MLT HEMATOLOGY BOARDS

The light-colored zone adjacent to the nucleus in a plasmacyte is the:

A. ribosome

B. chormatin

C. mitochondira

D. Golgi area

D. Golgi area

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

A. hemoglobin

B. hemosiderin

C. myglobin

D. transferrin

A. hemoglobin

The main function of the hexose monophosphate shunt in the erythrocyte is to:

A. regulate the level of 2,3-DPG

B. provide reduced glutathione to prevent oxidation of hemoglobin

C. prevent the reduction of heme iron

D. provide energy for membrane maintainance

B. provide reduced glutathione to prevent oxidation of hemoglobin

Which curve represents the production of alpha polypeptide chains of hemoglobin?

A. A

B. B

C. C

D. D

B. B

Which curve represents the production of beta polypeptide chains of hemoglobin?

A. B

B. C

C. E

D. D

D. D

Which curve represents the production of gamma polypeptide chains of hemoglobin?

A. A

B. B

C. C

D. D

C. C

Which curve represents the production of delta polypeptide chains of hemoglobin?

A. B

B. C

C. D

D. E

D. E

Which curve represents the production of epsilon polypeptide chains of hemoglobin?

A. A

B. B

C. C

D. D

A. A

In order for hemoglobin to combine reversibly with oxygen, the iron must be:

A. complexed with haptoglobin

B. freely circulating in the cytoplasm

C. attached to transferrin

D. in the ferrous state

D. in the ferrous state

In which of the following disease states are teardrop cells and abnormal PLTs most characteristically seen?

A. hemolytic anemia

B. multiple myeloma

C. G-6-PD deficiency

D. myeloid metaplasia

D. myeloid metaplasia

In the normal adult, the spleen acts as a site for:

A. storage of RBCs

B. production of RBCs

C. synthesis of erythropoietin

D. removal of imperfect and aging cells

D. removal of imperfect and aging cells

After the removal of RBCs from the circulation hemoglobin is broken down into:

A. iron, porphyrin, and amino acids

B. iron, protoporphyrin, and glob in

C. heme, protoporphyrin, and amino acids

D. heme, hemosiderin, and globin

B. iron, protoporphyrin, and globin

Heinz bodies are:

A. readily identified with polychrome stains

B. rarely found in G6PD deficient erythrocytes

C. closely associated with spherocytes

D. denatured hemoglobin inclusions that are readily removed by the spleen

D. denatured hemoglobin inclusions that are readily removed by the spleen

Cells for the transport of O2 and CO2 are:

A. erythrocytes

B. granulocytes

C. lymphocytes

D. thormbocytes

A. erythrocytes

Erythropoieten acts to:

A. shorten the replication of the granulocytes

B. stimulate RNA synthesis of erythroid cells

C. increase colony-stimulating factors produced by the B-lymphocytes

D. decrease the release of marrow retics

B. stimulate RNA synthesis of erythroid cells

What cell shape is MOST commonly associated with an increased MCHC?

A. teardrop cells

B. target cells

C. spherocytes

D. sickle cells

C. spherocytes

Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?

A. autosomal dominant inheritance

B. red cell membrane defects

C. positive direct antiglobulin test

D. meausre PLT count

B. red cell membrane defects

A patient is admitted with a history of chronic bleeding secondary to peptic ulcer. Hematology workup reveals a severe microcytic, hypochromic anemia. Iron studies were requested. Which of the following would be expected in this case? (chart on picture)

A. result A

B. result B

C. result C

D. results D

C. results C

Which of the following is MOST closely associated with iron deficient anemia?

A. iron overload in tissue

B. target cells

C. basophilic stippling

D. chronic blood loss

D. chronic blood loss

Evidence indicates the genetic defect in thalassemia usually results in:

A. the production of abnormal glob in chains

B. a quantitative deficiency in RNA resulting in decreased globin chain production

C. a structural change in the heme portion of the hemoglobin

D. an abnormality in the alpha- or beta-chain binding or affinity

B. a quantitative deficiency in RNA resulting in decreased globin chain production

An enzyme deficiency associated with a moderate to sever hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions from by denatured hemoglobin is:

A. lactate dehydrogenase deficiency

B. G-6-PD deficiency

C. pyruvate kinase deficiency

D. hexokinase deficiency

B. G-6-PD deficiency

Patients with A(-) type G6PD deficiency are LEAST likely to have hemolytic episodes in which of the following situations?

A. following the administration of oxidizing drugs

B. following the ingestion of fava beans

C. during infections

D. spontaneously

D. spontaneously

A patient has a congenital nonspherocytic hemolytic anemia. After exposure to anti-malarial drugs the patient experiences a severe hemolytic episode. This episode is characterized by red cell inclusions caused by hemoglobin denaturation. Which of the following conditions is MOST consistent with these findings?

A. G6PD deficiency

B. thalassemia major

C. pyruvate kinase deficiency

D. paroxysmal nocturnal hemoglobinuria

A. G6PD deficiency

Peripheral blood smears from patients with untreated pernicious anemia are characterized by:

A. pancytopenia and macrocytosis

B. leukocytosis and elliptocytosis

C. leukocytosis and ovalocytosis

D. pancytopenia and microcytosis

A. pancytopenia and macrocytosis

Lab tests preformed on a patient indicate macrocytosis, anemia, leukopenia and throbocytopenia. Which of the following disorders is the patient most likely to have?

A. anemia of chronic disorder

B. vitamin B12 deficiency

C. iron deficiency

D. acute hemorrhage

B. vitamin B12 deficiency

The characteristic morphologic feature in folic acid deficiency is:

A. macrocytosis

B. target cells

C. serum B12 and folate

D. leukocyte alkaline phosphatase

A. macrocytosis

The most likely cause of the macrocytosis that often accompanies anemia of myelofibrosis is:

A. folic acid deficiency

B. increased retic count

C. inadequate B12 absorption

D. pryidoxine deficiency

A. folic acid deficiency

Which of the following represents characteristics features of iron metabolism in patients with anemia of chronic disorder?

A. result A

B. result B

C. result C

D. result D

D. result D

A characteristic morphologic feature in hemoglobin C disease is:

A. macrocytosis

B. spherocytosis

C. rouleaux formation

D. target cells

D. target cells

Thalassemias are characterized by:

A. structural abnormalities in the hemoglobin molecule

B. absence of iron in hemoglobin

C. decreased rate of heme synthesis

D. decreased rate of glob in synthesis

D. decreased rate of glob in synthesis

Lab findings in hereditary spherocytosis do NOT include:

A. decreased osmotic fragility

B. increased autohemolysis corrected by glucose

C. reticulocytosis

D. shorted erythrocyte survival

A. decreased osmotic fragility

Which of the following types of polycythemia is a severely burned patient MOST likely to have?

A. polycythemia vera

B. polycythemia, secondary to hypoxia

C. relative polycythemia associated with dehydration

D. polycythemia associated with renal disease

C. relative polycythemia associated with dehydration

Which of the following is most likely to be seen in lead poisoning?

A. iron overload in tissue

B. codocytes

C. basophilic stippling

D. ringed sideroblasts

C. basophilic stippling

The characteristic morphologic feature in lead poisoning is:

A. macrocytosis

B. target cells (codocytes)

C. basophilic stippling

D. rouleaux formation

C. basophilic stippling

A 14 y/o boy is seen in the ER complaining of a sore throat, swollen glands and fatigue. The CBC results are:

-WBC: 16.0x10^3/µL(16.0x10^9/L)

-RBC: 4.37 x 10^6/µL(4.37x10^12/L)

-Hgb: 12.8 g/dL (128 g/L)

-Hct: 38.4%

-Plt: 180x10^3/µL(180x10^9/L)

Differential:

-absolute neurtophils: 3.9x10^9/L

-absolute lymphs: 6.0x10^9/L

-absolute monos: 0.5x10^9/L

-absolute atypical lymphs: 3.2x10^9/L

What is the most likely dx?

A. acute lymphoblastic leukemia

B. chroni lymphocytic leukemia

C. viral hepatitis

D. infectious mononucleosis

D. infectious mononucleosis

Which of the following technical factors will cause a decrease erythrocyte sedimentation rate (ESR)?

A. gross hemolysis

B. small fibrin clots in the sample

C. increased room temp

D. tilting of the tube

B. small fibrin clots in the sample

Which of the RBC indices is a mausre of the amount of hemoglobin in individual RBCs?

A. MCHC

B. MCV

C. Hct

D. MCH

D. MCH

The RDW-CV and RDW-SD performed by automated cells counters are calculations that provide:

A. an index of the distribution of RBC volumes

B. a calculated mean RBC hgb concentration

C. a calculated mean cell hub

D. the mean RBC volume

A. an index of the distribution of RBC volumes

The ESR can be falsely elevated by:

A. tilting the tube

B. refrigerated blood

C. air bubbles in the column

D. specimen being too old

A. tilting the tube

Which of the following is the formula for absolute cell counts?

A. number of cells counted/total count

B. total count/number of cells counted

C. 10x total count

D. % of cells counted x total count

D. % of cells counted x total count

Using the supra vital stain, the polychromatic RBCs below would probably be:

A. rubricytes (polychromatophilic normoblasts)

B. retics

C. sickle cells

D. target cells

B. retics

The lab tests performed on a patient indicated macrocytosis, anemia, leukopenia, and thrombocytopenia. Which of the following disorders is the patient most likely to have?

A. iron deficiency

B. hereditary spherocytosis

C. vitamin B12 deficiency

D. acute hemorrhage

C. vitamin B12 deficiency

The mean value of a retic count on specimens of cord blood from healthy, full-term newborns is approximately:

A. 0.5%

B. 2.0%

C. 5.0%

D. 8.0%

C. 5.0%

A RBC is about 5 µm in diameter that stains bright red and shows no central pallor is a:

A. spherocyte

B. leptocyte

C. microcyte

D. macrocyte

A. spherocyte

The flooding results were obtained on a patient's blood:

-Hgb: 11.5 g/dl (115 g/L)

-Hct: 40%

-MCV: 89 µm^3 (89 fL)

-MCH: 26 pg

-MCHC: 29%

Examination of a Wright-stained smear of the same sample would most likely show:

A. macrocytic, normochromic erythrocytes

B. microcytic, hypochromic erythrocytes

C. normocytic, hypochromic erythrocytes

D. normocytic, normochromic erythrocytes

C. normocytic, hypochromic erythrocytes

Evidence of active red cell regeneration may be indicative on a blood smear by:

A. basophilic stippling, nucleated RBCs and polychromasia

B. hypchromia, macrocytes and nucleated RBCs

C. hypochromia, basophilic stippling and nucleated RBCs

D. Howell-Jolly bodies, Cabot rings and basophilic stippling

A. basophilic stippling, nucleated RBCs and polychromasia

The smear represented below displays:

A. congenital ovalocytosis

B. Hgb C disease

C. poor RBC fixation

D. delay in smear prep

B. Hgb C disease

The presence of excessive rouleaux formation on a blood smear is often accompanied by an increased:

A. retic count

B. sed rate

C. Hct

D. erythrocyte count

B. sed rate

The characterisc peripheral blood morphologic feature in multiple myeloma is:

A. cytotoxic T cells

B. rouleaux formation

C. spherocytosis

D. macrocytosis

B. rouleaux formation

In polycythenmia vera, the Hgb, Hct, and RBC count and red cell mass are:

A. elveated

B. normal

C. decreased

A. elevated

The M:E ration in plycythemia vera is usually:

A. normal

B. high

C. low

D. variable

A. normal

Many microspherocytes, schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with:

A. hereditary spherocytosis

B. DIC

C. acquired autoimmune hemolytic anemia

D. extensive burns

D. extensive burns

Which of the following it closely associated with erythroleukopenia?

A. ringed sideroblasts, nuclear budding and Howell-Jolly bodies

B. DIC

C. micromegakaryocytes

D. lysozymuria

A. ringed sideroblasts, nuclear budding and Howell-Jolly bodies

The most characteristic peripheral blood smear finding in multiple myeloma is:

A. plasmacytic satellitosis in the bone marrow

B. many plasma cells in the peripheral blood

C. many Mott cells in the peripheral blood

D. rouleaux formation of red cells

D. rouleaux formation of red cells

The values below were obtained on an automated blood count system performed on a blood sample from a 25 y/o man:

These results are most consistent with which of the following?

A. megoblastic anemia

B. hereditary sphericytosis

C. a high tiger of cold agglutinins

D. an elevated retic count

C. a high tiger of cold agglutinins

A common source of interference in the cyanmethemoglobin method is:

A. hemolysis

B. very high WBC count

C. cold agglutinins

D. clumped PLTs

B. very high WBC count

With this blood picture, an addiontional test indicated is:

A. alkali desaturation

B. alkaline phosphate stain

C. peroxidase stain

D. Hgb electrophoresis

D. Hgb electrophoresis

The most appropriate screen test for detecting hemoglobin F is:

A. osmotic fragility

B. dithionite solubility

C. Kleihauer-Betke

D. Heat instability test

C. Kleihauer-Betke

The most appropriate screening test for hemoglobin S is:

A. Kleihauer-Betke

B. dithionite solubility

C. osmotic fragility

D. sucrose hemolysis

B. dithionite solubility

Hematology standards include:

A. stabilized RBC suspension

B. latex particles

C. stabilized avian RBCs

D. certified cyanmethemoglobin solution

D. certified cyanmethemoglobin solution

When using the turbidity (solubility) method for detecting the presence of hemoglobin S, and incorrect interpretation may be when there is:

A. concentration of less than 7 g/dL (70 g/L) Hgb

B. glucose concentration greater than 150 mg/dL (8.3 mmol/L)

C. blood specimen graeater than 2 hours old

D. increased Hgb

D. increased Hgb

Refer to the following pattern:

Which pattern is consistent with beta-thalassemia major?

A. patter A

B. pattern B

C. pattern C

D. pattern D

C. pattern C

Refer to the following pattern:

Which electrophoresis pattern is consistent with sickle cell trait?

A. pattern A

B. pattern B

C. pattern C

D. pattern D

A. pattern A

The lab findings on a patient are as follows:

-MCV: 55 μm^3 (55 fL)

-MCHC: 25%

-MCH: 17 ph

A stained blood film on this patient would most likely reveal a red cell picture that is:

A. microcytic, hypochromic

B. macrocytic, hypocromic

C. normalcytic, normochromic

D. microcytic, normochromic

A. microcytic, hypochromic

A patient has the following lab results:

-RBC: 2.00x10^6/µL (2.00x10^9/L)

-Hct: 24%

-Hgb: 6.8 g/dL (68 g/L)

-retic: 0.8%

The mean corpuscular volume (MCV) of the patient is:

A. 35 µm^3 (35 fL)

B. 83 µm^3 (83fL)

C. 120 µm^3 (120 fL)

D. 150 µm^3 (150 fL)

C. 120 µm^3 (120 fL)

The following results were obtained from a post-surgical patient receiving total parenteral nutrition:

The most consistent explanation for the above data is:

A. acute surgical bleeder

B. specimen on day 19 from wrong patient

C. improperly mixed specimen on day 19

D. lipid interference on days 17 and 18

D. lipid interference on days 17 and 18

A patient has a high cold agglutinin titer. Automated cell counter results reveal an elevated MCV, MCH and MCHC. Individual erythrocytes appear normal on a stained smear, but agglutinates are noted. The appropriate course of action would be to:

A. perform the RBC, Hgb, and Hct determinations using manual methods

B. perform the RBC determination by a manual method; use the automated results for the Hgb and Hct

C. report the determinations using a microsample of diluted blood

D. repeat the determination using a pre warmed microsample of diluted blood

D. repeat the determination using a pre warmed microsample of diluted blood

A blood sample from a patient with a high-titer cold agglutinin, analyzed at room temp, with an electronic particle counter would cause an error in the:

A. Hgb and MCV

B. MCHC and WBC

C. WBC and RBC

D. MCV and MCHC

D. MCV and MCHC

When using an electronic cell counter, which of the following results can occur in the presence of a cold agglutinin?

A. increased MCV and decreased RBC

B. increased MCV and normal RBC

C. decreased MCV and increased MCHC

D. MCV and RBC

A. increased MCV and decreased RBC

In polycythemia vera, the leukocyte alkaline phosphatase activity is:

A. elevated

B. normal

C. decreased

A. elevated

Which of the following is the formula for mean corpuscular hemoglobin (MCH)?

A. Hct/(RBC x 1000)

B. Hgb/Hct

C. RBC/Hct

D. (Hgb x 10)/RBC

D. (Hgb x 10)/RBC

What is the MCH if the Hct is 20%, the RBC is 2.4 x 10^6/µL (2.4 x 10^12/L) and the Hgb is 5 g/dL (50 g/L)?

A. 21 µm^3 (21 fL)

B. 23 µm^3 (23 fL)

C. 25 µm^3 (25 fL)

D. 84 µm^3 (84 fL)

A. 21 µm^3 (21 fL)

What is the MCH if the Hct is 20%, the RBC is 1.5 x 10^6/µL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)?

A. 28 µm^3 (28 fL)

B. 30 µm^3 (30 fL)

C. 40 µm^3 (40 fL)

D. 75 µm^3 (75 fL)

C. 40 µm^3 (40 fL)

Which of the following is the formula for MCHC?

A. (Hgb x 100)/Hct

B. Hgb/RBC

C. RBC/Hct

D. (Hct x 1000)/RBC

A. (Hgb x 100)/Hct

What is the MCHC if the Hct is 20%, the RBC is 2.4 x 10^6/µL (2.4 x 10^12/L), and the Hgb is 5 g/dL (50 g/L)?

A. 21%

B. 25%

C. 30%

D. 34%

B. 25%

What is the MCHC if the Hct is 20%, the RBC is 1.5 x 10^6/µL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)?

A. 28%

B. 30%

C. 40%

D. 75%

B. 30%

Which of the following is the formula for mean corpuscular volume (MCV)?

A. (Hgb x 10)/RBC

B. Hgb/Hct

C. (Hct x 10)/RBC

D. RBC/Hct

C. Hct x 10)/RBC

Given the following data:

-Hgb: 8 g/dL (80 g/L)

-Hct: 28%

-RBC: 3.6 x 10^6/µL (3.6 x 10^12/L)

The MCV is:

A. 28 µm^3 (28 fL)

B. 35 µm^3 (35 fL)

C. 40 µm^3 (40 fL)

D. 77 µm^3 (77 fL)

D. 77 µm^3 (77 fL)

What is the if the Hct is 20%, the RBC is 2.4 x 10^6/µL (2.4 x 10^12/L), and the Hgb is 5 g/dL (50 g/L)?

A. 68 pg

B. 83 pg

C. 100 pg

D. 120 pg

B. 83 pg

What is the MCV if the Hct is 20%, the RBC is 1.5 x 10^6/µL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)?

A. 68 pg

B. 75 pg

C. 115 pg

D. 133 pg

D. 133 pg

The principle confirmatory test for hereditary speherocytosis is:

A. osmotic fragility

B. sucrose hemolysis

C. heat instability test

D. Kaihauer-Betke

A. osmotic fragility

A screening test for paroxysmal nocturnal hemoglobinuria is:

A. heat instability test

B. sucrose hemolysis

C. osmotic fragility

D. dithionite solubility

B. sucrose hemolysis

The Prussian blue staining of a peripheral blood identifies:

A. Howell-Jolly bodies

B. siderotic granules

C. retics

D. basophilic stippling

B. siderotic granules

Suprabital staining is important retics since the cells must be living in order to stain the:

A. remaning RNA in the cell

B. iron before it precipitates

C. cell membrane before it dries out

D. denatured Hgb in the cell

A. remaning RNA in the cell

Which of the following is used for staining retics?

A. Giemsa stain

B. Wright stain

C. new methylene blue

D. Prussian blue

C. new methylene blue

Which of the following stains is used to demonstrate iron, ferrite and hemosiderin?

A. peroxidase

B. Sudan black B

C. periodic acid-Shiff (PAS)

D. Prussian blue

D. Prussian blue

Which of the following stains can be used to differentiate siderotic granules (Pappenheimer bodies) from basophilic stippling?

A. Wright

B. Prussian blue

C. crystal violet

D. PAS

B. Prussian blue

A patient has pancytopenia, decreased total serum iron, decreased serum iron binding capacity, and shows a homogenous fluorescence pattern with a high titer on a fluorescent anti-nuclear antibody test. This is suggestive of:

A. polycythemia vera

B. systemic lupus erythematosus

C. iron deficiency anemia

D. Hgb SC disease

B. systemic lupus erythematosus

In an uncomplicated case of sever iron deficiency anemia, which of the following sets represents the typical patter of results

A. A

B. B

C. C

D. D

C. C

Inclusions in the cytoplasm of neutrophils as shown in the figure below are known as:

A. Auer bodies

B. Howell-Jolly bodies

C. Heinz bodies

D. Döhle bodies

D. Döhle bodies

An increased amount of cytoplasmic basophilia in a blood cell indicates:

A. increased cytoplasmic maturation

B. decreased cytoplasmic maturation

C. reduction in size of the cell

D. deceased nuclear maturation

B. decreased cytoplasmic maturation

The term "shift to the left" refers to:

A. a microscopic adjustment

B. immature cell forms in the peripheral blood

C. a trend on a Levy-Jennings chart

D. a calibration adjustment on an instrument

B. immature cell forms in the peripheral blood

A term that means carrying degrees of leukocytosis with a shift to the left and occasional nucleated red cells in the peripheral blood is:

A. polycythemia vera

B. erythroleukemia

C. leukoerythroblastosis

D. megalobastoid

C. leukoerythroblastosis

Cells that provide antibodies and lymphokines are:

A. erythrocytes

B. granulocytes

C. lymphocytes

D. thrombocytes

C. lymphocytes

Specific (secondary) granules of the neutrophilic granulocyte:

A. appear first at the myelocyte state

B. contain lysosomal enzymes

C. are formed on the mitochondria

D. are derived from azurophil (primary) granules

A. appear first at the myelocyte state

In normal adult bone marrow, the most common granulocyte is the:

A. basophil

B. myeloblast

C. eosinophil

D. metamyelocyte

D. metamyelocyte

Elevation of the total granulocyte count above 7.7 x 10^3/µL (7.7 x 10^9/L) is termed:

A. relative lymphocytosis

B. leukocytosis

C. relative neurtophilic leukocytosis

D. absolute neutrophilic lekocytosis

D. absolute neutrophilic lekocytosis

Elevation of the total white count above 12 x 10^3/µL (12 x 10^9/L) is termed:

A. relative lymphocytosis

B. absolute lymphocytosis

C. leukocytosis

D. relative neutrophilic leukocytosis

C. leukocytosis

Elevation of the granulocyte percentage above 75% is termed:

A. absolute lymphocytosis

B. leukocytosis

C. relative neutrophilic leukocystosis

D. absolute neutrophili leukocytosis

C. relative neutrophilic leukocystosis

Elevation of the lymphocyte percentage above 47% is termed:

A. relative lymphocytosis

B. absolute lymphocytosis

C. leukocytosis

D. absolute neutrophili leukocytosis

A. relative lymphocytosis