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WorksheetsHEMA 1 PREFINAL EXAM
Total questions: 100
Worksheet time: 1hrs 17mins
Which of the following would be associated with an elevated ESR value?
Microcytosis
Polycythemia
Decreased globulins
Inflammation
What does the reticulocyte count assess?
Inflammation
Response to infection
Erythropoietic activity of the bone marrow
Ability of red blood cells to form rouleaux
A patient has a hemoglobin level of 8.0 g/dL. According to the rule of three, what is the expected range for the hematocrit?
21% to 24%
23.7% to 24.3%
24% to 27%
21% to 27%
Which of the following would not interfere with the result when hemoglobin determination is performed by the cyanmethemoglobin method?
Increased lipids
Elevated WBC count
Lyse-resistant RBCs
Fetal hemoglobin
If potassium cyanide and potassium ferricyanide are used in the manual method for hemoglobin determination, the final product is:
Methemoglobin
Azide methemoglobin
Cyanmethemoglobin
Myoglobin
What do you suspect is the cause of the variation in platelet counting among the four instruments (Beckman, Sysmex, Abbott and Siemens)?
Different instruments have different levels of sensitivity.
All instruments use the same principle for counting platelets
Some instruments are susceptible to false-positive platelet flagging under certain condition
Different instruments use different thresholds to capture and count platelets.
A patient peripheral blood film demonstrates agglutinated RBCs, and the CBC shows an elevated MCHC. What other parameters will be affected by the agglutination of the RBCs?
MCV will be decreased and the RBC count will be increased
MCV will be decreased and the RBC count will be decreased.
MCV will be increased and the RBC count will be decreased
MCV will be increased and the RBC count will be increased
Uses diffraction, reflection, and refraction of light waves
Impedance
Radio Frequency (RF)
Optical scatter
None of the given choices
Uses high-voltage electrical waves to measure the internal complexity of cells
Impedance
Radio Frequency (RF)
Optical scatter
None of the given choices
Involves detection and measurement of changes in electrical current between two electrodes
Impedance
Radio Frequency (RF)
Optical scatter
None of the given choices
Orthogonal light scatter is used to measure:
Cell volume
Internal complexity of the cell
Cellular granularity
Nuclear density
On the Beckman Coulter instruments, hematocrit is a calculated value. Which of the following directly measured parameters is used in the calculation of this value?
RDW
Hemoglobin
MCV
MCHC
Which hematology instrument uses volume, conductivity, and five angles of light scatter to determine WBC differential counts
Abbott CELL-DYN Sapphire
Siemens ADVIA 2120i
Sysmex XN-1000
Beckman Coulter UniCel DxH 800
Which hematology instrument uses peroxidase-staining absorbance and light scatter to determine WBC differential count?
Abbott CELL-DYN Sapphire
Siemens ADVIA 2120i
Sysmex XN-1000
Beckman Coulter UniCel DxH 800
Which hematology instrument uses sodium lauryl sulfate for hemoglobin determination at 555 nm absorbance?
Abbott CELL-DYN Sapphire
Siemens ADVIA 2120i
Sysmex XN Series
Beckman Coulter UniCel DxH 800
Which hematology instrument uses fluorescent staining instead of supravital staining for nucleated RBC counting
Abbott CELL-DYN Sapphire
Siemens ADVIA 2120i
Sysmex XN Series
Beckman Coulter UniCel DxH 800
A laboratory science student consistently makes wedge technique blood films that are too long and thin. What change in technique would improve the films?
Increasing the downward pressure on the pusher slide
Decreasing the acute angle of the pusher slide
Placing the drop of blood closer to the center of the slide
Increasing the acute angle of the pusher slide
When a blood film is viewed through the microscope, the
RBCs appear redder than normal, the neutrophils are barely visible, and the eosinophils are bright orange. What is the most likely cause?
The slide was overstained
The stain was too alkaline
The buffer was too acidic.
The slide was not rinsed adequately.
A stained blood film is held up to the light and observed to be bluer than normal. What microscopic abnormality might be expected on this film?
Rouleaux
Spherocytosis
Reactive lymphocytosis
Toxic granulation
A laboratorian using the 40X objective lens sees the following numbers of WBCs in 10 fields: 8, 4, 7, 5, 4, 7, 8, 6, 4, 6. Which of the following WBC counts most closely correlates with the estimate?
1.5 x 109/L
5.9 X 109/L
11.8 X 109/L
24 X 109/L
Which of the following blood film findings indicates EDTA-induced pseudothrombocytopenia?
The platelets are pushed to the feathered end.
The platelets are adhering to WBCs
No platelets at all are seen on the film.
The slide has a bluish discoloration when examined macroscopically
Given the following data, summarize the following blood picture:
WBC: 86.3 X 109/L
HGB: 9.7 g/dL
HCT: 24.2%
MCV: 87.8 fL
MCHC: 33.5%
PLT: 106 X 109/L
Leukocytosis, normocytic-normochromic anemia, thrombocytopenia
Microcytic-hypochromic anemia, thrombocytopenia
Neutrophilia, macrocytic anemia, thrombocytosis
Leukocytosis, thrombocytopenia
Where is most hematopoietic cells or tissue found in adults?
Liver
Lungs
Spleen
Long bones
What is the preferred bone marrow collection site in adults?
Second intercostal space on the sternum
Anterior or posterior iliac crest
Any of the thoracic vertebrae
Anterior head of the femur
What is the normal M:E ratio range in adults in bone marrow examination?
1.5:1 to 3.3:1
5.1:1 to 6.2:1
8.6:1 to 10.2:1
10:1 to 12:1
Which are the most common erythrocytic stages found in normal marrow?
Pronormoblasts
Pronormoblasts and basophilic normoblasts
Basophilic and polychromatophilic normoblasts
Polychromatophilic and orthochromic normoblasts
What cells, occasionally seen in bone marrow biopsy specimens, are responsible for the formation of bone?
Macrophages
Plasma cells
Osteoblasts
Osteoclasts
What is the largest hematopoietic cell found in a normal bone marrow?
Osteoblast
Myeloblast
Pronormoblast
Megakaryocyte
Which of the following is not an indication for a bone marrow examination?
Pancytopenia (reduced numbers of RBCs, WBCs, and platelets in the peripheral blood)
Anemia with RBC indices corresponding to low serum iron and low ferritin levels
Detection of blasts in the peripheral blood
Need for staging of Hodgkin lymphoma
What is the appropriate reagent for the reticulocyte count?
New methylene blue
Phyloxine B
Solution lyses erythrocytes and darkens the cells to be counted
None of the given choices
What is the appropriate procedure and characteristic for the Westergren method
The diluting solution lyses erythrocytes with propylene glycol and contains sodium carbonate and water
The procedure measures the rate of erythrocyte settling.
Ferrous ions are oxidized to the ferric state.
The diluting solution is either 1% hydrochloric acid or 2% acetic acid
What source of error will have greatest effect on Packed Cell Volume (hematocrit)?
Incorrect dilution of blood and diluent
Hemolysis of whole blood specimen
Excessive anticoagulant will produce shrinkage of cells
None of the given choices
A normal blood smear should have no more than approximately _____ (maximum) number of platelets per oil immersion field in an area where the erythrocytes are just touching each other.
10
15
20
25
Match the procedure and reference value: Reticulocyte count (newborn infant)
Up to 13 mm/hour
2.5 to 6.0%
150 to 450 × 109/L
36 to 45%
4.4 to 11.3 × 109/L
Match the procedure and reference value: Packed Cell Volume (Hematocrit)
Up to 13 mm/hour
2.5 to 6.0%
150 to 450 × 109/L
36 to 45%
4.4 to 11.3 × 109/L
Match the procedure and reference value: Westergren ESR method (adult male age 65 years)
Up to 13 mm/hour
2.5 to 6.0%
150 to 450 × 109/L
36 to 45%
4.4 to 11.3 × 109/L
Match the procedure and reference value: Total leukocyte count/Total WBC Count
Up to 13 mm/hour
2.5 to 6.0%
150 to 450 × 109/L
36 to 45%
4.4 to 11.3 × 109/L
Match the procedure and reference value: Direct platelet count
Up to 13 mm/hour
2.5 to 6.0%
150 to 450 × 109/L
36 to 45%
4.4 to 11.3 × 109/L
What clinical or specimen condition will produce an increased total leukocyte count.
Active allergies
Immediate hypersensitivity reactions
Inflammation
A lipemic blood specimen
Match the procedure with the clinical or specimen condition that will produce an increased test result.
Packed Cell Volume: ____________________
Splenectomy
Rouleaux formation
Polycythemia
Crisis associated with hemolytic anemia
Match the procedure with the clinical or specimen condition that will produce an increased test result.
Reticulocyte count: ____________________
Splenectomy
Rouleaux formation
Polycythemia
Crisis associated with hemolytic anemia
Match the procedure with the clinical or specimen condition that will produce an increased test result.
Westergren ESR Method: ____________________
Splenectomy
Rouleaux formation
Polycythemia
Crisis associated with hemolytic anemia
The Packed Cell Volume/Hematocrit procedure can be affected by the
speed of the centrifuge
length of time of centrifugation
ratio of anticoagulant to whole blood
All of the given choices
Which of the following erythrocytic inclusions contain RNA and can be observed by staining with new methylene blue?
Howell-Jolly bodies
Heinz bodies
Pappenheimer bodies
Reticulocytes
The sedimentation rate of erythrocytes can be affected
by all of the following except
ratio of anticoagulant to whole blood
position of the tube
temperature of the specimen or laboratory
All of the given choices
None of the given choices
Match the procedure with the specific stain or use.
Acidified serum lysis test (Ham test):________________
Positive in monocytes
Measures an extremely potent hemolysin at 4°C
Positive in cell of granulocytic lineage
Measures hemolysis
Match the procedure with the specific stain or use.
Alpha-naphthyl acetate esterase:________________
Positive in monocytes
Measures an extremely potent hemolysin at 4°C
Positive in cell of granulocytic lineage
Measures hemolysis
Match the procedure with the specific stain or use.
Naphthol AS-D chloroacetate esterase:________________
Positive in monocytes
Measures an extremely potent hemolysin at 4°C
Positive in cell of granulocytic lineage
Measures hemolysis
Match the procedure with its appropriate test reaction.
Kleihauer-Betke test:_________________________
Erythrocytes lysed by toluene and saponin with the released product being reduced by sodium hydrosulfite
Fetal hemoglobin is not eluted/degraded
Denatured by crystal violet
Screens for one of the most prevalent hereditary enzyme deficiencies
Leukocytes that demonstrate a positive reaction in the tartratic acid-resistant acid phosphatase cytochemical stain are the lymphocytes seen in
infectious lymphocytosis
malignant lymphoma
acute lymphoblastic leukemia (non-T type)
hairy cell leukemia
A decreased leukocyte alkaline phosphatase (LAP) score is seen in
polycythemia vera
chronic myelogenous leukemia
leukemoid reactions
acute myelogenous leukemia
In the leukocyte alkaline phosphatase procedure, blood smears should be stained
within 8 hours of specimen collection
within 48 hours of specimen collection
within 72 hours of specimen collection
within 5 days of specimen collection
The alpha-naphthyl acetate esterase stain is detected primarily in _____ and is almost absent in _____.
megakaryocytes; erythrocytes
monocytes; granulocytes
granulocytes; monocytes
erythrocytes; megakaryocytes;
Which of the following is not a benefit of laboratory instrumentation to the hematology laboratory?
Produces faster results from specimens
Reduced cost on rarely performed procedures
Less variation in technique from technologist to technologist
Increased accuracy because data are collected on more cells counted or analyzed
Electrical impedance principle
The volume of each cell is proportional to the degree of light scatter
Each cell momentarily increases resistance
The major application of fl ow-cell cytometry i
determining cell size and granularity
sorting of cells and cellular identification using monoclonal antibodies
treating cancer cells and identifying specific virus types
counting leukocytes and platelets
The term parameter means
a subset of a population
the mean value of a sample
two SDs on either side of the mean value
any numerical value that describes an entire population
Which parameters are calculated rather than directly measured
Hematocrit and erythrocyte distribution width
Erythrocyte count and leukocyte count
Leukocyte count and hematocrit
Platelet count and platelet volume
Applying the optical principle of laser scatter technology to cell counting and analysis, discrimination between erythrocytes and platelets depends on the
cellular volume
cellular refractive index
time of flight through the sensing zone
all of the given choices
In an erythrocyte histogram, the erythrocytes that are larger than normal will be to the _____ of the normal
distribution curve.
right
left
in the middle
The RDW and MCV are both quantitative descriptors of erythrocyte size. If both are increased, the most probable erythrocytic abnormality would be
iron deficiency anemia
acquired aplastic anemia
megaloblastic anemia
hemoglobinopathy
The MPV is
analogous to the MCHC
a direct measure of the platelet count
a measurement of the average volume of platelets
a comparison of the patient’s value to the normal value
An excessive accumulation of iron in body tissues is called
Hemochromatosis
Erythroblastosis
Megaloblastosis
Acrocyanosis
The most commonly used gauge of needles in venipuncture:
20, 21, 22
23, 24, 25
15, 16, 18
Either of the given choices
The two most widely used needle lengths are:
0.5 inch and 1 inch
1 inch and 1.5 inches
1.5 inch and 2 inches
2 inches and 2.5 inches
In venipuncture, the needle should be in the bevel up position (needle opening facing upward), pointing in the same direction as the vein, and should make an approximate ____ degree angle with them.
10 degree angle
15 degree angle
30 degree angle
45 degree angle
The tourniquet should not be left on longer than ____ minute(s). If it remains on for a longer periods, the blood on the area will have an increased concentration of cells (hemoconcentration)
1 minute
<2 minutes
3 minutes
4 minutes
All are true for skin puncture, except:
The site of choice in infant is the lateral (outside or medial (inside) surface of the plantar side (bottom of the heel)
The site should be warmed to a temperature no greater than 42 degrees Celsius for no longer than 2-5 mins unless collection if for capillary blood gas analysis.
Povidone iodine should not be used because of possible blood contamination, which would produce falsely elevated levels of potassium, phosphorus, or uric acid.
Punctures should not be made more than 4 mm deep because of the risk of bone injury and possible infection (osteomyelitis)
Th veins in this site should not be used without physician permission
Veins at the antecubital region
Veins at the dorsal side of the wrist and hand
Veins at the foot
None of the given choices
It takes approximately 18 days for a BFU_E to mature to an RBC, of which about 6 days are spent as identifiable precursors in the bone marrow. The mature erythrocyte has a life span of ____ in circulation.
5 days
8-11 days
9-12 days
120 days
Hemoglobinization can first be recognized in what erythrocyte maturation stage?
Pronormoblast
Basophilic normoblast
Reticulocyte
Orthochromic normoblast
Polychormatophilic normoblast
High energy in the cell is in the form of:
DNA
RNA
ATP
ADP
2, 3 DPG
An enzyme in the Embden-Meyerhof pathway and may be the most common causes of hereditary nonspherocytic anemia involving this patwhay.
G6PD Deficiency
Pyruvate Kinase Deficiency
Hexose enzyme deficiency
Beta galactosidase deficiency
The earliest granulocytic stage in which specific granules appear:
Myeloblast
Metamyelocyte
Promyelocyte
Band
Myelocyte
The lifespan of the neutrophils is approximately ____ from myeloblast to death:
1-5 days
6-8 days
9-10 days
120 days
Enzyme present only in maturing neutrophils from myelocyte onwards
Acid phosphatase
Leukocyte Alkaline Phosphatase
Peroxidase
Sudan Black B
This is helpful in differentiating chronic myelogenous leukemia from a leukomoid reaction or polycthemia vera
Acid phosphatase
Leukocyte Alkaline Phosphatase
Peroxidase
Sudan Black B
An OIF containing 100 RBCs should have ____ platelets, whereas field with 200 RBCs should have ____ platelets.
3-10, 5-20 platelets
8-20, 20-50 platelets
5-20, 10-40 platelets
20-40, 50-100 platelets
Cyanmethemoglobin method for determining hemoglobin concentration measures all of the following except?
Carboxyhemoglobin
Oxyhemoglobin
Sulfhemoglobin
Methemoglobin
Deoxyhemoglobin
A white cell count above ___ is termed leukocytosis.
4.0 x109/L
9.0 x109/L
10.0 x109/L
11.0 x109/L
Turbidity if the sodium dithionate tube test indicate the presence of
Adult hemoglobin
Fetal hemoglobin
Sickling hemoglobin
Unstable hemoglobin
Red blood cells appear grayish-blue and the white cell nuclei will stain very deeply purple
pH is too acidic
pH is too alkaline
Insufficient washing of smear
None of the given choices
A tachometer is used to check centrifuge and particularly measures:
optical density
pressure
surface tension
relative centrifugal force
revolutions per minute
Three values are counted directly on electronic impedance instruments
RBCs, WBCs, and platelets
RBCs, WBCs, and hemoglobin
RBCs, RDW, and MCV
Hematocrit
The major function of neutrophilic granulocytes is
antibody production
destruction of parasites
phagocytosis
suppression of inflammation
Which of the following are contents of basophilic granules?
Heparin
Histamine
Myeloperoxidase
Both histamine and Heparin
The tissue basophil can be referred to as a/an
mast cell
macrophage
mononuclear cell
antibody-producing cell
The major function of eosinophils is
suppression of inflammatory reactions
destruction of protozoa
participation in anaphylaxis
phagocytosis
Which of the following molecules is stored in platelet dense granules?
Serotonin
Fibrinogen
PF4
Platelet-derived growth factor
2/3 of the circulating platelets are found in the?
Liver
Peripheral Blood
Kidney
Spleen
Aperture plugs are probably the most common problem in cell counting. It is associated with:
Negative error
Positive error
Either positive or negative
Neither positive or negative error
Oval macrocyte
Megalocyte
Drepanocyte
Codocyte
Discocyte
Echinocytes
Short, scalloped, or spike-like projections that are regularly distributed around the cell
Fragments of erythrocytes
The scooped-out part of an erythrocyte that remains after a blister cell ruptures
Compact round shape
Associated with a decrease in hemoglobin synthesis.
Microcytes
Sickle cells
Macrocytes
Acanthocytes
Normocytic RBC are usually present in the following RBC disorders except?
Acute Post Hemorrhagic Anemia
Aplastic Anemia
Hemolytic Anemia
Chronic Blood Loss Anemia
Microcytes are seen in
Iron deficiency anemia
Abetalipoproteinemia
Pernicious anemia
No related disease state
Pappenheimer bodies
Nuclear remnants of DNA
Precipitated denatured hemoglobin
Granules composed of ribosomes and RNA
Aggregates of iron, mitochondria, and ribosomes near the red cell periphery as purple dots.
The x-axis on a blood cell histogram represents:
cell size
relative numbers per cell
right angle scatter
none of the given choices
Di Guglielmo's Syndrome
Acute Monoblastic Leukemia without differentiation
Acute megakaryocytic leukemia
Erythroleukemia
Acute myelomonocytic leukemia
Aka wandering cells.
Macrophages
Neutrophils
Monocyte
Plasmacyte
