Hematology Exam #5 – Flashcards
Unlock all answers in this set
Unlock answersquestion
Normally the production of autoantibodies is kept in check by:
answer
T suppressor lymphocytes
question
Which of the following is true regarding the mechanism of warm-reactive autoimmune hemolytic anemia (WAHA)?
answer
IgG autoantibodies cause extravascular hemolysis
question
A patient's blood smear shows a moderate number of spherocytes and polychromasia. Select the best test to distinguish warm autoimmune hemolytic anemia (WAHA) from hereditary spherocytosis.
answer
direct antiglobulin test (DAT)
question
Secondary cold-reactive autoimmune hemolytic anemia is found most often in patients with:
answer
Mycoplasma pneumoniae or infectious mononucleosis
question
Red cell agglutination is found on a blood smear. Select the best course of action.
answer
Warm the blood and rerun it though the automated cell counter
question
Monospecific Coombs sera indicates that a patient's red cells have complement coating them. Which of the following red cell morphology would be more likely?
answer
agglutination
question
All of the following have been linked to excess erythrocyte destruction except:
answer
IgE alloantibodies
question
Which of the following causes of alloimmune hemolytic anemia accounts for the largest number of deaths?
answer
ABO blood type errors from patient misidentification
question
Which of the following is most often the result of human error?
answer
immediate hemolytic transfusion reaction
question
A type A Rh-negative infant has spherocytes on his blood smear and a weakly positive direct antiglobulin test (DAT). What antibody will most likely be found on the baby's red cells?
answer
IgG anti-A
question
An Rh-negative woman is pregnant with her third child. She received little or no prenatal care during the first two pregnancies. Her anti-D titer is 1:512 at 30 weeks of gestation. What is the likely outcome for the baby?
answer
Rh hemolytic disease of the newborn (HDN)
question
A warm-reactive autoimmune hemolytic anemia is found in combination with thrombocytopenia in a patient. This is called:
answer
Evans syndrome
question
The Donath-Landsteiner antibody:
answer
is found in serum and causes lysis of donor red blood cells, which have first been incubated at 4C and then warmed to 37C
question
The qualitative hemoglobinopathies cause disease by producing hemoglobin that are:
answer
structurally altered.
question
Which of the following hemoglobinopathies is most common?
answer
sickle cell diseases
question
What clinical feature of sickle cell disease accounts for the highest number of hospital admissions?
answer
vaso-occlusion
question
Sickle cell disease (SCD) is found in individuals descended from ancestors from all of the following places except:
answer
Scandinavia
question
What percentage of African Americans have heterozygous sickle cell trait?
answer
8%
question
Which of the following would be an unusual finding in the blood smear of an adult with sickle cell disease (SCD) crisis?
answer
Heinz bodies
question
What is the probably etiologic association between malaria and sickle cell trait?
answer
Sickle gene offers some protection against malaria
question
Which of the following would be unexpected homozygous hemoglobn S?
answer
hemoglobin A
question
A patient has target cells and a positive tube solubility test. This patient probaby:
answer
has either sickle cell anemia or trait
question
Select the best test to confirm the diagnosis of the patient in Question 9.
answer
hemoglobin electrophoresis
question
A patient has two bands on alkaline hemoglobin electrophoresis. One lines up with hemoglobin A and the other is the S position. Select the best course of action.
answer
confirm sickle gene with tube solubility
question
All of the following improve the clinical outcome of sickle cell anemia (hemoglobin SS) except which of the following?
answer
keeping the oxygen saturation low
question
A patient has 45% hemoglobin S, 55% hemoglobin A, and a positive tube solubility. Which of the following would likely be found?
answer
normal blood smear and no disease
question
Moderate to marked target cells are found on a blood smear. Which of the following can most likely be eliminated?
answer
hereditary spherocytosis
question
Which of the following would be an unexpected finding for patients with hemoglobin SC disease or S.B0-thalassemia?
answer
normal tube solubility test
question
Which of the following is a typical finding in patients with hemoglobin M?
answer
elevated methemoglobin
question
Heinz bodies are found when hemoglobin:
answer
precipitates
question
What is the correct relationship between red cells' affinity for oxygen and red cell production?
answer
When affinity is high, less oxygen is released and the body compensates by increasing erythropoietin and making more red cells
question
What is a point mutation?
answer
replacement of one nucleotide in the normal gene with a different nucleotide
question
Cellulose acetate is performed on a patient with known homozygous hemoglobin S who has received red cell transfusions in the past week. What hemoglobins would be expected to be found?
answer
S, A, F, and A2
question
An adult female patient from Southeast Asia has no anemia, but her CBC shows an MCV of 68 fL and marked target cell are observed on her blood film. Cellulose acetate alkaline electrophoresis shows two large bands: approximately 55% migrating with hemoglobin A and 40% migrating with hemoglobin C. What is the patient's most likely genotype?
answer
hemoglobins A and E
question
What is the basic hemoglobin defect in the thalassemias?
answer
A structurally normal globin chain is absent or produced at lower levels.
question
Which of the following is the normal approximate percentage of hemoglobins in adults?
answer
a2b2 96% a2d2 2% a2y2 2%
question
Why are infants with beta-thalassemia major not ill until approximately 6 months of age?
answer
Infants are protected by their high concentration of fetal hemoglobin.
question
Which of the following is the primary mechanism for anemia in the thalassemias?
answer
an imbalance in the rate of globin chain synthesis
question
Which of the following is true regarding the clinical features of thalassemias?
answer
vary from benign forms to those incompatible with life
question
Which of the following is/are expected findings in beta-thalassemia minor?
answer
basophilic stippling
question
All of the following can distinguish beta-thalassemia minor from major except:
answer
presence of microcytosis, hypochromasia, and target cells
question
Which of the following would e an unexpected finding in homozygous beta0-thalassemia?
answer
normal fetal hemoglobin
question
A patient has 30% hemoglobin F. Which of the following an be eliminated?
answer
four missing genes for alpha chain production
question
What finding is present in all types of alpha-thalassemias?
answer
Barts hemoglobin present at birth
question
Which of the following is true of patients with hemoglobin H disease?
answer
have two missing genes for alpha chain productions
question
Homozygous alpha-thalassemia (--/--) has what clinical outcome?
answer
incompatible with life
question
Which of the following can help distinguish the combination Hb S-beta0-thalassemia from sickle cell anemia?
answer
MCV
question
Which of the following is least useful in diagnosing and differentiating the thalassemias from each other?
answer
osmotic fragility
question
Which of the following is useful in helping to distinguish mild asymptomatic iron deficiency from thalassemia?
answer
mild anemia
question
Hemoglobin Barts is composed of:
answer
y (gamma)
question
A patient with beta+-thalassemia has, from that gene locus:
answer
variable but decreased beta globin chain synthesis
question
Iron overload in severe beta-thalassemia (beta-thalassemia major) patients is primarily a consequence of:
answer
accumulation of iron from massive red blood cell transfusion therapy
question
Patients who are heterozygous or hemoglobin Lepore have a clinical course:
answer
similar to that of beta-thalassemia minor
question
Hemoglobin E is primarily found in individuals of which ethnic origin?
answer
Southeast Asian
question
Hemoglobins A2 and F can quantified by:
answer
performing high-performance liquid chromatography (HPLC)
question
A chemotherapy patient's WBC is 1.0 x 10^9/L. There are 60% segmented neutrophils, 38% lymphocytes, and 2% monocytes. What is the correct interpretation of the relative differential?
answer
normal
question
What is the absolute neutrophil count for the patient in Question 1?
answer
0.6 x 19^9/L
question
What is the correct interpretation of the absolute neutrophil count in the chemotherapy patient in Question 1?
answer
neutropenia
question
A patient has a white count of 15.0 x 10^9/L. What is the correct interpretation?
answer
normal for an infant, leukocytosis for an adult
question
What is the best test to determine the reason for the 15.0 x 10^9/L leukocyte count in Question 4?
answer
white cell differential
question
Neutrophilia accompanied by immature granulocytes and nucleated red cells is what kind of reaction?
answer
leukoerythroblastic
question
Neutrophilia and a left shift are most often found in patients with:
answer
acute bacterial infection
question
Which of the following is the poorest prognostic sign for a patient with a bacterial infection?
answer
low white count with immature neutrophils and toxic changes
question
A patient has 20% eosinophils. Which of the following can probably be eliminated?
answer
pertussis
question
A patient has a white count of 8.3 x 10^9/L and 65% lymphocytes. What is the correct interpretation?
answer
depends on the patient's age
question
Why is the absolute neutrophil count (ANC) monitored closely in patients receiving chemotherapy?
answer
Bacterial infection becomes a possibility when the ANC is <1.0 c 10^9/L
question
Nonmalignant disorders of leukocytes are:
answer
acquired or inherited, and range from benign to life threatening
question
Nuclear hyposegmentation and denser-than-normal chromatin clumping are features of:
answer
Pelger-Huet anomaly
question
What is the concern in Pelger-Huet anomaly is not recognized?
answer
The cells could be misclassified as immature neutrophils, indicating that the patient has a bacterial infection when he or she does not
question
The abnormal granules seen in Alder-Reilly anomaly could be confused for:
answer
toxic granulation
question
What are the abnormal cytoplasmic inclusions in Chediak-Higashi?
answer
fused granules that inhibit bactericidal functions
question
What abnormal findings are found in May-Hegglin anomaly?
answer
Dohle body like cytoplasmic inclusions and thrombocytopenia
question
Toxic granulation, Dohle bodies, and vacuolization in neutrophils are often found together in:
answer
bacteria infection
question
The nitroblue tetrazolim (NBT) test is used to diagnose:
answer
chronic granulomatous disease
question
Deficient enzymes that allow various lipids to accumulate in macrophages and monocytes describe:
answer
storage cell disease
question
Gaucher cells and Niemann-Pick cells are found in:
answer
bone marrow and spleen
question
A college student seeks medical care of extreme fatigue and swollen lymph nodes in the neck. The white blood cell (WBC) count is 11.3 x 10^9/L. The differential shows a relative and absolute lymphocytosis. Many of the lymphocytes are larger than normal with a basophilic cytoplasm indented by the RBCs. The nuclei are less clumped than normal and some have nucleoli. The rest of the complete blood count (CBC) is normal. What is the most likely diagnosis?
answer
Infectious monoucleosis
question
The lymphocytes in the student in Question 22 are most likely:
answer
differentiated T cells
question
A clinical laboratory scientist sees unusual darkly stained cytoplasmic inclusions in leukocytes that she has no seen before. She should:
answer
have a supervisor or pathologist look at the cells
question
The Epstein-Barr virus (EBV) is causative agent of:
answer
infectious mononucleosis
question
The diagnosis of infectious mononucleosis is most often made by which of the following findings?
answer
demonstration of the presence of the heterophil antibody
question
What laboratory tests are used to diagnose and classify leukemia?
answer
all of the above
question
Which of the following can be determined from examining the blood smear?
answer
presence and percentage of blasts
question
Which of the following malignancies has the greatest chance for long-term survival or cure?
answer
chronic myelocytic leukemia
question
What are the most common life-threatening complications after chemotherapy?
answer
bacterial infection and bleeding
question
What is the major drawback to chemotherapy?
answer
suppression of the bone marrow
question
How do chemotherapy drugs work to kill or inhibit tumor cells?
answer
variety of mechanisms can damage DNA or interfere with the cell cycle
question
What is the greatest drawback to autologous over allogeneic stem cell transplant (SCT) for leukemia?
answer
malignant cells more likely to return
question
Most malignancies of the hematopoietic system are an:
answer
acquired genetic disease
question
A proto-oncogene codes for a protein involved in cell:
answer
cycle regulation
question
What cell process is normally responsible for removal of redundant, damaged, aged, or defective cells?
answer
apoptosis
question
Viruses have been found as an etiologic agent for which of the following hematologic malignancies?
answer
Burkitt lymphoma
question
Which of the following is true concerning the use of the chemotherapeutic dugs?
answer
dosage limited by the impact on normal bone marrow cells
question
Graft-versus-host disease (GVHD) develops when:
answer
donor T cells attack patient tissue(s)
question
Hematopoietic stem cells can be harvested from all of the following tissues except:
answer
umbilical cord blood
question
Imatinib mesylate is an example of:
answer
targeted therapy
