or graft?
Arthritic
Dialysis
Hospice
Wheelchair-bound
Dialysis
89
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
Type B
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.
90
The recommended cleaner for removing oil from objectives is:
Benzene
Xylene
Water
70% alcohol or lens cleaner
70% alcohol or lens cleaner
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.
91
Often the objects appear to have “haloes” surrounding them.
Brightfield microscope
Darkfield microscope
Phase-contrast microscope
Polarized light microscope
Phase-contrast microscope
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.
92
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
Relatively easy to measure and maintain
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%.
93
Slope measures:
Random error
Constant systematic error
Proportional systematic error
Constant and proportional systematic error
Proportional systematic error
94
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
Has
95
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
Prevalence
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.
96
Type of chromatin represented by the more darkly stained, condensed clumping pattern and is the transcriptionally inactive area of the nucleus
Euchromatin
Heterochromatin
Heterochromatin
97
In ____, the tetraploid DNA is checked for proper replication and damage takes approximately 4 hours.
G1
S
G2
M
G0
G2
98
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
Enlarged cell size due to swelling
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
99
The process of replacing the active marrow by adipocytes (yellow marrow) during development is
Hematopoiesis
Progression
Regression
Retrogression
Retrogression
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.
100
The major site of blood cell production during the second trimester of fetal development.
Yolk sac
Liver
Spleen
Bone marrow
Liver
101
The largest lymphoid organ in the body:
Bone marrow
Thymus
Liver
Spleen
Spleen
The spleen is the largest lymphoid organ in the body.
It is vital but not essential for life and functions as an indiscriminate filter of the circulating blood. In a healthy individual, the spleen contains about 350 mL of blood.
102
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
IL-3, G-CSF and GM-CSF
103
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
Bone marrow, lymph nodes, spleen, liver and thymus
104
In aplastic anemia, the bone marrow is:
Empty
Empty, hypoplastic
Empty, hyperplastic
Either hypoplastic or hyperplastic
Empty, hypoplastic
105
Second step in phagocytosis:
Recognition and attachement
Ingestion
Killing and digestion
Formation of neutrophil extracellular trap
Ingestion
PHAGOCYTOSIS (RODAK)
1. Recognition and attachment
2. Ingestion
3. Killing and digestion
4. Formation of neutrophil extracellular trap
106
The promonocyte nucleus is deeply indented and should not be confused with a:
Lymphocyte
Erythrocyte
Segmenter neutrophil
Band neutrophil
Band neutrophil
107
Which of the following cells does not exhibit myeloperoxidase (MPO) activity?
Neutrophils
Eosinophils
Monocytes
Lymphocytes
Lymphocytes
108
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
Flow cytometry, cytogenetic analysis and molecular testing
109
Basophilic and granular cytoplasm
MK-I
MK-II
MK-III
MK-II
110
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
MK-I, MK-II and MK-III
111
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
TPO, IL-3, IL-6 and IL-11
Other cytokines that function with TPO to stimulate megakaryocytopoiesis include interleukin-3 (IL-3), IL-6, and IL-11.
IL-3 seems to act in synergy with TPO to induce the early differentiation of stem cells, whereas IL-6 and IL-11 act in the presence of TPO to enhance the later phenomena of endomitosis, megakaryocyte maturation, and thrombocytopoiesis.
112
Demonstrates the largest platelets seen and is also referred to as giant platelet syndrome:
Epstein syndrome
Mediterranean macrothrombocytopenia
May-Hegglin anomaly
Bernard-Soulier syndrome
Bernard-Soulier syndrome
113
Ratio of blood to anticoagulant for coagulation testing:
1:4
1:9
4:1
9:1
9:1
114
Hemostasis specimen STORAGE temperature:
1 to 6 C
18 to 24 C
36.5 to 37.5 C
30 to 37 C
18 to 24 C
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.
115
Most coagulation studies are carried out at which temperature?
-20C
-70C
24C
37C
37C
Most coagulation studies are carried out at 37C. The temperature of the incubator should not fluctuate more than ± 0.5C.
116
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
Measure PT using a mechanical coagulometer
117
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
PT falsely prolonged; recollect specimen.
118
Test that assess deficiencies of all factors except VII and XIII:
Prothrombin time (PT)
Partial thromboplastin time (PTT)
Thrombin time (TT)
Reptilase time
Partial thromboplastin time (PTT)
119
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
CBC, PT and APTT
A CBC is necessary to rule out thrombocytopenia as the cause of mucocutaneous bleeding, and PT and PTT, which assess the coagulation system, are part of the initial VWD workup.
No longer recommended are the bleeding time test and the PFA-100 or other automated functional platelet assays. These traditional screening tests generate “conflicting” sensitivity and specificity data.
120
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
Decreased vWF activity and personal/family history of mucocutaneous bleeding
Definitive diagnosis of VWD depends on the combination of a personal and family history of mucocutaneous bleeding and the laboratory demonstration of decreased VWF activity.
121
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
RBC and WBC counts, hemoglobin
The RBC and WBC counts and hemoglobin are considered to be measured directly.
122
Lipemia, icterus:
Increased Hb
Increased Hb, decreased MCH
Increased Hb and MCH
Decreased Hb and MCH
Increased Hb and MCH
Turbidity affects spectrophotometric reading for hemoglobin (Hb).
Hb value is needed to compute for MCH
123
Platelet clumps:
Decreased platelets
Decreased platelets and WBCs
Decreased platelets, increased WBCs
Increased platelets and WBCs
Decreased platelets, increased WBCs
Large clumps counted as WBCs and not platelets
124
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
Increased RBcs and hemoglobin, incorrect hematocrit
HGB increased, RBC increased, HCT incorrect
Turbidity affects spectrophotometric reading for HGB, WBCs counted with RBC count.
