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Hematology Review Questions

Due Date See Schedule.

Penalty Failure to turn in by due date will result in 5 point reduction in grade.

Directions Give brief, but complete answers to each of the following questions.
Place answers in spiral bound notebook. Skip a space between each answer.

1. a. What anticoagulant is used to collect samples for most routine hematology tests?
b. How does this anticoagulant work?

2. What type of iron is found in normal hemoglobin?

3. What protein is the main carrier of free hemoglobin in the plasma?

4. List the three hemoglobins found in normal adult blood and state how much of each is present.

5. Which hemoglobin is present in the highest amount in newborns?

6. a. What reagent is used to measure hemoglobin by the cyanmethemoglobin method?

b. What does this reagent contain?
c. What type of hemoglobin cannot be measured by Drabkin’s reagent?

7. What is the “rule of three” as it relates to CBC results?

8. Name three conditions that may interfere with the cyanmethemoglobin method for hemoglobin.

9. a. What are the dimensions of a Newbauer hemacytometer on one side of the counting chamber?
b. What is the depth of the Newbauer hemacytometer?
c. What is the depth factor used in calculations?

10. For a manual RBC count,

a. what squares of a Newbauer hemacytometer are used?
b. what is the total area of the counting squares?
c. what diluent is used?
d. what is the normal dilution?

11. For a manual WBC count,

a. what squares of a Newbauer hemacytometer are used?
b. what is the total area of the counting squares
c. what diluent is used?
d. what is the normal dilution ?

12. What is the generic formula for calculating a manual blood cell count using a Newbauer
13. a. What is the formula used to correct a WBC count for the presence of NRBC’s?
b. When must a WBC count be corrected for NRBCs?

14. For each of the following RBC indices, write the formula for calculation and the normal reference
a. MCV
b. MCH

15. a. Which RBC indice is used to determine cell size?

b. Which RBC indice is used to determine hemoglobin content?
c. Which RBC indice is used to express variation in RBC size?

16. a. What term is used to describe a variation in RBC size within a single patient sample?
b. What term is used to describe a variation in RBC shape within a single patient sample?

17. Sed rate:

a. An elevated sed rate indicates the presence of what general condition?
b. What is the normal reference value for Westergren sed rate for an adult male?

18. State how each of the following will affect a patient’s sed rate (increased, decreased):
a. presence of macrocytes
b. tilt tube
c. air bubble in tube
d. incubation temperature > RT
e. increased plasma acute phase reactants

19. What is the life span of a platelet?

20. On a normal peripheral smear, how many platelets should be seen per oil immersion field?

21. How do you estimate the number of platelets using a peripheral smear?

22. State how each of the following conditions will affect a patient’s platelet count (increase, decrease).
a. specimen not well mixed upon collection
b. Polycythemia vera
c. normal response to blood loss
d. myelofibrosis
e. post-splenectomy
f. DIC

23. For a manual platelet count,

a. what squares of a Newbauer hemacytometer are used?
b. what is the total area of the counting squares?
c. what diluent is used?
d. what is the normal dilution?
24. When making a wedge peripheral smear, at what angle is the spreader slide held?

25. What two stains are present in the Wright stain used for peripheral blood smears?

26. How do you estimate the number of WBCs using a peripheral smear?

27. Name the cell type seen on a peripheral smear described by each of the following:
a. nucleus contains several lobes connected by strands of chromatin, abundant cytoplasm with
b. nucleus stains deep purple and may be round or slightly notched, small amount of “robin’s egg
blue” cytoplasm
c. nucleus is horse-shoe shape with delicate chromatin, blue-gray cytoplasm which has “ground
glass” appearance
d. nucleus is band or sausage shape, abundant cytoplasm with granules
e. bi-lobed nucleus, cytoplasm contains many acidophilic granules

28. What three types of cells are considered granulocytes?

29. What are the two main types (principle) of automated cell counters?

30. Using the Coulter principle, what five analytes are actually measured by the instrument?

31 Using the Coulter principle, how is the hematocrit determined?

32. What is displayed on the x- and y-axis of a histogram?

33. List the three categories of cells displayed on a WBC histogram (from left to right).

34. How is cell sizing of the WBCs performed on automated counter? Be specific.

35. RBC histogram

a. Which two RBC parameters are shown on the RBC histogram?
b. What is indicated when an RBC histogram is shifted to the right?
c. What is indicated when the RBC histogram is wider than normal?

36. Which histogram contains two curves, smooth and fitted?

37. Give three reasons why the above curve would only show a smooth curve.

38. a. Which stain is used to produce WBC scattergrams?

b. Give the staining pattern for each type of WBC on a scattergram with the above stain.

39. What type of hemoglobin contains iron in the ferric state?

40. Name the sites of blood cell production in an adult.

41. Name the two sites normally used for bone marrow aspiration in an adult.

42. List the stages of development of the red blood cell from most immature to the mature red blood cell.
Use both sets of names.

43. Which RBC stage does each of the following describe:

a. First stage in which hemoglobin is formed?
b. Last nucleated stage (nucleus is described as pyknotic)?
c. Only stage normally found in bone marrow and peripheral blood?

44. Retics
a. What stain is used to perform a retic stain?
b. A technologist counts 25 retics in 700 RBCs on a patient with a hematocrit of 28 %. What is the
patient’s corrected retic count?

45. Miller disc - retics

a. Using a Miller disc, what is counted in the larger square A?
b. Using a Miller disc, what is counted in the smaller square B?
c. Write the formula used for calculating the result using a Miller disc.

46. Name the substance that normally attaches to the beta chains of hemoglobin A to prevent the binding
of oxygen in the tissues.

47. For each method of hemoglobin electrophoresis, give the pH of the buffer used and list the
hemoglobins in order of migration starting at the anode.

48. Kleihauer-Betke
a. What cells are resistant to denaturation by acid and stain orange using eosin?
b. Why is the K-B stain usually performed?

49. Give the scientific name for each abnormal RBC type.
a. Helmet cell
b. Burr cell
c. Teardrop cell
d. Cell fragment
e. Target cell
f. Target cell with target connected to cell membrane
g. Sickle cell
h. Mouth cell
i. Round cell with no central pallor
j. Cigar shaped cells

50. Complete the following chart for the RBC inclusions.

Can be seen on Can be seen on Composition
Wright stain supravital stain (RNA, DNA, etc)
Basophilic stippling (a ) (b) (c)
Cabot rings (d ) (e) (f)
Heinz bodies (g ) (h) (i)
Howell-Jolly body (j) (k) (l)
Pappenheimer body (m) (n) (o)
51. For each of the following types of anemia, state the morphology of the RBCs.
a. Acute blood loss
b. Sickle cell
c. Iron deficiency
d. Aplastic anemia
e. Beta Thalassemia
f. B12/folate deficiency
g. Anemia of chronic disease
h. Chronic blood loss

52. What antibiotic is associated with aplastic anemia?

53. What term refers to a decrease in the number of all blood cell types?

54. Fill in the following microcytic, hypochromic anemias.

Iron deficiency anemia Serum Iron: ____(a)_____ TIBC: ____(b) ___

Alpha Thalassemia Hemoglobin electrophoresis _______(c)________
Beta Thalassemia Hemoglobin electrophoresis _______(d)________

55. Which anemia is associated with the following finding on the peripheral smear?
a. hypersegmented PMNs
b. basophilic stippling
c. target cells
d. Pappenheimer bodies
e. drepanocytes
f. Heinz bodies

56. What amino acid substitution in the globin chains is seen with each of the following. Be specific.
a. sickle cell anemia
b. Hemoglobin C disease

57. Which anemia is diagnosed using the following tests?

a. Schilling test
b. Sucrose hemolysis
c. Osmotic fragility
d. Watson-Schwartz
e. Ham’s test
f. Donath Landsteiner
g. antibodies to Intrinsic factor

58. Sickle cell screen

a. What reagent is used to lyse the red blood cells?
b. What reagent is used to reduces the hemoglobin, allowing the Hgb S to become insoluble?

59. List the stages of development in the granulocytic series in the order of maturation.

60. Which stage in the granulocytic series is described by the following?

a. first stage to contain specific granules
b. nucleus is kidney-shaped
c. largest stage in series
d. nucleus is uniform in width
e. first stage to contain non-specific granules

61. List the stages of development in the monocytic series in the order of maturation.

62. List the stages of development in the lymphocytic series in the order of maturation.

63. Name the WBC inclusion or condition is described by the following.

a. red needle like rods in cytoplasm of blast
b. light blue inclusions in cytoplasm of neutrophil
c. Dohle bodies and giant platelets
d. neutrophils have bi-lobed nucleus
e. neutrophils have impaired chemotaxis
f. neutrophils contain precipitated mucopolysaccharides
g. neutrophils can ingest, but not kill, bacteria
h. foamy macrophages present in tissue
g. monocytes contain cerebroside

64. List the site of maturation for B and T cells.

65. a. What percentage of circulating lymphocytes are T cells?

b. What percentage are B cells?

66. For each of the following classification of acute leukemia, give the name.
a. M1
b. M2
c. M3
d. M4
e. M5
f. M6
g. M7
h. L1
i. L2
j. L3

67. Which type of WBC blast can contain Auer rods?

68. Name the type of acute leukemia is described by the following.

a. patients develop DIC
b. patients may have eosinophilia
c. infiltration of gums by immature cells (two answers)
d. most common type in young children
69. What two types of WBCs stain positive with myeloperoxidase?

70. What component of a WBC is stained by:

a. Sudan Black B
b. PAS

71. What types of leukemia give a positive reaction with

a. non-specific esterase stains?
b. TdT (terminal deoxynucleotidyl transferase)?
c. acid phosphatase with tartrate?
d. specific esterase?

72. a. What stain is used to differentiate leukemoid reaction from CGL?

b. What is the result in leukemoid reaction?
c. What is the result in CGL?

73. Name the type of malignant disorder associated with the following:
a. hypogammaglobulinemia
b. Philadelphia chromosome
c. presence of Bence Jones proteins in urine
d. Mycosis fungoides
e. monoclonal increase in IgG
f. monoclonal increase in IgM
g. presence of Reed-Sternberg cells

74. State the chromosomal translocation that occurs with the Philadelphia chromosome.

75. State the normal value for the following Hematology tests.
a. RBC
b. WBC
c. Platelet
d. Hemoglobin
e. Hematocrit
f. RDW
g. Diff
h. Retic