Clinical II: Hematology Review

Points= 64

Name:______

  1. A purple top tube was received from the ER on a 24-year old man with possible gastrointestinal bleed. An H&H were ordered. Once the sample was run through the automated instrumentation, a clot was detected. A redrawn specimen was ordered and again the same thing occurred- a clotted sample. Name 2 reasons for a clotted sample. ( 2 pts)
  1. Name 4 preanalytic variables that can affect samples. ( 4 pts)

3. It was a busy day in the pediatric unit. At the change of shifts, a

nurse discovered a labeled purple top tube sitting on the counter

along with the requisition. The nurse had no idea of when the

sample was drawn, but she sent it to the lab anyways. A CBC

and differential were ordered.Should this sample be processed?

If not, why. (1 pt)

  1. A 50 year-old man presented to the ER with chest pain, SOB, and tightness in his chest. He was moved to the treatment room, where cardiac enzymes, CBC, cholesterol and triglycerides were ordered. The results of the CBC were: (1 point)
  2. WBC 12.0 x 109/ L
  3. RBC 4.83 x 1012/L
  4. Hgb 15.0 g/dL
  5. Hct 39.0%
  6. MCV 84 fL
  7. MCH 31 pg
  8. MCHC 39%
  9. Platelet 340,000 x 109/L

Can we accept this specimen? If so, what is the next step?

  1. A sample is drawn and sent to the lab from L&D. The patient had recently delivered and the physician wanted to check her H&H. The nurse ordered a CBC on the patient. The results of the CBC were: (1point)
  2. WBC 15.0 x 109/L
  3. RBC 3.20 x 1012/L
  4. Hgb 9.5 g/dL
  5. Hct 28%
  6. MCV 88 fL
  7. MCH 30 pg
  8. MCHC 34%
  9. Platelet 89,000 x 109/L

Upon reviewing the blood smear, you notice platelet clumping.

What would you do?

  1. A CBC is received from the nursery on a baby born 1 day ago. The results of the CBC were: (1 point)
  2. WBC 60.3 x 109/L
  3. RBC 5.4 x 1012/L
  4. Hgb 16.2 g/dL
  5. Hct 49%
  6. MCV 91 fL
  7. MCH 30 pg
  8. MCHC 33%
  9. Platelet 210,000 x 109/L

The instrument has flagged blasts as a suspect. What could be

the cause of this flag?

  1. In the previous question, what equation would you use to correct for the flag? (1 point)
  1. Matching: Match the term with its definition. (5 points)

_____A. Sickle cell / 1. RBC with slit-like central pallor
_____B. Rouleaux / 2. Stack of coins
______C. Schistocyte / 3. Crescent or S or C shaped
______D. Target Cell / 4. Bull’s eye
______E. Stomatocyte / 5. RBC fragments, helmets, triangular cells
  1. At the physician’s office, one technologist was assigned to do complete differentials or to review smears depending on the automated count. She noticed that in every smear she reviewed, burr cells were a prominent part of the red cell morphology. She began to get suspicious and consider the possibility that the burr cells were artifactual. What are the potential causes for artifactually induced burr cells?( 3 points)
  1. Name the RBC Inclusion: (2 points)

A.______

B.______

  1. Fill in the chart: (3 points)

Cell / Function / Lifespan / Origination
RBC / 120 days / Bone marrow
Granulocytes / Defense against bacteria
Lymphocytes / Cellular/ humoral immunity / B- lymph: 1-5 days
T-lymph: 60-530 days
Platelets / Bone marrow
  1. As cells age they: ( 1 point)
  2. Become larger
  3. Nucleus becomes smaller and chromatin condenses
  4. Nucleus becomes smaller and nucleoli appear
  5. Cytoplasm of cells becomes more basophilic
  1. Stain: Wright-Stain Troubleshooting ( 3 points)

**Fill in the chart**

Problem / Cause
Holes in smear
Drop of blood too small
Smear too long / Drop of blood too large
Smear too thick / Drop of blood too large, spreader slide held at too high an angle, polycythemia
Smear too thin
Smear too long
Bluish RBCs / Overstaining, smear too old, stain/buffer too alkaline
No platelets seen
Crenated RBC’s
  1. What is this formula for? (1 point)

HCT (%) x 10

RBC (x 1012/L)

  1. MCHC
  2. MCH
  3. MCV
  1. What is defined as the average weight of hemoglobin in

the average RBC? (1 point)

  1. MCH
  2. MCV
  3. MCHC
  1. A presence of immature granulocytes in peripheral blood

is: (1 point)

  1. Toxic granulation
  2. Vacuolization
  3. Hypersegmentation
  4. Shift to the left
  1. Neutrophils make up ______% of the adult relative count.

(1 point)

  1. 20-40%
  2. 50-70%
  3. 2-8%
  4. 1-3%
  1. Name the three types of granulocytes: ( 1.5 points)

a.

b.

c.

  1. This leukocyte is characterized by having large orangy-red

granules in its cytoplasm.(1 point)

  1. Lymphocyte
  2. Basophile
  3. Eosinophil
  4. Monocyte
  1. Vacuolization within the leukocyte is seen with: ( 1 point)
  2. Drugs
  3. Septicemia
  4. Toxins
  5. All of the above
  1. This leukocyte is characterized by having a round or oval

nucleus with dense blocks of chromatin and a cytoplasm

that is sky blue. (1 point)

  1. Monocyte
  2. Lymphocyte
  3. Basophil
  1. A 50 year old woman was referred to a hematologist for

recurring pancytopenia. The results of her CBC were:

(2 points)

  • WBC 2.5 x 109/L
  • RBC 3.0 x 1012/L
  • Hct 30%
  • MCH 26 pg
  • MCV 68 fL
  • MCHC 30 g/ dL
  • Platelets 40 x 109/L

What is the likely cause for the pancytopenia?

  1. Ellen Barker is a 35- year-old white woman with a history

of systemic lupus erythematosus, diagnosed in her early

twenties. She was admitted to the hospital due to a recent

onset of jaundice. Her liver was enlarged and tender. The

results of her CBC were: ( 5 points)

  1. WBC 13.5 x 109/L
  2. RBC 3.63 x 1012/L
  3. Hgb 10.9 g/dL
  4. Hct 33%
  5. MCV 91 fL
  6. MCH 30 pg
  7. MCHC 33 g/dL
  8. RDW 12 %
  9. Platelets 139 x 109/L
  10. Differential
  11. Neutrophils 43%
  12. Bands 0
  13. Lymphocytes 55%
  14. 50% reactive
  15. Monocytes 2%
  1. Describe Ellen’s blood picture using appropriate

terminology.

  1. What conditions produce a blood picture like Ellen’s, and

which is more likely in her case?

  1. Which one of these features distinguishes a monocyte from

a lymphocyte? (1 point)

  1. Nucleoli
  2. Abundant gray-blue cytoplasm
  3. Round, flattened nucleus
  4. Large blue-black granules
  1. A 45 year old woman presented to the ER with vague

complaints of dizziness, right-sided abdominal pain and

intermittent blurred vision. A baseline CBC was drawn and

the results were: ( 3 points)

  1. WBC 6.5 x 109/L
  2. RBC 4.02 x 1012/L
  3. Hgb 13.2 g/ dL
  4. Hct 37.3%
  5. MCV 86 fL
  6. MCH 24.2 pg
  7. MCHC 30.3 x 109/L
  8. Platelets 30.3 x 109/L
  9. On review on the blood smear, platelets were seen spreading around the neutrophils

A. Is this a critical platelet count?

B. Why would you review the blood smear?

C. Would you have the specimen redrawn?

  1. A CBC is drawn on a 60 year-old man. On review on the

blood smear many band forms were observed. (2 points)

A. What are band forms?

B. What does this indicate?

  1. What is the causative agent in infectious mononucleosis?

(1 point)

  1. HIV
  2. EBV
  3. CMV
  4. CBC
  1. In which of the following conditions will monocytes be

increased? (1 point)

  1. Tuberculosis
  2. Parasitic infection
  3. Ulcerative colitis
  4. Skin disease
  1. In acute leukemia, the onset is usually: ( 1 point)
  2. Abrupt
  3. Subtle
  1. In chronic leukemia’s, the age group normally affected is:

(1 point)

  1. Adults
  2. Children
  3. Teenagers
  4. Toddlers
  1. Which of the following is most often associated with acute

leukemia?( 1 point)

  1. Erythrocytosis and thrombocyosis
  2. Neutropenia and thrombosis
  3. Anemia and thrombocytopenia
  4. Lymphocytosis and thrombocythemia
  1. Auer rods may be seen in which of the following cells?

(1point)

  1. Myeloblasts
  2. Myelocytes
  3. Lymphoblasts
  4. Megakaryoblast
  1. What would you do with this sample? (2 points)
  2. WBC 194.1 x 109/L
  3. RBC 3.89 x 1012/ L
  4. Hgb 11.3 g/dL
  5. Hct 34.0%
  6. MCV 91.0 fL
  7. MCH 29.1 pg
  8. MCHC 32.0 g/dL
  9. RDW 17.2%
  10. Platelets 41 x 109/L
  11. Flags
  12. +++WBC beyond reportable range
  13. RL,R, RH flags on entire CBC
  1. All of the following are lab findings of Multiple myeloma

EXCEPT: (1 point)

  1. Pancytopenia
  2. Normochromic, normocytic anemia
  3. Increased platelet count
  4. Increased ESR
  1. What is the most common presenting symptom in

individual’s with chronic lymphocytic leukemia? (1 point)

  1. Massive spleens
  2. Thrombocytosis
  3. Increased calcium
  4. Enlarged lymph nodes
  1. What type of anticoagulant is primarily used for

hematological studies? (1 point)

  1. Sodium citrate
  2. EDTA
  3. Sodium oxalate
  1. Given the following data: ( 1 point)
  2. WBC: 8.5 x 109/L
  3. Segs: 56%
  4. Bands: 2%
  5. Lymphs: 30%
  6. Monos: 6 %
  7. Eos: 6%

What is the absolute lymphocyte count?

  1. 0.17 x 109/L
  2. 0.51 x 109/L
  3. 2.55 x 109/L
  4. 4.76 x 109/L
  1. If a WBC count is performed on a 1:10 dilution and the

number of cells counted in 8 squares is 120, the total

WBC count is: ( 1 point)

  1. 1.2 x 109/L
  2. 1.5 x 109/L
  3. 12.0 x 109/L
  4. 15.0 x 109/L
  1. If a WBC count is performed on a 1:100 dilution and the

number of cells counted in eight squares is 50, the total

WBC count is: ( 1 point)

  1. 5.0 x 109/L
  2. 6.25 x 109/L
  3. 50.0 x 109/L
  4. 62.5 x 109/L
  1. Given the following data: ( 0.5 points)
  2. WBC: 8.5 x 109/L
  3. Segs: 56%
  4. Bands: 2%
  5. Lymphs: 30%
  6. Monos: 6 %
  7. Eos: 6%

What is the absolute eosinophil count?

  1. 0.17 x 109/L
  2. 0.51 x 109/L
  3. 2.55 x 109/L
  4. 4.76 x 109/L

10/18/2018