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)
2. 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)
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4. 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)
a. WBC 12.0 x 109/ L
b. RBC 4.83 x 1012/L
c. Hgb 15.0 g/dL
d. Hct 39.0%
e. MCV 84 fL
f. MCH 31 pg
g. MCHC 39%
h. Platelet 340,000 x 109/L
Can we accept this specimen? If so, what is the next step?
5. 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)
a. WBC 15.0 x 109/L
b. RBC 3.20 x 1012/L
c. Hgb 9.5 g/dL
d. Hct 28%
e. MCV 88 fL
f. MCH 30 pg
g. MCHC 34%
h. Platelet 89,000 x 109/L
Upon reviewing the blood smear, you notice platelet clumping.
What would you do?
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6. A CBC is received from the nursery on a baby born 1 day ago.
The results of the CBC were: (1 point)
a. WBC 60.3 x 109/L
b. RBC 5.4 x 1012/L
c. Hgb 16.2 g/dL
d. Hct 49%
e. MCV 91 fL
f. MCH 30 pg
g. MCHC 33%
h. Platelet 210,000 x 109/L
The instrument has flagged blasts as a suspect. What could be
the cause of this flag?
7. In the previous question, what equation would you use to correct
for the flag? (1 point)
8. Matching: Match the term with its definition. (5 points)
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_____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
9. 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)
10.
Name the RBC Inclusion: (2 points)
A.___________________
B.___________________
11.
Fill in the chart: (3 points)
Cell
RBC
Function
Granulocytes Defense
against
bacteria
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Lifespan
120 days
Origination
Bone marrow
Lymphocytes Cellular/
humoral
immunity
Platelets
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B- lymph: 15 days
T-lymph: 60530 days
Bone marrow
12.
13.
As cells age they: ( 1 point)
a. Become larger
b. Nucleus becomes smaller and chromatin condenses
c. Nucleus becomes smaller and nucleoli appear
d. Cytoplasm of cells becomes more basophilic
Stain: Wright-Stain Troubleshooting ( 3 points)
**Fill in the chart**
Problem
Holes in smear
Cause
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
14.
What is this formula for? (1 point)
HCT (%) x 10
RBC (x 1012/L)
a. MCHC
b. MCH
c. MCV
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15.
What is defined as the average weight of hemoglobin in
the average RBC? (1 point)
a. MCH
b. MCV
c. MCHC
16.
A presence of immature granulocytes in peripheral blood
is: (1 point)
a. Toxic granulation
b. Vacuolization
c. Hypersegmentation
d. Shift to the left
17.
Neutrophils make up ______% of the adult relative count.
(1 point)
a. 20-40%
b. 50-70%
c. 2-8%
d. 1-3%
18.
Name the three types of granulocytes: ( 1.5 points)
a.
b.
c.
19.
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This leukocyte is characterized by having large orangy-red
granules in its cytoplasm.(1 point)
a. Lymphocyte
b. Basophile
c. Eosinophil
d. Monocyte
20.
Vacuolization within the leukocyte is seen with: ( 1 point)
a. Drugs
b. Septicemia
c. Toxins
d. All of the above
21.
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)
a. Monocyte
b. Lymphocyte
c. Basophil
22.
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?
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23.
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)
a. WBC 13.5 x 109/L
b. RBC 3.63 x 1012/L
c. Hgb 10.9 g/dL
d. Hct 33%
e. MCV 91 fL
f. MCH 30 pg
g. MCHC 33 g/dL
h. RDW 12 %
i. Platelets 139 x 109/L
j. Differential
 Neutrophils 43%
 Bands 0
 Lymphocytes 55%
o 50% reactive
 Monocytes 2%
A. Describe Ellen’s blood picture using appropriate
terminology.
B. What conditions produce a blood picture like Ellen’s, and
which is more likely in her case?
24.
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Which one of these features distinguishes a monocyte from
a lymphocyte? (1 point)
a. Nucleoli
b. Abundant gray-blue cytoplasm
c. Round, flattened nucleus
d. Large blue-black granules
25.
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)
a. WBC 6.5 x 109/L
b. RBC 4.02 x 1012/L
c. Hgb 13.2 g/ dL
d. Hct 37.3%
e. MCV 86 fL
f. MCH 24.2 pg
g. MCHC 30.3 x 109/L
h. Platelets 30.3 x 109/L
i. 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?
26.
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?
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27.
What is the causative agent in infectious mononucleosis?
(1 point)
a. HIV
b. EBV
c. CMV
d. CBC
28.
In which of the following conditions will monocytes be
increased? (1 point)
e. Tuberculosis
f. Parasitic infection
g. Ulcerative colitis
h. Skin disease
29.
In acute leukemia, the onset is usually: ( 1 point)
a. Abrupt
b. Subtle
30.
In chronic leukemia’s, the age group normally affected is:
(1 point)
a. Adults
b. Children
c. Teenagers
d. Toddlers
31.
Which of the following is most often associated with acute
leukemia?( 1 point)
a. Erythrocytosis and thrombocyosis
b. Neutropenia and thrombosis
c. Anemia and thrombocytopenia
d. Lymphocytosis and thrombocythemia
32.
Auer rods may be seen in which of the following cells?
(1point)
a. Myeloblasts
b. Myelocytes
c. Lymphoblasts
d. Megakaryoblast
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33.
What would you do with this sample? (2 points)
a. WBC 194.1 x 109/L
b. RBC 3.89 x 1012/ L
c. Hgb 11.3 g/dL
d. Hct 34.0%
e. MCV 91.0 fL
f. MCH 29.1 pg
g. MCHC 32.0 g/dL
h. RDW 17.2%
i. Platelets 41 x 109/L
j. Flags

+++WBC beyond reportable range

RL,R, RH flags on entire CBC
34.
All of the following are lab findings of Multiple myeloma
EXCEPT: (1 point)
a. Pancytopenia
b. Normochromic, normocytic anemia
c. Increased platelet count
d. Increased ESR
35.
What is the most common presenting symptom in
individual’s with chronic lymphocytic leukemia? (1 point)
a. Massive spleens
b. Thrombocytosis
c. Increased calcium
d. Enlarged lymph nodes
36.
What type of anticoagulant is primarily used for
hematological studies? (1 point)
a. Sodium citrate
b. EDTA
c. Sodium oxalate
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37.
Given the following data: ( 1 point)
a. WBC: 8.5 x 109/L
b. Segs: 56%
c. Bands: 2%
d. Lymphs: 30%
e. Monos: 6 %
f. Eos: 6%
What is the absolute lymphocyte count?
a. 0.17 x 109/L
b. 0.51 x 109/L
c. 2.55 x 109/L
d. 4.76 x 109/L
38.
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)
a. 1.2 x 109/L
b. 1.5 x 109/L
c. 12.0 x 109/L
d. 15.0 x 109/L
39.
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)
a. 5.0 x 109/L
b. 6.25 x 109/L
c. 50.0 x 109/L
d. 62.5 x 109/L
40.
Given the following data: ( 0.5 points)
a. WBC: 8.5 x 109/L
b. Segs: 56%
c. Bands: 2%
d. Lymphs: 30%
e. Monos: 6 %
f. Eos: 6%
What is the absolute eosinophil count?
e. 0.17 x 109/L
f. 0.51 x 109/L
g. 2.55 x 109/L
h. 4.76 x 109/L
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