Review Cards - Hematology

Question 1

Adult reference ranges - WBC

Answer 1

Conventional: 4.5-11.5 x 10^3/uL
SI: 4.5-11.5 x 10^9/L

Question 2

Adult reference ranges - RBC

Answer 2

Conventional:
-Male: 4.6-6 x 10^6/uL
-Female: 4-5.4 x 10^6/uL

SI:
-Male: 4.6-6 x 10^12/L
-Female: 4-5.4 x 10^12/L

Question 3

Adult reference ranges - HGB

Answer 3

Conventional:
-Male: 14-18 g/dL
-Female: 12-15 g/dL

SI:
-Male: 140-180 g/L
-Female: 120-150 g/L

Question 4

Adult reference ranges - HCT

Answer 4

Conventional:
-Male: 40-54%
-Female: 35-49%

SI:
-Male: 0.40-0.54 L/L
-Female: 0.35-0.49 L/L

Question 5

Adult reference ranges - Mean corpuscular volume (MCV)

Answer 5

80-100 fL

Question 6

Adult reference ranges - Mean corpuscular hemoglobin (MCH)

Answer 6

27-31 pg

Question 7

Adult reference ranges - Mean corpuscular hemoglobin concentration (MCHC)

Answer 7

Conventional: 32-36%
SI: 32-36 g/dL

Question 8

Adult reference ranges - PLT

Answer 8

Conventional: 150-450 x 10^3/uL
SI: 150-450 x 10^9/L

Question 9

Reference ranges for red cell parameters: RBCs (x10^12/L) - birth

Answer 9

4.10-6.10 x 10^12/L

Question 10

Reference ranges for red cell parameters: RBCs (x10^12/L) - 1-2 MO

Answer 10

3.4-5 x 10^12/L

Question 11

Reference ranges for red cell parameters: RBCs (x10^12/L) - 1-3 YR

Answer 11

4.3-5.2 x 10^12/L

Question 12

Reference ranges for red cell parameters: RBCs (x10^12/L) - 8-13 YR

Answer 12

4-5.4 x 10^12/L

Question 13

Reference ranges for red cell parameters: RBCs (x10^12/L) - Adult

Answer 13

Males: 4.6-6 x 10^12/L
Females: 4-5.4 x 10^12/L

Question 14

Reference ranges for red cell parameters: HGB (g/dL) - birth

Answer 14

16.5-21.5 g/dL

(g/L): 165-215 g/L

-Preterm infants: about 1 g lower than full-term

Question 15

Reference ranges for red cell parameters: HGB (g/dL) - 1-2 MO

Answer 15

10.6-16.4 g/dL

(g/L): 106-164 g/L

Question 16

Reference ranges for red cell parameters: HGB (g/dL) - 1-3 YR

Answer 16

9.6-15.6 g/dL

(g/L): 96-156 g/L

Question 17

Reference ranges for red cell parameters: HGB (g/dL) - 8-13 YR

Answer 17

12-15 g/dL

(g/L): 120-150 g/L

Question 18

Reference ranges for red cell parameters: HGB (g/dL) - Adult

Answer 18

Male: 14-18 g/dL
Female: 12-15 g/dL

(g/L):
Male: 140-180 g/L
Female: 120-150 g/L

Question 19

Reference ranges for red cell parameters: HCT (%) - Birth

Answer 19

48-68%

(L/L): 0.48-0.68 L/L

Question 20

Reference ranges for red cell parameters: HCT (%) - 1-2 MO

Answer 20

32-50%

(L/L): 0.32-0.5 L/L

Question 21

Reference ranges for red cell parameters: HCT (%) - 1-3 YR

Answer 21

38-48%

(L/L): 0.38-0.48 L/L

Question 22

Reference ranges for red cell parameters: HCT (%) - 8-13 YR

Answer 22

35-49%

(L/L): 0.35-0.49 L/L

Question 23

Reference ranges for red cell parameters: HCT (%) - Adult

Answer 23

Male: 40-54%
Female: 35-49%

(L/L):
Male: 0.40-0.54 L/L
Female: 0.35-0.49 L/L

Question 24

Reference ranges for red cell parameters: MCV (fL) - Birth

Answer 24

95-125 fL

-macrocytes 1st 5 days, MCV higher in preterm infants

Question 25

Reference ranges for red cell parameters: MCV (fL) - 1-2 MO

Answer 25

83-107 fL

Question 26

Reference ranges for red cell parameters: MCV (fL) - 1-3 YR

Answer 26

78-94 fL

Question 27

Reference ranges for red cell parameters: MCV (fL) - 8-13 YR

Answer 27

80-94 fL

Question 28

Reference ranges for red cell parameters: MCV (fL) - Adult

Answer 28

80-100 fL

Question 29

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - Birth

Answer 29

14.2-19.9% (L/L): 0.142-0.199 L/L

Question 30

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - 1-3 YR

Answer 30

11.4-14.5% (L/L): 0.114-0.145 L/L

Question 31

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - 8-13 YR

Answer 31

11.5-14.5% (L/L): 0.115-0.145 L/L

Question 32

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - Adult

Answer 32

11.5-14.5% (L/L): 0.115-0.145 L/L

Question 33

Reference ranges for red cell parameters: Retic (%) - Birth

Answer 33

1.5-5.8% Newborns: increased polychromasia

Question 34

Reference ranges for red cell parameters: Retic (%) - 1-2 MO

Answer 34

0.8-2.8%

Question 35

Reference ranges for red cell parameters: Retic (%) - 1-3 YR

Answer 35

0.5-1.5%

Question 36

Reference ranges for red cell parameters: Retic (%) - 8-13 YR

Answer 36

0.5-1.5%

Question 37

Reference ranges for red cell parameters: Retic (%) - Adult

Answer 37

0.5-1.5%

Question 38

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - Birth

Answer 38

2-24/100 WBCs -Preterm infants: up to 25 for >1 week

Question 39

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - 1-2 MO

Answer 39

0/100 WBCs

Question 40

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - 1-3 YR

Answer 40

0/100 WBCs

Question 41

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - 8-13 YR

Answer 41

0/100 WBCs

Question 42

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - Adult

Answer 42

0/100 WBCs

Question 43

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - Birth

Answer 43

9-37 x 10^9/L

Question 44

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - 1-2 MO

Answer 44

6-18 x 10^9/L

Question 45

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - 1-3 YR

Answer 45

5.5-17.5 x 10^9/L

Question 46

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - 8-13 YR

Answer 46

4.5-13.5 x 10^9/L

Question 47

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - Adults

Answer 47

4.5-11.5 x 10^9/L

Question 48

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - Birth

Answer 48

37-67%

Question 49

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - 1-2 MO

Answer 49

20-40%

Question 50

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - 1-3 YR

Answer 50

22-46%

Question 51

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - 8-13 YR

Answer 51

23-53%

Question 52

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - Adult

Answer 52

50-70%

Question 53

Reference ranges for leukocytes and platelets - Bands (%) - Birth

Answer 53

3-11% -Newborns: occasional metamyelocyte (metas) & myelocyte (myelos) -More immature granulocytes seen in preterm infants

Question 54

Reference ranges for leukocytes and platelets - Bands (%) - 1-2 MO

Answer 54

0-5%

Question 55

Reference ranges for leukocytes and platelets - Bands (%) - 1-3 YR

Answer 55

0-5%

Question 56

Reference ranges for leukocytes and platelets - Bands (%) - 8-13 YR

Answer 56

0-5%

Question 57

Reference ranges for leukocytes and platelets - Bands (%) - Adults

Answer 57

2-6%

Question 58

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - Birth

Answer 58

18-38% -Newborns: a few benign immature B cells may be seen ("baby" or "kiddie" lymphs).

Question 59

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - 1-2 MO

Answer 59

42-72%

Question 60

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - 1-3 YR

Answer 60

37-73%

Question 61

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - 8-13 YR

Answer 61

23-53%

Question 62

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - Adult

Answer 62

20-44%

Question 63

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - Birth

Answer 63

150-450 x 10^9/L Newborns: variation in size & shape

Question 64

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - 1-2 MO

Answer 64

150-450 x 10^9/L

Question 65

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - 1-3 YR

Answer 65

150-450 x 10^9/L

Question 66

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - 8-13 YR

Answer 66

150-450 x 10^9/L

Question 67

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - Adult

Answer 67

150-450 x 10^9/L

Question 68

Hematopoietic cell differentiation & function

Answer 68

Question 69

Erythropoeisis - 1-2 MO of gestation - site(s)

Answer 69

-yolk sac -aorta-gonads-mesonephros (AGM) region -primitive erythroblasts -embryonic hemoglobin (Gower I, Gower II, Portland)

Question 70

Erythropoeisis - 3-6 MO of gestation - site(s)

Answer 70

-liver -spleen (Liver is primary site)

Question 71

Erythropoeisis - 7 MO of gestation to age 4 years - site(s)

Answer 71

bone marrow (all marrow is active)

Question 72

Erythropoeisis - Adult - site(s)

Answer 72

-active sites: pelvis, vertebrae, ribs, sternum, skull -shafts of long bones are filled with fat -fatty marrow may be reactivated to compensate for anemia -liver & spleen may be reactivated (extramedullary hematopoiesis) if bone marrow fails to keep up with demand

Question 73

Changes during cell maturation - size

Answer 73

becomes smaller

Question 74

Changes during cell maturation - N:C ratio

Answer 74

becomes smaller

Question 75

Changes during cell maturation - cytoplasm

Answer 75

-less basophilic due to loss of RNA -granulocytes produce granules -erythrocytes become pink due to HGB production

Question 76

Changes during cell maturation - nucleus

Answer 76

-becomes smaller -nuclear chromatin condenses -nucleoli disappear -in granulocyte series, nucleus indents, then segments -in erythrocyte series, nucleus is extruded

Question 77

Erythrocyte developmental series - pronormoblast

Answer 77

-14-24 um -N:C ratio 8:1 -royal blue cytoplasm -fine chromatin -1-2 nucleoli -normally confined to bone marrow

Question 78

Erythrocyte developmental series - basophilic normoblast

Answer 78

-12-17 um -N:C ratio 6:1 -deep blue cytoplasm -chromatin is coarser with slightly visible parachromatin -nucleoli usually not visible -normally confined to bone marrow

Question 79

Erythrocyte developmental series - polychromatophilic normoblast

Answer 79

-10-15 um -N:C ratio 4:1 -cytoplasm is polychromatophilic due to HGB production -chromatin is clumped with distinct areas of parachromatin (spoke-like pattern) -last stage to divide -normally confined to bone marrow

Question 80

Erythrocyte developmental series - orthochromatic normoblast

Answer 80

-8-12 um -N:C ratio 1:2 -nucleus is pyknotic -last nucleated stage -normally confined to bone marrow

Question 81

Erythrocyte developmental series - polychromatophilic erythrocyte

Answer 81

-7-10 um -NO nucleus -cytoplasm is diffusely basophilic (bluish tinge) -reticulum seen with supravital stain -0.5-1.5% of RBCs in adult peripheral blood

Question 82

Erythrocyte developmental series - mature erythrocyte

Answer 82

-7-8 um -biconcave disk -reddish-pink cytoplasm with area of central pallor 1/3 diameter of cell

Question 83

List the order of the erythrocyte developmental series.

Answer 83

Question 84

Asynchronous erythropoiesis - megaloblastic

Answer 84

Cause: vitamin B12 and/or folic acid deficiency Explanation: nucleus lags behind cytoplasm in maturation; cells grow larger without dividing Characteristics: oval macrocytes

Question 85

Asynchronous erythropoiesis - megaloblastic

Answer 85

Cause: vitamin B12 and/or folic acid deficiency Explanation: nucleus lags behind cytoplasm in maturation; cells grow larger without dividing Characteristics: oval macrocytes

Question 86

Asynchronous erythropoiesis - iron deficiency

Answer 86

Cause: iron deficiency (reduces erythropoietin production) Explanation: cytoplasm lags behind nucleus in maturation due to inadequate iron for HGB synthesis Characteristics: microcytic, hypochromic RBCs

Question 87

Hemoglobin - Hgb A

Answer 87

Molecular structure: 2 alpha + 2 beta chains Adult reference value: >95% Newborn reference value: 20%

Question 88

Hemoglobin - Hgb A2

Answer 88

Molecular structure: 2 alpha + 2 delta chains Adult reference value: 1.5-3.7% Newborn reference value: <1%

Question 89

Hemoglobin - Hgb F

Answer 89

Molecular structure: 2 alpha + 2 gamma chains Adult reference value: <2% Newborn reference value: 50-85%

Question 90

Hemoglobin - Hgb S

Answer 90

Molecular structure: valine substituted for glutamic acid in 6th position of beta chain Adult reference vale: 0 Newborn reference value: 0

Question 91

Hemoglobin - Hgb C

Answer 91

Molecular structure: lysine substituted for glutamic acid in 6th position of beta chain Adult reference value: 0 Newborn reference value: 0

Question 92

Hemoglobin electrophoresis - Cellulose Acetate pH 8.6

Answer 92

Question 93

Hemoglobin electrophoresis - Citrate Agar pH 6.2

Answer 93

Question 94

Hemoglobin derivatives - Methemoglobin

Answer 94

Cause: iron oxidized to ferric (Fe3+) state; usually acquired from exposure to oxidants; rarely inherited Effect: can't bind oxygen; cyanosis, possibly death Normal % of HGB: <=1% Other: Heinz bodies; treat with methylene blue; chocolate blood

Question 95

Hemoglobin derivatives - Sulfhemoglobin

Answer 95

Cause: sulfur bound to heme; acquired from exposure to drugs & chemicals Effect: O2 affinity 1/100th normal; cyanosis Normal % of total HGB: 0 Other: can't be converted back to normal Hgb; not detected in cyanmethemoglobin method; green blood

Question 96

Hemoglobin derivatives - Carboxyhemoglobin

Answer 96

Cause: carbon monoxide bound to heme Effect: decreased oxygen to tissues; can be fatal Normal % of total Hgb: <1% Other: affinity of hgb for CO is 200x greater than for oxygen; skin turns cherry red

Question 97

How are hemoglobin derivates quantitated?

Answer 97

differential spectrophotometry

Question 98

RBC morphology - Size - anisocytosis

Answer 98

-variation in size Significance: seen in many anemias

Question 99

RBC morphology - Size - macrocytes

Answer 99

-RBCs >9 um Significance: -megaloblastic anemias -liver disease -reticulocytosis -NORMAL in newborns

Question 100

RBC morphology - Size - microcytes

Answer 100

-RBCs <6 um Significance: -iron deficiency anemia (IDA) - thalassemia -sideroblastic anemia -anemia of chronic inflammation

Question 101

RBC morphology - Shape - poikilocytosis

Answer 101

-variation in shape Significance: seen in many anemias

Question 102

RBC morphology - Shape - elliptocytes/ovalocytes

Answer 102

-oval or pencil/cigar shaped Significance: membrane defect -hereditary elliptocytosis/ovalocytosis - various anemias

Question 103

RBC morphology - Shape - crenated RBCs

Answer 103

-round cell with knobby, uniform projections Significance: osmotic imbalance -if seen in most cells in thin part of smear, don't report; probably artifact due to excess anticoagulant or slow drying

Question 104

RBC morphology - Shape - echinocytes (Burr cells)

Answer 104

-round cell with evenly spaced blunt or pointed projections Significance: membrane defect -uremia -pyruvate kinase deficiency -may be drying artifact -a few can present in healthy individuals

Question 105

RBC morphology - Shape - acanthocytes (spur cells)

Answer 105

-small, dense cells with irregularly spaced projections of varying length Significance: membrane defect -severe liver disease -abetalipoproteinemia

Question 106

RBC morphology - Shape - schistocytes (helmet cells)

Answer 106

-RBC fragments Significance: RBCs split by fibrin strands -microangiopathic hemolytic anemias (DIC, TTP, HUS) -prosthetic heart valves

Question 107

RBC morphology - Shape - sickle cells (drepanocytes)

Answer 107

-crescent, S or C shaped, boat shaped, oat shaped Significance: sickle cell anemia

Question 108

RBC morphology - Shape - hemoglobin C crystals

Answer 108

-blunt, 6-sided (hexagonal), dark-staining projection; can also be rod-shaped or tetragonal Significance: Hemoglobin C disease

Question 109

RBC morphology - Shape - hemoglobin SC crystals

Answer 109

-finger-like intracellular crystals, often misshapen Significance: Hemoglobin SC disease

Question 110

RBC morphology - Shape - teardrops (dacrocytes)

Answer 110

-teardrop shaped Significance: -myelofibrosis -thalassemia -other anemias

Question 111

RBC morphology - Staining - hypochromia

Answer 111

-central pallor >1/3 cell diameter Significance: -IDA -thalassemia

Question 112

RBC morphology - Staining - anisochromia

Answer 112

-mixture of normochromic & hypochromic RBCs Significance: -dimorphic anemia -post-transfusion

Question 113

RBC morphology - Staining - polychromasia

Answer 113

-bluish-gray color Significance: young RBC; retics with supravital stain; sign of active erythropoiesis; 1-2% in normal adult -increased with: --acute blood loss --hemolytic anemia --following treatment for anemia (iron deficiency, pernicious anemia, folate deficiency, vitamin B12 deficiency)

Question 114

RBC morphology - Staining - target cells (codocytes)

Answer 114

-bull's eye Significance: -hemoglobinopathies -thalassemia -liver disease -may be artifact if observed in only 1 part of smear

Question 115

RBC morphology - Staining - stomatocytes

Answer 115

-RBC with slit-like central pallor Significance: -hereditary stomatocytosis -hereditary spherocytosis -thalassemia -alcoholic cirrhosis -Rh null disease -may be artifact in parts of smear that are too thin or too thick

Question 116

RBC morphology - Staining - spherocytes

Answer 116

-small, dark-staining RBCs without central pallor Significance: membrane defect -hereditary spherocytosis -autoantibodies -burns -hemoglobinopathies -hemolysis -ABO hemolytic disease of fetus and newborn (HDFN) -incompatible blood transfusion -transfusion of stored blood -a few are normal due to aging of RBCs

Question 117

RBC morphology - Arrangement - rouleaux

Answer 117

-RBCs resemble stack of coins Significance: serum protein abnormality (e.g., increased globulins or fibrinogen) -multiple myeloma -macroglobulinemia -may be artifact due to delay in spreading drop of blood or smear that's too thick

Question 118

RBC morphology - Arrangement - agglutination

Answer 118

-RBCs in irregular clumps Significance: -autoantibodies -cold autoagglutination

Question 119

RBC morphology - Shape - Bite cells

Answer 119

-RBCs have a "bitten" appearance Significance: -G6PD deficiency -oxidative drug effect -hemoglobinopathies

Question 120

RBC inclusions - basophilic stippling - stain

Answer 120

-Wright -new methylene blue

Question 121

RBC inclusions - basophilic stippling - description

Answer 121

multiple, irregular purple inclusions evenly distributed in cell

Question 122

RBC inclusions - basophilic stippling - composition

Answer 122

aggregation of RNA (ribosomes)

Question 123

RBC inclusions - basophilic stippling - significance

Answer 123

Coarse: exposure to lead Fine: young RBC

Question 124

RBC inclusions - basophilic stippling - conditions

Answer 124

-exposure to lead -accelerated or abnormal hemoglobin synthesis -thalassemia

Question 125

RBC inclusions - Howell-Jolly bodies - stain

Answer 125

-Wright -new methylene blue

Question 126

RBC inclusions - Howell-Jolly bodies - description

Answer 126

-round -purple -1-2 um in diameter -usually only 1 per cell

Question 127

RBC inclusions - Howell-Jolly bodies - composition

Answer 127

nuclear remnants (DNA)

Question 128

RBC inclusions - Howell-Jolly bodies - significance

Answer 128

-usually pitted by spleen -seen with accelerated or abnormal erythropoiesis

Question 129

RBC inclusions - Howell-Jolly bodies - conditions

Answer 129

-post-splenectomy -thalassemia -hemolytic & megaloblastic anemias -sickle cell anemia

Question 130

RBC inclusions - Cabot rings - stain

Answer 130

Wright

Question 131

RBC inclusions - Cabot rings - description

Answer 131

reddish purple rings or figure-8s

Question 132

RBC inclusions - Cabot rings - composition

Answer 132

may be part of mitotic spindle, remnant of microtubules, or fragment of nuclear membrane

Question 133

RBC inclusions - Cabot rings - significance

Answer 133

-rapid blood regeneration -abnormal erythropoiesis

Question 134

RBC inclusions - Cabot rings - conditions

Answer 134

-megaloblastic anemia -thalassemia -post-splenectomy

Question 135

RBC inclusions - Pappenheimer bodies - stain

Answer 135

Wright (siderotic granules with Prussian blue stain)

Question 136

RBC inclusions - Pappenheimer bodies - description

Answer 136

-small purplish blue granules -vary in size, shape, number -usually in clusters at periphery

Question 137

RBC inclusions - Pappenheimer bodies - composition

Answer 137

unused iron particles

Question 138

RBC inclusions - Pappenheimer bodies - significance

Answer 138

faulty iron utilization during hemoglobin synthesis

Question 139

RBC inclusions - Pappenheimer bodies - conditions

Answer 139

-sideroblastic anemias -post-splenectomy -thalassemia -sickle cell anemia -hemochromatosis

Question 140

RBC inclusions - siderotic granules - stain

Answer 140

Prussian blue

Question 141

RBC inclusions - siderotic granules - description

Answer 141

blue granules of varying size & shape

Question 142

RBC inclusions - siderotic granules - composition

Answer 142

aggregates of iron particles

Question 143

RBC inclusions - siderotic granules - significance

Answer 143

faulty iron utilization in hgb synthesis

Question 144

RBC inclusions - siderotic granules - conditions

Answer 144

-sideroblastic anemias -post-splenectomy -thalassemia -sickle cell anemia -hemochromatosis

Question 145

RBC inclusions - reticulocytes - stain

Answer 145

new methylene blue (polychromasia on Wright stain)

Question 146

RBC inclusions - reticulocytes - description

Answer 146

blue-staining network

Question 147

RBC inclusions - reticulocytes - composition

Answer 147

residual RNA (ribosomes)

Question 148

RBC inclusions - reticulocytes - significance

Answer 148

>2% = increased erythropoiesis <0.1% = decreased erythropoiesis

Question 149

RBC inclusions - reticulocytes - conditions

Answer 149

-hemolytic anemia -blood loss -following treatment for IDA or megaloblastic anemia

Question 150

RBC inclusions - Heinz bodies - stain

Answer 150

supravital stain (e.g., crystal violet, brilliant cresyl blue, methylene blue)

Question 151

RBC inclusions - Heinz bodies - description

Answer 151

-round blue inclusions -varying sizes -close to cell membrane -may be >1

Question 152

RBC inclusions - Heinz bodies - composition

Answer 152

precipitated, oxidized, denatured hemoglobin

Question 153

RBC inclusions - Heinz bodies - significance

Answer 153

normal during aging but pitted by spleen

Question 154

RBC inclusions - Heinz bodies - conditions

Answer 154

-glucose-6-phosphate dehydrogenase (G6PD) deficiencies -unstable hemoglobins -chemical injury to RBCs -drug induced hemolytic anemia

Question 155

Staining of RBC inclusions - reticulum

Answer 155

Wright stain: cell appears polychromatophilic New methylene blue: yes Prussian blue: no

Question 156

Staining of RBC inclusions - Howell-Jolly bodies

Answer 156

Wright stain: yes New methylene blue: yes Prussian blue: no

Question 157

Staining of RBC inclusions - Pappenheimer bodies

Answer 157

Wright stain: yes New methylene blue: yes Prussian blue: yes

Question 158

Staining of RBC inclusions - Siderotic granules

Answer 158

Wright stain: yes, but called Pappenheimer bodies New methylene blue: yes Prussian blue: yes

Question 159

Staining of RBC inclusions - Heinz bodies

Answer 159

Wright stain: no New methylene blue: yes Prussian blue: no

Question 160

Erythrocyte indices - MCV

Answer 160

-average volume of RBC -used to classify anemias -combination of microcytes & macrocytes may result in normal MCV -Normal range: 80-100 fL

Question 161

Erythrocyte indices - MCH

Answer 161

-average weight of hemoglobin in individual RBCs -varies in proportion to MCV -Normal range: 27-31 pg

Question 162

Erythrocyte indices - MCHC

Answer 162

-average concentration of hemoglobin per dL of RBCs -MCHC >37 may indicate problem with specimen (hyperlipidemia, cold agglutinins, icterus, elevated WBC) or instrument -normal range: 32-36 g/dL

Question 163

Hemoglobinopathy versus Thalassemia - abnormality

Answer 163

Hemoglobinopathy: qualitative abnormality; abnormality in amino acid sequence of globin chain, not in amount of globin produced Thalassemia: quantitative abnormality; amino acid sequence of globin chains is normal, but underproduction of 1 or more globin chains

Question 164

Hemoglobinopathy versus Thalassemia - Examples

Answer 164

Hemoglobinpathy: Sickle cell anemia & trait, hemoglobin C disease & trait Thalassemia: beta-thalassemia major & minor

Question 165

Normocytic anemias: Sickle cell anemia (SS) - etiology

Answer 165

-inheritance of sickle cell gene from both parents -valine substituted for glutamic acid in 6th position of beta chain

Question 166

Normocytic anemias: Sickle cell anemia (SS) - blood smear

Answer 166

-anisocytosis -poikilocytosis -sickle cells -target cells -nRBCs -Howell-Jolly bodies -basophilic stippling -siderotic granules -polychromasia

Question 167

Normocytic anemias: Sickle cell anemia (SS) - hemoglobin electrophoresis

Answer 167

S: >=80% F: 1-20% A2: normal A: none

Question 168

Normocytic anemias: Sickle cell anemia (SS) - decreased O2 & blood pH

Answer 168

hemoglobin S polymerizes under decreased O2 & decreased blood pH

Question 169

Normocytic anemias: Sickle cell anemia (SS) - disease not evident in newborn

Answer 169

because of increased hemoglobin F

Question 170

Normocytic anemias: Sickle cell anemia (SS) - diagnosis (test)

Answer 170

positive solubility test

Question 171

Normocytic anemias: Sickle cell anemia (SS) - CBC

Answer 171

-Retics: 10-20% -may have increased WBC with shift to left & increased platelets -moderate to severe anemia

Question 172

Normocytic anemias: Sickle cell trait (AS) - etiology

Answer 172

inheritance of sickle cell gene from 1 parent

Question 173

Normocytic anemias: Sickle cell trait (AS) - blood smear

Answer 173

-occasional target cells -no sickle cells unless hypoxic

Question 174

Normocytic anemias: Sickle cell trait (AS) - hemoglobin electrophoresis

Answer 174

A: 50-65% S: 35-45% F: normal A2: normal to slightly increased

Question 175

Normocytic anemias: Sickle cell trait (AS) - anemia

Answer 175

no anemia

Question 176

Normocytic anemias: Sickle cell trait (AS) - diagnosis (test)

Answer 176

positive solubility test

Question 177

Normocytic anemias: Hemoglobin C disease (CC) - etiology

Answer 177

-inheritance of gene for hemoglobin C from both parents -lysine substituted for glutamic acid in 6th position of beta chain

Question 178

Normocytic anemias: Hemoglobin C disease (CC) - blood smear

Answer 178

-many target cells -folded cells -occasional hemoglobin C crystals

Question 179

Normocytic anemias: Hemoglobin C disease (CC) - hemoglobin electrophoresis

Answer 179

C: >90% F: <7% A: none

Question 180

Normocytic anemias: Hemoglobin C disease (CC) - anemia

Answer 180

mild to moderate

Question 181

Normocytic anemias: Hemoglobin C trait (AC) - etiology

Answer 181

inheritance of gene for hemoglobin C from 1 parent

Question 182

Normocytic anemias: Hemoglobin C trait (AC) - blood smear

Answer 182

many target cells

Question 183

Normocytic anemias: Hemoglobin C trait (AC) - hemoglobin electrophoresis

Answer 183

A: 60-70% C: 30-40%

Question 184

Normocytic anemias: Sickle cell disease (SC) - etiology

Answer 184

inheritance of 1 sickle cell gene & 1 hemoglobin C gene

Question 185

Normocytic anemias: Sickle cell disease (SC) - blood smear

Answer 185

-many target cells -folded & boat-shaped cells -occasional SC crystals (finger-like projections)

Question 186

Normocytic anemias: Sickle cell disease (SC) - hemoglobin electrophoresis

Answer 186

>S than C F: normal to 7% A: none

Question 187

Normocytic anemias: Sickle cell disease (SC) - diagnosis (test)

Answer 187

positive solubility test

Question 188

Normocytic anemias: Sickle cell disease (SC) - anemia

Answer 188

mild to moderate

Question 189

Normocytic anemias: Hereditary spherocytosis - etiology

Answer 189

defect of cell membrane

Question 190

Normocytic anemias: Hereditary spherocytosis - blood smear

Answer 190

-spherocytes -polychromasia

Question 191

Normocytic anemias: Hereditary spherocytosis - CBC

Answer 191

-MCHC: usually >36 g/dL -retics: increased -increased osmotic fragility

Question 192

Normocytic anemias: Autoimmune hemolytic anemia - etiology

Answer 192

autoantibodies

Question 193

Normocytic anemias: Autoimmune hemolytic anemia - blood smear

Answer 193

-polychromasia -spherocytes -nRBCs

Question 194

Normocytic anemias: Autoimmune hemolytic anemia - hemoglobin electrophoresis

Answer 194

normal

Question 195

Normocytic anemias: Autoimmune hemolytic anemia - labs

Answer 195

-increased retics -increased indirect bilirubin -decreased haptoglobin -positive DAT

Question 196

Normocytic anemias: Hereditary spherocytosis - hemoglobin electrophoresis

Answer 196

normal

Question 197

Macrocytic anemias: Megaloblastic - folate deficiency - etiology

Answer 197

Deficiency impairs DNA synthesis. -nutritional deficiency -increased cell replication (e.g., hemolytic anemias, myeloproliferative diseases, pregnancy) -malabsorption -drug inhibition

Question 198

Macrocytic anemias: Megaloblastic - folate deficiency - blood smear

Answer 198

-oval macrocytes -Howell-Jolly bodies -hypersegmentation -anisocytosis -poikilocytosis

Question 199

Macrocytic anemias: Megaloblastic - folate deficiency - hemoglobin electrophoresis

Answer 199

normal

Question 200

Macrocytic anemias: Megaloblastic - folate deficiency - labs

Answer 200

-pancytopenia -increased lactate dehydrogenase (LD)

Question 201

Macrocytic anemias: Megaloblastic - B12 deficiency - etiology

Answer 201

Deficiency impairs DNA synthesis. -nutritional deficiency -malabsorption -impaired utilization -parasites

Question 202

Macrocytic anemias: Megaloblastic - B12 deficiency - blood smear

Answer 202

-oval macrocytes -Howell-Jolly bodies -hypersegmentation -anisocytosis -poikilocytosis

Question 203

Macrocytic anemias: Non-megaloblastic - etiology

Answer 203

-alcoholism -liver disease -increased erythropoiesis

Question 204

Macrocytic anemias: Non-megaloblastic - blood smear

Answer 204

-round macrocytes -no hypersegmentation

Question 205

Macrocytic anemias: Non-megaloblastic - hemoglobin electrophoresis

Answer 205

normal

Question 206

Macrocytic anemias: Non-megaloblastic - WBCs & platelets

Answer 206

WBCs & platelets: normal

Question 207

Microcytic, Hypochromic anemias: Iron deficiency anemia - etiology

Answer 207

insufficient iron for hemoglobin electrophoresis

Question 208

Microcytic, Hypochromic anemias: Iron deficiency anemia - blood smear

Answer 208

-anisocytosis -poikilocytosis -hypochromic microcytes

Question 209

Microcytic, Hypochromic anemias: Sideroblastic anemia - etiology

Answer 209

enzymatic defect in heme synthesis

Question 210

Microcytic, Hypochromic anemias: Sideroblastic anemia - blood smear

Answer 210

-dual population of RBCs (normocytic & microcytic) -pappenheimer bodies -basophilic stippling

Question 211

Microcytic, Hypochromic anemias: Sideroblastic anemia - RBC indices

Answer 211

usually normal

Question 212

Microcytic, Hypochromic anemias: Sideroblastic anemia - bone marrow

Answer 212

ringed sideroblasts

Question 213

Microcytic, Hypochromic anemias: beta-thalassemia major - etiology

Answer 213

decreased beta chain production

Question 214

Microcytic, Hypochromic anemias: beta-thalassemia major - blood smear

Answer 214

-marked anisocytosis & poikilocytosis -hypochromic microcytes -target cells -ovalocytes -nRBCs -basophilic stippling

Question 215

Microcytic, Hypochromic anemias: beta-thalassemia major - hemoglobin electrophoresis

Answer 215

A: little to none F: 95-98% A2: 2-5%

Question 216

Microcytic, Hypochromic anemias: beta-thalassemia major - anemia

Answer 216

severe

Question 217

Microcytic, Hypochromic anemias: beta-thalassemia major - inheritance

Answer 217

homozygous

Question 218

Microcytic, Hypochromic anemias: beta-thalassemia major - MCV

Answer 218

<67 fL

Question 219

Microcytic, Hypochromic anemias: beta-thalassemia minor - etiology

Answer 219

decreased beta chain production

Question 220

Microcytic, Hypochromic anemias: beta-thalassemia minor - blood smear

Answer 220

-anisocytosis -hypochromic microcytes -target cells -basophilic stippling

Question 221

Microcytic, Hypochromic anemias: beta-thalassemia minor - inheritance

Answer 221

heterozygous

Question 222

Microcytic, Hypochromic anemias: beta-thalassemia minor - hemoglobin electrophoresis

Answer 222

A: >90-95% A2: 3.5-7% F: 2-5%

Question 223

Microcytic, Hypochromic anemias: beta-thalassemia minor - anemia

Answer 223

mild

Question 223

Microcytic, Hypochromic anemias: beta-thalassemia minor - anemia

Answer 223

mild

Question 224

Microcytic, Hypochromic anemias: Anemia of inflammation - etiology

Answer 224

-hepcidin inhibits iron absorption & release -iron in bone marrow macrophages is not released to developing RBCs -impaired erythropoiesis due to decreased erythropoietin (EPO) production and decreased bone marrow responsiveness to EPO

Question 225

Microcytic, Hypochromic anemias: Anemia of inflammation - blood smear

Answer 225

60-70% of cases have normocytic normochromic RBCs 30-40%: microcytic, hypochromic

Question 226

Microcytic, Hypochromic anemias: Anemia of inflammation - associated with

Answer 226

-chronic infections & inflammation -malignancies -autoimmune diseases

Question 227

Which anemia is the 2nd most common anemia after IDA and the most common anemia in hospitalized patients?

Answer 227

Anemia of inflammation

Question 228

Differentiation of microcytic hypochromic anemias - Iron deficiency anemia: RBCs: RDW: Serum iron: TIBC: Serum ferritin: HGB A2:

Answer 228

RBCs: decreased RDW: increased Serum iron: decreased TIBC: increased Serum ferritin: decreased HGB A2: normal

Question 229

Differentiation of microcytic hypochromic anemias - Sideroblastic anemia: RBCs: RDW: Serum iron: TIBC: Serum ferritin: HGB A2:

Answer 229

RBCs: decreased RDW: increased Serum iron: increased TIBC: normal Serum ferritin: increased HGB A2: normal

Question 230

Differentiation of microcytic hypochromic anemias - beta-thalassemia major: RBCs: RDW: Serum iron: TIBC: Serum ferritin: HGB A2:

Answer 230

RBCs: increased RDW: normal/increased Serum iron: increased TIBC: normal Serum ferritin: increased HGB A2: decreased to absent

Question 231

Differentiation of microcytic hypochromic anemias - beta-thalassemia minor: RBCs: RDW: Serum iron: TIBC: Serum ferritin: HGB A2:

Answer 231

RBCs: increased RDW: normal Serum iron: normal TIBC: normal Serum ferritin: normal HGB A2: increased

Question 232

Differentiation of microcytic hypochromic anemias - Anemia of inflammation: RBCs: RDW: Serum iron: TIBC: Serum ferritin: HGB A2:

Answer 232

RBCs: decreased RDW: normal Serum iron: decreased TIBC: decreased Serum ferritin: increased HGB A2: normal

Question 233

Acute versus chronic blood loss - acute blood loss - definition

Answer 233

rapid loss of >20% blood volume

Question 234

Acute versus chronic blood loss - acute blood loss - RBCs

Answer 234

-normocytic, normochromic -may be transient macrocytosis when increased retics reach circulation

Question 235

Acute versus chronic blood loss - acute blood loss - WBCs

Answer 235

increased (up to 35 x 10^9/L) with shift to the left for about 2-4 days

Question 236

Acute versus chronic blood loss - acute blood loss - Retics

Answer 236

increased 3-5 days; peak around 10 days

Question 237

Acute versus chronic blood loss - acute blood loss - HGB/HCT

Answer 237

-steady during 1st few hours due to vasoconstriction & other compensatory mechanisms -can be 48-72 hours before full extent of hemorrhage is evident (after fluid from extravascular spaces moves into circulation to expand volume)

Question 238

Acute versus chronic blood loss - acute blood loss - platelets

Answer 238

immediate fall in platelets, followed by increase within 1 hour

Question 239

Acute versus chronic blood loss - chronic blood loss - definition

Answer 239

loss of small amounts of blood over extended period of time

Question 240

Acute versus chronic blood loss - chronic blood loss - RBCs

Answer 240

microcytic, hypochromic (due to iron deficiency)

Question 241

Acute versus chronic blood loss - chronic blood loss - WBCs

Answer 241

normal

Question 242

Acute versus chronic blood loss - chronic blood loss - Retics

Answer 242

normal or slightly increased

Question 243

Acute versus chronic blood loss - chronic blood loss - HGB/HCT

Answer 243

decreased

Question 244

Acute versus chronic blood loss - chronic blood loss - serum iron & ferritin

Answer 244

decreased

Question 245

Granulocytic maturation - myeloblast

Answer 245

-15-20 um -small amount of dark blue cytoplasm -usually no granules -nucleus has delicate chromatin with nucleoli

Question 246

Granulocytic maturation - promyelocyte

Answer 246

-12-24 um -similar to myeloblast but has primary (non-specific) granules

Question 247

Granulocytic maturation - myelocyte

Answer 247

-10-18 um -secondary (specific) granules (eosinophilic, basophilic, or neutrophilic) -last stage to divide

Question 248

Granulocytic maturation - metamyelocyte

Answer 248

-10-18 um -nucleus begins to indent -indentation less than 1/2 the diameter of nucleus (kidney bean)

Question 249

Granulocytic maturation - band

Answer 249

-10-16 um -nuclear indentation is more than 1/2 the diameter of the nucleus

Question 250

Granulocytic maturation - segmented neutrophil

Answer 250

-10-16 um -2-5 nuclear lobes connected by thin strands of chromatin

Question 251

Normal leukocytes of the peripheral blood - segmented neutrophil: Size: Nucleus: Cytoplasm: Adult reference range (relative - %): Adult reference range (absolute - x 10^9/L):

Answer 251

Size:10-16 um Nucleus: segmented; 2-5 lobes connected by thread-like filament of chromatin Cytoplasm: pinkish tan with neutrophilic granules Adult reference range (relative - %): 50-70% Adult reference range (absolute - x 10^9/L): 2.4-7.5 x 10^9/L

Question 252

Normal leukocytes of the peripheral blood - band: Size: Nucleus: Cytoplasm: Adult reference range (relative - %): Adult reference range (absolute - x 10^9/L):

Answer 252

Size: 10-16 um Nucleus: horseshoe-shaped; parallel sides with visible chromatin in between; no filament Cytoplasm: pinkish tan with neutrophilic granules Adult reference range (relative - %): 2-6% Adult reference range (absolute - x 10^9/L): 0.1-0.6 x 10^9/L

Question 253

Normal leukocytes of the peripheral blood - Eosinophil: Size: Nucleus: Cytoplasm: Adult reference range (relative - %): Adult reference range (absolute - x 10^9/L):

Answer 253

Size: 10-16 um Nucleus: band shaped or segmented into 2 lobes Cytoplasm: large red granules Adult reference range (relative - %): 0-4% Adult reference range (absolute - x 10^9/L): 0-0.4 x 10^9/L

Question 254

Normal leukocytes of the peripheral blood - Basophil: Size: Nucleus: Cytoplasm: Adult reference range (relative - %): Adult reference range (absolute - x 10^9/L):

Answer 254

Size: 10-16 um Nucleus: usually difficult to see because of overlying granules Cytoplasm: dark purple granules Adult reference range (relative - %): 0-2% Adult reference range (absolute - x 10^9/L): 0-0.2 x 10^9/L

Question 255

Normal leukocytes of the peripheral blood - Monocyte: Size: Nucleus: Cytoplasm: Adult reference range (relative - %): Adult reference range (absolute - x 10^9/L):

Answer 255

Size: 12-18 um Nucleus: round, horseshoe-shaped, or lobulated; convoluted; loose strands of chromatin Cytoplasm: gray-blue with indistinct pink granules; vacuoles; occasional pseudopods Adult reference range (relative - %): 2-9% Adult reference range (absolute - x 10^9/L): 0.1-0.9 x 10^9/L

Question 256

Normal leukocytes of the peripheral blood - Lymphocyte: Size: Nucleus: Cytoplasm: Adult reference range (relative - %): Adult reference range (absolute - x 10^9/L):

Answer 256

Size: 7-15 um Nucleus: round or oval; dense blocks of chromatin; indistinct chromatin/parachromatin separation Cytoplasm: spars to abundant; sky blue; may contain a few azurophilic granules Adult reference range (relative - %): 20-44% Adult reference range (absolute - x 10^9/L): 1.2-3.4 x 10^9/L

Question 257

Leukocyte abnormalities - shift to the left

Answer 257

presence of immature granuloctyes in peripheral blood Significance: -bacterial infection -inflammation

Question 258

Leukocyte abnormalities - toxic granulation

Answer 258

dark-staining granules in cytoplasm of neutrophils Significance: -infection -inflammation

Question 259

Leukocyte abnormalities - Dohle bodies (May-Hegglin)

Answer 259

light blue patches in cytoplasm of neutrophils composed of RNA Significance: -infections -burns

Question 260

Leukocyte abnormalities - Vacuolization

Answer 260

phagocytic vacuoles in cytoplasm of neutrophils Significance: -septicemia -drugs -toxins -radiation

Question 261

Leukocyte abnormalities - hypersegmentation

Answer 261

>5% of segs with 5-lobed nucleus or any with >5 lobes Significance: -folic acid deficiency -B12 deficiency -pernicious anemia -one of the 1st signs of pernicious anemia

Question 262

Leukocyte abnormalities - Pelger-Huet anomaly

Answer 262

most neutrophils have round or bilobed nuclei Significance: -inherited disorder -no clinical effect -may be misinterpreted as shift to the left

Question 263

Leukocyte abnormalities - Auer rods

Answer 263

-red needles in cytoplasm of leukemic myeloblasts -occasionally in promyelocytes & monoblasts from abnormal function of primary granules Significance: -rules of lymphocytic leukemia -seen in up to 60% of patients with acute myeloid leukemia (AML)

Question 264

Leukocyte abnormalities - variant lymphocytes (atypical or reactive)

Answer 264

1 or more of the following: -large size -elongated or indented nucleus -immature chromatin -increased parachromatin -nucleoli -increased cytoplasm -dark blue or very pale cytoplasm -peripheral basophilia -scalloped edges due to indentation by adjacent RBCs -frothy appearance -many azurophilic granules Significance: -viral infections (e.g., IM, CMV)

Question 265

Quantitative abnormalities of leukocytes - neutrophilia - associations?

Answer 265

-bacterial infection -inflammation -hemorrhage -hemolysis -stress

Question 266

Quantitative abnormalities of leukocytes - neutropenia - associations?

Answer 266

-acute infection -antibodies -drugs -chemicals -radiation

Question 267

Quantitative abnormalities of leukocytes - lymphocytosis - associations?

Answer 267

-IM -CMV -whooping cough -acute infectious lymphocytosis

Question 268

Quantitative abnormalities of leukocytes - monocytosis - associations?

Answer 268

-convalescence from viral infections -chronic infections -tuberculosis -subacute bacterial endocarditis -parasitic infections -rickettsial infections

Question 269

Quantitative abnormalities of leukocytes - eosinophilia - associations?

Answer 269

-allergies -skin diseases -parasitic infections -chronic myelogenous leukemia (CML)

Question 270

Quantitative abnormalities of leukocytes - basophilia - associations?

Answer 270

-chronic myelogenous leukemia (CML) -polycythemia vera

Question 271

World Health Organization (WHO) classification of myeloid and lymphoid neoplasms (2016) - criteria

Answer 271

-morphology -cytochemistry -immunophenotyping via flow chromosomal and molecular abnormalities -cytogenetics -clinical features

Question 272

World Health Organization (WHO) classification of myeloid and lymphoid neoplasms (2016) - major groups

Answer 272

-MPN -Myeloid/lymphoid neoplasms with eosinophils and rearrangement of PDGFRA, PDFGRB, or FGFR1 or with PCM1-JAK2 -MDS/MDN -MDS -AML & related neoplasms -Acute leukemias of ambiguous lineage -B-lymphoblastic leukemia/lymphoma -T-lymphoblastic leukemia/lymphoma -Blastic plasmacytoid dendritic cell neoplasm

Question 273

World Health Organization (WHO) classification of myeloid and lymphoid neoplasms (2016) - criteria for diagnosis of AML

Answer 273

>=20% blasts

Question 274

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - explanation

Answer 274

-pre-malignant HSC disorders involving overproduction of 1 or more myeloid (non-lymphocytic) cell lines -bone marrow & peripheral blood show increased RBCs, granulocytes, &/or platelets, with 1 cell line usually predominant -NORMAL maturation & morphology

Question 275

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - examples

Answer 275

-polycythemia vera -CML -essential thrombocythemia -primary myelofibrosis

Question 276

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - affected population?

Answer 276

usually older adults

Question 277

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - etiology

Answer 277

mutations in HSCs

Question 278

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - chronic or acute leukemia?

Answer 278

primarily chronic but can transform into acute leukemia

Question 279

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - symptoms

Answer 279

-splenomegaly -extramedullary hematopoiesis common

Question 280

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - explanation

Answer 280

-pre-malignant HSC disorders involving ineffective hematopoiesis in 1 or more myeloid cell lines -hypercellular bone marrow with maturation abnormalities (dysplasias) -peripheral blood cytopenias (decreased counts) & morphologic abnormalities

Question 281

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - examples

Answer 281

MDS with single lineage dysplasia

Question 282

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - population affected?

Answer 282

more common in elderly

Question 283

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - etiology

Answer 283

-exposure to chemicals -radiation -chemotherapy -viral infections -can transform into acute leukemia

Question 284

Myeloid and lymphoid neoplasms - Myelodisplastic/myeloproliferative neoplasms (MDS/MPN) - explanation

Answer 284

premalignant neoplasms with both myeloproliferative and myelodysplastic features

Question 285

Myeloid and lymphoid neoplasms - Myelodisplastic/myeloproliferative neoplasms (MDS/MPN) - examples

Answer 285

chronic myelomonocytic leukemia (CMML)

Question 286

Myeloid and lymphoid neoplasms - Leukemia - explanation

Answer 286

-malignant neoplasms involving unregulated proliferation of HSCs -abnormal cells in bone marrow & peripheral blood

Question 287

Myeloid and lymphoid neoplasms - Leukemia - examples

Answer 287

-acute lymphoblastic leukemia (ALL) -chronic lymphocytic leukemia (CLL)

Question 288

Myeloid and lymphoid neoplasms - Leukemia - classified as?

Answer 288

-acute or chronic AND -lymphoid or myelogenous

Question 289

Myeloid and lymphoid neoplasms - Lymphoma - explanation

Answer 289

malignant neoplasm of lymphoid cells in lymphatic tissues, bone marrow, or lymph nodes

Question 290

Myeloid and lymphoid neoplasms - Lymphoma - examples

Answer 290

-B lymphoblastic leukemia/lymphoma with t(9;22) (q34;q11.1) -BCR ABL

Question 291

Myeloid and lymphoid neoplasms - Lymphoma - when is this designation used?

Answer 291

when mass lesion and 25% or less lymphoblasts are observed in the bone marrow

Question 292

Acute versus chronic leukemia - age

Answer 292

Acute: all ages, with peaks in 1st decade & after 50 years Chronic: adults

Question 293

Acute versus chronic leukemia - onset

Answer 293

Acute: sudden Chronic: insidious

Question 294

Acute versus chronic leukemia - median survival time, untreated

Answer 294

Acute: weeks to months Chronic: months to years

Question 295

Acute versus chronic leukemia - WBC

Answer 295

Acute: increased, normal, or decreased Chronic: increased (may be >50,000)

Question 296

Acute versus chronic leukemia - Differential

Answer 296

Acute: peripheral smear greater than or equal to 20% myeloblasts Chronic: more mature cells

Question 297

Acute versus chronic leukemia - Anemia

Answer 297

Acute: mild to severe Chronic: mild

Question 298

Acute versus chronic leukemia - Platelets

Answer 298

Acute: mild to severe decrease Chronic: usually normal

Question 299

Acute versus chronic leukemia - lymphoid/myeloid

Answer 299

Acute: usually lymphoid in children, myeloid in adults Chronic: myeloid mostly in young to middle-aged, lymphoid in older adults; most go into blast crisis

Question 300

Acute versus chronic leukemia - methods used to diagnose

Answer 300

Acute: peripheral blood smear, bone marrow examination, cytochemical stains, immunophenotyping, cytogenetics, molecular genetics Chronic: same as acute but less use of cytochemical stains; BCR-ABL1+ analyzed for CML

Question 301

Four most common leukemias - AML - WBC (x 10^9/L)

Answer 301

usually 5-30 x 10^9/L but can range from 1-200 x 10^9/L

Question 302

Four most common leukemias - AML - blood smear

Answer 302

->=20% blasts -auer rods -pseduo-Pelger-Huet cells -Howell-Jolly bodies -Pappenheimer bodies -basophilic stippling -nRBCs -hypogranular or giant platelets

Question 303

Most common type of leukemia in children <1 year & adults?

Answer 303

AML

Question 304

Four most common leukemias - AML - labs

Answer 304

-increased uric acid & LD from increased cell turnover

Question 305

Four most common leukemias - ALL - WBC (x10^9/L)

Answer 305

-increased in 50% of patients -can be normal or decreased

Question 306

Four most common leukemias - ALL - blood smear

Answer 306

-small, homogeneous blasts in children -large, heterogenous blasts in adults -may not have circulating blasts

Question 307

Four most common leukemias - ALL - population affected

Answer 307

-peak incidence: 2-5 yr -smaller peak in elderly

Question 308

Four most common leukemias - ALL - labs

Answer 308

increased uric acid & LD

Question 309

Four most common leukemias - ALL - spreads to?

Answer 309

CNS

Question 310

Four most common leukemias - ALL - lineage testing (T or B)

Answer 310

immunophenotyping

Question 311

Four most common leukemias - ALL - tests for prognosis

Answer 311

-cytogenetics -molecular analysis

Question 312

Four most common leukemias - CML - WBC (x10^9/L)

Answer 312

usually > 100 x 10^9/L

Question 313

Four most common leukemias - CML - blood smear

Answer 313

-all stages of granulocytic maturation -segs & myelocytes predominant -increased eosinophils & basophils -Pseudo-Pelger-Huet cells -nRBCs -abnormal platelets may be seen

Question 314

Four most common leukemias - CML - population affected

Answer 314

most common after age 55 years

Question 315

Four most common leukemias - CML - finding in most patients?

Answer 315

splenomegaly

Question 316

What is the most common MPD?

Answer 316

CML

Question 317

Four most common leukemias - CML - Philadelphia chromosome

Answer 317

-caused by BCR/ABL gene translocation (9;22) -found in 90% of CML patients -prognosis is better if Philadelphia chromosome is present

Question 318

Four most common leukemias - CML - LAP

Answer 318

decreased

Question 319

Four most common leukemias - CML - eventually becomes?

Answer 319

AML or ALL

Question 320

Four most common leukemias - CLL - WBC (x 10^9/L)

Answer 320

30-200 x 10^9/L

Question 321

Four most common leukemias - CLL - blood smear

Answer 321

-80-90% small, mature-looking lymphs -may have hypercondensed chromatin & light-staining parachromatin ("soccer ball appearance") -few prolymphocytes -SMUDGE cells

Question 322

What is the most common type of leukemia in adults?

Answer 322

CLL

Question 323

Four most common leukemias - CLL - proliferation of?

Answer 323

B lymphocytes

Question 324

AML subtypes (WHO classification vs. FAB) - AML with genetic abnormalities - FAB?

Answer 324

No FAB classification

Question 325

AML subtypes (WHO classification vs. FAB) - AML with genetic abnormalities - examples

Answer 325

-AML with translocation between chromosomes 8 and 21 (t(8;21) -AML with translocation between chromosomes 9 and 11 t(9;11)

Question 326

AML subtypes (WHO classification vs. FAB) - AML with myelodysplasia-related changes - FAB?

Answer 326

no FAB classification

Question 327

AML subtypes (WHO classification vs. FAB) - AML related to previous chemotherapy or radiation - FAB?

Answer 327

no FAB classification

Question 328

AML subtypes (WHO classification vs. FAB) - AML with minimal differentiation - FAB?

Answer 328

M0

Question 329

AML subtypes (WHO classification vs. FAB) - AML without maturation - FAB?

Answer 329

M1

Question 330

AML subtypes (WHO classification vs. FAB) - AML with maturation - FAB?

Answer 330

M2

Question 331

AML subtypes (WHO classification vs. FAB) - Acute myelomonocytic leukemia - FAB?

Answer 331

M4

Question 332

AML subtypes (WHO classification vs. FAB) - Acute monoblastic/monocytic leukemia - FAB?

Answer 332

M5

Question 333

AML subtypes (WHO classification vs. FAB) - Pure erythroid leukemia - FAB?

Answer 333

M6

Question 334

AML subtypes (WHO classification vs. FAB) - Acute megakaryoblastic leukemia - FAB?

Answer 334

M7

Question 335

AML subtypes (WHO classification vs. FAB) - Acute basophilic leukemia - FAB?

Answer 335

no FAB classification

Question 336

AML subtypes (WHO classification vs. FAB) - Acute panmyelosis with fibrosis - FAB?

Answer 336

no FAB classification

Question 337

Cytochemical stains for differentiation of acute leukemia - myeloperoxidase - AML

Answer 337

positive

Question 338

Cytochemical stains for differentiation of acute leukemia - myeloperoxidase - ALL

Answer 338

negative

Question 339

Cytochemical stains for differentiation of acute leukemia - Sudan black - AML

Answer 339

positive

Question 340

Cytochemical stains for differentiation of acute leukemia - Sudan black - ALL

Answer 340

negative

Question 341

Cytochemical stains for differentiation of acute leukemia - Naphtol AS-D chloroacetate esterase (specific esterase) - AML

Answer 341

positive

Question 342

Cytochemical stains for differentiation of acute leukemia - Naphtol AS-D chloroacetate esterase (specific esterase) - ALL

Answer 342

negative

Question 343

Cytochemical stains for differentiation of acute leukemia - Periodic acid-Schiff (PAS) - AML

Answer 343

negative or diffusely positive

Question 344

Cytochemical stains for differentiation of acute leukemia - Periodic acid-Schiff (PAS) - ALL

Answer 344

positive (coarse granular or block-like)

Question 345

Leukemoid reaction vs. CML - WBC count

Answer 345

Leukemoid reaction: high CML: high

Question 346

Leukemoid reaction vs. CML - peripheral blood smear

Answer 346

Leukemoid reaction: shift to left (blasts rare), toxic granulation, Dohle bodies CML: shift to left with blasts, eosinophilia, basophilia

Question 347

Leukemoid reaction vs. CML - LAP

Answer 347

Leukemoid reaction: high CML: low

Question 348

Leukemoid reaction vs. CML - Philadelphia chromosome

Answer 348

Leukemoid reaction: negative CML: positive

Question 349

Plasma cell disorders - Multiple myeloma - etiology

Answer 349

malignant plasma cells in bone marrow

Question 350

Plasma cell disorders - Multiple myeloma - type of anemia

Answer 350

normocytic, normochromic

Question 351

Plasma cell disorders - Multiple myeloma - blood smear

Answer 351

rouleaux

Question 352

Plasma cell disorders - Multiple myeloma - ESR

Answer 352

increased due to increased globulins

Question 353

Plasma cell disorders - Multiple myeloma - serum protein electrophoresis

Answer 353

M spike -monoclonal gammopathy

Question 354

Plasma cell disorders - Multiple myeloma - protein in urine

Answer 354

Bence Jones

Question 355

Plasma cell disorders - Multiple myeloma - bone disease

Answer 355

lytic bone disease

Question 356

Plasma cell disorders - Plasma cell leukemia - form of?

Answer 356

multiple myeloma

Question 357

Plasma cell disorders - Plasma cell leukemia - etiology

Answer 357

plasma cells in peripheral blood

Question 358

Plasma cell disorders - Plasma cell leukemia - blood smear

Answer 358

-pancytopenia -rouleaux

Question 359

Plasma cell disorders - Plasma cell leukemia - gammopathy

Answer 359

monoclonal gammopathy

Question 360

Plasma cell disorders - Waldenstrom macroglobulinemia - type of disorder

Answer 360

malignant lymphocyte-plasma cell proliferative disorder

Question 361

Plasma cell disorders - Waldenstrom macroglobulinemia - gammopathy

Answer 361

monoclonal gammopathy due to increased immunoglobulin M (IgM)

Question 362

Plasma cell disorders - Waldenstrom macroglobulinemia - blood smear

Answer 362

-rare plasmacytoid lymphocytes or plasma cells -rouleaux

Question 363

Plasma cell disorders - Waldenstrom macroglobulinemia - protein in urine

Answer 363

Bence jones

Question 364

Plasma cell disorders - Waldenstrom macroglobulinemia - globulins

Answer 364

cryoglobulins

Question 365

Manual hematology procedures - manual WBC count, CSF - purpose

Answer 365

differential diagnosis of meningitis

Question 366

Manual hematology procedures - manual WBC count, CSF - method

Answer 366

-CSF loaded into Neubauer hemacytometer -WBCs counted in all 9 squares of each side under 10x

Question 367

Manual hematology procedures - manual WBC count, CSF - used to lyse RBCs

Answer 367

Acetic acid

Question 368

Manual hematology procedures - microhematocrit (packed cell volume, PCV) - purpose

Answer 368

screening for anemia

Question 369

Manual hematology procedures - microhematocrit (packed cell volume, PCV) - method

Answer 369

-microhematocrit tubes centrifuged at 10,000-15,000 rpm for 15 minutes -% of total volume occupied by RBCs determined

Question 370

Manual hematology procedures - microhematocrit (packed cell volume, PCV) - values versus values from automated analyzes

Answer 370

Values may be slightly higher than calculated values from automated analyzers

Question 371

Manual hematology procedures - reticulocyte count - purpose

Answer 371

assess rate of erythropoiesis

Question 372

Manual hematology procedures - reticulocyte count - method

Answer 372

-blood smear stained with new methylene blue -1,000 RBCs counted -% containing reticulum determined

Question 373

Manual hematology procedures - reticulocyte count - used to help with counting

Answer 373

Miller ocular

Question 374

Manual hematology procedures - reticulocyte count - adult reference range

Answer 374

0.5%-1.5%

Question 375

Manual hematology procedures - reticulocyte count - increased reticulocytes

Answer 375

Increased erythropoiesis - e.g., blood loss, hemolytic anemia, following treatment of anemia

Question 376

Manual hematology procedures - ESR - purpose

Answer 376

screen for inflammation

Question 377

Manual hematology procedures - ESR - method

Answer 377

-whole blood added to Westergren tube & placed in vertical rack -height of RBC column read after 1 hour

Question 378

Manual hematology procedures - ESR - reference ranges

Answer 378

Males: 0-15 mm/hr Females: 0-20 mm/hr

Question 379

Manual hematology procedures - ESR - what is preferred over ESR

Answer 379

CRP

Question 380

Manual hematology procedures - tube solubility screening test for Hemoglobin S - purpose

Answer 380

Screening for hgb S

Question 381

Manual hematology procedures - tube solubility screening test for Hemoglobin S - method

Answer 381

-blood mixed with reducing agent - e.g., sodium dithionite -HGB S is insoluble = produces a turbid solution that obscures black lines behind tube

Question 382

Manual hematology procedures - tube solubility screening test for Hemoglobin S - doesn’t differentiate?

Answer 382

Doesn’t differentiate SS from AS

Question 383

Manual hematology procedures - tube solubility screening test for Hemoglobin S - follow up with?

Answer 383

hemoglobin electrophoresis

Question 384

Manual hematology procedures - osmotic fragility - purpose

Answer 384

Dx of hereditary spherocytosis

Question 385

Manual hematology procedures - osmotic fragility - method

Answer 385

-blood added to serial dilutions of NaCl & incubated -amount of hemolysis determined by reading absorbance of supernatant from each tube

Question 386

Manual hematology procedures - osmotic fragility - increased in what conditions?

Answer 386

hereditary spherocytosis

Question 387

Manual hematology procedures - osmotic fragility - decreased in what conditions?

Answer 387

-target cells -sickle cell anemia -IDA -thalassemia

Question 388

Manual hematology procedures - Donath-Landsteiner (DL) test - purpose

Answer 388

Dx of paroxysmal cold hemoglobinuria

Question 389

Manual hematology procedures - Donath-Landsteiner (DL) test - method

Answer 389

-blood collected in 2 clot tubes -tube 1 is incubated at 4*C, then 37*C -tube 2 incubated at 37*C only -POSITIVE = hemolysis in tube 1, none in tube 2

Question 390

Manual hematology procedures - Donath-Landsteiner (DL) test - anemia

Answer 390

-rare autoimmune hemolytic anemia due to biphasic antibody (autoanti-P) that binds complement to RBCs in capillaries at <20*C & elutes off at 37*C -complement remains attached & lyses cells

Question 391

Changes in blood at room temperature - MCV

Answer 391

increased due to RBC swelling

Question 392

Changes in blood at room temperature - HCT

Answer 392

increased due to increased MCV

Question 393

Changes in blood at room temperature - MCHC

Answer 393

decreased due to increased HCT

Question 394

Changes in blood at room temperature - ESR

Answer 394

decreased (swollen RBCs don’t rouleaux)

Question 395

Changes in blood at room temperature - osmotic fragility

Answer 395

increased

Question 396

Changes in blood at room temperature - WBCs

Answer 396

decreased

Question 397

Changes in blood at room temperature - WBC morphology

Answer 397

-necrobiotic cells -karyorrhexis (nuclear disintegration) -degranulation -vacuolization

Question 398

Methods of automated cell counting & differentiation - electrical impedance (Coulter principle) - principle

Answer 398

-low voltage direct current (DC) resistance -increased resistance (impedance) when non-conductive particles suspended in electrically conductive diligent pass through aperture -height of pulses indicates cell volume -number of pulses indicates count

Question 399

Methods of automated cell counting & differentiation - radiofrequency - principle

Answer 399

-high-frequency electromagnetic probe measures conductivity -change in RF signal provides information about nucleus-to-cytoplasm ratio, nuclear density, granularity

Question 400

Methods of automated cell counting & differentiation - optical light scattering (flow cytometry) - principle

Answer 400

-hydrodynamically focused stream of cells passes through quartz flow cell past light source (tungsten halogen lamp or laser light) -scattered light is measured at different angles -provides information about cell volume & complexity, e.g., granularity -can also analyze nuclear DNA content, cell surface antigens (CD markers), and intracellular proteins and cytokines

Question 401

Methods of automated cell counting & differentiation - radiofrequency - application

Answer 401

WBC differential

Question 402

Methods of automated cell counting & differentiation - electrical impedance(Coulter principle) - application

Answer 402

Cell counting & sizing

Question 403

Methods of automated cell counting & differentiation - optical light scattering (flow cytometry) - application

Answer 403

-cell counting & sizing -WBC differential

Question 404

Flow cytometry- principle

Answer 404

measurement of physical, antigenic, and functional properties of cells suspended in fluid

Question 405

Flow cytometry- measurements - fluorescence

Answer 405

-cells stained with antibodies conjugated to specific fluorochrome pass 1 by 1 in front of laser light source -electrons of fluorochrome raised to higher energy state;emit light of specific wavelength as they return to ground state -emitted light detected by photodetectors for specific wavelengths

Question 406

Flow cytometry- measurements - forward scatter

Answer 406

-photodetector in line with laser beam measure FS -proportional to volume or size

Question 407

Flow cytometry- measurements - side scatter

Answer 407

-photodetector at right angle measures SS -reflects granularity, surface complexity, & internal structures

Question 408

Flow cytometry- measurements - cell populations

Answer 408

-cell populations with similar characteristics form clusters on dot plot -specific populations & subpopulations can be selected with cursor (gating)

Question 409

Flow cytometry- applications

Answer 409

-immunophenotyping: differentiating cells on basis of surface & cytoplasmic markers; can determine lineage & maturity of cells in hematologic malignancies in order to classify and subclassify the malignancy -diagnosis, follow-up, & prognosis of leukemias and lymphomas; certain immunophenotypes associated with specific cytogenetic abnormalities -Dx & monitoring of immunodeficiencies (cell counts and screening panels) -Dx of paroxysmal nocturnal hemoglobinuria -enumeration of stem cells -quantitation of fetal hemoglobin

Question 410

Common cluster of differentiation (CD) markers - CD2

Answer 410

early T lymphocytes

Question 411

Common cluster of differentiation (CD) markers - CD3, CD4, CD5, CD7, CD8

Answer 411

T lymphocytes

Question 412

Common cluster of differentiation (CD) markers - CD10

Answer 412

precursor B lymphocyte

Question 413

Common cluster of differentiation (CD) markers - CD19, CD20, CD21, CD22

Answer 413

B lymphocytes

Question 414

Common cluster of differentiation (CD) markers - CD34

Answer 414

stem cells

Question 415

Common cluster of differentiation (CD) markers - CD41, CD61

Answer 415

megakaryocytes and platelets

Question 416

Common cluster of differentiation (CD) markers - CD15

Answer 416

promyelocyte

Question 417

Common cluster of differentiation (CD) markers - CD13, CD33

Answer 417

meylocyte

Question 418

Common cluster of differentiation (CD) markers - CD14, CD64

Answer 418

monocytes

Question 419

Common cluster of differentiation (CD) markers - CD45

Answer 419

all leukocytes

Question 420

Common cluster of differentiation (CD) markers - CD16, CD56

Answer 420

NK cells

Question 421

Technologies used in automated hematology analyzers - Impedance instruments (Beckman Coulter - LH series)

Answer 421

-cell counting & sizing: electrical impedance -WBC differential: VCS (volume, conductivity, scatter) technology Parameter: Volume -measurement: DC impedance -information: cell volume Parameter: Conductivity (opacity) -measurement: RF -information: cell size & internal structure Parameter: Scatter -measurement: light scatter as cells pass through laser beam -information: cell surface structure & cellular granularity

Question 422

Technologies used in automated hematology analyzers - Impedance instruments - Sysmex (X-series)

Answer 422

impedance, RF, absorption spectrophotometry, & flow cytometry with fluorescent dyes

Question 423

Technologies used in automated hematology analyzers - Impedance instruments - Abbott (CELL-DYN)

Answer 423

impedance, fluorescence staining, flow cytometry, multiple polarized scatter separation (MAPSS)

Question 424

Technologies used in automated hematology analyzers - Light-scattering instruments - Siemens (Advia)

Answer 424

light scattering, cytochemical analysis & cyanmethemoglobin

Question 425

Automated CBC - cell counts - various methods used

Answer 425

-impedance -light scatter

Question 426

Automated CBC - WBC differential - various methods used

Answer 426

-VCS technology -fluorescent flow cytometry & light scatter -MAPSS technology (multiangle polarized scatter separation) -cytochemistry (peroxidase) & optical flow cytometry

Question 427

Automated CBC - HGB - various methods used

Answer 427

-cyanmethemoglobin method -modified cyanide-free cyanmethemoglobin method -sodium lauryl sulphate (SLS-hgb) method

Question 428

Automated CBC - HCT - various methods used

Answer 428

-calculated from RBC & MCV -cumulative pulse heights detection

Question 429

Automated CBC - MCV - various methods used

Answer 429

-mean of RBC volume histogram -calculated from HCT & RBC

Question 430

Automated CBC - MCH - various methods used

Answer 430

calculated from HGB & RBC

Question 431

Automated CBC - MCHC - various methods used

Answer 431

calculated from HCG & HCT

Question 432

Automated CBC - RDW - various methods used

Answer 432

CV of RBC histogram

Question 433

Automated CBC - Retics - various methods used

Answer 433

-staining with new methylene blue; VCS technology -staining with auramine O; fluorescence detection -staining with fluorescent dye; light scatter & fluorescence detection -staining with oxazine; optical scatter & absorbance

Question 434

Graphic representation of cell populations - Histogram

Answer 434

-size distribution graph that plots cell size (x axis) vs. relative number (y axis); size thresholds separate cell populations -use: RBC, WBC, & PLT

Question 435

Graphic representation of cell populations - Scatterplot or cytogram

Answer 435

-cells are plotted based on 2 characteristics, e.g., size vs. granularity -separates cells into distinct populations and subpopulations -use: WBC differential

Question 436

Quality assurance/quality control (QA/QC) for automated hematology analyzers

Answer 436

-periodic calibration with stabilized whole blood calibrators (every 6 months at a minimum or as specified by manufacturer) -periodic calibration verification -analysis of at least 2 levels of control material each day of testing (more if specified by manufacturer) -instrument maintenance -participation in proficiency testing program -delta checks

Question 437

Hematology calculations - Retic %

Answer 437

Question 438

What is the retic count if reticulum is observed in 15 of 1,000 RBCs?

Answer 438

Question 439

Hematology calculations - Reticulocyte % using Miller Disc

Answer 439

Question 440

What is the retic count if 60 retics are counted in square A and 300 RBCs are counted in square B?

Answer 440

Question 441

Hematology calculations - Absolute retic count (ARC) (x10^9/L)

Answer 441

Question 442

What is the ARC if the retic count is 2% and the RBC is 5.2 x 10^12/L?

Answer 442

Question 443

Hematology calculations - corrected retic count (CRC)

Answer 443

Question 444

What is the CRC if the uncorrected retic count is 5% and the HCT is 36%?

Answer 444

Question 445

Hematology calculations - Retic production index (RPI)

Answer 445

Question 446

What is the RPI if the corrected retic is 5% and the HCT is 35% (maturation time correction factor for HCT of 35% is 1.5)?

Answer 446

Question 447

Hematology calculations - MCV

Answer 447

Question 448

Calculate the MCV if the RBC is 3 x 10^12/L, the HGB is 6 g/dL, & the hematocrit is 20%.

Answer 448

Question 449

Hematology calculations - MCH

Answer 449

Question 450

Calculate the MCH if the RBC is 3 x 10^12/L, the HGB is 6 g/dL, & the HCT is 20%.

Answer 450

Question 451

Hematology calculations - MCHC

Answer 451

Question 452

Calculate the MCHC if the RBC is 3 x 10^12/L, the HGB is 6 g/dL, & the HCT is 20%.

Answer 452

Question 453

Hematology calculations - Rules of Three

Answer 453

Question 454

What should the HGB be if the RBC is 4.1 x 10^12/L?

Answer 454

Question 455

What should the HCT be if HGB is 12.3 g/dL?

Answer 455

Question 456

Hematology calculations - Manual cell count

Answer 456

Question 457

Calculate the CSF WBC count if 18 WBCs were counted in 9 mm^2 on 1 side of a Neubauer hemacytometer using undiluted CSF.

Answer 457

Question 458

Hematology calculations - Absolute WBC

Answer 458

Question 459

Calculate the absolute lymphocyte count if the total WBC is 10 x 10^9/L and there are 70% lymphocytes.

Answer 459

Question 460

Hematology calculations - Corrected WBC

Answer 460

Question 461

The automated hematology analyzer reports a WBC of 30 x 10^9/L. The technologist counts 115 NRBCs per 100 WBCs while performing the differential. What is the corrected WBC?

Answer 461

Question 462

Overview of hemostasis - primary hemostasis

Answer 462

-vasoconstriction -platelet adhesion -platelet aggregation to form primary hemostatic plug at injury site

Question 463

Overview of hemostasis - secondary hemostasis

Answer 463

-interaction of coagulation factors to produce fibrin (secondary hemostatic plug) -fibrin stabilization by factor XIII

Question 464

Overview of hemostasis - fibrinolysis

Answer 464

-release of tissue plasminogen activator -conversion of plasminogen to plasmin -conversion of fibrin-to-fibrin degradation products

Question 465

Coagulation factors - Fibrinogen (I) - pathway

Answer 465

I, E, C

Question 466

Coagulation factors - Fibrinogen (I) - inherited deficiency

Answer 466

Rare

Question 467

Coagulation factors - Fibrinogen (I) - converted to?

Answer 467

Fibrin by thrombin

Question 468

Coagulation factors - Prothrombin (II) - pathway

Answer 468

I, E, C

Question 469

Coagulation factors - Prothrombin (II) - inherited deficiency

Answer 469

Rare

Question 470

Coagulation factors - Prothrombin (II) - precursor of?

Answer 470

Thrombin

Question 471

Coagulation factors - Tissue factor (TF) (III) - pathway

Answer 471

E

Question 472

Coagulation factors - Tissue factor (TF) (III) - what is it?

Answer 472

Phospholipid released from injured vessel wall; not normally in blood

Question 473

Coagulation factors - Ca2+ (IV) - pathway

Answer 473

I, E, C

Question 474

Coagulation factors - Ca2+ (IV) - bound by?

Answer 474

Anticoagulant sodium citrate (In assays using citrated plasma, must be supplied by reagents)

Question 475

Coagulation factors - Labile factor (proaccelerin) (V) - pathway

Answer 475

I, E,C

Question 476

Coagulation factors - Labile factor (proaccelerin) (V) - inherited deficiency

Answer 476

Rare

Question 477

Coagulation factors - Labile factor (proaccelerin) (V) - deterioration

Answer 477

Rapidly deteriorated

Question 478

Coagulation factors - Stable factor (proconvertin) (VII) - pathway

Answer 478

E

Question 479

Coagulation factors - Stable factor (proconvertin) (VII) - inherited deficiency

Answer 479

Rare

Question 480

Coagulation factors - Antihemophilic factor (VIII) - pathway

Answer 480

I

Question 481

Coagulation factors - Antihemophilic factor (VIII) - inherited deficiency

Answer 481

Common (hemophilia A)

Question 482

Coagulation factors - Antihemophilic factor (VIII) - circulates in association with?

Answer 482

VWF - stabilizes VIII, prolonging half-life

Question 483

Coagulation factors - Antihemophilic factor (VIII) - VIII:C

Answer 483

coagulant portion; extremely labile

Question 484

Coagulation factors - Christmas factor (plasma thromboplastin component) (IX) - pathway

Answer 484

Intrinsic

Question 485

Coagulation factors - Christmas factor (plasma thromboplastin component) (IX) - inherited deficiency

Answer 485

Common (hemophilia B)

Question 486

Coagulation factors - Stuart factor (X) - pathway

Answer 486

Intrinsic, extrinsic, common

Question 487

Coagulation factors - Stuart factor (X) - inherited deficiency

Answer 487

Rare

Question 488

Coagulation factors - Plasma thromboplastin antecedent (XI) - pathway

Answer 488

Intrinsic

Question 489

Coagulation factors - Plasma thromboplastin antecedent (XI) - inherited deficiency

Answer 489

-rare (hemophilia C) -may or may not cause bleeding

Question 490

Coagulation factors - Hageman factor (contact factor) (XII) - pathway

Answer 490

Intrinsic

Question 491

Coagulation factors - Hageman factor (contact factor) (XII) - inherited deficiency

Answer 491

No bleeding

Question 492

Coagulation factors - Hageman factor (contact factor) (XII) - activation factor

Answer 492

Glass activation factor - not part of in vivo coagulation

Question 493

Coagulation factors - Fibrin stabilizing factor (XIII) - pathway

Answer 493

intrinsic, extrinsic, common

Question 494

Coagulation factors - Fibrin stabilizing factor (XIII) - inherited deficiency

Answer 494

-rare -poor wound healing

Question 495

Coagulation factors - Fibrin stabilizing factor (XIII) - function

Answer 495

stabilizes fibrin clot

Question 496

Coagulation factors - High molecular weight kininogen (Fitzgerald factor) (HMWK) - pathway

Answer 496

Intrinsic

Question 497

Coagulation factors - High molecular weight kininogen (Fitzgerald factor) (HMWK) - inherited deficiency

Answer 497

-rare -no bleeding

Question 498

Coagulation factors - High molecular weight kininogen (Fitzgerald factor) (HMWK) - in vivo coagulation

Answer 498

Not part of

Question 499

Coagulation factors - Prekallikrein (Fletcher factor) (PK) - pathway

Answer 499

Intrinsic

Question 500

Coagulation factors - Prekallikrein (Fletcher factor) (PK) - inherited deficiency

Answer 500

No bleeding

Question 501

Coagulation factors - Prekallikrein (Fletcher factor) (PK) - in vivo coagulation

Answer 501

Not part of

Question 502

Functional classification of coagulation factors - substrate

Answer 502

-substance changed by an enzyme -factors: fibrinogen

Question 503

Functional classification of coagulation factors - cofactor

Answer 503

-protein that accelerates enzymatic reactions; no enzymatic activity of its own -factors: V, VIII (V is cofactor for Xa; VIII is cofactor for IXa)

Question 504

Functional classification of coagulation factors - enzyme

Answer 504

-protein that catalyzes a change in specific substrate; secreted in inactive form (proenzyme, zymogen); must be activated to function -factors: —serine proteases: thrombin (IIa), VIIa, IXa, Xa, XIa, XIIa, prekallikrein) —transglutaminase: XIIIa

Question 505

Summary of coagulation factors - contact group

Answer 505

-factors involved in initiation of intrinsic pathway -factors: PK, HMWK, XII, XI

Question 506

Summary of coagulation factors - prothrombin group

Answer 506

-Vitamin K-dependent factors -factors: II, VII, IX, X

Question 507

Summary of coagulation factors - fibrinogen group

Answer 507

-factors acted on by thrombin (V, VIII, & XIII are activated; I is converted to fibrin); ALL are high molecular weight proteins -factors: I, V, VIII, XIII

Question 508

Summary of coagulation factors - factors in extrinsic pathway

Answer 508

TF and VII

Question 509

Summary of coagulation factors - factors in intrinsic pathway

Answer 509

PK, HMWK, XII, XI, IX, VIII

Question 510

Summary of coagulation factors - factors in common pathway

Answer 510

X, V, II, I

Question 511

Summary of coagulation factors - extrinsic tenase complex

Answer 511

-acts on X -factors: VIIa/TF

Question 512

Summary of coagulation factors - intrinsic tenase complex

Answer 512

-acts on X -factors: IXa/VIIIa

Question 513

Summary of coagulation factors - prothrombinase complex

Answer 513

-acts on prothrombin -factors: Xa/Va

Question 514

Summary of coagulation factors - factor VIII complex

Answer 514

-factors: —VIII:C = procoagulant —von Willebrand factor (VWF) = carrier protein

Question 515

Which coagulation factors are produced in the liver?

Answer 515

All of them

Question 516

Summary of coagulation factors - require vitamin K for synthesis

Answer 516

II, VII, IX, X

Question 517

Summary of coagulation factors - affected by anticoagulant therapy (Coumadin)

Answer 517

-all that require vitamin K; Warfarin is a vitamin K antagonist -factors: II, VII, IX, X

Question 518

Summary of coagulation factors - consumed during clotting

Answer 518

-not present in serum -factors: I, II, V, VIII, XIII

Question 519

Summary of coagulation factors - labile factors

Answer 519

V, VIII

Question 520

Coagulation theories - Cascade model - overview

Answer 520

-focuses on role of coagulation factors -sees coagulation as chain reaction in which each coagulation factor is converted to active form by preceding factor -intrinsic & extrinsic pathways converge on common pathway

Question 521

Overview of hemostasis - Cascade model - steps

Answer 521

Extrinsic pathway (TF, factor VII): -TF from injured blood vessel wall activates factor VII -TF:VIIa activate factor X Intrinsic pathway (factors XII, XI, IX, VIII): -factor XII activated by exposure to collagen -factor XIIa, HMWK, & PK activate factor XI -factor XIa activates factor IX -IXa:VIIIa activates factor X Common pathway (factors X, V, II, I): -Xa-Va converts prothrombin (II) to thrombin (IIa) -thrombin cleaves fibrinogen (I) into fibrin & activates factor XIII to stabilize clot

Question 522

Coagulation theories - Cell-based or physiological model - overview

Answer 522

-focuses on role of receptors for coagulation factors on surface of TF-bearing cells (e.g., fibroblast or monocyte) & platelets -sees coagulation as 3 overlapping phases that begin with small amount of thrombin formation on surface of TF-bearing cells, followed by large-scale thrombin production on platelet surface

Question 523

Coagulation theories - Cell-based or physiological model - steps

Answer 523

1. Initiation (on surface of TF-bearing cell): -break in vessel wall exposes extravascular TF-bearing cell to plasma -factor VII binds to TF on cell membrane -TF:VIIa activates factors IX & X -factor Xa combines with factor Va -Xa:Va generates small amount of thrombin, but no fibrin formed at this point 2. Amplification: -thrombin & collagen activate platelets -platelets release factor V from granules -thrombin activates factors V, VIII, & XI -factor XIa supplements activation of factor IX 3. Propagation (on surface of activated platelet): -factor Xa binds to factor VIIIa on platelet -IXa:VIIIa activates factor X -Xa:Va converts prothrombin (II) to thrombin (IIa) -thrombin cleaves fibrinogen (I) into fibrin & activates factor XIII to stabilize clot

Question 524

Quantitative platelet disorders - thrombocytopenia - explanation

Answer 524

-decreased production (e.g., aplastic anemia, MDS, chemotherapy, severe viral infection) -increased destruction (e.g., immune thrombocytopenic purpura, drugs, DIC, mechanical destruction by artificial heart valves) -splenic sequestration -massive transfusion (dilution effect) -heparin-induced thrombocytopenia (HIT)

Question 525

Quantitative platelet disorders - thrombocytopenia - clinical manifestations

Answer 525

<30 x 10^9/L: petechiae, menorrhagia, spontaneous bleeding <10 x 10^9/L: severe spontaneous bleeding

Question 526

Quantitative platelet disorders - thrombocytopenia - lab tests

Answer 526

PLT <150 x 10^9/L

Question 527

Quantitative platelet disorders - Primary thrombocytosis - explanation

Answer 527

-unregulated production of megakaryocytes in bone marrow -seen in myeloproliferative neoplasms with essential thrombocythemia having the highest platelet count

Question 528

Quantitative platelet disorders - Primary thrombocytosis - clinical manifestations

Answer 528

thrombosis or hemorrhage

Question 529

Quantitative platelet disorders - Primary thrombocytosis - lab tests

Answer 529

PLT usually >600 x 10^9/L -giant platelets may be seen in blood smear -leukocytosis, or slight anemia may be present -platelet aggregation may be abnormal

Question 530

Quantitative platelet disorders - Secondary or reactive thrombocytosis - explanation

Answer 530

-increased platelets due to another condition (e.g., hemorrhage, surgery, splenectomy, & IDA)

Question 531

Quantitative platelet disorders - Secondary or reactive thrombocytosis - clinical manifestations

Answer 531

thrombosis or hemorrhage infrequent

Question 532

Quantitative platelet disorders - Secondary or reactive thrombocytosis - lab tests

Answer 532

PLT >450 x 10^9/L but usually <1,000 x 10^9/L

Question 533

Qualitative platelet disorders - Hereditary - Von Willebrand disease - explanation

Answer 533

-deficiency in VWF -platelets can't adhere to collage to form platelet plug -most common inherited bleeding disorder -autosomal dominant (both sexes affected) -3 primary types (1, 2, and 3)

Question 534

Qualitative platelet disorders - Hereditary - Von Willebrand disease - lab tests

Answer 534

PLT: Normal Closure time (PFA): Normal or increased Platelet aggregation: abnormal with ristocetin (do not aggregate) PT: normal APTT: normal or increased Factor VIII: normal or decreased VWF: Ag: decreased

Question 535

Qualitative platelet disorders - Hereditary - Bernard-Soulier syndrome - explanation

Answer 535

-lack of functional glycoprotein GPIb-IX complex (receptor for VWF) on platelet surface prevents interaction with VWF -abnormal platelet adhesion to collagen

Question 536

Qualitative platelet disorders - Hereditary - Bernard-Soulier syndrome - lab tests

Answer 536

-giant platelets with dense granulation -increased closure time (platelet function assay (PFA)) -abnormal aggregation with ristocetin

Question 537

Qualitative platelet disorders - Hereditary -Glanzmann thrombasthenia - explanation

Answer 537

-deficiency or abnormality of platelet membrane GP IIb/IIIa -fibrinogen can't attach to platelet surface & initiate platelet aggregation

Question 538

Qualitative platelet disorders - Hereditary -Glanzmann thrombasthenia - lab tests

Answer 538

-increased closure time (PFA) -abnormal aggregation with all aggregating agents except ristocetin

Question 539

Qualitative platelet disorders - Acquired - explanation

Answer 539

-functional platelet disorders occur with chronic renal failure, myeloproliferative disorders, cardiopulmonary bypass, use of aspirin & other drugs -mechanisms vary

Question 540

Qualitative platelet disorders - Acquired - lab tests

Answer 540

abnormal platelet aggregation

Question 541

Tests of platelet function - platelet aggregation - method

Answer 541

-aggregating agent (e.g., ADP, collagen, ristocetin, epinephrine) added to platelet suspension -as platelets aggregate, increase in light transmittance -platelet aggregation curves generated (time vs. % transmittance)

Question 542

Tests of platelet function - platelet aggregation - clinical significance

Answer 542

-abnormal curves with platelet dysfunctions such as von Willebrand disease, Bernard-Soulier syndrome, platelet storage pool defects, idiopathic thrombocytopenia purpura, drugs

Question 543

Tests of platelet function - PFA - method

Answer 543

-citrated whole blood drawn through capillary tubes coated with ADP/collagen or epinephrine/collagen -platelets adhere & aggregate when exposed to collagen -closure time = length of time for platelets to form platelet plug & close aperture of capillary tube

Question 544

Tests of platelet function - PFA - clinical significance

Answer 544

-screening test for qualitative platelet defects -replaces bleeding time -Von Willebrand disease: prolonged with collagen/ADP & collagen/epinephrine -defects related to drugs (e.g., aspirin): normal with collagen/ADP, prolonged with collagen/epinephrine

Question 545

Tests of platelet function - von Willebrand factor (VWF): Ag - method

Answer 545

immunologic tests (e.g., enzyme immunossay [EIA]) using monoclonal antibodies to VWF

Question 546

Tests of platelet function - von Willebrand factor (VWF): Ag - clinical significance

Answer 546

-VWF connects platelets to collagen -decreased in von Willebrand disease, so platelets don't function normally

Question 547

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - purpose

Answer 547

to detect deficiencies in extrinsic & common pathways & to monitor coumadin (Warfarin) therapy

Question 548

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - reagent(s)

Answer 548

thromboplastin reagent (thromboplastin, phospholipid, Ca2+)

Question 549

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - prolonged results

Answer 549

-anticoagulant therapy -deficiency of VII, X, V, II, or I -circulating inhibitors

Question 550

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - INR

Answer 550

-the INR standardizes the PT value regardless of instrument and reagent combination used or location -Prothrombin ratio (PR) and International Sensitivity Index (ISI) are used to calculate the INR: PR = PT (patient)/PT (mean normal) INR = PR^(ISI) NOTE: geometric mean of normal is used, not the population mean

Question 551

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - APTT - purpose

Answer 551

-to detect deficiencies in intrinsic & common pathways & to monitor unfractionated heparin (UFH) therapy

Question 552

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - APTT - reagent(s)

Answer 552

-activated partial thromboplastin reagent (phospholipid, activator) -CaCl2

Question 553

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - APTT - prolonged results

Answer 553

-heparin therapy -deficiency of HMWK, PK, XII, XI, IX< VIII, X, V, II, or I -circulating inhibitors

Question 554

Interpretation of PT/APTT: -PT = prolonged -APTT = Normal Possible deficiency?

Answer 554

VII

Question 555

Interpretation of PT/APTT: -PT = Normal -APTT = Prolonged Possible deficiency?

Answer 555

-HMWK (Fitzgerald factor) -PK (Fletcher factor) -XII -XI -IX -VIII

Question 556

Interpretation of PT/APTT: -PT = Prolonged -APTT = Prolonged Possible deficiency?

Answer 556

X, V, II, I

Question 557

Other coagulation tests - mixing studies

Answer 557

-follow up to abnormal PT or APTT -test is repeated on 1:1 mixture of patient plasma & normal plasma -if patient has factor deficiency, time will be corrected because normal plasma supplies missing factor -if time is not corrected, an inhibitor is present, e.g., antibody or anticoagulant

Question 558

Other coagulation tests - Activated clotting time (ACT)

Answer 558

-whole blood clotting method using point-of-care analyzer -often used with cardiac surgery to monitor heparin

Question 559

Other coagulation tests - Thrombin time (TT)

Answer 559

-measures time required for thrombin to convert fibrinogen -prolonged with hypo- or dysfibrinogenemia, heparin, fibrin(ogen) degradation products (FDP)

Question 560

Other coagulation tests - Reptilase time

Answer 560

-similar to TT except uses reptilase (snake venom enzyme) instead of thrombin -prolonged results with afibrinogenemia & most congenital dysfibrinogenemias -variable results with hypofibrinogenemia

Question 561

Other coagulation tests - Fibrinogen

Answer 561

-estimation of fibrinogen level by modified TT -thrombin added to dilution of patient plasma -results obtained from calibration curve prepared from testing dilutions of fibrinogen standard -Normal: 200-400 mg/dL

Question 562

Other coagulation tests - Factor assays

Answer 562

-% of factor activity determined by amount of correction of PT or APTT when dilutions of patient plasma are added to factor-deficient plasma

Question 563

Other coagulation tests - Factor XIII screening test

Answer 563

-patient's platelet-rich plasma mixed with CaCl2 -clot placed in urea or monochloroacetic acid & incubated at 37*C -clots from individuals with normal factor XIII are stable for at least 24 hours, while in factor XIII deficiency, clot dissolves rapidly

Question 564

Other coagulation tests - Anti-Factor Xa assay

Answer 564

-test to measure therapy with low molecular weight heparin (LMWH) -can also be used instead of APTT to monitor therapy with UFH -patient plasma added to excess factor Xa & substrate specific factor Xa -Heparin in sample forms complex with AT & inhibits factor Xa -residual factor Xa cleaves substrate to produce colored product whose intensity is inversely proportional to concentration of heparin

Question 565

Other coagulation tests - Thromboelastography (TEG)

Answer 565

-citrated whole blood using POCT analyzer -measures the strength of a clot using a torsion wire

Question 566

Coagulation disorders - Hemophilia A - deficiency

Answer 566

Factor VIII

Question 567

Coagulation disorders - Hemophilia A - clinical findings

Answer 567

varies from asymptomatic to crippling bleeding into joints, muscles, & fatal intracranial hemorrhage

Question 568

Coagulation disorders - Hemophilia A - laboratory findings

Answer 568

PLT: normal PT: normal APTT: increased Factor VIII: decreased

Question 569

Coagulation disorders - Hemophilia A - inheritance

Answer 569

-sex-linked recessive -occurs primarily in males -mothers are carriers

Question 570

What is the 2nd most common inherited bleeding disorder?

Answer 570

Hemophilia A

Question 571

Coagulation disorders - Hemophilia B (Christmas disease) - deficiency

Answer 571

Factor IX

Question 572

Coagulation disorders - Hemophilia B (Christmas disease) - clinical findings

Answer 572

varies from asymptomatic to crippling bleeding into joints, muscles, & fatal intracranial bleeding

Question 573

Coagulation disorders - Hemophilia B (Christmas disease) - laboratory findings

Answer 573

PLT: normal PT: normal APTT: increased Factor IX: decreased

Question 574

Coagulation disorders - Factor XIII deficiency - deficiency

Answer 574

Factor XIII

Question 575

Coagulation disorders - Factor XIII deficiency - clinical findings

Answer 575

-poor wound healing -keloid formation

Question 576

Coagulation disorders - Factor XIII deficiency - laboratory findings

Answer 576

PT: normal APTT: normal Screen for with 5 mol/Urea test

Question 577

Coagulation disorders - Factor XIII deficiency - why is it unique?

Answer 577

because Factor XIII is a transglutaminase not a protease

Question 578

Coagulation disorders - Hemophilia B (Christmas disease) - inheritance

Answer 578

sex-linked recessive

Question 579

Acquired factor deficiencies - liver disease

Answer 579

coagulation proteins are synthesized in the liver

Question 580

Acquired factor deficiencies - vitamin K deficiency

Answer 580

vitamin K is needed for synthesis of II, VII, IX, X

Question 581

Acquired factor deficiencies - DIC

Answer 581

-uncontrolled formation & lysis of fibrin in blood vessels -fibrinogen, II, V, VIII, XIII, & plts are consumed

Question 582

Acquired factor deficiencies - primary fibrinolysis (fibrinogenolysis)

Answer 582

-plasminogen activated to plasmin; degrades fibrinogen, V, VIII, XIII -no fibrin formation

Question 583

Acquired factor deficiencies - acquired inhibitors (circulating anticoagulants)

Answer 583

-antibodies against coagulation factors -inhibitors to VIII & IX are most common & usually in patients who have received replacement therapy for hemophilia A or B -occasionally associated with other diseases or in normal individuals

Question 584

Tests of fibrinolytic system - D-dimer - explanation

Answer 584

fragment that results from lysis of fibrin by plasmin

Question 585

Tests of fibrinolytic system - D-dimer - method(s)

Answer 585

-latex agglutination using monoclonal antibodies against D-dimer -ELISA

Question 586

Tests of fibrinolytic system - D-dimer - clinical significance

Answer 586

-marker for DIC -also positive with deep vein thrombosis, pulmonary embolism, & after lytic therapy -negative in primary fibrinolysis

Question 587

Tests of fibrinolytic system - FDP - explanation

Answer 587

product of action of plasmin on fibrin or fibrinogen

Question 588

Tests of fibrinolytic system - FDP - method(s)

Answer 588

latex agglutination using antibodies against FDP

Question 589

Tests of fibrinolytic system - FDP - clinical significance

Answer 589

-sign of increased fibrinolytic activity -doesn't differentiate between fibrin degradation products & fibrinogen degradation products -present in DIC, primary fibrinolysis, deep vein thrombosis, pulmonary embolism, & after lytic therapy

Question 590

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - PT

Answer 590

DIC: prolonged Primary fibrinolysis: prolonged

Question 591

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - APTT

Answer 591

DIC: prolonged Primary fibrinolysis: prolonged

Question 592

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - Fibrinogen

Answer 592

DIC: decreased Primary fibrinolysis: decreased

Question 593

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - Platelets

Answer 593

DIC: decreased Primary fibrinolysis: normal

Question 594

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - FDP

Answer 594

DIC: present Primary fibrinolysis: present

Question 595

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - D-dimer

Answer 595

DIC: positive Primary fibrinolysis: negative

Question 596

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - RBC morphology

Answer 596

DIC: schistocytes Primary fibrinolysis: normal

Question 597

Tests to assess risk of thrombosis (hypercoagulability assessment) - Antithrombin (AT) - significance

Answer 597

-plasma inhibitor that neutralizes all serine proteases, including thrombin -deficiences associated with increased risk of thrombosis

Question 598

Tests to assess risk of thrombosis (hypercoagulability assessment) - Antithrombin (AT) - assays

Answer 598

-chromogenic substrate assay -immunologic assay -nephelometry for AT concentration

Question 599

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein C - significance

Answer 599

-coagulation inhibitor -inactivates Va & VIIIa -deficiencies associated with increased risk of thrombosis

Question 600

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein C - assays

Answer 600

-immunologic assa -chromogenic substrate assay -clot-based assay

Question 601

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein S - significance

Answer 601

cofactor for protein C

Question 602

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein S - assays

Answer 602

-clotting assay -immunologic assay

Question 603

Tests to assess risk of thrombosis (hypercoagulability assessment) - Factor V Leiden - significance

Answer 603

-most common cause of hereditary activated protein C resistance (APC) -mutation that makes V resistant to activity of activated protein C -increased risk of thrombosis

Question 604

Tests to assess risk of thrombosis (hypercoagulability assessment) - Factor V Leiden - assays

Answer 604

-APC resistance assays is most frequent screening test -patient plasma diluted in V-deficient plasma -activated protein C added -APTT or dilute Russell viper venom time (dRVVT) performed -abnormals must be confirmed by molecular testing (e.g., PCR, restriction fragment length polymorphism)

Question 605

Tests to assess risk of thrombosis (hypercoagulability assessment) - Lupus anticoagulants - significance

Answer 605

-risk factor for thrombosis & recurrent spontaneous abortion -acquired antiphospholipid antibodies that interact with phospholipid in APTT reagent & prolong time -in vitro phenomenon -patient doesn't have factor deficiency or bleeding -present in patients with lupus, other autoimmune diseases, neoplasms, infections, drugs -also present in some normal individuals

Question 606

Tests to assess risk of thrombosis (hypercoagulability assessment) - Lupus anticoagulants - assays

Answer 606

-detected by unexplained prolongation of APTT that isn't corrected by addition of equal volume of normal plasma -no definitive assay

Question 607

Tests to assess risk of thrombosis (hypercoagulability assessment) - HIT - significance

Answer 607

antibodies form against heparin-platelet factor 4 complex, which causes thrombocytopenia and thrombosis via platelet activation

Question 608

Tests to assess risk of thrombosis (hypercoagulability assessment) - HIT - assays

Answer 608

functional assays to measure platelet activation or aggregation as well as immunoassays to detect heparin-platelet factor 4 antibodies

Question 609

Antithrombic therapy - Coumadin (Warfarin) - administration

Answer 609

oral

Question 610

Antithrombic therapy - Coumadin (Warfarin) - action

Answer 610

vitamin K antagonist

Question 611

Antithrombic therapy - Coumadin (Warfarin) - effect

Answer 611

slow acting

Question 612

Antithrombic therapy - Coumadin (Warfarin) - duration

Answer 612

long

Question 613

Antithrombic therapy - Coumadin (Warfarin) - test(s) for

Answer 613

PT and INR

Question 614

Antithrombic therapy - Coumadin (Warfarin) - decreases production of

Answer 614

II, VII, IX, X

Question 615

Antithrombic therapy - UFH - administration

Answer 615

IV

Question 616

Antithrombic therapy - UFH - action

Answer 616

catalyzes inhibition of thrombin, Xa, & IXa by AT

Question 617

Antithrombic therapy - UFH - effect

Answer 617

immediate

Question 618

Antithrombic therapy - UFH - duration

Answer 618

short

Question 619

Antithrombic therapy - UFH - test(s) for

Answer 619

-APTT -anti-factor Xa (colorimetric assay where amount of free Xa is inversely proportional to the heparin concentration - more accurate than APTT)

Question 620

Antithrombic therapy - UFH - requires what to be effective?

Answer 620

AT

Question 621

Antithrombic therapy - LMWH - administration

Answer 621

subcutaneous

Question 622

Antithrombic therapy - LMWH - action

Answer 622

catalyzes inhibition of Xa by AT

Question 623

Antithrombic therapy - LMWH - effect

Answer 623

immediate

Question 624

Antithrombic therapy - LMWH - duration

Answer 624

longer than UFH; shorter than Warfarin

Question 625

Antithrombic therapy - LMWH - test(s) for

Answer 625

-monitoring usually not required -if needed, anti-factor Xa should be used

Question 626

Antithrombic therapy - LMWH - APTT

Answer 626

insensitive to LMWH

Question 627

Antithrombic therapy - Aspirin (antiplatelet drug) - administration

Answer 627

oral

Question 628

Antithrombic therapy - Aspirin (antiplatelet drug) - action

Answer 628

inhibits COX enzyme & the formation of TXA2

Question 629

Antithrombic therapy - Aspirin (antiplatelet drug) - effect

Answer 629

immediate

Question 630

Antithrombic therapy - Aspirin (antiplatelet drug) - duration

Answer 630

effect on platelets lasts for the entire platelet lifespan

Question 631

Antithrombic therapy - Aspirin (antiplatelet drug) - test(s) for

Answer 631

-platelet aggregation -VerifyNow/PFA-100 POCT devices

Question 632

Antithrombic therapy - Aspirin (antiplatelet drug) - complication

Answer 632

immune-mediated complication associated with HIT suspected with a reduction in platelet count by 40% of baseline along with lack of patient response to heparin; therapy must be stopped immediately

Question 633

Coagulation instrumentation - endpoint detection - mechanical - principle

Answer 633

change in electrical conductivity between 2 probes or change in movement of steel ball when clot forms

Question 634

Coagulation instrumentation - endpoint detection - photometric - principle

Answer 634

-turbidity: decrease in light transmittance as fibrin forms -nephelometry: increased side and forward scatter as clot forms (quantitative)

Question 635

Coagulation instrumentation - endpoint detection - chromogenic - principle

Answer 635

increase in light absorbance at 405 nm as para-nitroaniline (pNA) is cleaved from synthetic substrate by coagulation enzyme

Question 636

Coagulation instrumentation - endpoint detection - immunologic - principle

Answer 636

increase in light absorbance as latex particles coated with specific antibody are agglutinated by antigen

Question 637

Sources of error in coagulation testing - incorrect anticoagulant

Answer 637

-3.2% sodium citrate should be used -labile factors are preserved better

Question 638

Sources of error in coagulation testing - drawing coagulation tube after other anticoagulant tubes

Answer 638

contamination with other anticoagulants can interfere

Question 639

Sources of error in coagulation testing - probing to find vein

Answer 639

tissue thromboplastin activates coagulation & decreases times

Question 640

Sources of error in coagulation testing - incorrect ratio of blood to anticoagulant

Answer 640

-need 9:1 blood to anticoagulant ratio -tubes <90% full will have longer times

Question 641

Sources of error in coagulation testing - failure to mix anticoagulant with blood

Answer 641

blood will clot

Question 642

Sources of error in coagulation testing - polycythemia

Answer 642

HCT >55% leads to longer times - anticoagulant must be reduced

Question 643

Sources of error in coagulation testing - heparin contamination from catheter or heparin lock

Answer 643

-will prolong times -lines must be flushed with saline, first 5 mL drawn discarded

Question 644

Sources of error in coagulation testing - hemolysis

Answer 644

-hemolyzed RBCs may activate clotting factors -hemolysis may interfere with photometric reading

Question 645

Sources of error in coagulation testing - lipemia

Answer 645

-may interfere with optical methods -test by mechanical method

Question 646

Sources of error in coagulation testing - improper storage of specimen

Answer 646

-should be stored in vertical position at RT with stopper on to prevent change in pH -specimens for PT must be tested within 24 hours of collection, APTT within 4 hours (if APTT is for monitoring heparin, must be centrifuged within 1 hour of collection)

Question 647

Sources of error in coagulation testing - improper storage or reconstitution of reagents

Answer 647

run normal & abnormal controls every 8 hours & with each change of reagents to verify system performance

Question 648

Sources of error in coagulation testing - equipment malfunction (e.g., temperature, timer, detector, volumes dispensed)

Answer 648

run normal & abnormal controls every 8 hours & with each change of reagents to verify system performance

Question 649

In which age group would 60% lymphocytes be a normal finding? A. At birth B. 1-3 years C. 8-13 years D. 40-60 years

Answer 649

B. 1-3 years

Question 650

All of the following occur as an RBC matures EXCEPT: A. Size of cell becomes smaller B. Cytoplasm turns pink due to formation of hemoglobin C. The N:C ratio increases D. The nucleus is extruded by mature phase

Answer 650

C. The N:C ratio increases

Question 651

During hemoglobin electrophoresis, at a pH of 8.6, which of the following hemoglobins migrated to the same position as hemoglobin A2? A. Hemoglobin H B. Hemoglobin F C. Hemoglobin S D. Hemoglobin C

Answer 651

D. Hemoglobin C

Question 652

If a patient has had a splenectomy, which of the following RBC inclusions will most likely be observed on a peripheral blood smear? A. Basophilic stippling B. Heinz bodies C. Howell-Jolly bodies D. Reticulocytes

Answer 652

C. Howell-Jolly bodies

Question 653

In which hypochromic, microcytic anemia do patients have little or no hemoglobin A produced? A. Thalassemia major B. Thalassemia minor C. Iron deficiency anemia D. Anemia of chronic infection

Answer 653

A. Thalassemia major

Question 654

Which of the following is associated with hemoglobin C disease? A. 35-45% hemoglobin S B. Target cells C. Nucleated nRBCs D. Increased osmotic fragility

Answer 654

B. Target cells

Question 655

Iron deficiency anemia is characterized by which set of laboratory values? A. Decreased serum iron, increased TIBC, & decreased ferritin B. Increased serum iron, increased TIBC, & increased ferritin C. Decreased serum iron, decreased TIBC, & decreased ferritin D. Decreased serum iron, increased TIBC, & increased ferritin

Answer 655

A. Decreased serum iron, increased TIBC, & decreased ferritin

Question 656

CML can be differentiated from leukemoid reaction by: A. CML will have high WBC count whereas leukemoid reaction will have low WBC count B. CML will have low LAP whereas leukemoid reaction will have high LAP C. CML will have high LAP whereas leukemoid reaction will have low LAP D. The Philadelphia chromosome will only be found in leukemoid reaction

Answer 656

B. CML will have low LAP whereas leukemoid reaction will have high LAP

Question 657

Which coagulation factors would be deficient in someone with vitamin K deficiency? A. II B. VII C. X D. All of the above

Answer 657

D. All of the above

Question 658

Which of the following is TRUE of hemophilia A? A. Associated with factor X deficiency B. Patients would have prolonged APTT and normal PT C. Patients with hemophilia A have abnormal platelet function D. Patients would have a prolonged PT and a normal APTT

Answer 658

B. Patients would have prolonged APTT and normal PT