Hematology Case Studies Module 2
UPDATED ACTUAL Exam Questions and
CORRECT Answers
A patient has a RBC of 1.95x10^6/uL, RDW 21% and MCV 121 fL. Describe the RBC
morphology. - CORRECT ANSWER - macrocytes varying in size
A patient with hereditary spherocytosis has 150 cells with blue/green inclusions per 1000 cells
with new methylene blue stain. The RBC is 3.25x10^6/uL and Hct 33%.
A. What red cell morphology would be expected?
B. Calculate the MCV. Is this expected? Why or why not?
C. What is the uncorrected retic? Is it within normal range?
D. Corrected retic:
E. Absolute retic:
F. Is this retic result expected? Explain.
G. What test could be used to distinguish hereditary spherocytosis from AIHA?
H. Describe or draw what would be expected osmotic fragility results.
I. What does the retic count indicate? - CORRECT ANSWER - A. spherocytes,
polychromasia, anisocytosis
B. 101.5 fL; patients with extreme polychromasia often have slighting increased MCV because
retics are larger than normal cells
C. 15%, increased
D. 10.9%, Hct/45 x uncorrected retic
E. 487,500/uL, uncorrected retic x RBC
F. yes, people with hemolytic anemia have increased retics
G. DAT or history
H. increased; cells would start to lyse at 0.70% and have complete hemolysis at 0.55%.
I. percentage of new cells entering blood; normal retic of 1% means 1% of RBCs are turned over
daily
, Which of the following is increased in intravascular hemolysis but not in extravascular
hemolysis? - CORRECT ANSWER - urine hemosiderin
What is Hgb H disease? How is it detected? - CORRECT ANSWER - A 3 gene deletion of
Hgb A. The excess beta chains form tetramers that can be detected by Hgb electrophoresis,
precipitation with brillian cresyl blue or by the heat denaturation
Match the following RBC morphology with its associated condition. - CORRECT
ANSWER - AIHA - spherocytes
cold auto antibody - agglutination
multiple myeloma - rouleaux
myelofibrosis - tear drops
DIC - schistocytes
liver disease or hemoglobinopathies - target cells
artifact or uremia - echinocytes (burr or crenated)
What would you expect RBCs to look like if Hgb = 10.2 g/dL, MCV = 90 fL, MCH = 29.5 pg
and MCHC = 34%? - CORRECT ANSWER - normal
Describe or draw Hgb C crystals (A). If seen, is it most likely Hgb C trait or disease (B)? Draw
Hgb C trait and disease on a cellulose acetate electrophoresis (C). - CORRECT
ANSWER - A. dense oblong crystals in and around RBCs
B. disease
C. Trait will have thin line under C and A; disease will have thick line under C
A patient has malarial rings and crescent shaped gametocytes. Which species is most likely? -
CORRECT ANSWER - Malaria falciparum
MCV 95 fL
UPDATED ACTUAL Exam Questions and
CORRECT Answers
A patient has a RBC of 1.95x10^6/uL, RDW 21% and MCV 121 fL. Describe the RBC
morphology. - CORRECT ANSWER - macrocytes varying in size
A patient with hereditary spherocytosis has 150 cells with blue/green inclusions per 1000 cells
with new methylene blue stain. The RBC is 3.25x10^6/uL and Hct 33%.
A. What red cell morphology would be expected?
B. Calculate the MCV. Is this expected? Why or why not?
C. What is the uncorrected retic? Is it within normal range?
D. Corrected retic:
E. Absolute retic:
F. Is this retic result expected? Explain.
G. What test could be used to distinguish hereditary spherocytosis from AIHA?
H. Describe or draw what would be expected osmotic fragility results.
I. What does the retic count indicate? - CORRECT ANSWER - A. spherocytes,
polychromasia, anisocytosis
B. 101.5 fL; patients with extreme polychromasia often have slighting increased MCV because
retics are larger than normal cells
C. 15%, increased
D. 10.9%, Hct/45 x uncorrected retic
E. 487,500/uL, uncorrected retic x RBC
F. yes, people with hemolytic anemia have increased retics
G. DAT or history
H. increased; cells would start to lyse at 0.70% and have complete hemolysis at 0.55%.
I. percentage of new cells entering blood; normal retic of 1% means 1% of RBCs are turned over
daily
, Which of the following is increased in intravascular hemolysis but not in extravascular
hemolysis? - CORRECT ANSWER - urine hemosiderin
What is Hgb H disease? How is it detected? - CORRECT ANSWER - A 3 gene deletion of
Hgb A. The excess beta chains form tetramers that can be detected by Hgb electrophoresis,
precipitation with brillian cresyl blue or by the heat denaturation
Match the following RBC morphology with its associated condition. - CORRECT
ANSWER - AIHA - spherocytes
cold auto antibody - agglutination
multiple myeloma - rouleaux
myelofibrosis - tear drops
DIC - schistocytes
liver disease or hemoglobinopathies - target cells
artifact or uremia - echinocytes (burr or crenated)
What would you expect RBCs to look like if Hgb = 10.2 g/dL, MCV = 90 fL, MCH = 29.5 pg
and MCHC = 34%? - CORRECT ANSWER - normal
Describe or draw Hgb C crystals (A). If seen, is it most likely Hgb C trait or disease (B)? Draw
Hgb C trait and disease on a cellulose acetate electrophoresis (C). - CORRECT
ANSWER - A. dense oblong crystals in and around RBCs
B. disease
C. Trait will have thin line under C and A; disease will have thick line under C
A patient has malarial rings and crescent shaped gametocytes. Which species is most likely? -
CORRECT ANSWER - Malaria falciparum
MCV 95 fL
