Hematological Parameters and Cell Maturation: Review & Analysis

MEDICAL LABORATORY SCIENCE 9. SUMMATIVE EXAM REVIEW QUESTIONS #13 + ANSWERS & RATIONALIZATIONS 1. 2. 3. 4. 5. Which parameters are calculated rather than directly measured? a. Hematocrit and erythrocyte distribution width b. Erythrocyte count and leukocyte count c. Leukocyte count and hematocrit d. Platelet count and platelet volume If the RBC distribution on histogram demonstrates a homogenous pattern and small SD, the peripheral blood smear would probably exhibit: a. Extreme anisocytosis b. Very little anisocytosis c. A single population of spherocytes d. A single population of macrocytes The RDW and MCV are both quantitative descriptors of erythrocyte size. If both are increased, the most probable erythrocytic abnormality would be: a. Iron deficiency anemia b. Acquired aplastic anemia c. Megaloblastic anemia d. Hemoglobinopathy In an erythrocyte histogram, the erythrocytes that are larger than normal will be to the ______ of the normal distribution curve. a. Right → macrocyte b. Left → microcyte c. Middle d. Variable RL flag EXCEPT: a. Platelet clumps b. RBC fragments c. Giant platelets d. Cold agglutinins e. RL vs RU flag: 10. 11. 12. 13. 14. 15. 6. 7. 8. Mean platelet volume (MPV): a. Analogous to MCHC b. Direct measure of platelet count c. Measurement of the average volume of platelets d. Comparison of the patient’s value to the normal value The MPV is often decreased in: a. Sickle cell anemia b. Megaloblastic anemia c. Idiopathic thrombocytopenic purpura d. After splenectomy Normal PDW: a. Less than 5% b. Less than 10% c. Less than 15% d. Less than 20% 16. Which cell surface membrane marker is used for enumeration of hematopoietic progenitor cell (HPC) enumeration? a. CD 4 b. CD 8 c. CD 34 d. CD 45 The normal sequence of blood cell development is: a. Yolk sac—red bone marrow—liver and spleen b. Yolk sac—thymus—liver and spleen—red bone marrow c. Yolk sac—liver and spleen—red bone marrow d. Liver and spleen—yolk sac—red bone marrow The abbreviation MAPCs stands for: a. Multiple adult progenitor cells b. Multipotent adult progenitor cells c. Many abnormal progenitor cells d. Multiply active potential cells The best source of active bone marrow from a 20year-old would be: a. Iliac crest b. Femur c. Distal radius d. Tibia → Appropriate sites in an adult include the posterior iliac crest (preferred site), anterior iliac crest, and sternum. → The tibia may be used in infants younger than 18 months of age. Primary target cells of G-CSF, EXCEPT: a. Fibroblasts b. Leukemic myeloblasts c. Neutrophil precursors d. T and B cells Bone marrow cellularity refers to the ratio of: a. Red cell precursors to white cell precursors b. Hematopoietic tissue to adipose tissue c. Granulocytic cells to erythrocytic cells d. Extravascular tissue to intravascular tissue The maturational sequence(s) of the erythrocyte is (are): a. Rubriblast—prorubricyte—metarubricyte— rubricyte— reticulocyte—mature erythrocyte b. Rubriblast—prorubricyte—rubricyte— metarubricyte— reticulocyte—mature erythrocyte c. Pronormoblast—basophilic normoblast—polychromatophilic normoblast—orthochromic normoblast—reticulocyte—mature erythrocyte d. Both B and C The cell maturation sequence of the segmented neutrophil is: a. Promyelocyte—myeloblast—myelocyte— metamyelocyte—band or stab—segmented neutrophil (PMN) b. Myeloblast—promyelocyte—myelocyte— metamyelocyte—band or stab—segmented neutrophil (PMN) c. Monoblast—promyelocyte—myelocyte— metamyelocyte—band or stab—segmented neutrophil (PMN) d. Promyelocyte—myelocyte—metamyelocyte— band or stab—segmented neutrophil (PMN) 1 17. The maturational sequence of the thrombocyte (platelet) is: a. Megakaryoblast—promegakaryocyte— megakaryocyte—metamegakaryocyte— thrombocyte b. Promegakaryocyte—megakaryocyte— metamegakaryocyte—thrombocyte c. Megakaryoblast—promegakaryocyte— megakaryocyte—thrombocyte d. Megakaryoblast—promegakaryocyte— metamegakaryocyte—thrombocyte 18. As a blood cell matures, the overall cell diameter in most cases: a. Increases b. Decreases c. Remains the same d. Variable 19. As a blood cell matures, the ratio of nucleus to cytoplasm (N:C) in most case: a. Increases b. Decreases c. Remains the same d. Variable 20. The chromatin pattern, in most cells, as the cell matures: a. Becomes more clumped b. Becomes less clumped c. Remains the same d. Variable 21. In general, cytoplasmic color in younger cells: a. Pink b. Red c. Dark blue d. Light blue → In general, cytoplasmic color progresses from darker blue (indicating active protein synthesis) in younger cells to lighter blue or pink in mature cells. 22. In the blast stage of development of leukocytes, the cytoplasm of the cell is: a. Dark blue and lacks vacuoles b. Light blue and lacks granules c. Light blue and has specific granules d. Gray with many dark-blue granules → Myeloblast: The cytoplasm appears as a small rim of basophilic cytoplasm that lacks granules. 23. Hemoglobin appears for the first time in the ___ maturational stage of erythrocytes. a. Second b. Third c. Fourth d. Fifth 24. Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to the formation of hemoglobin? a. Reticulocyte b. Pronormoblast c. Basophilic normoblast d. Polychromatic normoblast 25. With a normal diet, an erythrocyte remains in the reticulocyte stage in the circulating blood for: a. 1 day b. 2.5 days c. 3 days d. 120 days 26. In a Wright-stained peripheral blood film, the reticulocyte will have a blue appearance. This is referred to as: a. Megaloblastic maturation b. Bluemia c. Polychromatophilia d. Erythroblastosis 27. The types of granulocytic leukocytes found in the proliferative compartment of the bone marrow are: a. Myeloblasts, myelocyte and metamyelocytes b. Myeloblasts, promyelocytes and metamyelocytes c. Myeloblasts, promyelocytes, myelocytes and metamyelocytes d. Myeloblasts, promyelocytes, myelocytes, metamyelocytes and band neutrophils 28. The types of granulocytic leukocytes found in the maturation-storage compartment of the bone marrow are: a. Metamyelocytes, band form neutrophils, segmented neutrophils, mature eosinophils and mature basophils b. Only band form neutrophils, segmented neutrophils, mature eosinophils and mature basophils c. Metamyelocytes, band form neutrophils, segmented neutrophils, mature eosinophils and mature basophils d. Segmented neutrophils, immature and mature monocytes and mature lymphocytes 29. Identify the cell with these characteristics: prominent primary granules that are rich in myeloperoxidase and chloroacetate esterase and have a diameter of 14 to 20 um. a. Myeloblast b. Promyelocyte c. Myelocyte d. Promonocyte 30. The earliest granulocytic maturational stage in which secondary or specific granules appear is: a. Myeloblast b. Monoblast c. Promyelocyte d. Myelocyte 31. The most mature granulocyte precursor that can undergo mitosis is the: a. Myeloblast b. Promyelocyte c. Myelocyte d. Metamyelocyte 32. Which of the following can differentiate metamyelocytes from other stages of granulocyte maturation? a. Presence of specific granules b. Indentation of nucleus c. Absence of nucleoli d. Color of cytoplasm → Indentation of the nucleus (kidney shape) is the feature that characterizes the metamyelocyte stage. 33. The stage in neutrophilic development in which the nucleus is indented in a kidney bean shape and the cytoplasm has secondary granules that are lavender in color is the: a. Band b. Myelocyte c. Promyelocyte d. Metamyelocyte 2 34. Which of the following are contents of basophilic granules? a. Heparin b. Histamine c. Myeloperoxidase d. Both A and B 35. The half-life of circulating granulocytes in the blood is estimated to be: a. 2.5 to 5 hours b. 7 to 10 hours c. 24 hours d. 2 days 36. A characteristic of a segmented neutrophil is: a. Large orange granules b. An elongated and curved nucleus c. Light sky-blue cytoplasm d. Greatest number of WBCs in the peripheralblood of an adult 37. A characteristic of mature eosinophil is: a. Large orange granules b. Elongated and curved nucleus c. Light, sky-blue cytoplasm d. Kidney bean-shaped nucleus 38. A characteristic of mature monocyte: a. Large orange granules b. Elongated and curved nucleus c. Light, sky-blue cytoplasm d. Kidney bean-shaped nucleus 39. A characteristic of mature lymphocyte is: a. Large, orange granules b. Elongated and curved cytoplasm c. Light, sky-blue cytoplasm d. Kidney bean-shaped nucleus 40. An increase in metamyelocytes, myelocytes and promyelocytes can be referred to as: a. Leukocytopenia b. Shift to the right c. Shift to the left d. Pelger-Huet anomaly 41. The major function of the neutrophilic granulocytes: a. Antibody production b. Destruction of parasites c. Phagocytosis d. Suppression of inflammation 42. The principal leukocyte type involved in phagocytosis: a. Monocyte b. Neutrophil c. Eosinophil d. Basophil 43. The major function of eosinophil is: a. Suppression of inflammatory reactions b. Destruction of protozoa c. Participation in anaphylaxis d. Phagocytosis 44. Which of the following is/are characteristic/s of erythropoietin? a. Glycoprotein b. Secreted by the liver c. Secreted by the kidneys d. All of the above 45. Stimulation of erythropoietin is caused by: a. Tissue hypoxia b. Hypervolemia c. Inflammation d. Infection 46. Biochemical abnormalities characteristic of polycythemia vera include: a. Increased serum B12 binding capacity b. Hypohistaminemia c. Hypouricemia d. Decreased leukocyte alkaline phosphatase activity 47. Increased erythropoietin production in secondary polycythemia can be caused by: a. Chronic lung disease b. Smoking c. Renal neoplasms d. All of the above 48. Relative polycythemia exists when: a. Increased erythropoietin is produced b. Total blood volume is expanded c. Plasma volume is increased d. Plasma volume is decreased 49. The primary pathophysiologic mechanism of anemia associated with chronic kidney disease is: a. Inadequate production of erythropoietin b. Excessive hemolysis c. Hematopoietic stem cell mutation d. Toxic destruction of stem cells 50. Effect of increased amounts of 2,3-DPG to oxygen affinity of the hemoglobin molecule. a. Increases b. Decreases c. Do not alter d. Variable 3