Hematology FINAL EXAM LMAOOO

1. The anticoagulant most often used when platelet clumping has occurred is:

sodium citrate

The anticoagulant most often used for cell counting is:

EDTA

1. The main site of hematopoiesis in the fetus from the second to the seventh month is the:

liver

In adulthood, the main site of hematopoiesis is in the:

flat bones and the proximal ends of long bones

. The hematopoietic marrow of the bone is:

red marrow

The main function of the marrow is to:

Is to supply mature hematopoietic cells into the peripheral blood in a steady state condition as well as to respond to increased demands

The erythrocyte stage that marks the beginning of hemoglobinization is called

Polychromatophillic normoblast--rubricyte

A bone biopsy is needed when:

Diagnosis and staging of hematologic disease is needed

Marrow cellularity is determined by comparing:

The percentage of marrow space occupied by hematopoietic cells to the percentage of marrow space occupied by fat

The M:E ratio is determined by dividing the number of:

Nucleated RBCs into the sum of all cells belonging to the granulocytic series

The normal M: E ratio in adults is:

3:1

The RBC membrane is a (n):

The structure that regulates volume and shape

The main integral (extrinsic) protein in the RBC is:

glycophorin

The main peripheral (intrinsic) protein in the RBC is:

spectrin

What is a significant morphologic difference between irreversible sickled cells and reversible sickled cells?

Pointed projections to the sickle cell

Spherocytes and bite cells are evidence of:

membrane loss, G6PD deficiency

. The purpose of the cationic pumps in the RBC are to:

Maintenance of cell volume and shape by pumping Na+ out of cell and K+ into cell

The carrier protein that delivers iron to the RBC membrane is:

transferrin

If one of the normal enzymatic steps in heme synthesis is blocked or deficient, the resultant disorders are called:

porphyrias

. The globin chains that are usually present only during embryonic development are:

epsilon and zeta

All normal adult hemoglobins contain a dimer of which chain?

alpha chains

The RBC organic phosphate 2, 3-DPG (2,3-BPG):

is one of the most important controls of hemoglobin affinity of oxygen—is an inverse relationship between amount of 2,3-DPG available for binding by Hgbb and the affinity for Hgb for O2. Produced via anaerobic glycolytic pathway (Embden-Meyerhof pathway). When Hgb binds to 2,3 DPG, O2 decreases. When plasma level of 2-3, DPG decreases, Hgb 2,3-DPG is released, and Hgb affinity of O2 increases. Adequate oxygenation requires adequate supplies of 2,3-DPG to encourage Hgb to release O2 to tissue

The hemoglobin pigment that cannot be converted to oxyhemoglobin is:

sulfhemoglobin

Ninety percent of the ATP required for RBC energy is produced by the:

Embden-Meyerhof glycolytic pathway

A deficiency in the hexose monophosphate shunt results in:

Heinz bodies

The majority of senescent RBC's are removed from the body by______ hemolysis (catabolism).

Extravascular hemolysis

The growth factor responsible for regulation of RBC production is?

Erythropoietin (EPO)

The RBC precursor that is most plentiful in an aspiration from the normal adult marrow is the:

rubricyte

Reticulocytes may be seen in Wright's stained smears as:

Blue-gray and are referred as polychromatophic

Name one condition that may shift the oxygen dissociation curve to the left.

Increased affinity, increase in blood pH, decrease in CO2, decrease in temperature

The following statement is true of mutations in α thalassemia compared to those ween in β thalassemia:

alpha thalassemias occur as a result of the deletion of one or more globin genes

The packed cell volume is also known as the:

hematocrit

The normal hemoglobin level for people living at high altitudes would be:

increased--higher than the normal given range

Approximately ____ percent of RBC's are replaced daily in the adult

1%

The "rule of three" suggests that:

RBC 3= Hgb 3 = Hct

The anemia of a patient who's MCV=65.1 fL, MHC=22.2pg, and MCHC=0.295 g/L is termed:

microcytic hypochromic

The recommended method for hemoglobin measurement is spectrophotometric absorbance reading of:

540 nm

Which of the following best describes the function of the hexose monophosphate pathway?

Provide reduced glutathione to prevent oxidation of hemoglobin

Body stores of iron are most closely paralleled by serum levels of:

ferritin

Porphyrias are disorders of:

due to a detect in the enzymes in the pathway of heme synthesis

The hematologic parameter that is most sensitive to macrocytosis is:

hematocrit

When reticulocytes are stained with supravital stains, the substance that stains is:

RNA

Hemoglobin in the ferric (Fe 3+) state is called:

methemoglobin

The typical CBC findings in hemolytic anemia include:

Macrocytic, normochromic cells with increased polychromasia

The RBC histogram below is indicative of:

normal

A variation in size of RBCs is termed:

ansiocytosis

A variation of shape of RBCs is termed;

poikilocytosis

A patient's genotype is _α/_α. This patient will have a CBC that shows which of the following?

Increased RBC count with microcytic/hypochromic RBCs

Macrocytosis can be caused by:

Megaloblastic anemias, shift reticulocytes, and anemia of liver disease

Microcytes can be caused by:

Iron-related disorders, sideroblastic anemias, thalassemias, beta-thalassemia major & minor, alpha thalassemia (Hgb H disease and hydrops fetalis), and lead poisoning

Any RBC having an increased central area of pallor is said to have:

Hypochromia/hypochromic

If polychromasia is increased in the peripheral smear, the _____ should be elevated.

retics

Cells that are more often artifactual than a true result of a disease process are:

Infected with parasites that are outside the norm of a normal histological examination like malaria

Cells that occur as a result of a decreased oxygen environment are:

reticulocytes

The morphologic difference between acanthocytes and burr cell is evident in the:

Red cell membrane—enchinocytes are smaller and much more uniform in shape and distribution

. An aid for dealing with RBC agglutination in a laboratory specimen is to:

warm the specimen

An aid for dealing with rouleaux in a laboratory specimen is to:

plasma replacement with saline

A stain used to confirm the presence of precipitated iron in the RBCs is:

prussian blue

A patient with lead intoxication typically has numerous RBCs with:

basophilic stippling

Patients with sickle cell anemia and β thalassemia major may not show clinical symptoms until the patient is at least 6 months of age because of which of the following?

Infants are protected by their high concentration of fetal hemoglobin (HbF)

If 2,3,DPG increases / decreases, the hemoglobin molecule releases more oxygen. This is known as a ____OD Curve.

-increase: right shift
-decrease: left shift

Heinz bodies are:

Hgb

Heinz bodies can be seen only with______ stain.

crystal violet

Disorders involving any component of hemoglobin synthesis usually result in RBCs that are:

normocytic; normochromic

. In the body, iron primarily acts as a(n):

oxygen/carbon dioxide transport

The majority of iron in the body is found in the:

Hemoglobin iron (2/3) and the rest is found as tissue iron

Eating food high in vitamin C along with iron-rich foods will cause iron absorption to be:

enhanced

Pappenheimer bodies are also known as:

Siderotic granules or iron-containing

The peripheral blood smear and bone marrow picture sometimes will look similar in myelodysplastic syndromes and some RBC disorders. Which of the following RBC disorders tends to have a peripheral smear appearance similar to cases of myelodysplastic syndromes?

megaloblastic anemia

. The most common cause of iron deficiency in adult men is:

GI bleeding

During treatment for iron deficiency anemia, recovery is fist seen in peripheral blood as:

sudden increase of RDW

The clinical manifestation that distinguishes pernicious anemia from folic acid deficiency is:

Neuropathies in pernicious anemia—neurologic abnormality

When the maturation rates of nuclear and cytoplasmic development of hematopoietic cells differ, it is called:

Nuclear-cytoplasmic asynchrony

In megaloblastic anemias, the M:E ratio of the bone marrow is often:

1:1 to 1:3--low

A major cause of non-megaloblastic macrocytosis is:

Alcoholism and chronic liver disease

A chemistry test that is often elevated in patients with megaloblastic anemia is:

LD

Following correct diagnosis and treatment of a megaloblastic anemia, the patient's complete blood count (CBC) returns to normal in approximately:

3-6 weeks based on severity of the disease

Aplastic anemia manifests as a decreased production of:

erythrocytes, leukocytes, and platelets (pancytopenia)

One of the more common causes of aplastic anemia is:

idiopathic

A drug that frequently causes aplastic anemia is:

Chloramphenicol

. An infectious state that is occasionally associated with bone marrow suppression is:

hepatitis

Clinical manifestations of aplastic anemia are the result of:

Impairment or failure of bone marrow—leading to pancytopenia

Peripheral blood cell morphology in aplastic anemia is most often:

Normocytic normochromic anemia with little or no evidence of regeneration such a polychromatophillic cells, basophilic stippling, or nucleated red cells seen

The reticulocyte count of a patient with aplastic anemia is usually:

Decreased (pancytopenia)

In aplastic anemia, an abnormality that may be noted in the WBC differential is:

relative lymphocytosis

A 3-year old female patient is seen in the hematology clinic to investigate the cause of the persistent anemia. Hemoglobin electrophoresis was ordered, and results showed an elevation of Hgb X , with a small increase in Hgb X . Based on these results, what is the most likely disorder?

Beta thalassemia major

Which of the following statements regarding 2,3 DPG is correct?

The affinity of BPG binding to Hb would be reduced if the N-terminal groups of the four subunits were modified to make them uncharged
-enhances O2 release from hemoglobin

For children and young adults with severe aplastic anemia, the preferred treatment is:

Allogenic bone marrow or peripheral stem transplantation

Anemia of chronic disease (inflammation) is usually:

Normocytic normochromic but can progress to hypochromic microcytic

Anemia of chronic disease (inflammation) may be confused initially with iron deficiency anemia because both disorder exhibit;

low serum levels

In inflammation, the erythrocyte sedimentation rate is often:

Increased, due to C-reactive protein increase

The primary cause of anemia of chronic renal disease is:

deficiency of erythropoietin by damage to the kidneys leading to decrease of erythrocytes

When RBCs from a healthy donor are transfused into a patient with an extracoupuscular RBC defect, the life span of the donor cells will be:

destroyed

94. Hemoglobinenia, hemoglobinuria, and hemosiderinuria are good indicators of:

Chronic intravascular hemolysis

Cells that have a decreased osmotic fragility and are less deformable than normal are:

xerocytosis

Hereditary spherocytosis is considered a disorder of the:

membrane, due to deficiency in spectrin

A common treatment for hereditary spherocytosis is:

splenectomy

The osmotic fragility in most patients with hereditary elliptocytosis is:

normal

The disorder in which RBCs exhibit thermal instability in hereditary;

pyropoikilicytosis

The most commonly encountered anemia is the congenital non-spherocytic hemolytic anemia is caused by a deficiency of:

G6PD, PK enzyme deficiency in the Ebden Myerhof pathway