Hematology Board Exam

What is the first type of cell produced by the developing embryo?

Erythrocyte

What percentage of tissue located in the bone marrow cavities of adults is fat?

50%

Not characteristic of pluripotent hematopoietic stem cells?

Express the stem cell marker CD13

In an adult, what are the two best areas for obtaining active bone marrow by aspiration?

Posterior iliac crest and sternum

What is the normal ratio of myeloid to erythroid precursors in bone marrow?

4:1

Does not accurately describe hematopoietic growth factors?

Action of majority is lineage restricted

In the third month of gestation, what is the primary site of hematopoiesis?

Liver

The mechanism that relays information about tissue oxygen levels to EPO producing sites is located:

In the kidney

Antigen-independent lymphopoiesis occurs in primary lymphoid tissue located in the:

Thymus and bone marrow

In what area of the bone marrow, does hematopoiesis take place?

Cords

Bone marrow cellularity refers to the ratio of:

Hematopoietic tissue to adipose tissue

Interleukins and colony simulating factors are cytokines produced by:

Monocytes and T lymphocytes

What is the approximate total blood volume in an adult?

6 L

The myeloid progenitor cell can produce cells committed to:

Granulocytic, erythrocytic, monocytic or megakaryocytic lineage

The largest hematopoietic cells in normal bone marrow:

Megakaryocytes

When evaluating a bone marrow aspirate smear, which finding is considered abnormal?

The presence of 10% myeloblasts on the cell differential count

As most blood lines mature what is characteristic?

Nucleus to cytoplasm ratio decreases

Describes TPO:

Hormone produced by the liver that stimulates megakaryopoiesis

When the hepatic phase of fetal life is reactivated in an adult, hematopoiesis can be termed:

Myeloid metaplasia or extramedullary

What is the average life span of a normal red blood cell?

120 days

The function of Na+K+ cation pump is to maintain a high level of:

Intracellular K+

Depicts the structure of the hemoglobin molecule:

Four heme groups, four globin chains

Describes the process known as culling:

Removal of abnormal red cells by the spleen

Hemoglobin forms that are incapable of oxygen transport include:

Carboxyhemoglobin and methemoglobin

The majority of iron found in an adult is a constituent of:

Hemoglobin

A senescent red blood cell is one that has been:

Lived its life span

What red cell morphologic abnormality is described by the term "poikilocytosis"?

Deviations from normal shape

HJ bodies are composed of:

DNA

When spherocytes are reported, what is observed on the peripheral blood smear?

Red cells without a central pallor

The red cells found in lead poisoning characteristically exhibit coarse granules composed of - that are reported as -.

Aggregated ribosomes; basophilic stippling

Rouleaux of red blood cells when seen in the monolayer of a blood smear is characteristic of:

Multiple myeloma

Most frequently associated with HJ bodies:

Post-splenectomy

True about iron absorption:

Absorption increases when erythropoietic activity increases

What term describes a red blood cell that contains iron granules or deposit?

Siderocyte

Associated with a "shift to the left" in the oxygen dissociation curve of hemoglobin?

Decreased oxygen release

Does not characterize EPO:

Decreases stimulation of erythropoiesis when cellular hypoxia increases

Factor will result in an immediate increase in oxygen delivery to the tissues?

Increased hemoglobin binding of 2,3-BPG

Periods of intense erythropoietin activity cause premature release of marrow reticulocytes into the blood. True of early reticulocytes:

Loss of residual RNA occurs immediately upon marrow release

Which inclusion is only visible with supravital staining?

Heinz bodies

The presence of schistocytes on the peripheral blood smear is commonly associated with:

Increased red cell destruction

May be a sign of accelerated bone marrow erythropoiesis:

Nucleated red cells in the peripheral circulation

Microcytic, hypochromic red cells are most often associated with impaired:

Hemoglobin synthesis

When in bone marrow, the nucleated red cells with densely condensed nuclei are:

Orthochromic normoblasts

When acanthocytes are found on the blood smear, it is usually the result of:

Altered membrane lipids

Which erythrocyte metabolic pathway generates ATP via glycolysis?

Embden-Meyerhof

Red blood cell precursor is the last stage to undergo mitosis:

Polychromatophilic normoblast

The major adult hemoglobin requires the synthesis of alpha-globin chains and:

Beta-globin chains

Defective nuclear maturation commonly results in the production of red cells that are:

Macrocytic

The major storage form of iron is:

Ferritin

The red cells observed on a peripheral blood smear have extreme anisocytosis with equal macrocytes and microcytes:

MCV 90.0 fL

RDW 25.0%

Excessive extravascular red cell destruction is associated with:

Bilirubinemia

Which protein is primarily responsible for transport of hemoglobin dimers resulting from intravascular hemolysis?

Haptoglobin

The morphologic abnormality characteristically found in hemoglobinopathies is:

Codocytes

Where do the early and late stages of heme synthesis occur?

In mitochondria

Spectrin is a protein that occupies a major role in:

Red cell membrane structures

What is the function of reduced GSH in the red blood cell?

Neutralizes intracellular oxidants that accumulate

What does the TIBC represent?

Amount of iron that transferrin can bind

Serum ferritin is a good indicator of the amount of:

Storage iron

Fetal hemoglobin differs from adult hemoglobin in that hemoglobin F:

Resists elutio from red cells with acid solutions

Impaired DNA metabolism is characteristic of:

Megaloblastic anemia

Associated with G6PD deficiency:

G6PD gene is located on the X chromosome

In regard to variant hemoglobin E, a2b2 26glu->lys; which is false:

Glutamic acid replaces lysine on position 26 of the beta chains

Elliptocytes with anemia, dizziness, jaundice and mild splenomegaly; DAT negative

An intrinsic hereditary defect of red cells should be suspected

Infant with hepatosplenomegaly, microcytic, hypochromic anemia with high RDW; 97% HgB F

Cooley beta-thalassemia major

Microcytic, normochromic anemia with high RDW; target cells

Hemoglobin SC disease

Pica is most commonly associated with:

Iron deficiency

Leading cause of folate deficiency:

Dietary insufficiency

False about sickle cell syndrome:

Hemoglobin S is more soluble in dithionite than is normal hemoglobin

Not responsible for MAHA red cell destruction:

Idiopathic thrombocytopenic purpura

Which blood findings do not correlate with the presence of ringed sideroblasts in the bone marrow?

Increased TIBC

Not associated with marked reticulocytosis:

Pernicious anemia

Hereditary stomatocytosis is manifested physiologically by changes in:

Membrane cation permeability

In addition to an increase in red blood cells, which is characteristic of polycythemia vera?

Increased platelets, increased granulocytes, decreased EPO

Not characteristic of aplastic anemia:

Extramedullary hematopoiesis

What values would you expect to obtain on hemoglobin and hematocrit determinations done immediately after a major hemorrhage, if hemoglobin and hematocrit values were normal prior to the hemorrhage?

Both normal

Infant with high HCT, HGB, MCV and nucleated reds:

No further testing indicated

Red blood cells with single elongated projection are seen in:

Dacryocytes, myelofibrosis

A patient with normochromic, normocytic anemia secondary to small cell carcinoma may be exhibiting an anemia designated as:

Myelophthisic

Idiopathic aplastic anemia is best defined as a form of anemia that:

Has no identifiable cause

True red cell aplasia:

Diamond-Blackfan anemia

Not a cause of absolute secondary erythrocytosis:

Dehydration secondary to diuretic use

A cellulose acetate hemoglobin electrophoresis, performed on the blood of a stillborn infant revealed a single band that migrated farther toward the anode than did the Hb A control. What is the most likely composition of the hemoglobin? What is the cause of the condition?

Four gamma chains

Hydrops fetalis

Which conditions show similar blood findings?

Folic acid and Vitamin B12 deficiencies

Which test would be useful when determining the cause of spherocytosis?

DAT

Which is not associated with the presence of schistocytes and spherocytes?

Aplastic anemia

High H&H with vomiting suggests

Relative polycythemia

An excessive accumulation of iron in body tissues is called:

Hemochromatosis

Abetalipoproteinemia is characterized by mild anemia and numerous - on the peripheral blood smear.

Acanthocytes

What is the most common cause of iron deficiency?

Bleeding

Which does not characterize beta-thalassemia major?

Decreased alpha chains result in excess beta chains

In the anemia of chronic disease, what are the usual serum iron and transferrin levels?

Serum iron decreased, transferrin decreased

In children, the most important effect of lead poisoning is on the:

Neurologic system

Which would not result in a red cell dual population?

Spleen removal

What genetic defect causes sickled red cells?

Substitution of valine for glutamic acid in position 6 of the beta-globin chain

On what is the classification of sickle cell trait versus sickle cell disease based?

Percentage of hemoglobin S on electrophoresis

Most appropriate treatment for sickle cell anemia:

Supportive therapy

Value which can be used to indicate the presence of a hemolytic anemia:

Reticulocyte count

Microcytic anemia with stippling and target cells; Hemoglobin A2 is 5%

Heterozygous beta-thalassemia

What causes the hemolytic process in G6PD deficiency following oxidant exposure?

Precipitation of denatured hemoglobin

In clinically sever hereditary spherocytosis, which findings would not be found after splenectomy?

Higher number of circulating reticulocytes