*Medical Laboratory Science Review - Harr - Hematology

Insufficient centrifugation will result in:

A Insufficient centrifugation does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.

It is the last stage of erythrocyte maturation wherein the cell is capable of undergoing Mitosis and it is the stage in which pink color becomes visible.

Rubricyte

Erythrocyte maturation stage wherein salmon pink color becomes apparent.

Metarubricyte

Erythrocyte maturation stage wherein nucleus disappears

Reticulocyte

Type of myelobast that shows the presence of azurophilic granules

Type 2

Neutrophil development stage which forms a para nuclear halo or what we call “hof”

Promyelocyte

Give the three pools of developing neutrophils in the bone marrow

1. Stem cell pool

2. Mitotic (proliferation) pool

3. Maturation (storage) pool

Give the four types of neutrophil granules

1. Primary (azurophilic) granules - Last to be released

2. Secondary (specific) granules - 3rd to be released

3. Tertiary (gelatinase) granules - 2nd to be released

4. Secretory granules - 1st to be released

What do you call the macrophage found in the following:

A. Liver

B. Lungs

C. Brain

D. Skin

E. Spleen

F. Intestine

G. Peritoneum

H. Bone

I. Synovial marophage

J. Kidney

K. Lymph nodes

A. Kupffer cells

B. Alveolar macrophages

C. Microglia

D. Langerhans cells

E. Splenic macrophage

F. Intestinal macrophage

G. Peritoneal macrophage

H. Osteoclasts

I. Type A cells

J. Renal macrophages

K. Dendritic cells

French-American-British Classification of Acute Myeloid Leukemia

• M0

• M2

• M3

• M4

• M4eo

• M5a

• M5b

• M6

• M7

• M0

(Acute myeloid leukemia, minimally differentiated)

• M1

(Acute myeloid Leukemia, without maturation)

• M2

(Acute myeloid leukemia with maturation)

• M3

(Acute promyelocyte leukemia)

• M4

(Acute myelomonocytic leukemia)

• M4eo

(Acute myelomonocytic leukemia with eosinophilia)

• M5a

(Acute monocytic leukemia, poorly differentiated)

• M5b

(Acute monocytic leukemia, well-differentiated)

•M6

(Acute erythroleukemia)

• M7

(Acute megakaryocytic leukemia)

Variation in red cell size observed on the peripheral smear is described as:

A A mature erythrocyte is approximately 7-8 μm in diameter. Variation in normal size is denoted by the term anisocytosis. Hypochromia is a term that indicates increased central pallor in erythrocytes, and poikilocytosis denotes variation in red cell shape.

Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult?

A The iliac crest is the most frequently used site for one marrow aspiration and biopsy. This site is the safest and most easily accessible, with the bone just beneath the skin, and neither blood vessels nor nerves are in the vicinity.

Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult?

A The iliac crest is the most frequently used site for one marrow aspiration and biopsy. This site is the safest and most easily accessible, with the bone just beneath the skin, and neither blood vessels nor nerves are in the vicinity.

Mean cell volume (MCV) is calculated using the following formula:

B MCV is the average "volume" of the red cells. This is obtained by dividing the Hct or packed cell volume PCV) by the red blood cell (RBC) count in millions per microliter of blood and multiplying by 10. The MCV is expressed in cubic microns (μm3) or femtoliters (fL).

Calculate the mean cell hemoglobin concentration (MCHC) using the following values:

Hgb: 15 g/dL (150 g/L)

Hct: 47 mL/dL (0.47)

RBC: 4.50 × 106/μL (4.50 × 1012/L)

C MCHC is the average concentration of Hgb in red cells expressed as a percentage. It expresses the ratio of the weight of Hgb to the volume of erythrocytes and is calculated by dividing Hgb by the Hct, and then multiplying by 100. A decreased MCHC indicates that cells are hypochromic. In this example, (15 ÷ 47) × 100 = 31.9%. The reference range for MCHC is 32%-36%.

Calculate the mean cell hemoglobin concentration (MCHC) using the following values:

Hgb: 15 g/dL (150 g/L)

Hct: 47 mL/dL (0.47)

RBC: 4.50 × 106/μL (4.50 × 1012/L)

C MCHC is the average concentration of Hgb in red cells expressed as a percentage. It expresses the ratio of the weight of Hgb to the volume of erythrocytes and is calculated by dividing Hgb by the Hct, and then multiplying by 100. A decreased MCHC indicates that cells are hypochromic. In this example, (15 ÷ 47) × 100 = 31.9%. The reference range for MCHC is 32%-36%.

When an erythrocyte containing iron granules is stained with Prussian blue, the cell is called a:

D Siderocytes are red cells containing iron granules and are visible when stained with Prussian blue.

A 7.0-mL ethylenediaminetetraacetic acid (EDTA) tube is received in the laboratory containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the following tests will most likely be erroneous?

C Excessive anticoagulant causes shrinkage of cells; thus, the Hct will be affected. RBC and WBC counts remain the same, as does the Hgb content.

A 1:200 dilution of a patient's sample was made and 336 red cells were counted in an area of 0.2 mm2. What is the RBC count?

B RBC count = number of cells counted × dilution factor × depth factor (10), divided by the area. In this example, 336 × 200 × 10 = 672,000 ÷ 0.2 = 3.36 × 106/mm3 = 3.36 × 1012/L.

What phagocytic cells produce lysozymes that are bacteriocidal?

D Neutrophils are highly phagocytic and release lysozymes, peroxidase, and pyrogenic proteins. Eosinophils migrate to sites where there is an allergic reaction or parasitic infestation, releasing peroxidase, pyrogens, and other enzymes, including in oxidase that neutralizes histamine. They are poorly phagocytic and do not release lysozyme.

If a patient has a reticulocyte count of 7% and an Hct of 20%, what is the corrected reticulocyte count?

B In anemic states, the reticulocyte percentage is not a true measure of reticulocyte production. The following formula must be applied to calculate the corrected (for anemia) reticulocyte count. Corrected reticulocyte count = reticulocytes (%) × Hct ÷ 45, the average normal Hct. In this case, 7 × (20 ÷ 45) = 3.1.

A decreased OSMOTIC FRAGILITY TEST would be associated with which of the following conditions?

A Osmotic fragility is decreased when numerous sickle cells and target cells are present and is increased in the presence of spherocytes. Spherocytes are a prominent feature of hereditary spherocytosis (HS), hemolytic disease of the newborn, and acquired hemolytic anemia. The osmotic fragility test is increased in the presence of spherocytes, whereas this test is decreased when sickle cells, target cells, and other poikilocytes are present.

What effect would using a buffer at pH 6.0 have on a Wright's-stained smear?

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

What effect would using a buffer at pH 6.0 have on a Wright's-stained smear?

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

A falsely elevated Hct is obtained. Which of the following calculated values will not be affected?

B The MCH = Hgb × 10/RBC count and is not affected by the Hct. The MCV = Hct × 10/RBC count, and MCHC = Hgb × 100/Hct; therefore, an erroneous Hct will affect these parameters. Centrifugal force for microhematocrit determination should be 12,000 g for 5 min in order to avoid error caused by trapped plasma. The red cell distribution width (RDW) is calculated by electronic cell counters and reflects the variance in the size of the red cell population. Electronic cell counters calculate Hct from the MCV and RBC count. Therefore, the RDW would be affected by an erroneous MCV.

A Miller disk is an ocular device used to facilitate counting of:

B The manual reticulocyte count involves the counting of 1,000 RBCs. The Miller disk is a reticle (grid) that is placed in the eyepiece of the microscope and divides the field into two squares, one being nine times larger in size than the other. Reticulocytes are enumerated in both the squares. Mature red cells are counted in the smaller one.

SITUATION: RBC indices obtained on an anemic patient are as follows: MCV 88 μm3 (fL); MCH 30 pg; MCHC 34% (.340). The RBCs on the peripheral smear would appear:

C The MCV, MCH, and MCHC are all within the reference interval (normal range); hence, the erythrocytes should be of normal size and should reflect normal concentrations of Hgb. Therefore, the anemia is normocytic normochromic.

All of the following factors may influence the erythrocyte sedimentation rate (ESR) except:

A EDTA and sodium citrate can be used without any effect on the ESR. Anisocytosis and poikilocytosis may impede rouleaux formation, thus causing a low ESR. Plasma proteins, especially fibrinogen and immunoglobulins, enhance rouleaux, increasing the ESR. Reference ranges must be established for different caliber tubes.

What staining method is used most frequently to stain and manually count reticulocytes?

B The reticulum within the reticulocytes consists of ribonucleic acid (RNA), which cannot be stained with Wright's stain. Supravital staining with new methylene blue is used to identify the reticulocytes.

The Coulter principle for counting of cells is based upon the fact that:

A Electronic cell (Coulter) counters use the principle of electrical impedance. Two electrodes suspended in isotonic solutions are separated by a glass tube having a small aperture. A vacuum is applied, and as a cell passes through the aperture it impedes the flow of current and generates a voltage pulse.

A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because:

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

A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because:

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

Given the following values, which set of red blood cell indices suggests spherocytosis?

C Spherocytes have a decreased cell diameter and volume, which results in loss of central pallor and discoid shape. The index most affected is the MCHC, usually being in excess of 36%

Which of the following statistical terms reflects the best index of precision when comparing two CBC parameters?

C Standard deviation(s) describes the distribution of a sample of observations. It depends upon both the mean (average value) and dispersion of results and is most influenced by reproducibility or precision. Because s is influenced by the mean and expressed as a percentage of the mean, the coefficient of variation ([s ÷ mean] × 100) can be used to compare precision of tests with different means (e.g., WBC and RBC counts or low vs. high controls).

Which of the following is considered a normal hemoglobin?

D Deoxyhemoglobin is the physiological Hgb that results from the unloading of oxygen by Hgb. This is accompanied by the widening of the space between β-chains and the binding of 2,3-diphosphoglycerate (2,3-DPG) on a mole-for-mole basis.

Which condition will shift the oxyhemoglobin dissociation curve to the right?

A Acidosis is associated with a shift to the right of the oxyhemoglobin dissociation curve and, therefore, increased oxygen release (decreased affinity of Hgb for oxygen). Alkalosis does the opposite. Multiple blood transfusions shift the curve to the left because the transfused blood is low in 2,3-DPG. Hgb S and Hgb C do not change the affinity of oxygen for hemoglobin; however, many hemoglobinopathies do. For example, Hgb Kansas causes a right shift and Hgb Chesapeake causes a left shift of the oxyhemoglobin dissociation curve.

What is the major type of leukocyte seen in the peripheral smear of a patient with aplastic anemia?

B Lymphocytes constitute the majority of the nucleated cells seen. The bone marrow in aplastic anemia is spotty with patches of normal cellularity. Absolute granulocytopenia is usually present; however, lymphocyte production is less affected.

What is the normal WBC differential lymphocyte percentage (range) in the adult population?

C The normal adult percentage of lymphocytes in a white cell differential is between 20% and 44%, although normal ranges vary by institution, patient population, and testing methodology. This range is higher in the pediatric population.

In which age group would 60% lymphocytes be a normal finding?

A There is a relative neutropenia in children from ages 4 months to 4 years. Because of this, the percentage of lymphocytes is increased in this population. This is commonly referred to as a reversal in the normal differential percentage (or inverted differential)./

Which of the following results on an automated differential suggests that a peripheral smear should be reviewed manually?

A. Segs = 70%

B. Band = 6%

C. Mono = 15%

D. Eos = 2% C A relative monocyte count of 15% is abnormal, given that the baseline monocyte count in a normal differential is between 1% and 8%. An increased monocyte count may signal a myeloproliferative process such as chronic myelomonocytic leukemia, an inflammatory response, or abnormal lymphocytes that may have been counted as monocytes by an automated cell counter.

Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to the formation of hemoglobin?

D In normal erythrocytic maturation, Hgb formation in the late polychromatic normoblast stage gives the cytoplasm a prominent pink coloration. The red cell continues to produce Hgb throughout the reticulocyte stage of development.

Which of the following Hgb configurations is characteristic of Hgb H?

C The structure of Hgb H is β4. Hgb H disease is a severe clinical expression of α-thalassemia in which only one α-gene out of four is functioning.

Which of the following Hgb configurations is characteristic of Hgb H?

C The structure of Hgb H is β4. Hgb H disease is a severe clinical expression of α-thalassemia in which only one α-gene out of four is functioning.

Autoagglutination of red cells at room temperature can cause which of the following abnormal test results?

A. Low RBC count

B. High MCV

C. Low hematocrit

D. All of these options

D Autoagglutination at room temperature may cause a low RBC count and high MCV from an electronic counter. The Hct will be low because it is calculated from the RBC count. Low RBC count and low Hct cause falsely high calculations of MCH and MCHC, respectively

Hypersplenism is characterized by:

C Hypersplenic conditions are generally described by the following four criteria: (1) cytopenias of one or more peripheral cell lines, (2) splenomegaly, (3) bone marrow hyperplasia, and (4) resolution of cytopenia by splenectomy

Which of the following organs is responsible for the "pitting process" for RBCs?

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

Spherocytes differ from normal red cells in all of the following except:

A. Decreased surface to volume

B. No central pallor

C. Decreased resistance to hypotonic saline

D. Increased deformability

D Spherocytes lose their deformability owing to the defect in spectrin, a membrane protein, and are therefore prone to splenic sequestration and hemolysis.

Which of the following is not associated with hereditary spherocytosis?

A. Increased osmotic fragility

B. An MCHC greater than 36%

C. Intravascular hemolysis

D. Extravascular hemolysis

C Classic features of intravascular hemolysis such as hemoglobinemia, hemoglobinuria, or hemosiderinuria do not occur in hereditary spherocytosis. The hemolysis seen in hereditary spherocytosis is an extravascular rather than an intravascular process.

Which of the following disorders has an increase in osmotic fragility?

A. Iron deficiency anemia

B. Hereditary elliptocytosis

C. Hereditary stomatocytosis

D. Hereditary spherocytosis

D Spherocytic cells have decreased tolerance to swelling and, therefore, hemolyze at a higher concentration of sodium salt compared with normal red cells.

The anemia seen in sickle cell disease is usually:

A. Microcytic, normochromic

B. Microcytic, hypochromic

C. Normocytic, normochromic

D. Normocytic, hypochromic

C Sickle cell disease is a chronic hemolytic anemia classified as a normocytic, normochromic anemia.

Which is the major Hgb found in the RBCs of patients with sickle cell trait?

D The major hemoglobin in sickle cell trait is Hgb A, which constitutes 50%-70% of the total. Hgb S comprises 20%-40%, and Hgb A2 and Hgb F are present in normal amounts.

Select the amino acid substitution that is responsible for sickle cell anemia.

B The structural mutation for Hgb S is the substitution of valine for glutamic acid at the sixth position of the β-chain. Because glutamic acid is negatively charged, this decreases its rate of migration toward the anode at pH 8.6.

All of the following are usually found in Hgb C disease except:

A. Hgb C crystals

B. Target cells

C. Lysine substituted for glutamic acid at the sixth position of the β-chain

D. Fast mobility of Hgb C at pH 8.6

D Substitution of a positively charged amino acid for a negatively charged amino acid in Hgb C disease results in a slow electrophoretic mobility at pH 8.6.

Which of the following hemoglobins migrates to the same position as Hgb A2 at pH 8.6?

C At pH 8.6, several hemoglobins migrate together. These include Hgb A2, Hgb C, Hgb E, Hgb 0Arab, and Hgb CHarlem. These are located nearest the cathode at pH 8.6.

Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?

A. Hgb A: 40% Hgb S: 35% Hgb F: 5%

B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%

C. Hgb A: 0% Hgb A2: 5% Hgb F: 95%

D. Hgb A: 80% Hgb S: 10% Hgb A2: 10%

B Electrophoresis at alkaline pH usually shows 50%- 70% Hgb A, 20%-40% Hgb S, and normal levels of Hgb A2 in a patient with the sickle cell trait.

Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?

A. Hgb A: 40% Hgb S: 35% Hgb F: 5%

B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%

C. Hgb A: 0% Hgb A2: 5% Hgb F: 95%

D. Hgb A: 80% Hgb S: 10% Hgb A2: 10%

B Electrophoresis at alkaline pH usually shows 50%- 70% Hgb A, 20%-40% Hgb S, and normal levels of Hgb A2 in a patient with the sickle cell trait.

Which of the following is most true of paroxysmal nocturnal hemoglobinuria (PNH)?

A PNH is a rare acquired stem cell disorder that results in abnormalities of the red cell membrane. This causes the red cells to be highly sensitive to complement-mediated hemolysis. Because this is a stem cell disorder, abnormalities are seen in leukocytes and platelets, as well as in red cells. PNH is characterized by recurrent, episodic intravascular hemolysis, hemoglobinuria, and venous thrombosis.

Hemolytic uremic syndrome (HUS) is characterized by all of the following except:

A. Hemorrhage

B. Thrombocytopenia

C. Hemoglobinuria

D. Reticulocytopenia

D The hemolytic anemia of HUS is associated with reticulocytosis. The anemia seen in HUS is multifactorial, with characteristic schistocytes and polychromasia commensurate with the anemia.

An autohemolysis test is positive in all the
following conditions except:

A. Glucose-6-phosphate dehydrogenase (G6PD) deficiency

B. Hereditary spherocytosis (HS)

C. Pyruvate kinase (PK) deficiency

D. Paroxysmal nocturnal hemoglobinuria (PNH)

D The autohemolysis test is positive in G6PD and PK deficiencies and in HS, but is normal in PNH because lysis in PNH requires sucrose to enhance complement binding. The addition of glucose, sucrose, or adenosine triphosphate (ATP) corrects the autohemolysis of HS. Autohemolysis of PK can be corrected by ATP.

Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?

D PCH is caused by the anti-P antibody, a cold autoantibody that binds to the patient's RBCs at low temperatures and fixes complement. In the classic Donath-Landsteiner test, hemolysis is demonstrated in a sample placed at 4°C that is then warmed to 37°C.

All of the following are associated with intravascular hemolysis except:

A. Methemoglobinemia

B. Hemoglobinuria

C. Hemoglobinemia

D. Decreased haptoglobin

A Methemoglobin occurs when iron is oxidized to the ferric state. Normally, iron is predominantly in the ferrous state in the hemoglobin that circulates. During intravascular hemolysis, the red cells rupture, releasing hemoglobin directly into the bloodstream. Haptoglobin is a protein that binds to free Hgb. The increased free Hgb in intravascular hemolysis causes depletion of haptoglobin. As haptoglobin is depleted, unbound hemoglobin dimers appear in the plasma (hemoglobinemia) and are filtered through the kidneys and reabsorbed by the renal tubular cells. The renal tubular uptake capacity is approximately 5 g per day of filtered hemoglobin. Beyond this level, free hemoglobin appears in the urine (hemoglobinuria). Hemoglobinuria is associated with hemoglobinemia.

Autoimmune hemolytic anemia is best characterized by which of the following?

B Spherocytes are characteristic of autoimmune hemolytic anemia and result in an increased osmotic fragility. In autoimmune hemolytic anemias (AIHAs), production of autoantibodies against one's own red cells causes hemolysis or phagocytic destruction of RBCs. A positive direct antiglobulin (DAT or Coombs') test identifies in vivo antibody-coated and complement-coated red cells. A positive DAT distinguishes AIHA from other types of hemolytic anemia that produce spherocytes.

"Bite cells" are usually seen in patients with:

C In patients with G6PD deficiency, the red cells are unable to reduce nicotinamide adenine dinucleotide phosphate (NADP) to NADPH; consequently, Hgb is denatured and Heinz bodies are formed. "Bite cells" appear in the peripheral circulation as a result of splenic pitting of Heinz bodies.

The morphological classification of anemias is based on which of the following?

C RBC indices classify the anemia morphologically. Anemias can be classified morphologically by the use of laboratory data; physiologically, based upon the mechanism; and clinically, based upon an assessment of symptoms.

Which of the following is a common finding in aplastic anemia?

C Aplastic anemia has many causes, such as chemical, drug, or radiation poisoning; congenital aplasia; and Fanconi's syndrome. All result in depletion of hematopoietic precursors of all cell lines, leading to peripheral blood pancytopenia.

Congenital dyserythropoietic anemias (CDAs) are characterized by:

A There are four classifications of CDAs, each characterized by ineffective erythropoiesis, increased unconjugated bilirubin, and bizarre multinucleated erythroid precursors.

Microangiopathic hemolytic anemia is characterized by:

A. Target cells and Cabot rings

B. Toxic granulation and Döhle bodies

C. Pappenheimer bodies and basophilic stippling

D. Schistocytes and nucleated RBCs

D Microangiopathic hemolytic anemia is a condition resulting from shear stress to the erythrocytes. Fibrin strands are laid down within the microcirculation, and red cells become fragmented as they contact fibrin through the circulation process, forming schistocytes. NRBCs are also formed in the process.

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

D Chloramphenicol is the drug most often implicated in acquired aplastic anemia. About half of the cases occur within 30 days after therapy and about half of the cases are reversible. Penicillin, tetracycline, and sulfonamides have been implicated in a small number of cases.

Sickle cell disorders are:

A Sickle cell disorders are intracorpuscular red cell defects that are hereditary and result in defective Hgbs being produced. The gene for sickle cell can be inherited either homozygously or heterozygously.

Which of the following conditions may produce spherocytes in a peripheral smear?

A Sickle cell disorders are intracorpuscular red cell defects that are hereditary and result in defective Hgbs being produced. The gene for sickle cell can be inherited either homozygously or heterozygously.

A patient's peripheral smear reveals numerous NRBCs, marked variation of red cell morphology, and pronounced polychromasia. In addition to a decreased Hgb and decreased Hct values, what other CBC parameters may be anticipated?

C This patient's abnormal peripheral smear indicates marked red cell regeneration, causing many reticulocytes to be released from the marrow. Because reticulocytes are larger than mature RBCs, the MCV will be slightly elevated.

What red cell inclusion may be seen in the peripheral blood smear of a patient postsplenectomy?

B As a result of splenectomy, Howell-Jolly bodies may be seen in great numbers. One of the main functions of the spleen is the pitting function, which allows inclusions to be removed from the red cell without destroying the cell membrane.

What red cell inclusion may be seen in the peripheral blood smear of a patient postsplenectomy?

B As a result of splenectomy, Howell-Jolly bodies may be seen in great numbers. One of the main functions of the spleen is the pitting function, which allows inclusions to be removed from the red cell without destroying the cell membrane.

Hereditary pyropoikilocytosis (HP) is a red cell membrane defect characterized by:

C HP is a membrane defect characterized by a spectrin abnormality and thermal instability. The MCV is decreased and the red cells appear to be budding and fragmented. Answer. Misshapen budding fragmented cells

The osmotic fragility test result in a patient with thalassemia major would most likely be:

B The osmotic fragility is decreased because numerous target cells are present and have increased surface volume in thalassemia major patients.

The osmotic fragility test result in a patient with thalassemia major would most likely be:

B The osmotic fragility is decreased because numerous target cells are present and have increased surface volume in thalassemia major patients.

Iron deficiency anemia may be distinguished from anemia of chronic infection by:

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

Which anemia has red cell morphology similar to that seen in iron deficiency anemia?

B Iron deficiency anemia and thalassemia are both classified as microcytic, hypochromic anemias. Iron deficiency anemia is caused by defective heme synthesis; whereas thalassemia is caused by decreased globin chain synthesis.

B Iron deficiency anemia and thalassemia are both classified as microcytic, hypochromic anemias. Iron deficiency anemia is caused by defective heme synthesis; whereas thalassemia is caused by decreased globin chain synthesis.

Storage iron is usually best determined by:

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

All of the following are associated with sideroblastic anemia except:

A. Increased serum iron

B. Ringed sideroblasts

C. Dimorphic blood picture

D. Increased RBC protoporphyrin

D Sideroblastic anemia has a decreased red cell protoporphyrin. The defect in sideroblastic anemia involves ineffective erythropoiesis. The failure to produce RBC protoporphyrin occurs because the nonheme iron is trapped in the mitochondria and is unavailable to be recycled.

Iron deficiency anemia is characterized by:

C In thalassemia major, there is little or no production of the β-chain, resulting in severely depressed or no synthesis of Hgb A. Severe anemia is seen, along with skeletal abnormalities and marked splenomegaly. The patient is usually supported with transfusion therapy.

What is the basic hematological defect seen in patients with thalassemia major?

C In thalassemia major, there is little or no production of the β-chain, resulting in severely depressed or no synthesis of Hgb A. Severe anemia is seen, along with skeletal abnormalities and marked splenomegaly. The patient is usually supported with transfusion therapy.

A patient has an Hct of 30%, a hemoglobin of 8 g/dL, and an RBC count of 4.0 × 1012/L. What is the morphological classification of this anemia?

A. Normocytic normochromic

B. Macrocytic hypochromic

C. Microcytic hypochromic

D. Normocytic hyperchromic

C The indices will provide a morphological classification of this anemia. The MCV is 75 fL (reference range 80-100 fL), the MCH is 20.0 pg (reference range 27-31 pg), and the MCHC is 26.6% (reference range 32%-36%). Therefore, the anemia is microcytic hypochromic.

In which of the following conditions is Hgb A2 elevated?

C Hgb A2 is part of the normal complement of adult Hgb. This Hgb is elevated in β-thalassemia minor because the individual with this condition has only one normal β-gene; consequently, there is a slight elevation of Hgb A2 and Hgb F.

Which of the following parameters may be similar for the anemia of inflammation and iron deficiency anemia?

B Thirty to fifty percent of the individuals with the anemia of chronic inflammation demonstrate a microcytic hypochromic blood picture with decreased serum iron. Serum iron is decreased because it is unable to escape from the RE cells to be delivered to the nucleated red cells in the bone marrow.

ANSWER. Deceased

Which morphological classification is characteristic of megaloblastic anemia?

D Megaloblastic macrocytic anemia is normochromic because there is no defect in the Hgb synthesis. These anemias comprise a group of asynchronized anemias characterized by defective nuclear maturation due to defective deoxyribonucleic acid (DNA) synthesis. This abnormality accounts for the megaloblastic features in the bone marrow and the macrocytosis in the peripheral blood.

Which anemia is characterized by a lack of intrinsic factor that prevents B12 absorption?

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

All of the following are characteristics of megaloblastic anemia except:

A. Pancytopenia

B. Elevated reticulocyte count

C. Hypersegmented neutrophils

D. Macrocytic erythrocyte indices

B Megaloblastic anemias are associated with an ineffective erythropoiesis and therefore a decrease in the reticulocyte count.

A patient with a vitamin B12 anemia is given a high dosage of folate. Which of the following is expected as a result of this treatment?

Which of the following disorders is associated with ineffective erythropoiesis?

D Ineffective erythropoiesis is caused by destruction of erythroid precursor cells prior to their release from the bone marrow. Pernicious anemia results from defective DNA synthesis; it is suggested that the asynchronous development of red cells renders them more liable to intramedullary destruction.

A 50-year-old patient is suffering from pernicious anemia. Which of the following laboratory data are most likely for this patient?

A. RBC = 2.5 × 1012/L; WBC =12,500/μL (12.5 ×109/L); PLT = 250,000/μL (250 × 109/L)

B. RBC = 4.5 × 1012/L; WBC = 6,500/μL (6.5 ×109/L); PLT = 150,000/μL (150 × 109/L)

C. RBC = 3.0 × 1012/L; WBC = 5,000/μL (5.0 ×109/L); PLT = 750,000/μL (750 × 109/L)

D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 ×109/L); PLT = 50,000/μL (50 × 109/L)

D Patients with pernicious anemia demonstrate a pancytopenia with low WBC, PLT, and RBC counts. Because this is a megaloblastic process and a DNA maturation defect, all cell lines are affected. In the bone marrow, this results in abnormally large precursor cells, maturation asynchrony, hyperplasia of all cell lines, and a low M:E ratio.

Which of the following may be seen in the peripheral blood smear of a patient with obstructive liver disease?

B Patients with obstructive liver disease may have red blood cells that have an increased tendency toward the deposition of lipid on the surface of the red cell. Consequently, the red cells are larger or more macrocytic than normal red cells. Answer. Macrocytes

The macrocytes typically seen in megaloblastic processes are:

A. Crescent-shaped

B. Teardrop-shaped

C. Ovalocytic

D. Pencil-shaped

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

Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias?

A. MCV 99 fl, MCH 28 pg, MCHC 31%

B. MCV 62 fL, MCH 27 pg, MCHC 30%

C. MCV 125 fL, MCH 36 pg, MCHC 34%

D. MCV 78 fL, MCH 23 pg, MCHC 30%

C The red cell indices in a patient with megaloblastic anemia are macrocytic and normochromic. The macrocytosis is prominent, with an MCV ranging from 100 to 130 fL.

Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias?

A. MCV 99 fl, MCH 28 pg, MCHC 31%

B. MCV 62 fL, MCH 27 pg, MCHC 30%

C. MCV 125 fL, MCH 36 pg, MCHC 34%

D. MCV 78 fL, MCH 23 pg, MCHC 30%

C The red cell indices in a patient with megaloblastic anemia are macrocytic and normochromic. The macrocytosis is prominent, with an MCV ranging from 100 to 130 fL.

A patient has 80 nucleated red blood cells per 100 leukocytes. In addition to increased polychromasia on the peripheral smear, what other finding may be present on the CBC?

B The patient will have an increased MCV. One of the causes of a macrocytic anemia that is not megaloblastic is an increased reticulocyte count, here noted as increased polychromasia. Reticulocytes are polychromatic macrocytes; therefore, the MCV is slightly increased.

In a patient with human immunodeficiency virus (HIV) infection, one should expect to see:

C HIV infection brings about several hematological abnormalities seen on peripheral smear examination; most patients demonstrate reactive lymphocytes and have granulocytopenia.

In a patient with human immunodeficiency virus (HIV) infection, one should expect to see:

C HIV infection brings about several hematological abnormalities seen on peripheral smear examination; most patients demonstrate reactive lymphocytes and have granulocytopenia.