Hematology Sample Questions PDF

68 HEMATOLOGY SAMPLE QUESTIONS 1. The major iron storage compound is 6. A patient with a negative dithionite solubility A. Hemosiderin test has a band in the A region and a band in B Ferritin...

68 HEMATOLOGY SAMPLE QUESTIONS 1. The major iron storage compound is 6. A patient with a negative dithionite solubility A. Hemosiderin test has a band in the A region and a band in B Ferritin the S region on cellulose acetate hemoglobin C. Siderotic granules electrophoresis at pH 8.6. On citrate agar D. Transferrin there is only a band in the A region. Which of the following is compatible with these results? 2. How would the following resul1ts on a 32 year A. HhAS old adult female be interpreted? B. HbAE Hemoglobin - 9.0 gm/dl C. HbAD MCV - 74 fl D. Hh ACHarlem MCH - 27 pg 7. The failure of gronulocytes to develop past the MCHC - 30.0 g/dl "band" or two-lobed stage is characteristic of RDW - 19.0 % A. Bernard-Soulier syndrome Serum ferritin - 4 ng/ml (N=20-250 ng/ml) B. Chediak-Higashi syndrome Serum iron - 29 g/dl (N=70-200 g/dl) C. May-Hegglin anomaly TIBC - 590 g/dl (N=250-435 g/dl) D. Pelger-Huet anomaly % Saturation - s 8. A patient with on elevated WBC count with A. Anemia of chronic inflammation neutrophilia, a left shift, toxic granulation, B. Iron deficiency anemia vacuoles, dohle bodies and an increased LAP C. Thalassemia minor probably has which of the following? D. Siderohlastic anemia A. Acute myelogenous leukemia B. Chronic myelogenous leukemia 3. How would the following results on a 72 year C. Bacterial sepsis old adult female be interpreted? D. Viral sepsis Hemoglobin - 6 g/dl 9. The following results were obtained on an MCV - 114 fl automated CBC. MCH - 39 pg MCHC - 34 g/dl Hemoglobin -11.2 g/dl RDW-18.S % Hct - 27% Oval macrocytes on Wright stain RBC - 2.1 X 106/ul Reticulocyte count - 1.2% MCV - 128 fl Serum 812 - 55 pg/ml (N=200-1000 pg/ml) MCH - 53.3 pg Serum folate - 7 ng/ml (N=2-10 ng/ml) MCHC - 41.5 g/dL Anti-IF (intrinsic factor) antibodies - positive RDW - 19.0 % All results are flagged. The technologist found A. Folate deficiency B. Liver disease no evidence of clots in the sample. What C. Pernicious anemia should be done next? D. Reticulocytosis A. Ask for a redraw 4. Which of the following results from decreased B. Warm the sample to 37° C and synthesis of globin chains? rerun A. Beta-thalassemia C. report the results if controls are in B. Hemoglobin C disease range C. Hemoglobin M D. Rerun the sample and sign out if D. Sickle cell disease results match S. The normal M:E ratio for an adult is 10. Plasma cells evolve from which cell line? A. 1:1.5 A. Lymphocytic B. 3:1 B. Monocytic C. 5:1 C. Myelocytic D. 9:1 D. Megakaryocytic  69 11. In performing a manual white blood cell count, 14. A bone marrow differential performed on a 0.02 ml of blood was diluted with 1.98 ml of patient showed 20% blasts. Flow cytometry ammonium oxalate. An average of 50 cells studies demonstrated the blasts to be positive were counted using a Neubauer hemacytome- for CDlO, CDl9, CD22, and negative for CD13 and ter. What is the patient's white count? CD33. Which of the following diseases is most A. 5,000/µL compatible with these findings? B. 5,500/µL A. ALL C. 10,000/µL B. AML D. 11,000/µL C. CML D. CLL 12. A 4 ml EDTA tube was received in the laboratory containing approximately 1 ml of 15. Which of the following is diagnostic of acute whole blood. If performed on this sample, promyelocytic leukemia? which of the following manual laboratory tests A. t(9 ;22) is most likely to be affected? B. t(l5;17) A. Hemoglobin C. t(l6;16) B. Retie count D. t(8;21) C. Sed rate D. WBC count 16. Plasma cell (multiple) myeloma may be sus- pected if which of the following is seen on a 13. A peripheral blood smear stained with peripheral smear? Prussian blue demonstrates siderocytes. A. Basophilic stippling On a Wright stained smear, what would B. Bizarre blast cells be expected? C. Hyper segmented neutrophils A. Basophilic stippling D. Rouleaux B. Howell Jolly bodies C. Heinz bodies 17. Which parameter is most likely affected by D. Pappenheimer bodies lipemia? A. MCV B. WBC count C. Hemoglobin D. RBC count ANSWERS AND RATIONALE l. B 3. C Option A is a long-term water-insoluble iron storage compound hut not the major one. Oval macrocytes, decreased Bl2 and positive Hemosiderin can be found in found in IF antibodies are all indicators of pernicious macrophage lysosomal membranes and seen in anemia. Option A is incorrect because the folate bone marrow aspirates stained with Pmssian is normal. Option B is incorrect because the blue. Option C are iron inclusions found in red anti-IF antibodies would NOT be positive. Option D is incorrect because of the normal cells stained with Prussian Blue. Option D is the reticulocyte count and the additional abnormal transport protein specific for iron. data. 2. B 4. A An RDW greater than 14.5%, decreased All other options result from structural iron/increased TIBC and greatly decr eased abnormalities. ferritin (indicating no iron stores) support this diagnosis. Option A is incorrect because ferritin 5. B would NOT be decreased and the TIBC would be decreased. Option C is incorr ect because in The normal M:E ratio is between 3:1 and 4:1. thalassemia minor, the Fe and TIBC would 6. C probably be normal and the anemia would be less severe. Also, the RDW would proabably be Rb AS would give a positive solubility and in the normal range. Option D is incorrect would show a separate band in the S region on because the ferritin would be increased as would citrate agar. Rb E would give a negative the serum iron. solubility test but would migrate to the C position 70 on cellulose acetate. Hb C 1-farlem would give a 12. C positive solubihty test and would migrate to the C position on cellulose acetate. Underfilling results in excess EDTA causing the red cells to shrink. This would cause the sed 7. D rate to be falsely decreased since the smaller cells will settle out more slowly. The other values Option A is a platelet adhesion problem would probably not be affected. characterized by giant platelets. Option B is characterized by giant lysosomes in leukocytes. 13. D Option C is characterized by giant platelets and Doble bodies. Siderotic granules are composed of iron and on a Wright stained smear appear as 8. C Pappenheimer bodies within the red cell. They are frequently seen in sideroblastic anemia, Option A is incorrect because there would be alcoholism , thalassemia and some preleukemic a predominance of lymphocytes and an LAP states. Option A is composed of R A remnants would not be performed. Option B is incorrect and does not stain with prussian blue. It is because the LAP score would be decreased. associated with lead poisoning, thalassemia, and Option D would show a normal WBC count and hemolytic anemias. Option B is composed of LAP score with no dohle bodies, toxic DNA remnants and is associated with granulation or vacuoles seen. hyposplenism, pernicious anemia and thalassemia. Option C is denatured hemoglobin , 9. B is OT seen on a Wright stained smear and is These results violate the "Rule of Three" and associated with G6PD deficiency, exposure to are strongly suggestive of a cold agglutinin. oxidizing drugs, alpha thalassemia, and unstable Warming the sample to 37°C will usually cause hemoglobins. the agglutination to disperse. Option A would not 14. A be the first course of action. Options C and D are not acceptable because the results are flagged >20% blasts in the bone marrow is associated and indicate some type of interference or erro- with acute leukemias. CDlO, CD19 and CD22 neous result. are indicative of B- lineage ALL. Option B would be positive for CD13 and CD33. Options 10. A C and D would not have >20% blasts in bone Plasma cells evolve from B cells which are marrow. lymphocytes. 15. B 11. B The t(l5;17) translocation is diagnostic of The formula for calculating manual cell APL counts is as follows: 16. D # cells counted x _1_ x dilution factor tot vol Rouleaux due to increased plasma proteins (monoclonal immunoglobulin) may be seen in The dilution is 1:100. So the dilution factor is plasma cell myeloma. The serum viscosity is 100. volume factor can be eliminated by taking increased and the albumin:globulin ratio is 10% of the number of cells counted and adding decreased. Option A is seen in conditions this to the number of cells counted. associated with disturbed erythropoeisis. Option 50 X.1 = 5 Bis seen in leukemia states. Option C is seen in 50 + 5 = 55 pernicious anemia. So, 17. C 55 x 100 = 5,500/mm3 Options A,B and D are measured by the impedence principle and are not affected by lipemia. Hemoglobin is measured optically and lipemia will cause a false increased value.