ASCP Hematology Review 2023 Questions with correct Answers

Name the locations of active marrow in adults: - Answer- sternum, skull, ribs, pelvis, vertebrae Where does hematopoiesis take place during the first 2 months of gestation? - Answer- yolk sac Where does the majority of hematopoiesis take place during the 2nd through 7th month of gestation? - Answer- spleen When does the bone marrow take over hematopoiesis? - Answer- after birth What are the stages in order of the erythrocyte lineage? - Answer- (1)rubriblast, (2)prorubricyte, (3)rubricyte, (4)metarubricyte, (5)reticulocyte, (6)erytrocyte What are the stages in order of the granulocyte (neutrophil, eosinophil, basophil) lineage? - Answer- (1)myeloblast, (2)promyelocyte, (3)myelocyte, (4)metamyelocyte, (5)band, (6)segmented (7)eos/baso What are the stages in order of the macrophage lineage? - Answer- (1)monoblast, (2)promonocyte, (3)monocyte, (4)macrophage What are the stages in order of the platelet lineage? - Answer- (1)megakaryoblast, (2)promegakaryocyte, (3)megakaryocyte, (4)platelet What are the stages in order of the lymphocyte lineage? - Answer- (1)lymphoblast, (2)prolymphocyte, (3)lymphocyte Which growth factors stimulate the erythrocyte lineage? - Answer- GM-CSF, EPO, IL-3 Which growth factors stimulate the granulocyte lineages? - Answer- GM-CSF, IL-3 Which growth factors stimulate the platelet lineage? - Answer- GM-CSF, IL-3, TPO Which growth factors stimulate the lymphocyte lineage? - Answer- IL-2, IL-4, IL-6, IL-7 Which protein functions in the transport of Fe? - Answer- transferrin What is the major storage form of Fe? - Answer- ferritin What is the long-term (H20) insoluble Fe storage form called? - Answer- hemosiderin Excess Iron is stored where? What does this cause? - Answer- tissues and body organs, hemosiderosis, hemochromatosis Porphyrias are attributed to? - Answer- excessive formation of porphrins due to blockages in any enzymatic step in the heme synthesis pathway. Red or port wine colored urine can be seen in which condition related to the build up of heme precursors? - Answer- porphyria Neuropsychiatirc symptoms are seen when a build up of which precursors occurs? - Answer- early precursors (Delta-aminolevulinic acid/Porphobilinogen) Cutaneous symptoms such as photo-sensitivity and facial hair are seen when a build up of which precursors occurs? - Answer- later precursors (uroporphyrinogen/coproporphyrinogen, protoporphyrin/heme) Synthesis of heme requires what two components? - Answer- iron, protoporphyrin What are the heme precursors in order of synthesis? - Answer- (1)delta-aminolevulinic acid, (2)porphobilinogen, (3)uroporphyrinogen, (4)coproporphyrinogen, (5)protoporphyrin, (6)heme What type of hemoglobin is seen primarily in newborns? - Answer- Hgb F What type of hemoglobin is seen primarily in adults? - Answer- Hgb A2 What type of hemoglobin is rarely seen in adults as well as newborns? - Answer- Hgb A What hemoglobin types are seen in embryos but not in adults or newborns? - Answer- gower I, gower II, portland All non-embryonic hemoglobin types are comprised of what type of globin chain? - Answer- alpha Hemoglobin A2 is composed of what types of globin chains? - Answer- alpha, beta Hemoglobin A is composed of what types of globin chains? - Answer- alpha, delta Hemoglobin F is composed of what types of globin chains? - Answer- alpha, gamma Multiple transfusions can cause what kind of shift in the hemoglobin-oxygen dissociation curve? - Answer- left shift An increase in hemoglobin F can cause what kind of shift in the hemoglobin-oxygen dissociation curve? - Answer- left shift A left shift in the hemoglobin-oxygen dissociation curve causes what changes in the following substances: CO2, pH, 2,3-DPG? - Answer- increased pH, decreased CO2, decreased 2,3-DPG A right shift in the hemoglobin-oxygen dissociation curve causes what changes in the following substances: CO2, pH, 2,3-DPG? - Answer- decreased pH, increased CO2, increased 2,3-DPG How does EDTA work as an anticoagulant? - Answer- it chelates Ca++ How does heparin work as an anticoagulant? - Answer- it is an anti-thrombin agent Hemoglobin is measured by its conversion to what? By? - Answer- cyanomethemoglobin, potassium cyanide, potassium ferricyanide What are potential sources of error in the measurement of hemoglobin? - Answer- lipemia, icterus, high white count, resistant hemoglobins (SS, CC) What is the normal reference range of hemoglobin for males? - Answer- 14-18 g/dL What is the normal reference range of hemoglobin for females? - Answer- 12-16 g/dL Methemoglobin carries iron in what state? - Answer- oxidized (Fe3+) What color is methemoglobin? - Answer- brown True or False: Methemoglobin can bind O2. - Answer- false What causes an increase in carboxyhemoglobin? - Answer- smoking, carbon monoxide poisoning What color is carboxyhemoglobin? - Answer- cherry red What does the hematocrit measure? - Answer- packed cell volume in a percentage What are sources of error seen in using the microhematocrit method to measure the hematocrit? - Answer- failure to seal tube adequately, incorrect reading due to uneven clay plug, inappropriate centrifuge specs, excess EDTA resulting in RBC shrinkage How is the hematocrit measured using automated methods? - Answer- calculated from MCV and RBC What are sources of error seen in using the automated method to measure the hematocrit? - Answer- cold agglutinins, high WBC cound What is the normal reference range for hematocrit of males? - Answer- 42-52% What is the normal reference range for hematocrit of females? - Answer- 37-47% What is the calculation used for manual cell counts? - Answer- # of cells counted X 1/total volume X dilution factor What is the reference range for a WBC? - Answer- ul What is the reference range for platelets? - Answer- 150 - 400 X 10^3 What is the reference range for MCV? - Answer- 80-100 fl What is the reference range for MCH? - Answer- 28-32 pg What is the reference range for MCHC? - Answer- 32-36% g/dl What is the reference range for RDW? - Answer- 11.5-14.5% The function of what cell is to transport O2 to tissues and remove CO2 from tissues? - Answer- RBC The function of what cell is a phagocytic response to bacteria? - Answer- neutrophil The function of what cell is in humoral and cell mediated immunity? - Answer- lymphocyte The function of what cell is an inflammatory response mediator? - Answer- basophil The function of what cell is an allergic response regulator? - Answer- eosinophil The function of what cell is in clotting? - Answer- platelet What are the dyes used in a Wright stain? - Answer- eosin, methylene blue What is the pH of the phosphate buffer used in a Wright stain? - Answer- 6.4 What can cause a Wright stained slide to appear more blue? - Answer- prolonged staining, pH too basic What can cause a Wright stained slide to appear more red? - Answer- prolonged washing, pH too acidic Neutrophil counts are increased in what conditions? - Answer- bacterial infections Lymphocyte counts are increased in what conditions? - Answer- viral infections Monocyte counts are increased in what conditions? - Answer- TB, syphilis, malignancies Eosinophil counts are increased in what conditions? - Answer- allergies, parasites Basophil counts are increased in what conditions? - Answer- immediate hypersensitivies Hyper-segmented neutrophils are associated with what condition(s)? - Answer- pernicious anemia Hypo-segmented neutrophils are associated with what condition(s)? - Answer- pelger huet, pseudo-pelger huet, AML, AIDS Toxic granulation and vacuoles are associated with what condition(s) - Answer- bacterial infections, burns, chemotherapy Dohle bodies are associated with what condition(s)? - Answer- bacterial infections, burns, May-Hegglin Variant lymphs (increased size and basophilia) are associated with what condition(s)? - Answer- infectious mono, other viral infections Large to giant platelets are associated with what conditions? - Answer- Bernard-Soulier, May-Hegglin, myeloproliferative disorders, stress platelets If platelet count seems low what would be the corrective action? - Answer- check feather edge for clumping and satelitism. (Is an EDTA related phenomenon) If seen redraw in Na citrate What type of cells are expected to be seen with a low MCHC? (<32) - Answer- hypochromic What type of cells are expected to be seen with a high MCHC (<32) - Answer- hyperchromic Acanthocytes are commonly seen in what condition(s)? - Answer- severe liver disease, abetalipoproteinemia Another word for sickle cells is? - Answer- drepanocyte Echinocytes are commonly seen in what condition(s)? - Answer- uremia (can also be an artifact) Spherocytes are commonly seen in what condition(s)? - Answer- hereditary spherocytosis, increased MCHC, ABO HDN, other hemolytic processes Elliptocytes are commonly seen in what condition(s)? - Answer- hereditary elliptocytosis, iron deficiency, thalassemia Stomatocytes are commonly seen in what condition(s)? - Answer- hereditary stomatocytosis, liver disease Macroovalocytes are commonly seen in what condition(s)? - Answer- megaloblastic anemia Target cells are commonly seen in what condition(s)? - Answer- liver disease, Hb C, thalassemia, other hemoglobinopathies Helmet cells are seen in what condition(s)? - Answer- hemolytic processes Another name for helmet cells is? - Answer- keratocyte Teardrop drop cells are seen in what condition(s)? - Answer- extramedullary hematopoiesis, thalassemias, pernicious anemia Schistocytes are seen in what condition(s)? - Answer- DIC, hemolytic processes Howell-Jolly bodies are composed of? - Answer- DNA What condition(s) are howell-jolly bodies seen in? - Answer- disturbed erythropoiesis, hemolytic anemias, megaloblastic anemia, post-splenectomy The inclusions seen in basophilic stippling are composed of? - Answer- RNA What condition(s) is basophilic stippling seen in? - Answer- thalassemia, lead poisoning What stains are utilized to see basophilic stippling? - Answer- wright, new methyene blue Pappenheimer bodies are composed of? - Answer- iron What stains are utilized to see pappenheimer bodies? - Answer- wright, prussian blue What conditions are pappenhemier bodies seen in? - Answer- sideroblastic anemia, hemoglobinopathies What are heinz bodies composed of? - Answer- denatured precipitated hemoglobin What stain can you NOT see heinz bodies? What stain is used instead? - Answer- Wright, supravital stain (brilliant cresyl blue/new methylene blue) What conditions are heinz bodies seen in? - Answer- G6PD deficiency, thalassemia, unstable hemoglobins What are cabot rings composed of? - Answer- remnants of the mitotic spindle What conditions are cabot rings seen in? - Answer- megaloblastic anemia How does the value for hemoglobin compare to the value for the hematocrit? - Answer- Hgb X 3 = Hct +/-3% How does the value for RBCs compare to the value for Hgb? - Answer- RBC X 3 = Hgb +/-3% An increased MCV with MCHC and decreased RBC is associated with what condition? - Answer- cold agglutinin disease What can be done to circumvent interference from cold agglutinin disease? - Answer- warming the sample What does the erythrocyte sedimentation rate measure? - Answer- rate of fall of red cells through plasma What is the normal reference range of the ESR for women? - Answer- 0-20 mm/hr What is the normal reference range of the ESR for men? - Answer- 0-15 mm/hr An increase in the ESR value is see in conditions involving? - Answer- the presence of abnormal plasma proteins (inflammatory conditions) A falsely elevated ESR can be attributed to? - Answer- tilting tube, standing too long, increased temperature, excess EDTA A falsely decreased ESR can be attributed to? - Answer- QNS specimen, decreased temperature What types of stains are used to view reticulocytes? - Answer- supra vital (new methylene blue, brilliant cresyl blue) Reticulocyte counts are used to monitor? - Answer- erythropoiesis What is the normal reference range for a reticulocyte count? - Answer- 0.5-1.5% A reticulocyte production > 2 indicates? - Answer- adequate bone marrow response to anemia A reticulocyte production < 2 indicates? - Answer- inadequate bone marrow response to anemia Retic counts are increased in which of the following conditions> - Answer- hemolytic anemias, post-acute blood loss, following therapy (iron, folate, B12) What is the normal amount of megakaryocytes seen per lpf in a bone marrow prep? - Answer- 5 What is the normal reference range for the myeloid to erythroid ratio? - Answer- 3:1-4:1 Dry bone marrow taps are associated with what pathological condition(s)? - Answer- myelofibrosis, aplastic anemia What condition(s) can lead to a decreased myeloid to erythroid ratio? - Answer- hemolytic anemia, erythroleukemia What condition(s) can lead to an increased myeloid to erythroid ratio? - Answer- myeloid hyperplasia, myeloid leukemias What are the most common aspirate sites for bone marrows? - Answer- sternum, hip (iliac crest) What stain is used on a bone marrow? - Answer- romanowsky stain What is the normal ratio of cells to fat seen in a bone marrow - Answer- 50/50 Bone marrow biopsies are performed to in order to evaulate what? - Answer- overall cellularity of the bone marrow A WBC differential is performed on a bone marrow in order to do what? - Answer- determine the type of leukemia present if diagnosed When using cellulose acetate for hemoglobin electrophoresis what is the pH used? - Answer- 8.6 When using citrate agar for hemoglobin electrophoresis what is the pH used? - Answer- 6.2